Congratulations, Gillyan! Glad you had a happy birth!

UPDATE

And the spinal went in 2nd time - easy as that!

UPDATE

Thansk for all the advice I got on this thread,

DD2 was born by elective c/section on 23/06/09 8lbs Summer Jennifer

I ended up in and out of hospital from 34 wks with premature labour that was stopped, kept having to go back in with contractions. Then at 36 wks baby was breech but kept turning every other day as I had excess fluid.

finally decided I wanted the lective section and every time they thought I was inestablished labour - dependning on what doc was on call - they tried to talk me out of the section.

Ended up back in on the 23rd, having biggest contractions yet - cervix wasn't dilating and although it was 6 days to go before my planned c/s I saw the head consultant man who happened to be on call and he was mazing and said if I wanted hee would do the section that day! I had a show in the morning and then lost more blood so I think I would of been established before long. He explained the risk to the babies lungs as I was 37 + 5 but he said it was just a small risk.

We took an hr to think and decided to go for it - I was in theatre within 30 mins and she was born within 10 mins from then, she came out screaming with an apgar of 9 and 9 so no worried about the lungs and 8lbs at 37 + 5!!

out of hospital in 2 days and am making a good recovery

I would chose section over possible 3rd degree tear anyday. The recovery is a million times better than from the tear and the whole experience was amazing and enjoyable.

Congratulations Cote. Make sure you keep on top of your pain relief, it is very important.

I can recommend elec CS as well.

Congratulations Cote!

Much love to you and DS.

Remember to keep on top of the pain though. If you wait till that trolley has gone before deciding you need something you can be in for a long wait.

So glad it all went well.

DS was born this morning by elCS. Very positive experience. I haven't had painkillers for a few hours now and while there is some pain, it's totally manageable. Much less than with previous normal birth with huge episiotomy.

cote You're having a elcs this wed???? OMG! Wow, hope it goes well, yes please come back and tell us how tou get on. Best of luck!! xx

ballon LOL at the cozy comments, yes I can imagine that will be lovely actually! I'm weeing all the time now and I know it will only get worse over the next few weeks. My bathroom is a floor below our bedroom and it's such a pain to get down the stairs every few hrs!

sunshine thanks for your info, glad you had such a good experience!

I rang to try and get hold of the MW today (the nice one) but she wasn't in so I asked to leave a message for her to call me back. 5 mins later another MW called from my team and said nice MW was away for the wk on annual leave and could she help....It was the bitch MW who told me a load of crap last week so I said 'no thanks I'll wait till she gets back' I bet she's wondering why I want to speak to the Senior MW having only just seen her ( horrible one ) a few days ago.

Thinking about it too, the consultant never said anything about c/s on booked day only and neither have the oother 2 MW's so she's just talking rubbish.

I will still get hold of other MW to confirm it but if i go into labour I will also just insist ( where feesable ) that I am having a c/s

Thank you to EVERYONE who has posted on here, I know there is no right or wrong answer but I just needed to keep talking it through and all the info off all of you has been really really great. I'll probably change my mind again yet, we'll see

Gillyan just to reiterate what you've been told here, I was booked in for an elective CS with DD and was told if I went into labour in advance it was entirely up to me if I wanted to try and give birth or have the section at that point.

Having had an EMCS following a 55 hour failed induction with DS, the elective with DD (which I had a 38 weeks) was a breeze. It took about half an hour from start to finish, I was out of bed four hours later and ready to go home in 2 days. Initial pain soon wore off too.

Hope this helps.

I posted earlier on the thread Gillyann, and now I see you have opted for the CS.

As I mentioned, I have had three and have always found recovery pretty easy. With my second, there was some trouble getting the spinal to work properly, I got in a bit of a state. It worked in the end, but wore off before I even got to the ward - a far cry from the one I had with DC1 which lasted for about ten hours.

I was worried about the spinal not working when I had my third DC. But the anaesthetist was great and it was as easy as anything, and lasted a good long time. Shame on me to say it but after being up in the night to wee every hour for the preceding two months, I love that post-CS cosy feeling from an spinal and a catheter you can't feel [lazy cow emoticon].

My sister had a CS for her first as she was breech. For her second she had a VBAC, and was given an episiotomy. She told me it hurt just as much as the Caesarean scar had, the only difference was she got no sympathy from anyone.

Good luck!

Gillyan - I will try to come back at some point after my elCS Wednesday morning, and let you know how recovery goes.

Meanwhile, don't be afraid to say "No" in your meetings with consultant, anesthetist, and midwife. When in hospital for first birth, I thought they knew best and had my best interests at heart, which I sadly realized later was not necessarily true for everyone I met. This time, I have been refusing what I don't like (early induction, stereoid injections so I could be induced, being kept 'hungry' in case I'm induced, etc). They can't make you do anything you don't want to do.

gasman thanks so much for your advice - yes I think MW was just being a bitch TBH, i shall have words with her boss tomorrow.

Arh thanks your advice/info ahs been great.

Just been speaking to DP now and I am going to have the c/s. I am going to try and get hold of my MW tomorrow ( the supervisor ) and get it confirmed from her that I can have an elec/c/s at anytime if I go into labour ( obviously not if head is on it's way )

I will speak to my consultant at 36 wks about the anesthetist and if not on the day be firm about them trying as much as is possible or getting someone else to try.

