Calling all Raggedies - the THIRD Ragged Bits thread. Childbirth injuries, sphincter problems, fistulae... all welcome.

[Jacksmania]

First thread here, May 2008 to June 2009.

Second thread here, June 2009 to Oct 2012.

Welcome everyone with ragged bits due to childbirth. We're sorry you had to find us, but we promise to hold your hand and listen.

There is no TMI here and nothing is too gross, too embarrassing or too horrible.

All welcome.

Oh my gosh, where do I start? I had posted separately last week, when I was feeling particularly rubbish. I am feeling rubbish today.
I don't know why I had a fourth degree tear. Baby was born Aug 5th.
Here goes, long story… LONG POST WARNING!
Pregnancy was fine, other than insomnia from the start, which was exhausting, had to have a few growth scans but that was because they were rightly overcautious if a measurement didn't seem right. Had MASSIVE legs and ankles though, even though BP was fine. Had shared care because of my history with IBS and anal fissures until I was 38 weeks. Went into labour on the second day of mat leave. I was pushing for ages. But, it was rather hands off, he did an episiotomy in the end and DS arrived, then he suspected a tear and then there were blurry moments when, instead of having those precious moments with baby, I was moved to another room where the midwife wouldn't help me out of the wheelchair onto the examining table and examined and 3c or 4th degree tear was suspected, so I was wheeled down to the labour ward, where the anaesthetist saw me, I was vomiting (midwife very cold, just handed me sick bowls) and dizzy. Anaesthetist at least hooked me to a drip, took bloods and then I was consented for the repair. Was in theatre for about an hour under spinal. Then taken to a side rom on the post natal ward where I stared at the wall for most of the day and couldn't lie down as I was numb and wouldn't be able to get up myself if baby needed to be fed. Notes weren't written up clearly -I had a 4th degree tear but notes had 3c written. Missed a dose of antibiotics because they weren't written up properly. Sigh.
I won't go on about the lack of complete success with breastfeeding here; I did my best for as long as I could.
Had issues with the wound afterwards- a stitch poking out of my bottom and infection, so multiple antibiotics, eventually ended up having it removed (after 3hrs via A+E and eventually gynae)..Was discharged from consultant clinic (?!!) at 8 weeks even though at 6 weeks still had issues. Still had infection due to a possible sinus 3 days after the consultant discharged me, but had to go via A+E, this time trawling around the hospital with my 9 week old. Eventually was reviewed by a consultant who could be bothered and got referred for an endoanal scan. Results were encouraging, I see a physio.
I have some urgency that is getting better, but I could at times wipe my bottom forever, depending on how soft the stool was. Feels too tender for me to attempt any massage for the scar tissue (How do you do that anyway) and wind incontinence. and I've got no interest in sex anymore.

Sorry- previous post was long and all over the place, I haven't even included everything. I complained about the issues in triage and post op to the hospital-they are still looking into it 3 months later!

Mentally and emotionally, I am exhausted. Nobody tells you what a toll such a bad tear will take on you and how it affects you. Physically/medically, I appear to be healing. I don't know is it just the 5 months and more of lack of sleep that is getting to me. My joints ache, I'm losing loads of hair, my fingertips are splitting and dry, "downstairs" still feels sore if I don't sit quite right, or if I "slide" off the sofa, for example. WInd incontinence bugs me and I sometimes still have to rush to the loo. My parents are both doctors (father is an obstetrician) and they were both appalled I had a 4th degree tear. Far from feeling like I am getting more energy, I feel so tired and disappointed all the time. DS is getting more active and I want to feel able to keep up with him, he is such a joy in my life. He just doesn't sleep much and still feeds at night. I can't quite describe all my feelings right now. I'm feeling upset today and I'm getting tearful all over again. I've shed most of the fluid I think, but I'm broader than before. Nobody tells you you get wider shoulders and ribs. Wider hips makes sense at least. I'm probably 2 dress sizes bigger. I never had any issues with my weight or how I looked before. I just don't feel like myself.

