Tearing and needing stitches, can this be prevented?

[dejags]

When DS was born I was attended by four midwives the last of whom made me take things very slowly. She was a strong personality and didn't "allow" me to push when I should have been panting. She did have to yell at me a few times though to stop pushing.

I didn't tear or need stitches and I was wondering if this was the result of having an experienced midwife manage my 2nd stage or if tearing is more physiological (I think that's the correct phrase)?

Incidentally I had a failed epidural and no other pain relief. My labour was induced with syntocin due to my waters breaking and labour not starting spontaneously - it was 12 hours from start to finish.

[wmf]

katie32 - this time last year I posted (further down on this thread) about problems with a tear. I had dd in December, tore again along the scar, 2nd degree but not quite as badly as before, but this time healed up quickly and perfectly. I have no pain from it. So tearing badly and recovering badly don't necessarily mean the same will happen again. I wonder whether I healed better 2nd time because I was stitched up by a very senior midwife with decent pain relief, rather than by an impatient, tired, Senior Reg with very poor pain relief. Perhaps it's also to do with having gone through full labour once before? You've been through both vag birth and caesarian, so you've got a perspective on both, but it doesn't necessarily mean that this next one will be the same IFYSWIM.

A bit garbled, but HTH and GL.

[Rhubarb]

This has worried me a bit. I tore very badly with dd and it took me 6 months to recover. The GP was talking about surgery for me. Apparently I was stitched too tightly and had a large knot of scar tissue that was taking its time to heal. I've opted for a home birth this time round and obviously don't want to tear again. Should I be examined to see how the scar tissue has healed first?

[willow2]

Katie32 - go for the c section. You've done the "natural" birth thing and suffered a 3rd degree with horrendous problems. Yes, you might be ok this time, but you could go one step further - namely a 4th degree with lifelong problems. I appreciate that a c section has it's own set of risks, but IMO you're better off with one. I also know for a fact that the most senior physiology consultant at St Marks Hospital - which specialises in repairing bums! - would definitely recommend a cs.

[aloha]

From what I gather an elective (which I had) is nothing like an emergency cs usually.

[Zerub]

Hmm, I've been wondering about this natural birth / tearing vs caesarian thing... First baby was an "elective" cs (was planning a homebirth till we discovered she was coming feet first at 38 weeks). It was really easy, I appeared to be in far less pain than the lady with the huge episio in the next bed (presumably I got better drugs than her?). Recovered in 6 weeks, no probs now. DD didn't fare so well - too small, not ready to be born, didn't bf for a week. She's fine now, I just wish she could have chosen when to be born.

Sooo - next time, I could probably have another elective cs if I asked determinedly enough - or a homebirth if I was equally determined! The main thing that puts me off the latter is all the stories of women with huge tears - it seems like they take longer to recover and have more pain than my cs scar! Which should I go for? Whats a tear actually like? (I know it wouldn't necessarily happen).

[mears]

Katie32 - the chances of a normal delivery are high because your last baby was the equivalent of your first vaginally. It is less likely that you would need an assisted delivery this time round as the way has been made by your last baby IYKWIM. Third degree tears are assocaited more with assisted delivery/ episiotomy. You are likely not to have either next time. I can understand why you might want to opt for a C/S however, but you may well end up with a vaginal delivery and no stitches. I would rather aim for the latter than opt for the former - but you all knew I would say that didn't you

[lou33]

I had a 3rd degree tear with my first after an episiotomy, and had terrible trouble recovering from it, went on to have 3 other natural deliveries with no problems at all.

[ThomCat]

I think so Dejags. I had one midwife with me and then a second came in once the head was out. I was standing at the edge of the bed, she climbed onto the bed on her hands and knees, put her face in my face and said 'right, look at me, now don't do anything other than pant ok, just pant, copy me' and then just panted at me, I copied, eyes locked inches from each other and little Lottie just slipped into the world, no tearing no stiching, thank the lord.
Having said that though I did have a couple of piles! A nurse examining me said 'you poor thing, they're more painful then stitches' to which I wanted to punch and say 'and that hopefully hurt more than both put together'!! Once she had said that I felt a bit sorry for myself, I was putting up with the pain before that!!!

