Advice for a desperate new mum - Perineum, clitoral and labia tear - will it ever get better?

[BeaRuss]

Hello,

I had a beautiful baby 5 weeks ago and the birth was pretty horrendous. The hospital didn't think I sounded far enough along when I phoned to go in when I was in labour so told me to stay home and call back after an hour or two. Basically, I was a lot further along than they expected and an hour later I was pushing. Baby ended up being delivered at home - my husband did most of the hard work before a midwife arrived as the baby's head was beginning to crown. I do need to say, I don't mean to talk ill of the midwife, she delivered my healthy baby boy and for that I'll always be grateful. It wasn't her fault that I was delivering at home, however she didn't have half her kit on her and she kept leaving through the actual delivery to go to look for things in her car, so it wasn't great.

Anyway, baby's head was on an angle so he wasn't moving very much through the birth canal. The midwife kept checking his heart rate and it was quite elevated so we knew I had to get him out. Really it should have been an assisted delivery or a c-section, but since we were at home those options weren't available! She said she would do an episiotomy but then realised she didn't have her scissors on her so I had to tear naturally. She was really tired and clearly just wanted to go home - everything was very rushed and she made it clear she wanted to leave once the baby was out (she even gave him a bottle of formula milk as he didn't latch on my breast straight away). She said I had a second degree perineal tear and she would suture it there and then, which she did. She finished up and went off on her way, and that was that. Except it wasn't...

I was in a lot of pain for days after the birth and kept being told by the midwives who came to the house in the following days that that's normal. They did have a look but I was so swollen that they couldn't really see much. Then about a week after birth, a midwife checked and sent me to the hospital to be seen. A consultant saw me who told me that the tear was actually very bad, and that the stitches had come undone. She told me I had a clitoral tear and my labia had also quite badly torn. The perineum tear also extended into my bum (sorry, TMI!). I was put on antibiotics as where it was all exposed it had become infected. When she was having a look she asked if I'd been admitted to hospital straight after birth so I explained that the midwife had sutured at home. She asked if I had refused admission and I said the midwife didn't even mention going to hospital, she just sewed me up and left. The consultant told me that I should have been admitted as I would have likely needed surgery. She said to take the antibiotics and to go back in two weeks so she could see the extent of the tears once the infection had gone. She said it was likely I'd need to be resutured as nothing was being held together anymore. She arranged for me to be regularly seen by midwives in the interim so that they could keep an eye on it.

However I didn't see a midwife then for over a week as my son was admitted to hospital and I was staying with him. I did phone the midwifery team to tell them and asked if I could be seen as they were in the same hospital but nobody turned up. I then asked to be seen once we were back home and a midwife came out to have a look at how things were healing. She wasn't happy with it so I was sent back into hospital where I saw another consultant. He had a look and told me that I had a fourth degree tear and that it was very severe, but because of the time that had passed it would cause more damage to resuture and it would be best to leave it. He told me if they resutured it would probably come apart again anyway and that it would cause even worse scarring. Basically I was told to leave it, see how it heals over the coming months and if it is causing problems months down the line they would review whether it needed to be 'refashioned'.

I was ok with that as I was told chances were it would heal naturally as I am young, however I've just had a look at it for the first time and I'm an absolute mess...again, sorry, TMI! The tear is so far apart and there are no stitches holding anything together so I don't see how it's going to heal and join back together. I'm not so concerned about the perineal tear, I'm more worried about the clitoral and labia tears. I don't see things ever going back together down there. It has started to heal apart already and I can't even tell what used to be where ☹😳 even though it is starting to heal I'm still in a lot of pain and am still bleeding. I have no idea how the tears are going to affect me in the future but I don't imagine my sex life will be the same. The damage to my clitoris is so extensive I'm not sure what that will be like in the future. I feel so unattractive now and so ashamed of how I look.

Has anybody had a similar experience or healed from a severe clitoral or labia tear when it hasn't been sutured together? How long did healing take?

