to be sick to death of getting conflicting information from these 'heath care proffesionals?'

[Gillyan]

MIDWIVES, CONSULTANTS, ANESTHETISTS! Getting really sick of all the conflicting information I'm being given. None of them seem to know what they are on about.

Saw MW yesterday and was chatting to her about birth options as I have STILL not made my mind up what to do. (I'm 32wks)

For those few souls on here that haven't heard me whinging on - I had a 3rd degree tear last time for no apparent reason, I am booked in for a section this time at my choice but still don't know if I even want it.

So far..

One MW said she would recommend an elective episiotomy to avoid a tear going into my bum and not to birth in water as it makes your tissue more likely to tear.

Consultant said - NO WAY for episiotomy as I would be more likely to tear and he suggested a water birth or happy for me to have a section.

Anaesthetist said, as it took 9 times to get the spinal in last time it would be better to have a General for the section.

When they were trying to get the spinal in I had just given birth, was bleeding everywhere and totally distressed and begged them to knock me out and was told it would be better for me to be awake.

Now I am being told it will be perfectly fine to be knocked out while still pregnant!!

He said they would try the spinal as often as I could bare

MW yesterday said they are only allowed to try 3 times and thats it??????

When I asked one MW what happens if I go into labour before the section date she said we just examine you to see how far on you are then if you change your mind and want to give birth thats fine or we just whisk you in for the section.

MW yesterday said NO WAY that will happen, she said if you go into labour before your section date they won't give you a section without a medical reason - to which I relpied, erm..what about the reason I am terrified about ending up with a colostomy bag and the consultants have already agreed I have every right and reason to have one???? She said not. Section is booked for 39 wks and I had DD at 37 so now scared I'll go into labour and my choice will be taken away from me.

WHO do I believe, getting so so fed up of this. I really don't know what to do. I spent all afternoon crying yesterday.

The only thing I can do is to go for it and just hope I don't tear as badly again. Thats it, 'hope' or maybe give birth in water...if the pool is free..if my labour is safe to do so.

Otherwise I go for the section ( if I make it to the day ) and risk having to have a general anaesthetic as they had problems getting the spinal in last time when I needed to be put back together.

What do you reckon?

And I did start a thread asking about anyone who had a bad tear last time, what happened second time but didn't get too many replies so would be very intersetd to hear your stories

Can you write it all down as you have done here and show your MW? It does look pretty ridiculous with so much conflicting advice that you have been given.

Sorry, no advice on the tear, I had c-sections with both of mine.

Yes good idea

I have just re-read the thread I started about bad tears and I did actually have lots of replies - I take it back.

I didn't tear so have no experience of what your going through but I felt so bad for you to have all this stress and uncertainty at such a late stage of your pg. I am 32 weeks with dc2 as well the only advice I can give is regarding the general surely if you have an elective c section there is no hurry to get the epidural in and it will prob be easier as you won't be in pain providing you don't go into labor early. with regards to the mw and consultant I would insist the get together and discuss your options together so you can hear why they have such conflicting opinions. I would hazard a guess that the diffence in opinions is due to different agenda the mw being pro vb and the consultant being pro c section. Hope you manage to sort this out.

Can you ring the antenatal clinic at the hospital and ask for the supervisor of midwives to co-ordinate what's going on and sit down with you to make a birth plan.

northen Hi, I have done that and half the info above was form the supervisor of midwives!!! Have just been sat here thinking I might just have to ring her and arrange to see her again, she is lovely and spent 2 n half hrs with me at her suggestion I should add. She picked up on the fact I was very anxious and saw me at 20 wks.

She's the one that said my tear was half a cm away from leaving me with a colostomy bag and then went on to say she would recommend an elect episiotomy - I asked her about water birth as had heard it helps and she said she wouldn't recommend. She is also the one who said about what would happen if I went into labour before the section date.

Consultant was very nice but didn't have a lot of time - saw him for all of 10 mins and he said it was totally up to me, he suggested water birth but said it was my body and he would fully support a section

AARRGGGHHH??????

YANBU.
I agree with listenglisten.
Do you know, in retrospect, why you had such a large tear last time?
Can you get your MW, consultant and anaethetist together in the same room and work out a plan of action, or is this not possible?
If they have agreed to an elective c-section this time, why not go for that option at 39 weeks- I don't think they're allowed to do electives any earlier than that unless the baby or mother are at risk (and obviously they don't rate anal tearing as a "risk" - rightly or wrongly!). Then, if you do go into labour earlier, see how you feel at the time. If they are saying that you can choose the c-section at any point during labour, it sounds as though you acutally have quite a lot of choices, which is a good thing.
Re. spinal/GA - totally up to you, I would have thought. Go with your instinct. If they are saying a GA is safe, I would believe them.
Sorry, I have no experience of tearing but I did have an episiotomy with my first baby and they stitched me up waaaaaay too tight afterwards (gross, sorry) - I had to have physio and all kinds of stuff for about a year afterwards. So, whilst not the same as your situation, I can sympathise. Normally I am not particuarly pro- c-sections but in your case it sounds like the best option, whether or not you go into labour naturally first. It's quite normal to be undecided about what kind of delivery you want, all the way through the pregnancy ... what does your instinct tell you to do?
Sorry I can't be of more help though. Good luck with whatever you decide.

