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Friday
Jun022006

Okay, so she was a footling breech

Shiloh Jolie-Pitt seems to have been a footling breech

http://www.nzherald.co.nz/section/6/story.cfm?c_id=6&objectid=10384352

Thanks so much to anonymous for sending that link.

So, that makes more sense to me. Turning a footling breech is very difficult if possible at all. And, to be honest, I would have a cesarean for a footling breech as well. Is that weird?

I've often thought of what circumstances I would submit to a cesarean. I've come up with a few.

- baby with myelomenincocele (scheduled)
- baby with hydrocephalus (scheduled)
- baby with a serious heart defect (scheduled)
- footling breech (after labor began)
- prolapsed cord (whenever it might occur)
- a compound presentation ([remind me to tell you a story about this] - in labor)
- baby that was incompatible with life, but who could donate organs to another child (scheduled)
- persistant mal-presentation (after trying everything under the sun and, obvious, in labor)

Those are the ones I can think of off-hand... might be more.

Story mentioned above: A midwife-friend I know from a birth center I once worked at called and told me she'd been attending a woman for about 24 hours or so. She said things had really slowed down a lot and she wasn't sure what more to do. I asked what position the baby was in and she told me she could feel a hand. (!) I asked if the baby's hand was on the head and she said she thought so. So, I see a compound presentation that very well might not make it through and the body is pooping out. The mother does NOT want to go to the hospital and midwifery is illegal in this state. I really encouraged the midwife to take mom to the hospital, but she wasn't ready to do that yet.

I hear from another midwife that she called and asked her what she should do about 12 hours after my call. How come the baby isn't coming? When pressed to describe the presentation, the midwife said the ARM could be felt. This midwife nearly screamed at her to get the woman to a hospital or the baby was going to die. I guess this midwife's imploring was stronger than mine because she did take her in and the baby born by cesarean (of course) - and all are well.

It is this kind of ineptness that docs despise. This midwife is one who has seen a lot of complications, but when one believes that ALL babies are able to be born vaginally - God/the Universe is sure to bring that believer to his/her knees in humility to reality.

I wish all midwives were perfect. I wish all doctors, nurses, and midwives were perfect! I have seen equal ineptness from docs and nurses - so, if you are a doctor reading this thinking, "See?!? I told you they were stupid!" you have your stupid peers, too. We just see them in court.

What would YOU have a cesarean for (or for VBACs, a repeat cesarean)?

I wonder how many women really consider this question.

References (2)

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    [...]- Navelgazing Midwife Blog - Okay, so she was a footling breech[...]
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    - Navelgazing Midwife Blog - Okay, so she was a footling breech

Reader Comments (19)

when I had my homebirths I had thought this over-and at the time there were few things I would have had a section for- because I did not have ultrasounds--- some things would not have been detected that I think would be reasonable to have a section for if you knew ahead of time- also things are different now in what can be done for treatments.
many of the closure problems-like myelomenincocele, gastroschisis

certainly cord prolapse if birth was not eminent --
i have a huge pelvis so not too sure about compound presentation- do you mean things like arm and leg or shoulder and head sure that makes sense- but nuchal hands I see all the time- nuchal elbows,
if I had a fibroid in the way
any of the stuff where maternal environs are more dangerous for baby to stay in rather than out- bp or preeclampsia issues-true placental insufficiency where SGA stuff is happening-
MOMO twins...

June 2, 2006 | Unregistered CommenterAnonymous

Ditto your reasons, and what about if there was an active herpes outbreak? I don't have herpes but think I have read enough about the risks to baby...

Hh

Oh, and of course placenta previa.

Hh

triplets or more

June 3, 2006 | Unregistered CommenterAnonymous

Hey, I left the link to the Angelina story, but I'm not "anonymous"- I'm Lili, a.k.a. the woman in Ireland who had two c-sections, both of which could have been avoided if I'd had non-knife-happy birth attendants! :-)

June 3, 2006 | Unregistered CommenterLili

I had a fatal shoulder dystocia and could not imagine (emotionally or physically) having my next baby vaginally. I chose to have a section and I had a wonderful experience. Oddly enough, I am pregnant again and pondering VBAC this time, but would be OK either way.

June 3, 2006 | Unregistered Commenterclara

I was just thinking about this recently. I decided that my cesareans would be for: Placenta Previa, Placental abrubtion, true fetal distress if birth is not imminent, cord prolapse if birth is not imminent, & compound presentation. I am sure there are others but they are few and far between.

