stitches - obtetricrian, midwife or registrar?(44 Posts)
So as a first time mum I've pretty much have to accept that there will be SOME tearing involved during VB.
Who actually does the stitching the midwife or the OB? I've seen some posts where it is the registrar is that like a junior doctor?
I heard thy glaze over these details in antenatal classes and focus more on the birth preparation rather than the post natal care and risks so I thought I'd do some reading. And in some hospitals the midwife do the first degree tears but refer to the OB for 2-4th degree. Who actually decides how bad the tearing is? Does the midwife do the OB referral or will an OB always do a check for hospital births?
I know it's probably rare but I've heard horror stories of post birth stitches not done well, having to be redone, causing on-going problems or longer recovery (some cases longer than CS recovery or requiring further treatment or surgery).
Anyone had any experiences either way of postpartum care for a new mother? eg midwife vs OB skills, lower risk of botched postpartum procedures in private hospitals, etc?
A midwife did my stitches. There was a consultant in the room for the birth briefly, but as far as I can remember he didn't look at me after baby was out.
I guess the midwife assessed how bad the tear was. I had 4 stitches and I can't remember what degree tear I had to be honest.
Her stitching must have been perfect, because I had no pain or tightness afterwards, everything has healed as it should, and no pain during sex or anything (sorry if tmi!)
Im not sure if it's always a midwife who does it but she was there for the birth and everyone else buggered off whilst she did the stitching.
Midwife did my stiches. Couldn't tell you who made the call as to the category (or even what it was, 2nd or 3rd, you forget). Doctor might have had a say as I had a post partum haemorrhage so they dealt wuth thay before the stitching.
It's great your trying to get an informed view, very sensible, but I wouldn't worry about ot too much. I don't actually know anyone who hasn't had a tear with a VB, it's so common it's just part of the midwives day job really.
You won't necessarily tear. I did a bit with both mine. (Convinced that this is completely due to my inability to "breathe the baby out". Instead I go for the "fucking push as hard as you can and get the bastard out" approach! )
Both times MW did stitches. No issues.
A doctor did mine both times. Midwife assessed first though.
I was looking at the stats for my hospital the other day and over 50% of people who had a vaginal birth had no tears or stitches so it's not necessarily a given
First birth, I had an episiotomy (long story as to why), midwife stitched me.
Second time, I tore. The midwife who delivered for in another midwife who was more experienced to stitch as she felt her colleague would do a better job than her.
and loads of people hung around to watch
I needed stitches with my first. Junior (possibly student I'm not sure tbh) Midwife did it under supervision of a senior midwife.. Tbh once you have you lovely baby you will not give a monkeys what's going on down there. I had no complications so I assume all is fine.
Just had my second and did not need any stitches this time.
Dr did it first time, midwife the second.
I didn't tear or have stitches with either VB. I felt like I was going to when I delivered my son in his full amniotic sac but it was just grazing.
I did the perineal massage and definitely felt it relaxed the area. I did it while squatting - which I did as part of my birth prep.
The massage is supposed to help.
I also had a water birth as I heard it made the skin more stretchy.
I'm sure there are people who did everything they could and still had the stitches but most people I know who haven't required them did do the massage.
Most people I know have been stitched by the MW.
The midwife looked at mine and decided a doctor should do it. He looked and said he could do it but a theatre surgeon would do a better job and it was up to me. I went for the theatre surgeon option.
Mine was a bad 2nd degree. Was fine after a few weeks.
Two doctors, lots of stitches. Fine after a few weeks.
A consultant was brought in to do my stitches after baby 1, i'd been cut and tore but I also had a PPH and was in a bad way.
After baby 2 the midwife did the stitches but there was only a couple needed as my previous scar tore.
Episiotomy and third degree tear- registrar
On advice from MN, my birth summary stated if I needed stitches, would like them done by an expert and not a student. The team of a dozen people in theatre called a MW and one chap told me if he ever needed intimate stitching, she's the one he'd want to do it. So a bit of a wait, but 24 hours later I was having medics tell me it was the best stitching they'd ever seen!
Second time, a MW and doctor and eventually a consultant conferred for about 40 minutes about how to go round the previous stitches, before doing a good job.
I had some from an Obs with birth 2, but they were not as good as the fabulous head of midwifery who did them after birth 3.
I'd prefer a female and experienced to do them (just more likely to have had them herself).
I had a second degree tear with my first which was stitched by a registrar in the delivery room ( I think it was quite an awkward one) and a third degree tear with my second which was stitched by a registrar in theatre. A registrar is a junior doctor but will have been a doctor for at least four years and worked in obstetrics for at least two of those!
Episiotomy- registra, but he was already down there dealing with pph and retained placenta.
First baby I had an extended second degree tear and was stitched by the registrar (or maybe more junior dr) with a consultant supervising. Second baby had a second degree tear and was stitched by midwife. Both were done in the delivery room.
Neither gave me any bother after (even in the first few days - no having to sit on a cushion or anything like that).
Midwife both times. First was an episiotomy and second was a 2nd degree tear after water birth. Both times straightforward with no issues.
Midwife for ds after episiotomy. Consultant with dd after a bad tear where increasingly senior people looked at my fanjo wondering whether to send me for surgery. Consultant ended up doing it in delivery room. Wouldn't tell me how many stitches! Did hurt for a long time after but am now pg with another dd (10 years later though!)
It's not guaranteed - two VBs and no tearing or grazing. I did a lot of massage and used an Epi-No. Worth prepping yourself as best as possible, you may be surprised.
Four people had a go with me. Natural tear as opposed to an episiotomy and quite a bad one - the student midwife had a go, that didn't get it, the midwife tried but then it had to all be undone, the registrar had a try and finally they called in the on-call obstetrician who got it done. Took about two hours all in all.
It sounds like a horror story but it was actually fine, they let me keep the gas and air on (local anaesthetic doesn't work on me) and I had gorgeous baby cuddles too of course! By the time the obstetrician came in and asked if it was okay to have a go I was a little high on the gas and air and announced "I think everyone else has seen my vagina by now, what's one more?"
Try not to worry too much about tearing. It's not automatically a horror story, even when it's a bad one!
It depends how you tear, basically they are categorised by which tissues tear, not the size of the tear
First degree - superficial tear of perineal skin, can heal on its own
Second - tear into perineal muscle, midwife can suture it
Third - partway into the anal sphincter and will be down by a surgeon
Fourth - all the way through the analysis sphincter and will need an experienced surgeon and maybe follow up.
I think the risk of 3rd/4th degree tears is 1 in 100 so really not worth worrying about. I had 3rd degree on first and second births and it was repaired by a surgeon post birth, needed a spinal anaesthetic and took about 2 hours both times. The scar felt tender for several months afterwards (mainly only during sex) but it wasn't as bad as it sounds and mostly recovered after a couple of weeks.
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