I had a homebirth client a few months back who had a 4th degree tear last time in birth centre. She apparently waited 5 hours to be stitched up and had terrible probs afterwards - fecal incontinence, couldn't squat without severe pain, couldn't have sex etc etc. Finally after a year and seeing many specialists she found a guy who agreed to cutting and restitching and she said she didn't look back.
She had a beautiful homebirth with an intact peri and an 8lb bub. Cheers Jo -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Meaghan Moon Sent: Wednesday, 31 August 2005 6:18 AM To: [email protected] Subject: Re: [ozmidwifery] 3rd degree tears Funny you should ask that right now. We have two mum's in care with previous 4th degree tears. ( One of these happened a couple of years ago while under my care - as prime with large baby but no other concerns, just happened. I had two in one week and am hoping I will never see another. She also broke her coccyx during that birth. What a loud crack it made!!!) Anyway, both mum's in care now are having some fecal incontinence, which has started during third trimester : ( . The one that happened under my care was referred for physio after the birth which she went to for 6 weeks but has not been religious about doing exercises since. Physio says she has some muscle strength there. Mum is working hard at her diet to reduce excess sugars/carbs to keep babe handleable size, which seems to be working. We (midwives) have had some hemming and hawing about the possibility of episiotomies with repairs at the time of birth, but seem to have decided against this. The midwives would like to see them both attempt vaginal birth without epis (haven't seen any evidence that epis would be beneficial), see how they recover after birth and refer to an appropriate surgeon (not obs/gyne) in a larger centre for assessment and subsequent repair if necessary. Of course, if a 4th happens again they will need to be repaired on site and then referred later. Discussions with mums about this as potential plan is to occur yet. Both have requested consult to obs (different docs) and we are waiting for responses - mums and midwives will be unhappy if cesarean is suggested. In the research I have done so far, it seems it is not just previously torn muscles that contribute to incontinence. Pudendal nerve damage could be the etiology. This would require different treatment than surgical reconstruction, so assuming that one could "cut and then fix" at next birth does not seem logical or humane. I am hoping both mums will have faith in their bodies abilities to have healed well and that they will have less trouble this time. Any other ideas out there? Meaghan, in Canada At 06:18 PM 8/29/05, you wrote: >Out of curiosity...... does anyone have any experiences of vaginal birth >following previous 4th degree tear? I've just recently met a woman who >wants to give vaginal birth a go - has new partner (says old one was >huge!). She is smallish person - 60kg, last babe 10lbs (1st baby). What >do you think. She will be birthing in hospital. I've asked her to get a >copy of her obstetric records from previous hospital. Still in early >pregnancy so can't gauge size yet. Is a later ultrasound a good idea for >a gestimate on the weight? I know they can be so inaccurate. > >Kiwi Kim, > >-------Original Message------- > >From: <mailto:[email protected]>[email protected] >Date: 29/08/2005 11:10:23 a.m. >To: <mailto:[email protected]>[email protected] >Subject: [ozmidwifery] 3rd degree tears > >Hi, >I've just returned from a clinical placement in SA where I spent a >mindblowing three hours in an incontinence clinic in an outpatients unit >at a major hospital. >The mindblowing element was the following statistics (copied from one of >the handouts): > * 39-49% women tear or have an episiotomy needing sutures > * 0.5 - 2.5% have a 3rd or 4th degree tear after vaginal childbirth > that is visible > * 25-35% after first vaginal delivery have a concealed or closed 3rd > degree tear, not visible >Listed as contributing factors were: > * 1st vaginal birth > * forceps/instrumental delivery > * long second stage >1 hour > * big baby >4kgs > * tissue type, short perineum, epidural, uncontrolled pushing, rapid > delivery, midline tear or episiotomy > >The nurse practitioner stated this was all evidence-based information and >recommended c/sections to women who had had previous 3rd degree repairs - >these were the ones who knew about their tears obviously. >The handouts do not give references and as yet I have not had time to >begin researching. > >Are you all as mindblown as I am?? >What do you think - are 1/4 - 1/3 of us walking around with damaged anal >sphincters and not aware of it?? >Where does this sort of information lead us - if our bodies are so inept >at giving birth then all first babies and subsequently all babies should >be born by c/section. > >Sue > ><http://www.incredimail.com/index.asp?id=54475> >Add FUN to your email - CLICK HERE! > -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