I however would not choose a cesarean for footling breech as my first was a planned and successful footling breech homebirth. I will say however, my water did not break until 30 minutes into pushing (just 30 minutes before he was born) and both legs were descending nicely.

June 5, 2006 | Unregistered Commenterdoulasherry

I just wanted to post this link if anyone wanted to see a footling homebirth! It's not my site, but it's public. I am about to start midwifery school, so I found this pictorial birth story very interesting!

http://www.birthingway.com/footling_breech.htm

Enjoy!
Loving Pecola
www.minoritynursingstudent.blogspot.com

June 14, 2006 | Unregistered Commenter"Loving Pecola"

I would not have a scheduled section for a baby with a serious heart defect. My son was born vaginally (a VBAC no less) with several serious heart defects (DORV, AVSD, hypoplastic left ventricle, and pulmonary stenosis) and I believe being a vaginal birth actually may have saved his life.

Any additional compromise in his alertness from drugs, or being early (he was born at 39w5d, SVD), or not having the fluid squeezed from his lungs could have been fatal. He was distressed anyway, apgars only 4 & 5, was bagged and then stuck under an oxygen tent when he finally did start breathing on his own.

I didn't really know about his heart before he was born. (I'm sure if I did, I'd have been pushed into an ERCS so I'm glad I didn't) They couldn't see all 4 chambers at the 20 week US, but I was told its usually nothing but I needed to follow up with a PC for a fetal echo. Well we were in the middle of a move and new insurance didn't kick in for 3 months so I wasn't paying out of pocket for something that could wait until we had insurance again. By that time I was 36 weeks and had my OB check before scheduling with the PC. He did a US and declared my son's heart "perfect" so I assumed he knew what he was talking about and didn't get the echo.

June 21, 2006 | Unregistered CommenterAnonymous

Also, wouldn't schedule it for gastrochisis. I know someone who was pregnant with a baby with this and her perinatologist was going to let her try a vaginal delivery since she already had a child vaginally. I also saw a birth show on one of the discovery channels once where a baby had that and the mom delivered vaginally which is what the perinatologist recommended.

June 21, 2006 | Unregistered CommenterAnonymous

I also would not c/s automatically for herpes. The vast majority of complications that happen arise when it's a primary outbreak in the mother and worse, when the mother is unaware she has the virus and is in her first primary outbreak. Research shows the vast majority of infants in mothers w/ herpes and even w/ active outbreaks can be delivered vaginally.

June 21, 2006 | Unregistered CommenterAnonymous

I sure do like reading what everyone has to say. I think one of the main points, albeit hidden, is that each of us has different levels of comfort regarding our child's health - and our own.

I would choose to have a cesarean for several things others would not, but I wouldn't for some other common reasons.

The herpes example being one. Unless I had an active lesion on my inner labia or in the vagina proper, I would slap some Tegaderm on the lesions and go through labor and birth without a worry. (I have a Tegaderm story in my Birth Stories blog.)

However, gastroschisis, I would have a cesarean - probably not scheduled, though, but perhaps. The gastroschisis I have seen were dramatically large, so it might depend on how serious the issue was before making a decision.

I know that women do birth babies with spina bifida (myelomenigocele), but the one that I witnessed was as large as a navel orange and would have surely killed the child coming through the vagina. I would also want the neuro team right there to do the repair for my child, hence, scheduling surgery would most likely be my choice.

Of course, I am not pregnant, not going to be pregnant again, and am not faced with these decisions. We each have to do what is right for us, even if that is terminating a baby that would otherwise be extremely ill or birthing a baby at home we know is going to die no matter where it is born.

I will do my best to honor every woman's choice - even if it isn't the one I would make for myself.

June 21, 2006 | Unregistered CommenterNavelgazing Midwife

My daughter was born by emergecy c-section a year ago. At 37+6 my waters suddenly went at home, and her foot came out. It was very frightening and I had to have a general anaesthetic. Thank goodness we all ended up ok (after a stay on the high dependency unit for me.) It's taking a long time to get over it psychologically though, and sometimes I still wonder whether there could have been an alternative to a GA section. I never wanted a section.

June 30, 2006 | Unregistered CommenterAnonymous

Hi - just stumbled across your site while googling compound presentation. I am neither doctor nor midwife - just a mum to 4 gorgeous kids.