Sorry, x-posts there, hadn't seen your other 2 posts Gillyan

Yes totally agree about the different opinions slushy I am just doing my own head in about what to do.

Another thought. Ask the consultant what he would recommend if it was HIS wife.

Thanks mummydragin yes I've explained some of what you asked in crossed posts.

Reason for the tear - NONE! thats whats so annoying, I was fully dilated, controlled pushing, panted when head crowned, DD was 7.5, she came out the right way, there were no instruments involved, I was in an ok position etc etc, so I feel there is nothing I can do differently this time round.

Just worried about the section and recovery and any complications and I think I keep hanging on to the dream of anything less than a 3rd degree tear and being able to get out of that bloody hopsital ASAP. ( was in 6 days )

Oh I do feel for you!

I don't have a lot of advice having had three sections, one emergency and two elective for the simple reason that I was not going through all that malarky again. Actually if I were you I would have a section without hesitation, but as you can see I am a section fan

I'd feel a spreadsheet coming on. Question down the side, person you have asked along the top and the answers in the boxes. Then book another appointment and take it in with you and show them just how stupid you are finding it all.

As a gut instinct I would guess that consultants probably don't have a lot to do with water births, whereas midwives do, so I might be inclined to value a midwife's experience more re water births. (Consultants tend to get called in when there is trouble, by which time you've had to come out of the bath)

And IME consultants usually want you not to have sections - if he is being positive about it then that's a sign he thinks it's probably a good idea.

But you shouldn't have the likes of me guessing - you need to get back there and make them explain themselves.

Good luck

gillyan I had a planned cs for #3 after a vaginal birth (2nd degree tear) with #1 and emergency cs with #2. It was fab, completely different from the emergency one, I would recommend it to anyone. No pain after as pain relief adequate, just a bit stiff and feeble for a while after. OK the recovery not as quick compared to my vaginal birth but absolutely worth it. As #2 was 4 weeks premature and I was scared of going into birth naturally with #3 the mw assured me that I should come into hospital immediately if I do go into labour and they will do a cs there and then. I got all this on my birth notes. Oh yes and I was out of hospital in 3 days too!

balloonslayer I am a spreadsheet kinda gal! I do love to make lists! Thansk for the advice.

kiera thanks for your positive c/s story.

I'm almost starting to think I will just give birth at home with DP and sod them all off!

I am a very indecisive person but usually armed with the right info I am a good decision maker. I just cannot make up my mind and neither option seems tempting. There are pro's and con's for both.

Also, I am way more inclined to get advice of all the mumsnetters, who have actually had babies! All 3 midwives I have seen from my team don't even have kids and the consultant is a man! Although I must say a very sympathetic man and said to me, 'hey thats just my advice but I'm not the one who has to get the baby out, so I'm happy for the section too'

Anaesthetists tend not to want to give general anaesthetics for obstetric patients so if you've been offered one there must be a good reason.

Did you see the consultant anaesthetist? If you haven't ask to do so.

Be aware as well that different doctors will say different things too (as we are all people and have our own very slightly different 'take' on the world) so it is quite possible that when one person says you should go straight to GA another might have a really good attempt at siting a spinal (which on the whole we know to be safer). However an elective LSCS under GA is probably safer for organisation reasons than an 'emergency' operation.

If you were really keen to have a regional anaesthetic (spinal) and were prepared to cooperate given that it is likely to be difficult then the anaesthetist on the day (possibly not the one you saw in clinic as that is often the way cover works) may well be prepared to have a go. You would need to accept though that it might not work and you would end up being stabbed in the back AND having a GA.

God, you poor thing. I had lots of bad second degree tears and episiotomy with DS (but not third, so you have my utmost sympathy).

If I were you, I'd go for a section, and ask to be whipped into the theatre if you've gone into spontaneous labour before your section date.

Also, I'd push to have the C-section at 38 weeks, as opposed to 37 as this is what they were going to do for me if I went into spontaneous labour beforehand (like you, my previous DS was born at 37 weeks). Threaten not to leave the office if they go for 39.

For me it would not be worth the risk of a colostomy to go for the natural delivery, but obviously it's up to you.

I hope you have more luck.

OMG thats a lot of conflicting information.

All I can offer is personal experience (with a little bit of info from my nursing training)

1stly its ok to have a general when pregnant. I have to have an ovarian cyst removed as an emergency. DS1 is absolutely fine.

i had a tear and a cut with DS1. the tear healed quicker than the cut and it was a 3rd degree one.

