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.

traceybath - I was almost that woman. I had fought for a C section when DD1 had not descended at all despite lots of upright active labouring. I was bullied into an instrumental birth, and even though I insisted that I didn't want an episiotomy, I was given a huge cut that went almost up to my cervix (and then they denied that they'd done it ). I was told afterwards that they had thought that the instrumental delivery would fail, so they had prep'd me for a C section. On the final push I managed to get her out. I was screwed up badly enough from that, I can't imagine how I'd have coped with a C section scar too. There was no follow-up, and I had dreadful problems getting anyone to take me seriously and refer me to anyone that could help. I really feel that these kind of postnatal problems are swept under the carpet.

I completely agree with Cote that this is the only body that I have and they almost screwed it up for good. I had extensive problems with the scarring, was in pain for months, and couldn't have sex at all. Bizarrely it was lucky that we are infertile, as it meant that I could conceive again without sex, and I was very lucky that a second delivery stretching the scar, and a sympathetic gynae with his cortisone injections have sorted me out to the extent that I'm functional again. I'm sure you can imagine my mental state during the pregnancy though. The fantastic gynae says that he is convinced that there are a lot of women that he could help, but who don't come forward for treatment as they're too embarrassed and feel that they are the only ones suffering.

I went for a c-section with number 3 purely because of realistic fear of tearing. Have no regrets.

all i would like to add to this thread, is an apology for making anyone feel bad or dismissed, patronised or angry by saying 3rd & 4th degree tears are rare/uncommon. i base that on the work i do and the stats i have seen and on my understanding. where i do my doulaing, 3rd& 4th degree tears are taken v seriously, incident forms have to be filled in and it is looked into. if hopsitals massage the figures as the OP says, and your personal experience bears the uncommoness out, then you can hardly be cross with people for saying it is uncommon/rare

Actually, I think that most (all?) of the anger on this thread is directed at rose-tinted antenatal classes and medical staff who are neglectful, dismissive, or who lie to women to improve their stats. I am very willing to believe that a doula sees a much lower number of bad tears as by definition that women will be well-supported during her delivery, and encouraged to push in a very controlled manner.

I guess I should just apologise for being a midwife.

i do do my best though honest.

God some of the stories on here are shocking!

Re: the caesarian thing, as I say with my second labour I was really pressured into having a caesarian, to the extent that a consultant appeared during the labour trying to persuade me to have one. The mw who went through my notes said it was because it was the only way that they could guarantee no tears. Which now makes me wonder whether that hospital had particularly high tearing rates that they were trying to bring down!

I tore both times. Of course it happens. How could people claim that it doesn't happen 'any more'. What has suddenly happened to prevent it happening 'any more'

It's totally bonkers that one woman would feel pressure to have a section and another be refused one.

Our trust have no issue with sections for prev perineal trauma - or vaginal deliveries either.

There have to be incident forms for all complicated tears as well. I think this should comfort us as service users, as it shows reflective practice and use of audit to track practice.

So what about a woman who'd had 6 stitches the first time?

I never thought to ask for a cs, but just indulge me for a moment TD, if I'd asked for one the 2nd time, on the basis of having torn and had 6 stitches, would I have got one?

Or, is 6 stitches not all that bad?

I was booked for a c-section as my fear of tears was a major issue. At 26 I already had stress incontinace and my consultant agreed to one. Anyway, DS was very early and very quick I ended up with an episiotomy and worse stress incontinace.

I will have a c-section next time!

What degree is an episiotomy?

Well, anyone can have a section. Maternal request for maternal preference is perfectly within the RCOG and NICEe guidelines.

On the basis of your perineal trauma I guess there are loads of ways at looking at it.

Your leg may not have fallen off, but it might have been enough to instil the fear in you - therefore your request would be perfectly understandable.

Your tear may have been small but complicated.

Your tear may have been nothing out of the day to day labour ward experience, but still been a pig to heal.

Just depends on the reality of it, and then how you interpret that reality.

In blunt black and white on paper, a tear that required 6 stitches is likely to heal well, and the perineal function should not be overly comprimised at the next delivery. But whoever said anything was black and white.

Does this make sense?