If I have to have a GA I suppose it's not the end of the world as long as we are both ok.

The fear of getting terrible MW's is a real one too. I have some lovely MW's on my team nut also a crap one. The one's I had with DD were awful, they were short staffed and left me on my own until they realised I was ready to push.

The hospital is a big one BTW.

I guess the section is the only way to avoid my biggest fear about further injury to my bum.

Also DD I had on my own - I had split up with the 'father' before I had even found out I was PG. This time is all planned but my partners family have a history of MASSIVE babies - both over 10-11lbs, first resulting in emer/sect next one planned. So I had a bad enough time having a 7.5 baby let alone anything bigger!

gillyan

I've done loads of "booked elective LSCS now in labour so needs a section now" work in the middle of the night so I think the MW was talking bollocks about you not being able to get one if you went into labour.

If you came in like that there will still be an anaes. consultant on call to support the oncall team so don't fear. If it was a junior anaesthetist on call (junior being relative as to cover Obs out of hours you will usually have done at least 24months of anaesthesia) I don't think they'd feel happy doing either the spinal or the GA given your history so would want the boss in ASAP.

Good luck!

Let us know how you get on - update this thread if you like. I for one wil be interested in how you get on.

Just re-read all the last 3 pages properly.

Just want to add it was a spinal not an epidural. And I sat still, never flinched.

Also I think the plumbing analogy works

TBH the anesthetist was very quick to recommend a GA and when I said ina shocked voice 'oh no I don't want a general' he said 'why?' like I was mental, I would of thought it would be alst rosrt too and avoided if possible.

Also reading back from other posts, I will try and go down the route of either confirming that I can have a section at any time or trying to nring it forward to 38 wks as this is when I had DD anyway.

Thanks for the tips about refusing forceps, if I did have to give birth for e.g. and baby got stuck or soemthing I now know that I would insist on emerg/section rather than instrumental delivery - risking more damage down there.

Gillyan - to add to my post about that fear, I would simply ask the hospital to futher reassure you on that matter. That unless this baby is visable and you agree to vaginal birth [tounge in cheek but you know what I mean] you are having a section.

Re the ga to suit them, IME - the culture against GA for section is so strong this is unlikely. Not impossible though so I don't mean to counter your concern as such, I would just encourage you to get more clarification and reassurance as to the managemnet and reasons for it. From the aneas. team. No use asking a midiwfe for example.

treedelivery crossed posts.

Yes I am bothered about the whole 'can't have an elective befoe the planned date' comment which was from the MW I saw last week.

The consultant never said I could only have it on the specified date!

i think I'll give the senior MW a ring and double check everything that thsi woman told me.

Yes it would be sods law wouldn't it. They did manage to get it inlast time and it did hurt with all the attempts but nothing like giving birth, I'm not bothered by needles at all so quite happy for them to keep trying.

I would totally accept anything that I have to if needed.

I was just starting to feel like I could be a bit pushed around i.e having the GA to suit them, I will just have to be firm and and insist, nicely, if someone else can try.

Starting to think, yes I'll have the section now as all this stress and anxiety will go away. Was not as worried about the risks associated with c/s as much as the risk of tearing again and having bad care until the prospect of the GA.

But I'm alos now worried that if i FINALLY decide on the section and go into labour before I won't get it. Although this would fall into my 'out of my hands' category.

That's how I decided in the end. I knew that I would recover from the section - it was controlled if you see what I mean whereas no-one could tell me what would happen if I had a vaginal delivery. I could've ended up having to have reconstructive surgery, which I understand is not pleasant and the results of which were not guaranteed either.

I have...erm...issues with the message that has come through that you won't have a c/s if you labour prior to an elective c/s.


Having dragged my tired butt to theatre many a night to do just that.

If you are a planned c/s then it can happen anytime. Although the anaes. side of things would need review.

Sometimes, if an elective is booked for different reasons to yours, and the woman presents ina great labour, that she is coping with, where clear progress is being made, then all parties may reconsider. Which I would consider good flexible woman centred care. The words 'never' and 'definately' tend to be useless in the relms of birthing women.

I would raise your concerns with the anaesthetic staff at the 36 week meeting.

If you go in, and say you know it was hard last time but you are really really really keen to have a regional I can't imagine that you'll get denied the opportunity to have one. However it might not work you need to accept this.

Sods law dictates though that it will inevitably go in first time and you'll decide the anaesthetist last time was truly useless .

I would hope you would get somone senior to do it without making a huge fuss.

Yes didn't want to have a general but starting to think about all of this a bit more clearly now and the risk of furthe rdamage is what MOST terrifes me. So at the end of the day a GA wouldn't be the end of the world but a colostomy bag would, for me.

I totally agree about turning whatever happens into a positive experience though

Gillyan - I know what you mean by this: "I feel I am giving up on my only chance of a better birth by having the section and I honestly just don't see the section as an easy option."

That is exactly how I feel.

It sounds like you have come to a decision that feels right to you. I wish you lots of luck and hope it works out

I think, to try and summarise...