Did want to say I'm amazed at having read up on compound presentations. I had no idea how devastating my last birth might have been.

My youngest (now 18 months) was induced at 38w4d, due to worsening PIH (150/105, +2 protein). I'd birthed my three elder vaginally, with HCs in the order of 39-40cms, so thought this birth would be a breeze..... (as a sidenote, will mention that she was footling breech with polyhydramnios and cord presenting until ECV performed - still considered unstable lie as she was very high)

After labouring for 30-odd hours with just the gel, my ob. performed ARM. What part do you think presented ? Yep, her arm, over the top of her head. So on top of her 38cm head, I was trying to deliver who knows what combined circumference. The pain was *out of this world* I was trying to will my body to pass out from the pain (no pain meds).

I was stubborn, though, and still pushed, and pushed and pushed. Only trouble was her arm and hand were then becoming very swollen and purple, so ob. advised we were risking nerve damage w/out c-section.

So off we went - only problem was because she was so well impacted in my pelvis, ob. was VERY rough with my internal organs in attempting to get her out. I ended up with a paralytic ileus, and vomiting blood 48 hours after the c-section. Iv fluids and ng tube, and 10 days in hospital.

Not pleasant, and I'm not an advocate of c-sections unless *Really* necessary. So, after that diatribe, wanted to say "thankyou" for confirming that the c-section was the right route to take for my wee Annabelle.

Cheers,
Sally (in Oz)

July 16, 2006 | Unregistered CommenterSally

Sally: What an amazing story!

If I saw an arm, I would have not hesitated one second to get you to an operating room. Not one second. I am STUNNED a doctor didn't rush you to the OR and put you under general anesthesia to get the baby out. Amazing.

I'm glad you found me here... be sure to poke around the rest of the site, too. I have loads to say about cesareans.

Welcome. Thanks for being here.

July 17, 2006 | Unregistered CommenterNavelgazing Midwife

Now that I have finished typing up this post, I recognize that it is ridiculously long. So I am not expecting you to post it. But if you could please read through it and email me with your input, it would be VERY greatly appreciated.


I know it's been a year since you posted this. But I happened upon it recently and thought I should post. Firstly, b/c your post totally validated my thoughts, and secondly b/c I am interested in feedback and advice. Especially b/c as I run from dr to dr I am learning that most Drs don’t even realize that a compound presentation is any different than a regular presentation.
Here’s my abbreviated story about my labor and delivery.

I was with an MD practice that I chose b/c they work with midwives. Turned out the midwives were associated with them but did not work with their patients. One of the MDs in this practice was rather stupid and I was scared what would happen if he was on call when I went into labor. So I switched to a new dr, based on very detailed info (low c-section rate, listens to her patients etc) from the top midwife around.

The new dr has her own practice so she tells me to get a labor coach. Next appt she wants to again make sure I have a labor coach and take a labor class. So I ask who she recommends and I get the info for the labor coach and the labor class (2 different women). I am very happy with the dr each time I go to her.

I meet with the labor coach a few times and really like her. I discuss not only my history with her but also how I really want to minimize tearing. We discuss different positions. I make it clear to her that even if I end up with an epidural I still want to change positions, as I learned in my labor class it is possible.

She says she’s ok with e/t but since the nurses in the hospital have been difficult to her lately, I should ok e/t with my dr.
So I do. The dr is cool with e/t and really trusts my labor coach. And I know my LC really trusts my dr.
In my labor plan the only thing I have written under ‘delivery’ is that I should NOT be on my back- if I don’t have an epi than I want to be side-lying, and if I do have an epidural then I want to be on hands and knees.
I review things with my DH but don’t expect him to remember a/t- that’s why I am paying a labor coach. Right?

As my due date approaches I ask my dr when to call her. She trusts the labor coach and feels she’ll take care of that. I ask the labor coach when to call her. She tells me to first call her early on so she’ll have a heads-up re scheduling her day, but I’ll know when I need her.

