Tear or Episiotomy After Child Birth
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MAUREEN MASON: Vaginal births commonly end with a tear and occasionally with an episiotomy. Learning how to treat and recover from this can make the postpartum recovery time go a lot more smoothly. I’m Maureen Mason, physical therapist specializing in pelvic therapy and treating postpartum women and you’re listening to Newbies.
KRISTEN STRATTON: Welcome to Newbies, broadcasting from the Birth Education Center of San Diego. Newbies is your online, on the go support group guiding new mothers through their baby’s first year. I'm your host, Kristen Stratton. I’m also a certified Birth Doula, Postpartum Doula and owner of In Due Season Doula Services.
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SUNNY GAULT: Hey everybody. Thanks so much for listening into Newbies today. We have a few ways that you can participate on the show. Newbies has a Facebook Page. We have a Twitter Page and we’re always posting different articles that we see different conversations that we’re having here on the studio. So be sure to visit those pages, like them, follow them for the latest information on Newbies.
Also, if you want to be a part of the actual Podcast, you can do then in a couple of different ways. We have a couple of segments that we’re always looking for people to participate in – one is called: “Our Ask the Experts Segment.” That is where you can ask our experts any questions you have. I’m sure you have a lot being a new mom. So feel free to submit your questions through our website at www.NewMommyMedia.com and we will get them answered.
Another one is in oops, we call it like: “Mama Oops.” It’s the stuff that happens, the funny stories that you have as a new mom that happened to you and your baby where you’re like: “This is going to end in the record book. It’s a funny situation.” If you have those kind of funny stories you want to share on our show, you can do the same thing. Go to our website, send us an e-mail.
We also have a voice mail line that you can call so no one’s actually going to pick up the phone, you just leave a message and we’ll use your recording on the show. The number for that is 619-866-4775. So today, I will actually going to be participating in our conversation. So go ahead and introduce myself as a panelist and then we’ll learn more about the other people in the room.
I’m Sunny. I’m producing today’s show. I’m also the owner of New Mommy Media which not only produces Newbies but Parent Savers, Preggie Pals, Twin Talks and The Boob Group. I have four children of my own. My oldest just turned five. Then I have a three year old and then I have twins that are 21 months. My first son is a vaginal birth and I did tear. So I do have some experience with this – all my other children were C Section babies. Okay. So let’s see. Serena, tell us a little bit more about yourself.
SERENA SALINAS: Hi my name is Serena Salinas. I am 33. I am an attorney as well as a yoga instructor. I do mama and me classes. I was pregnant when I went through my yoga teacher training which was a really awesome experience. I have a daughter who is eight months and she is my one and only child as of now. People ask if I’m thinking about having another, I’m just trying to survive this one.
SUNNY GAULT: Okay, so before we kick off today’s show, I found a news headline that I thought was really interesting. It’s actually a visual headline and I posted it to our Facebook Page so you guys can check it out. But there is a photo that is going around the internet and it’s of a mother who just had a C Section and her new born is laying just below her C Section line and is cuddled up right next to the mother.
Over 11 million people have viewed this picture on social media. It’s getting a lot of good feedback but at the same time, there are some people that don’t appreciate the photo as much as others. It’s been liked on Facebook by nearly 200,000 people. The people that appreciate it or are moms that either have had a C Section or had a birth that maybe didn’t necessarily go their way but they can appreciate the birthing process and however you get your baby out, you get your baby out.
In this particular situation, the baby – it had to come via caesarian. It was a situation where a caesarian saved the baby’s life. So that’s why the mother wanted to capture this image. It is the black and white image I should say because sometimes that comes off a little more artistic than color images. Sometimes people are un-offended as much by black and white.
Yes, I wanted to show you guys this image; get your take on it. The people that don’t like it or calling it pornography, it does show pubic hair. Okay? I know. It is in an area of a body that is very sexualized in our society but it’s also an area of the body where babies come out. So anyways let’s start, I guess with Maureen. What do you think about this image Maureen?