I have moments when I feel better and confident and good about myself. DH is always trying to make me feel better and helps when he can, but he is also tired, has a long commute to work in London and messiness in the house doesn't bother him.
It sounds like I'm just feeling sorry for myself, but I've tried to work all my feelings out; some days I can do that better than others.

so happy to find this thread (but so sorry you all had to go through such bad experiences)

my birth was a piece of cake compared to most of yours (3b tear, horrendous for the first few weeks, now getting much better), but I still find myself thinking about it a lot and being very emotional about it. I want other children, but I am absolutely terrified of giving birth again and having the same thing (or worse) happen again. It's the total lack of control that terrifies me, it seems like there's nothing I can do to avoid another tear and all the possibilities that come with it.

I find myself feeling angry, but objectively I was given good medical care, so I have nothing to direct my anger towards. How do you all deal with the "why me" feeling?

The one thing I do feel deserves my anger, is the flippancy with which our society treats the emotional trauma that can come with bad birth experiences. No one ever talks about all the things discussed in this thread, I had absolutely no idea before I had a tear myself and started researching things.

Sorry this is rambling, I don't even really have a point here... hugs to everyone in this thread.

Labour was much worse than I hoped. I tried the hypnobirthing CD which help me sleep (not the intended purpose!) but I wasn't anxious about the thought of labour and giving birth. Which is why it was such a shock. Due to my experience I am now worried about what it will be like second time. I don't want a CS either. Reassurances that it is better second time are not helping as I don't believe them! What worries me more than anything is the terrible post natal care that seems to be rife everywhere.

same here sksk - I wasn't anxious about birth at all. My NCT classes had made it sound like the worse bit was the contractions, and that deep breathing and gas and air would see me through it. Hah. As it turned out, the worse bit by far was after the birth, with the pain of the stitches, the humiliation of pooing myself in the hospital, and then the fear of excruciating bowel movements. No one warned me beforehand, no one really gave me any advice. I had to go online to find it was actually quite common, and get lots of wonderful advice from other MNers.

Just being warned beforehand, and having someone to talk about it with afterwards, would make such a difference.

I hear that I have about the same low chance of tearing for my second birth as for my first, but that's not exactly helping since I did tear badly in my first birth. I know I could probably get a CS, but there's no guarantee to actually get there, since the next DC may well come early. So I'll probably be stressed out of my mind for the duration of my next pregnancy.

Chacha23 You would probably need to be delivered by a doctor rather than midwife with the history of a severe tear? SOme women just pop out their babies, have no issues with feeding and just seem to bounce back into normal life like it's no problem. Sigh.

Chacha i will try to reassure you about next pregnancy & baby. I had 4th degree tear 2 years ago and am currently 36 weeks with DC2. I knew immediately that i would choose elcs and it was easy to get it agreed. I have had pain on my episiotomy scar and all my perrenium and other scars are tender but i'm neary full term. I've had smearing issues since about 28-30 weeks but otherwise my body has held up pretty well.

I too have been worried about going into labour early, my DS arrived at 38 weeks (fully cooked). I'm hypermobile which means i'm slightly more at risk if early labour. Currently i'm actually having contractions (or very strong braxton hicks) and was in hospital being monitored last night. All the staff were very happy to reassure me and they all said that if the pain gets worse or i have any other signs of labour i'm to go straight back in and they can preform c-section straight away. I only live 10 mins from hospital so resting at home is favourable for me to being in a reallyhot stuffy maternity ward. So try not to worry as second time around they seem to take you a lot more seriously.