I keep thinking about the recovery from a normal vaginal delivery ( anything less than a 3rd degree tear ) versus a definate recovery from major abdominal surgery. Obviously I am lured by the prospect of the first and I think Ihave forgotton about the reason for the elective section.

I was having the section until I was told a GA may be necessary, then I started to think of the risk of tearing as badly again v's having to have a GA.

Part of the reason I don't want to have a bad tear again is I don't want to have to go to theatre after giving birth and missing the first few hrs etc, I don't want it to interupt bonding, I don't want to have to have further surgery down the line with a little baby and I don't want to have to live with a colostomy bag with a new baby. It would just plain suck! I don't want me and DP to miss the birth.

Then the MW says about I can't have an elective section if I go into labour earlier than the elective date.

I also asked MW about what it is she can do to care for my perineum i'e, pressing on it ( which another MW had said she could do and I have read about it ) and she said there is nothing she could do and all I can do is to do perinial massage! So terrified of which MW I'll actually end up with and them refusing to do what I ask.

hence me thinking I'll just go it alone on the dining room floor!

I suppose the thing that is worrying me the MOST is the risk of further damage to my bottom and how it would impact my life so I think I just need to accept a section is the only way to know this won't happen and I won't end up with horrible MW's like last time....so the only problem now is the anesthetist. I ams eeing the consultant at 36 wks for a pre-op meeting thing so could I speak to him about ensuring I get someone senior to do the spinal? Or I sould just insist on the day?

So true what you say about the choices being problem. The pita for all of us who have babies and look after women who have babies is that we are making choices without knowing what is actually going to happen.

If I choose a yellow coat with green spots on, I am going to be wearing a yellow coaat with green spots on.

If I choose to labour, I may end up with sphincter damage, or an intact perineum.

If I c/s, I may avoid sphincter damage, or avoid a cathartic birthing experience. [Although it is possible to feel positive about birthing and have perineal damage, I say this as the op is keen to avoid iyswim]

It's pants, and it's the burden of choice imo. Though I wouldn't have it any other way.

Just believe that whatever the choices you make, if you end up with a less than ideal story to tell, that doesn't mean the choices you made were bad. I think alot of the emotional fall out from birthing stems form this, bad outcome=bad choice= my fault.

Am I right in thinking you would not go to GA for section if the spinal could not be sited? Didn't want to read it wrong iyswim?

Wow, lots of chatting been going on! Thanks to everyone for their input.

sympatheticconsult thanks so much for all the detailed info - it really is great.

To try and answer a few of the things that have come up.

RE - anesthetist.

He was a senior one and when he was doing it he said he had NEVER had such a problem in all the years he had been doing them, He said he thought he kept hitting bone but then decided it was cartilidge and asked if I had done any sports that would give me a strong back. I am used to trampolune all the time and am a qualified coach.

Although in my original post I did say I was distressed and bleeding etc I sat stock still and never moved an inch each time he tried.

Re - 'posh' NHS??? I have had to see the consultant as was classed high risk becuase of previous tear. The MW suggested I have a meeting with her as she is a superviser of midwives and she wanted to pull my notes as there was also a LOT of other things that went wrong with my care before, during and after the birth. As she went through my notes with me she said booked me in to see the consultant anesthetist as she saw the surgical notes and the comments about how many times it took to get the spinal in.

The anesthetist was really lovely but when he saw me they had lost the surgical notes and he thought he would of written some comments. He was very quick to say about a GA and after I saw him I started to feel that maybe it was more so to fit round him than what was best for me. I asked if he could not even try a spinal and he said yes, he would try until either I got fed up or he did. Again, I thought well I'm not having the GS just because you get fed up of trying.

Have decided if I did go down the section route then if I had him again, and he wasn't able to get it in, I would ask for someone else and I don't think I would give my consent to have a GA. I really think I would just wait and go home and wait to go into labour.

I have no problem with GA and had 2 last year for wisdom teeth out and appendix. I just don't want to CHOOSE to have my baby like that as I missed the first 3 hrs of DD life last time. However if something went wrong and I HAD to have a GA then of course I would just be happy and grateful that whatever was done to have a happy outcome for both me and the baby.

My 3rd Degree tear was described as a 3rd degree b, which means the tear went half way through to the middle of my sphincter. The MW should me the surgical notes and the diagrams and said the tear was half a cm away from a 'c' which would of resulted in a colostomy bag at least for 3 months if not longer.

This is the bit of info that made me start to consider a section as I know it's the only way to avoid completely any further injury to the sphincter.

The surgeon who put me back together said at my 6 wk post natal chk that she'd advise a ssection next time and I am wondering if she said that as she could see my tissues were 'friable'. No way to know this and wonder if anyone could tell by looking?

It's the choices I have which are the problem, ironically. If i had a quick labour and no time to do anything or had abreech baby etc then the decision would be taken out of my hands and I know that I would be happy as long as we were both ok. I am really worried about the effect it would have on me mentally if I did end up with incontinence issues from choosing to give birth again. And likewise I feel I am giving up on my only chance of a better birth by having the section and I honestly just don't see the section as an easy option.

I know that there is just no right answer but I do agree with the sypatheticconsult that as I have been asymptamatic since the tear it is recommended that I go for vaginal.

BTW the second stage was 1hr 50 mins.

