Getting to see a 'good' consultant - how to find one?

[Gem13]

I had a difficult birth with DS resulting in a third (bordering on fourth) degree tear.

When pregnant with DD I saw two consultants (changed areas), one who didn't even mention the tear (and wasn't interested when I did) and one who advised me to have a c-section as the risks of becoming incontinent were higher than the risks associated with a c-section.

So, with relief (as my first birth was traumatic) I had an elective c-section.

It was fine but I'm still holding out hopes for having a natural birth if possible next time (not pregnant at the moment). It was difficult looking after a toddler post section as well as the new baby and next time there would be three of them!

I saw a physio the other day who suggested that the consultant who advised the section might be 'out of date'.

So, how do I find 'the' consultant? I would like to know my options before getting pregnant.

Well consultants all have different opinions.... where in the country are you?

Near you! In Sussex.

I know it is down to opinions but I would like to see someone who would weigh up my particular situatution.

A friend of a friend (who is a consultant) believes that every woman with a third degree tear should have a section but then she is anti homebirth too!

How do I find the consultant who says that I can have a lovely homebirth without complications is what I'm trying to say?

well my experience is the opposite but... I had a very very traumatic first birth. When pregnant with my second child, i asked for an elective section. The consulktant wouldnt even discuss my obs notes with, let alone give me any advice. I asked the senior midwife, on duty in the clinic (!) to give me the name of a good consultant. She told me to ask for a referal to another consultant and to ask for the one i wanted (she came highly recomended)

I did get the referal on the nhs, and the consultant i saw was very good. i made an 'informed' choice. She didnt just say 'yes, you can have a section', it was talked at length and she gave me time away to think about what I wanted. I eventually decided to have a section, my reasons were different to your reasons though.

my consultant was good because she let me decide. She gave me all the information so I could make my own mind up, with her support. i think that is what a consultant should be like

Sorry cant advise on consultants though, even though i am very close to sussex now!

I have CAT you

At the risk of repeating myself (see earlier c section thread) the only thing that matters is that you and your baby are delivered safely. How that happens is not important. I had a fourth degree tear and have spent the last five years wishing I'd had a c-section. I have been told by every consultant I have seen that if I ever do get pregnant again I have to have a c-section.
I am astounded that your physio suggested otherwise. I see one of the best - if not the best - physio in the country. There is no way that she would suggest that the information that you have been given is out of date. In all honesty, when I see posts like yours I am terrified. I would not want anyone to go through what I did - you tore badly last time, why risk so much just for a "natural birth"? That said, the decision has to be yours, but please make sure that it is an informed one. Finally, if you do decide to go for it don't let anyone come near you with ventouse or forceps. 1 in ten babies are born by forceps. Yet well over 50% of the women with bad tears that my physio sees had forceps deliveries. Considering that you have already had a bad tear I would imagine any intervention is best avoided.

Anyway, good luck, whatever you decide to do.

Hi Willow

I have seen your point several times today (as you say )
I am sure this point makes sense to many.... but you have to understand two things (IMHO)

1. for some women "giving birth" goes beyond having a baby at the end.... it is something they have a primal need to fulfil (not for everyone and I respect that)
2. you regularely get MISinformation by doctors and midwives and I think it is right for women to question and ask for a 2nd opinion. It is THEIR body and THEIR baby!

I would not be surprised if 2 doctors had a very different opinion on the matter and regardless of physio (best in the world or not) he/she may also be wrong....

Gem13, you need to discuss this with consultant at your local hospital. Get their views and then if you don't feel that your views are being respected, get referred to another consultant. Midwives can be very helpful in pointing you to a consultant whose practice will support you in making the decision that is right for you, with your medical history and your baby.

Willow2, your physio clearly has very strong opinions on this. Doesn't mean they are 100 per cent right for every woman though. I'd be very wary of someone issuing a blanket ban on vaginal delivery following 3rd degree tear ? smacks of someone riding a personal hobby horse. The research I've seen suggests it's a decision best made on a case by case basis, looking at the medical history of the individual woman. Mears once posted that 3rd degree tear is not necessarily cause for an elective caesar and it is possible to have a trial of labour (I remember because I had a 3rd degree tear).

