Do you see many cases of women with a previous 3rd degree tear?
Most women require some stitches after a vaginal delivery. Usually, the tear involves only the muscles near the vagina. This is called a 1st or 2nd degree tear and is repaired under anaesthetic by an obstetrician using absorbable stitches. Occasionally, the tear can include part of the circular muscle near the anus – this is called a 3rd degree (or anal sphincter) tear. The rate of 3rd degree tears is approximately 2-3% of all vaginal deliveries, meaning that many women have such a history in a future pregnancy. 3rd degree tears are more common in certain women such as 1st time mothers, women delivering bigger babies and women of Asian ethnicity.
Am I at increased risk in my current pregnancy?
Yes, slightly. Women with a previous 3rd degree tear have an approximately double-risk of another 3rd degree tear with this baby. However, even doubling the risk means that 90%+ of women with a previous 3rd degree tear will have a very straight-forward delivery requiring minimal stitches in their next pregnancy.
What additional treatment do you recommend in this pregnancy?
We are highly experienced in caring for women with a previous 3rd degree tear. Dr. Colin Walsh previously spent 3 years helping to co-ordinate a specialised perineal trauma follow-up clinic in Sydney, dealing exclusively with women with this problem.
Usually, no extra treatment is required antenatally. The main decision relates to the mode of delivery for this baby – in other words, vaginal delivery versus caesarean section. It may be helpful to organise specialised testing of the sphincter muscle if this has not previously been performed. In general, caesarean section is usually reserved for women with a very complex 3rd degree tear or who have persistent problems with bowel control since their last baby. Vaginal delivery is the better option for most women with a previous 3rd degree tear but you can discuss your own individual case with us.