Theatre for tear repair. Random questions.. can anyone answer?

[Tattybogle89]

Struggling a little after childbirth, perfect labour turned into 4th degree tear and 2 hours in theatre to fix. This was a few weeks ago. I have random questions I should probably speak to someone about but in the mean time if anyone has answer to these recurring visions and memories I am having it would clear my head slightly.

• watching someone tallying things up on a whiteboard in theatre . Only remember being able to read suture needles 8 at one point. What and why is she counting?
• why so many needles and not one?
• is 2hours s normal time for 4th deg tear repair in theatre? I ended up with pressure sores. *why so many people in the room who don’t seem to be doing much who are they all)
• normal for these people to be discussing their xmas plans and favourite music etc amongst themselves during surgery? Made it very strange for me *how many stitches does a 4th tear require roughly ? Was anyone ever told? *why was a cannula inserted when I don’t recall anything being given through it.

Lots more but il see if any replies
Just trying to process things in my head

X

You would always have a cannula I think, so it’s there in case they need it. I suspect it’s probably normal for them to be talking about Christmas during any operations sorry! And I don’t know how many stitches but could be many. I may have had about 40 for a 3rd degree tear I think.
Good luck recovering, take all the stool softening meds and watch your diet, and get back to hospital / specialist physio if you aren’t sure.

The needles are attached to the suture material so a new one for each thread if that makes sense

Cannula for safety just in case.

They sometimes chat, I suppose for most ops people are asleep. Takes as long as it takes but someone should have kept an eye out for pressure sores.

Everyone has an assistant so the anaesthesia team and the surgeons etc

I remember it too it was horrible. I hope you have a quick recovery x

She is counting the needles, swabs and instruments to make sure nothing gets lost (inside)

Counting is a necessity to ensure nothing is ‘left’ inside a wound and every piece of equipment has to be accounted for including swabs/needles etc. One person will have the job of noting all the counts in and out!...
Not unusual to have random discussions in theatres.
Cannula would be incase you needed any drugs eg if your health deteriorated or you needed pain relief.
Sorry I don’t know anything about the specific repair surgery.

Thank you for replies they are stupid questions but just things pottering about inside my head.
So one thread on each needle is that one stitch or lots of stitches per thread?

Stitches can either be one continuous stitch or multiple individual stitches. For a 4th degree year there will be multiple layers of tissue being repaired, and they may use different types and thicknesses of material for each layer. Internal stitches would normally be done in different continuous stitches for each layer. External stitches can be several individual stitches or another continuous one. Does that make sense?

Yes I understand thank you

Does anyone know how they measure blood loss? I was told I haemorrhaged after birth and trebuchet noted the loss right away . But I delivered in the pool and immediately the large pool water was deep red..then gushed a few times when lying waiting to go to theatre. How do they know how many mls blood is lost he do they measure that especially if a lot was in water?!

They estimate based on past experience and they weigh dry and wet sponges. Changes in your pulse and BP also provide clues.

Hi, I had a 4th degree tear and spent about 2.5hrs in surgery - I was told I needed over 100 stitches. The staff were all lovely and chatting amongst themselves and I joined in as one of the midwives was sat next to me. It was 8 years ago but I remember a midwife, surgeon, anaesthetist and assistant and a couple of theatre nurses. The whiteboard was straight in front of me so I watched them tallying up swabs, needles etc as they were used and then removed. It did feel strange being ‘on show’ but everyone was very professional and lovely.

The needles are one per length of suture material, maybe about 30cm material per needle. But plenty gets lost on knit tying. Each suture would be able to do lots of stitches. But if the year is quite ragged then one might be used for a small bit, tied off and then a new one started in a slightly different place. Plus different sized sutures will be used for different parts.

Two hours is longer than usual, but every tear is different.

You’d have at least one dr, possibly another junior one if they’re learning/observing, possibly a second senior dr for a second opinion, then an anaesthetist, an ODP who assists the anaesthetist, midwife, possibly a scrub nurse, a theatre runner.

Cannula is in case you bleed which is more common with a bad tear. People do chat about random stuff in theatre, I think staff often thinks it may take the patients mind off stuff.

Nobody counts stitches.

It’s very hard to estimate blood loss in the pool. Once on dry land it’s a lot easier.

I don’t know about in water but I had a haemorrhage and remember them weighing all the gauze etc they used to wipe it up, presumably they know the weight of the gauze used (esp. as it was also tallied in and out) and Then I think there was an element of estimation at the end, presumably based on lots of experience.

I highly recommend seeing if your hospital has a birth reflections service, really helpful for things like this. I didn’t know how many things I had blamed myself or the staff for that in fact I’d just got the wrong end of the stick on.

When you're feeling a bit stronger, request a birth debrief with the hospital. These are done by specially trained midwives usually and they will get your notes and talk through anything you want to discuss, whether physical or emotional, and can signpost you on to other services as needed. If your hospital doesn't offer this (most do), contact the head of midwifery and request to speak to someone about your birth and they should arrange it for you.

I really need to do this as I'm suffering a lot of trauma related to my emergency c section where my spinal was an absolute disaster and one of my twins nearly died (not the hospital's fault at all, they were fantastic but I don't really know what happened). Now I work with the maternity service I'm struggling to ask as I know all the staff who do them and feel strange talking about such personal stuff with them. I know lots of women have really benefitted but there's often a minimum wait period (8-12 weeks) so that you can properly process what's happened and have a bit of distance I think.

As said above, counting is of the needles, instruments, swabs etc to make sure no foreign objects are left inside you during the repair or surgery.

The cannula will be most likely due to blood loss. While you didn't need a transfusion, if you had started to bleed heavily again, your veins can collapse and make inserting a line for transfusion or in drugs very difficult or impossible. So it is good practice to have a pre-positioned cannula, and good news that it wasn't actually needed in your case.

It does sound like there was some inadequate communication with you. It doesn't sound like anything was done wrong or strangely, but it would have been a lot better to have someone explaining things to you and making sure any of your questions were answered. Likewise, it would have been nice for them to check that you were ok with small talk and chit chat taking place.

It is scary and disorienting and can be confusing. However with a fourth degree tear, you absolutely needed to be there and it is good that things were so well under control that they were chattering away etc. but they really should have made sure you were calm and informed and at ease also. M
Best wishes for the recovery.