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Discussion Starter #1
Hi,<br>
I nearly labeled this "TMI," but reconsidered, given the audience.<br><br>
In November, I gave birth to my daughter. She was large (10 lbs. 7 oz.), and I delivered in a hospital with a CNM. Overall, the experience was fantastic--nothing like my first hospital birth at all. Although I spent the majority of my labor walking around the maternity floor at the hospital, and transition sitting completely upright (in a position my sister likened to a Buddha stance), the CNM had the nurse recline my bed to a semi-reclined position for the delivery.<br>
My daughter delivered relatively quickly (15 minutes or so of pushing), and had some shoulder dystocia (I don't know shoulder dystocia well enough to say how bad...I have the birth on video, and I'd say it was 60-90 seconds from head delivery to the rest of her body, and she was born limp and had to be given oxygen...although this is sort of a different subject altogether, I'd love a professional opinion on this; I didn't feel like my midwife or nurses were very up-front with me about it). Anyway, as a result of her size, my birthing position, the dystocia and the relative quickness of delivery, I ended up with a pretty bad 2nd degree perinneal tear, and two 1st degree labia tears.<br>
My recovery was more drawn out and a bit more painful than with my first, but I was feeling all right after a few weeks. At 8 weeks, I saw my midwife. At one point during my exam, she inserted her fingers into my vagina and instructed me to tighten around them. I did. She said, "Really tighten everything up." I did. "Like you're doing a sit-up, almost." I did. "Everything as tight as you can." Finally, I sort of raised my eyebrows, shrugged my shoulders--"This is it." She had this sort of disappointed, "Oh I see," look on her face, and then moved on.<br>
Resumed intercourse. I used to have a little bit of pain with intercouse--I'm sure my husband would like to believe that this was his fault<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/winky.gif" style="border:0px solid;" title="Wink">--but not any more. I seriously couldn't tell when he penetrated me. I was waiting. Waiting.<br>
Took a look with a mirror. Not the same vagina. Not at all. It's like I didn't get stitched up after the tear or something. But I did.<br><br>
So...two questions:<br>
1. Should I see my midwife about this? She's already seen it, and she didn't seem terribly upset by what she saw, like, "Oh God, your vagina--it's broken."<br>
2. Will this have any ramifications for a subsequent delivery? Am I less apt to tear again, since I'm sporting this new, improved, extended-cab vagina? Or am I more apt to tear because the shape of it almost looks like it's mid-tear as it is? And, if so, am I more likely to sustain a more serious tear? There wasn't a whole lot seperating me from a 3rd or 4th degree tear as it was. Will a subsequent child simply finish what his or her older sister started?<br><br>
Thanks. I'm really verbose; sorry about that.<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/redface.gif" style="border:0px solid;" title="Embarrassment">
 

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<div>Originally Posted by <strong>redpajama</strong> <a href="/community/forum/post/7809820"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Hi,<br>
I nearly labeled this "TMI," but reconsidered, given the audience.<br><br>
In November, I gave birth to my daughter. She was large (10 lbs. 7 oz.), and I delivered in a hospital with a CNM. Overall, the experience was fantastic--nothing like my first hospital birth at all. Although I spent the majority of my labor walking around the maternity floor at the hospital, and transition sitting completely upright (in a position my sister likened to a Buddha stance), the CNM had the nurse recline my bed to a semi-reclined position for the delivery.</div>
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Semi-reclining is something that reduces the pelvic outlet - you're stitting on the sacrum so it is compressed and does not move like it should.<br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">My daughter delivered relatively quickly (15 minutes or so of pushing), and had some shoulder dystocia (I don't know shoulder dystocia well enough to say how bad...I have the birth on video, and I'd say it was 60-90 seconds from head delivery to the rest of her body, and she was born limp and had to be given oxygen...</td>
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It doesnt' sound like a true shoulder dystocia if it was only that long - that actually sounds very normal.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">although this is sort of a different subject altogether, I'd love a professional opinion on this; I didn't feel like my midwife or nurses were very up-front with me about it). Anyway, as a result of her size, my birthing position, the dystocia and the relative quickness of delivery, I ended up with a pretty bad 2nd degree perinneal tear, and two 1st degree labia tears.<br>
My recovery was more drawn out and a bit more painful than with my first, but I was feeling all right after a few weeks. At 8 weeks, I saw my midwife. At one point during my exam, she inserted her fingers into my vagina and instructed me to tighten around them. I did. She said, "Really tighten everything up." I did. "Like you're doing a sit-up, almost." I did. "Everything as tight as you can." Finally, I sort of raised my eyebrows, shrugged my shoulders--"This is it." She had this sort of disappointed, "Oh I see," look on her face, and then moved on.</td>
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this could be normal, unless you had been doing kegels quite a bit in the last weeks since the birth. sometimes it takes longer to isolate those muscles again.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Resumed intercourse. I used to have a little bit of pain with intercouse--I'm sure my husband would like to believe that this was his fault<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/winky.gif" style="border:0px solid;" title="Wink">--but not any more. I seriously couldn't tell when he penetrated me. I was waiting. Waiting.</td>
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I wonder more if you have scar tissue, which is very numb?<br><br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Took a look with a mirror. Not the same vagina. Not at all. It's like I didn't get stitched up after the tear or something. But I did.</td>
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Most vaginas do not look the same after birth, especially if there has been a deep tear.<br><br>
So...two questions:<br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">1. Should I see my midwife about this? She's already seen it, and she didn't seem terribly upset by what she saw, like, "Oh God, your vagina--it's broken."</td>
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Yes - you are worried about it, she is your midwife, she was at your birth and the repair. Talk to her about it.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">2. Will this have any ramifications for a subsequent delivery? Am I less apt to tear again, since I'm sporting this new, improved, extended-cab vagina? Or am I more apt to tear because the shape of it almost looks like it's mid-tear as it is? And, if so, am I more likely to sustain a more serious tear? There wasn't a whole lot seperating me from a 3rd or 4th degree tear as it was. Will a subsequent child simply finish what his or her older sister started?</td>
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I'm not sure if your vagina is necessarily LARGER - or that what you're seeing is different externally. there's not a ton of room between the bottom of the vaginal opening and the rectum - the perineum isn't very long.<br><br>
But to answer your question about subsequent pregnancies and births, I have seen a couple women with 4th degree tears and extensive (like in the OR) repairs birth without any tears in subsequent births.<br><br>
Call your midwife. Make an appointment. Talk to her. That's what they're there for. In the meantime, start doing some kegels and maybe refrain from thinking of your vagina as "extended cab" size. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol">
 

