appointment with consultant after 4th degree tear... completey extremely scared! what questions do i need to ask

[kittenbaby]

hi im dreading my apointment with consultant on thu about my 4th degree tear in childbirth

anyone thats been though this
what questions should i ask

this is what ive thought of so far

1. why do you think this happened
   
2. could of it been avoided
   
3. how will it effect me in the future
   
4. future children cs or vaginal
   
5. when will i stop being in pain
   
6. when will i stop having nightmares over this ?[could be difficult to answer ,i know]
   
   
   can you think of any others

[kittenbaby]

also can they give me any drugs to help me relax if i have to be examined

i say if ,im pretty sure i def will be

[Anna8888]

kittenbaby - please try to relax, the doctor is there to help you

[NoNameToday]

Couple of Q's re delivery

1. spontaneous or assisted, ie forceps or ventouse, any shoulder dystocia.
   
2. any fetal distress involved
   
3. term and weight of baby

[kittenbaby]

hi

answers re delivery

1. spontaneous or assisted, ie forceps or ventouse, any shoulder dystocia.
   
   spontaneous,non intremental, no shoulder dystocia, baby right way etc
   
   
2. any fetal distress involved
   
   no none at all
   
   
3. term and weight of baby
   
   38+8 8lb 4 and a half oz
   
   water birth
   on all fours
   only gas and air during labour
   nothing at pushing stage
   
   
   
   
   
   this is what happend
   
   
   
   had my beautiful gorgeous bay girl on the 27th of june so 10 and a half weeks ago now
   
   i did so well during the labour and giving birth
   only had gas and air during the labour and nothing at the pushing stage
   apart from the fact i was in the water
   thought everything had gone so well
   after dd was born i delivered the plactena naturally after nearly and hour while bf dd
   and i thought thats it ive done it!
   
   then when i was examined the mw said we need to get someone more senior to look at you the look of horror on her face im not sure ill forget
   then a sister examined me then a doctor then a surgeon they said i had 4th degree tears
   i never knew anything like that existed and that id have to have a spinal tap and a repair operation
   i was crying my eyes out even though when i was in labour and giving birth i was pretty silent and just got on with it
   i found the examinations far far far worse than the labour and birth
   thats was the worse bit
   
   i just cant understand how this has happened to me
   like if i had had an epidural or even pethidine and had lost the urge to push and had to had forceps or vontouse and that had caused it then i could understand why it happened
   or if dd got stuck and they had to rush her out , or if she came out the wrong way round i could understand it obv im glad those things didnt happen but then id understand what happened
   
   but i only had gas and air
   was on all fours
   was in the water
   only pushed when i was told to do so
   i just cant understand it
   
   just can believe this has happened

[NoNameToday]

Thanks for the response kittengirl.

First, let me say how sad I am that this happened.

Sadly, sometimes there are no reasons, but soemetimes there are indicators, hence my questions.

In your situation, you did nothing wrong and probably neither did your midwife given your answers.

Was the midwife experienced? I know that's a difficult one for you to answer, but what's your gut reaction?

[kittenbaby]

yes she was quite experienced and at least she was nice to me unlike other midwives

im so scared i just dont know how im gonna get through this

[kittenbaby]

noname can you think of any other questions i should ask

[expatinscotland]

See your GP first and perhaps get a prescription for a couple of diazepam or another light tranquiliser.

[kittenbaby]

ive actually got some diazepam due to a neck injury a year ago they are still in date

[kittenbaby]

do you think i should take one ?
would it effect breast feeding ?

im just gonna check the leaflet

[NoNameToday]

Please don't dread the appointment

I really can assure you that all the people involved would have felt pretty gutted that you sustained a 4th degree tear, even if it could not have been avoided.

It will be your decision whether to opt for a vaginal delivery or a CS for future deliveries.

The obstetrician will probably advise CS, but you need to ask him has he studied your delivery notes carefully.

I have known ladies who following previous tears went with their 'gut' feelings and opted for a vaginal delivery with success.

Ultimately it is your choice.

[spudballoo]

What kind of consultant are you seeing? A colorectal or obs/gynae? Why are you seeing him/her?

I had a 4th degree tear and have ongoing treatment on the colorectal side. I can help you with that if you are having any continence issues.

Yes, you will be examined so that they can assess how well you have repaired or otherwise. It's not dreadful, and to be honest I would avoid taking any unprescribed drugs not least because you will want to be as with it as you can be to ask the right questions etc.

How else can I help you? It really depends on whether you are having continence issues. Have you been referred to an obstetric physio? You should be so that they can help you with your pelvic floor excercises which are now critical for you.