Chacha i also want to try to answer your question on how i deal with the 'why me'. Quite simply i still ask myself that often and wonder. I have had counselling (which a lot of us on this thread have) to help deal with my DS birth. While i've been able to deal with most of it i still ask myself that question. Counselling has helped change my focus so it seems less important (but not always, some days i still cry about it). I try to think of it, and every challenge in life, as a what doesnt kill me only makes me stronger sort of thing. Physically i'm not what i was but mentally i've been to hell & back a few times and am a more well-rounded person because of it.

thanks so much for the replies, and best of luck with the upcoming birth cravingcake!

what you're saying about elcs is reassuring. I was never keen on the idea of a c-section, but it may well be a case of the least bad option...

when I'm feeling sorry for myself I try to think of the generations of women who had to go through it without proper medical care... even not that long ago. My grandmother was telling over Xmas that her giant first-born child tore her up pretty badly, and that she had to wait until the next day to be sawn up without anaesthetics. (shudder) She went on to have three more

Just wondering if anyone has contacted Birrh Crisis and if it helped them?
Also, I've heard perineal massage can help the scar tissue from a bad tear- I'm too squeamish to try yet as it still feels a bit weird and tender (5 months post partum) and also don't know how to do it? Any suggestions?

Happy new year to everyone! Here's hoping 2014 is a better year for all

Hi sksk I had a 3c (almost 4th) degree tear in February 2013 and I completely understand your feelings about the birth haunting you. I too found that, mentally, things got worse over time and not better. In the early weeks following the tear all the doctors were telling me that I'd be all healed up and back to normal by 6 months PP, but when I hit that mark and found I still had a lot of physical problems my mental state took a nose dive. False hope does no one any favors. Like cardamomginger I too am having trauma therapy and am finding it's helping although I only started it 2 months ago. Please keep an eye on how you're feeling and speak to your GP if you think you're struggling.

As to a vaginal delivery after 4th degree tear (I prefer to call it vaginal delivery rather than 'natural', there was nothing natural about my natural birth!) yes I believe it's possible however there'd be certain criteria the doctors would want you to meet. I'm assuming they'd want you to have full continence of bladder and bowel (flatulence included) as well as good results in an endoanal ultrasound and/or anal mamometry testing. They'd probably also want you to avoid induction and assisted birth as these are risk factors. That being said, many doctors here in Australia don't allow vaginal after 3c or 4th degree tears ad the risk of litigation is just too high. I personally will be having cesareans for any future children. What type of birth do you want?

KaFay I'm wondering if you might benefit from some pelvic floor physio? If your sphincter muscles are weak it can make it a) hard to push out when too solid and b) hard to hold onto when soft. Not sure if this is what is causing your problems but it's probly worth mentioning to your GP if it's bothering you. I do think many women have bottom troubles after childbirth, it's just that it never gets talked about!

How is everyone else? How long until D Day cravingcake?

xxx

chacha23 I still have the 'why me' anger 10.5 months on. It's only since taking anti-Ds and seeing a psychologist I'm beginning to move past that. I still feel that it's not fair, that I did everything right in labour (stayed at home til I was fully dilated...! No pain relief) and yet ended up being shredded on the delivery table. I agree with cravingcake, that it's helpful to adopt a 'what doesn't kill me will make me stronger' attitude but it takes time to get to that. You don't have to like what happened to you, you don't have to think it's fair, you're entitled to feel rage, but know that one day you'll be ok about it, no matter how long it takes to get there.

I also found labour more difficult and painful than my antenatal classes let on. It still makes me angry more women aren't told the realities of birth, and that we all fall for the glossy lies in the pregnancy magazines. I suppose I'm glad I'll be able to better empower my daughter with knowledge about birth once she has kids of her own. And if it makes you feel any better, I pooed myself the day after birth in hospital, didn't even know it was coming

sksk I still have some bowel urgency and wind incontinence but both have improved with intensive physio. What sort of physio have you been having? I found estrogen cream helped the toughness of my scars, I was never keen on massaging that area.

Hi Neptuna I'm booked in for the 21st so just 16 days away. However i've been back & forth to hospital all week with suspected contractions but nothing happening so i've been told to take paracetamol & codeine to manage the pain and to go back if it gets worse or any other signs of labour. Am really frustrated as i saw consultant yesterday to disciss bringing forward elcs (to 38+2 rather than 39+2) and it was an outright no, they wouldnt listen to me or my DH and just said to take pain relief. The one thing i've said all along is that i dont want to labour or experience painful contractions as mentally it puts back to what i went through with DS. So i'm rather exhausted and trying to rest as much as i can, both physically & mentally.