Hi Pupuce - I didn't for a minute suggest that Gem13 shouldn't get a second opinion. I actually made a point of saying that she should make sure that her decision is an informed one. That said, the very many hugely respected consultants who would advise on a c-section would suggest that a vb might be an extremely risky thing to do. Additionally, while I call her a physio, the person I am referring to is a leading authority -worldwide - on tears of this nature. I very much doubt that her advice would be wrong.
Ultimately, and somewhat sadly considering what a magical experience the birth of a child is, what this all boils down to is risk assessment. Of course, some women do have bad tears and then go on to deliver a second or third baby without further damage - but they should be made aware of the risks so that they can weigh up what is ultimately important to them.
I am well aware that it is Gem13's body and baby (sorry, should I have put that in capitals?) and if she has a primal need to have a vb then she should have one. But I feel very strongly that she should speak to the experts first so that she is aware of any potential risks.
Oh, and without wishing to be pedantic, I have made this point(albeit in far less detail) once today, so how you have seen it several times is beyond me.
For the record, I am not some c-section obsessed anti-vb nutter. (Just as I am sure you are not a vb-obsessed natural-birth nutter.) I just feel that people can become too focused on the process rather than the end result. As someone on here said recently, people should try to remember that they are having a baby. Not a birth.
I very seldom get annoyed by other MN's comments to me - but, intentionally or not, tonight you have me seething.

Oh - and apologies to Gem for apparently hijacking this thread. I'm sure normal service will be resumed. Also I can recommend a good specialist in town who will give you an honest opinion - feel free to cat me if you wish.

Finally... and I will stop in a minute... it was the fact that Gem13 said the tear bordered on the 4th degree that got me so very worried. 4th degree tears are really best avoided.

Peace man

I've had enough blood and gore for one night. I'm off to watch The Sopranos.

This PDF file might help Gem13 :

www.rcog.org.uk/resources/Public/Perineal_Tears_No29.pdf

It's from the Royal College of OB and Gyn. - the conclusion on subsequest delivery is this :
Subsequent vaginal delivery may worsen anal incontinence symptoms. All women who had a third- and fourth-degree tear in their previous pregnancy should be counselled regarding the risk of developing anal incontinence or worsening symptoms with subsequent vaginal delivery. If symptomatic or with abnormal endoanal ultrasonography or manometry, the option of elective caesarean section should be discussed. If asymptomatic, there is no clear evidence as to the best mode of delivery. There were no Cochrane reviews or randomised controlled trials to suggest the best method of delivery following a previous third- and fourth-degree tear. The risks of a subsequent vaginal delivery after third- and fourth-degree tear were examined in four studies, 12,23?25 which showed between 17?24% of women developed worsening faecal symptoms after a second vaginal delivery. This seemed to occur particularly if there had been transient incontinence after the index delivery. 23 All women who have had a previous third- and fourth-degree tear should be counselled at the booking visit regarding the mode of delivery and this should be clearly documented in the notes. If the woman is symptomatic or shows abnormal anorectal manometric or endoanal ultrasonographic features, it may be advisable to offer them elective caesarean section. There is no evidence regarding the role of prophylactic episiotomy.

This page from UK Midwifery might be useful too
www.radmid.demon.co.uk/thirddeg.htm

Thank you for your replies sorry for the delay in responding.

willow2 and pupuce - I agree with what both of you are saying regarding third degree tears. I think that the section was best thing last time but I do want to have a good experience while having a baby (although I like that line about having a baby not a birth). It's difficult because I want to have a happy experience but not jeopardise how I feel as a mother by having my children in less than ideal situations (although the c-section was very calm and nice in a way, both DH and I feel that DD wasn't ready to be born). The more I read about the benefits of natural childbirth the more I feel I've done my children a diservice.

What I was trying to get at was how to find the world's best consultant and not just the one at the local hospital who may or may not be great.

Don't think I've explained myself very well but it's late so I shall stop now.

Why do you think you've done your children a disservice? Do you think that the nature of their births has affected how you relate to both your children and motherhood? Or do you think your children would be "better" in some way if their births had been "better"? I am not sure what you mean but, either way, I am sure you haven't done them a disservice. You sound like a very caring mum to me.

Thanks willow2.

I know it sounds ridiculous, I would think it was mad if I heard anyone else say the same things but there is that nagging doubt that their start in the world could have been better.

Both children are just perfect; healthy, happy and beautiful. But DS was born with a massive blister on his head and grazes on his face (ventouse and forceps) and DD yelled loudly for the first couple of months. It took her quite a while to master feeding and sleeping. We feel she was sprung too soon (a week before her due date). That's why I'd like to have a go at a natural birth again.

Ultimately I guess it's all part of maternal guilt

Maternal guilt is over-rated. Ditch it immediately. My ds was born resembling an elf he had such a pointed head and he still has scars from the forceps (very faint but I know they are there)but I don't blame myself for that... just the numpty who mismanaged his birth. Do not blame yourself for anything that is out of control - and do not think for a minute that when your children are getting their degrees in astrophysics that they are going to be thinking, "Now if only I hadn't been born by forceps/c-section - I would have got a quadruple first instead." There's other thoughts that I'll gladly share with you - but off board as I can't be bothered to start another heated debate - so cat me if you want."

There are, even