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View Full Version : Could this really cause complications during pregnancy and delivery?



edurnemk
08-16-2010, 06:55 PM
Ok, so I'm not even pregnant yet (I think), but we're TTC and something my OB said on my last checkup early this year is really bothering me.

DS was born in Chicago, natural bith, and I had some tearing which was repaired. A few months ago we moved to Mexico and the doctor here (he's a very good doctor, FWIW) said that I had also had internal tearing which was not repaired. He said in the US it's standar practice to let internal tears heal on their own to avoid risk of infection but here they always repair them. His opinion is that these internal tears could cause problems for my next pregnancy, specificall during labor. He wasn't very specific and we weren't TTC back then or thinking about it so I kind of dismissed it.

Now I keep wondering if this is true, or if he's just setting the scene for a "scheduled c-section". BTW the c/s rates here are crazy, higher than in the US. I like to avoid unnecesary interventions, which I know would be a fight here, since they're not used to letting the mother have much controll over the birth experience. A lot of friends have been talked into c/s or induction just for convinience. Seriously, I heard one lady go on and on about how C/s are better for mom and baby after talking with her OB.

Anyone know anything about this? Is it cause for real concern or should I look for a second opinion? I don't want to end up with a c/s if it's not really necessary. I'd also like to find a new OB now, and not further along, if I decide I want to change OB's

swissair81
08-16-2010, 07:51 PM
I would look for a second opinion. I haven't seen your internal tearing, so it's kind of hard to stand on one foot. However, the fact that the c/s rate is so much higher there (and it isn't so low here) makes me kind of wary. This is especially if you are a freethinking American, who likes to make choices about her own healthcare & not be dictated to.

MommyAllison
08-17-2010, 12:58 AM
I had internal tearing with DD, and am trying to remember if they stitched it at all...I think they put a few stitches in (hard to remember as I had an episiotomy and a small tear as well). Anyway, I had absolutely no issues or internal tearing with DS. Not sure if that helps at all. I would get a second opinion as well. From everything I've ever read, tears heal well on their own, much better than episiotomies do, so I'm not sure what issues he is referring to?

Neatfreak
08-17-2010, 01:23 AM
I had 3rd degree tearing with DD1, and had a few stitches. Zero impact with DD2 - also a vaginal birth. In fact, my tearing that time was so minimal that I didn't have any stitches and six hours later it didn't really feel like I'd just pushed out a baby at all. So, I'd third getting another opinion.

citymama
08-17-2010, 01:25 AM
Ditto the PPs above. I think there is some amount of stage-setting going on. Will you be back in the States any time before TTC or perhaps for your next delivery? My friend in Mexico was told at 2 months pg that she was going to have to have a c-section because her body was too small for a vaginal birth! And she did both times!

edurnemk
08-17-2010, 09:42 AM
Thanks everyone. I will start looking for another OB for a second opinion, I don't even know where to start, since most of my friends here have had the birth experience I am trying to avoid, so I don't know who to ask for recommendations. It seems there is only one private hospital where they have LDR rooms (instead of separate labor room, delivery room and recovery) room) and where they allow rooming in with baby, and support BF (BF rates here in middle and upper classes are LOW). So I'll start by asking about doctors that attend there I guess.

I am planning to go to the States soon, hopefully in October, but if not definetely for Xmas. So I might get a second opinon there as well. I'm also still considering having the baby there, but we'll see.

misshollygolightly
08-17-2010, 12:21 PM
I agree that you should get a second opinion. But, fwiw, I had lots of tearing when DS was born (fourth degree, blah blah blah), healed up fine, and my OB seems to think having another vag. birth won't be a problem if/when the time comes. However, he *did* say that *sometimes* you can run into a problem where you have a lot of scar tissue there that isn't as elastic and stretchy as normal tissue. So I'm guessing that's what your current doctor might have been thinking of. I still think you should get another opinion and most likely you'll be fine, but I'm not sure your doctor is totally crazy or c-section-happy either.

