Can I have some perineal-trauma support please?

[MrsTittleMouse]

I've posted on this here before. DD is now 15 months and even though my scar has healed up better than before (after stopping breastfeeding on the advice of a gynaecologist) it still isn't right. I was also given dilators, which have increased my capacity to the extend that I can have sex, but it still hurts. DH and I made love this week and even though I was really keen (and initiated the whole thing) once he was inside I just wanted it to be over.
DD's birth was horrible; I agreed to try to labour naturally, but I knew that the women in my family have a history of large, badly presented babies, big episiotomies or scars, and healing very badly after. So if anything went wrong I wanted a C section. DD was stuck (high up, not in immediate danger) and I was bullied by the consultant into an instrument delivery, DH sided with him not me, he gave me a very large episiotomy without my consent, lied to me and said he hadn't, and then I healed very badly.
We'll be TTC again soon (I'm getting on, so waiting isn't an option). DH wants me to have an elective section if I am lucky enough to get pregnant. I'm hoping that another pregnancy and deliver might make things better - clutching at straws??? As well as the large internal ridge-scar on the muscle, I also have skin that has healed so that it extends over the entrance to my vagina, and it gets pulled when DH is inside me which is very sore. Has anyone had this? Can it be sorted out? Would it tear really badly if I gave birth again?
Sorry, just feeling really sorry for myself today. I had counselling which did help, but I seem to be slipping back again, I think because I thought that things would just get better over time and they haven't.

Have they offered you a repair and restitch op?

No - I saw two consultants, the first was an arse (long story), the second was much more helpful, neither thought that an operation was a good idea. The attitude was that surgery almost never worked and would just create a new scar that would probably be as bad as the old one, and could be worse.
I've heard stories on here about successful surgery though, so I don't really know what to believe. I'm tempted to go back to the non-arsey consultant to see if it's possible to sort out the external skin. I would imagine that it would be easier than the internal muscle scarring and would at least sort out one problem.

Go back, did they give you a follow up appt to see how you were getting on?

No - or rather the horrible one did, but I'd already arranged an appointment with the other one, so I cancelled it. Not much point seeing that [expletive deleted] anyway. The second consultant said that 90% of people could "tolerate" sex at 15 months. I asked what would happen if I couldn't, she said nothing, I broke down, nothing of use happened after that.

Is it even worth going now if I'm TTC? Will they tell me to go off and see if I get pregnant? TTC does not involve sex BTW, just a speculum and a lot of yoga breathing by me.

so sorry that things are still bad .... with little hope of resolving, or at least with the information you have had

as for being able to 'tolerate' sex,that is not very fulfilling

time for a 3rd opinion?

certainly if you are TTC, then you should see someone quickly

definitely see someone again
ask how they would feel if they could possibly only tolerate sex in future

also you need an informed opinion re delivery

Am I better off if I admit that we're TTC? Or would they take that as evidence that I'm OK and right me off. I don't really want the NHS to know (private treatment), but if it would help then I would be OK telling.

Is there any evidence either way re: next baby? Would it generally help (I've heard that PG hormones are good) or will I just tear really badly and end up worse? Or maybe there isn't enough evidence because women in my position don't have enough sex to get pregnant.

Am I better off if I admit that we're TTC? Or would they take that as evidence that I'm OK and right me off. I don't really want the NHS to know (private treatment), but if it would help then I would be OK telling.

Is there any evidence either way re: next baby? Would it generally help (I've heard that PG hormones are good) or will I just tear really badly and end up worse? Or maybe there isn't enough evidence because women in my position don't have enough sex to get pregnant.

you might stretch more and not tear, or tear , or need another epi, it is impossible to predict.... certainly hormones do have an effect on the pelvic floor

i think if you are undergoing any gynae examinations etc, you need to be totally honest re TTC, as it could have an impact on what treatment can be given...

