August - 9 month update - Discharge (not that kind)

Here I am.  Sitting in the hospital again, waiting for what may be my last appointment with the consultant.  I really hope so.  It's been a long 9 months but here I am.  I am back at the hospital where I had Flynn.  I'm sat in the same chair in the same waiting room where I sat with Flynn in his car seat ready to go home for the first time.  We've both come a long way since then.  Flynn can sit, smile, clap, high-5 and crawl.  I can also sit now.  This chair is much more comfortable 9 months on.

The consultant is running an hour behind and so I sit and wait.  I'm surrounded by new Mums and expected Mums.  Pregnant ladies with their brand new maternity notes folder with all this ahead of them.  I hope they don't go through what I did.

My name is called and it's time.  The consultant apologies at length but really I just want her to crack on with it.  Finally she does.  She has my scan results and feedback from my physio.  It all looks good.  I once again have to answer the question "have you had any (toilet) problems?  Accidents?".  And for the thousandth time I answer no.  "Well then I think we can discharge you".

Who'd have thought that the word "discharge" could bring so much joy to someone.

I am elated.  I feel I can carry on with life as a Mum now and finally put the birth experience behind me.  I look forward to it becoming a dim and distant memory - just like labour now is.  It's funny reading back some of the earlier stuff on the blog.  I was pretty traumatised by what happened to me but I tried to put a brave face on it as that's what we do.  Writing this has helped process it all and it's nice to be at this end of it now.

Of course, I'll still continue to do my pelvic floor exercises.  I'll be doing them for the rest of my life in fear of incontinence.  It's recommended anyway that you do regular exercise of the pelvic floor muscles.  Like all muscles they need exercise to work well so you should maintain regular exercise throughout life not just if you've had a child.  But hey, that's any easy task to do.  It takes 5 minutes before bed each evening and will be more than worth it in the long run.  I've spent enough money on maternity pads and sanitary towels since having Flynn, I won't want to spend money in the future on Tena Lady.

And on that note, I end this months blog!

June - 7 month update - can I have a drum roll please...

So I've been working hard on my pelvic floors with the physio and using the coconut oil which all seems to be going well.  I have days now where I forget about it all and that's really nice (until the evening when I have to do exercises etc).

But all this may be for nothing if I have to have more surgery.  I'd be right back to square one again.  Mr T and I have a gut feeling that I won't.  Im not in pain and I'm having no (toilet) accidents - all good signs right?

All these thoughts flooded through my head as I sat in the hospital waiting for my scan.  I didn't know what to expect, what the results would be or when I would get them.  I saw a lovely doctor who put me right at ease.  Well, as at ease as you can be when confronted by the scanner she was going to put up "there".  She said "this will take about a minute".  I took her at her word and begin to count.  If she ran a second over I would not be impressed.  True to her word it was less than a minute and although uncomfortable wasn't actually painful.

I got myself dressed and she immediately began to talk me through what she had seen.  She pulled out a diagram - never a good sign in my books - and told me I did have some damage at "2 o'clock" but with good pelvic floor I could avoid any problems in future.  "So no surgery?" I asked.  She said no!  She said further surgery could actually make it worse but I would have to have a C-section if and when I had another child.  I could have hugged her.  If I do have another child I certainly wouldn't want to be worried about all this happening again.  She suggested I wait another couple of months before I went ahead with another pregnancy?  Had she read my notes??!!  "I'm only just getting over this one, I have no plans for another".  And with a very big thank you for the good news I left.  Having had potential surgery hanging over me since January it was good to know that I didn't have to worry about it anymore.

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.