I’ve been going to the osteopath during the pg for CST and when my due date comes and the baby barely dropped and my dr says nothing will happen over the week, the osteopath sees that my uterus is ‘locked posteriorly’ [I have had a retroverted and retroflexed uterus for yrs] and works on me for quite some time. I feel the baby drop and sit on my sacrum within a day, as the DO had predicted. I go back to her one week later and she works on me some more, especially on the back which has been hurting me a lot since last visit, and abdominally where I have scar tissue from a previous surgery (I also went to some pelvic PT for this, as my uterus got totally pulled over to the left toward the end of the pg by this scar tissue, indicated not only by the pain, but by my belly-button being up to 4 inches over to the left from where it should be). My mucous plug starts coming out that night and I have a brief episode of bad vaginal pain [I didn’t yet know what contractions feel like!]

The next AM there’s a mucous chunk that comes out. I call the labor coach. She says not to worry. I keep having mucous come out. I call the LC again with more Qs. (at some point I mentioned to her about what I then described to her as ‘shooting nerve pain’ I had had vaginally.) She will be popping by where I am anyway (I was running a booth at a health fair) so she says not to worry. Then I start having water come out of me slowly over time, especially if I stand. When I see her I tell her this. She notes that I have really dropped since she last saw me. I have no cramps so she says not to worry-I just have a tear in my water and it may be another 4 days until I go into labor. As the day goes on I get more nervous. No pain, but the vaginal opening feels somewhat more relaxed as I sit. And water keeps coming; I try to sit as much as I can. In the evening I make up with my husband that I will call the LC b/c I really want her to check me before I go home for the night. I want to know what’s going on so I can plan my schedule as best as possible. I call her again. She asks why I am so nervous that I keep calling. I explain that 1. I thought usually they don’t let you go more than 24 hr after the water breaks 2. I am on blood thinners and shouldn’t take them during labor!

She asks if I have cramps. I say no. she assures me that I am not in labor, it’s safe to do anything b/c my water didn’t break; it’s just a tear. I should have a nutritious supper and a good night's sleep but I can call her in the morning before her first appt which is at 9:30. [as it turns out, b/c I had had a PSN yrs ago (which was most definitely in my history form) and a rare SE of it is that you don’t feel the first stage of labor, I was, indeed, in labor when I called the LC.]
A bit later that night I feel like I have to have a BM b/c there is rectal pressure, but only a bit comes out. I figure the rest will come out the next AM.

Even though the LC said e/t is ok, somehow I still think that something is going on inside me. But I feel no cramps. I touch my stomach everywhere to see if it hurts. There’s one really tender spot across the left lower abdominal area but no cramps. So I go to sleep. It’s 2am.

I awaken at 5 am. I think I need to have a bowel movement. I try but nothing happens. I go back to sleep. I wake up 15 minutes later with this same pain. Again no BM. I realize I am not going to be able to get back to sleep with this kind of weird rectal discomfort and I tell this to DH. I figure just like last night that it’s the baby’s pressure there that’s preventing me from having a BM, but if I relax enough I should be able to have a BM. But I can’t even relax enough to urinate. I walk around for a while.

I figure maybe this has s/t to do with labor. They say you have to eat and drink when you are in labor. So I sit down and eat some crackers. And drink a lot of water. Now the rectal discomfort is happening more frequently. And every time I stand in place to try to pee I get it even more. I realize this isn’t helping me relax. So I figure if I go in the tub maybe that will help me relax enough to be able to go number 1 or 2. But it’s not too comfortable to sit or lay in the tub b/c of my size. I start pacing back and forth in the tub. I think maybe to time these painful episodes. Its 5:40 now and they seem to be every 5 minutes and last for 1 minute. I remember something about a 5-1[-1, which I fogot!] rule. But I am not in that much pain. It’s mostly rectal, thought slightly lower back too. When I had bent down to fill the tub I had felt the pain shift from being rectal to vaginal... the same vaginal pain I’d had one night before.
I figure I’ll wait till 8 to awaken the LC.
DH groggily comes to the bathroom and asks if there’s anything he can do, so I say no- he can go back to sleep.

I spend a while pacing around my apt and deep breathing, alternating with going in the tub. When I keep walking and breathing the pain is pretty bearable. Though it is rather annoying that I still can’t urinate or have a BM. But I do keep drinking water.

I keep thinking that this must be false labor b/c the pain is not what anyone’s described. That if I go to the hospital they will send me home. And in this amount of pain it’s going to be bad enough going in the car the first time. The last thing I need is to have to go back in the car and go back home.

