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.

Fencingpost - you absolutely should at very least have had a 6 to 12 week follow up with an obs, and at best a 6 to 12 week routine follow up with a clinician specialising in this area.

Absolutely.

We did that as a matter of course where a 3/4 degree tear has occured. Or for any tear you think would benefit from a good check over, so maybe not 3rd degree but complicated, or from a referral for a perfectly straight forward tear that isn't healing well. Anything.
lots of people don't come which I took to be a good sign they feel it is not needed.

I personally know 3 women who have had third degree tears, one of whom will not have another baby for fear of it happening again

I had a second degree tear with DD1 caused by compound presentation (hand by face), not even a graze with DD2 and she was my heaviest baby, second degree tear with DD3 probably die to the speed at which she was born, stitches first time none the last time as it was a straight tear, hurt like hell though.

Totally agree with ebd. I joined MN when pregnant and found the doula input in the childbirth section very unhelpful, especially on subjects such as tears of which I have had during two births as my babies have DH's huge heads compared with my petite frame. No amount of antenatal exercises/massages or positive thoughts would have changed this physical mismatch. Although some people will say it's not relevant, I watched a documentary about a country in Africa recently, where they have virtually no access to hospitals for births, and the tear rate is horrific. The damage to the women (not helped by the fact that many were young teens) was horrific.

Can I link in my charity of choice. If I die rich this is where it's going.

I put a poster up in our area for their recent campaign that went like this - but I had to take it down as people found it upsetting. So don't link in if you wouldn't like to.

'she walked for 3 days after labouring for 4 days. There will be no baby, but the health centre may save her. There is faeces leaking from her already, and so she will not be allowed back to the village. Her husband will be made to disown her, and she is 12'

It's to try educate local care givers to try avoid fistula. I always try to locate a place to mention them
www.endfistula.org/sudan.htm

Hope you don't mind but this is my charity - I think they are amazing

I had a 3rd degree tear which then got infected, it took me months to recover. I've also had a 2nd degree which felt like nothing in comparison. I wouldn't say it was rare because I have a few friends who've also had 3rd degree.

If everyone was told about 3rd and 4th degree tears when pregnant I think most people would be clammering for an elective c-section. To be told they're rare is reassuring if not exactly true.

I had a lot of aftercare when I had the 3rd degree tear which helped. Plus a senior midwife at my DS2's birth to make sure it didn't happen again. And when I decide not to have any more children I'll probably need a procedure (Fentons I think it's called) to properly repair everything down below.

No point getting angry about it though. If we were given every bit of information about giving birth most of us wouldn't have children in the first place. Giving birth to a healthy baby was more important in my view.

well said, fencing post. it's people who haven't suffered a 3rd or 4th degree tear who don't understand how hard it is after you have given birth.

I remember struggling at home with this little person we brought home from the hospital, but I was struggling to walk and to use the toilet so my mind wasn't all on my baby's needs. I needed a lot of help from DH and family, and I believe the tear contributed to me feeling low in mood. It was horrendous. Having a tear really spoiled my experience of giving birth. I wouldn't wish it on my worst enemy.

I have been completely talked around by this thread.

But now find myself wondering what to do when you know the risks. I know there is advice to do perineal massage, active labour, water births, best birth positions etc, and as prepared as I was, these all flew out of the window with dd1 and 2 and both times I ended up flat on my back with wires, catheters and drips. In the same way I had been warned about breastfeeding problems (not enough IMHO), but still found them inconquerable (partly through appalling support after 3rd degree tear).

From the stories on here it seems that a lot of the failings are with the maternity services in many hospitals, and I don't know when things will change there.

It depresses me to hear that Swindon (my local now) is planning a MW led birth centre, because great as these are in themselves (I started both labours in one), as soon as anything veers from the perfect birth plan, you are whisked off to the labour ward, and all the lovely birth centre facilities are another universe away.

sweetkitty, I also understand where your friend is coming from on being put off having more kids after tearing during the birth of the first child. I'm unsure of going through it all again, but part of me wants to have another, if that makes sense!

After my third degree tear I went back to the hospital 7 weeks afterwards for a checkup. I assumed I'd see a consultant or the surgeon who "repaired" me. Unfortunately for me I saw a very junior doctor who stuck her hand up me, declared I was healed and sent me on my way, despite me telling her I was crippled up in pain and didn't feel right. Went back to my gp who told me that because the tear was so severe it would take months to heal. Eventually had to pay to see another consultant who removed the extensive scar tissue that the junior doctor had missed. Didn't ever have any physiotherapy, scans or ultrasounds to check everything was OK. I think my care was appalling.

ebd, I was given a check up at around 6 wks too, and was told besides the bit of scar tissue, that everything was fine and to just carry on with the pelvic floor exercises. i'll be honest i tried them a few times when i was in hospital after the birth, but haven't done any since.
I was told that they could operate and remove the scar tissue if it was affecting my love life (ha! like there's much of one anyway!) but we just use different positions to avoid me any discomfort on the rare occasion we do it. I just don't want to go into surgery, it was traumatic enough after the birth, and I don't see the point of going through it all again. I'd be frightened they'd make things even worse down below. That's my real fear.

Perhaps 3rd and 4th degree tears are more common amongst your friends and aquaintances because you have very poor midwifery and obstetric care in your area?

I agree, there has to be more to help those who tear badly (as in 3rd and 4th degree tears), there's lack of support as it is. Thank goodness for forums like this where we can all talk frankly about our experiences of this. We don't have to feel alone.
I feel I've still got unanswered questions lingering after the birth of DS in regards to the tearing. We all deserve answers. Let's hope things change over the next few years.