So baby could be any day but at the latest will be the 21st.

Neptuna, thank you for listening and sharing your own story

I have an appointment at the perineal clinic tomorrow, and I was wondering if any of you had suggestions of questions to ask. I want to know my options for possible future births, but I am afraid the consultant will make me feel unreasonable for being absolutely terrified of tearing again.

(I don't know why people think the "you only have a 5-10% chance of tearing again" argument is so powerful... the statistics didn't exactly work out for me the first time, did they?!)

I posted on the childbirth thread asking if anyone knew of actual statistics regarding the risks of VB after a bad tear, because all I can find online is anecdotal evidence. This is probably also a good place to ask? I would quite like to go to my appointment armed with some knowledge!

Chacha i asked at my first consultant appointment if they could give me statistics, or where i could find stats about vaginal birth vs c-section after 4th degree tears and was told that due to the rareity of a 4th degree tear there was none as there isnt a big enough sample of women to test. Its not exactly answering yor question but maybe if you ask then they can see you are serious about considering both options.

Regarding your fear of tearing again you may need to be quite specific with them. Make sure they know its not just the thought (which would make you more tense during labour) or pain but the long term effect on your body, i.e permanent incontenence or prolapse etc. They may examine you to see how you are healing, for me they told me that because i've healed well they would prefer to do elcs as when you tear the best chance of fixing it is first time and if i was to tear again they wouldnt be able to guarantee i would be stitched as well or heal properly. I think most people who have had a 3rd or 4th degree tear are given the option of vb or elcs but it is always good to try to get it in writing.

Good luck.

Thanks cravingcake, and you're exactly right - it's not really the pain I'm afraid of, it's doing irreparable damage to my body.

From the threads I've read it sounds like consultants tend to highlight the difference in immediate recovery (with elcs being tougher), but it's the long-term risks that are more relevant in my opinion. So yes, definitely something to ask.

Urgh cravingcake that's awful, I'm annoyed for you they won't do your c sec earlier. Why can't they just do the steroid shots? I'm worried about being in a similar situation to you, feeling I'm inn the brink of labour and totally freaking out. So are they just bad Braxton hicks then? Have you effaced or dilated at all?

chacha23 I have some suggestions for questions you can ask. Firstly, do you have any incontinence symptoms now? (I'm not sure how far past birth you are??) if you do many consultants will not even allow you a vaginal birth anyway.

Ask about having an endoanal ultrasound this will show you how well your sphincters have healed and whether attempting another vag birth is a good idea or not. I think you need to see a colorectal surgeon for this, not sure if OBs do it.

Ask about why you tore. If it was because of forceps or induction you may be able to avoid that next time.

Ask to have your pelvic floor muscle strength assessed it's important these muscles remain strong to prevent prolapse etc

Ask about damage to the pudendal nerve from pushing a second baby out.

Ask about occult sphincter damage (damage that occurs internally and so isn't detected and thus not repaired)

And finally, ask about what your chances are of worsening incontinence after menopause as the damaged muscles will weaken further then.

Good luck, let us know what they tell you!!!

Neptuna i'm now 37+1 so full term - yay! And in one piece still. I wont lie, its extremely hard mentally and physically. I was examined last week when we thought it was really happening and was told cervix is closed and thick. So its either strong braxton hicks or very early contractions just warming up. Either way they get very regular (every 8 mins) and last for almost 2 mins and bring me to tears with pain. Not fun. And after a couple of hours & codeine they dull down again to just tightenings and irregular.

