Hospital birth trauma- c-section next time? - Mothering Forums

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#1 of 24 Old 03-27-2008, 11:55 AM - Thread Starter
 
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Hi all

I was hoping to get some experienced opinions on my situation. We've been recently thinking about a second baby, but my birth experience the first time around has me frankly quite terrified.

In short, I have a bicornuate uterus, my son was breech most of the pregnancy until the very last few weeks when he turned into several different positions. I ended up opting for a vaginal birth although a C-section had originally been scheduled (DS was head-down when I got to the hospital), and was basically torn up completely during the birth- 3rd degree perenium tear, torn vaginal wall on both sides, torn cervix, torn artery, torn labia, massive swelling for many weeks after the birth. I lost a lot of blood (about 1.5 liters) and was not "right" for about 2 years afterwards. After my birth, the attending doctor told me "next time, C-section!". My entire birth story (just finally wrote it!) is here.

I've read a lot of encouraging stories of natural births after 3rd and 4th degree tears, but have not yet read anything about torn vaginal walls and cervixes, and what effect that may have on future births.

Does anyone have any stories or advice or recommendations for me? I feel I am so traumatized by the first experience, I want to be ready and informed next time around. I never want to go through that again, and am wondering whether a c-section really is the best way to go.
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#2 of 24 Old 03-27-2008, 05:00 PM
 
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Wow, that is quite the tale! I don't have advice to offer but just wanted to encourage you that information does help and maybe someone here can help you! Perhaps do a search for 'bicornate uterus'.
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#3 of 24 Old 03-27-2008, 07:16 PM - Thread Starter
 
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Thanks for your response.

I have searched quite a bit regarding bicornuate uterus but so far I have not come across any stories where the injuries were this extensive. I have the feeling that the bicorn uterus didn't cause the injuries, but rather the meds that turned my birth into a race against the clock, but I may be wrong.

I will still keep looking for answers, but would be happy for any suggestions, tips, experiences, stories, etc.
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#4 of 24 Old 03-27-2008, 07:25 PM
 
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I have a bicorniate uterus as well. There is not a lot of info out there, as I remember from when I was researching. I can't give you any advice as my DD was born by c/s. Good luck.
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#5 of 24 Old 03-28-2008, 03:00 AM
 
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I also have a bicornuate uterus. Mine is very slight, though. Although my DS was a footling breech at birth (discovered when I was 10cm -- he was born by emergency cesarean), my DD was not breech at birth. She was head down my entire pregnancy. Her birth still ended with a cesarean, but I labored for 24 hours and pushed for 3 hours. I am very glad that I labored with her.

It sounds to me like you will have to do a lot of soul searching, talking and thinking this one through. Do you know anyone who is a doula or midwife that you could sit down and talk with a few times? I know that there are many doulas that you could connect with and talk with even over the phone... that might help you process your past and what you see for your future births.

Your birth sounds very traumatic, and I can see why you would be drawn to the idea of a cesarean. I think if you really start looking into the risks/benefits of a vbac vs. cesarean, and looking inward and how you feel about each of those choices, your heart will tell you which way to go. Another thought is that you could decide while you are in labor. You could find a doc who is flexible either way and see how you feel while you are actually doing it.

GL and

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#6 of 24 Old 03-28-2008, 01:21 PM - Thread Starter
 
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AugustineM, yes, you're right, I have realized now that the idea of a second child is becoming more concrete that I have a lot of things to come to terms with and think about that I kind of pushed aside for the past few years. I will certainly look for a doula who I can talk things through with.

I am actually not at all drawn to the idea of a caesarian, it scares me as much as having another traumatic vaginal birth, and the thought of having to spend 6 days in the hospital again totally puts me off. I will keep searching for success stories of natural births after birth injuries such as the ones I have.

Thanks for your words!
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#7 of 24 Old 03-28-2008, 02:45 PM
 
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I just read your story. I think that the actions of the doctor were irresponsible. To put you on medications you hadn't requested nor did you need and then give you so much. It seems very irresponsible.

I imagine your labor and birth would have been a lot less traumatic with less intervention.

I would take some time to learn more, get your medical notes, and then make a decision.

Mom of a 7 yr old, 4 yr old, and 1 yr old. Wow. How did that happen?
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#8 of 24 Old 03-28-2008, 03:35 PM - Thread Starter
 
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Thank you for taking the time to read my story, Megan.