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Discussion Starter #3
Pamamidwife--thanks for your reply. I'll kegal as I type this. (There's not a smiley for that, is there?)<br><br>
So maybe I'll make an appointment with the midwife. Unfortunately, the way it works is that you see one midwife throughout your pregnancy, but whoever is on call at the hospital when you have you baby delivers. So my midwife didn't actually deliver my baby or do my repair. In fact, I delivered her on Thanksgiving Day, when the midwives were all taking really short shifts, so one midwife examined me upon arrival at the hospital, one delivered the baby, and then an altogether different one did the repair. None of them was "my" midwife, though--I didn't see her at the hospital at all. But maybe I won't bother...to be honest, my biggest concern was with what might happen in a subsequent delivery. From what you said, maybe it isn't as bad as it seems. And if it is, maybe that doesn't have much bearing on next time. I will be more insistent on delivering in a more conducive position next time, to be sure.<br>
I guess some of this came as a surprise to me because I didn't have the same problems after my first child was born--everything looked and felt pretty recognizeable.<br><br>
I'm actually most interested in what you were saying about the dystocia (or not-dystocia), though. I've read such conflicting things, and the hospital staff made a few elusive allusions, but were never direct with me about it. Although I never had the impression during the delivery that there was any serious problem, but then she was born limp and they couldn't get her started with just talking/rubbing/et cetera. So they cut the cord without warning and took her away (well not away, away...but away from me--to their little cart) and used bag/mask and gave her oxygen. So the things I read seem to contradict each other with regard to dystocia--different definitions, especially. Some define it in terms of time, others more qualitatively (if the body doesn't follow with slight traction to head, for example). Anyway, because I *don't* actually see the midwife who did my delivery (I've never seen her since), I didn't get a real chance to ask about it. What you're saying makes sense, though, and is consistent with what I've thought after reading about a lot of cases of SD.<br><br>
Anyway, thanks for the response.
 

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According to my anatomy book, the pubococcygeus is commonly the culprit when it comes to torn muscles in the pelvic floor. There is a great illustration in here that shows the head coming out and the muscles of the pelvic floor allowing for the baby to pass. I wish I could share the picture with you. I'll type out the whole thing.<br><br>
"During childbirth, the <b>pelvic floor</b> supports the fetal head while the cervix of the uterus is dilatingto permit delivery of the fetus. The <b>perineum, levator ani, and pelvic fascia may be injured during childbirth.</b> It is the <b>pubococcygeus</b>, the main and most medial part of the levator ani, that is usually torn. This part of the muscle is important because it encircles and supports the urethra, vagina, and anal canal. Weakening of the levator ani and pelvic fascia resulting from stretching or tearing during childbirth may alter the position of the neck of the bladder and urethra. These changes may cause urinary stress incontinence, characterized by dribbling of urine when intra-abdominal pressure is raised during coughing and lifting, for instance." (<i>Essential Clinical Anatomy</i>, 3rd edition, Moore & Agur)<br><br>
I know you didn't address incontinence but maybe you're experiencing it, and if not then hey, the more you know! I would Google the bolded terms for more info, perhaps info about healing and pictures so you can get a visual. You might be able to find other remedies besides kegels (which are GREAT!) or timelines for healing. I'll poke around for more info for you but I'm on cruddy dialup and it's sloooooooow!
 
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