4th degree tare - healing? *UPDATE* - Page 2

[maxmama]

Originally Posted by homebirthbaby

*UPDATE*

Yesterday, I went with my sister to her consultation with the colorectol surgeon who was recommended by the OB.
She was very disappointed to find out that they won't be doing the surgery any time soon (she's 6 weeks pp tomorrow and is still in a considerable amount of pain!)
In Janurary, they will start nerve and muscle testing to see how much nerve and muscle damage there is, but the surgeon said they won't do surgery while she is nursing because she needs to be producing estrogen to ensure the success of the surgery.
The colorectol surgeon will be consulting with a gynecological-urologist to help with the reconstruction of the pernium.
There is nothing there, except a small section of skin between the vagina and anus.

My questions today are:
1. is there a possibility of her "healing" or not being in pain enough to start back to work - she's a CNA at a nursing home - without / before the surgery?
2. would an estrogen only birth control pill have the same effect as natural estrogen? ( I know next to nothing about birth control pills...)
3. is there anyone who has had a similar experience without having it repaired for a year or two? This is her first baby and nursing is going well now - she had every intention of nursing a minimum of 18 months!

THere is no "estrogen-only birth control". First, because unopposed estrogen can lead to endometrial cancer, and second because the contraceptive benefits of OCPs are largely due to progesterone.

She can have the repair done in a year or so, but life is likely to be very difficult in the meantime. Does she have fecal or urinary incontinence? Is there a fistula? 3rd and 4th degree tears have a lot of functional implications.

[LAWoman]

That's just awful for your sister. While I'm a big fan of extended nursing, I can't imagine waiting too long to have a surgical repair in that situation. Her health and well being need to be top priority right now.

I wonder if finding the right balance of nursing and supplementation could get her ovulating sooner. All of my friends who combined nursing with formula got their cycles back pretty early. Mine came back the month after I stopped pumping during the day and started offering a single bottle of formula each day. We're still nursing 2 years later so it didn't affect our long term nursing relationship at all. There aren't many situations where I'd recommend supplementing so soon if nursing is going well but given how serious this is it seems worth looking into so she can get it taken care of as soon as possible. Maybe a lactation consultant could help her figure out how to find that balance. Wishing her health and healing.

[Kathryn]

Your poor sister. I can't believe no one checked her out and took her in quickly. I feel so awful for her.

While I did CLW with my oldest and nursed my triplets as long as I could, I wouldn't wait to get surgery, even if it meant weaning, partially or fully. Can she start pumping around the clock right now, to build up a storage for the baby? I'm sure she really does want to BF as long as possible, but I'm also sure she doesn't want a gaping injury and possible life altering complications from it.

[wombatclay]

I'm so sorry. I had a 4th degree tear with my first vbac and although it was repaired right then and there (my attending OB actually teaches a class for midwives in how to repair serious tears, and although her own client don't usually have 4th degree tears she is the one the hospital calls in to repair them so I really lucked out in that respect.) She felt that I could consider vaginal births in the future but her partner felt very strongly that rc/s would be the best option. I did just have a vbac-after-4th-degree and although I had a 2nd degree tear along the scar line, I haven't had any serious (new) problems. In her case though there is going to be a lot more scar tissue and more "compromized" tissue/muscle/nerves so she needs to be aware of the risks of vaginal delivery and take an honest look at her options and how she would feel if different things happened.

There is a 4th degree tear thread and a Pelvic Organ Prolapse thread (both in Healing from Birth Trauma) that might help her figure things out. Lot's of resources and BTDT stories. (I'm suggesting the POP thread since many women there are dealing with incontinance issues, and several have had significant tears... it's a risk factor for POP... and then gone on to have more children. Also surgical treatment for POP is similar to what she may face, including the need for estrogen therapy.)

I'm sorry the birth was complicated and had such a lasting impact. In my case, even with immediate repair, I was in pain or uncomfortable for about a year. DTD was extremely painful for the first 6-8 months. But other women have different experiences. Check out the threads for some amazing healing stories. I put together a "how to heal" FAQ (PM me if you'd like a copy) based on things I learned here, heard from my surgeon, gathered at health clinics, etc.

big hugs and hopes for healing...

[amyjrn23]

3. is there anyone who has had a similar experience without having it repaired for a year or two? This is her first baby and nursing is going well now - she had every intention of nursing a minimum of 18 months!


Several of the ob/gyn's I work with have gone on medical mission trips where they have performed this type of surgery on women years out from their delivery with great sucess.

[nikirj]

Even a properly repaired 4th degree takes months to heal. Really, a repair should be done within the first 6 hours. Earlier is easier because swelling is less.

It sounds like the tissues haven't come back together. No amount of estrogen therapy is going to fix that; if the muscles, supportive tissues, etc. aren't in contact with each other, the body is going to have a lot of trouble doing anything but healing them separately, which isn't going to be good in the long term. If your sister isn't happy with how the doctor is managing it, can she get a second opinion? There are some surgeons who specialize in these types of repairs, and I'd seek one out, especially if the current care isn't making her happy. One example of such a provider is Kathryn Arendt, who is a urogynecologist in WA State. You want someone with lots of experience doing exactly this type of repair, and it's worthwhile to ask around because of the potential lasting consequences if it's not done well.

