Some obstetricians will advise you to have a Cesarian for your coming birth after a repair of a third degree tear. Others will tell you it depends on if you are suffering from incontinence or not. I suggest you see a specialist in pelvic floor for a good examination as to the function of your sphincter. If you are going to have a vaginal birth, then it is VERY IMPORTANT and necessary for you to use the epi-no, and the chances are that you will not tear or have any problems. You should begin from 37 weeks, twice a day according to instructions. Also make sure you have a good midwife or doctor and that you work together with them to minimize tearing by not pushing when they tell you to breathe as the head is crowning. Also better not to take an epidural as there is higher incidence of vacuum, which can cause more tearing. Watch you diet so you don't have a very big baby. Good luck