4th degree tear. Struggling.

[newmumtotwo]

Hi, I'm new to this board, and am sorry to begin with such a downbeat post. I think I am just looking for info & support really.

Had twins nearly 9 months ago. Both were vaginal deliveries but twin one was face/brow presentation and forceps delivery. Twin two followed four minutes (and some pushes!) later. Somewhere in amoungst all this I suffered a fourth degree tear and lost 2.5 litres blood.

I am struggling to get over all this. Now I have to reply to my boss about going back to work and I just don't know what to do. My tear is still symptomatic (minimal bowel control, no wind control, beginnings of bladder problems) and long term does not look good for bowel continence (have seen specialist). Thankfully I am seeing a fantastic physio who specialises in continence issues - she was first to suggest various products to help me (i.e. spongey anal plugs, pads).

Had a birth debriefing, but still have questions. Tear occurance is not documented in my notes, cause of bleeding is not listed. Also, hospital "forgot" to arrange any follow up checks for the tear and I ended up scared and embarrased self-referring to my GP.

I feel butchered and violated. Is this normal? Am I just unlucky or should I think about pursuing action against hospital (as it seems I will not be able to return to full time work - how do I earn money?).

Thank you if you have read this far - any advice appreciated, I have posted on other sites so apologies if you have already read my long-winded story!

sorry for you. i'm not surprised you are struggling to get over it. i think it is normal to feel the way you do and maybe you should follow it up with the hospital. Maybe ask your GP for advice on responding to your boss? Perhaps they can write on your behalf. I'm no expert in emotional health (other than that i suffered emotional ill health for 2 years without really realising it!) but do make sure your fmily/partner/gp keeps an eye on this for you too!

Can you ask for some additional maternity leave??

You sound like you need it.

as I think you need loads.

What an outrageous disgusting experience you've had. Visit the birth trauma website that may help. Also I would indeed discuss with a solicitor your experience because those people have seriously affected your life.
I too had a horrible birth experience 9 months ago.
I wish you well xxx

I want to say it sounds like you have had a horrific time . Congratulations on your babies . I think you should NOT be scared to self refer as I think with the NHS the people who are consistently demanding tend to be the only ones who get what they need . How about approaching the PCT as I think they handle complaint procedures ?

Oh, poor you . I'm not surprised you feel butchered and violated. It IS normal to feel this bad after what has happened to you - but that doesn't mean you should just swallow it. Could you ask for some proper counselling to work through what happened? I strongly advise you to do this while the memory is still fairly fresh. I wish I had done so (although my horrific birth wasn't as horrific as yours, you poor thing )

As for pursuing an action against the hospital - I think it's a very personal decision. I know some people feel that it is cathartic and helpful to get the blame placed where it belongs. Others feel that they can't face the process emotionally. My advice to you would be to get some impartial legal advice, and some immediate counselling, and try and make the decision calmly, don't rush yourself. You've got time, the hospital isn't going anywhere. People make successful claims years after the event sometimes.

My heart goes out to you. I used words like "butchered" after my first delivery. I came out feeling as though I had died in the hospital and just a shell remained. I had crazy notions about my life/happiness having been exchanged for the baby's. I SHOULD have demanded counselling immediately.

Also if you are going to start proceedings and going through the whole experience with a fine-toothed comb, be vigilant about PND/PTSD. These things can hit you hard quite a while after the event (I don't mean to be pessimistic, but just be careful with yourself).

It does get better, trust me, you won't always feel this bad.

I would ask to be signed off too I had a bad third degree tear with my first baby and have to be quick with toilets

I know mine hapened because his arm was by his head and the midwife was a trainee she didnt notice untill there was so much blod she called a dr and I was taken into theatre

I think you have a right to know what happened and why and you also can go for councelling,
I was not offered this but found out it is available only because I am terrified of internals and actually giving birth!!! (had two more since) I am fine till they say push then have a panic attack am terrified of smears, internals and had to have gas and air to be induced!

Your not alone and to have no follow up appointments is a disgrace I would pursue action if it would make you feel better

I don't have any advice but I'm sorry you've had a tough time. I hope things get better.

Hi there, Poor you nmtt. You have had a very traumatic experience. I wonder whther counselling may help you heal the hurt of what you went through. if your life is negatively affected, in like you say, your ability to work, then I think you should see a solicitor. I am that there is no mention in your notes about the tear and subsequent blood loss. That along to me would suggest that the hospital wouldn't have much of a case against you. If it hasn't been recorded how it occured the hospital has no way of proving they weren't at fault. Good luck with what ever decision you reach, and I hope your recovery continues well.

along = alone

I'm really sorry to hear about your problem. I def agree that it's a good idea to take some advice from a solicitor regarding how the hospital preformed and also what to do about returning to work.

