to be pissed off at hearing how "third and fourth degree tears" are rare by people on here, mainly doulas.

[ebd]

I had a third degree tear with my second ds and have since found out that third/fourth degree tears are actually more common than people realise. I know 5 people in real life who suffered serious tearing (out of an antenatal class of 14)and my midwife and health visitor tell me they see women with these type of injuries on a regular basis. My consultant even specialise in repairing women who've experienced this. So when I read on childbirth threads that third/fourth degree tears are "not very common" it gets my blood boiling. It is common for posters with no medical experience to make this sweeping statment and although I will get flamed for saying this, it is mainly doulas who quote this to women worried about tearing or women who have had a third degree tear and are worried about it happening again. There is one poster who is a doula who just quotes the "it's very rare" line all the time". It really pisses me off. I wish these type of tears were rare but they're not. One consultant gynae friend told me that often hospitals will "massage" the figures and say a woman has had a second degree tear rather than a third as if lots of third degree tears are reported, doctors can be investigated. I know mumsnet has a disclaimer that they haven't checked the medical qualifications of anyone posting, but I think posters with no medical knowledge shouldn't be spouting claims which are factually incorrect.

OP I think YABU for singling this out. Women should be much better informed about this and many other aspects of labour. Too many go into it unprepared and ill-informed of their rights and good labouring practice.

In truth, a well informed, well supported woman is LESS likely to tear, so YANBU about feeling that women should be aware of the risks, but tearing is not something that happens in isolation from the birth experience.

Doulas help to increase the chances of an optimal birth outcome (which SHOULD be a 'normal' outcome) and in these circumstances a bad tear IS rare.

mooma My DH held the torch while I was stitched.

I was lead midwife in a perineal trauma clinic. The vast vast vast majority of problems regarding healing of 3-4 degree tears or delayed healing of any perineal trauma were attributable to instramental delivery and infection. The placement of sutures and poor diet also figured in our opinions - but was not possible to research this without a huge trial.

No stats but the consultant is collecting as we speak.

btw - that was all in our opinion. Not proven or nationwide. It was just what we saw.

Ebd, I think yanbu when it comes to women being given a rose tinted view of birth. I swotted up on everything as i knew my mum had had awful births with me and my sister. Personally i prefered to know the gory details in advance, it made me feel better prepared. FWIW I had an em cs in the end but I had read up on them too.

mamalino the blokes were sent to the pub during that part of out class too . But our teacher did speak to them seperately.

The 9% figure seems to be taken out of context.
If you read the professional guidelines that the patient information leaflet is derived from, the overall risk of a third degree tear is 1%.

The 9% figure comes from this sentance "Severe perineal tears that involve the anal sphincter complex and/or the anal epithelium (obstetric anal sphincter injury) are identified in 0.6?9.0% of vaginal deliveries where mediolateral episiotomy is performed."
Which doesnt read to me like a 9% risk for everyone.

Also, there were some posts earlier on about where these tears should be repaired. The RCOG says "Repair of third- and fourth-degree tears should be conducted in an operating theatre, under regional or general anaesthesia."

RCOG

Maybe I have misunderstood but if midwifes are at risk of losing their jobs due to a mis-managed birth then I'd guess they don't fully report the correct figure of women who do have a bad tear. I suspect its easily covered up and the true numbers aren't reported, its still a minority but even so those women will be really suffering.

watchtheworldcomealivetonight - fair enough. didn't realise you had a really crap time. sorry to hear of it. giving birth is meant to be such a 'great experience' - pity some of us seemed to have missed that bit out.

I had a 3rd degree tear and many, many stitches, but DS2 was first "natural" birth as DS1 was elective caesarian which DS2 should have been in heinsight. However, he was in distress and he had to come out - quick! I always think of the surgeon with gratitude although it wasn't much fun at the time. Never really thought about it much, just one of those things. Have a friend who is pregnant atm and I certainly wouldn't go into gory details. What's the point? It may never happen. The other thing no-one mentioned to me was piles! I thought something terrible had happened to me.

Watchtheworld.. good on you for being honest about your experience. I think a lot of people want to just get out and forget about it. When i went back to hospital to have dd2, the MW i had told me she had used me as a case study of how not to treat patients who have had a traumatic birth! My stay in hospital was horrendous and I discharged myself after 3 days, despite dd1 not feeding properly, and then went home with an infection and thrush. I do think that there should definately be more help after having a tear, I was pretty much given an enormous dose of lactulose and left on my own!

watchthewprld. you midwife sounds like mine. I nkow she was hauled up. I also know that about 2 yrs later, after she had her first baby, she ended up in counseling at the same place i was. with the same fecking counsellor.

I was offered the chance to talk to her, but it never happened.

Informed or not i see how it can go wrong anyway, that it something I have to hang on to. Yet Iam the sort of person who goes into detail about everything, wether buying a suitcase or a tyre, i wish i had been more thorough and looked online. I just bought stupid maternity books.
I remember thinking, 'my god, why didn't anyone TELL me this sort of thing can happen'
I would have been more proactive in my labour too, but had severe SPD and could barely support my weight standing. Sqautting and such was out of the question.

7 yrs on and I still think about it with horror.

hazey thats very . it's a disgrace.

I remember being in the bath after labour, i could not get out, dh had gone off with the baby to another part of the delivery suite. I begged the midwife to help me, as i was exhausted, shocked, and with many many stitches, but she just shrugged and said 'no, you can do it', and left me there. I had infections too, and thrush.

I remember the district midwife coming to visit me and looking at me, and she started crying.

