3rd degree tear and retained placenta - chances of repeat?

[spub]

Dear all,
Have just found out that I'm pregnant - due Jan '06. Am delighted! However, I gave birth in Jan '03 and had a retained placenta (adhesion to the wall of my uterus - I think) and a 3rd degree tear. As it happened, the retained placenta meant that I had to have a spinal block and go to theatre (having just delivered my dd with only gas and air..) and whilst in theatre they also did the repair work due to the tear. I was catheterised and not allowed out of bed for the first 2 days and was kept in for 5 days. I was in quite a lot of discomfort and on heavy painkillers as well as the fabulous combo of lactulose (so as not to be constipated,strain and tear the stitches) and iron (which makes you hugely constipated but which I needed because I was anaemic )

I'd prefer a vaginal delivery again but am a bit worried that one or both of these things could recur and wondered if anyone could offer some advice?
My main concern is not so much another trip to theatre to remove a placenta but the risk of faecal incontinence that accompanies a 3rd degree tear (and that fortunately hasn't come about due to the tear in Jan '03).
The thought of me and a baby in matching nappies is a bit scary...Help!

[gallileo]

After having my first DS by emergency CS I opted for VBAC with DS2. I also suffered a 3rd degree tear. It all got fixed up OK and I haven't been left incontinent, thank goodness. However my recovery from this compared to my recovery from the c/s has been so slow. I have abandoned any hope of ever feeling 'normal' down there TBH, although I don't have any pain. Based on this if I was pg again I would not hesitate to have a c/s. Just my opinion of course and lots of things to consider. Good luck whatever you decide

[Flossam]

gallileo, don't mean to sound patronising at all, but do you do pelvic floor exercises frequently. I do when I remember and I find that it really does make things feel better. I only had 2nd degree though. No real advice Spub, every birth is so different. I doubt it is likely that you would be unlucky enough to have retained placenta twice, but tearing depends on many things, not least how your birth is managed. Good luck, and hopefully mears will make it here to help you.

[gallileo]

Flossam, for the first few months I must admit I didn't do the pf's, but recently have started big time and yes it really has helped. I just can't help comparing the recovery though to that after the c/s and I wish I had opted for c/s again. I really liked the fact that my bits and pieces were as good as new after and have found the whole 3rd degree tear experience very depressing, although it didn't hit me until 6 months post natal. It was also a very traumatic birth though, probably doesn't help

[Flossam]

Poor you. I am told by DP that I don't look or feel any different down there. I hope you PF exercises continue to help you, how long ago did you give birth?

[spub]

Good to know I'm not the only one who finds this all hard to get their head around!
Thanks for the input to date - sorry you guys can only advise 'cos you've had this happen to you, too!
Maybe Mears or one of the other fab midwives will be able to offer some more info?

[gallileo]

DS2 is seven months old. DH also says all feels the same and looks the same to him but that is without glasses on. The feeling I have is kind of a stiffness or numbness, gets worse by end of day or when tired. I think it is caused by inflexiblity of scar tissue? The pf exercises and perineal massge have helped and some friends have given me hope that this feeling may disappear by about 12 months. Spub I do feel for you because I found it so hard to make the decision last time. If only we could have crystal balls. Another friend of mine who suffered a third degree tear first time when for an elective episiotomy second time around and was just fine

[spub]

Gallileo,
My dd was born in Jan '03 and I also had the numbness, aching and throbbing. It does go away - honest. Mine lasted almost a year, though - not helped by my dd being nearly nine pounds and coming out with a hand up at her face and literally adding insult to injury.
I was a bit of a mess and it still doesn't look too pretty "down there" but then it was never that gorgeous to begin with and I'm usually selective about who sees it!
It's so hard thinking about all of this stuff but I want to be well informed when I do decide.

[gallileo]

Spub- thanks for that, has made me feel better. Feel bad now though we are supposed to be helping you!!! Hopefully someone will come up with statistics of whether your complications are likely to happen again. A consultant did once give me some advice though when I was trying to decide whether to have an amniocentesis. He said to try and consider what would be the worst thing that could happen, in that case would it be to have a disabled child or to possibly lose a healthy one? - so not easy!. In your case I guess the worst case would be faecal incontinence, you have to try and put that up against the downsides of a c/s.

[almostanangel]

hi hun CONGRATULATIONS!! i had retained placenta with my 2nd dd,so i can understand your worries but i did not have it with dd1 or 3 so hopefully you should be ok but maybe mention it to youer gp or midwife to put your mind a little more to rest ,my midwife was very careful when she examined my dd3 placenta just to be on the safe side ,,

[SoupDragon]

I can't believe how often I've discussed my nether regions on the internet but here we go

DS1 was a 10lb ventouse delivery resulting in an episiotomy and a 3rd degree tear and I had a good long time in theatre under spinal block having the repair work. 10 weeks or so after the birth I had a delightful ultrasound scan to check the repair (and no, I didn't get to take a picture home with me!) and everything was fine and the consultant told me there was no reason for me not to have another vaginal delivery. Obviously I laughed at him and said there was no way I was having any more children.

