RE: [ozmidwifery] vaginal wall tearing

[Isis and Andrew Caple]

I apologize in advance for rehashing an old topic of discussion, but I need to get this off my chest.   I had a 36 week ANC appointment with one of the hospital OB’s yesterday and I left the appointment shaking with anger. I also left questioning my own wishes and plans. I was asked if I realized the risks of a VB due to my tear. I answered to the affirmative. I was asked if I truly appreciated the ‘great’ possibilities of incontinence if I had a VB. I answered yes, but didn’t engage in a debate over the actual research done and what may cause the incontinence.. I was then asked how I felt in the event of a successful VB, with no tear, still meaning that 10-20-30-40 years down the track I would most likely still need a colostomy bag due to the damage to the perineal nerves/muscles- all linking back to my ‘ungiving’ scar tissue and my adamant wish to have a VB. How does he expect me to feel, with this doom and gloom prediction being spouted in an extremely patronizing tone of voice?  He went on and on for about 6-7 minutes about how I must realize the risks that my choices could entail. I felt my face getting hot, I felt sweat beading on my upper lip, I started shaking. The only part of my wishes that he actually ‘approved’ was the possibility of an episiotomy..  Then he started on my wish for a physiological 3rd stage- again predicting doom and gloom. His exact wording was ‘Sure it is great to have a natural delivery of the placenta, but you can also die naturally from massive blood loss. Did you know that a PPH can mean that blood is running with the speed of a household tap and before you know it you have lost 3000cc of blood?’ I just nodded dumbly in shock and disbelief..   Today I doubt myself, my abilities, my wishes, my knowledge, my body. I feel physically sick, thinking of all the women who go to see a doctor and end up being scared into submission. No wonder the rates of intervention are so high, no wonder the concept of a normal, natural birth doesn’t actually mean what it sounds like..   I am scared of this birth, I am wavering in my resolve to not have a c-section just in case. I feel empty.   -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lois Wattis Sent: Friday, 6 June 2003 10:15 AM To: [EMAIL PROTECTED] Subject: Re: [ozmidwifery] vaginal wall tearing   Dear Isis - I am impressed with your response to Jo, and the way you have worked through your own experiences.  Congratulations.  You display courage and wisdom in your choice to birth (again) as naturally as possible.  I applaud and endorse the advice given by the private OB.  Being upright through labour and especially the use of water immersion which assists the process of softening and stretching the perineum, and 'feeling' your own progress in the expulsive stage.  Most importantly, allowing the time for the crowning and birth of the baby's head and body to be SLOW, and not forced in any way - YOU WILL PROBABLY NOT NEED AN EPISIOTOMY!!    Many birth practitioners (midwives AND ob's) get very anxious when the birth is slow, and feel compelled to intervene, especially if the birth is in water. Birth in water is gentle on baby and on you...Be guided by your instincts.  Best wishes, and let us know how it goes.  Kind regards, Lois           ----- Original Message ----- From: Isis and Andrew Caple To: [EMAIL PROTECTED] Sent: Wednesday, June 04, 2003 6:19 AM 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...