I still want to give the doctor the benefit of the doubt, somehow. i don't think she meant to do me harm, and I keep thinking that maybe I was just too sensitive to the pitocin? I am relatively sensitive to meds, and usually need a lower dose then others. I even had them reduce the epidural meds because the basis dose was too strong for me. Maybe it was a normal dose of pitocin and I just reacted very strongly? I don't know.

I vividly remember the IV drip being on 25 until just before my son was born, and the doc turned it up to 65. I am not a doctor and don't know what this means, but on my hospital release form it says the pitocin drip was 15 IE/500ml. Maybe it was just too much for me? My neighbor (a neonatal nurse) delivered at the same hospital 3 months before me and said hers was on 200, so maybe it really was just a hypersensitivity.

Anyone know anything about this?
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#9 of 24 Old 03-28-2008, 06:44 PM
 
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In terms of the tearing (don't know about the pit, sorry!) I do know one wonderful mama who helped me after my own 4th degree tear. She also had a tear that extended into her cervix... she went on to have vaginal deliveries free from tearing (and with bigger babes). I know it's only one anecdotal story, but since I know how hard it can be to find information on this sort of thing I thought I'd share.

Is there a therapist in your region who works with birth trauma? A physical therapist of chiropractor who could help you re-align your body (which is probably holding onto some of the physical stress/pain of that experience!)? Maybe a hypnotherapist who could help you explore and restore the emotional/physical pain these experiences caused you? A doula or midwife trained in Birthing From Within who could meet with you?

I'm so sorry you're having such trouble (though glad you've realized the need to work through this before you're pregnant again and under a deadline so to speak). I would love a third child but know I'm not yet emotionally or physically ready to face another pregnancy and birth. For me, gathering all the data I can on SD, 4th degree tears, pelvic organ prolapse, etc and the impact of future births on my existing condition has been soooo helpful. So I hope you find the information you need to make the decision that will work best for you.

And something an OB told me... it's ok to change your mind. I was terrified of getting pregnant and "having" to have a c/s but terrified of another complicated delivery and she said "you know, you don't have to decide now...you can wait till you're actually in labor and decide that it is or is not working for you and go from there". Not maybe the most "natural living" advice on the block, but it made me realize that even when that baby-deadline is in place there are options.

hugs.

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#10 of 24 Old 03-28-2008, 09:09 PM
 
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I suggest that you get ALL of your records before you make any decisions at all and read up on what probably happened and how it all was managed.

As for a bicornuate uterus, there are gradations of this variation of the normal uterus, and I would ask your doctor which category your fit in and go from there. If your doctor does not know, do not go back to him. He should. That is why he went to medical school, to diagnose and treat properly.

And...I am sorry you endured that kind of torture. Labor is hard, but it can be gratifying also. If you have another baby, I would suggest a savvy doula to advocate for you.

"The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic."
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#11 of 24 Old 03-28-2008, 09:22 PM
 
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I wanted to respond after reading your post, because I am going through much the same feelings and have so much sympathy for your situation. My first birth was quite traumatic, and it has only been recently that I've thought I may be able to do it again - I think I do want a second child, but it's so hard to sort those feelings out from my fear of birth.

I wish you well in finding the best path for you. One thought for you is that birth trauma counseling could be helpful. I had the luck to live in the same city as Penny Simkin and found her birth counseling to be so helpful. I no longer live there, but I know she does phone counseling as well, and am thinking about doing that - it could be something for you to consider.
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#12 of 24 Old 03-29-2008, 05:31 AM
 
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I agree with the previous advice about getting your records. I am so sorry you had a traumatic birth. I wouldn't rule out having a vaginal birth - keep searching for answers and info. Have you posted in Birth Professionals?

Mama to my spirited J, and L, my homebirth: baby especially DTaP, MMR (family vax injuries)
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#13 of 24 Old 03-29-2008, 12:05 PM
 
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Wow, what a difficult experience you have had! I have to say I'm really impressed that you managed to breastfeed your baby despite what must have been incredible pain. And I'm also impressed that you're still thinking so rationally about your birth options. I think a lot of women in your position would just automatically jump for the c-section without further consideration.

When I have decisions to make, I like to make lists of pros and cons. I dunno, maybe this will help you?

Pros of having a scheduled c-section:
- You know when the baby will arrive and can plan around it.
- You know approximately what the risks are, and what sort of pain you will be in, instead of facing the unknown.

Cons of a scheduled c-section:
- Risk of significant complications to you and your baby. The Coalition for Improving Maternity Services lists most of them here.
- You know you will have significantly more pain than if you manage a good, normal vaginal birth.

