6 week check after 3rd degree tear

[kaytees]

Hi all,

I'm wanting to know if it's a totally standard thing that people have a 6 week check after a 3rd (or more) degree tear?

I had DS in 2016 and never had / was offered a check to see how it had healed. Never thought too much about it (though my recovery was slow and painful, midwife just said 'that's to be expected'). Am now 19 weeks with my second baby and midwifes keep asking why I didn't have a check, and I don't have an answer!

I'm assuming they do the check at 6 weeks to ensure everything is healing well, and having one now wouldn't be much use...

I had an episiotomy in the immediate post-partum period, the midwives checked on it. At the 8 week check with the GP, I had to ask the GP to check it as I was worried about infection. His response " you want me to have a look? "

I've just had to have surgery to fix it as it didn't heal properly.

Out of interest, OP, what is the midwife saying about how this will affect your labour?

I had the regular 6 week check you have with a gp where they check your baby and also check how you're recovering, and then a 12 week check at the hospital with an obstetrician to check the scar and whether I was having any incontinence issues, and then at 6 months had a meeting with the hospital physios to check I wasn't having any problems, some tests on pressure resistance and an ultrasound of my back passage (not as bad as it sounds but not exactly pleasant) and met with a specialist who focuses on these sort of injuries to discuss the results and the implications for future births. At that stage I had no symptoms but the tests did show some pressure resistance issues and so it was recommended that I consider an elective csection for future births (which is what I opted for).

This was all arranged as standard practice at my hospital (St Thomas's in London) - I didn't arrange any of it and wasn't having any problems with healing or continence. They told me in hospital a few days after the birth that they'd be arranging for those appointments to happen. My tear was at the milder end of third degree tears.

I was told they do the checks to look for any undetected pressure resistance issues that can lead to faecal incontinence later in life if subsequent deliveries are traumatic or have a long second stage or repeat 3rd degree tear. The hospital said it would be up to me how I wanted to deliver and if I wanted a natural birth later they could potentially repeat the testing to see if the resistance had improved, if I wanted that info as part of the decision making, or I could just decide to try a natural birth without further testing if that's what I wanted.

At the hsotpial I work all 3 degree tear patients are offered the opportunity to be referred to the women's health physios, and they are then to be given an appointment between 6-8 weeks post natally if they wish to have treatment. I'm admin though, not a professional, so I don't know if this is standard practice

Oh @FirstTimePetitioner that sounds like really rubbish experience, especially having to have more surgery. I don't recall anyone (midwife or GP) looking at my stitches at any point. As I also had shoulder dystocia with my son I have the option of ELCS this time around, midwife has pushed for natural birth (told me there's no more likelihood I would tear again, which isn't statistically true!) but I have consultant in a few weeks to discuss further.

@Microwavey those sound more like the checks and tests midwife suggested I should have had - agree, not pleasant but best to check! Sounds like your hospital were very proactive in helping you. Immediately after birth I was told future births would likely be a c section (unless they were small babies, but my son was over 9 pounds so I'm not sure I make small ones!) but usefully, I'm at a different hospital now and the notes from first birth have 'gone missing' according to first hospital.

My area does physio and tests as standard on 3rd degree tears. Altho I think this isn't quite as thorough as it was when I had mine 5 years ago. I didn't have to ask for anything it was arranged as a matter of course.

If it helps I had a nasty 3rd and episiotomy first time but this time it was much better and I had a small 2nd. I'm only 7 weeks post partum so long term effects unknown but so far so good! I would have really had to push for a c section and after doing lots of reading I decided to give it a go naturally.

Thanks @frogprincess84 - always useful to have the admin point of view, you guys know what happens and what's meant to happen! I did have a physio appointment at 8-10 weeks (I think) but it was group physio focused on pelvic floor exercises so no chance for me to be checked (midwife suggested the checks could have been done by physio).

@Mammmoo yes the decision on what to do this time feels huge - I'm glad yours went well and hopefully you continue to feel good! I know I get extra growth scans this time to check if baby is big, so hopefully that'll feed into whatever my decision is.

I think every HCP I saw wanted to have a look.. in hospital immediately after, a doctor actually called a midwife over because "they've done such a good job"

The midwives I saw at home all asked if I wanted them to check the stitches but I declined as I had no issues at the time. I did ask a midwife to look at about 6 weeks because things felt a bit wrong but she assured me all was fine. I got the doctor to check at my 8 week check because a stitch was poking out but she refused to do anything with it.

The midwife I saw at the 12 week gynae check at the hospital said it was healing fine, and the doctor should have just snipped the stitch but no harm done.

Similar to pp I was offered a rectal ultrasound at 6 months but I declined because I've got no issues, and no intention to have any more children!

I had a bad 3rd (almost 4th) degree and an episiotomy with my first (now 12 months old)

I was worried my stitches had split and got a same day appointment with a nurse. Also had them checked a couple of times by a midwife.

I had the usual 6 week check but the GP refused to check them and told me to book an appointment with a female member of staff....