If you've made it this far, thank you so much for keeping reading!! I'm really hoping there will be somebody who has had a similar experience with a positive outcome 🤞🤞

Thank you! X

I'd bloody well get all my notes and paperwork and evidence (forgot her scissors?! Advised you not to go to hospital?! Wtf!!!) and then sue for negligence and the cost of reconstructive surgery.

I would also beg borrow and crowdfund, ask family, get a loan, to get that reconstructive surgery.

...and I am calm person.

For reference, I was cut to prevent a tear (that is the professional view) and a cut is neater to stitch, more controlled. I was then stitched up by an obstetrician-gyneacologist, then back for check ups twice, then it was healed 100% without even a scar. That was the right way to do it, and avoided me heaps of misery.

You need to fight here, you deserve it and you are in the right.

Didn't want to read and run and I am sure other MNetters with more experience than me will have better advice but what I would say is go to the GP and get another referral ask for your notes of the birth and say you want a clear explanation of what has happened and what the options are to ensure that you are healed properly and with as good an outcome as possible. Good luck OP

I think you have serious grounds for complaint. No experience with the clitoral stuff -My situation wasn't exactly the same, but I had an episiotomy and some tearing which went badly wrong. Stitches all went after 2 days. In summary I had a gaping wound for 12 weeks or so (midwivea said it was the worst they'd seen), I then needed 2 procedures to remove the excess granulation (over healed tissue). I had lots of physio and was eventually able to attempt intercourse after 7 months although it was a bit longer before it was pain free. I was on the waiting for for a procedure to refashion everything (after crying that I was too young to give up on sex in front of my consultant) but by the time I was called up I didn't actually need it, as I wasn't having any problems anymore.

It was a long hard recovery but I got there. It will never look the same, I have a sort of gap in my labia. I'm now pregnant with no 2 (2.5ywars later) and the scar does twinge with the extra weight, but I got to a point of of having a good sex life. I will be having a C-section this time.

So there is hope, even though things will never look the same. But do not be fobbed off, keep pushing pushing pushing the medical professionals until you are happy.

You poor thing, this is so tough on you :( :( I haven't had time to read all responses properly except yours.
I had a difficult birth with a bad tear towards anal sphincter 3b & pelvic floor damage a year and a half ago, took me awhile to feel normal but am fine now so just wanted to give you some hope.
I was terrified afterwards and had to wait over 3 months for them to check everything had healed properly.
My advice is please try to get some treatment and second opinion if you can. Research some specialists and camp out at the GP 's until you're seen or if you can even go private please do.
Definitely do a pals complaint, formally complain about midwife and also look into legalities after health issues are sorted.
Sending you hugs. Hope you are getting to enjoy your time with the baby. Get lots of rest, xx

You have grounds for serious complaints there and I would check on the hospitals procedures for this not only to make sure they don't ignore you but to make sure this does not continue happening. Two mistakes were made. One, the person who told you not to come in yet and the midwife who should have sent you to hospital after the birth to get sutured correctly. My daughter had a traumatic birth with her first DD and our local hospital does something called "After thoughts" which means you get to speak to the hospital about your birth and what went wrong so hopefully if you have another you don't have the same issues. It might be worth seeing if your hospital does a similar thing. Sometimes you have to push.

Sending hugs and a handhold. You are valuable and worth fighting for. Imagine if it was your daughter or best friend getting these rebuttals. Please push the GP for referral. X

On the hospitals website there’ll be a procedure for applying for a copy of your notes. Fill in the form and request everything from the date you called in to present.

In the meantime research good medical negligence lawyers who work on a no win no fee basis. Contact one. Do this sooner rather than later. You should be able to get reconstructive surgery funded as well as compensation. It’s utterly unacceptable. I’d also make a formal complaint but follow the solicitor’s advice on that front.

Reading this makes me so bloody angry.

Wishing you strength.