I suppose I am leaning towards vaginal delivery and trying to use the water where appropiate, give birth on all fours and breathe the baby out. And..hope the best. I suppose if I end up needing reconstructive surgery or something I will just have to try not to get down about it and know that I gave myself the best chance of the better birth.

Hi Gillyan

I'm sorry you're getting all sorts of conflicting advice - its a hard enough decision to make without all that.

I had a 4th degree tear with my DS and I elected for a c-section with my DD. The thought of sustaining more damage down there was enough to put me off going for a vaginal delivery and I was booked in for a section from when I was 20 weeks pg.

In retrospect, all I can say is that I'm glad that I chose a section, it was a much more peaceful experience! I was still under the care of the colorectal surgeons until recently - the last one I saw said that if I was his wife he would have insisted on a c-section. That made me feel easier about my decision.

Don't know if this helps or not but good luck with making your decision and whatever you decide, I hope it all goes well.

We don't know anything about the OP.

She might weigh 10 tonnes,
She might have a massive scoliosis
She might have had previous back surgery.
She might just have had a really shit time in her last labour and been leaping around all over the shop. All of these things may make a spinal difficult

Or she might as you so charmingly put it have a 'mutant' spine. They do exist. I've met two women who have had serial failed proceedures by increasingly senior clinicians. The last one ended up with nerve damage despite her procedure being attempted only Consultant level staff one of whom is internationally renowned (who i would willingly allow near my own back).

I did say in my original posting she should make sure she had seen a Consultant (but in general the anaesthetist in clinic is a consultant). We don't know the grade of the anaesthetist who failed last time either. Sadly procedures like this have learning curves and the fact it was a trainee may well have contributed to the 9 attempts but WE DON'T KNOW THAT.

In cases like this (ie difficult cases) most anaesthetists will document in the notes why they thought it was difficult. The person who saw her in clinic (and suggested the GA) had the benefit of those notes you and I don't.

Is your argument really that OP must be a mutant with an extremely rare kind of spine that is exceedingly hard to get a needle into? Really?

Or, it is possible that meeting another (more senior, as SymConsultant said) anesthetist could be a good idea?

cote
It took 9 goes to get the spinal in last time. Her back presumably hasn't changed.
We don't know the full story as to why (if there is a why) it was so difficult. Therefore there are good grounds to believe it might be difficult again.

Regional is generally felt to be 'safer' for the average woman for obstetric proceedures but the 'average' woman doesn't need 9 attempts at siting a spinal.

There are risks to having any proceedure and sometimes those risks outweigh the benefits.

However risk-benefit analysis is very individulalised so what is acceptable to one patient isn't to another.

If the OP is very keen to try regional anaesthesia again provided there are no definite contraindications I would be surprised if the anaesthetist on the day won't attempt to site a spinal for her.

However she needs to know before she gets there that there is a risk it might not work and that may still end up having a GA. Sounds like she has also been presented with the option of having a GA as a first line treatment.

Spinals involve a smaller needle being inserted further than in an epidural and whilst they are generally easier to learn to do (as if you go too far with an epidural you cause lots of side effects) they aren't easy. You are basically trying to pass a very small needle into a very precise place between the spinous processes in the back. The spaces can be very small (milimetres).

It is not just that it took him 9 stabs to place an epidural, but that he then gives this as a reason why OP should go for GA in a CS.

Cheers sympatheticconsultant.

It is my understanding that spinals are less technically difficult due to space the anaes. has to find. They are therefore quicker. [generalisation, but hey what ya gonna do]

The idea of labouring in water then delivering ob land is good imo - the research does not enlighten us as to how water births affect those with prev scars. Hmmm. Dunno how feasable it would be though - it would take determination on your part op, to get yourself up and out during the second stage. But that is for you to decide/wait and see at the time.

On the side issue of the analogy - I think the whole body is very like plumbing, many aspects of medicine are to do with flows, pipes, blockages, tubes, and so on.

It will always rankle a bit with hcp's who hear of a fellow hcp being deemed incompetent, based on one sentence or example. Here on mumsnet were I to decide a mother was too incompetent to feed her child because she once, say, gave her child food poisoning [crap analogy sorry], I would get flamed. I do not know the mother, her circumstances, I don't know the child and how it came about, I don't know if the food was in date, why she thought it was ok and so on and so on.

So I disagree, I think on this evidence it is a bit offensive, but not cardinal offence. Should try being a mw around here! .

chilly - Plumber story was an analogy. Do you know what that means?

You can laugh all you like, but I would still not go straight for GA for CS just on the word of an anesthetist who took 9 tries to put an epidural in me last time.

By the way, an anesthetist gave me an epidural while in throes of labour last time, with seconds between contractions. He cleaned the area, then waited for contraction to pass. Then he did local anesthetic, and waited for the next contraction to pass. It took another 1-2 contractions to complete the procedure, but he managed to put the epidural in no problems.

Yes, I know there are many good anesthetists out there. It just doesn't sound like OP's is one of them, and it's not offensive to the whole profession to say so.

SymConsultant - My understanding (from anesthetist meeting at hospital last week) is that a spinal block for CS is different than an epidural, because it is a single shot and not a drip. Does that mean it is easier to do?