I have some blood that is a mucousy consistency. I get a bit nervous.
The pain is getting closer.
I time it and now they’re about every 3 minutes.
Maybe 30 seconds long.
It’s 7 and I decide that by 7:30 I am calling my LC even if I am awakening her.
I watch the time tick by as I pace back and forth deep breathing.

I call the LC at 7:30. I tell her I will have to stop talking every few mintues. I tell her that I awoke at 5 AM thinking I had to have a BM but have been unable to. I tell her they are every 3-5 minutes, 30-60 sec long. She tells me I am really in labor. She asks if I urinated, and I tell her no. she says that happens to some women. She asks if I feel the baby. I tell her I only felt him once, quite a while ago. She says this often happens too. She asks if I have eaten. I tell her I had crackers. She asks if I have some protein. I say no. she asks if can cook myself some eggs. I imagine myself trying to bend down between contractions to get a frying pan. The image alone is enough to assure me that I can not. I tell her there is no way. I tell her I am bleeding. She asks if it is bright. I tell her it is slightly mucousy in consistency. She says it’s cervical, not to worry. She tells me that I should be at her house by 8:05 b/c that is when her kids get picked up by the school bus. And we may go straight to the hospital or possibly stay at her house. She ‘talks’ me through 2 contractions during this 5 minute phone conversation.

I hang up with her. I wipe again and am bleeding bright blood. I awaken DH and tell him we are going to the LC immediately. He gets himself together and brings things in from the car [argh]. The last contraction I have before going, my entire body shakes after it.

We rush over to her house. It is before 8. She wants to check me; I somehow muster the energy to rush up the 15 stairs, as I feel the next contraction coming on. When it comes on she looks at my facial expression and says “do you have to push?” I say "yes.” She says she won’t check me and we should go to the hospital. So we go in the car. I’m sitting in the back with a seat belt. She calls the dr’s answering service twice (since she didn’t call back after the first time) and tells them she has a pt "in active labor”. She calls the dr directly on her cell and tells her to be there. After some time she sees my deep breathing isn’t working so well. So she talks me through a shallow kind of breathing so that I don’t push. This does make things somewhat easier. She drives very slowly and carefully. And it’s the time of morning when all the buses are out. She doesn’t try to get us there any more quickly than if I had a pimple that had burst. Except that I have a baby who is jamming the top of his skull numerous times. And I am bleeding all over the place.

We get to the hospital over 30 minutes later. The dr meets us at the elevator.
We go straight to the L&D room and the nurses put the FM around me as they throw a gown on me and I lay down. The young nurse on my left, who I will soon learn will be directing this labor [which other patients of this dr have confirmed is not usually the case-the dr usually tells the patient when to push] says “you can push with the next contraction.” I turn to the LC and say “what about the best position for least tearing?” The dr asks the LC what I said. The LC tells me “don’t worry, dr so-and-so is very good at not causing tearing.” And they leave me on my back.

I don’t feel the urge to push with the next one so I tell the nurse that (as my friend had recently told me that her dr told her she doesn’t have to push with the contractions when she doesn’t feel the need to) and she says I can wait till the next one to push. I do, and try, but nothing happens. [The hospital records note a large caput]

Again with the next one I don’t feel the need to push so we wait for the next. I try again but nothing happens. I tell the nurse “I can’t” she says “push through the burning.” There is no burning; it is just that no one ever told me it would be this hard to push out a baby. The contraction ends. The dr turns to the LC and says “did you check her?” she replies “no, there was no time.” The nurse now has me pushing the third time. The dr says “this is going to burn a little. [the only thing she tells me during the entire delivery.]” I start pushing and this time I remember from labor class to push like I am having a big BM. So I do. The baby starts coming out and the nurse, who is watching the FM all along, tells me to keep pushing. I say “I shouldn’t breath?” She has one eye on me and one on the FM. She says “no, keep pushing, keep pushing.” I do so [since the FM changes only occurred once he began coming out, I am pretty suspicious as to whether or not the cord was caught on his hand- as I now understand that this is not uncommon with a compound presentation]. The LC says to me meekly “lower your chin [this is the only thing she tells me during the entire delivery]” I do so and push straight through and my son is born at 8:44 am.

They put an IV in me [from my itemized hospital bill I know it was for oxytocin …a lot of it...]. The dr puts a retractor between my feet, I get a pedundal nerve block, and she spends quite some time sewing me up. I felt a raw burning on my left so was confused when I felt her put in the last few stitches on my right. The dr simply tells me I “tore a bit b/c his right hand was on top of his head.” (Note that he weighed 6lb 14oz, and I am petite.)