That sounds horrendous, I’m so sorry for you. Do whatever it takes to get yourself fixed, if you need to sue them then you should. So many mistakes have been made and it’s awful you’re still suffering for them. Your body will heal to an extent but it doesn’t sound like everything’s going to magically get better without significant intervention.

for you OP.

I'm not a PI/med neg soicitor, but worth posting on legal. I wonder whether it is worth researching specialist surgeons in this area of work, private and NHS, then seeing a solicitor about suing for negligence. Part of the remedy of the litigation being remedial work by the specialist paid for as part of the settlement? I'm not sure if this is possible, but if you need to see the best person to fix the damage, that will probably not be anyone in your current area and may even be abroad?

You poor thing.
I think you need to request a birth debrief with a senior midwife. Following that meeting you need to say that you wish to make a formal complaint about what has happened. I think that would be through PALS.
After my 3rd degree tear I was stiched by a senior doctor in theatre. It took about 1 hour and several junior doctors came to watch so they could also learn how to deal properly with complex tears. I just can't see how a midwife on her own in a home could ever hope to do a comparible level of repair.
I had follow up physio appointments very soon after the birth and after about 6-12 months (I can't remember the exact timescale) I went for an rectal ultrasound so they could assess how things had healed.
You need to make sure you get the physio and ultrasound as well as a proper repair.
With a 5 week old and such a traumatic birth experience this is a lot for you to deal with and take in. I don't think I would have been pysically and mentally on the ball enough at 5 weeks post birth and my traumatic birth and injury was no where near what you have gone through. If you can take someone with you to these appointments who you can trust to be assertive and also speak up on your behalf of needed.
I hope things start to get better soon.

www.theguardian.com/lifeandstyle/2010/dec/10/torn-apart-by-childbirth

This is a very useful article and mentions a solicitor you might want to contact. I don't know what else to say, except I hope things work out ok for you and your family.

Agree with lindy2, take someone with you for your appointments.

Also want to add that some women make full recoveries after 4th degree tears. It's too early to say because you've had an infection and pelvic floor muscles take a long time to recover all their strength.

My understanding of a clitoral tear is that it's extremely painful. Keep asking for pain relief (if you need opiates, they should give you osmotic laxatives to counter the constipation). It may be that your anatomy will be different but that function is the same.

If you need further surgery, they will wait to see what physiotherapy can do first. As I said further up, I had surgery 18 months after birth. I saw a physiotherapist before and we tried various things before declaring surgery was definitely needed.

There are treatment options available. It's just very early to know what would be best. Keep strong. And do get in touch with Birth Tear Support. They are all very nice and supportive.

I don't know how old you are OP but sometimes younger people tend to accept what they're told by doctors,midwives etc a little too uncritically. As you get older it's easier to question things (or that could just be me!)

The point is, you and your husband need to pursue this vigorously to get proper answers and proper treatment. It's a completely shocking story and my heart goes out to you. It's enough to deal with a new baby-especially as he's been in hospital- without the physical and emotional trauma you've had /are still having.

I echo what others have said including finding a good solicitor that specialises in medical negligence. I hope things improve for you.

You poor poor thing. I don’t have kids and have no idea what is normal but the treatment you received was horrendous. Please, please complain formally and loudly. No patient should be made feel like the HCP Just wants to get home. Surely they must carry all equipment with them at all times?

That’s really horrible for you.

Could you afford a private consultation? My friend (who is a Consultant herself) recommends Sohier Elneil at UCH for serious birth injuries. She has a private clinic on Harley Street. Might be worth it to get a second opinion and understand your options.

I am so sorry to hear about your terrible experience. It sounds as if you have been let down badly and you may have grounds for a complaint.

I had nothing like what you describe, but I had stitches which came open and left a "hole" - can't really describe it any other way. The midwife said nothing about it and so I went to the GP, several times, who didn't really say much but when I kept going back eventually referred me to a consultant at the hospital. I was booked in for surgery and the consultant was great. After a couple of months on the waiting list, I was told it'd healed on its own enough and I didn't need surgery.