I had a 3rd degree tear with both of my DS's - DS1 was 9lb 6oz and face up and I had to have an episiotomy but with DS2 he was only 8lb 6oz and no episiotomy.

I would urge you not to consider a home birth as despite the conflicting advice you'll need these people around if you go down the same route I did. The one bonus was I was only in labour the second time for 4 hrs!!!

I would also agree that being unable to site an epidural in a distressed and active person does not equal incompetence - sorry Cote but you are wrong here and a tad offensive to the excellent anesthetists out there. But then I guess you don't do the job so don't understand ......
It makes me laugh that you think you can compare the competence of an anesthetist with that of a plumber. Unfortunately that just shows your ignorance.

I am not an anesthetist btw but have worked with plenty of them down the years.

ooooh - sympatheticconsutant - what you said with bells on! Isn't mumsnet handy like that?!

growlyg (a sympathetic GP who was going to try to compose a response only to find a much better one already done!)

I'm just lurking here as I had a 3rd degree tear with dd (but she was 9lb 5oz).

Thank you SymConsultant for such an informative overview. Mumsnet is rather fabulous.

Gillyan, I hope it all goes well for you.

Hi Gillyan,
Without knowing the full details surrounding your last pregnancy and the delivery circumstances yours does sound like an unfortunate and unusual case. Assuming last time was a first pregnancy and you did n't have a particularly long 2nd stage of labour, other than it being a first labour you have none of the commonly associated risk factors associated with a 3rd degree tear.
The guidelines from the Royal College of O&G advises that "all women who are symptomatic after a 3rd/4th degree tear should be given the option of an elective CSection". Asymptomatic women are usually encouraged to consider vaginal delivery.
The problem is that there is still a lack of good quality research in this area with regards to the best course of action in future pregnancies bearing your individual circumstances in mind (damage sustained despite no obvious risk factors).

Unless you feel strongly about having a vaginal birth a CSection is the only guaranteed method of avoiding further anal spincter damage (but it has its own risks). A mediolateral episiotomy may reduce the risks of further sphincter damage but also cannot prevent it.

With regard to anaesthetic for a CS a GA is usually the last option when the anaesthetists cannot insert a regional block (spinal/epidural). Again not knowing the exact circumstances of your last delivery/postpartum problems it is difficult to advise on this. It may have been a relatively inexperienced anaesthetist or the circumstances which could have contributed to the difficulties experienced. This time round if you have been assessed by a senior anaesthetist I would take their advice.It may be that they feel that with an elective CSection (when you are not in pain and losing blood at a rapid rate) that a senior Aneasthetist will be successful inserting a spinal/pidural. At worst if they are unsuccessful with a 1st or 2nd attempt then they have early recourse to considering a GA.

If you were keen to go for a vaginal delivery then if you were my patient I would encourage you to labour in the pool but not to deliver in it. I feel that your second stage should be out of the water where the midwife could have utmost control in:
1)Guarding the perineum
2)Controlling the delivery of the head
3)Performing a medio-lateral episiotomy if that was deemed necessary (yours especially is not a case where you want any suboptimal placement of the episotomy due to wet slippery gloves/perineum!).
I would suggest forceps delivery not be contemplated and if anything other than a low cavity assisted delivery was required then they consider resorting to a CSection in labour.

It is a difficult decision but bearing in mind the relative risks and the long term implications of those risks together with the fact that you sustained a3rd degree tear without any obvious contributory factors if you were my wife/patient I would recommend a CSection but with assurances that a Consultant Anaesthetist would be inserting your epidural/spinal (assuming the anaesthetists did not feel this was contra-indicated for some other reason)!

Again as stated above raise your concerns regarding the conflicting advice you are being given so that your key specialists can come to an agreed best plan of management with you.

I hope everything works out for you. Do let us know how you get on!

FYI the RCOG guidelines & Pt information on this can be found :

"here"
&
"here"

It must depend on the individual patients anatomy as to how easy it is to get an epidural in, not everyone is the same.

To stretch the bathroom analogy, at least there the plumber can look at, and measure the bathroom in advance to see what its dimensions are. I imagine that the anaesthetist has much less idea in advance of how easy it will be to put in an epidural.

Woah, Is this what The NHS is like in posh other parts of the country?!

I've seen my midwife about 3 times during my whole pregnancy, never a doctor/consultant/anesthetist.

All labours are different hun, maybe just go with what seems the most appealing and see what happens. I never even glanced at my birth plan 1st time round and am not going to bother writing one this time at all. Am sure you'll be fine,

news.bbc.co.uk/1/hi/world/africa/662472.stm

gasman -

OP said: "Anaesthetist said, as it took 9 times to get the spinal in last time it would be better to have a General for the section."

Regardless of what you find offensive , that is a moronic statement, not to mention an acknowledgment of incompetence - "It was so hard for me to give you the epidural last time, I think you should have a GA this time" .

If a plumber took nine tries to install a bath in my bathroom, then had the nerve to say I should have a shower in my other house because it was oh so hard for him to put in a bath last time, I wouldn't forgo the bath. I would find another plumber.

And you know what - I wouldn't care one bit if all the plumbers in the world find that offensive

Oh, I've got the unsettled little one too. I tend to be up with him when everyone starts posting in the morning though - it gets too addictive so I end up waiting for a thread to refresh at 2am instead of getting much needed sleep! So... much the same over here, just with nicer weather! (Sorry!)