I'm so sorry this has happened to you, I know it's very shocking xx

[kittenbaby]

thanks for your help girls
can you tell m what a 4th degree actually is

i read on one website it was going though the spinghter sp
and on another one that 4th involves the walls of the bowels ?

i dont really even know whats happened to me

[kittenbaby]

i dont really know what typ of consultant he is just says on the letter gynaecology out patients so does that mean hes a gynecologist ?

[NoNameToday]

Spudballoo has more knowledge than me regarding the ongoing problems resulting from 4th degree tears andI feel she will be of immense support.

My feeling albeit sympathetic is from a clinical standpoint.

Watching with interest

[NoNameToday]

It will be the obstetrician/gynaecologist kittenbabe and he may, depending on your current problems refer you to a clorectal surgeon.

[kittenbaby]

no name can you think of any other questions i can ask noname or do u think ive covered most of them ?
and do u know what a 4th degree is? is it the walls of the bowels ?

spud can you think of anyother questions ?and do you know if its the walls of the bowels ?
im so sorry to hear this has happned to you xx
when did it happen to you?

[NoNameToday]

The bowel usually refers to that part above the rectum.

Not involved in 4th degree tears as such.

I am trying to find a website with a simple diagram which will explain with reasonably easy to understand explanations.

I think the answer to your Q6 will be aided by the information you receive in answer to your other questions..

[kittenbaby]

thanks so much noname xx

[Porpoise]

Hi Kittenbaby

So sorry that no one has explained things to you.

I'm a journalist and this is what I wrote a while back when I did an article on tearing in childbirth.

"Tears are classified by degrees, with first-degree being the least severe and fourth-degree the most severe. It is not the size of the tear that counts but its depth and the extent of the damage it may have caused, so a small third-degree tear is more serious than a large second-degree one. Over 97% of tears are first or second-degree ones, and heal rapidly without problems.
[x-head] First degree: Tearing of the perineal or vulval skin.
[x-head] Second degree: Tearing of muscle, as well as skin.
[x-head] Third degree: Tearing that involves some or all of the anal sphincter.
[x-head] Fourth degree: Very severe tearing that involves some or all of the anal sphincter."

Are you in London? If so, can recommend v. good place for aftercare...

[NoNameToday]

This is the definition from the Royal College of Obstetricians and Gynaecologists

Table 1. Definition of spontaneous tears
Degree Trauma
First Injury to the skin only
Second Injury to the perineum involving perineal muscles but not involving the anal sphincter
Third Injury to perineum involving the anal sphincter complex:
3a: less than 50% of EAS thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn
Fourth Injury to perineum involving the anal sphincter complex (EAS and IAS) and anal epithelium

EAS = External anal sphincter
IAS = Internal anal sphincter

If you can imagine pillow with a cotton lining inside and out, filled with a sponge and the a rubber insert, then picture piercing a hole through all the layers!

Not necessarily a tear through the end of the pillow.

In other words, the 4th degree tear may not be obvious when lokking at the perineum externally.

Hope that makes sennse.

[kittenbaby]

well im only 30 mins from london
i dont mind travelling

can you tell me more ? thanks

[NoNameToday]

Well porpoise, that made it a lot clearer.
Not too good with smileys

[spudballoo]

Hi there, hope the explanations have helped. A 4th degree tear is sometimes described as tearing 'front to back' which isn't a bad way of looking at it in terms of severity but it isn't necessarily totally accurate.

It sounds like your appointment is a routine follow up with a gynae consultant. Many hospitals have these as standard for 3rd and 4th degree tears.

They will likely ask you about how you've healed, as far as you know yourself, how you feel, continence issues etc and will examine you.

Personally i would ask to be referred to a colorectal consultant who can perform a series of physiological tests to ascertain how well your repair has worked, as this cannot be accurately assessed by a digital examination. If the repair hasn't worked particularly well, then it's best to get it sorted out now rather than in the future as this gives you your best chance of a strong and lasting repair. Plus, the colorectal people are the experts in 'bums' and a 4th degree tear means there has been damage to your bum - to put it very crudely.

I would also ask for a referral to an obstetric physio as per previous message.

I had my first child 2 years ago tomorrow, and had a 4th degree tear. It has never healed, alas. But I have gone on to have another child and hope to be on the mend on the bum front in the next few weeks!

Child2 screaming, must fly....x

[kittenbaby]

thanks for all the help
its so good of you xx

yes i think its a routine follow up

still not sure what anal epithelium is
is it muscle ?

spud when did u realise you had not healed ?

what sort of things does a physio do for your bum ?
i cant imagine what kind of exercises you can do ?
also do you know anything about uv light treatment ?

spud happy bday to your dc 2moro xxx