MAUREEN MASON: I think it’s a beautiful picture because there’s the area of the womb where the incision that is healing well. The baby’s head is resting against what I recognize as a pubic symphysis – the pelvic bone. The baby has almost a little smile and the skin just looks skin-to-skin baby to mom. There’s nothing showing that would be distasteful. I think it’s a beautiful nurturing picture to me.
SUNNY GAULT: Yes. What do you think Kristen?
KRISTEN STRATTON: I think it’s beautiful. I think it was well-photographed and well done. Certainly, this is part of mom coming to terms with how her baby was born and this was a road to healing for her both physically and emotionally. So while I can understand why this might be triggering for maybe moms who are not there yet with their belly births or maybe their traumatic vaginal birth. I can see how this would bring up things that were upsetting to them.
But we have to remember that: “Everyone is in their own journey in their own place and we all birth our babies differently.” So for this particular mom, this is a way for her to celebrate having a healthy baby and feeling proud and strong of what she went through to accomplish that goal.
SERENA SALINAS: Well first of all, I had a vaginal birth. The lens in which I’m looking at this photo is from that but I would like to echo about of what Maureen and Kristen said that: “It’s a beautiful photo for me.” It’s a beautiful photo for a number of reasons. One just because I’m still in that mommy little bubble and it’s very touching. If this is how this mother was able to end that particular journey and start the next journey of being the mother; whatever was in that package, whatever in motions was in that package. You have indicated that this caesarian’s save her baby’s life then I think that’s really empowering. I think that we should be respectful of that.
She’s being very vulnerable sharing this image, sharing some not only the image itself but what the image represents not only the sexual organs but also all the emotion that comes with that. She may not have wanted a caesarian. She may have really wanted a vaginal birth. So Kristen alluded to this may have been the way in which she was able to take ownership of this journey. So to me, that takes a lot of courage and a lot of strength and I respect that.
SUNNY GAULT: I think that indeed was the case. I think she was going for a vaginal birth but just the sheer power and the fact that: “The caesarian saved her baby’s life” I think she just wanted to be grateful and remember further down the line about this important experience that she had. So all right, thanks ladies for sharing your opinions.
KRISTEN STRATTON: Today on Newbies, we’re discussing: “Tears and Episiotomy following the vaginal birth.” Maureen Mason is a physical therapist specializing in public therapy. Thanks for joining us Maureen and welcome to the show.
MAUREEN MASON: Thank you Kristen.
KRISTEN STRATTON: Maureen, when women come to see you to help recover from a vaginal birth, what problems are they typically experiencing?
MAUREEN MASON: They’re kind of in a state of bewilderment sometimes. Why are they in physical therapy – because people think of us as the shoulder, back, knee that sort of thing. So the first thing is explaining what we do. We simply bring out the model of the pelvis. Here are your muscles. Here are your labia. Underneath those, you have this urogenital triangle; that’s your surface, equipment. I empower women to map and understand their own body.
A woman cannot see her perineum. Right? A woman does not understand that these are muscles that have so many different functions. We do a lot of mapping of the perineum where there is tenderness, where there is pain; there can be simply a little scar and it’s little uncomfortable and we teach some myofascial release to some selective soft tissue mobilization or it can be more extensive. It can cause quite a little bit of pain and need more care.
KRISTEN STRATTON: Can you explain some of the physiology of the pelvis and the perineum and how they are affected during the vaginal birth?
MAUREEN MASON: Yes. First of all, the bony support of the architecture of our pelvis – the symphysis pubis in front separates a little bit or a lot and then it comes back together or not so well. So we have the abdominals and the back muscles are helping where the glutes in the deep hip muscles and the pelvic muscles all holding the bones together. So we have the bony architecture that should be a little flexible but also solid enough for walking.
Then the pelvic muscles themselves – imagine three sets of mixing bowls. Imagine a wide, large mixing bowl – that’s your deepest most internal pelvic muscle group. Okay? Imagine a little shallower bowl and then a shallower bowl. All those three levels nest inside of each other.