It sounds as if you have had to deal with far more than me, but you must keep pushing and don't be fobbed off. X

Oh you poor thing. I can't even imagine how you feel right now.
I don't have any personal advice, but I was previously a medical professional (don't want to go into detail) and I have seen an injury like this before. The woman I saw did have further surgery down the line (to resuture) and I am delighted to say that she has had another child since and is now healthy and happy. All of the further surgery happened quite a while after the birth of her baby though, to give everything a chance to heal properly first.

One thing I would recommend though is going through the hospital (maybe PALS) to speak to someone about the care you received. You've been through an unbelievably traumatic time and need to be emotionally, as well as physically, healed xx

I am so sorry to hear about your experiences OP. I agree strongly with PPs that you have been let down and deserve better treatment. I also agree with the following suggestions:

1. Contact PALS to make a formal complaint. Take someone else to any meetings and have everything that happened written to you written down, along with your expectations of what should be done.

2. Ask the Head of Midwives for a full discussion of your birth. Again, take an advocate.

3. Consider counselling.

4. Consider legal action to fund any private surgery/treatment you may need. Can you afford to see a private surgeon for a second opinion? I mean at least a first consultation, even if you couldn't afford private surgery.

5. Insist on referral to a pelvic physio for assessment.

6. Insist on adequate pain relief.

I too have birth injuries (different type though) and I really feel for you going through this, especially with a new baby to look after. I think from other stories I have heard that this may all be very fixable and you will have a pain-free future with normal function, but I'm so sorry you were treated like this and are not getting the help you deserve. I wish you all the very best.

You poor thing. It’s awful how those things happen...something similar to what I went through (not a home birth but they missed the fact it was a third degree tear and When I was seen said it was too late to repair as would make things worse.
This is absolutely 100% medical negligence. On a more positive note I am now 2 years down the line and ALOT better than I was. Also you haven’t mentioned any issues with using the bathroom- are you able to hold on when you need a number 2? Because this was my issue that flagged something had been missed.
Go to your gp. Ask to be referred to urogyne, colorectal and women’s health physio. Tell them the tear was missed and you need help getting your pelvic floor strength back.
I’m sorry this has happened to you. I hope it will get better as it did for me x

Hi op.
I’m so sorry for what’s happened to you here.
I had a problem with a deep second degree tear where the stitches came apart. It did eventually heal but I was told that they would have to wait and see how it healed before attempting any surgery if necessary.
I do believe there is good rationale for this as the tissues will all be quite swollen, and your hormone levels which can affect things down there aren’t quite back to normal this soon after the birth, I don’t know if you are breastfeeding or not but the hormones can be even more out of balance if you are. So from my (non expert opinion only personal experience), leaving things a while is probably for the best.

However, in missing a fourth degree tear, the health care trust have set themselves wide open for you to take legal action. Much of this could have been prevented had the midwife recognised the tear at the time.
There is still more they could be doing for you now. For example they could make sure you are seen by women’s physio therapy who will help you do your pelvic floors. They could have made sure you were their top priority in terms of the wound being assessed/monitored.
They could have offered a scan for you to have the severity of the tear checked by ultrasound. Have they asked about your emotional well being in all of this, after what their mistakes have done? I think they should have been going above and beyond for you, given that you will probably be entitled to large amounts of money if you decide to take legal action.

www.teeslaw.com/article/tees-settles-three-maternal-birth-injury-cases-securing-compensation-ps400000-clients

I’m not normally in favour of suing the nhs where genuine mistakes have been made. But from the sound of things, they have not tried very hard at all to make up for what has gone wrong and ensure the best standard of care for you going forward.
I would strongly urge you to seek legal advice about this.
Also speak to complaints and pals, but in my experience with the nhs, they will fob you off until money talks.

Good luck. I will keep you in my thoughts and wish you a good recovery. Just remember to try to take it easy where possible and don’t lift anything heavy as this will put pressure on your pelvic floor which won’t be working very well at the moment. Try to eat well, plenty of protein does make a difference to a healing wound and sleep as much as you can.

