This post holds new meaning to me now that I am actively involved at the perineum. For each birth I have done, only one had an intact perineum. I feel horribly when the woman ends up with a tear of some sort, and fortunately nothing has been bigger than a second degree laceration. But I end up questioning my hand maneuvers, or if I should have done something different to prevent the tear that does appear. One of my preceptors told me to not put the blame on myself, some women are just going to tear no matter what. But still....
Stem to Stern
There is one thing that bothers me in my line of work: 4th degree perineal tears.
One word: OUCH.
Fortunately, it's unusual. But it's just awful. It looks awful prior to repair, it looks awful after repair, it's awfully uncomfortable to say the least, and my heart (and perineum) goes out to those who end up with one.
Some of the nurse's I work with have said that some tears actually have a sound. Like a pop or a ripping noise. I can't say that I have heard it, and I am so glad that I haven't. I don't go listening for it either.
I've just had a marvelous idea for my research project (if I make it that far): looking at the correlation of the women's diet and perineal trauma. I'm going to see what research has already been done with this. It comes to mind because I have noticed that women with vegetarian diets seem to have larger perineal tears and longer healing time. Hmm...
But the worst has got to be the risks that are associated with 4th degree lacerations. Like fistulas. Imagine every time you poop or fart that some leaks into your vagina. Ya, that's a fistula. It happens.
Take for instance the phone call I received from a woman who delivered 2 years prior. She was still dealing with the sequela of the 4th degree laceration she suffered during a vacuum extraction. She had surgery on the fistula, but it didn't end up correcting it completely, and so she was facing yet another surgery. And she was angry.
Apparently she was trying to obtain her medical records for the birth. She felt like she was being lied to by the delivering physician. I'm not sure exactly why but she felt that he was hiding something. Either way, her medical record happened to be missing some vital components (which is probably why she was suspicious). I asked her, "Are the nurses notes from the delivery in your record?"
She didn't know. I told her to get them. If her nurse at delivery was prudent, then everything that happened would be documented there.
Not only was she angry about the records and whatnot, she was angry because it ruined her marriage. It caused a great strain on the relationship because she was in pain for so long, requiring surgery, trying to care for an infant, and her marriage began to dissolve. I can see why. She said she couldn't blame her husband for feeling like he didn't have his "original" wife. Because he didn't. He had a women who was dealing with chronic pain that took away an intimacy; it took away any future children. She said it was frustrating because people she spoke with couldn't understand why it would affect a marriage the way it did. They thought that he should be more understanding. He was trying, she said. But how could she expect him to love an angry, depressed woman?
On an aside, this was the one and only time I recommended looking into an elective c-section. I worked with one physician that did them for prior severe perineal trauma and she would be a candidate. But then she reminded me in order to have a c-section she'd have to have sex. Oh...ya... I knew that....
Her case is probably extreme. But either way it sucks. I pray for perineums at every birth.
"May the perineum remain supple and intact. Amen!"