Pubococcygeus goes from pubic bone back to our tail bone or coccyx. The PC muscles are a slinger hammock. They go front to back and they also go side-to-side. So I’ll take my hands and cradle them and show this front to back and the side-to-side just like we’re cradling a baby to know that we have those muscles. Towards the surface, what a woman can see and feel with a mirror is the perineum and we have the vaginal ring muscle which stretches with vaginal child birth.
In an ideal world, women have perineal massage preparing them for birth. They have perineal massage for 36 or 38 weeks on, spending 15 minutes twice a week doing some perineal elasticity training. Where that doesn’t happen and a woman has a very tight sphincteric ring, as she goes to push and she’s at the final stage of labor, the baby doesn’t come out. So then what are the choices? Tear, episiotomy and caesarian.
KRISTEN STRATTON: What are the various degrees of a perineum tear and also of an episiotomy?
MAUREEN MASON: Sure. So the simplest episiotomy is just a grade one. Okay? That’s just a skin around their vaginal opening according to the medical reports, it heals in a couple of weeks.
KRISTEN STRATTON: Okay.
MAUREEN MASON: We usually don’t see those in physical therapy. A grade two, it’s a larger tear that’s going in to the muscles of the perineum – the urogenital triangle. Ischiocavernosus transfers perineal bulbocavernosus; I call them a little bit of muscles BIT and that tends to heal in a few months.
A grade three goes into the vaginal sphincter further back into the anal sphincter region, okay approaching the anal sphincter. This uses stitches, a grade two and a grade three and then when we get into a grade four, that’s all the way into the anal sphincter, now we’re talking big stuff and more healing time.
KRISTEN STRATTON: What would an episiotomy typically be used for?
MAUREEN MASON: So their decision for an episiotomy varies quite a bit throughout the world. So we look at the literature and in some cases there are 60% episiotomy rates. The rates are overall are coming down 10%, 7%. Optimum perineal massage, working with a midwife, birth doula – the rates are much lower. We have medical literature and the birth journal to substantiate that doula or midwife-assisted birth has less rate of the episiotomy.
If the baby’s heart rate is dropping suddenly, if the mother is completely wiped out, the mother’s pushing forever and the baby is crowning forever, the mother’s blood vessels are breaking their eyes for popping and the baby’s not coming out, ayuda – help please. It’s an alternative to a caesarian, okay? I don’t know of a rating system for the tears. It’s probably similar. But when you look at what happens, tears are usually better than the episiotomies.
In the medical literature, episiotomies tend to have more painless sex and more bladder problems than the natural tears. Where is going to tear were its weakest. Where is it going to be cut with an episiotomy? Usually right down the mid line or to the lateral – that’s the anchor into the perineal body. Perineal body is like a figure of eight for the vaginal to the anal sphincter and that perineal body that’s your muscular base.
KRISTEN STRATTON: Why would someone would prefer to tear versus an elective episiotomy?
MAUREEN MASON: Right. Women would prefer to tear because they’re not getting what medically actually looked as a laceration when the doctors cutting with the knife. They’d want their own birth canal to open up on their own. That being said, some women come to physical therapy and they’ve had extensive tears that then have ended up requiring stitches as well.
So I think any women listening that’s experienced some of these things, don’t put yourself in a box, accept what your body needed and what it is what it needed. There are very few stories of episiotomies and tears that women feel great with and they don’t even notice. However, I have had some clients share their episiotomy story or their tear with someone and they say: “Well that didn’t happen to me and then the woman feels bad.” So we want to naturalize, there’s quite a spectrum of things that happen.
KRISTEN STRATTON: When a woman has a tear or an episiotomy and has stitches, what can she do at home to help feel better and to aid in her recovery?
MAUREEN MASON: Okay, ice helps but how the heck do you put ice on your butt? Right?
KRISTEN STRATTON: Just sit on I guess.
MAUREEN MASON: There are the reusable cold packs that could help. They really do help. A wise woman, a mom of four told me to take some menstrual pads, get them wet, wrap them in [inaudible], wrap them and put them in the freezer. I was glad I had them when I came home. Yes, they melt. You better be sitting on a towel. So ice could help.