[LordVenger]

I just did my first vaginal birth with no drugs or tears and found the whole second stage very easy and managable which I'm sure was down to perineal massage. i couldnt reach down there either, so i got my husband to do it - the day before i gave birth he managed to stretch me so much he had four fingers abreast inside me - knowing he could do that gave me enormous confidence when it came to getting a little head out. doing something similar would also let you know how stretchy your scar is.

[monkey]

Just discovered this thread. In a similar position to Katie32. 1st baby undiagnosed breech & emergency c-section. 2nd baby very quick - 2 hours from 1st contraction to delivery. i had an epesiotomy & also 3rd degree tear. i seem to heal really badly & slowly - had loads of pain & months to recover from both, but the recovery from c-section was quicker. (if you can call 9 months quick).

I'm now weeks away from 3rd delivery & totally confused. Doc reckons this one might be as quick or even quicker than last time - 2 hours speed labour with no pain relief was horrific. (I'm even worried I'll be able to get to the hospital on time if it's 2 hours or less) Also worried about feeling as totally out of control. A big part of me wants an elective c-section. I'm terrified of tearing again & taking nearly a year if not longer to recover. I'm confused. I've sort of skimmed this thread, and on the one hand at the start, people seemed to be saying if you tear 1st time, you might not, or not as badly 2nd time. On the other hand, people all seem to be saying in Katie32's position, they'd go for elective.

I've got an appointment at the hospital tomorrow & I need to try & get my head round everything I need to ask/all the info etc. Any advice please? Go on, someone egg me onto a c-section! bf is totally for, dh a bit against, me sort of want it but don't know what to do for the best.

[elliott]

monkey, no experience of any use to you, but can you identify what your gut reaction is? Which are you most afraid of? Your post seems to indicate that you are most afraid of a vaginal birth, but there is clearly something holding you back from the c section - can you work out what that is? If you were to go for vaginal delivery, is there anything you can do to try to avoid such a bad tear - do you feel confident that the people with you during labour will be able to help you with things like appropriate positions for slowing down labour, and help with breathing to control the speed of crowning etc?
Best of luck, hope you can sort your thoughts out....

[Bekki]

Sorry to hijack this thread, I just wondered whether anyone had heard of a woman tearing on her inner labia? I didn't know where my stitches were placed and I didn't bother to check until a week after when I felt a hard lump on my labia. I asked my midwife if all the stitches had come out and she checked and said yes. I didn't say anything about where I thought the stitch may have been because i wasn't sure where my stitches were placed and I had never heard of anyone having stitches there. I didn't want to point something out that wasn't there. After two months I noticed that the lump had become a small hole and after three months it was swollen and the damage was extensive. I went to my gp who didn't beleive that it was done during childbirth because you 'don't tear there'. I was very embarrassed but thankfully when ds was 10 months I had surgery to correct it. Alot of my labia is now missing and it is still occasionally sore. I'm due in under two weeks and I feel I should mention this to my midwife but I don't want to embarrass myself by mentioning it if shes convinced that women don't tear there. Has anyone else torn there and should I mention this when in labour?

[Bekki]

It must just be me then.

[SueW]

Bekki, no personal experience but I have heard of women tearing towards the front rather than to the back - is this what you meant?

[SofiaAmes]

Bekki, my labia ripped during childbirth from the clitoris down diagonally so that it was two flapping pieces. I had a haemmorage after the birth (unrelated to the rip) so while the doctors were poking around trying to find out why I was bleeding (turned out to be non-contracting uterus), my midwife insisted that they stitch my labia. According to her, they were just going to leave it as two flaps since there was no "medical" reason for it to be stitched into one.
Anyway, I would definitely mention it to the midwife before and during labor. And let tem know that you will insist on having it stitched properly if it does rip again.

