Incorrect perineal stitching. Pregnant again - what are my options?(8 Posts)
Hi all, have name-changed I know a few mnetters and I don't want them to know all about my foofal problems.
DD was born 14 months ago. I desperately wanted a birth where I felt as in control as possible. It didn't happen. I had a bleed at 38+5 and was admitted. My waters were broken and labour pain went from 0-60 very quickly. I had an epidural, and when my daughter was almost fully descended they were worried about her being in distress so I had to push her out as quickly as possible. The result was an internal muscular tear and a perineal tear. The sewed me up (taking two attempts!). The recovery was horrendous.
After it healed it definitely didn't feel right. Looking at it, they sewed my perineum much more 'closed' and higher than it was before. This was confirmed by a surgeon who said that they could offer me perineal re-fashioning to fix it, or I could wait until I had completed my family before fixing it for good
I was debating whether to have the surgery and then I had a happy accident and fell pregnant again. Am now 7 weeks and panicking about it.
There is absolutely no doubt that I will tear again, and possibly quite badly from the look of things downstairs. This is TMI but if I stretch out my inner labia to as wide as possible (as if I was giving birth) the hole is no bigger than a golf ball. My perineum is 'fixed' (for the want of a better word!) a good inch higher than it should be, and made up of scar tissue that won't stretch. Not sure if i'm describing this well!
Am I right in assuming that I can't have the re-fashioning now under local? I am debating whether to have an ELCS but i'm scared of such a big op. Has anyone been in this position before please?
Thanks for reading
(Also posted in health section!).
Not an expert, but sounds like your options are
1) ELCS with elective repair down below at some point after the birth.
2) Normal delivery with planned episiotomy under local anesthetic and immediate repair at the time.
Whichever you go for, it sounds like an excellent reason for an appointment with an obstetrician well in advance, so chat to your midwife and ask to be referred on.
Not been in the same situation but because of a episiotomy and then a subsequent 4th degree tear at my postnatal hospital check up they said if I ever had another baby it would be by c section as risk of tearing a third time too great and could cause long term problems. Can you speak to someone in the hospital where you had your baby? Did you have a follow up appointment?
I've not had a c section so can't comment on recovery but that v incontinence made my mind up for the future
Good luck with your pregnancy
Wildfire - thanks, I have a midwife appointment in a few weeks so I'll ask for a referral.
Dyslmimi - I'm sorry to hear about your injury. I haven't spoken to anyone and haven't had a follow-up. My hospital notes were so badly written (glaring mistakes, omissions etc) that I'm not sure I have much faith in them to be reliable now (the notes, not the staff!).
Tbh the 4th degree was not as bad as was repaired properly in surgery so recovery was not as bad as the episiotomny (sp?) which still makes me wince at the thought.
I think as it was surgically repaired the hospital likes to follow it up and I had some lovely Tests to check the muscles were repaired
You have time to make sure you get a referral and are happy with the plan. Make sure it's all in your notes and anyone with you at the birth knows what is needed as your mind may be focused elsewhere
I'm pretty sure a refashioning can be done under a local (not an expert). I say this as a veteran 4th degree "tearer" who's perineum was also badly repaired (under general but bear with). I left it because
there was no bloody way I was going through that agony again my family was complete at one child.
However, 7 years on all was not well. The post birth perineum was (like yours) no more than a thin band of scar tissue. Alongside that I also had double prolapse. SO, 3 weeks ago had all the prolapses repaired AND a perineumoplasty (sp, but rebuilt). The consultant asked if I wanted it done asleep or awake (...and there we get to it!). I opted asleep.
So, what I will say is research all options, massive congrats on your delightful news, research prolapses and how to help avoid (though not 100% guarantee especially after birth trauma sadly). Oh, and the good news is my perineum was repaired internally so NOT ONE external stitch and the comparison to the first
and second, and third repair has been amazing!
My sister had a botched repair job after her first (third degree tear), but she was able to have to repaired before she got pregnant again. Her surgeon arranged for her to be induced on a day where the surgeon was in the hospital, and everything was fine the second time round...
It is very easy to get a referral, the midwife can arrange it at your booking in, I always get one because I had a 3rd degree tear at my first, I have big babies, and I like the Birthing centre which gets twitchy about those things! So I need consultant approval to go there...
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