3rd degree tear and retained placenta - chances of repeat?

[spub]

Dear all,
Have just found out that I'm pregnant - due Jan '06. Am delighted! However, I gave birth in Jan '03 and had a retained placenta (adhesion to the wall of my uterus - I think) and a 3rd degree tear. As it happened, the retained placenta meant that I had to have a spinal block and go to theatre (having just delivered my dd with only gas and air..) and whilst in theatre they also did the repair work due to the tear. I was catheterised and not allowed out of bed for the first 2 days and was kept in for 5 days. I was in quite a lot of discomfort and on heavy painkillers as well as the fabulous combo of lactulose (so as not to be constipated,strain and tear the stitches) and iron (which makes you hugely constipated but which I needed because I was anaemic )

I'd prefer a vaginal delivery again but am a bit worried that one or both of these things could recur and wondered if anyone could offer some advice?
My main concern is not so much another trip to theatre to remove a placenta but the risk of faecal incontinence that accompanies a 3rd degree tear (and that fortunately hasn't come about due to the tear in Jan '03).
The thought of me and a baby in matching nappies is a bit scary...Help!

Yes I know what you mean. You can get an adherent placenta for a number of different rteasons. From my own observations though, I have not come across retained placenta where it has been physiological. Soemtimes I have had to resort to giving an injection when time has passed with no delivery of placenta. Interestingly I have not seen a retained placenta in thoses cases. I have however seen lots of retained placentae (proper spelling) when syntometrine has been given.

Mears,
Thanks.
I have a bit of thinking to do now! Hope you don't mind if I post again once I make 12 weeks and have done some more research.
I appreciate the input (and the spelling!!

Hi Spub
I too had a third degree tear and tho I am not pregnant again yet, have been advised to have a CS for another birth. I think this is partly because my daughter was large (8 lb 13) and it was quite a difficult ventouse delivery, but I agree with whoever said earlier that women are often now offered a CS if they have had a previous 3rd degree tear. I am also a midwife (albeit a rusty one as I have just returned to practice after a break!) and would agree with Mears' advice, particularly regarding episiotomy. My tear followed on from an episiotomy so I would not necessarily regard this as protecting against another 3rd degree tear. However, like Mears I have known women who have had a previous 3rd degree tear and have had an episiotomy and no further damage. I think unfortunately, it's one of those things where there is a certain amount of luck (or bad luck) involved. Sorry to be the bearer of bad news, but I would also say that, as far as I know, having had a previous 3rd degree tear and retained placenta puts you at increased risk of both these conditions, but I couldn't quote figures on that. I think because 3rd degree tears are quite rare,it's quite hard to get the stats. Even if you did, it still doesn't tell you whether or not it will happen to you again, so it's all a bit hard, isn't it?

My consultant also told me that having a subsequent vaginal delivery, even without a 3rd degree tear,puts you at increased risk of faecal incontinence, which is of course the thing we all worry about. I don't know what research that's based on and my midwife friends all think that's a bit dubious, but I think it depends very much what perspective you're coming from (hers was very medicalised). There is a really good website for midwives at \link {midirs.org}, for an information organisation called MIDIRS, and they will do searches for you on particular topics and give you research-based information. I don't think you have to be a midwife to access it and their contact details will be on the website.

Sorry to ramble on, but lastly could I say how nice it is to hear other people's experiences. I really found my tear and recover from it quite traumatic and tho I am not pleased others had a bad time, I'm glad to know its not just me being weedy.

Since I discussed my slow recovery/feelings of numbness from 3rd degree tear that occurred 7 months ago with all you fab MN's, the strangest thing happened. For several days now I have 'forgotten' about it, haven't noticed it at all. Perhaps it is pscyhological or maybe I am just all healed up now. Whatever it is, I feel great now and would like to say to anyone who is feeling miserable after suffering something like this, 'YOU WILL GET BACK TO NORMAL IN THE END'

had retained placenta with dd2 and ds 2 but had ds1 in between with no probs!

Just found this thread as I was talking about this same subject last night with DP! I had a third degree tear with DS 1 last August - he came out like Superman (ie head and an arm - ouch! ) - and was gutted as I had to go to theatre for stitching up (which meant a spinal block when I had managed the birth on just gas and air). I must say I found the whole thing quite traumatic and still shudder when I recall the pushing stage of labour...Would love more babies too but am terrified of tearing again. Am even considering an elective caesarean to avoid this happening again...

i also had 3rd degree December 99 due again end of August.(didnt take long to pluck up the courage)
with ds he was a very quick labour 3 hours and his heart couldnt take it so i had episiotomy and ventouse, the episiotomy was very tramatic for me as i was told i was getting injection to numb the area but before it worked the scissors were in and done the job, so form my personal experience i would never have another one, all the midwives i have seen have advised from my previous notes to have c/s as they feel that what happend was a main factor in me getting PND and if i worry about it happening again it can trigger PND before the baby is born. I have been told if i start to worry to see consultant straight away and go all options until i am happy.
I actually saw my midwife from previous pregnancy today she looked after me at home after the birth and she was saying it still brings tears to her eyes what state i was left in and putting her cards on the table wouldnt risk it for me to try natural again, especially with things being so quick i might not make it to our hospital and i wouldnt fancy having a 3rd degree tear in a layby.
I think it is alot down to luck - personally i know i couldnt cope with another tear like that and plan to have the c/s