3rd degree tear and a restitch

[margherita76]

18 days ago I gave birth - assisted delivery, forceps, episiotomy and a 3rd degree tear. 5 days later the stitches came undone. I was given anti biotics and have been taking them since the birth. 10 days ago the registrar checked and said I should wait 10 days to see if it comes together - it hasn't. So whilst the tear is not infected it has come undone and the MW said I should go back to the hospital and get it restitched.

However, other advice has been to not get a restitch and to leave it to heal on its own.

I will do whatever the consultant says on Monday but I wondered if there is any advice from MN regarding the restitching as I am concerned about more pain ( I am not in much pain its just uncomfortable and horrible having a gaping hole down there) and also infection and so on.

I have been on other threads and had really good advice about keeping clean and baths but wondered if anyone has any advice specifically on getting a restitch v waiting for it to heal naturally.

thanks M

I'm so sorry to hear you've had a rough time margherita, I remember your posts about being overdue and can't believe your baby is already 18 days old! I didn't have the same problem as you but I had an episiotomy and my stitches came out when ds was 6 days old and it healed on its own. I had lots of baths with tea tree oil which was an absolute godsend! I found that after ds was born I was pretty much forgotten about, no one bothered to check so its good that you're having follow up appointments. Iirc Muslimah had a lot of problems with stitches and seems to know a lot about healing and restitching so hopefully she'll be along with some helpful advice soon. I hope you get it sorted soon xx

Hi Marjee

yes after all that worry about being overdue and induction I went into labour naturally and had a rather difficult time- but all that is behind me now- except for this bit! I just want to be OK and feel normal.

I have had such conflicting advice about baths- I think I was overdoing it but I have had a lot of good advice from Muslimah who suggested sloshing the area with salt baths amongst other things.
thanks for your reply Marjeex

I had the same, forceps with episiotomy, 3rd degree tear. Stitches didn't come undone though.

As it is such a bad tear I wouldn't have thought it was something that would heal on its own and I would much prefer that it was repaired.

Who told you to let it heal? Medics or other people?

hi there margherita

so sorry you're still unwell. hang in there it will get better

in terms of your question above, im surprised the midwife suggested a re stitch to you so early on, as my understanding is that they would never re stitch so early on, once its opened up they need to see if it will heal on its own, and also there is a risk of stitching up infected tissue (although theyycould just checkkfor this before they restitch so i don't fully understand this reason, but this is the reason given to me for not restitching so soon)).

so even if you do need to have a restitch eventually, there will still be a period of time prior to this surgery in which you can try to promote natural healing.

the thing to keep an eye on is the growth of granulation tissue.

i personally think women in this situation should have the wound monitored whilst it is healing. i don't know how you request that though, unless you can get a tissue viability nurse like dhosonia did for his wife.

also, a couple of weeks ago i found another website called netmums (!) which has forums on it and a really good birth trauma section. in this are quite a few threads about people with episiotomy healing problems. i personally find the mumsnetters more informed than the netmums, so i would always post any questions i had myself to this site, but the netmums threads are good just to read about more people with our specific problem, and also they have moderators who comment on threads and offer some expertise.

i don't know if any of the above helps but that's what i can think of for now.

take care

actually no one who has seen the extent of the wound (ergh) to be able to realistically comment. The registrar who saw me last seemed to think it would heal on its own. I have always felt it was far too deep for that.

Detective P how are you doing now then? what was your recovery like?

just to clarify what ive said about natural healing- i don't believe such deep wounds can heal on their own, and ive not heard of one case where its been deep and its sorted itself out. what i mean is you can encourage that process, but youwill still likely need intervention, of which there are other types not just restitching, such as covering the wound (TVNs do this), cauterisation and cutting any 'bad' tissue (granulation). and my point about regular monitoring is because then problems can be nipped in the bud.

sory my dodgy keyboard is playing up even more today!

DS is now 2.7. I am ok now. It healed really well. I had a follow up appointment with the colorectal surgeon when DS was 8 months and he said it had healed really well and it doesn't appear as damaged as they first thought.

I have been left with a sense of urgency when I need to go to the toilet (not a wee). I need to go fairly quickly after realising I need to go. I don't know how well I would be able to hold on. It could have been much worse and I could have been left with no bowel control and needed further surgery, which can happen with these tears.

I would go back for a second opinion and tell them you are not happy to just leave it.

Hello

Muslimah - really - you have never heard of deep wound that has sorted itself out? I agree about the having it monitored and I have had various midwives checking it but they are never the same and so don't know what to check against. So might as well have not bothered in a way.I don't mean to sound ungrateful but the one that came yesterday was full of doom and gloom - from her own epist story and inept doctors and she didn't fill me with confidence.

However I am seeing the consultant this week so we'll see - she may say I have to wait. I have read the other threads about TVN and I have to say I wouldn't have known to ask for one / if I can ask for one. Also I have no idea about granulation and so on- what am I looking for? I think you asked me before about a DP - which I have but he doesn't check the wound, as he's working a lot and he would if I asked him to but he is not volunteering to get down there!
Anyway - it is brilliant to have this advice from you as I know what to ask for and how to promote the natural healing. I have been sloshing with salt water as you suggested.

DPot, I know after 3 weeks about when you need to go you need to go. I find it a bit scary to be honest but they told me as 3rd degrees go it could be worse ( its only damaged a tiny bit of muscle ). It's certainly motivation to do the pelvic floors.

