Re: [ozmidwifery] vaginal wall tearing

[Marilyn Kleidon]

I have just attended 3 women postnatally who were advised to have caesarean births because of prior perineal tearing. On reading their notes at the beginning of antenatal care the women wanted vaginal births but by week 34 or so they had been convinced to have c/s.   Is this being taught in ob school?  I have also seen the same for shoulder dystocia!! What is happening?? (like I don't already know!!!!) I am just amazed and appalled. There are many valid reasons for c/s, but the above makes no sense to me, especially if the women's original preference was a vaginal birth. And none of the shoulder dystocias were disastrous. I could totally understand if a baby had been damaged or the woman so traumatised that she requested a c/s, but when the woman desires a vaginal birth so much that it is noted boldly in her chart, why is she not supported instead of beaten down??!!!    What is so interesting to me is that many of the women I cared for (in the USA) who sought homebirths for their 2nd or 3rd babies had been so traumatised by their hospital experiences, which included perineal scarring and/or  shoulder dystocias) that they opted out and mostly achieved homebirths with little or no perineal trauma. So, i guess I am wondering if there really is some research out there that supports this ob trend to advise c/s for the above reasons, or is it something else?   always curious   marilyn ----- Original Message ----- From: Isis and Andrew Caple To: [EMAIL PROTECTED] Sent: Tuesday, June 03, 2003 3:19 PM Subject: RE: [ozmidwifery] vaginal wall tearing Hi Jo,   I tore to the 4th degree with my daughters birth. A mix of factors caused it- very fast labour, compound hand and forced pushing while on my back with my legs braced on midwives hips.. My poor perineum didn�t stand a chance.. Unlike your lady, I have had no problems healing, with incontinence or sexual dysfunction.   This birth I have been advised by hospital OB�s to have a c-section. Any midwife I speak to disagrees with that recommendation. A private OB agreed that a VB was indeed possible, but to keep upright, active during first stage. During second stage, no forced pushing as such. Follow my urges and to breathe/grunt with the uncontrollable urges. An episiotomy may be advisable while babe�s head is crowning to �take the pressure off� the peri scar tissue. This same OB mentioned being in a bath, peri massage, hot compresses, having my hands on my peri to �feel� what is happening- but most important, stay off my back J   I wish your lady luck and strength. It is a hard decision to make and only one that we (as the mother) can make. We are the ones that have to stick up for ourselves and take the bit between our teeth.. Then we have to be the one to climb back on the horse and ride again if we fall off..   I shall keep you all posted as to how this birth goes. Less then 10 weeks till birth time finds this family again J   Cheers-  Isis   -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of M & T Holroyd Sent: Thursday, 29 May 2003 10:35 PM To: [EMAIL PROTECTED] Subject: Re: [ozmidwifery] vaginal wall tearing   Dear Jo,   I don't know if this will help, but as a midwifery student I cared for a woman who had had a previous 3rd degree tear (I think... can't remember all the details as it was 5 years ago).  She had to have it repared in OT at the time & I think maybe one more op later down the track... as you can imagine she was very worried this time around.  The Dr's notes stated that she was to have an episiotomy at even the slightest indication that she might tear.  Looking at her perineum the scar was large & there was a dint in it like someone had removed a piece.  Anyway,  from memory she stayed mostly active & only just made it back onto the bed in time for me to catch the baby (I know better now with regards to the bed thing) & I didn't even have time to call the registered midwife until the baby was almost all the way out.  The woman did not have even a graze to her perineum / vulva.  She was absoulutly happy (& so was I ).  She followed her own instincts & no coaching from me or her husband.   Good luck to this woman for whatever she chooses.    Tina H. ----- Original Message ----- From: Jo & Dean Bainbridge To: [EMAIL PROTECTED] Sent: Thursday, May 29, 2003 11:07 AM Subject: [ozmidwifery] vaginal wall tearing   I know there has been discussion in the past about this but I am in a hurry to get some information for a woman whom had a positive vaginal birth that turned ugly when she "tore badly inside and out" (in quotes because that is what she said and I have no further knowledge of what sort of tearing it was.) She has had incontinence problems and sexual dysfunction for the last 16 months.  Her first OB said to have a cs (of course) and then yesterday she was told that she should not have a cs and that a vag birth would be the best option.  She is now very confused and scarred as hubby wants her to have cs and her fear is that a vag birth will increase problems they already have. She is willing to have a vag birth if she can optimise her chance of reducing the damage if a tear happens again. Can anyone offer midwifery woman focused care and positions etc that she could use during a vag birth?  She would have a home birth but she can not afford it.  I suggested an independent mw to take with her to hospital but that was dismissed without reason.  She is an intelligent woman and if she can read evidence to support the chance of her not having further damage caused then she will opt for a vag birth I think.  She wants to make her choice in three weeks so I would appreciate some help in gaining information and not waste time surfing around cheers wonderful women! Hope  you can help me help a woman avoid putting herself and her baby through a cs. Jo Bainbridge founding member CARES SA www.cares-sa.org.au [EMAIL PROTECTED] phone: 08 8388 6918 birth with trust, faith & love...