Tearing badly once raises the risk of tearing badly again
And it changes the conversation about your next birth.
Among 639,402 English women followed into a second birth, those who had a severe tear in their first birth and delivered vaginally again had a 7.2% recurrence rate, against 1.3% in women without a previous tear.
Those women also chose differently. A planned cesarean at the second birth was chosen by 24.2% of women with a previous severe tear against 1.5% of women without.
Across 8 studies, factors raising recurrence risk were forceps (odds ratio 3.12), vacuum (odds ratio 2.44), a previous fourth-degree tear (odds ratio 1.7), a baby of 4 kg or more (odds ratio 2.29) and maternal age 35 or over (odds ratio 1.16).
What guidance says about the next birthRoutine cesarean is not recommended for every woman with a previous sphincter injury. The decision is individualised, taking account of symptoms, testing of the sphincter, and your own preference. What matters is that the conversation happens rather than being assumed either way.
Where this comes from:
213. Edozien LC, Gurol-Urganci I, Cromwell DA, Adams EJ, Richmond DH, Mahmood TA, et al. Impact of third- and fourth-degree perineal tears at first birth on subsequent pregnancy outcomes: a cohort study. BJOG. 2014;121(13):1695-1703.
214. Jha S, Parker V. Risk factors for recurrent obstetric anal sphincter injury (rOASI): a systematic review and meta-analysis. Int Urogynecol J. 2016;27(6):849-857.
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This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.