They then show me the baby. I ask how many stitches I got. The LC says “2 or 3. That’s pretty good considering the size of the baby and the size of the mother…”

The dr goes back to her office. I am in L&D for over another 3 hrs b/c of all the bleeding. The nurse who was on my right through the delivery stays with me. After a few hrs she lets me attempt to void. Soon after she has me go back into bed telling me that if I sit on the toilet more than briefly I am going to get a lot of swelling. When she is satisfied with the decrease in bleeding she brings me to recovery. They again make me attempt to void, they have me sit with a warm sitz bath under me, etc. Finally they call the dr and she tells them to straight cath me. The nurse from delivery caths me along with some help from the nurse in recovery.

This is at 12 pm. It’s been ages since my bladder has emptied itself- and I have drank plenty of water during and after labor [and the fact that I couldn’t urinate during labor goes with a very posterior/retroverted uterus (as do the rectal and not vaginal contractions, so I guess he was jammed pretty well into the sacrum during labor) meaning that the cervical pressure restricted normal funneling of the bladder outlet and thus interfered with micturition, and I therefore had the baby jamming himself up and down on my very full bladder for hours.]

Before the nurse from delivery leaves I ask her how many stitches. She looks a bit uncomfortable and says “between 5 and 21 b/c she only used one pack of ???”

My sacral area in my back- and straight down from there as well- is really hurting so I ask for ice. Which I keep doing over the next day or so. E/o looks confused when I ask. But I tell them it really hurts. Some ask if I want heat. Some ask if I had back labor. I say no to both. I explain that the ice really helps and I keep holding ice there.

Over the next few hours I can urinate when I try, although with some difficulty. I am very good at holding ice on the perineum b/c I know from my sister who tore with her last one. By late afternoon I again can’t urinate. They make me keep trying. By night time when I try it is really bad; if I try standing to urinate I get bladder spasms and if I try to sit to urinate I get rectal spasms. There’s no way I am going to be able to urinate. I speak to the night nurse who calls my dr. She says she doesn’t know what’s going on but she can straight cath me and they’ll call Urology in the AM. The nurse doesn’t want to keep straight cathing me so she puts a Foley in. It hurts on my right when it is in but she doesn’t know why.

Instead of calling urology, early in the AM the dr shows up and wants to know “what’s going on.” The nurse comes in and listens to my conversation with the dr. It is the same day nurse I had the day before. So I tell the dr about the bladder and rectal spasms. I speculate that it’s b/c I had a very rectal labor. She says “no...it’s normal, you just had a baby.” The nurse tells her it’s b/c I need some pain killers so that I can then relax things enough to pee. The dr isn’t sure, but the nurse repeats herself. (I think all I really needed was the catheter there overnight till things relaxed and 'deswelled' there a bit!) and tells the dr she’ll do this.

Before the dr leaves I ask her how many stitches I got. She says “oh...i don’t know...just like 2 inches or so.” (and she shows me 2 inches with her fingers.)
The dr never comes in again to see me while I am in the hospital.

The nurse is really nice to me after the dr leaves. She is not her usual obnoxious self and I can’t figure out why she tells me her story how with her last kid she had the worst dr and her daughter was 10 lbs 14 oz and should have been a c-section. And she keeps going on about it as she shows me how to do as sitz bath.
When I do the sitz baths that night it hurts more afterwards. The night nurse says I should do them differently. Then she tells me to do them for longer.

I have some burning on the left side with urination. I figure I must have gotten a laceration on this side and the nurse tells me I can use some A&D for this.

The next day the sitz baths are even worse. This new nurse tells me I have to do them more times a day. The rectal pain and right side swelling get worse and worse every time I sit and do them. I even try percocet again and it does NOTHING. She finally mentions to me that I can do sitz baths at home laying flat on my back in the tub with 3-4 inches of water.

I leave the hospital in miserable pain. Even if I lay on my left and don’t move at all it is pure torture. [I will leave out out my subsequent nursing problems which began with blocked ducts b/c of always lying in this position. The nursing story is a saga in it of itself...]. I try ice and heat and witch hazel pads. Nothing helps. I can’t even sit up a bit or turn enough to burp my son. So every time I nurse him (which I have been doing side-lying since I was first brought to recovery in the hospital) I have s/o else burp him when he’s done with each side. My mom thinks this is crazy b/c she had c-sections w/ all of us and could nurse better than this. So she finally has me call the Drs office.