I had a similar experience (not to your extent) with a bit of a different outcome.

1st child, planned homebirth, 1st time I called the midwives they said they were too busy and I would have to come in - not at any point in my planning of a homebirth had any of the hcp who visited the flat/saw me had mentioned this as a possibility. Perhaps I was naive. Anyway they managed to find a midwife who came and checked me and basically said I had ages so not to worry, also that the baby was back to back. I tried to sleep, woke up a few hours later in full blown Labour, called the midwives and when the first eventually turned up I suspect I was transitioning. She came up (1st floor flat) with no equipment what so ever. Immediately left (after just seeing the state of me it was obvious the baby was on the way) had to run back to her car to get entonox, and I think she kept running back for things she'd forgotten, I think I remember my husband having to help her too!

Things progressed well and my baby was birthed in a pool, as she came out something 'burst' and the pool filled with blood. Turns out because she was back to back and came out star gazing, the pressure from the 'incorrect presentation' split my foof.

The midwife immediately got me out but I seemed fine so I think the blood looked worse in water. 2nd midwife had arrived by this point and they both assessed the tear. They decided I had a labial tear leading up to a ureathra or possible clitoral tear. They both weren't confident about stitching it and I was bluelighted to hospital very quickly.

Writing that down makes me wonder if they thought it was much worse than it was.

When I got there i was stitched up by a very nasty (but competant) surgeon who made it very clear she disagreed with homebirth and laughed when I asked how many stitches I had had. She also left me completely uncovered in stirrups for a long time and didn't bother telling the nurses she was done, they were horrified by her. However I think she did a very good at her job...

I couldn't sit for a long time, couldn't walk, was in HUGE amounts of pain for about 5/6 weeks and incredibly swollen. None of my notes were very clear about what I had torn and how badly. I took lots of salt baths (which I'm not sure is the suggestion these days) I was in a really bad way and looked incredibly pale for a long time. Lots of arnica tablets and ate good healthy food where i could. The stitches were so tight and incredibly painful, sex was difficult for a long time afterwards.

Anyway, I did heal, nothing looks the same, I'm not sure it ever does after birth. I have one longer labia that sort of doesn't sit right but my urethra and clitoris healed fine. I've gone in to have 2 more kids within 4 years of that.

Sorry that was really long. I think they were negligent as all pp have said to you. But I just wanted you to know that healing takes a very long time and it will get better.

This sounds horrendous op, you poor thing. I was lucky that my 3c tear was picked up straight away and I spent about 2 hours in surgery afterwards. Is there any chance you have private health care through work or anything? They covered a 3rd degree tear for me when I needed a follow-up.

I feel so angry for you OP, you have been treated horrendously

I also had an unplanned home birth. I didn't get a midwife coming to my home, there was an ambulance instead who took me to hospital where a doctor (the midwives said it was too tricky for them to do) sorted out my second-degree tears. I just can't believe you weren't sent to hospital.

I really hope you can get to see someone who will take you seriously. Agree with a PP who said this would not happen to a man, that would be taken much more seriously

Complain.

And get referred to a surgeon to do a decent repair job, if not under general, at least with a spinal block/epidural.

I tore (perineum and urethra) and then had an episiotomy the first time, had a clitoral tear the second.

Both times I laboured with a private obstetitrician - mainly because I knew I would tear, I knew i would want an epidural and that I would need repair.

With both labours, my doc spent longer stitching than I spent pushing...and his very fine needlework paid off, everything beautifully fixed, stitching so fine no scarring at all, clit still works !

It is a fact that a midwife led birth means less chance of getting an epidural if you want one, and much higher likelihood of being stitched up quickly afterwards because you are uncomfortable because you have had less pain relief.

I know a few women who had to be cut and restitched following botch jobs by their docs or midwives. It pays to have it corrected, however, I would insist on adequate pain relief.