Sorry for hijacking.

Ho well don't be too impressed, this ain't no literature review, just me having a google! Plus I am not forming management here, just reading around it a bit, y'know? Am bound by my governing body, being a hp myself, so I can't advise or make statements that are percieved as guidence. But I do feel comfortable pointing people towards info that might help them out a bit.

Nice has a bit on the warm compress thing.

A bit at being in California. Have you anyidea how glam that sounds to me here with unsettled bubba?

<<appear to have hijacked poor OP's thread, sorry >>

I'm in California, so just making dinner over here! Really impressed with your research, Tree, I'm going to take a look at those guidelines later. I love mumsnet for actually throwing up research that the professionals never tell you about (or just tell you one side of!)

Blimey another soul up late!

I think the research very much supports water as a perineum protector, but that the op's history of a 3rd degree tear means the research may not stand iyswim?

Did see research on warm water compress too somewhere......<<dashes off on another mission>>

That's interesting, tree. I always took it as read and put it down to the same reasoning that tweezering your eyebrows is easier after a hot shower. (not very scientific! )

By the way, home birth isn't such a mad option. I went that way with my waterbirth very late in the pregnancy when I realised I wasn't going to get the support or birth I wanted in hospital here. Wouldn't regret a thing - much bigger baby than vbac1 too!

From a quick google the opinion seems to be that water offers protection to the perineum, particulary in 1st timers. Occasional research throws up a slight increase in tendancy to tear, but to 2nd degree, with less episiotomies and 3rd degree tears.
How that is changed by a previous 3rd degree tear I cannot say, and I haven't bumped into any reasearch to help you out on this one

Sorry! I tried!

I am not trained in water birth either, so I can't give you much insight into the inn's and outs of management there.

Nice is always a good place to start when looking at birthing options, as it is very good at plainly expressing the reasons for chosen management. So for example, it cites that some research found being upright or on the side for delivery was associated with more 2nd degree tears, but overall research finds that simply adopting the most comfortable postion is best. nice labour guidelines

The other thing I would add is that if a person can come to a plan and have that put in place [say to cover the what if I labour before an elective sceanrio] and that is in the notes, then unless there is a will on all sides to change the plan on the day, that is the plan. Thereby removing the dreaded conflicting advice worry and giving a firmer footing to things.

Sorry to ramble, I just really feel for you. Hopefully you will be able to have some of the muddle cleared for you. Hth by the way

I would also add there is research to say the oppposite!

There is some research to suggest tearing can occur with more frequency in water, but please don't ask me the details cos it's late and I haven't a clue. It should be fairly easy to google up though. Also with standing I believe.

AS with all research however, it applies across the statistics and does not address the unique needs of an individual [the op]

Only anecdotal but for my first vbac (dry land), I had second degree tear. For my second vbac (water) I had only a tiny graze. I've frequently been told by midwives and read that warm water softens tissues and makes you less likely to tear, so I'm a little confused as to why a mw says a waterbirth would make tearing more likely.

They used to lay hot wet towels against the perineum for this reason!

By not cooperative patient I assume you mean unable to sit still due to pain and hold the position?

Cos you know you'll get your ass whooped for that dearie .

It is unfair to assume incompetence because a procedure was difficult imo. Thats not to say it wasn't in this case, just that it is an assumption on limited evidence.

Doesn't help the op though - my advice is to listen to the expert in each field. A midwife does not have indepth knowledge of anaesthetics, nor does the anaesthetist of water births. Within midwifery, a practitioner performing waterbirths will have better insight than a cummunity practitioner who kicks ass at spotting dehydrated babies.

There are too many specialist areas for one person to be a one stop shop, and this leads to masses of conflicting info.

Also, there may be no right or wrong management. Just information, research, and the choice. The choice will always be yours, unless there is some immediate life threatening event, which is good - but also puts alot of responsibility and stress on you.

RE; 3rd degre tear. Some skin is more friable than others, it scars easily and heals slowly. Or You may have a perineal structure that lends its self to tearing, or both. Unforeseeable in many respects, and a plauge on women through the ages. I hope it is healed ok for you.

Cote Your statement that nine attempts at a spinal = incompetence is offensive.

I don't know what you do for a living but I can tell you that a distressed women either in labour or immediatly post partum can prove to be 'anaesthetically' challenging. The stakes are very high for having a general anaesthetic in this time and in unsupported remote units multiple attempts may be made. This does not equal incompetence.

I failed to site an epidural in a patient repeatedly one night, my colleague failed too, the boss (v. v experienced obs anaesthetist) also failed. None of us is incompetent she just wasn't a very cooperative patient with tricky anatomy.

In your place, I would have a c-section. If it took 9 tries for anesthetist to give you an epidural last time, have another person do it this time as he is clearly incompetent.

You can ask for it to be done at 38 weeks. Have steroid shots to mature baby's lungs if necessary.

re Episiotomy - You will not tear towards the anal sphincter if you have a mediolateral episiotomy (towards the side, at a 45 degree angle). Your consultant might be thinking of a median episiotomy (straight down towards the anus).