AshleyAnn
08-17-2010, 01:30 PM
With DD I tore in 2 areas (a 1 degree and a 2 degree) before getting a 3rd degree episiodomy. The 2 degree and 3 degree were repaired, 1 degree was allowed to heal naturally. At my 6 week PP I asked my OB if he thought I'd need another epi during future deliveries and he said no because the muscles are inheretly weaker now and easier to stretch but the skin's scar tissue is weaker and less likely to stretch easily so 1 degree tears are more likely but not deep nasty stuff like an epi.

luv2bmommy
08-17-2010, 04:56 PM
I'm sorry I don't know much about internal tearing, but, I was told that from internal uterine scarring the fetus might not attach as strongly in the uterine wall, so I guess it depends where this tearing was, if it was external it is much better. I would also get another opinion as pps have said.

edurnemk
08-17-2010, 11:13 PM
I'm sorry I don't know much about internal tearing, but, I was told that from internal uterine scarring the fetus might not attach as strongly in the uterine wall, so I guess it depends where this tearing was, if it was external it is much better. I would also get another opinion as pps have said.

The tearing was in the birth canal, apparently there's some not so nice scars in there. I just don't understand why that would be a problem during delivery. I'm pretty sure he'll try to sell me on the scheduled c/s on the grounds of avoiding more damage or something like that. I can't find much info on the subject, but it doesn't make much sense to me.

DrSally
08-17-2010, 11:20 PM
I don't know about internal vs. external tearing, but I do know that with extensive tearing (4th degree), the risks (of more damage to mom) are increased during a subsequent vaginal birth. I knew this going in and discussed it with my OB, but still opted for a vaginal birth, and it turned out fine.

edurnemk
08-17-2010, 11:33 PM
However, the fact that the c/s rate is so much higher there (and it isn't so low here) makes me kind of wary.

I just found these statistics:
In public hospitals 40% of births are C/S
In private hospitals it's 70%

Is that scary or what? I found a couple of doctors that promote humanized childbirth, so I'll check those out.

DrSally
08-17-2010, 11:41 PM
I just found these statistics:
In public hospitals 40% of births are C/S
In private hospitals it's 70%

Is that scary or what? I found a couple of doctors that promote humanized childbirth, so I'll check those out.

Wow, that is scary. It does sound like he's trying to set the stage for a planned C-section.

american_mama
08-23-2010, 01:24 AM
Are you going to a public or private hospital? Would you be willing to switch to a public hospital where C sections are less the norm, or is that not possible or desirable for other reasons?

What complications did he mean? Was he saying you should be looking at a scheduled c section, or was he saying you might have more extensive tearing, more extensive bleeding, etc? Or maybe he was saying that after recovery, he thinks you might have problems due to the these internal tears? Maybe not setting the stage for a c section, exactly, but in his mind trying to warn you about some potential problems.

Not that I buy it. I can't see why internal scars would make a huge difference in a delivery. I don't think the US obstetric model is all that great, but this is one "problem" that I never hear mentioned, making me wonder about its validity.l

I had a baby overseas in a European hospital where C section and epidural rates were very comparable to the US, and I wanted a natural birth. Things I did that you might be able to do in Mexico: stumbled on a midwife organization and asked for their doctor recs, split my prenatal care between a homevisit midwife and a hospital OB (unusual even for that country, from what I understood), toured the hospital, got in touch with an expat family organization that offered a short prental course in English for second-timers, and went to the hospital late in labor (8 cm) with a husband who was well-versed in what I wanted. I also asked for a delivery room with a tub (only a few had them).

You might ask if there are any nurse/midwife organizations in your general area, even if they don't actually deliver babies. The midwives I found didn't do deliveries, but they did homevisits for high-risk moms and moms who were discharged early from the hospital after delivery. There might be something like that in Mexico, and you can ask them for doctor recs who are more naturally-minded, plus find out about common obstetric practices in your area so you are prepared how to navigate them and get what you want.

