4th degree tear and second pregnancy

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anon32 Posts: 4
I had a 4th degree tear while having my son. I was taken to theatre immediately after the birth, was stitched up and thankfully made a great recovery and suffered no after-effects as a result. I am now 38 week pregnant and had a hospital appointment on Monday where they were to advise me on how I should give birth this time. I first met the physio Monday morning. She checked me and although things look OK said she would recommend I have an elective c-section this time. This is to ensure I avoid further damage to the area. I then had a scan with a male doctor who thinks babs is about 7 1/2lbs now so he said he would recommend inducing me next week. I then went to the doc in the semi-p clinic who agreed with him re. induction next week. Finally I met with another doctor who has specialised in this area and she said no to induction as she feels there's a higher chance of other interventions being needed. She said she would avoid a c-section if possible but the research is not there to say what the long term effect of having another normal delivery is. So as you can imagine, I don't know what to do! Ideally I want to deliver myself again but can't get the physio's words out of my head, and she was the only one who gave me an honest opinion. Apologies for the long post but I would love to hear other's experience or what you would do in my situation. Thanks
Toblerone Posts: 2698
Hey anon, I haven't been in the situation so this is just an opinion. Firstly and most importantly from your message - why do you think the physio was " the only one who gave me an honest opinion"? Do you not trust the opinion of your doctor or the doctor who is specialised in the area?????? From my research in the area, there never a guarantee that you will have similar birth the second time and I would have thought that induction increases the likelihood of interventions and thus potential 3rd/4th degree tearing. If you want to deliver yourself vaginally just go with that. It sounds as if everything is ok with your healing and baby isn't huge. It's alot more favourable second time around as your body has been through it before. I'd try to avoid the induction and make sure you have a birth plan which ensures all midwives know of your past tear and try to get them to assist you with positions to prevent tearing eg. squatting rather than on back. If you still have doubts - talk to your doctor again and just ensure they understand your fears. Good luck - I'll be thinking of you. :wv
Momma Posts: 427
Hi Anon32 I posted about this a couple of weeks ago but no-body replied so I guessed there was no-one in the same situation :o( I had a third degree tear and I think relatively no complications after it however when I made my booking app for this pregnancy (only 10 weeks now), a c-section was mentioned already. Anyway my point is, if you are not induced and nothing happens naturally you'll end up with a section anyway which may / may not be an emergency. I do believe with induction, there is a higher chance of assistance. Has anyone spoken to you about the long-term damage that a second tear could do? I will def worry about long term damage as it can be very severe? Did you have those repeat tests at 22 weeks and were the results good? What hospital are you going to? Sorry this is a pretty useless post but it might help you make a decision?
anon32 Posts: 4
Hi girls, thanks so much for your replies. I will try to answer some of your questions. Firstly I am attending the rotunda semi-p so am not under the care of one specific doctor. The reason I am a little sceptical about the doctors advice is that two recommended induction, and one said to avoid this at all costs. From what I've read myself, induction is definitely not recommended so why did two doctors think it would be OK to do this?! I did ask what were the chances of a similar tear re-occurring and the possible long term effects. The doctors were pretty vague as there is very little documented research in this area, but did say its about 5%. The physio however told me that I'm running the risk of having on-going incontinence problems afterwards, due to the pressure of another birth :eek The reason I'm taking her opinion on board is because she's an older lady that sees women well into their 40's, 50's and beyond, so she has seen the long term effects. Also, she was the only one that said if she were me, she'd go straight to section, whereas the doctors kept saying its up to you, but they weren't giving me enough info to decide one way or the other. I know this is my decision to make, but not one of them mentioned positions to try next time, etc. that could reduce the risk. I'm back in on Monday and will discuss it further with the doctor then. Its so hard to know as I'd prefer to avoid a section if possible, but who wants to be left with incontinence problems!
Momma Posts: 427
Its unreal - this has been on my mind for ages too I do know someone who had a very bad tear go on to have a very quick easy second labour with very few stiches. but the woman who spoke to me was in her 50's also and told me exactly the same as you - better have the section than suffer for 20 years with incontinence and its not only urine incontinence if you know what I mean :eek :eek :eek what if your labour doesn't start tho - would that be an automatic section over induction so many questions!!! Anyway I've no advice really apart from get as much info as you can
totalnovice Posts: 787
I replied in your other post but just saw this one too. I am going to have to come up with some questions to ask the consultant at 1st appointment, worried though that as i am going public i may not get the right answers or attention about it. Will have to have all the questions ready before I go in. I think you defo need to think it through fully cos another tear could have long term repurcussions & none of us want that
Toblerone Posts: 2698
[quote="anon32":3ckyjqgl]Hi girls, thanks so much for your replies. I will try to answer some of your questions. Firstly I am attending the rotunda semi-p so am not under the care of one specific doctor. The reason I am a little sceptical about the doctors advice is that two recommended induction, and one said to avoid this at all costs. From what I've read myself, induction is definitely not recommended so why did two doctors think it would be OK to do this?! I did ask what were the chances of a similar tear re-occurring and the possible long term effects. The doctors were pretty vague as there is very little documented research in this area, but did say its about 5%. The physio however told me that I'm running the risk of having on-going incontinence problems afterwards, due to the pressure of another birth :eek The reason I'm taking her opinion on board is because she's an older lady that sees women well into their 40's, 50's and beyond, so she has seen the long term effects. Also, she was the only one that said if she were me, she'd go straight to section, whereas the doctors kept saying its up to you, but they weren't giving me enough info to decide one way or the other. I know this is my decision to make, but not one of them mentioned positions to try next time, etc. that could reduce the risk. I'm back in on Monday and will discuss it further with the doctor then. Its so hard to know as I'd prefer to avoid a section if possible, but who wants to be left with incontinence problems![/quote:3ckyjqgl] thanks for answering my queries. I think I know that particular physio in the Rotunda and I completely understand why you'd believe her. I feel so bad for you with so little information and very little assistance from the very people who should be guiding you. It seems as if the doctors don't want to make the decision for you but aren't being v helpful with information to allow you make an informed choice. There is guidance on RCOG site I'm trying to see if there is anything further that may assist you but it does seem as if there is little research done on this area. I did find one article from 2006 that specifically looks at Managing future pregnancies after a severe perineal laceration. Pm me your email and I'll send it on if you want it. :wv oh I should mention I work in research in health sciences!
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