So a big episiotomy would actually prevent a tear. However I've had one of these, and if there is a worse pain that takes longer to go away in the world, I don't want to know about it.

So, my vote is for CS. With a better anesthetist.

OMG thats a lot of conflicting information.

All I can offer is personal experience (with a little bit of info from my nursing training)

1stly its ok to have a general when pregnant. I have to have an ovarian cyst removed as an emergency. DS1 is absolutely fine.

i had a tear and a cut with DS1. the tear healed quicker than the cut and it was a 3rd degree one.

With DS2 i had an elective due to a skull fracture when they delivered DS1. It was a spinal rather than a general and a lot more comfortable than the epidural i had with DS1. dont know if that was the calm of the theatre or because i knew how to sit (leaning forward to arch my back).

I agree with previous posts that: MW know more about waterbirths (consultants arent generally involved in them), MW are very anti c-sections but a consultant wont push you towards major surgery unless there is an indication for it. IME both as a nurse and a patient, i have always found anaesthetists to be knowledgeable and arent prepared to take unnecessary risks.

Could you not arrange a meeting with the consultant and the anaesthetist to discuss the c-section option?

God, you poor thing. I had lots of bad second degree tears and episiotomy with DS (but not third, so you have my utmost sympathy).

If I were you, I'd go for a section, and ask to be whipped into the theatre if you've gone into spontaneous labour before your section date.

Also, I'd push to have the C-section at 38 weeks, as opposed to 37 as this is what they were going to do for me if I went into spontaneous labour beforehand (like you, my previous DS was born at 37 weeks). Threaten not to leave the office if they go for 39.

For me it would not be worth the risk of a colostomy to go for the natural delivery, but obviously it's up to you.

I hope you have more luck.

Anaesthetists tend not to want to give general anaesthetics for obstetric patients so if you've been offered one there must be a good reason.

Did you see the consultant anaesthetist? If you haven't ask to do so.

Be aware as well that different doctors will say different things too (as we are all people and have our own very slightly different 'take' on the world) so it is quite possible that when one person says you should go straight to GA another might have a really good attempt at siting a spinal (which on the whole we know to be safer). However an elective LSCS under GA is probably safer for organisation reasons than an 'emergency' operation.

If you were really keen to have a regional anaesthetic (spinal) and were prepared to cooperate given that it is likely to be difficult then the anaesthetist on the day (possibly not the one you saw in clinic as that is often the way cover works) may well be prepared to have a go. You would need to accept though that it might not work and you would end up being stabbed in the back AND having a GA.

Also, I am way more inclined to get advice of all the mumsnetters, who have actually had babies! All 3 midwives I have seen from my team don't even have kids and the consultant is a man! Although I must say a very sympathetic man and said to me, 'hey thats just my advice but I'm not the one who has to get the baby out, so I'm happy for the section too'

balloonslayer I am a spreadsheet kinda gal! I do love to make lists! Thansk for the advice.

kiera thanks for your positive c/s story.

I'm almost starting to think I will just give birth at home with DP and sod them all off!

I am a very indecisive person but usually armed with the right info I am a good decision maker. I just cannot make up my mind and neither option seems tempting. There are pro's and con's for both.

gillyan I had a planned cs for #3 after a vaginal birth (2nd degree tear) with #1 and emergency cs with #2. It was fab, completely different from the emergency one, I would recommend it to anyone. No pain after as pain relief adequate, just a bit stiff and feeble for a while after. OK the recovery not as quick compared to my vaginal birth but absolutely worth it. As #2 was 4 weeks premature and I was scared of going into birth naturally with #3 the mw assured me that I should come into hospital immediately if I do go into labour and they will do a cs there and then. I got all this on my birth notes. Oh yes and I was out of hospital in 3 days too!

Oh I do feel for you!

I don't have a lot of advice having had three sections, one emergency and two elective for the simple reason that I was not going through all that malarky again. Actually if I were you I would have a section without hesitation, but as you can see I am a section fan

I'd feel a spreadsheet coming on. Question down the side, person you have asked along the top and the answers in the boxes. Then book another appointment and take it in with you and show them just how stupid you are finding it all.

As a gut instinct I would guess that consultants probably don't have a lot to do with water births*, whereas midwives do, so I might be inclined to value a midwife's experience more re water births. (*Consultants tend to get called in when there is trouble, by which time you've had to come out of the bath)

And IME consultants usually want you not to have sections - if he is being positive about it then that's a sign he thinks it's probably a good idea.

But you shouldn't have the likes of me guessing - you need to get back there and make them explain themselves.

Good luck

Thanks mummydragin yes I've explained some of what you asked in crossed posts.

Reason for the tear - NONE! thats whats so annoying, I was fully dilated, controlled pushing, panted when head crowned, DD was 7.5, she came out the right way, there were no instruments involved, I was in an ok position etc etc, so I feel there is nothing I can do differently this time round.

Just worried about the section and recovery and any complications and I think I keep hanging on to the dream of anything less than a 3rd degree tear and being able to get out of that bloody hopsital ASAP. ( was in 6 days )

Another thought. Ask the consultant what he would recommend if it was HIS wife.

Yes totally agree about the different opinions slushy I am just doing my own head in about what to do.

