I'm slightly bored this evening so browsing the net and came across an extravagant birth plan where it is stated, 'no stitches under any circumstances'. There is also refusal of all drugs for 3rd stage management on there.

Now this is all fine and well if everything goes perfectly but what consequences could there be of not repairing a 3rd or even 4th degree tear, surely this isn't even an option? The thought of it scares me.

What about in emergency circumstances, PPH say? in the 3rd stage, is any attention paid to the 'rules' laid out in the birth plan?

Is it the responsibility of the midwife attending this birth to notice these details and discuss it with the woman prior to these circumstances arising.

(I should add it has apparently been OK'd by the community midwife, as I realise ideally it should be picked up during antenatal appts).

Anyone have thoughts on this?

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Applying for September 2009 intake at West of Scotland Uni

Ive attended women who werent sutured or who were sutured badly in the past and it chronically affected their confidence, sex life and comfort. One woman didnt have her left labia sutured (she didnt refuse it just wasnt deemed appropriate at the time) and she became very sore very easily as her labia was almost in two and she was too embarressed to seek help after.

I can envisage many situations where drugs and suturing are appropriate.

We cannot act without consent even in emergncy situations if the woman is compis mentis but is refusing. However with a PPH for eg she would soon become disorientated and at that point her partners consent would be sought.

With jehovah witnesses we have to have a form completed and consented before birth re blood products and transfusions so I would imagine if a woman came armed with a legal document stating her wishes and it said under no circumstances X then we would have to abide by that.

We always look at a womans birth plan and discuss her wishes with her when she arrives on del suite or when we attend a homebirth, so yes we would need to make ourselves aware of a womens wishes.

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i know i would be uninclined to have stiches again if i tore unless it was a realy bad tear.

With my first daughter I was first told that I would not need stitches until the 2nd MW started saying "erm wheres that blood coming from?" I then refused stitches as they were the scariest part of giving birth for me (i was only 18) The midwife then started saying "hmm that should be there, that bit there" Basically saying I was mutilated down there!! I was so scared and frightened. I still refused stitches. Mw basically said I would never be able to have sex again (not a good argument to a woman just given birth IMO) Eventually consented. Was the worst time of my life. Was in so much pain, held onto the gas and air as if my life depended on it, and at that stage I think I did think that. 2nd birth was so scared of having to have stitches agian but was lucky and didn't need them.

I can understand why women put this on there birth plan.

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... but on the other side of the coin, I cared for a woman in the not too distant past who had a third degree tear with her second baby. I took over her care, and she basically got on and pushed - it was not until her perineum bulged that I could see that she had had a second degree tear with her first baby which had been left unsutured and had healed very badly - the edges weren't together at all. As the head (quickly but steadily) advanced, the scar went, along with the tissue behind it which went from having little pressure on it to the full force of the baby's head, the whole lot just went.

Of course we can't do anything without the woman's consent, but it really made me rethink leaving small tears alone.

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i think this is a good pont but i also dont think i would be very happy stitching up someone else after what i have had...i still dont have the abilaty to err "how do you say?" perform in the bedroom? and it has been a while now, me son is nearly 2....so knowing the consiquesnces if it dose go wrong and i could be at fualt for ruaning someone elses sex life....dont know if i wanna do that....or im just over thinking about it and what has happened to both me and sooz is just like being in the minnoraty of cases?

Hi sm_abigail

Do you mean you have been at the end of a bad stitching job? (For lack of a better way to put it..) Do you think your situation would be improved by being left alone after birth?

I've never seen a 3rd or 4th degree tear so really have no idea how bad this looks or can be. Is it actually possible for a tear like this to be left and to heal successfully or will it always impact on the womans future ability to have intercourse?

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Applying for September 2009 intake at West of Scotland Uni

it an ok stitching job it looks the same and feels the same to me but everything is stitched back together to tightly and there is a nerve stitched in.

Ouch hun, it's a big responsibility isn't it - trying to return someone to their prior condition.. I don't relish the thought of it, I'd hate to leave someone in a worse condition.

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Applying for September 2009 intake at West of Scotland Uni

Is it possible to have this fixed? Doesn't sound very pleasant sm_abigail-sorry to hear about it, K x