I can see the value in being honest - rather than being on the waiting list for surgery and then suddenly I can't have it because I'm pregnant. The chances of conceiving another DB are very low though. I don't know whether to wait and see, and if I don't get PG then kick up a fuss.
I was told by the second GP I saw that I wouldn't get treated for a perineal scar until they knew I was done with childbearing, as another birth could get my back to square one and I'd just need more treatment.
Sorry, I'm rambling on; it's because everything is swirling around my head. It's been a bad day today.

don;t apologise ! it must be really difficult

not being able to have a fulfilling sex life and being in pain is not pleasant.

have you contacted the birth trauma association? they have volunteers who specifically support women with big perineal trauma.. usually 3rd/ 4th degree tears, but i am sure someone on there could help you

Thank you. One of the worst things is that I knew the risk that I was going to have the birth that I had and the problems that I've had since. I predicted that I would have a bad scar, and there was nothing that I could do to stop everything that happened.
I keep going back to the time when I arrived in the consultant-led unit and the consultant laughed at me, and basically wouldn't listen to any of my arguments, until I was in so much pain/so exhausted that I signed the paper to let them try an instrumental delivery. I keep wondering that if I'd held on for just 5 more minutes, or 10 more minutes, would he have given me a C section? And then I wouldn't have a lifetime of no sex life with my husband.

This happened to me and YES surgery DOES HELP! Had episiotomy after pushing for 90mins and ds shot out tearing inside and out. MW sewed up top too tight and didn't do anything internal so i lost lots of blood, took ages to heal and was in pain/couldn't walk properly for weeks. Asked GP about it at 6week check and got fobbed off, went back after 4 months when sex hgand't worked at all and got referred. Saw registrar who suggested maybe i should wait until i had finished having children, i was sooo mad and said there wuldn't be any more children if it wasn't fixed. She (yes!!! obviously hadn't had children herself) booked me in for a basic procedure (fenton's - google it for more info) but when i got to theatre the consultant said it was much bigger op cos so much damage but did it anyway on day surgery. Anyway.... had surgery, opened up whole thing and rebuilt, took good 6 weeks to recover and then i had to do lots of stretching (like perineal massage) to relax muscles again but after all that SEX IS GREAT AGAIN. Please ask for another referral, missing out on sex because of crap advice from Drs is not right - I suffered PND because of trauma of birth and subsequent problems and ended up on ADs but everything is fully functioning now and I am 37weeks pg with DS2. Have spent lot of this pregnancy v distressed about going through labour again and possibility of damage again and am now booked in for an elective cs - can't face any risk of damage after last time. ANyway, sorry for waffling but want you to know you are not on your own - I scoured web and Mumsnet whe I was going through it and other peoples stories really helped me so hope i can return the favour. Ask any questions - am off for bath and bed now but will be back tomorrow - not sure my CAT address is right.

manamana - THANK YOU!
I don't know how to CAT, and I can't email anyone as my email address has my actual name. I've posted too much on here to risk that I know you in real life!
May I ask what your scar was like? I seem to have problems with the doctors because a "typical" problem scar is like a tight ring around the vagina, whereas mine is like a ridge running along the vagina (it must have been one hell of an episiotomy, it's a really long scar). I don't think they know what to do with me.

MrsTM - to CAT you simply click the envelope by manamama's message header
MNHQ fwd your msg on but it would include the email addy you have registered for MN

Good lord, you poor thing!

I can't offer any help on the scarring issue as I had a caesarean delivery (and a whole different basket of scar issues...) but I did want to urge you to push for further referrals and treatment.

It's absolutely not right that you are in this much pain and I think it's downright outrageous that you've been counselled by the medical profession to think that being able to "tolerate" sex post-birth is in any way acceptable. We're not in 1865. They're effectively suggesting "tough luck; lie back and think of England" because they've run out of ideas and I think that's disgraceful.

This isn't the end of the road. There is no reason why you shouldn't be repaired. You've just come up against medical professionals who are beyond their area of expertise which just means that you have to keep pushing for further referrals until you are referred to someone who knows what they are talking about. You obviously haven't had 'standard' damage but you won't be the only person that this has happened to.

Can you push for an alternative referral? You are entirely in your rights to do so if you are not happy with the treatment to date. There is no cap on how many people you see - keep pushing until you meet someone who knows what they are talking about.