There are different peri sprays that people use that are soothing. Sitz bath definitely helps where you’re doing a luke warm bath that sort of thing. Being really careful where you sit, there are soft squishy couches that really let you sink down in. Those are difficult and you may end up sitting on one cheek or the other for a little bit and prefer a more firm support.
There are also donut cushions or you could simply take two decorator pillows and make a V out of them. Many people have the airline travel pillows. Some woman might sit on that for a few minutes. It’s their rather plump; don’t put yourself in a box that one type of pillow is going to work for you. It could depend on the day too. Sometimes things are more sensitive in our body and other times, they are fine.
SUNNY GAULT: I think in the hospital, I was given witch hazel – is that right?
MAUREEN MASON: Yes.
SUNNY GAULT: Yes then the little squirty bottles.
MAUREEN MASON: Yes the peri spray.
SUNNY GAULT: That helps a lot.
MAUREEN MASON: It does.
KRISTEN STRATTON: What about you Serena? What is your experience then?
SERENA SALINAS: I feel like I was fortunate. I really love my birth story because there are lot of anxiety before because I didn’t want tears. I didn’t want episiotomy but I have three small tears. At that time, I was just like: “I don’t care. Just get my love bug out of me. I can’t deal with this anymore.”
My three small tears included two within the vaginal canal and then I’m not quite sure what the correct term is but at the base of my vaginal canal on the outside. So I had three small stitches and I used witch hazel. I actually used the witch hazel pads to dab after using the restroom. But when you Maureen was talking about the pillows, I actually used my daughter’s Boppy.
MAUREEN MASON: Sure.
SERENA SALINAS: The boppy that I’ve had, I was like: “Man. I should have gotten two of these – one for me and one for my daughter because the Boppy was perfect for me.” I was able to move it to whatever was sensitive on that day. My doula provided me with a tea as well that I used in a peri bottle.
MAUREEN MASON: Wonderful
SERENA SALINAS: Immediately. So when I was at the hospital, we’ve made some and I used it. I used it for the first month and a half and that was really helpful for me. So I tagged team to my tears with the witch hazel as well as the tea that I had.
MAUREEN MASON: Wonderful.
SUNNY GAULT: Yes. As far as my experience is concerned, so I have four children – three pregnancies because I have a set of twins. But my very first birth that I had, my son I had a second degree tear. I don’t think they told me a lot about where it was and I know you’re talking about like in the canal. I don’t think they’ve told me that. I think what they were referring to is just on the outside.
So it was painful but like I said, I use the witch hazel. I think it was a spray. Did they put it on a spray? Does anyone know? Like a spray and then obviously, there’s a beautiful like whatever linen underwear they give you in the hospital.
KRISTEN STRATTON: Those are really comfortable.
SUNNY GAULT: They are kind of.
KRISTEN STRATTON: They’re really comfortable.
SUNNY GAULT: They really fine like Victoria’s Secret.
KRISTEN STRATTON: No.
SUNNY GAULT: Then they had these really long pads and stuff. I just remembered having to do that multiple times. It was kind of a lengthy process but I continue to do that even if after I left the hospital and I went home. My case is a little bit different because I had extreme incontinence after that birth. So I had a totally different after care experience simply because of that because I had like no control over the urine that was coming out.
But I did all of the sitz bath that you were talking about and that seem to really bring a lot of comfort just because when you have urine combine to it with a tear
KRISTEN STRATTON: It burns.
SUNNY GAULT: It’s the worst burning feeling ever.
MAUREEN MASON: Sunny, thank you for sharing your story because it’s just we have quite a spectrum in the room here of what women experience and we are so good at keeping things private and being tough. Women actually suffer silently a lot with these things.
SUNNGY GAULT: It’s true.
MAUREEN MASON: Yes.
KRISTEN STRATTON: When we come back, we will continue our discussion about: “When to think about getting intimate with your partner after recovering from a tear or episiotomy.” So stay tune and we’ll be right back.
KRISTEN STRATTON: Welcome back to the show. We’re talking with Maureen Mason about: “Recovering from a tear or episiotomy following a vaginal birth”. When a woman has been cleared for sexual activity from her doctor, is there anything that she can do or that she should know to make sex more comfortable after recovering?