Sometimes i'm ok with it as baby isnt showing any sign of distress so best place is for baby to stay put for now, but then every slight niggle or twinge i'm wondering is this it. And then i get very frustrated as baby & my body is obviously showing signs its almost ready and the mental roller coaster is very tiring, i'm exhausted. Second labours are often quicker and so i'm scared that if it all gets going i'll be in a lot of pain for quite a while until its determined if its ok to do c-section & i'll be knackered rather than the calm elective section would be.

Thank you so much Neptuna, that's amazing. I want to make the best possible use of my appointment, feel much better armed now! (after quickly googling some of the terms )

I'm only 12 weeks pp, so this is only a check-up appointment for my tear, I'm not planning to get pregnant for at least 6 months. I know exactly why I tore, I was pretty much cumulating the risk factors - first baby, very large baby, back to back, forceps. So my hope is that next time I could try a VB, but request a C-section if any of those risks pop up again.

I still have a small degree of incontinence (wind only), but it's still early days so not sure how significant that is.

Best of luck to you and cravingcake! I hope things move forward quickly for you cravingcake, I had a very long pre-labour for my first with painful contractions, I know exactly how bad it is. (holds hand)

update - so, I guess it wasn't the kind of appointment I thought it would be... it lasted about 5 minutes, the consultant asked me exactly 2 questions ("do you still have any symptoms", and "do you do your exercises religiously"), then looked at my lady bits, said "I'm happy to discharge you" and left. She clearly wanted to be done asap, and I was too much of a chicken to insist and make her speak with me.

I was really looking forward to talking about my birth and discussing my worries, guess it'll be for another time :-(

Oh Chacha how frustrating. I've had that before when you loose confidence and dont feel able to ask the questions or get a proper answer. If you have been signed off by her you can go back to your gp, explain that you arent happy with being signed off and could you be re-referred for a second opinion.

Also, if you contact your hospital you can arrange to go through your birth notes & discuss with a midwife what happened and that may help you too.

thanks cravingcake, actually I will do that in the first instance - just left a message for the "birth afterthoughts" midwives, a friend of mine did it and said it was really helpful.

hope your contractions are leaving you in peace today!

Oh chacha how frustrating ! I found a similar attitude when I had my initial postnatal check ups, they only wanted to know if I had any incontinence and didn't really care about all my other Qs. They did want to see me again at 6 months PP though as they said they were worried about my trouble with controlling wind. Sounds like your consultant wasn't worried about that at all?

I agree that a birth afterthoughts session would be helpful. The other option is to go private and have all your concerns addressed there. This is what I did as the public health system here (equivalent to your NHS) didn't seem too interested in all my queries. After going private I got to talk at length about all my worries and thoughts. It's not cheap though, that's for sure! I'll be going private for the next baby too, I don't want a registrar cutting my tummy open. I hope you can get some answers!

cravingcake it sounds all very painful indeed I'm for you too that they won't just give you the course of steroids and do the cesarean now, especially as your body seems pretty much primed to go into labour at any point. I'm glad to hear you say your body has held up ok, makes me a little more hopeful mine won't fall apart when I get pregnant again Have you been able to get any sleep despite the pain?

thanks Neptuna, I was pretty down when I came out of my appointment, but now I'm thinking I probably already know most of what they could have told me anyway... since my symptoms are mild I doubt they would really send me for extra checks etc until I am actually pregnant again. I will make sure to whip out my list of questions then

the consultant didn't seem worried about the wind issue, she told me she expected it to resolve itself by 6 months pp, so we'll see. (I know you've heard this one before!..)

I'm hoping the birth afterthoughts will really help. It does worry me a bit that as the weeks go by, I find myself thinking about the birth more, and not less. But it's probably not a consultant I need to see, just someone to talk things through with so I can have a clear picture of what happened and start coming to terms with it.

cravingcake, how are you getting along?

Well i'm hanging on in there. Thankfully contractions have calmed down but i'm still knackered. Had a good day yesterday but needing lots of rest today.

Chacha thats really normal to feel the way you do, the inital high of actually having your baby is wearing off and you are settling into things so have time to reflect on the birth. Ask your health visitor or gp for some counselling asap as well as the birth reflections.