I'm not sure whether private is an option but I can really recommend Jane Bridges who is a gynaecologist based at The Lister and Cromwell hospitals in London (if you google her she'll come up). She has looked after me for other issues and also helped a girlfriend who tore VERY badly (near 4th degree) post birth. Even if she can't specifically treat you she'll be able to point you in the right direction and she's a lovely lady - very reassuring and kind and gentle.

Hope this helps.
Kx.

Mrs T, sorry I can't remember exactly what the scarring was like before op just that whenver i had a feel in the bath i would be totally freaked out. I definitely had the 'elastic band' ring of scarring (which is still there to a certain extent, but I also had some bulging of tissue through the back vaginal wall (sorry if tmi!) as the 2nd gp thought it was a cyst. Also scarring all along the pernieum with 'dips' either side. One word of caution is that even after the op I felt like I had been butchered (both from birth and op) and it took a while to be comfortable with my body again - although once it all started 'working' again it was a big help (as were the ADs)!

hi i couldnt read and not post
sorry to hear about your troubles mrstittlemouse i tore quite badly in childbirth (2nd-3rd degree) and your scar sounds similar to mine. i havent got the elastic band type scar i have one that runs vertically down the back wall of my vagina and it protrudes out slightly onto my perenium. i had pain for months during sex and finally after bein fobbed off by my GP i decided to try and promote healing using massage and lavender oil. this helped loosen up the tight feeling i had and now sex is much improved i think that you should speak to someone who actually knows what they are on about rather that the docs you have already seen (they can be utterly useless cant they!!) and if all else fails look up homeopathic healing remedies. it helped me no end
xx ei xx

Thank you very much for everyone's replies. I spoke to DH last night in bed and admitted that things weren't right. I've been a bit scared that I'd frighten him into impotence if he knew that it hurt. He was lovely and reassuring about the fact that he still loved me and fancied me, and we've decided that we will take things further after the first TTC attempt (tis all set up, so doesn't seem worth cancelling).
I was a bit concerned that because I'd already had a second opinion that that was it, and I'd had all the help that I could get (have seen 4 GPs too - mostly useless - had comments like "just have lots of sex, that'll sort it out", and "I've had 3 C sections (yes, I know that if I'd been a doctor I'd have been taken seriously and given a section, thanks for rubbing it in), and "you should be grateful, my SIL was incontinent").
OK, enought ranting! Off to give DD her tea and get pampered by DH.

I'm glad I'm not the only one! It was great reading this thread if you know what I mean...not great reading such horrible stories but that other people have been in the same boat as me. MrsTittleMouse I am in the same situation as you - not TTC right now but planning soon - and I will be making sure I can have an elective c-section before I even get pregnant! I'm like you, I knew because of a family history the strong likelihood there would be problems. When I developed problems before I went into labour (pre-eclampsia) I begged for a c-section (on that grounds). I told the consultant - as she did it! - on no terms was she to cut me but she did, and I tore terribly.....has taken ages to get back to any degree of normality....feel for you....I really think you should demand a c-section, don't think it will be easier next time around just because you have gone through it once...you don't know either way, but I wouldn't risk it. A lot of people talk about c-sections as risky and hard to recover from....but they definitely haven't had our births!!!! A c-section couldn't be riskier than the birth you had (or I had!!!)

Hello. I haven't read all the replies in this thread - just your initial message so sorry if I'm repeating anything already said. I had a third degree tear with my first delivery which required stitching up in surgery afterwards. It healed ok-ish but I had lots of pain and problems going to the loo for ages (as well as some pretty awful incontinence tests at the hosiptal). With my second baby, I agonised over whether to try for a natural delivery again, hoping it would be different and might erase some of the trauma of the first. The consultant advised that I may just be prone to tearing so even a gentle delivery may cause the same problem. I eventually realised that my reasons for wanting a natural delivery were emotional only and were unlikely to lead to a good result. So I opted for the elective section. The thing that sealed it for me was the consultant advising that i might suffer incontience problems usually encountered by people in their 70's if I suffered any further damage. There was no ideal option but the section was the least bad for me. My daughter was delivered at 39 weeks and the recovery was okay but I needed help with my toddler (21 months) as I couldn't lift him for a few weeks. Good luck with it all. Listen to as much advice as you can/or want to but make your own decision in the end as it's you who has to live with it. All the best x

Do I ever feel at home here. Unfortunately I cannot give any advice as I was just searching for similar information myself.