My sense of urgency did improve a bit in time as well so hopefully yours will too if its only a tiny bit of muscle damage. Sounds just like mine.

i haven't heard of this in the research ive done on the internet, but i guess at the end of the day its an anecdotal comment as i'm not a medic. i have heard of small tears healing by themselves fine, and often such tears are not stitched. but i've just come across so many stories of: episiotomy opening, starts to heal, granulates, body gets into overhealing mode, starts to get pain, needs treatment/intervention. but there again, maybe i've only come across those stories becauase those are the ones i've been looking for given that that's what happened to me...

granulation tissue is basically a normal part of the body's healing process. its dark red in colour and looks like a piece of flesh,literally if you can imagine a slither of meat. the body produces it to help the tissue join so normally its healthy. but it produces it at an uneven rate (again, normal) but then it can sometimes overproduce it,which means you then have some tissue which is then an obstacle in the way of the wound joining up.

its up to you if you get your DP to check the wound when he is around,but i personally found it really helpful for my DH to tell me how well the wound was healing which gave me the motivation to keep airing it and also gave me the hope that i would get better. actually airing alone helped about half of my 3 inch wound to heal. i didn't learn about the salt baths until much later (but just wish i'd done them earlier when i saw the difference they made to the wound).

good luck with your consultant appointment tomorrow.

Muslimah, a stroke of luck - I managed to see the TVN today and I'll see her next week and so for the first time I'll have the same person seeing me more than once. they decided I don't need a restitch but that it will take a good few months to heal. I feel so relieved because as you pointed out - I feel I am being monitored. And I didn't even know TVN existed until you mentioned it!

DetectiveP, i see from another post you are having another one! One of the doctors today mentioned contraception to me ( after checking my wartorn undercarriage!) - I was incredulous!

And that reminds me - the tissue viabity nurse I saw said that there is no reason to worry about the same thing happening again. Anyway I hope your consultant app goes well and you feel able to make the right decision and it takes some of the worry away.

Thanks.

Contraception with an open wound . Yes I'm sure having sex is at the forefront of your mind right now.

Hopefully I can avoid a c section. There is no way to tell if the same thing will happen again. Could be more chance because the muscles are already damaged or it may be ok because it is more stretched than before! No way to tell.

margherita i'm so so pleased for you it sounds like you had a good appointment and are now hopefully on a good care pathway.

i think the MWs and HVs just have a checklist they have to work through- i remember my HV mentioning contraception on day 19 and apologising that she had to do so!she just gave me a leaflet and told me to put it in a drawer until i needed it....

Margherita,

So sorry to hear about what you've been through, I came across this thread as I am preg with number 2 and terrified of the same happening again - I went through almost exactly what you did, stitches came undone, hard to walk, sit, lie and felt like (and I was) tearing at every step! I was in and out of hospital for weeks and given awful advice by a number of midwives who advised 'granular healing' - never was going to happen for me with such a large deep wound. Finally I managed to see a lady consultant at the hospital who cut away the old flesh (sorry! yuk) and restitched me - I never looked back, it was the start of my recovery 6 weeks post birth. She couldn't beleive that I had been advised to leave it be.
How are you getting on now? I really hope that things have improved for you!! Reading your posts took me back to some dark dark days and I hope you are better now.
J

Hi Jenkers
I only just saw this from you hence the late reply.

I am much better actually, thank you, as I got to see a tissue viability nurse who has kept an eye on things and it is definitely healing. She said she thinks it could take a few months to heal completely which feels like a very long time - but I am glad that the same person is checking rather than different midwives. So, fingers crossed, I am getting there. I havent had all the 6 week checks yet to find out the state of my pelvic floors but I think they are OK.

How about you? Congratulations on your second - are you getting good advice re which way to go for this one. When / if I have number 2 I should imagine I would be terrified as well.

hey margherita i got a bit worried for you when i saw this thread up on the forum again, had been wondering how youve been getting on.

am so glad you're feeling better, and i really hope you continue to get better and better and are able to enjoy being mummy.

Hi Muslimah

Thank you for your message. I am very much enjoying my baby she is amazing.

I had the 6 week consultant app today and she seemed happy with things - there is still a bit left to heal but the TVN said she thought it would take ages anyway. So if I did have any surgery it would be refashioning rather than restitching. Of course now I have to start working out if there was any lasting damage to the muscles (other than normal pregnancy stuff) and doing PF exercises all the time! I think it is OK though (fingers crossed)

I have to say -having such a warwound is / was scary and my level of after care has been pretty good compared to some, but partly I feel because of advice from people like you, I knew what to ask for / to look out for. I think there is a bit of an absence of coherent information for women sustaining tearing. Midwives, doctors GPs all saying different things or being (unhelpfully) shocked etc. Some saying wait some saying got to the hospital NOW...

But, in the end, I got very good medical attention and so I don;t want to sound ungrateful but I think many women just accept things as part and parcel of having a baby, and don't want to make a fuss.

Anyway thank you for all your help on this, I hope you too are healing and the pain is easing, and that you are enjoying being a mum to your baby.

good to hear you're doing well. i had a similar experience in that once i got to the right person in the end, i had really good medical care. but similarly it seemed like some people early on just didn't understand how serious this was. i think healthcare for people with episiotomies needs to be much improved. NICE guidelines seem to just gloss over it, only talking about immediate after care, and on the presumption that everything is fine. i think getting better guidelines into NICE postnatal guidelines may be a way to improve things. whenever i get a moment i plan to write a 'suggestion' to them- as any member of the public can do this. and i will be linking to mumsnet threads so they can see how significant a problem this is!! they won't respond straight away, as this would need to be included in the revision of the guidelines which i understand are done at set intervals, but at least i can get it onto their radar.

Muslimah - I applaud you for taking such the decision to contact NICE about their guidelines. So often people encounter serious problems concerning an aspect of healthcare but once recovered put it behind them and take it no further.
What you are proposing could, ultimately, have an impact on the care of hundreds and hundreds of women. And they will have you to thank!! Please let us know what feedback you get.