scared...not of tearing but of poor repair!

[Peace+Hope]

so, i have several friends who've had a lot of trouble healing from perineal tears because they weren't stiched up properly, and/or have scar tissue that has to be removed for proper healing. for the ones who have a poorly matched up suture, it's a permanent problem of discomfort for them. one was told it can be repaired when she tears "next time."

i'm more afraid of a botched stitching job than an actual tear!

so, i have a couple of questions:

1, is "granulated" scar tissue related to poor care, or is it something i could prevent PP by how i treat the area?

2, how would you broach this topic w/ your care provider? i'm planning a home birth with a pair of midwives - i guess i need to just bring up my concern with them. i don't understand how so many women i know irl would have this problem unless there's a lack of attention or proper care going on (not with these midwives, in those cases). don't want to insinuate that!

[lifeguard]

I would definitely bring up your concerns with your care provider. I would even ask how often they have had to do repairs 'cause quite frankly practice makes perfect.

I had granulated tissue but the repair my ob did (on a 3rd degree tear) was VERY good. My understanding is that the granulated tissue really doesn't have anything to do with the repair job or the care taken afterwards because it is in fact a type of scar tissue. Someone else might have different info on this though.

With the granulated tissue though removing it took seconds & it was a instant fix (for me anyway) so it is not something I would worry about.

[MsBlack]

One way to avoid issues with poor repair is first, try to avoid tearing! LOL, of course....true enough, but not always possible under best of circumstances and care. Still, investigate what helps to avoid tears, in terms of pregnancy as well as birth matters. Being healthy overall, and also choosing your own birthing positions along with exercising some control (from within yourself) over pushing during those final 'ring of fire' contrax, can go a long way toward avoiding a tear.

With that, you might look now into natural healing techniques, and support your body in healing itself if you tear--instead of getting sutures. Most tears heal just fine if you give your body the right kinds of support for that healing. There are things to do, and things to avoid doing (such as avoiding sitting upright, or stair climbing) for a period of days or weeks after tearing, depending on the tear.

Some tears are indeed too severe, or too complicated, to risk natural healing. So I would want to know how much experience my mws have with suturing, how often they suture, what kinds of lacerations they have sutured and which kinds they might recommend you going to an OB after birth for repair. For any serious or complicated laceration, I would want someone to suture me who does a fair amount of suturing on a regular basis. I know CPMs who do not offer suturing, even if they have been 'trained' to it; they told me that they seldom see tears, and what they see most often is minor and not in need of suturing. So they get so little practice with suturing that they feel it's best to refer out to a practiced OB, when they occasionally do see a more serious/complicated tear.

[Mrsboyko]

If this is such a major concern with you, you could always transfer in the case of a tear. OB's by definition have more experience with tears and repairs than any midwife will have.

[GoldmanBaby09]

I was really afraid of tearing, too, but I did and it wasn't any big deal at all. I had four internal and 3 external and my hb midwife stitched them up like she could do it in her sleep. In fact, I consider those to be $3300 stitches because she didn't get there until I was ready to push, and other than feed me ice chips, it was really the most she had to do! But she gave me a peri bottle with some antiseptic to mix with water to squirt. I felt totally healed by two weeks and DH and I have been back to DTD without any pain since then.

I agree to try and find the best position that works for you. I thought for sure there was no way I would end up at home pushing on my back in bed, but low and behold that was what ended up working for me. My DS also barrelled out head to chest in one big push after two hours and many different positions.

[terrabella]

I never teared, knock on wood. But I did have an epi with my first babe. It healed beautifully! No scar tissue at all. Healed fast too. I've never had any problem with it in later births. So, a repair down there can turn out ok!

Definitely have your midwife use a lubricant. It makes a HUGE difference.

[camprunner]

I had a partial 3rd degree tear with my first in the hospital and with my 2nd at home.

At the hospital, the procedure went very smoothly and it really didn't seem to be a big deal at all.

With the second, the back up midwife who attended my home birth was not experienced in sutures and had not done stitches unsupervised until me. The litacain wore off half way through the procedure and had hurt the first time (I think she waited to long to do them?) So I was very insistant that there would not be aother needle down there. It took an hour and a half for her to get halfway done with them. However, I walked like a stick figure for 6 weeks and healed up the rest of the way. She did get the stitches done well in the muscle so I guess that's why I was ok. The original midwife had more experience with stitches and I often wonder if it would have gone more smoothly had she been able to attend but I will never know.

I have never had a problem with the tear or the stitches.

[Peace+Hope]

thanks ladies!

bringing it up here makes me more comfortable with the idea of having a conversation about this with my midwives. i've read so many birth stories, and of course sometimes even women under the best care and with the best options for birthing and positioning still tear. i'm working through birthing from within now and doing my best to address all my fears up front. i believe in trusting in my intuition during the birth!

heh, still makes me a little uncomfortable asking them, so, how are you with sutures? but, if i approach it from the perspective of that being MY fear, i'm sure they will be able to help ease my concern.

i guess if i do tear, i will probably ask them if they are comfortable with the type/severity, and consider transferring if they are not - it'd have to be pretty bad!! i know, i do things well that i'm confident about, and i will trust them if they are confident it's something they can do well.

i'll also be asking them about naturally healing vs. suture, great point! i need to do more reading about how severe a tear can be and not need stitches.

funny.... nothing else about labor/birth scares me - i feel like it's all me, my body, my baby, my husband. suturing (MW fixing something on me) falls in a different headspace.

[MsBlack]

Originally Posted by Peace+Hope

thanks ladies!
suturing (MW fixing something on me) falls in a different headspace.

Well I can see why! All of the rest that you name is 'the birth'; tearing/suturing is 'the rest of your life'! It's your yoni, it's peeing, pooping, sex/pleasure, sitting, moving....from now until death do you part

So I'm not surprised to hear you say that. Pretty important stuff after all

[Peace+Hope]

Originally Posted by MsBlack

Well I can see why! All of the rest that you name is 'the birth'; tearing/suturing is 'the rest of your life'! It's your yoni, it's peeing, pooping, sex/pleasure, sitting, moving....from now until death do you part

So I'm not surprised to hear you say that. Pretty important stuff after all

well said!!! hard to feel laid-back about it when i want to be like, PLEASE do not screw up my tissues for life!

reminds me of the "pushed" blog heading, "but my vagina" haha

[nikirj]

Don't be afraid to ask your MW!!! It is not going to offend her at all, and it is TOTALLY her job to talk to you about your worries during prenatal appointments.

I am forever grateful to the women who let me do their repairs while I was training. My preceptors were always *right there* to make sure I did good repairs, but I still think that it was such an amazing thing that women let me do it.

And *gah* I have never taken so long to do a repair that the lidocaine wore off, even when I did some really rough repairs overseas.

I've seen a really botched OB repair with a very experienced OB. I could tell while she was doing the repair that it was going to heal badly, and sure enough, it did. Experience/numbers aren't everything! Your MW might be so conscientious that she does a much better job than someone with more experience would.