The Wonderful World of Birth Injuries

FAIR WARNING

If you don't want to read about the treachery / reality of what happens to *certain parts of your body* during and after birth, run away now. This post isn't for you. 

You've been warned. 

Carrying and delivering a child is probably one of the most OUT-OF-CONTROL things your body can do. There’s a laundry list of things that I wish I knew before, during, and after this experience, and one of them that totally blows my mind is the lack of information about birth injuries. Of all of the doctor’s visits, pamphlets, books, birthing class, etc, that I attended and read through, there was extremely limited information about potential birth injuries. The only thing I felt I knew about was that I could and probably would experience a tear in my perineum (Google (NOT GOOGLE IMAGE) if you don’t know what that is). Other than that, I feel like I was in the dark.

Crazier still is numbers – actually, even crazier is a seemingly small amount of research and studies out there about this. This article is a really great insight into birth injuries and how it affects people’s lives - http://www.cosmopolitan.com/lifestyle/a59626/birth-injuries-postpartum-pain-untreated/ If you don’t want to read that whole thing, here are the highlights:

• A study published last June in the journal PLoS One found that 77 percent of more than 1,500 mothers studied had persistent back pain a year after having their babies, and 49 percent had urinary incontinence.
• A 2014 study of 1,115 mothers — about half who had cesarean sections, half who had vaginal births — found similar degrees of continuing pelvic pain regardless of how their baby was delivered
• Researchers from the University of Michigan likened childbirth to running a marathon — only before a marathon, you train — after giving 68 women MRIs seven weeks after birth. The MRIs showed that 29 percent of them had evidence of fractures they never even knew they had in their pubic bones, while 41 percent had undiagnosed tears in their pelvic floor muscles, which wrap around the vagina and anus
• In a landmark report from the Institute of Medicine in 2011, a team of experts noted that women "have faced not only severe pain, but also misdiagnoses, delays in correct diagnosis, improper and unproven treatments, gender bias, stigma, and ’neglect, dismissal and discrimination’ from the health care system."

I was in that 41% that have undiagnosed tears in their pelvic floor muscles. I recently had a surgery 10.5 months postpartum to finally correct it, and, like you, I kept finding myself wondering “how the hell did this take so long to catch??????” Here’s how.

Believe it or not, I had never given birth to a ~9 pound baby before. I didn’t know what was normal and what wasn’t, and if they told me anything in the hospital before I left I certainly didn’t retain it. I had the standard fraught-with-fear-postpartum-first-bathroom-trip that everyone does, which went fine. Every trip to the bathroom after that was fine, or as fine as it could be, until it wasn’t. I started experiencing fist-clenching, searing pain when I went to the bathroom. I assumed I had the dreaded postpartum hemorrhoids (very common), loaded up on stool softeners, and treated with over the counter stuff. I had my 6-week postpartum check up with a midwife in our practice and brought up my pain. They did the standard pelvic exam and I was told I was healing very nicely, especially my stitching for the episiotomy. I think the first mishap in this process was that they focused on the tear they knew I had (because they gave it to me), and I didn’t speak up enough about the pain I was in. I did mention it, but I didn’t insist on further investigation because they said I was good to go.

I was NOT good go. Definitely not good to go. Over the next few months I went through ups and downs. Sometimes the pain would all but disappear, sometimes I was nearly in tears at work and wondering how I was going to go back to my desk for the rest of the day. I didn’t seek immediate treatment because it would get better, and I would think “great! I’m healed!” and then the pain would come back. But then I would think “well, it got better last time so I just have to tough it out for a little bit and it will heal up again, hopefully for good”. Eventually I called the OB-GYN again, and then started the battle with my insurance company. It took about two weeks of a back and forth between the OB’s office and my insurance because what the OB wanted to prescribe wasn’t covered, but when I asked the insurance what WAS covered they said they didn’t have a list (??????????????????????? I know.). I tried three different prescribed treatments, some did make an improvement, some didn’t. The OB finally suggested I go to my primary care, so I had to get a new PCP with my new insurance and then get the appointment set up.

My PCP saw the tear and sent me to a surgeon. Surgeons actually like the avoid surgery, so the surgeon gave me one last ditch effort of a prescription that had to be specially compounded (not covered by insurance) and had about 75% success rate. I had to use that for 6 weeks. By the time I ended that course of treatment I was about 10 months postpartum. That treatment made slight improvements but not enough, and by the end of that I was back to where I started again.

Finally, at nearly 10.5 months postpartum, I had to have a surgery to correct the tear, and they actually do that by slicing surrounding muscle to manually “relax” the muscle so the tear can heal, which seems kind of counterintuitive but it works with about 99% success. The surgery itself takes about 3 minutes total, but because it’s such a sensitive area I had to go under a spinal anesthesia. My spine is a whole other story, the short version is that I had mild scoliosis and a twist in my spine, so getting the injection in the right spot was tough. I had four different jabs in the back with a pretty hefty needle before they got it right. Thankfully the recovery was relatively quick and I was back to normal within a few days.. and PAIN FREE!

I stumbled across this photo and couldn't stop laughing

The surgeon told me at the follow up that my tear was “pretty massive”. A “big tear” in the pelvic floor is actually quite small, small enough that if you had a cut on your body elsewhere the same size you wouldn’t notice it a whole lot. The pelvic floor is so sensitive and packed with so many nerves that even the smallest tear can be pretty excruciating. My tear was internal and large enough that internal muscles were actually exposed. I laughed and said “huh. No wonder it hurt so badly!” Sometimes you just gotta laugh.

The more women you talk to, you the more you realize how common this sort of problem is. The nurse that works with my surgeon had the same thing happen. When I told them about my birth they immediately asked “vaginal birth? Episiotomy? Mmmhmmm that’s why”. One of the nurses attending my surgery fractured her tailbone with her first baby (AND SAID IT VERY CASUALLY “oh yeah, I broke my tailbone with my first”. Excuse me?). Many people will share this information freely in the right setting. I told my mom friends and a very select few people what I was going through. Other than that, I was pretty alone in the experience. When I had a flare up I was in almost constant pain but felt to embarrassed or weird to share, so I just toughed it out. But now here I am posting it on the Internet. Ah, how times have changed.

So why the hell share all of that? Well, I wish I had read someone else’s story like this. I wish I had demanded some other treatment, another opinion, something, to avoid months of pain. In the grand scheme of my life this was a relatively minor, however, it affected my personal life, my work life, and my body. I know now what to say to the doctor’s now, and hopefully this at some point helps someone else understand how common these problems are despite there being so little conversation about them.