Fast forward 2 years and DS2's arrival 2 weeks early and 2lbs lighter (bless him). I had written in my birth plan that I wanted an episiotomy should the tear look vulnerable - it did, I had an episiotomy and all was fine.

I healed well after both births with no residual , "problems".

[spub]

Bumping for a midwife!
No offence to the rest of you and thanks to Soupy and almostanangel for their messages, too!

[SoupDragon]

hrumph. My tear not good enough for you eh?

[spub]

Soupy,
It sounds like your tear and my tear could go down the pub together and have an intimate conversation for HOURS!!!
I didn't get the ultrasound that you did and in fact after the first few weeks when the community midwives were doing their "wound management" in my house with me, no one looked at it and my consultant never saw it after I was discharged from hospital! I had a smear test a few weeks ago and was bricking it in case the nurse told me that I was deformed......
Thankfully, it all held together during the test. I'm just trying to find out my options and an episiotomy like the you had might be a good idea!

[Azure]

I had a 3rd degree tear giving birth to DS and 4 years later am due at the end of August. I discussed the forthcoming birth with a doctor at the hospital, who said that there was no reason a tear should happen again with a vaginal birth. I can't quite believe that I wouldn't be more susceptible the second time around and for that reason am seriously thinking about a c-section. I am also interested to hear what others have to say.

[SoupDragon]

I'm sure Mears the Midwife will be along eventually

The u/s scan wasn't one of my more pleasant experiences! The consultant insisted on showing me the pictures on screen and pointing out the line of the repair! Your GP may be able to help you with information or your consultant if you get to see one.

Azure, I would imagine you are more susceptible second time round but it all depends on the strength of the scar I guess.

[Sonnet]

Spub - I havn't read all this thread but your initial post could have been me with DD1 - absolutly identical!
I then went on to have DD2 3 yrs later - I had a vaginal birth, no tears therefore no stiches, and no retained palcenta!! - so it can be done!
Good luck - it is such a fab feeling when the placenta appears.
I alos had a heamorage when intheatre and a blood transfusion 2 days later. This time the midwives and a surgeon wereon standby should it happen again!

[bundle]

[Franniban]

I had a 3rd degree tear with my first, 17 months ago, I'm due in 4 weeks and I am worried about tearing again. I spoke to my midwife about it and she said that there is more chance of tearing again with scar tissue, but that the midwife will make sure that you deliver very slowly to avoid tearing again. Hadn't thought about an elective episiotomy, but shall definately put this in my birth plan. I had thought about an CS, but decided that not being about to pick up ds and the new one for 6 weeks was not ideal.

[muppety]

I think consultants have differing opinions on this. 2 of my friends were both advised to go for sections after 3rd degree tears.I think it depends on your attitude to risk of it happening again. No personal experience though.

I have just had el c section for second baby and feeling really fed up that did not manage normal delivery. Reading this thread though I realize normal deiveries aren't always easy.

[spub]

Cheers, all.
Hope all goes well for you Franniban! Do let us know!
Maybe a Mears or another midwife will pop on and give us some feedback in a professional capacity.

[spub]

Sonnet - Did you have the syntometrine injection first or second time? I ask because I'm wondering if you experienced a different outcome that was related to that or whether you just had a far better time 2nd time around!

Dinosaur - can you tell me more about the physiological third stage??

[mears]

Hi all,

IME, women can deliver normally after 3rd degree tear with no stitches at all. If there is any sign of a tear starting then an elective episiotomy can be performed to divert it. There are actually more third degree tear associated with episiotomy than there are with spontaneous tears. Mainly due to the fact that episiotomies are usually performed with difficult deliveries like forceps or ventouse. I personally have not seen a recurrence of a third degree tear.

Retained placentas are ofetn the result of having syntometrine to manage the third stage. The ergometrine component of the injection can cause the cervix to close and trap the placenta. If you have a drug free labour then there is no reason not to have a physiological 3rd stage where the placenta delivers naturally. If however you have injected pain relief or the cord needs cut early for any reason the third stage can be managed with syntocinon which is the other component of syntometrine.

Unfortunately I need to go just now but if you do a search you will get lots of info on physiological third stage.

[spub]

Thanks, Mears.
Can I ask - if the placenta had actually adhered to the wall of my uterus (basically got stuck to me - I'm crap at biology stuff so forgive any massive stupidity)would the syntometrine have made any difference?
I understand that it can close off the lower bits and so effectively prevent the placenta coming away but is that still the case if the placenta is stuck anyway?
Sorry, clumsily put. Hope you get mu gist!
Thanks.