[Moomatoo]

Bekki - 18yrs ago when dd1 was born, her hand was up at the side of her face and as a consequence I tore at the lower edge of my right inner labia. Like you, I only noticed when there was a funny lump after the stitches were removed. I think this labial tearing can happen when the baby's hand is in an awkward position - at least, that's how it was explained to me. The shape of the healed labia did worry me for a while, but then I don't make a habit of staring at that bit so my worries faded. dd2 was breech, vaginal delivery with big epesiotomy, dd3 and ds1 no tearing or stitching so no problems.

[Bekki]

Thankyou i was beginning to worry that it was just me. As far as I know the delivery was normal no hands in odd places but he was big for my size and I pushed him out far too quickly. The tear (or repair of the tear)is extensive and the labia is no longer joined to the clitoris so I can't imagine the problem reacurring. I just find it odd that no one told me where I had torn or warned me of any future problems. I've just added to my birth plan that I would like the most experienced person available to stitch me up, I hope they don't take it the wrong way but I'm not going through that again, the pain was awful. I was unable to walk properly for two weeks after the birth and the pain really affected how I bonded with my son. Having to go through surgery months later wasn't brilliant either and with no explanation of how it happened made it alot worse. Thats my winge over thankyou SofiaAmes and Moomatoo. Fingers crossed for no stitches this time!

[Bekki]

Moomatoo- a vaginal breech birth, yuo are vey brave!

[Bekki]

Oops! i'll put the bottle of vodka now!

[Bekki]

That should of read "down now". Oh my god this pregnancy really has mushed my mind. I'll go back to bed now.

[Cha]

Bekki -I ripped there too, both sides of my inner labia split in half. And dd was not particularly big, nor did she have a hand in the way. My second stage seemed to go on forever, so it wasn't crowning too quickly either that caused it. I really don't know why it happened, but it did. And like you, the stitches hurt like hell for weeks, so much so that I would scream every time I had to wee. Even pouring luke warm water over the whole area at the same time didn't really help. And, a bit like you, the whole area didn't heal properly. All of the stitches on one side came undone, so I now am in the enviable position (not) of having 2 flaps down one side... and one knotty, bumpy one down the other.

Am about a week off from my second baby so am dreading the whole thing happening again. However, this time I am having a water birth and I have been told that being in water for a long time makes the whole area softer and less tight and so less likely to tear. Hope they are right. Was also told that Victorian midwives used to place a hot, wet poultice over the whole area as the baby's head was crowning, to achieve much the same result. So maybe you could try this if it's too late to have a water birth? Good luck anyway - let's get together in about a month and compare scar stories.................

[aloha]

Oh, Jesus, just read this thread and thanked God once again for my c-section!
I cannot imagine how any of you could bear this! You are all extremely brave.

[Moomatoo]

Bekki - the vaginal breech delivery was nearly 16 yrs ago - don't think they'd allow it nowadays. Funnily enough, I was terrified of a c-section!
Cha - my 4th was a water birth and no tearing or stitches, so good luck, I wish the same for you.
Aloha - I don't like to talk about it (except on Mumsnet )

[Bekki]

I am hoping for a water birth this time round, mainly because of some pelvic pain that i'm suffering with in this pregnancy, it seems to relieve the pain quite effectively. So it would be an added bonus to see if it helps to avoid tearing as well.


Having no idea where my tear was I couldn't understand why I was in so much in pain, especially when friends of mine had more stitches and were quite happy. I would avoid going to the toilet so that I would only need to go through the pain once a day. I would grit my teeth through it and more than often I would be in tears at the end. Thankfully the pain does disappear after 2 weeks and it was worth it but I wish they could have explained the situation to me. Good luck Cha, not long to go now.

[NQWWW]

Really wish I hadn't opened this thread! Must persevere with the perineum massage, even though in pain after last night's effort.....