It sounds to me like you should get hold of your medical records and get lots of second opinions about your first birth. Is there some reason why you tore so badly? Did your baby come out in an unusual position that made tearing more likely? Did the pitocin and epidural play a part in the tearing? (I think there's a good chance that they did- if you had been able to feel what was going on as you were pushing, you might have wanted to change positions for one that would have minimalized the tearing.) I would also look into having a midwife instead of a OB- midwives are (in general) more committed to viewing birth as a natural process and might have helped you to labor in ways that would have avoided the epidural-pitocin combo.

Whatever you decide, I hope you will be at peace with your decision and have a wonderful birth!
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#14 of 24 Old 03-29-2008, 06:23 PM - Thread Starter
 
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Wow, so many encouraging words and great advice.

I am in Germany, and natural birth here is strongly promoted, even in hospitals. Health insurance pays for a midwife to care for you before and 8 weeks after the birth, so I am sure that I can easily find someone to talk through this with.

I guess what I am looking for here is to finally BELIEVE that I can give birth again without sustaining injuries like I did the first time. I've been told (by my ob/gyn, who is NOT the doc I had in the hospital) that I don't necessarily need to get a C-section, but until I started reading other people's stories, I didn't really believe that there really is a good chance I could come out of birth relatively unharmed next time around. Reading all of your comments and stories and advice is helping me more than you know!!!
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#15 of 24 Old 03-29-2008, 09:44 PM
 
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I read your birth story that you linked to, as well as this thread, and I have a few thoughts:

First of all, please don't blame yourself - you aren't "too sensitive" to the pitocin - it is completely unnatural, you should not be used to it! I get the impression that your birth was extremely rushed (likely due to the upcoming shift change).

I used to be a L&D RN, the standard protocol for pitocin was to add 10 units (IU, I think?? sorry, can't remember for sure) of pitocin to 1000 ml of IV fluid. I am not totally sure how that translates to the dosage you mentioned but it sounds like yours may have been a stronger concentration. Then, we have very specific protocols to only increase the amount being delivered through the IV by a tiny bit every 15-30 minutes, but no increase if the contraction pattern was already good or the baby's heart rate was not good. No matter what units you are talking about, going from 25 to 65 is a HUGE increase and should not have been done.

I am pretty confident in saying that your extensive injuries were due to a combination of being rushed, forced pushing, epidural causing you to not be able to feel anything, high pitocin, and the baby (your first) being born in 4 minutes. It takes TIME for the tissues to stretch properly, especially with the first baby. Of course no one could say that you would not have had any tears if those things hadn't happened, but what happened to you is certainly not normal. I also wonder if you were actually fully dilated at the time they had you start pushing, or if they told you to push before it was actually time (this may have contributed to your cervix tearing).

s to you as you continue healing. I'm sorry for what you went through, no one should be treated that way.
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#16 of 24 Old 03-30-2008, 09:54 AM
 
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i tore in my vagina with my first. it was pretty extensive and then i had a lot of healing issues. i was worried about my second birth. i had a homebirth. it was wonderful, i could do what ever i wanted and move how i needed. i had an almost 9 pound posterior baby come from high to out in 15". i had a small labial tear, 2 stitches and no problems healing this time. i just wanted to share my experience.

i agree the "management" of your labor was very likely the cause. i would definately get a new care provider, preferably a midwife this time around. best of luck, i totally understand your fear of another birth, i was there. for me, my homebirth was very healing of my trauma from my first birth, both physically and mentally.

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#17 of 24 Old 04-01-2008, 04:05 PM - Thread Starter
 
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Thanks Mama2Xander and Sarah for your responses.

After hearding so many opinions, I am pretty convinced it was the drugs/epidural that caused my tearing.

My only concern still remaining is whether it is common to tear again the same way the next time around, or to have additional complications even if I don't tear (I have heard about incontinence even if the second time was not as bad as the first.). Sarah, it was really a relief to hear about your experience!!! I'm glad to hear it went well for you the second time around.
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#18 of 24 Old 04-02-2008, 12:27 AM
 
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thank you. in my experience and those that i am aware of (with doula clients and friends) it doesn't seem to make tearing more likely the second time. i can't think of anyone that had more than a small labial/perenial tear for a second or more baby and i know a couple people that had significant tears with their first. i think the most important things are allowing the baby to come on its own (ie no pit, ect), trying to let the baby come down slowly (i wasn't able to do this, my body likes to expel babies quickly!), and making sure your tissues are in good shape going into birth (for me that means seeing a specialist at a vulvar/vaginal clinic and doing lots of different things baking soda soaks, zinc oxide, steroid cream, ect as part of difficulies healing after my first birth.) for some people that may mean using evening primrose oil because it's good at softening scar tissue.

the incontience thing is unrelated to tearing, it's a matter of strong pelvic floor muscles and prolapse issues. a weak pelvic floor and a prolapse are more likely in any subsequent pregnancy.