(sorry to crash on the UC board, the discussion drew my attention)

[fyrebloom]

With the seriousness of the damage and the pain she must be in, she probably should get it repaired as soon as possible. What crappy luck! Hopefully she'll start ovulating soon and can get the surgery done sooner.

I think that having someone on hand to do repairs in the future or making an immediate transfer after another UC for future babies is the best bet. I had a second degree tear and a second degree episiotomy which extended to a 4th degree tear. My next vaginal birth I did not tear, just had two small abrasions, but mine were repaired right after DS1s birth. There is alot to be said for scar massage during the next pregnancy and she should wait a while before testing that scar. I don't get how major abdominal surgery would be better for her then having her perineum repaired again, kwim. Seems like overkill. She will certainly have special considerations next time, but i'm sure there is another way.

[ArtsyHeartsy]

Originally Posted by caro113

I haven't read the replies but when my daughter was born, I literally tore in half. It took 45 minutes to stitch me up.

What really helped me deal with the pain was hemorroid cream and pads. I lined my underwear (or pad depending on pp bleeding at the time) with the pads and then put a line of cream down the middle. Helped immensely. The pads help keep the area cool and the cream helps numb the area.

As far as healing, in what way? I was stitched up so tightly that sex still hurts - 13 months later. I'm pretty certain they screwed that up but it really does do me any good now. It definitely has gotten better but even now I still need to use lube or it's way to painful.
HTH

Same here! Yikes. I still have issues, and my daughter is almost 6. Sex and even when I have my period it hurts worse in the area. I also had a stitch pop, but nobody believed me. So now I have a very small spot where there is a sort of opening. It's not bothersome but not lovely either. Someone should have fixed it for me.

I am so sorry your sister has to go through this, it is SO painful. I think it took me about 6 months before I really felt almost normal again after my tears. Mine were internal and external but I am not sure of the degree, they never told me, it took FOREVER for them to stitch me up. The same thing happened with my DD too, she just shot out, landed on the tray.

Like others have said, the pads with cream are what helped me, I sort of treated it like hemorrhoids sitting on a boppy helped sometimes, I also used some disinfectant spray they gave me in the hospital. I know in the hospital they gave me frozen baby diapers to use for swelling. Not very environmental but something about those frozen gel diapers was very comforting and just the right size. I'm sure any type of cold compress would help. I lived on Ibuprofen for a very long time.

I feel for your sister, I hope she gets some sort of surgery or help soon, I can't imagine living with that for too long. I think it would be very hard for her to go back to work any time soon. Good luck to her and keep us updated!

[wombatclay]

I don't get how major abdominal surgery would be better for her then having her perineum repaired again, kwim. Seems like overkill. She will certainly have special considerations next time, but i'm sure there is another way.

C/s certainly carries some major risks. The risk with a vaginal birth after 4th degree is that if you have another 4th degree tear it is a lot harder to fix and the chance for long term complications (permanent fecal incontinance for example) goes sky high because there is less tissue/muscle to work with. And that is assuming the initial tear was repaired and the woman healed well. (for example, "minor" incontinance after the first tear often translates into "significant" incontinance after a second sphincter tear)

So the balance is between the known risks of the c/s and the possible risk of a repeat tear. Given the risks and the long term impact, it's a hard choice. I feel really blessed that my own vaginal birth after 4th degree didn't cause more trauma! The vaginal birth after 4th degree thread has links to studies/research but also BTDT ramblings of women working through their options and stories of positive birth outcomes.

[modadan]

me too

MIL sounds like a nightmare!!!

[Banana731]

Originally Posted by amyjrn23

3. is there anyone who has had a similar experience without having it repaired for a year or two? This is her first baby and nursing is going well now - she had every intention of nursing a minimum of 18 months!

I would think, that if she used pacifiers, that is didn't have the baby fill her non-nutrative sucking needs at the breast, that her AF would return sooner. Also, once she has breastfeeding well established (after the first several weeks) even if she supplemented some for a time to get am early return of ovulation, she could most likely get her supply back up enough to cut out supplementation when she was ready to (though by then, her LO might be eating solids, and really rebuilding her supply might not even be necessary). I'm a huge advocate of BF and not a fan of supplementing, as it can be a slippery slope, but it can be done if mom is dedicated. While breastfeeding is super important, that repair is important to her health and well being, as well.

[Maluhia]

I had under-anesthesia general surgery to fix tears when DD was two months old. I pre-pumped and had to pump and dump for 24 hours. I pray your sister will find a 2nd opinion, even waiting two months I have physical issues five years later from the scar tissue, repair, etc.

[JessicaS]

I think on average ovulation returns about when the baby starts solids, it is difficult to say though. It is different for everyone and every baby.

I will keep her in my thoughts, what a nightmare.