I also had a 12 week-ish check with a midwife who described my pelvic floor as "moderate". Interesting that others has physio as standard, i was told it could be arranged if I had any continence issues

Will definitely be asking for more tests if I have another, though I'm pretty sure I will go down the CS route

@DiscombobulatedWomble now wondering if I should be offended that no one wanted to check mine, but yours were so popular  in seriousness though that sounds a bit much, glad you healed ok and didn't need anything more!

Agreed @TwinkleTea I might just have to ask for the tests now and see what can be done. I'm not opposed to the c section really but the recovery from it with an active toddler does make me want to be sure it's the right choice for me and baby!

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If I remember correctly my mudwife checked things were healing ok a few days after tbe birth and my GP checked things at the 6 week check.
I was referred to physio as standard and after 6/12 months I had a check up with scans to see if things had healed ok/muscle strength etc.
For my secind pregnancy I was automatically consultant led and on the consultant's advice I had an elective c section for my second baby.

I had a 3rd degree tear last year. I was checked during my stay in hospital and at 3 weeks pp when I went back in due to suspected infection (not infected). I had no phsyio, wasn't checked at my 6 week GP appt, missed a call from the hospital around 11 weeks pp who said they'd call me back but never did. I suspect things aren't quite right but nothing too awful so I've just left it. Now ttc number 2 and will be asking for an ELCS.

After a 3c tear I had a 6 week check (separate to my son's 6 week check) but my GP was happy just to ask how things were healing until I asked her to have a look as I had a stitch that was stabbing me.

I then had a 12 week check with a physiotherapist that specialises in women's health and she very thoroughly checked the strength of my pelvic floor and how things had healed internally.

I’ve had 2 x 3a tears, can’t remember if they were checked by midwife/gp or if I declined. Both times I had a hospital appointment at around 12 weeks which seemed to be to check strength of pelvic floor but included an examination. Not had any subsequent issues.

@Lindy2 that's really interesting that the consultant recommended it - do you mind my asking were there other reasons consultant suggested that? The reason I ask is that I'm under consultant care (though only meeting consultant at 24 weeks) due to shoulder dystocia and the midwife gave me the impression that the shoulder dystocia and tear wasn't enough of a reason to recommend a c section (despite consultant who delivered my son saying it was!). It sounds like you had a consultant who listened!

My GP would quite happily just have chatted to me and looked at my baby at the 6 week check. I had to request a physical check after a tear, episiotomy and forceps theatre delivery, because I was convinced I had a prolapse. She said she wasn't sure and referred me. I'm still in treatment now at 8 months pp, so useful to get checked

I initially didn't really want an c-section. The scan (rectal ultrasound) I'd previously had done did show reduced muscle strength although luckily I haven't had any problems at all.
My consultant was very worried about what a second tricky birth could do and recommended c section. I took his advice and had a great c section birth. Way better than the trauma of foreceps with my first.
If you haven't had a rectal ultra sound I think you should ask why. It's not a particularly pleasant experience but it shows how well things have really healed and if you are at risk of any further tear damage.

Thanks both @Lindy2 @sar302 - I had forceps too and sounds like they played a part in my slow recovery. You were both very sensible to follow it up so well!

I feel a bit of an idiot for never chasing up if it should have been checked out - am usually very proactive and organised and on reflection I don't know why I didn't chase it more! I will definitely speak to consultant / midwife and see if I can get the checks done, my sense is if I had such a slow and painful recovery / am getting pain in the site of the tear now in my second pregnancy it probably didn't heal that well.

I only had the checks done as that's what my hospital arranged and organised for me. With a new baby keeping me busy I don't think I'd have got round to arranging it myself! It does seem like my hospital was very good with my aftercare.

I definitely wouldn't have chased up doing the tests if they hadn't chase me so don't feel bad. I decided to have a csection for dc2 as the thought of it happening again was too scary for me. The csection was great - a really joyful experience with staff who were all really happy and made it feel like a real celebration. But my sister who is a midwife says she's seen many successful natural second births for women who have had third degree tears where they've had it much easier and haven't had anywhere near as much damage the second time. I just couldn't face it!

I had an episiotomy & 3rd degree tear late last year with my first. I was automatically referred to women’s physio & a gynaecologist, who I saw at 3 months for tests etc. My Midwife also offered to check it in the first few weeks after but I had no issues. I was told if I have a second baby I can have an ELCS. But, the risk of a 3rd degree tear is about 1.5% I think. If you’ve had one before that increases to about 7%. (Stats on royal college if midwives website). So I think I’d opt for a vaginal birth if I do have another as the risk is still low. My care is standard for my trust, which seems excellent for postnatal health.

I only had a 2nd degree year and whilst the midwife always had a look at my stitches for me at home visits, I had to demand the GP check at the 6 week appointment as I knew things weren't right. He seemed to think everything was healing well yet I had to be referred for physio (by one of the other doctors) and actually have a prolapse. He obviously didn't have a clue!

Had similar to @Microwavey and I believe it should be standard practice.
There is growing awareness of serious tears with the creation of the MASIC Foundation last year (I think).
I would ask your GP to be referred to a pelvic floor clinic so they can assess.