All confused - consultants have different opinions about fixing tear problem at subsequent birth. Please help...

[bracingair]

At my last birth I had an episiotomy and the stitches got infected and broken down. They couldnt be resutured and healed together on the own. They did heal, however there is a little gap, similar to between the thumb and first finger.

i had met Mr Fernando of the lindo wing to get an opinion about the area down there and with also a view to possibly taking him on privately. He said if i should tear again then we could utilise the time to bring the whole area together.

I recently saw Mr Anthony Silverstone at UCLH and he said that the state of the perinium after birth is not like how it would be once it settles down, so he recommends fixing the whole area at at a later date and not immeadiately post bith.

I am really confused! Mr Fernando specializes in post birth injuries, but Mr Silverstone is extremely senior at UCLH. He did say that he is not a surgical specialist but on the other hand what he does says make sense. What's best?

anyone please?

I'm not sure how many MNetters are consultant OBGYNs, so what you're going to get on here is anecdotes rather than evidence-based clinical advice. For what it's worth, my consultant advised waiting for a year after giving birth to repair my injuries, for the reasons that your Mr Silverstone gave.

i auppose you're right, i just don't know what to do when they seem to contradict each other. I really want to get it right down there!!

Hi Bracing Air,
I dont believe there is any evidence to show that a perineal repair (for a pre-existing perineal defect) at the time of your delivery is better than a perineal repair done after the postnatal period!
In view of this I would suggest a pragmatic approach that if you do not need an episiotomy or repair for a tear sustained at this delivery then I would recommend waiting until a few weeks later for a formal perineal repair operation. It appears logical that the chances of another infected wound are likely to be higher immediately after a delivery whilst you are still bleeding, as both these factors would form an environment where bacterial infection could thrive. If however you did sustain a significant tear at the delivery which needed repairing anyway then it would be sensible to repair both at that time.
I hope that kind of makes sense!!

Tears do heal better than episiotomies, that's one positive.

Hawkmoth - i'll look forward to that

SympatheticConsultant (cool name!) - i think the point of disagreement is that if i do tear in a differennt place one is advocating fixing both at the same time like you say, and the other one is saying that the perinium does not look post birth like it should, so to wait for that bit. I most likely will go private, i'm just worried about what he says iykswim?

I think it is more likely that with a 2nd baby you will not sustain a significant tear or if you do tear it will be in the same place as before (unless whoever is conducting the delivery intentionally performs an episiotomy in a different site). It is less likely that you would tear spontaneously in a different site altogether. If it does occur at the same site then there is no option, if however by chance a significant tear occurs in an entirely different site then I would wait let it repair the new tear and let it heal and deal with the old one separately once you have recovered from the delivery and are no longer bleeding.
Try and be positive there is still a good chance you will not even sustain a significant tear this time round! Perineal tears are much more likely the first time round when the tissues have never been stretched before and secondly when delivery of the head is not controlled and occurs too quickly so the perineum does not have a chance to stretch as the head is crowning. .
But now you've been through a labour the fear of the unknown is less of a factor and you yourself will feel more in control this time!!