Another idea... are you seeing an ob or a family doctor? Most countries rely heavily on family doctors/general practitioners so I wonder if you could get prenatal care from one, and if they would be less surgical in their approach? Or, if you already have a family doctor in Mexico but he doesn't delivery babies, could he give you a recommendation for a less intervention ob?

What about organizations that promote breastfeeding, or any breastfeeding specialists at your Mexican hospital? They might be hard to find (my big Belgian university hospital did not have any lactation consultants), but they might have some good suggestions too.

Neatfreak
08-23-2010, 01:38 AM
I just found these statistics:
In public hospitals 40% of births are C/S
In private hospitals it's 70%

Is that scary or what? I found a couple of doctors that promote humanized childbirth, so I'll check those out.

You might need to clarify those statistics by determining how many of those c/s were elective. I delivered DD2 at an overseas hospital where the c/s was 70% as well, but was not concerned b/c my OB explained that there is a cultural preference for scheduling births, so the 70% was not something pushed by the medical staff or the hospital, but by the patients. Anyway, not something to be taken at face value without a little research!

ETA: I do remember that your own OB was pushing the c/s, though!

american_mama
08-23-2010, 01:30 PM
>> You might need to clarify those statistics by determining how many of those c/s were elective. I delivered DD2 at an overseas hospital where the c/s was 70% as well, but was not concerned b/c my OB explained that there is a cultural preference for scheduling births, so the 70% was not something pushed by the medical staff or the hospital, but by the patients. Anyway, not something to be taken at face value without a little research!



I'd be very nervous about wanting a vaginal birth, of any kind, in a hospital/culture with a 70% C section rate, regardless of how many were elective. In fact, I would kind of assume that with such a high rate, many are elective: I know this is very common among certain wealthy women in Brazil, for instance. I don't think you can get a 70% c section rate without obstetricians pushing c sections to some extent, whether consciously or not. I certainly believe that women's preference is the dominant force, but clearly it is occuring unchecked by obstetricians, public health, insurance, pop culture.

I would be very suspicious that obstetricians and nurses in that country would make inaccurate assumptions about my desires for birth and in general be very old school about vaginal birth, even to the point of using worst practices (birth only while laying flat on your back, shaving pubic hair, giving an enema, moving mom to a different bed or room for delivery, limited or no support for breastfeeding. All of these were sometimes done in my overseas hospital with "only" a 30% c section rate.)

There has to be some balance between women's desires for their birth and the medical knowledge of the obstetrician, based in good research (and yes, that applies even in the reverse situation, a woman who wants a vaginal birth no matter what). I think a lot of obstetricians already like c sections because they are faster, use their surgical skills, give the ob a more active role. I think it's a very short distance from liking c sections to prefering them to pushing them, consciously or not, and if a huge percentage of women are choosing elective c sections, I think ob's might move rapidly down that path.

edurnemk
08-23-2010, 01:48 PM
I'd be very nervous about wanting a vaginal birth, of any kind, in a hospital/culture with a 70% C section rate, regardless of how many were elective. In fact, I would kind of assume that with such a high rate, many are elective: I know this is very common among certain wealthy women in Brazil, for instance.

This is exactly what happens here, healthy women have elective c/s. Or inductions before their due date (week 38 or 39). I know from several acquaintances that their OB's and/or them have chosen this route because of mere convinience (i.e the doctor knows that if you're scheduled for C/s or induction he won't be woken up in the middle of the night to attend a birth).

I found a few doctors already tht focus on natural birth, and the one private hospital that sort of supports that (even that one has more OR's in the LDR area than actual LDR rooms). Public hospitals are not an option we'd consider, fo rmany reasons. So I'll probably see one of these OB's and choose a more naturally minded one.

edurnemk
08-23-2010, 01:50 PM
Not that I buy it. I can't see why internal scars would make a huge difference in a delivery. I don't think the US obstetric model is all that great, but this is one "problem" that I never hear mentioned, making me wonder about its validity.l



My OB in the US never mentioned it could be a problem, so I was surprised by the assesment of the mexican OB.