I'm 5 months pregnant with my second child. The tearing from the first was so brutal, I also had a haematoma at delivery, the stitching I thought was overdone, not only did it pull everything so much closer (now I have pubic hair where I didn't and it's so uncomfortable to try to get rid of. If it's not taken care of it is not only unsightly but contributes to more pulling during sex) but I felt from the start things weren't sewn right. Although I haven't had any accidents as yet, I feel as though I'm just around the corner from fecal incontinence. I also suspected at the time that my tailbone was broken at birth as sex was always painful afterward and the pain went straight to my tailbone. At 5 months pregnant now the pain to my tailbone and very lower back are already quite bothersome, I can't imagine 20 more weeks of this.

I am looking for information as well. My obgyn things that even with second degree scarring (I think it was worse and nobody recorded it properly because they made me push too hard too soon that it even caused the haematoma), I should be ok for vag delivery. But I can only assume it will make things worse and not better.

I have never looked into any surgery after birth although my son is 4 years old now. My husband witnessing that birth and stitching and seeing the damage was enough to put HIM off having sex with me for about a year after our son was born - he had severe difficulty with arousal. My son was also 9 lbs 4 oz. and pushed out in 20 minutes. I was even told on the table to push like I was having a big bowel movement. I did and now the worst part of damage is closer to the anus. I can't even imagine breaking through the scarring again as it is very thick there.

I don't know enough about surgeries or what they'll do but after reading this thread I feel like I'm one step closer to making up my mind and getting the c-section. My obgyn tells me it's up to me if I feel that I just can't go through with the vag.

It's funny isn't it? The last thing that I would wish on anyone is for them to be going through what I'm experiencing, but it is reassuring to find others in the same boat.
I had a little "explore" last night, and whenever I move the skin that has healed over the entrance, it feels like a mini-version of crowning. Not something I want to associate with sex! I think that when I go ahead and see a consultant, one of my big concerns will be to find out if they ever talk to the OBs who did this to us. I can't believe that they would do this in a non-emergency situation if they knew the consequences - would they?

Mrs T and others - I do quite a bit of suturing as a midwife and I have to say, I do the best I can each time. But we never see the women we suture afterwards to get feedback, most are home in a day or two. I often wish I could get to see how they healed a few weeks later, but it is impossible. Even if we had feedback, we probably would not remember the individual case to compare it to how we sutured it.

We do occasionally see people in labour ward who have an infection or a worry about their stitches, but the people who return really are a cross-section of the delivering population, having been sutured by junior midwives to consultants, with no particular bias towards who sutured them having problems.

You do seem to have had a horrific time of it, and I can only offer my greatest sympathy, and very that you are having to go through this.

Surgeons and gynos have to suture a straight wound or something hidden inside with an anaesthetised patient, and I would not for one minute wish to swap jobs with them but as a midwife (or an obstetrician) we have to suture an area that sometimes looks like a small bomb has exploded there, with a conscious patient, and try to make it look like it did when you came in. It can be incredibly difficult sometimes to get a great cosmetic and functional result and I must admit, if it looks beyond my capabilities, I will gladly pass the stitching on to one of the senior Drs. But they have still probably stitched less peris than me!

I hope you dont take this post the wrong way, as it is not meant as an excuse for, or as a belittling of your experience, because it is not meant that way, but instead is a way to try to explain our role, and to say that its obviously not done with intent to cause problems, but that there are some things which we cant predict.

Hi mintpurple,
My comments weren't directed against MWs or doctors in general, honest!
My point was that I was given an episiotomy without my consent and I was bullied into an instrument delivery, despite there being no rush to get DD out and a family history to indicate that an instrument delivery would cause me all these problems. The job that they did stitching me up was just the icing on the cake (before I signed the form I questioned the doctor that told me that he would sew me up if I tore very closely about his experience etc - when I was sewn up he buggered off and left a junior doctor to stitch me ).
I have to say though, it's really daft to me that there isn't any kind of formal follow-up. How on earth are doctors and MWs supposed to know what is the best method if there isn't?