HBMW doesn't suture tearing - would this be a problem? - Page 2

[MsBlack]

Originally Posted by Twinklefae

:

I had a second degree tear, which was admirably stitched up. And anyone who says their midwife or doctor 'goes slow birthing the head' - you do know that YOU are the one in control of that right? I was told multiple times to ease up pushing, but the urge was so strong that apparently I told the doctor something that was a UAV, rather than the "I can't" I intended.

And since I then tried to have intercourse 3 weeks pp, and tore them all open again, I am living with an essentially unsititched second degree tear. It's not fun or exciting or something I would recommend for anyone.

I'm so glad you pointed this out--it's important. The best way, IMO, for a provider to 'help' a woman birth the head slowly, is to work with her to slow herself down a bit. It can be SO HARD to resist bearing down when the uterus is demanding that from us! Yet I've seen many times how women can breathe through that urge--at least *just enough* to slow down the baby's emergence, to allow a bit more time for perineum to stretch, and help prevent the kind of tearing you had.

Yeah--if a woman is bearing down actively through that burn of crowning, the mw or doc cannot really slow the birth of the baby's head. At least, they can't do that without causing harm! Far more effective if they, or your other support people, can help you blow through that burn without bearing down. The uterus is still pushing the baby out--but descent is slowed just enough usually, if mom can blow through instead of bearing down.

Also sounds like you maybe didn't get good, firm advice about when to start sex, pp--? Mamas need to be taught how to check out their yonis after birth, so they can know when they are really ready for intercourse...no one should accidentally re-injure a tear, because of not knowing enough about the issue.

[Twinklefae]

I still don't know if I would have been able to stop pushing - as we discussed in another thread, I wanted to push SO badly.

And I was told to wait til 6 weeks - I just didn't, and paid the price. (It's not painful or anything, just awkward.)

[honeybee]

This was a major issue for me with my first homebirth. I had a 3rd degree tear in the hospital with my first. I had a fp, and the tear was bad enough that even though she *could* have stitched it up, she called in the on-call OB. I did not have any lasting problems from the stitches, and I was glad she knew her own experience level.

So, the "what happens if I tear?" question was one of my main concerns when interviewing hb midwives. I interviewed a CNM who was just beginning her hb practice. She used to teach nurse-midwives how to suture at a large teaching hospital. She told me it was very likely I would tear again, but not to worry because she could stitch me up.

The other two mws I spoke to were experienced hb mws. They both said they rarely saw tears, and it was unlikely I would tear that badly again. They could both do some suturing, but in general it was better to let small tears heal naturally. If I ended up with a bad tear again, they would call in the suturing CNM as backup. Before the CNM was available, the clients would need to go to the hospital for stitches.

FWIW, I had a fast birth with #2, and the midwife arrived after his head was born. I did not have time for any kind of perineal massage, nor could I "breathe" through contractions. My body did all the pushing. BUT, I was also in the position that was most comfortable for me, hands and knees, and there was a natural pause after his head was born. I had a very small tear that healed up fine on its own.

I'm comfortable with a mw right now who does not do suturing. If I tear badly and we need to go to the hospital, so be it. A minor tear is better off healing at home, and if I had a major tear that needed major repairing, I'd rather go in to see someone who has lots of experience with suturing.

I do have a friend who had a 2nd degree tear during a hb, which she allowed to heal naturally. But she also didn't get out of bed for several days and made sure to give the area lots of air. It's a judgement call, and probably depends on how much help mom has after the birth.

[nikirj]

Your window to repair a tear after the birth is about 4-6 hours, just FYI.

A third degree is very unlikely to heal properly without suturing, and these repairs also take longer, so I wouldn't hesitate to transfer for that. First and seconds are a different story and that all depends on what the tears look like and how immobile you can be.

Not being able to (vs. not liking to) suture would throw up a red flag for me about a MW's qualifications. I'm not saying to dismiss her out of hand, but in my area where choices are plentiful it would probably be an automatic "no" for me.

[Tithonia]

I realized early on that this was my biggest lingering fear about going with my current MW, who doesn't suture. I apparently had a 2nd degree tear with my first birth, although I actually never noticed it. (Didn't notice tearing, didn't bother me when they stitched it up, never bothered me afterward.) However, when I thought about it further, I realized that I'm pretty sure I wouldn't have torn if I had had my current MW for my first birth. My MWs then did directed pushing (which I was not articulate enough to argue with or question at the time, although it was not at all what I wanted and felt like I was working against my body), and had me lie back for the actual birth. I guess they were trying to help things go slowly (that's what my husband remembers them saying, anyway), but I've read since that that position puts a lot more pressure on the area that's most likely to tear, which I totally believe.

So I'm actually really not worried about it this time, since I have chosen a context and MW which will allow me to do things my own way, listen to my body, and minimize the chance for tearing again. If for some reason it does happen, I'll deal with it then...

[MsBlack]

Originally Posted by nikirj

Not being able to (vs. not liking to) suture would throw up a red flag for me about a MW's qualifications. I'm not saying to dismiss her out of hand, but in my area where choices are plentiful it would probably be an automatic "no" for me.

Wow, that is a pretty strong statement, Nkirj. I appreciate you qualifying that by saying that for you, given your region of plentiful (and legal) mws, no suturing could be an automatic no.

I guess I reserve my 'red flags' for safety concerns, not something like suturing...a midwife, IMO, most needs the qualifications that serve safety. Other qualifications are nice, too--such as LLL leader or LC status, to name one--they're just not my measure of 'general qualification for practice'.

Of course, my region is not legally (or medically) supportive of hb mws--and far fewer practice here, so that definitely colors my perceptions about what is important in a mw, and what is less important.

[homemademom]

For me, being capable and competent at suturing would be part of what I looked for in a midwife. I don't want to have to see a doctor for anything short of an emergency, so if I tore enough to require sutures, I would want it done well and done at home.

[homebirthing]

I am in Minnesota too and I am apprenticing with a midwife that doesn't suture. You can always go in if you feel like it needs more then herbal care to heal.

I feel the same as most of you do as far as suturing. While I still need to learn more about it, when I am hired as a primary midwife, I make sure that I have another midwife on board who can come and suture for me if the mother requests it.

Honestly though, most tears DO heal beautifully if cared for herbally and with baths and rest. But I do think ultimately it is the mothers choice.

Happy birthing!
Sarah

[mwherbs]

I actually read a small study on this today, they either sutured or did not sutured tears that were 2 cm by 2 cm. And then at the 6 week evaluation they had evaluations done by providers who did not know if mom was sutured or not the results were about equal with maybe 20% either way not perfect.

[Ophelia]

Thanks for all the information! I did go with the MW that I had wanted, that doesn't suture. We discussed supporting the perinium, herbal care, etc. so I felt comfortable after talking with her. If I have to go to the hospital to have stitches (if I can't go to a regular clinic or it is middle of the night), then I will do that but hopefully we can do what we can to prevent it in the first place. Really good to know that if I do need to be stitched it has to be soon after birth.