Ahkeckit I found out I was pregnant with dd2 when dd1 was 5 months old, and was terrified! After having dd1 I said that was it, i couldn't go through that again (on top of the fact that we had been trying for 7 years to have dd1)

I was pressured throughout to have a caesarian (the only way that they can be sure of no tears), but despite horrendous 1st labour, was even more scared of a caesarian.

I found a MW who I trusted from dd1's labour and sat down with her for an hour going through my notes and talking about what went wrong. She didn't give me any guarantees, but she did take away some of the fear. Dd2's labour was utterly different from dd1s and despite having problems of it's own, not half as terrifying, because of what i had been through with dd1 IYSWIM.

On the other hand a friend that suffered a 3rd degree tear chose to have an elective caesarian for her 2nd labour, because of fears for another tear and continence issues, and she had a very positive experience with that.

Sorry I cross posted with you Ahfeckit, you should be able to go through your notes with someone, I think everyone has access to their own notes.

'If everyone was told about 3rd and 4th degree tears when pregnant I think most people would be clammering for an elective c-section. To be told they're rare is reassuring if not exactly true'.

That is unbelievably patronizing

We are all adults here. And these are the only bodies we have. We should have correct information and be allowed to make a choice for ourselves.

There are apparently factors that increase the likelihood of a 3rd & 4th degree tear - big baby (over 4 kgs) and induction of labour, for example (from that RCOG link). So perhaps it is a perfectly rational decision for women carrying big babies and needing to be induced to ask for a c-section!

This was my case when pregnant with DD, incidentally. Late scan showed she would be 4 kgs, and I had to be induced for medical reasons at 39 weeks. As recommended by RCOG, I was given a huge mediolateral episiotomy, whose pain and anguish caused me to completely miss the first weeks of DD's life, not to mention plunge me in despair for months afterwards, not knowing if I would ever be ok down there.

Apparently, it was a known fact from the second I was induced that I would have a huge episiotomy. How exactly is it ok that they withheld this information from me?!? Why were my fears ridiculed and my demand for a c-section overruled because "it was going to be just fine"!?!

thanks hazeyjane - you have given me a bit hope there! you must have been really apprehensive but in the end everything has worked out well. I suppose it was good that you got both labours out the way quite quickly, close to one another. Means you didn't have to think about it too much. I do and don't want to have another, I'm just scared of it happening all over again. But there's hope if others have done it without tearing, and you're right, there's no guarantee that it would happen again.

ahfeckit - if you ever feel able or can go there, there is a consultant out there somewhere who can take all your fears on board and help you. I know this. It's just finding the slippery buggars!

Thats if you ever want to, you may in fact be fine. Nothing worse than bloody mning do-gooders, sorry!

Cote - i wonder how much of the decision is financial.

C-sections cost more than an episiotomy so my cynical head wonders if thats part of the decision making process. In the UK pct's seem to be under a lot of pressure to get the c-section rate down too.

I was very lucky with ds1 - was taken to theatre ready for ventouse/forceps but consultant examined me again and just said its not going to happen lets go straight to c-section.

Opposite me on the post-natal ward was a lady who'd had failed forceps with episiotomy and then c-section - i felt very sorry for her.

CoteDAzur, that's shocking that you went through all that and was told 'everything will be just fine'. It reminds me that after my tear, the MW was insistent 'no it's a 2nd degree tear, but i'll get Sister to have a look at it..wait a min'. I said to her that it was worse than a 3rd degree tear and she wondered why I wouldn't let her catheterise me, even with local anaethestic!! It was so bloody painful and she just wasn't getting it atall... Turns out I was right and she was wrong, so I ended up going under a spinal to get the 3rd degree tear repaired. Geez, do they not listen to us. We may not be experts in midwifery but we do know what's painful and what isn't. The MW also said to me - 'I think this is all psychosomatic' - in regards to me not letting her near me to catheterise. Hmm I wonder?! She wasn't taking my pain seriously. So I know what you mean when it's like no one is listening to you even when you feel like screaming from the rooftops.

This is very interesting and a valid OP I think

I can QUITE believe that the 8% figure is under-estimated. For both of my births my gynae would say my tear was one degree worse than the midwife reported it . I think it is possible that a midwife IS more likely to 'underestimate' a tear because it is thought to reflect on how she managed the birth. AND of course, there is generally NO FOLLOW UP. Which I think is really wrong.

I think tearing IS shoved under the carpet and women should be educated about it in antenatal classes. I don't see the POINT of breathing exercises!!!!! But who has ever sat through an hour's antenatal class about tearing and the fallout (no pun intended) from that? No one really admits that tearing is NORMAL.

sorry, meant to type 'I said to her that it was worse than 2nd degree tear'.

traceybath - I've a friend who suffered a fourth degree tear with her first child and was turned down for a c-section with her second!

She is a doctor though so insisted and got it in the end.

I don't know how a midwife could sit there and tell her she could not have a section after what she went through.

I think you are right - they are under pressure to get the ceasarean rate down.

They could start by making sure women are properly supported in labour.

Oh and while we are talking about exploding arses, I tore from the inside out through my anus - a birth-related anal fissure which apparently happens in 11% of births. There was NO information that I could find about it! A massive fecking rip from the inside out is no fun either, I can tell you. Took about 18 months to heal.

We should not be scared to talk about these things!

p.s. I did lolol at swedes severed legs

I'm carrying an even bigger baby this time and got my c-section date.