With DS2 i had an elective due to a skull fracture when they delivered DS1. It was a spinal rather than a general and a lot more comfortable than the epidural i had with DS1. dont know if that was the calm of the theatre or because i knew how to sit (leaning forward to arch my back).

I agree with previous posts that: MW know more about waterbirths (consultants arent generally involved in them), MW are very anti c-sections but a consultant wont push you towards major surgery unless there is an indication for it. IME both as a nurse and a patient, i have always found anaesthetists to be knowledgeable and arent prepared to take unnecessary risks.

Could you not arrange a meeting with the consultant and the anaesthetist to discuss the c-section option?

In your place, I would have a c-section. If it took 9 tries for anesthetist to give you an epidural last time, have another person do it this time as he is clearly incompetent.

You can ask for it to be done at 38 weeks. Have steroid shots to mature baby's lungs if necessary.

re Episiotomy - You will not tear towards the anal sphincter if you have a mediolateral episiotomy (towards the side, at a 45 degree angle). Your consultant might be thinking of a median episiotomy (straight down towards the anus).

So a big episiotomy would actually prevent a tear. However I've had one of these, and if there is a worse pain that takes longer to go away in the world, I don't want to know about it.

So, my vote is for CS. With a better anesthetist.

Cote Your statement that nine attempts at a spinal = incompetence is offensive.

I don't know what you do for a living but I can tell you that a distressed women either in labour or immediatly post partum can prove to be 'anaesthetically' challenging. The stakes are very high for having a general anaesthetic in this time and in unsupported remote units multiple attempts may be made. This does not equal incompetence.

I failed to site an epidural in a patient repeatedly one night, my colleague failed too, the boss (v. v experienced obs anaesthetist) also failed. None of us is incompetent she just wasn't a very cooperative patient with tricky anatomy.

By not cooperative patient I assume you mean unable to sit still due to pain and hold the position?

Cos you know you'll get your ass whooped for that dearie .

It is unfair to assume incompetence because a procedure was difficult imo. Thats not to say it wasn't in this case, just that it is an assumption on limited evidence.

Doesn't help the op though - my advice is to listen to the expert in each field. A midwife does not have indepth knowledge of anaesthetics, nor does the anaesthetist of water births. Within midwifery, a practitioner performing waterbirths will have better insight than a cummunity practitioner who kicks ass at spotting dehydrated babies.

There are too many specialist areas for one person to be a one stop shop, and this leads to masses of conflicting info.

Also, there may be no right or wrong management. Just information, research, and the choice. The choice will always be yours, unless there is some immediate life threatening event, which is good - but also puts alot of responsibility and stress on you.

RE; 3rd degre tear. Some skin is more friable than others, it scars easily and heals slowly. Or You may have a perineal structure that lends its self to tearing, or both. Unforeseeable in many respects, and a plauge on women through the ages. I hope it is healed ok for you.

Only anecdotal but for my first vbac (dry land), I had second degree tear. For my second vbac (water) I had only a tiny graze. I've frequently been told by midwives and read that warm water softens tissues and makes you less likely to tear, so I'm a little confused as to why a mw says a waterbirth would make tearing more likely.

They used to lay hot wet towels against the perineum for this reason!

There is some research to suggest tearing can occur with more frequency in water, but please don't ask me the details cos it's late and I haven't a clue. It should be fairly easy to google up though. Also with standing I believe.

AS with all research however, it applies across the statistics and does not address the unique needs of an individual [the op]

I would also add there is research to say the oppposite!

From a quick google the opinion seems to be that water offers protection to the perineum, particulary in 1st timers. Occasional research throws up a slight increase in tendancy to tear, but to 2nd degree, with less episiotomies and 3rd degree tears.
How that is changed by a previous 3rd degree tear I cannot say, and I haven't bumped into any reasearch to help you out on this one

Sorry! I tried!

I am not trained in water birth either, so I can't give you much insight into the inn's and outs of management there.

Nice is always a good place to start when looking at birthing options, as it is very good at plainly expressing the reasons for chosen management. So for example, it cites that some research found being upright or on the side for delivery was associated with more 2nd degree tears, but overall research finds that simply adopting the most comfortable postion is best. nice labour guidelines

The other thing I would add is that if a person can come to a plan and have that put in place [say to cover the what if I labour before an elective sceanrio] and that is in the notes, then unless there is a will on all sides to change the plan on the day, that is the plan. Thereby removing the dreaded conflicting advice worry and giving a firmer footing to things.

Sorry to ramble, I just really feel for you. Hopefully you will be able to have some of the muddle cleared for you. Hth by the way

That's interesting, tree. I always took it as read and put it down to the same reasoning that tweezering your eyebrows is easier after a hot shower. (not very scientific! )

By the way, home birth isn't such a mad option. I went that way with my waterbirth very late in the pregnancy when I realised I wasn't going to get the support or birth I wanted in hospital here. Wouldn't regret a thing - much bigger baby than vbac1 too!