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Originally Posted by midwifemom3 
1. I am so sorry she is going through this. I ama midwife, and when you have a tear to this extent it is soimportant that it be repaired right away. I wish the support people at the birth had taken her in. With a fourth there is so much muscle and rectal capsule disruption that there is persistant pain and often incontinence. She will likely have pain until it is repaired. They can use estrace cream so that the estrogen is acting locally on the tissues and still breastfeed. Unfortunate when tissues have healed by secondary retention like they have here they often flatten into onethisarea because none of the dead space was closed, so there is not a lot of tissue for the surgeon to work with, and now she will need reconstructive surgery. sometimes it is so bad that women end up with one hole down there. This will be a major surgery and require 6 weeks to heal. If she has more children most physicians will recommend a section, but I am sure she willnot want that, but I highly recommend in the future that she have a provider attend her birth that can repair. She will have a lot of scar tissue, and scar tissue does not stretch well.Good Luck to her.
Jen
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Thanks Jen for taking time to help us out! Unfortunately, her support people didn't realize how bad she had torn, and there were some other issues going on at the same time.
(Her In-law's came, un-invited by her but her husband was insistent they would be there so he wouldn't tell them no. So they barged in to her (and my) parents house, assuming they would be able to be at the birth, and basically, someone had to guard the door so her MIL wouldn't come in! Then they (mostly her MIL) sat outside the door whining because they knew that baby had been born and why couldn't they see her yet??? (she was still attached and placenta hadn't been delivered!) So there were tons of "underlying issues" going on at the same time as all this!)
So checking to see how badly she tore was not foremost in anyone's mind, and even if it had been, they didn't know that it had to be repaired very quickly. Since she was at her parents house, 3 hours away from her home, she didn't seek medical help because she was already scheduled to see at DR at home for the blood test and rhogam shot (if needed). 32 hours after the birth, a good friend who is a CNM stopped by the house and did examine her and that's when she found out how bad the tear was, but it was already too late to fix it.
I'll have her ask the surgeon about the estrogen cream, I did read something about that today and was wondering if it would be an option.
The surgeon did tell her that if she has another vaginal birth after having reconstructive surgery that she would run the risk of completely tearing it all out and ending up with a colostomy, and that a c-s would be the only way to go after this. While that's obviously not my sisters first choice, she is making peace with that possibility.
We live out in the middle of nowhere, so the closest surgeon is 3 hours away, so if and when the surgery is done, it really needs to all be done at once. I and all the women in our family are big proponents of extended breastfeeding and self weaning and all, but in this case, I do feel like the repair might trump in importance.
One other thing - if a woman is breastfeeding but ovulating regularly, she IS producing estrogen, right? With both of my babies, I started having regular AF's at 6 months post-partum while exclusively breastfeeding on demand, and this was another sisters experience also, so maybe this sister will be that "lucky" too!
. Perhaps some ice (ok lots of ice) and a second opinion on the tear is in order?
(she's 6 weeks pp tomorrow and is still in a considerable amount of pain!)
