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Wednesday, May 28, 2008

Stitches in the Butt

She was 17 years old, but seemed to have the mental capacity of a 6 year old. She had hid her pregnancy until she went into labor; she knew she was pregnant the entire time but was able to conceal it because of her size.

I met her at her postpartum follow up appointment. The conversation went in circles, and I was having a hard time understanding exactly what she was describing to me. Her concern was that her stitches in the butt were bothering her, and it was causing her to bleed when she moved her bowels. I found this concerning, given that her records stated that she had a first degree tear- 6 weeks later and her stitches in her rectum were causing her to bleed? This wasn't adding up.

She said that she was trying to get the stitches to heal, so she started putting "cream" on it. The cream wasn't doing anything, she said, but she thought it might just be taking some time. I told her that we would be doing an exam and would assess what was going on. When I got to the pelvic exam, I noticed that her entire bottom- perineum, labia, buttucks, and into the anus- was covered in Balmex.

Now, I know most of you are familiar with this product. It's thick, and it's white. We couldn't see anything, she was slathered in the stuff. We tried washing it off, and in the process came across an infected hair follicle in her butt crack. It started to bleed when we washed it. I think we found our culprit, I thought, but how could she have mistaken this for her stitches?

My preceptor drained the follicle, as it was full of pus and Balmex. And then just to make sure we weren't missing anything we reassessed the entire area. Everything looked fine. Once she got dressed, I tried explaining exactly what we saw, what was causing her pain and bleeding with her bowel movements. She just didn't get it. I tried explaining that her laceration and stitches were healed and I didn't see anything unusual in that area. But she insisted that she had stitches that were bleeding in her butt area. There was no convincing her otherwise.

I'm curious as to how her laceration was explained to her, or how she interpreted it. Based on my entire interaction with this 17 year old, I know she's not playing with a full deck, but it's just an interesting disconnect here.

But at least she knows not to use Balmex on herself now.

12 comments:

womantowomancbe said...

"An infected hair follicle in her butt crack" -- I've heard everything now! :-)

Prisca said...

wow, sounds very much like a 17 yo patient i had in antepartum recently...

these girls!!!!! *shaking my head*

razorbackmama said...

hemorrhoid, maybe?

anal fissure?

How very sad.

Redspiral said...

:O

How is the mothering going?! Eeek, I pray this girl has a TON of support.

Anonymous said...

Ok, so who takes care of this new baby is what I want to know.......if she is not playing with a full deck then what kind of care and mothering and LOVE is her new baby getting? Did anyone check on that? Makes me sick and sad........

Leslie G.

Labor Nurse said...

As far as I know, the baby was in the hands of her mother and grandmother. They all lived together, so hopefully they have enough brain cells between the three of them to take care of this baby.

PE Mommy said...

This makes me sad as I can easily give a new baby a home. Ugggh.

may said...

children having children is a big challenge.

Sarah said...

I was about to say the same thing as anonymous said. If you can't understand something as simple as where your stitches were and the reason why your "butt" wasn't stitched maybe you aren't exactly ready for raising children.

Anonymous said...

Maybe the midwife/OB who delivered her did not explain exactly where and how they were stitching. I am a midwifery student and I have yet to see a midwife go into a detailed "this is where the perineum is...your stitches are being placed here, here, and here...this is not the anus...etc." I will now do a better job of explaining this when I have to put in a stitch, but it also has me thinking that we don't explain all of this during prenatal care either (the anatomy of the vagina/perineum/anus etc.

Do you do all of this when you put in a stitch?

I don't think not knowing the details of anatomy she's probably never seen means that she wont be able to take care of her baby, and think the "hopefully they have enough brain cells between the three of them to take care of this baby" comment was a little...?

I, too, am a NM student in the North East. I know how hard it is. Congratulations on being almost done!

Labor Nurse said...

I'd imagine that it wasn't explained to her more than just, "We need to put in a few stitches", but I wasn't there at her birth so I can't say for sure.

As far as the brain cell comment...I can see how this could be taken offensively, but having met this girl on several occasions I was truly amazed at how she was lacking in common sense.

katie said...

I am curious why the anonymous commenter above me put "LOVE" in capital letters. I understand the concern about the quality of care the baby is receiving, but a low IQ doesn't equal an inability to love, of all things!