December - 1 month - slow progress

A few months ago when I was interviewing people at work to cover my maternity leave, I had to ask a question to which I had no answer. The question was "what is your greatest achievement?"
Nothing sprang to mind.  I have qualifications and a job but none of it felt "outstanding". Lots of people have degrees, a job in television etc. What had I achieved with my life at the age of 34?

Only now can I answer that. My greatest achievement is Mr Flynn. It's as simple as that. I'm so proud of him even before he's able to hold his own head up!

But he's also the hardest thing I've ever done.

It's hard to know what the first few weeks of Flynn's life would have been like if I hadn't had a tear.  I guess I'll never know.  I'm sure no matter how your first child comes into the world, it still feels like a massive shock.  Life is broken down into 2-3 hour cycles of changing, feeding and sleeping and then running round trying to keep everything else together.

I'm in a lot of pain and taking the maximum amount of painkillers I can.  It turns out I have an infection and so I'm now on antibiotics.  The doctor has kindly given me some that I can still drink alcohol on as it's Christmas so that's a silver lining I suppose.  I may not be feeding Flynn myself but I'm still responsible for him so I won't be going crazy with booze.  It was nice to have a drink on Christmas Eve night though whilst we watched a festive film and Flynn slept.  I briefly felt "normal" again.

Sitting down is painful and I have a large array of cushions on the couch to help.  Putting my feet up helps with the pain.  By the end of the day, it hurts to walk so Mr T is doing a lot of the late night changes as I can't make it to the changing mat.  Thank goodness for Mr T who is currently responsible for all of us and the house.  I don't know how he's doing it.  I feel guilty but hope by resting now I will get better much more quickly.

I'm still wearing enormous post-pregnancy knickers and all my maternity wear.  I can't bear the thought of wearing anything remotely tight as I know it will hurt.  I'm living in leggings and pyjama bottoms but it's not like I'm out and about much.

I'm trying to do my pelvic floors but it feels so odd.  I can't even work out if I'm doing them properly as it all feels so odd down there.  But the word "incontinence" scares me so I'm persevering and hoping for the best.

It's hard to stay positive when there is no definite timeframe on when I will be "better".  I comfort myself by the fact that both Flynn and I are here and that Flynn himself is absolutely fine.  Not that many years ago neither one of us would have survived the birth.  So I try to stick with the positives of my lovely baby boy even when I miss the "old me" who didn't have all these problems.  Still, I know that eventually I will be 100% better and I really look forward to that.

The Science Bit

Long before all this, back in the hazy rose-tinted days of NCT classes I didn't really give much thought to what could happen when I gave birth.  I'd done the class where we covered all the different options - being induced, sweeps, caesareans, forceps delivery etc.  I kept thinking "I won't plan my labour too much as anything can happen" but in reality I didn't think things would turn out this way.

Maybe it was best that I was in the dark.  Certainly my friends who don't yet have children have pulled some faces when I've explained what happened to me.  I hope I haven't put them off.

It wasn't until after the birth that I learnt a lot about tears.  Who knew there were different degrees of tear?  Thankfully, my consultant actually gave me a handout to help explain it and for that I was very grateful.  So here is the information care of that handout.

What is a third or fourth degree tear?
This is a type of tear sustained during vaginal childbirth which involves the tissues of the vagina, the perineum and the structures around the anus.  If the tear involves the muscles around the anus, it is called a third degree tear; if it also involves the tissue on the inside of the anus, it is called a fourth degree tear.

Third and fourth degree tears happen to roughly 1 to 3% of women having a baby vaginally.  Factors such as having a venthouse or forceps delivery, having a baby weighing more than 8lbs or having a baby that is "back to back" at delivery increase the risk that you may have a third or fourth degree tear.  Often there is no particular reason identified.

How is a third or fourth degree tear treated?
Third and fourth degree tears are repaired in the operation theatre usually under a spinal/epidural anaesthetic.  You will be given antibiotics in the operating theatre and the layers of the tear will be stitched back together.  All of the stitches used will dissolve by themselves.  A catheter tube will be left in your bladder until the anaesthetic has worn off.

What will happen afterwards?
You should not need to be in hospital for more than 1 or 2 days.  After sustaining a third/fourth degree tear, we recommend treatment for a week with antibiotic tablets, plus stool softeners and laxatives for a minimum of two weeks to make it easier for you to open your bowels.  You will also be given pain relief to take home.  All of the medications that you will be given are safe to be taken when breastfeeding.  You will be seen by a physiotherapist, and we recommend that you perform regular pelvic floor exercises during the postnatal period.

You will be offered an appointment with a doctor 8 to 10 weeks following your delivery.  At this appointment, we will ask you some questions about your delivery and any bowel symptoms that you might have.  You will be examined to make sure that the perineum has healed properly.  You will also have the opportunity to discuss your delivery and ask any questions.

You may also be offered a specialised internal scan of the entrance to the back passage, which will allow us to confirm that the anal muscles have healed together adequately.  The scan may feel slightly uncomfortable but is not painful.