MAUREEN MASON: Ha-ha-ha
KRISTEN STRATTON: A glass of wine maybe?
MAUREEN MASON: Okay, let’s imagine that man have gotten four hours of sleep for a couple of weeks. Let’s imagine their equipment hurts and let’s approach them as soon as they put a baby down, right? So nobody tells you what things change. The woman has juggling with the husband and the baby and your pelvic tissues when you’re nursing, you’re not getting your estrogen and you progesterone. So the vag can hurt, the tissues can become tender.
If when nursing, we’re not getting our cycle and we’re not sleeping, the libido can disappear. We love to talk about sex. It’s a fascinating topic but when a woman has no libido that starts the problem right there. So sleep deprivation, sleep hygiene is number one for woman having a good sex drive. Men loading the dish washer baby care that sort of thing specific for the appease or a tear site – lots of warm up activity sexually, keeping clothes on. Letting that natural lubrication happen and then exploring different positions for comfort, what might have been comfortable in the past might not be comfortable now.
One strategy is for a woman for vaginal penile to control the rate and depth of penetration specifically and have date nights. Okay. But don’t have a date night and go out for a big dinner and be sleep deprived and then think you’re going to come home and have sex for the first time because you’re going to fall asleep on a full stomach.
SUNNY GAULT: That sounds good to me right now.
KRISTEN STRATTON: I’m actually going to say that. That doesn’t sound like a bad date – not at all actually.
SERENA SALINAS: Yes, this one’s fantastic. Sorry honey.
MAUREEN MASON: But we can also look at sexual intimacy is any touching or cuddling that is private and intimate between a couple. Okay? So much we think of sex as one particular act but really the sexologist, sex therapist consider a whole spectrum of activity that makes things more fun.
I tell a lot of my patients that might be a little shy here or tired, keep your clothes on. Go back to the some of that cuddling to start and see where it takes you. Sometimes take intercourse off the table and start with some other things maybe something for your partner. If woman’s libido is low or the libido may be high too.
KRISTEN STRATTON: When should a woman consider a visit to a public therapist?
MAUREEN MASON: If you’ve possibly explored pelvic perineal massage on yourself, okay? Contacting the tissue, maybe looking in the mirror; maybe most woman are shy and uncomfortable visualizing their tissue. We want to picture flowers down there. This is an elastic accordion type structure – the vaginal walls. It is the birth center and it’s a beautiful part of the body. So the self talk is important.
When there’s continued pain, come on in. Most of the grade threes and fours would really benefit from the pelvic physical therapy. Not only could there be pain at the perineum, there’s most likely associated problem such as Sunny mentioned. Some bladder problems could be bowel problems. Pelvic prolapsed also that’s when things are too low. This can happen and cause some pressure or heaviness that sort of thing.
In the beginning I’ve mentioned pelvic girdle pain, the joints being out of the alignment that sort of thing. So come on in, get a screen, and get checked. You might just get a couple of visits or you may want more support building up for athletic training type functions to that whole process.
SUNNY GAULT: I think we almost do ourselves a disservice as women because we’re told before we have babies: “Once you have a baby, you’re going to have some bladder issues or there’s stuff to expect, right?” That might be true but then after it happens, I feel like: “A lot of woman just think – that’s just part of having a baby and you just deal with it.” Whereas there are things that can be done like you really don’t have to pee a little bit every time you laugh.
Even if it’s just an initial consultation, just going to see someone to kind of tell you what’s happened to your body says. I think that’s invaluable knowledge just to know because your body – we say this a lot but it’s true. Your body is never the same after having a baby and it doesn’t mean that it’s bad. It means it’s different and you’ve got to adjust.
MAUREEN MASON: Exactly.
KRISTEN STRATTON: Yes, knowledge is power.
MAUREEN MASON: Yes.
KRISTEN STRATTON: Panelists, when did you feel ready to continue your everyday activities following your birth?