I am horrified about the bad treatment and follow-up so many of you have had. Sounds like the next thing the NCT should be lobbying about.

I have a friend who had a third degree tear and was refused a C-section with her second. And guess what, she tore again. Shocking. And yet all over the place labour is mismanaged and "unnecessary" C-sections cause women and babies trauma. She was gobsmacked they said no. She won't be having any more children.

I must be unusual in that I heard about these in detail in my late twenties. I was so appalled it put me off having a baby for a long, long time.

If I was 'allowed' a section why not your friend ThingOne? I thought that according to NICE, women should be given the choice?

I couldn't understand it at the time, tbh. We had our second babies in 2006, so not that long ago.

After a horrendous 1st delivery, I was very grateful for being able to discuss and research online, to find ways to avoid the trauma with next DC. This site really helped me, and I'm very grateful that so many people, including (and sometimes especially) Doulas, are prepared to be open and helpful in their own free time.

I had an unnecessary induction, was bullied into an epidural by a lazy midwife, ended up with huge episiotomy from forceps delivery, and horrendous perineal haematoma. I was relatively well educated on such matters, but had no idea how quickly decisions can be taken out of one's hands by a medical professional saying "but this will be safer for your baby."

For me the one of the joys of mumsnet is pregnant women being told it is okay (even positive!) to make choices that are right for them, have great support in run up to and during delivery, and fight for what we want and need during pregnancy. I'm sure for some women it might be helpful to read about stats for bad tears (such as if they run in family) but that bigger message about not believing everything a hcp tells you and standing up for yourself is the most important, imo.

And for those of you who are scared, I had DC2 and DC3 in very easy labours with only G&A (despite complications and another induction) where I didn't even graze and very much enjoyed the birth. I'm pregnant now and looking forward to the delivery - I never would have believed that was possible after my experience with DC1!

Its just terrible. Women should have the same choices wherever they live.

i had a third degree tear with extended episiotomy the first time, a short but deep tear second time which they said had been fixed with a running stitch, a tear but no stitches for number 3 and nothing for number 4

trying - in theory they do because of NICE. So yes they are guidelines, but there would need to be a strong clinical ground for countering them. The practice doesn't reflect this I realise.

I was intact for 1st, and tore for second who was smaller. Go figure!!

But I had an epidural for ist, and pushed very slowly and gently, whereas 2 was a heave ho type of thing as I couldn't control it.

GPs can be just as unsympathetic, when I went to mine to talk about sex hurting she just said 'yes, that'll be all the scar tissue, just have lots of sex and that will strech it and sort it all out'! Things did get much better in time but I was a bit taken aback with that as a solution.

I think it all depends on the position of the baby how tired you are and the help you get in hospital. I had a very traumatic first birth. Had 3/4 degree tear- owing to forceps delivery. I'm still not right after 10 years. (Drank RL tea for months too).I had second child 7 years after first and docs recommended CS. I went through with normal V delivery and had 2nd degree tear. The midwifes on my second birth were fantastic and held down my perineum when i pushed so I didn't tear into my anus again. It worked. However I tore upwards. I have 2 beautiful children so no regrets. Funny thing is they say you follow your mother. Mine never even had a stitch on 3 kids! I sympathise with you EBD.

I sympathise with you hedgiemum. I know how you have felt. I felt I was not in control and bullied during my first time in hospital. I take my hat off to you with DC4- happy pregnancy.X

My third degree tear was at a home birth should have been transferred to hospital after the birth but wasn't and wasn't told how bad the damage was. I was left to find that out myself in the weeks following the birth.

I've only had PND following 1 birth and that was it. I resisted agreeing to a c section for next child as I am hippy dippy home birth Mum but the words 'colostomy bag' convinced me and that was my nicest birth so far.

my gosh angrypixie - what happened to your MW?

I have no idea - nothing as far as I know. It was never 'reported'

That's what happens with so many bad births. We are not up to reporting and complaining and so many MW/docs get away with it. I know ther are many good mw/docs about so i am not targetting the whole population. I felt I should have made more of my 1st birth and when due to give birth second time, they couldn't find my notes! suprise suprise. i know it was few years later but no record of details at all.