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  1. #1
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    Default 3rd degree tear - risk of happening again?

    Hi all,

    I had a third degree tear with my son in July 2015, he was 4kg and had a big head. I had him at a family birth centre with no drugs. I am now 24 weeks pregnant with our second son and doing community midwifery program (hoping to birth in birth rooms again rather than hospital). I had a routine appointment at the hospital which will be my back-up hospital today (to go to if anything goes pear-shaped) and the obstetrician gave me a stern warning that I might tear again and then will face risk of faecal incontinence by the time I'm 40 (I'm 29). He said this baby will probably be big as well and if it was up to him he'd induce me at 38 weeks to reduce the risk of big baby/repeat tear.

    I'm scared now! I had thought because I healed so well from my first birth, no pelvic floor issues at all, even now while pregnant, that it would be ok to have another natural birth since things are already probably a bit stretched down there but faecal incontinence would be my worst nightmare, plus with 2 boys under 2 to look after I don't want to be facing complicated issues after birth. I don't know what to do ... As much as I want a natural birth, I'm not fixated on it, I'd rather things just go smoothly. But I know obstetricians tend to be pro-interventions where community midwife program is the opposite.. I feel like I'm getting biased advice on both sides!

    Does anyone have experience of this situation?

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    Just my own personal experience.
    I had a second degree tear with my first born. He was only 7lb 14oz but he had his arm on his head so I crowned his shoulder and head at the same time.

    21 months later I had my 8lb 15oz baby with nothing more than a graze. 14 months later had an 8lb 11oz baby with no skin damage at all, then 16 months later had a 9lb baby with no skin damage either.

    So in my own experience, it definitely "loosens up" down there.

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  4. #3
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    Look into perineal massage. I'm bit sure how it would go with the scar tissue, but it may help prepare the perineum for labour. Good control of the head as it crowns can also help reduce the risk of tearing, but there are no guarantees. I've only seen a handful of 3rd deg tears happen first hand, but when they have its mostly because the woman has had such a strong uncontrollable urge to push, that rather than listen to the midwife with the short pushes and breathing, they've given an almighty push as it helped with the pain and as the head delivers it pops up and the chin popping up is what has caused the majority of the tear. Hot/warm compresses during the second (pushing) stage can also help relax the perineum to allow it to stretch. Have a chat to your Midwife about it too.

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    Not my experience but a friends, she had an episiotomy and third degree internal tear with her first (due to her daughters hand being against her face) and then very minor tearing with the second- only a few stitches here and there. Can you get a second opinion? I totally understand why faecal incontinence scares the bejezus out of you, it would me too!

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    I had a 2nd degree tear with number 1 but number 2 had nothing.

    Maybe have a chat to the midwives about it?

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    Hi OP, my mother was a midwife and now a community nurse specialising in incontinence. I don't have experience myself with tearing m, but yes the risk is certainly very real. She helps mothers and elderly manage their incontinence. A large portion of the patients are more mothers than elderly which might surprise some people. You may not have any issues (after birth)- but if the dr is telling you that there is a risk you will become faecal before 40 I would certainly pay attention.

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    Thanks SO much ladies!!! Yes my first tear was because my son put his hand up to his face, he was in a bad position (posterior and high) so the whole thing was a bit of a mess, maybe I could get an ultrasound to assess size and position at around 38 weeks before I make my final decision?

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    I had a 3rd degree tear with my son (as well as an episiotomy - tear site not at episiotomy site) in Nov 2014. He was vacuum assisted, and once the vac was on he came out in one push. His head was also not in optimal position.
    The obs I spoke to said the general population has about a 2% risk, and I've got an 8% risk of 3rd degree or worse happening again. I'm due in 6 weeks. She has advised to consider a c-section, but I have other factors along with the risk of tearing (coccyx fracture during DS's birth and recovery from this is worse than recovery from a c-section, and previous birth trauma causing massive anxiety which is not great when you should be calm).
    If he is basing it off bub's likely size, an ultrasound to reassess at 38 weeks doesn't sound unreasonable.

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    Just my experience
    I had one with my 2nd. I started perineal massage with my 3rd and i haven't even had a graze since this includes a 4.5 kg bub and a face presentation bub. I have 6 bubs

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    Default 3rd degree tear - risk of happening again?

    In my experience it's how the pushing stage is. I had a 21 month gap between my two.

    I had my son in April 2014. I had pre eclampsia as was induced at 38 weeks but not with my ob as she had a family death. He was 2.7kg (6p) but my epidural was so strong I couldn't feel a thing. They told me to push and push and push and he shot out with his hand up and his chin tilted like LadyEm desscribed and I got a 3rd degree tear that healed perfectly. I believe it was borderline 2nd/3rd. No forceps or vacuum.

    I had my daughter 11 months ago and was induced again at 40 weeks due to low fluid, bigger baby (no pre eclampsia yay!) and previous tear. Again I had an epidural but got my ob this time and a wonderful old school experienced midwife. They took away my control of the epi and turned it off when I was fully dilated. While I felt no actual pain I felt the contractions and pushing and stretching. They coached me through it slowly and I only grazed. again no forceps or vacuum. She was 3.49kg/7p 11 so nearly a fully kg bigger but no damage compared to last time!


 

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