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.

Completely agree with you about the follow up.

I have also regularly seen doctors performing episiotomies routinely for instrumental deliveries against the express wishes of the patient (and even the protests of the midwife). This is actually assault and there is a very strong case for legal action against the doctor in this case, but I have never heard of it happening. A complaint maybe, but that is easily swept away by saying that there would have been a much worse tear otherwise.

You really do sound like you have had a bad deal last time. One side of me says that another vaginal birth may fix the problem if they restitch you, but I can also see a great allure in an el C/S.

Good luck.

Thank you for the sympathy.
I think that a lot of my concern about a second delivery is that I did everything "right". I did loads of optimal-foetal-positioning stuff, I went to the MW-led birthing unit, I got out of the wonderful pool to speed things up, I walked, danced, leaned, bounced etc. etc., and then I really did push in every position and pushed so hard that I gave myself piles.
There is nothing that I could do differently next time. Except that DH is guilt-ridden and has promised not to side with the doctor against my wishes this time. I know what my body needs, and during the last birth I wanted to try natural birth, under the understanding that as long as I tried my best that I would get a section if things didn't work out. The consultant had no respect at all for the birthing-unit, or the MWs though, and didn't pay any attention to the notes telling him that I had tried really hard. He just treated me as "too posh to push" and laughed at me.

Just disgusted with the attitude of the doctor.

The fact is that you did everything right, and so take credit for the fact that you got to fully dilated and that baby was far enough down that they could do an instrumental delivery. In most cases, that is far preferable to a c/s, however in your case, and with the benefit of hindsight, a c/s would probably have been the better choice.

As I continually say on threads, if you have made it to fully dilated and had a vaginal birth, your chance of needing a c/s is really small, and with a first baby the instrumental rate is about 20-30% in most units, but for a second baby the chances of an instrumental is probably about 5%, if baby same size, term etc.
So if you did what you did last time you should be more than capable of a lovely birth centre birth, and I would encourage you to go for that.

As for the suturing, with the problems that you have described in your posts, I would think that you would need stitches, as such a lot of scar tissue will not stretch as well as a non scarred peri, but like I said, it may be the best thing, if you could be resutured by a very experienced doctor, one of the senior registrars or consultants. I think it would be well worth having tht written on the front of your notes in red and highlighted!

'If suturing needed, must be done by SR or Consultant'

Im sure if you have a reasonable consultant antenatally, they would ensure this. Also you could put your foot down yourself if the need arises and tell them that you would rather bleed to death than let the SHO near you! Im sure they will listen

I am thinking about having a T-shirt made with "I do NOT consent to an instrument delivery unless my baby is in IMMEDIATE danger". What do you think?
Although the weasely consultant would probably twist everything to make it look as though DB was in danger to cover his arse. All my notes from the consultant-led unit were written "in retrospect" so they could pretty much write the script as they wanted after the fact.

Do you think that it's worth writing to the consultant and telling him about the bad healing, how dreadful it was to have an epi without consent and the birth trauma? Or would he brush it off with a "but your baby is alive isn't she?" and make me feel worse?

LOL - I think they would put a cloth over the tshirt so they couldnt see it! But seriously, you shouldnt need an instrumental next time.

I think it would be worth getting in touch with the consultant but through the PALS Patient liason office at the hospital who could set up a meeting and mediate etc.

I would imagine that you have your gynos backup re the state of your peri if needed, and I think it would be a worthwhile part of your mental and emotional healing to deal with this before being pregnant again, although I imagine there may be a fair bit of wriggling and twisting of the truths but usually these meetings are quite productive. Especially if he doesnt know if you are preparing to instigate legal action against the hospital, I think he will be fairly amenable to an open discussion. You should also be able to pin him down to agreeing to ensure a senior doc was available for your resuturing if need be next time.

Why dont you call the PALS office today and run it past them and see what they think. They are usually very supportive of patients.

Anyway I have to go to sleep now - night shifts! Ill check in later. xx

Thank you for "chatting" with me about this. It's silly really - the chances of me conceiving again (even with fertility treatment) are minimal, so I probably won't even have to deal with it again.

I have moved since giving birth. The downside is that it's hard to get to the hospital where I delivered. The good side is that there is NO chance of having the same consultant again!