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#19 of 24 Old 04-02-2008, 01:10 AM
 
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Originally Posted by applejuice View Post
I suggest that you get ALL of your records before you make any decisions at all and read up on what probably happened and how it all was managed.
I would recommend this to anyone who births in a hospital. I ordered my records and our DDs records and went over it with a CNM friend of mine. I finally got to see what the hell happened to us (even though our birth was not very traumatic, per se).

As informed as I was two years ago, stuff still happened that I wish didn't happen. It could have been avoided (most likely) had I had a homebirth instead. Next time...
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#20 of 24 Old 09-10-2008, 05:52 PM
 
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As long as you don't have to much scar tissue and no time to soften it I would at least look at it again. Your records can be so interesting.

I didn't tear with number three (I knew I would with #2 since my ob with number stitched a bunch extra and sex hurt clear up till #2 was born)
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#21 of 24 Old 09-20-2008, 06:01 PM
 
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Originally Posted by Erdbeer View Post
I vividly remember the IV drip being on 25 until just before my son was born, and the doc turned it up to 65. I am not a doctor and don't know what this means, but on my hospital release form it says the pitocin drip was 15 IE/500ml. ... Anyone know anything about this?
I looked up the package insert to Pitocin shortly after I had a client who I believed had been over dosed on Pitocin. She was.

Basically what the package insert says is that the Pitocin drip should be started at 0.5-2 microunits per minute, and slowly raised every 30-60 minutes until an adequate contraction pattern is achieved. The package insert further says that dosing at 6 microunits per minute mimics a "natural labor" and that levels higher than 9-10 microunits per minute are "rarely needed."

What you were seeing--the 25 and 65--is the milliliters of solution being delivered to you per hour. The "microunit per minute" dosing can be calculated based on that and your statement that your Pitocin solution was mixed at 15 IE/500ml (15 units per 500 milliters). Many OB's do raise the Pitocin immediately after the birth (running the remainder of the bag of fluid in) after pushing is complete to help prevent post partum hemmoraghe...but since only 5% of women will even have a hemmoraghe...it does seem like over-treatment to do it to ALL women.

Anyway...based on the numbers you gave, when your IV pump was reading 25, you were at a dose of 12.5 microunits per minute. Go back and read above...levels greater than 9-10 microunits per minutes are "rarely needed." Of course I've yet to have a doula client who was given Pitocin who *didn't* eventually get to 12...even when it was a CNM giving the Pitocin. And of course every one of them started having decels of the fetal heart rate at 12...including one really scary case where the nurses were instructed to go start getting the OR ready for a crash cesarean...which fortunately was avoided when the heart rate recovered after the Pitocin was turned off. Of course they turned it back on again and there were some mild decels again...2 separate episodes that led to turning off the Pit abruptly again. GGGGRRRRR.

Actually, in the case of the birth that led me to learn specifics of Pitocin dosing, the drip was started out at 4 microunits per minute, raised to 8 at 15 minutes, 12 at 30 minutes (at which point the midwife left the room, leaving the expectant dad and I alone with the mom who had finally started having contractions at 15 minutes--she'd been trying prostaglandins to no avail for nearly 24 hrs before Pitocin was started--her water had broken), 16 at 45 minutes. By 45 minutes she was absolutely out of her mind with the intensity of the contractions. That would be *before* the 16 really had time to kick in--she was reacting to the 12. I finally went and tracked down the midwife to tell her things were just too intense, and she told me "this is what labor is." I didn't want to argue with her, so just went back to my client. But a couple of minutes later the CNM came into the room, observed a few contractions, and then quietly turned the drip back down to 12. The mom went from 4 cm to complete in 1 hr 45 minutes--first time mom.

When your drip was raised just after the birth it was raised to 32.5 microunits per minute (which I've seen done post partum--even higher in one case, but the risks are much smaller at that point). I haven't read your birth story yet (I plan to!), but I believe that if you had the Pitocin for very long that you may have started to retain water (a common side effect of Pitocin), which may have caused swelling. This coupled with the extreme power of the contractions may have very well contributed to your severe tearing.

Jenn

Editted to add...