Sorry, x-posts there, hadn't seen your other 2 posts Gillyan

YANBU.
I agree with listenglisten.
Do you know, in retrospect, why you had such a large tear last time?
Can you get your MW, consultant and anaethetist together in the same room and work out a plan of action, or is this not possible?
If they have agreed to an elective c-section this time, why not go for that option at 39 weeks- I don't think they're allowed to do electives any earlier than that unless the baby or mother are at risk (and obviously they don't rate anal tearing as a "risk" - rightly or wrongly!). Then, if you do go into labour earlier, see how you feel at the time. If they are saying that you can choose the c-section at any point during labour, it sounds as though you acutally have quite a lot of choices, which is a good thing.
Re. spinal/GA - totally up to you, I would have thought. Go with your instinct. If they are saying a GA is safe, I would believe them.
Sorry, I have no experience of tearing but I did have an episiotomy with my first baby and they stitched me up waaaaaay too tight afterwards (gross, sorry) - I had to have physio and all kinds of stuff for about a year afterwards. So, whilst not the same as your situation, I can sympathise. Normally I am not particuarly pro- c-sections but in your case it sounds like the best option, whether or not you go into labour naturally first. It's quite normal to be undecided about what kind of delivery you want, all the way through the pregnancy ... what does your instinct tell you to do?
Sorry I can't be of more help though. Good luck with whatever you decide.

northen Hi, I have done that and half the info above was form the supervisor of midwives!!! Have just been sat here thinking I might just have to ring her and arrange to see her again, she is lovely and spent 2 n half hrs with me at her suggestion I should add. She picked up on the fact I was very anxious and saw me at 20 wks.

She's the one that said my tear was half a cm away from leaving me with a colostomy bag and then went on to say she would recommend an elect episiotomy - I asked her about water birth as had heard it helps and she said she wouldn't recommend. She is also the one who said about what would happen if I went into labour before the section date.

Consultant was very nice but didn't have a lot of time - saw him for all of 10 mins and he said it was totally up to me, he suggested water birth but said it was my body and he would fully support a section

AARRGGGHHH??????

Can you ring the antenatal clinic at the hospital and ask for the supervisor of midwives to co-ordinate what's going on and sit down with you to make a birth plan.

I didn't tear so have no experience of what your going through but I felt so bad for you to have all this stress and uncertainty at such a late stage of your pg. I am 32 weeks with dc2 as well the only advice I can give is regarding the general surely if you have an elective c section there is no hurry to get the epidural in and it will prob be easier as you won't be in pain providing you don't go into labor early. with regards to the mw and consultant I would insist the get together and discuss your options together so you can hear why they have such conflicting opinions. I would hazard a guess that the diffence in opinions is due to different agenda the mw being pro vb and the consultant being pro c section. Hope you manage to sort this out.

Yes good idea

I have just re-read the thread I started about bad tears and I did actually have lots of replies - I take it back.

Can you write it all down as you have done here and show your MW? It does look pretty ridiculous with so much conflicting advice that you have been given.

Sorry, no advice on the tear, I had c-sections with both of mine.

MIDWIVES, CONSULTANTS, ANESTHETISTS! Getting really sick of all the conflicting information I'm being given. None of them seem to know what they are on about.

Saw MW yesterday and was chatting to her about birth options as I have STILL not made my mind up what to do. (I'm 32wks)

For those few souls on here that haven't heard me whinging on - I had a 3rd degree tear last time for no apparent reason, I am booked in for a section this time at my choice but still don't know if I even want it.

So far..

One MW said she would recommend an elective episiotomy to avoid a tear going into my bum and not to birth in water as it makes your tissue more likely to tear.

Consultant said - NO WAY for episiotomy as I would be more likely to tear and he suggested a water birth or happy for me to have a section.

Anaesthetist said, as it took 9 times to get the spinal in last time it would be better to have a General for the section.

When they were trying to get the spinal in I had just given birth, was bleeding everywhere and totally distressed and begged them to knock me out and was told it would be better for me to be awake.

Now I am being told it will be perfectly fine to be knocked out while still pregnant!!

He said they would try the spinal as often as I could bare

MW yesterday said they are only allowed to try 3 times and thats it??????

When I asked one MW what happens if I go into labour before the section date she said we just examine you to see how far on you are then if you change your mind and want to give birth thats fine or we just whisk you in for the section.

MW yesterday said NO WAY that will happen, she said if you go into labour before your section date they won't give you a section without a medical reason - to which I relpied, erm..what about the reason I am terrified about ending up with a colostomy bag and the consultants have already agreed I have every right and reason to have one???? She said not. Section is booked for 39 wks and I had DD at 37 so now scared I'll go into labour and my choice will be taken away from me.

WHO do I believe, getting so so fed up of this. I really don't know what to do. I spent all afternoon crying yesterday.

The only thing I can do is to go for it and just hope I don't tear as badly again. Thats it, 'hope' or maybe give birth in water...if the pool is free..if my labour is safe to do so.

Otherwise I go for the section ( if I make it to the day ) and risk having to have a general anaesthetic as they had problems getting the spinal in last time when I needed to be put back together.

What do you reckon?

And I did start a thread asking about anyone who had a bad tear last time, what happened second time but didn't get too many replies so would be very intersetd to hear your stories