Does this sound right?

[DieDeutschLehrerin]

Hi! I'm just after advice/opinions really. I gave birth 12.5weeks ago. It was a ventouse delivery. I had an episiotomy and a 3rd degree tear which required stitching in surgery afterwards. I was told by the OB who stitched my up that I would have a follow up appointment in 8weeks time to check the muscle had healed correctly and in the meantime to door pelvic floor exercises.

No mention of this appt was made at discharge so the midwife chased it up for me. By my 6 week check so the GP sent a letter
to the consultant who had led my antenatal care (for horseshoe kidney & recurrent UTIs).

I've been sent through an appt for thus week with the urogynae continence nurse together with a 3 day drink/wee/urinary incontinence diary (I am not experiencing any problems with this) and a questionnaire about how severely various urinary problems affect my life (they don't really).

Does this sound right? Have other mums with 3rd degree tears had this?

Also, I am confused about the extent of my tear. 3rd degree was written in my notes & discharge letter but after the OB had finished stitching me up he came round to my head end and said "it had cut right into your rectum. It happens sometimes but we will see you in 8 weeks because it is a very important muscle and you will need to do your pelvic floor exercises". Does this suggest 4th degree rather than 3rd? Does anyone know who I need to talk to find out? This was my first child. I would like more so I would like all the information to be fully clued up for any future pregnancies.

Thanks for any help.

I sustained a 3rd degree tear after delivering my DS. All my immediate aftercare was done by MWs who checked how my stitches were healing until they discharged me. My GP then checked the healing at our 6 week check.

I received an Out Patients appointment with a Proctologist about 4 months after the birth and he examined me to see that the normal function of the rectal muscles had been regained. I would imagine that this is the appointment that you haven't received yet. I would think that the Urogynae appointment would be due to your previous medical condition, rather than the tear? I could be wrong as so many hospitals do things quite differently.

My tear was definitely 3rd degree and I was told that it was a 'hair's breadth' from tearing into my rectum, I was under the impression that if it had have done it would have been a 4th degree tear? If it helps at all my tear has healed brilliantly and I've suffered no after effects from it except mild piles. The Proctologist was really pleased with how I healed too. I'm currently 23 weeks pregnant with DC2 so a bit anxious about tearing again. I'm going to speak to my MW about the risks at my next ante-natal appointment.

Thanks for your reply. Turns out the appointment was to check it was all healed. I asked about the extent of the tear and the nurse said it was prob 3rd degree but she wasn't sure as it wasn't on the computer system! It all seems to be fine though.

I did ask about future pregnancies and she said that it's the hospital's policy to monitor more closely in 2nd pregnancy and if you're coping well, the baby isn't large and is not breech then they would support you going for a VB and it should be fine. But she did say that you're entitled to ask for a cesarean if you are worried. It's good you're going to talk through things with your midwife. I hope it all goes well.

Do your notes say what degree of tear you had? They grade them 3a, 3b, 3c and 4. The risks of incontinence etc vary a lot and are usually higher for 3c and 4th degree (where the tear extends more than 50% or into the rectal mucosa).

Also, the follow up care will probably vary a lot between NHS Trusts - for my 3a tear I had an assessment at 18 weeks, anal manometry and an anal ultrasound (what fun!). You might like to read the RCOG guidelines - these should give a bit more info as well as an idea of what sort of follow up care you could expect?
www.rcog.org.uk/womens-health/clinical-guidance/management-third-and-fourth-degree-perineal-tears-green-top-29

Great that you are feeling well and with no signs of probs though!

Midworld - I'm 28 weeks and have been told that I have no more chance of having a bad tear than anyone else :)

28 weeks pregnant that is!