That is so sad. I had quite an extensive 2nd degree tear with Lord knows how many stitches when I had my 1st VBAC. I did not have an episiotomy as my doctor had respected my request to tear rather than cut. (Csec was two years prior for supposed fetal distress).
With my 2nd VBAC 3 years later I said I did not want an episiotomy this time either. Birthing with a midwife this was not even questioned. During this birth my daughter had shoulder dystocia which necessitated the midwife sticking her hand "up there" in order to release the shoulder. My daughter was born fine and I had a tiny little first degree tear that didn't even need a stitch and caused me no discomfort afterwards what so ever. I had also had a perenial abcess layed out between these two pregnancies and my "bum" doctor could see no reason that this should pose any complications or risks to vaginal birth.
I recently spoke to a woman who had been advised to have an elective csec for her current pregnancy due to a prior 3rd degree tear. We did a bit of research together and could find no justification for this as the research generally seemed to show that whilst some women did tear worse the majority tore less. She decided the risk of this was better than the risks of 100% having a cut with a csec and opted to deliver vaginally. She did so without a single tear.
The saddest thing I find is that the OBs don't even tell the women both sides of the fence. Yes they can end up with a fourth degree tear and potentially fecal incontinence but this risk is very small women should be allowed to consider this risk against the very real risks associated with elective csecs - but most OBs seem to gloss over this don't they?
Debby
>
>-----Original Message-----
>From: [EMAIL PROTECTED]
>[mailto:[EMAIL PROTECTED] On Behalf Of Veronica
>Sent: Wednesday, 25 June 2003 4:26 PM
>To: [EMAIL PROTECTED]
>Subject: [ozmidwifery] 3rd degree tear and C/S
>
>
>
>Hi all,
>I wanted to know weather it is common place for women who have had a 3rd
>degree tear to be offered an elective C/S for thier next birth. Today I
>was working with a midwifery student and we did a beautiful birth with a
>women who was having her first babe. Unfortunately she had a 2nd degree
>tear that needed attending to. The resident that was on came and
>sutured her but then we had to call the registrar because she was unsure
>of what she was doing. The registrar had to take the sutures out and in
>doing this the tear extended to a 3rd degree tear. Afterwards, I was
>reading the notes and talking to the midwife who had taken over the care
>of the women and the registrar had offered the women a rpt C/S or an
>elective episiotomy for her next birth. I wanted to know if there was
>any research to back up this because I was pretty upset at the thought
>of this women having to have a C/S after birthing so fantasically.
>Veronica
>
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