Okay, I just read your birth story. Yikes! The Pit was raised to 65 BEFORE you started pushing! HOLY COW! Yeah, your OB was going to make sure you birthed that baby before 10pm no matter what the consequences. Kind of similar to an aquaintance of mine who discussed episiotomy with her OB who told her "I only do them when medically necessary." "Medically necessary" became "I've got another client who needs to have a cesarean so you've got 10 minutes to push your first baby out...here, let me cut a nice episiotomy (without getting consent first of course) to help you out with that..." No wonder you tore stem to stern! As for the comment about your being a red head...its CRAP! I bought into that too..."you're a red head, so nursing will hurt..." blah, blah, blah. NOT! I tore with my first birth (2nd degree)--I was squatting and pushed my DD out in 20 minutes. But second birth I pushed my DD out in 10 minutes and had "skid marks." No stitches. 3rd birth (biggest baby) was born with his hand up next to his ear with about 5 minutes of pushing, and I had NOTHING. Same with 4th baby--no skid marks or anything. And as for nursing (just in case that was an issue for you), I finally learned before my 3rd was born that you REALLY need to watch that top lip to make sure it is flared out. My babies didn't tuck it in--they just just kept it straight--so I didn't think anything was wrong with their latch because it wasn't curled under. If I pulled it out with my pinky finger, I had no pain.

Hugs!
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#22 of 24 Old 09-20-2008, 06:05 PM
 
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I used to be a L&D RN, the standard protocol for pitocin was to add 10 units (IU, I think?? sorry, can't remember for sure) of pitocin to 1000 ml of IV fluid.
That is the dilution that is reccommended on the package insert for Pitocin. Unfortunately, standard protocol varies from hospital to hospital. What I've seen in my area is 30 units in 500 ml of IV fluid, then it gets piggy backed with a bag of straight IV fluid.
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#23 of 24 Old 09-20-2008, 08:49 PM
 
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Yikes, what an ordeal! I'm so sorry, that truly does sound horrific.

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Originally Posted by Erdbeer View Post

My only concern still remaining is whether it is common to tear again the same way the next time around, or to have additional complications even if I don't tear (I have heard about incontinence even if the second time was not as bad as the first.).
The tearing that was inflicted on my cervix during my C-section was nothing compared to what you endured, but it did raise some flags for my next birth. I was hyper-vigilant about taking tons of EPO and also using it to massage the scar tissue. I think it really helped, because I had no problems with it during my homebirth. My midwives and I were really worried because the scar was right over a major artery in my cervix, and I had nearly hemorraged to death after my first birth because of it. But everything was fine, thank goodness. My body does heal exceptionally well when it comes to scarring, however.
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#24 of 24 Old 10-06-2008, 03:54 PM - Thread Starter
 
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Knitted... Wow, thanks for all the time you've taken on my story. I just decided to check back after a long time because I am now 19 weeks pregnant and trying to figure out what to do about birthing next time around.

In the meantime, I ordered my records from the hospital and it says the pitocin was turned up to 60ml/h (guess I was a bit off) about 50 minutes before my son was born, and was turned from 36ml/h to 48ml/h about 25 minutes before that. I really remember the doc turning it up from 25, although this is not reflected in my record. Then again, several things that happened during my birth (like my blood pressure dropping through the floor and me being sewn up for 2 hours, not 40 minutes) are also skipped over or inaccurate in my record.

I also spoke to my ob/gyn who advises me to birth in the hospital, simply due to the cervical tear. Since I bled so much, she says it would be unwise to risk this happening outside a hospital environment. I asked her to look through my record, and she glanced at if for about 90 seconds and said she didn't find anything out of the ordinary and couldn't see a reason for me tearing.

After that, I spoke for 2 hours with a midwife who worked for several years in a large hospital and now exclusively does home births. She said reading my record made her sick and angry, and it is evident that the doctor overdosed me on pitocin to try to get the baby out fast. She said my body didn't have adequate time to adjust to the changes that were happening and she's 100 percent sure this is the cause of my tearing. She said she's seen this quite a bit in hospital births. She seemed very confident that I should go for a home birth next time, but I am still full of doubt. Also, maybe it is unfair of me, but this midwife is quite young and can't be practicing for more than 8 or 9 years max... this somehow makes me insecure because maybe she's just overconfident? I'd feel better if I got this info from someone who's been doing this for a bit longer.

Barefootpoetry, I've also read that evening primrose oil is good for softening scar tissue. The midwife also suggested I see an osteopath to work my scar tissue for 2 or 3 sessions before I give birth.n These are things I'm definitely going to look into.
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