Agree with ebd -had 4th degree tear with dd1 = first child. Surprised that this could happen - suprised that bad 2nd/ or 3/ 4th degee tears seem to happen to so many

I know the thread has moved on a little from the op

but i just wanted to say that I think that things like this are Uncommon, a figure of 8-9% has been stated.

If you look on the threads dedicated to any subject on MN - from sphincter injury - to Stately homes - domestic violence etc - it could appear that these things were commonplace - what it is infact is not commonplace which is why the need to discuss with other people who have been through the same experience.

I tore with both labours, I don't know to what degree, I just know that in the near future I will almost definately need surgery to fix things. I am not sure who has said that they are rare or don't happen but I am not sure what is to be gained by being so cross about it.

The number of 3rd and 4th degree tears is bwtween 0.5% and 2.5%. Quoted from "Are Third Degre Tears Unavoidable, The Role Of the M/w. British Journal of Midwifery, Vol. 14, Iss. 4, 05 Apr 2006, pp 212

As a m/w I've only seen one 4th degree tear (in a woman I've been looking after), and 2x 3rd degree tears.

As a unit overall I think our 3rd degree tear rate is about 1% and 4th degree (much)less than that.

tigger - This sentence that comes right after the one you pasted in the same report looks quite relevant to me:

"However, since the introduction of endoanal ultrasound, sonographic abnormalities of the anal sphincter anatomy has been identified in up to 36% of women after vaginal delivery, in prospective studies."

And report says 9% risk in women who have had mediolateral episiotomies, because it actually recommends mediolateral episiotomies for prevention of 3rd & 4th degree tears. I assume overall rate would then be higher in women who have not had mediolateral episiotomies - i.e. cut away from the anus.

"I am not sure what is to be gained by being so cross about it"

Let's see:

OP has had a car accident. She is trying to talk about it, but is shouted down with cries of "Don't scare others, it's very rare for cars to have accidents".

Yet there is something to be gained from this conversation - if others are better informed about these accidents, they would be more likely to use seat belts, or go slower, or get insurance.

I do understand why OP is "cross" about it. It's not enough that she has suffered horrible pain but then isn't allowed to warn others or talk about her experience. It happened to me too, and yes, it is quite incredibly annoying.

3rd degree tear here for my first child

Anecdotally i know one person who had a 4th degree tear and has i believed taken action against the hospital for a mis-managed labour. She ended up having surgery several times to try and repair the damage and was extremely traumatised.

Do know 3 or 4 others who have had third degree tears including my mother and my sister. Sister then went on to have an elective which she found far easier to recover from.

Interestingly when discussing birth options with my gp he told me 4th degree tears didn't exist - umm - i beg to differ.

So from my experience/friends they're not that unusual.

Oh and personally i never get this 'lets not talk about what can go wrong' regarding childbirth.

I like to know as much info - good and bad as possible.

Also, people don't always talk about these things, even to their closest friends.

They might say "I tore, and it was quite painful" but not necessarily "I tore all the way through my bum hole".

So I am not surprised that we don't hear about 3rd and 4th degree tears often in RL.

The problem with the statistics that are being quoted are that they are not necessarily reliable. I have already said that some midwives/doctors try and conceal the extent of women who have suffered third/fourth degree tears. This is because they fear investigation and it "ruins" their statistics. My maternity ward has (shockingly) a good reputation and yet I know lots of women who went in perfectly healthy and came out with a third degree tear. It's obvious just from the replies on this thread that lots and lots of women have had third degree tears and it is by no means rare.

As to the "I am not sure what is to be gained by being so cross about it" post well . Obviously this poster has never suffered from childbirth complications, if she had and knew what if was like to be suffering in agony while trying to look after a newborn, all the time with the threat of double incontinence hanging over her, she might be more sympathetic.

I had a 3rd degree tear also so obviously I don't think they are rare .

At the time I was just told oh that looks quite bad,we need to call a doctor and was then stitched in theatre.I didn't know what degree tear it was until later and wasn't informed about the implications - or would have insisted someone of a more senior level than a supervised SHO did the repair .

I still have no idea why I tore so badly as it was not a first delivery and was non instrumental.I suspect the student midwife mismanaged mine as she was still telling me to push hard when the baby was coming out.

I do think some advice on the risks in vaginal delivery should be given to pregnant women so there is some understanding if it does happen.You certainly hear about c -section risks.

There is a small but real risk of anal incontinence with a 3rd/4th degree tear and you should be told the degree of tear at delivery and later what to possibly expect, particularly long term.You should be followed up for incontinence and receive specialist women's health physio yet these are both things I had to initiate myself rather than automatically from the hospital.

I also think you don't often hear about other women as most women with tears into their back passage and anal incontinence don't easily talk about it at post natal meet ups.

I think if you've been there you do feel quite strongly about this like ebd.Can you tell I'm still .

I had a 3rd degree tear after episiotomy. I didn't know at the time as no-one told me and I was unaware of degrees of tear anyway. I only worked out a lot later that it had been a 3rd degree tear and had this confirmed at later antenatal appts.

I'm glad that I didn't know anything about degree of tears at the time as I just assumed that's what sometimes happened when a woman had a baby. I didn't think it was anything to worry about and expected that it would heal and be okay. Fortunately for me it did. I realise now that some women are not so fortunate. As I didnt' have problems and I had been unaware of the possible complications of it I was completely untraumatised by the whole thing. This worked in my favour and although I had an episiotomy for my second baby, I never tore again on any of my subsequent babies.