I have not personally had great outcomes with my GP when it comes to more complex matters such as this. Yours may be better. I had a traumatic birth but a GREAT independent midwife who talked things through with me afterwards. This may be a bit off-piste, but what I was going to suggest you could consider is contacting the independent midwives association to see if they could recommend one of their midwives willing to go through what happened with you and your notes. In addition to just being really understanding, they may have some useful advice as to how to proceed in discussions with the hospital and/or your GP. They deal with people who have had traumatic births all the time, that's why people tend to use them for subsequent labours. I know my IM would do this, it might be an option to try. Otherwise, perhaps try one of the charities? I think it may help if you felt you had some sort of an advocate behind you in these discussions.

You poor love - try contacting the Birth Trauma Association and keep posting here for support.

Definitely get signed off sick - you can't think about returning to work until you are sorted, both physically and mentally.

Oh, my heart goes out to you newmum! It sounds like you had a really awful time of it and it is no wonder you feel the way you do! Birth is so traumatic as it is nevermind having to go through all this without the support and aftercare you needed. I had a third degree tear and, physically I have healed up generally ok, but I still find it hard to get over the whole thing and get very upset thinking about it.
Have you discussed the problem with your boss (not very easy I woul imagine but it may help if they know what you are going through)? What are the chances of you being signed off sick for another few months? Perhaps this would be the best short term solution? Sorry I don't really have any better advice but if you need to talk or just sound off you know you will be listened to by mn! Welcome and congrats on your 2 lo's by the way!

also, this site is excellent, as well as the BTA
birth crisis

i would go back to the hospital for another talk, and ask specifically about the tearing and bloodloss, and the lack of follow up. make sure you can take someone with you for support.

it is not normal, but sadly, too common to feel buthcered and violated after birth....and there are places you can get help

perhaps see the hospital, get some answers from them, and if it looks as though your long term future and capacity to work and earn to your full potential has been affected, then maybe seek legal advice

i hope you get some help and support, you need it and you deserve it x

I've been thinking about this on and off all morning. I hope you have enough RL support, nmtt. Do keep us posted about what you decide to do and how you are.

Big hugs to you newmum. As someone else said, it WILL get better, and you WILL start to enjoy life with your twins.

I was induced and had a HUGE episiotomy despite my protests. I could not sit, lie on my side, nor walk for three weeks and had to breastfeed standing up. The episiotomy scar hurt for ages. The only "cure" I was offered was to kill the related nerve. (Men! Why would I want to lose all feeling down there?!?!)

Which brings me to my first recommendation: I found a cream called "Contractubex" through a female gynecologist who herself suffered badly from postpartum scar tissues. You rub this cream to your scars down there twice a day. The difference in just two weeks was phenomenal for me. Sex is possible again and no nerve killing, thank you very much!

My second recommendation is to have your GP refer you to a specialist physio that can help tone your pelvic floor muscles. This is twofold (1) She inserts a sensor which you squeeze and hold. You see the strength at which you squeeze on the screen. (2) She inserts a larger sensor which emits a light electrical charge, to stimulate your muscles and help them tone up. In this one, you don't squeeze at all but feel your muscles tighten up (possibly well beyond what you would be able to do) on their own.

It's all very depressing, but I just want to let you know that it CAN and WILL get better. Psychologically as well as physically. I used to cry floods of tears every time I told anyone about the birth, or even when I had to go back to that hospital for unrelated treatments.

Sending much affection and hugs your way xxx

Just wanted to say that I really feel for you. I gave birth 3 months ago and reading your post makes me realise how lucky I was, I only suffered 2nd degree tear but at the time you think it's so bad!

Make sure you get all the help and support you can....I don't think you can return to work, I'm sure your GP will advise you.

Good Luck, enjoy your babies xxx

Hi newmum

REALLY sorry to hear of your awful experience.

There are some GREAT gynae's and consultants out there who have people skills (shock!) and also great medical knowledge. You are seeing a specialist and a physio - do you feel that your care is lacking in any way at the moment, or is that all okay?

As a rule hospitals don't do follow-ups for tears (bizarre I know) but wait until people self-refer.

But of COURSE your notes should mention a tear!!!! I would ask for the complaints procedure and ensure that the midwife in charge receives proper training as a result of bad note-taking.