What are the long term effects of a third/fourth degree tear?
The majority of women (80%) recover well and have no problems at the three year point.  A small number of women may have problems at follow up with urgency (being unable to hang on and having to rush to the toilet to open the bowels) or being unable to control bowel motions or wind.  Most of the time, these problems will settle with measures such as physiotherapy.  A small proportion of women will need further treatment for bowel disturbances.

What will happen with future pregnancies?
The overall risk of having another third/fourth degree tear is 5%.

If you do not have any bowel symptoms and the muscle appears to be well healed, we would generally recommend aiming for a normal delivery in any future pregnancies.  However, any woman who has had a third/fourth degree tear is seen by a doctor in the antenatal clinic in subsequent pregnancies to discuss options.

Why this blog?

It was a cold and frosty night...that's how lots of stories start and its sort of how my child birth story starts.

My son was born on 30th November 2016 at 12:39pm.  My "birth plan", although never really formalised, was a water birth.  Following on from NCT classes, which talked about staying calm during labour, I thought a water birth would be great as I loved being in the water, especially in the later stage of pregnancy.  I went into labour on 29th November at 12:00pm on the way home from the supermarket.  I rang my husband and he came home from work.  We had a quiet afternoon, timing contractions on one of those apps, we watched a film, had a lie down and had a big meal of pasta ready to tackle what was to come.  As the contractions got stronger, I paced up and down the house, whilst my "upbeat labour" playlist went on in the background.  Just after midnight, we went to the hospital on what was "a cold and frosty night".

We got to the hospital and I wasn't far along at all.  (2cm!!)  I accepted some pethidine (not in my birth plan) and a bed on the ward.  Several hours later I was 7cm.  Hurray for me!  I was rocking this. Time to move to a delivery room and get in that bath.  And so I did with the gentle sounds of my "relaxing labour" playlist in the background.  I was calm, doing what came naturally, concentrating on one contraction then the next with the gas and air clutched in my hand.  Soon, the midwife reminded me what it was all for.  "You'll meet your baby soon".  "Of course!" I thought.  I was so busy concentrating I almost forgot what I would get at the end of this.  An hour and a half later of pushing and nothing.  No baby.  It was mid-morning.  There was nothing in the tank.  My husband tried to encourage me to find something to keep going by offering me some Jaffa Cake (part of our "lets pack high energy snacks for labour - like there was time for that!  Like I was hungry!).  "I need some help" I said.  I knew you could only push for 2 hours until there would be intervention and I clearly wasn't getting anywhere.

After a brief, blurry trip in a wheelchair from the birthing unit to the delivery suite of the hospital I was surrounded by people.  Doctors, nurses, midwives and goodness knows who else.  A doctor kept telling me "we're going to help you get the baby out" to which I would respond "so you're going to get the baby out?".  I felt as though we had that conversation several times over whilst a midwife held my hand, another nurse put a drip in my other and the world (and his wife) seemed to examine me.  Then the doctor administered some anaesthetic and a few seconds later I had a weird sensation.  "What was that?", I said.  "Your baby".  And then there he was, a bundle of warmth on top of me.  I was elated that he was here and he was okay, albeit with a nasty bruise on his head.  He was a ventouse delivery but what I hadn't realised until then was that my son, in his eagerness to see the world for the first time, had delivered face up instead of face down.  Babies are born face down for a reason.  If face up, the circumference of their head is much wider and thus if they don't come out this way they do damage.

I was soon to hear the words "third degree tear" and would become very familiar with them over the next 9 months.  After a few minutes holding my son, I was taken to surgery to remove the placenta which hadn't delivered and to repair the damage done during delivery.  It was as I lay on the table in surgery that I realised that things were pretty serious.  I was meant to be enjoying moments with my boys - my husband and son - my new family - the three of us.  But here I was, legs akimbo, exhausted, thirsty with wet hair (a mixture of water from the pool and my own "waters" (them having broken in there too - eeegh!)) surrounded by medical staff.  It was not what I had pictured.  I felt angry.  This wasn't how it was meant to be.

A few hours later and I was finally reunited with my son.  I'd been worried.  He would be hungry. Then there was skin-to-skin to think about.  They lay him next to me and he cuddled in.  It was okay.  He knew me and the tiny feet that used to kick me from the inside were now kicking me on the outside.

Afterwards, it was explained to me the nature of what had happened and why.  It was a third degree tear, I would need to be on a high fibre diet to avoid any straining down there as I had stitches, I'd lost  lot of blood so would be on iron supplements, I would need antibiotics to prevent infection too.  It would be painful and I would need painkillers.  I'd need laxatives too.  Wow.  Who knew that could happen?  What I didn't quite realise then was that it would be a long road to recovery.  I would need to be patient but that's hard when you have a new baby and need to be a Mum.  Internet research didn't seem to offer me much help or comfort and that's why I started this blog.  I didn't know anyone who had been through this and I felt very much alone.  I felt every other new Mum I knew was up and about, healthy and getting on with things whilst I could barely walk.  And so I want people in a similar situation to know that you are not alone, others have been through this and it does get better.  Welcome to "Love in the Third Degree".


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