SERENA SALINAS: Well no for me. I’m an anxious person and so I immediately wanted to start walking up and down the stairs in our apartment. My boyfriend was very adamant about making sure that I sat down in my boppy and I didn’t move. It actually took a lot of self-discipline to stop me from moving because I wanted to just jump back up and I wanted to do the dishes and I wanted to feel productive around the house. So I actually had to temper that desire to get back to my routine. Little did I know or fully understand that my routine was going to be very different because I had my daughter.
But to get to the heart of the question of when I actually was able to get back to the daily routine or just the activities, it would have probably been about two months in all honesty maybe even a little longer to get to the function where I could walk or jog without peeing a little, where I could physically exert myself and not have to worry about: “I peed a little” or where I was even able to laugh without losing some pee.
So I would say about two and a half months. It probably would have been less if I would have just sat down and enjoyed being still rather than having to deal, having to temper myself from getting up and doing the dishes or getting up and watering the plants. I felt the need to lift things that were heavier than what my doctor had suggested. Again, that was my own personal thing where I felt like I needed to clean the house or whatever. But it took about two and a half months.
SUNNY GAULT: I think mine was different depending on the birth. With my first, I was just so flooded like: “What is going on with my body?” People say: “You’re supposed to pee a little but I can’t control anything.” Then I was going to see a urogynecologist on a regular basis and he was talking about surgery. So that first birth to me was just: “I was just so focus on how do I feel somewhat normal; not even what can I accomplish.”
Literally, I was changing my newborn’s diaper and then I was like having to change my own diaper I seriously wearing to pants. It was crazy. Mentally, I was just in a very weird, crazy place that I was really just trying to care for myself so I could care for my baby. But I would say with the subsequent pregnancy is births – mentally I think I bounced back pretty quickly.
With the C Sections too, my body was pretty good about recovering from those and me hopping back pretty quickly. Having your own business is tough. No one’s really going to kind of do all your work for you. So you have to jump back in a little bit but I will always do give myself those first six weeks. I was just: “You know what, once you have more and more kids, you really value. I always tell women: “You have a hospital birth, just stay there as long as they let you stay.”
When you go home, it’s totally different. People are waiting on you and especially if you already have a kid at home, right? So I was pretty good at holding off. But I would say: “Definitely for those first six weeks, until you’re able to see your OB or something like that. That’s kind of what I did at least.”
KRISTEN STRATTON: Thank you so much Maureen and our lovely panelists for chatting with us today about recovering from tears and episiotomies.
For our Newbies Club members, our conversation will continue after the end of the show as Maureen will show: “Techniques about preventing and reducing the risk of tearing or needing an episiotomy.” For more information about the Newbies Club, please visit our website at www.NewMommyMedia.com.
SUNNY GAULT: Okay it’s time for a fun segment we have on the show and it is called: “Baby Oops.” I love today’s story. This comes from Jenny of New York.
“When I brought my second son home, my oldest son was three years old. I was holding the new baby in front of me and talking. I said – aren’t you hard to chop. Suddenly, my normally calm three year old hit the new baby upside his head; I was shocked. I put my baby down and drew the three year old closer to handle the situation.
His answer? Mommy, he’s not hard to chop. Thankfully, baby was not hurt and the three year old was innocent. I’m very thankful they’re very close even to this day.”
So Jenny, thank you so much for sending in this story. If you have a funny Baby Oops you want to share with our listeners, please send us an e-mail through our website at www.NewMommyMedia.com. You can also leave a voicemail for us and the number to call is 619-866-4775.
KRISTEN STRATTON: That wraps up our show for today. We appreciate you listening to Newbies.
Don’t forget to check out our sister shows:
• Preggie Pals for expecting parents
• Parent Savers for moms and dads with infants and toddlers
• The Boob Group for moms who breastfeed
• Twin Talks for parents of multiples.
Thanks for listening to Newbies: “Your go-to source for new moms and new babies.”
This has been a New Mommy Media production. The Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Well such information and materials are believe to be accurate, it is not intended to replace or substitute for professional, medical or advise or care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
SUNNY GAULT: New Mommy Media is expanding our lineup of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or organization interested in joining our network of shows through a co-branded podcast, visit www.NewMommyMedia.com .
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