I don't know why you want to pursue action agains the hospital as you don't say how their action caused the tear - but that is something you will need to discuss with someone with appropriate medical legal knowledge. If you are unable to return to work for medical reasons you should contact your CAB office or jobcentre and get some advice about the benefits you would be entitled to.

p.s. I second the advice to seek counselling - you have been through a great deal of trauma and should look after your mental health as well as your physical health. x

So sorry to hear about your traumatic experience. A lot of the things you're saying, and the tone of your writing, remind me of the way I felt after the birth of my daughter. I had a long, difficult labour and nasty continence problems as a result. The horror and self-loathing I felt completely took over my life for a long time. I didn't enjoy my baby and simply felt that my life had been ruined. I also convinced myself that there must have been some negligence involved - I was desperate for someone to blame.

The happy bit of my post is this:

It's a cliche but time really is a great healer. Two years on, my physical problems are greatly improved. The physio you're seeing will be a major help in this, but it's also just a matter of giving your body a long time to heal.

There are many people / organisations out there who can help you get over the psychological distress you're feeling - the Birth Trauma Association are great. I've also managed to get a year's therapy with a specialist perinatal psychologist at the hospital where I had my baby - she sees women who've been through birth traumas of all kinds. You should definitely find out if your hospital or one nearby offers this - I just kept asking everyone I could until i got a source of help - speak to your GP, your physio, your uro-gynae consultant...

As far as the work thing goes, maybe you need a longer break, but don't write it off completely. You don't know that in three or four months' time you'll still be feeling like this. What does your physio say about your propects for return to work? I was absolutely convinced that i'd never be able to work in an office again but it's been such an important step for me. All part of the fight to prevent your trauma and physical problems dominating your life.

Big hugs also - you're going through a horrible experience and need love and understanding. And you've got twins to deal with!! I take my hat off to you.

Thanks for all the replies. I'm no further forward in making any decisions about going back to work. Really don't know what to do and have to meet my boss Sat 14th. I have to return the forms stating my intentions before then. I think I am going to have to ask her if I can keep my job if I ask for an extension to my unpaid maternity leave. Then try and find out if I can get sick pay or something meantime? Also have to fill out bowel assessment forms so I can get pads/anal plugs on prescription. I can't even face doing that. This is so far from how I imagined I would be at this time.

Called my old community midwife to see if she could answer my further questions about the birth (she said to do this if more questions came up) but she is off sick, they don't know when she will be back. Kind of stuck now as she is the only person involved who I would trust to be honest with me when I ask if any of this could have been avoided.

I am currently still on medication for post natal depression and seeing a psychiatrist approx monthly, but that is not really addressing the labour and birth. The physio I see suggested counselling so maybe I should go for that too?

definitely go for the counselling....there are two good links further down for birth related counselling,peer support, usually from women who have had similar experiences

also, you do not have to wait for your community midwife, you can go through your notes with the head of midwifery, and get copies of your notes too.

good luck

Definitely go for the counselling. I had a 3rd degree tear and a lot of internal tearing with a lot of other long-term hassles. Also, as Lulumama suggested, try the birth trauma website. I have found it very helpful to talk to others who know how this all feels. huge e-hugs to you!

I wonder if it would help to discuss your concerns about the management of your birth and the possibility of making a complaint with the PALS (patient advocacy and liason service) of the nhs trust that you were with/ They are independent so can advise you and hopefully will be honest about what the trust should/need not have done.
The other recommendation I have is to ask your psychiatrist to refer you to a clinical psychologist. The two are completely different, a psychologist will talk to you about all of your concerns and feelings re this birth and aftermath. You have the right to access psychological treatment for PND it is an established treatment but underfunded so may face a waiting list.
The other advice I have is to contact the maternity alliance or your workplace personel department re your maternity leave/sick leave rights. You obviously need to have some income, yet may be incapable of returning full time at present. I don't think that anyone can force you to tell them your intentions before 12mths after the beginning of your maternity leave. You only have to give 1mth notice of your return to work in order for them to restart your payroll etc.. You then have the right to take parental leave for up to another 13 weeks but this is unpaid. I'm not sure if you would technically have to return to work in order to be signed off sick etc. Your personel dept should be able to advise you of this.
Phone numbers for PALS and maternity alliance are in the birth to five book.
HTH FFT

Thanks all again - so good to have some useful and practical ideas to implement. I looked up PALS but I am in Scotland and can't seem to find the scottish version of PALS? Will definately ask the physio about her suggestion of councilling. Have pre warned my boss (small company, my boss, me and two other casual staff) that I will be asking to extend my unpaid mat leave as I didn't think it fair to not give her a chance to let me know what is actually workable from the business point of view.

This might help with finding out about the PALS equivalent in Scotland.