[gemasita]

I have a client who has had two hemmoroids removed, one 8 days ago and one yesterday. She called me this morning and is having contractions, pretty spread out though. She's 39 weeks. I had NO idea what to tell her so I kept asking her what her doctors said about the procedure she had and how that could affect labor and pushing and she really got different responses from everyone. One doctor said it shouldn't effect pushing and another said, "Is there any way you can wait?" (she was in terrible pain from them) and a nurse said, "This is going to be like pushing with an open wound." ARG!

Needless to say, she's now terrified and I didn't want to scare her but I really know NOTHING about this! She's wanted a med-free birth and mentioned a c-section a couple of times so them I suggested to her that an epidural during pushing could be an option since that area is tender. I told her that it could be helpful in this situation where she might have sensations that don't normally go along with pushing.

ANY ADVICE for me as her doula?

 

[Peppamint]

Ouch...

This is a case where I can't help but think some perineal support may be needed- perhaps that would help with the sensations of pushing. I can only imagine that it's going to feel like her anus is tearing apart.

I've never heard of anyone having hemorrhoids removed right before they were due, it seems like very poor timing.

 

[dewi]

Is a hemorrhoidectomy a cut and they take it out it and stitch her up?
This sounds like a real mess.

It sounds like it would still be too painful to push with the recent surgery.

Personally if my hemorrhoids were so bad I needed them surgically removed the week before my due day I might have chosen to have c/section while they were removing the hemorrhoids! Or now choose to have a c/sec after going into labor. It just hurts my bottom thinking about her pain.

Beside counter pressure with a compress, I don't know how will she push without bursting open her fresh wounds from surgery. I certainly hope they don't plan on cutting a 4th degree episiomety (up around her anus) and use forceps or suction to get the baby out.
That type of cut and recovery is horrifically painful.

PS. As her doula I have no advice for you except the normal stuff of being supportive in any decision she makes. If she choose a c/sec there are ways you can help her plan the c/sec to be more civilized then how doctors treat it as mere "surgery", asking the the doctors to treat it as a birth, with good vibes and mom bonding with the baby, etc.

 

[hedgehogs4]

If that just happened to me, I think ANY plan you give her could be comforting. Maybe tell her that during the pushing stage you'll hold cool compresses to her rectum - I'm not sure what was in it but my doula made me an herbal sitz bath for my hemorrhoids that i kept in the fridge - so tell her you'll support her anus with cool herbal compresses and maybe that will reduce her anxiety. Good luck to both of you!

 

[dewi]

I just read on webMD about the procedure, and I'm beyond shocked they did this the week before her due date.

 

[gemasita]

I am shocked too but trying not to show it since she's already freaking out!

 

[doctormom]

That is beyond weird - she is at risk of developing all new hemorrhoids from pushing during labor, I wonder why she & her surgeon didn't wait a few weeks to do the repair?

Ask her to get a copy of the surgical record. Was this something simple like opening and draining a small clot from a thrombosed hemorrhoid, in which case she is mostly healed by now - or did she actually have surgery with stitches? Perhaps she is misunderstanding what was done. You need the op note.

I agree with cool compresses, witch hazel, comfrey, even plain tea bags moistened (tannic acid) can help with swelling and pain. Perineal support during active labor. And not having your client push in lithotomy position, obviously!

 

[BirthTender]

We just had a client to birth at the birth ctr. about 3 weeks ago who had this doen about 8 weeks before her EDD. MY assistant held cool mositened guaze compresses against her hemorrhoids while I did the perineal support. the client said that she had only slight pain there after the baby & over the next several days used lots of cold witch hazel compresses & of course high fiber & lots of water.
I'm also wondering why they did the surgery so close to her due time? unless they were strangulated.
Karen Benfield of BirthTender DEM & an almost done SNM

 

[gemasita]

Cindy - thanks. I will ask her for some more info. I *believe* she has actual stitches. She's birthing at Rex (you are local so you know that place!) and not with a midwife so I am hoping her OBs are going to know how to best manage her second stage. They are usually lithotomy all the way....

Thanks everyone for all the information. Keep it coming. This is really helpful.

 

[mamato3cherubs]

My thoughts were the same as above, I really think the support with compresses would be in order. I would also strongly suggest a pushing position that requires less strain than on the back. hands and knees maybe?

And absolutly NO coached or forced pushing. NONE. I would try to encourage my client to "labor the baby down" as much as possible. Some women the pushig urge is so strong that it is really difficult. But trying to blow through part of the contraction, small pushes at a time, might help.
I am really in disbelief at some of the things people and doctors do.