At this point I also know I have a UTI [though hospital records note abnormally high wbc and neutrophil counts on day 1, but I guess no one ever looked at that.] b/c I have to go every 15 minutes and it’s burning with urination. I call and tell them about the uti [I had them for some time during the pg too- now I understand that due to the very posterior position of the uterus during the pg I was unable to fully empty myself] and explain that the swelling is getting worse and worse and about the rectal pain. The secretary gives me the nurse who tells me I can try ice..i can try heat…I tell her I’ve done all this. She says she thinks it’s normal but will speak to the dr and maybe the dr’ll talk to me. A few hrs later the nurse calls me back: “I spoke to dr so-and-so. She said ‘it’s normal; you just had a baby’ .”

I learn about arnica (PO) and it saves my sanity. I keep doing the sitz baths lying flat on my back, twice a day. It helps the rectal pain but the swelling is often worse after. And the vagina often hurts from the heat. I do gentle yoga [inner thigh] stretches most every day. I am also really good about going to the osteopath every week. She tells me the arnica is a good idea and I should stay on it for 2 weeks.

The significant swelling is on the entire right side, though the upper left half of the outer labia and that area are also swollen. I figure it must just be from the pushing.

I think I have another UTI again, b/c there is bad burning with urination on the left side and I know the right side is where I have stitches. The Drs office gives me antibiotics again, although they also have me come in for a culture and it comes out negative.

I stay on stool softeners almost a month b/c they told us to in our labor class. But after a while I feel that it makes my BMs so soft that I have to wipe more, but every time I wipe it burns. Mostly on the inside of the anus, so I can’t really figure it out, but I stop taking the stool softener and eventually the rectal irritation goes away.

Every time I try stopping the arnica the right side swelling returns.
After a month I can sit if I really have to, but the anus still hurts deep inside.
Even after 8 wks when I try stopping the arnica the right side swelling returns.
I realize it’s b/c of the pulling coming from there. So I do the perineal massages as I had done during the pg, as per my PTs advice. I work on the muscles where ever I feel the tenderness and burning and tightness. I can feel the scars as well. I discover that I tore on the left in the vaginal floor area horizontally, and from there it continues upward towards the opening. I work on these. I work on the perinial muscle on the right alot too. After 2 weeks the pain is now much better. But there is still all this tension coming form the rectal area. So I try working rectally but it feels more than the usual amount of uncomfortable for this and keeps hurting a bit after as well, so I leave it alone. When I go to the osteopath over these weeks she feels the rectal tension too and works as deeply as she can on these muscles, which helps a lot, albeit temporarily.

I mention the rectal tension to my dr when I see her about 3 months later and tell her that I even got in there rectally to try to work on it. She doesn’t address it, but does keep asking me what my plans are for next ttc. I tell her that first I want to go to PT to get rid of the perineal pain before I’d even consider intercourse and then we’ll start thinking of what our plans are..that my cycles were very regular before so I can probably go by my cycles. She gives me a whole speech how I need an IUD etc.

Even after that, there are times it even feels tight where I ripped down the front. So much so that it’s like I have stitches in there and I am afraid to cough. This is while I am on a med that dries me out so my stool is a bit harder and I suspect I am a bit constipated. But I still have a BM every day. Then the effects of the med wear off and one day I have a bunch of BMs. By the last time that night I have really bad anus pain again. That BURNING is back. It’s on the right, anteriorly, directly inline with the right perineal pain and scar. And this is the same pain I had after the baby. So I stay up all night online trying to figure it out. Aha-I have an anal fissure. And I did by the time I had gotten home form the hospital too.

Background search on the dr shows a restriction on her hospital privileges a half a year before she opened her practice here. Which is probably why she’s been watching her back; her info on that website was updated so that it no longer lists those restrictions; this was updated the day after I called the previous hospital to find out about the hospital restrictions (I told them I was checking into a dr that was relatively new in town and I was considering using) and they transferred me from one dept to another finally telling me that they had to check with her before releasing any info on this.

To abbreviate the rest of the story...over the next few weeks I learn much more about my internal scarring. I follow it with my fingers as far back as I can. I have a scar extending the entire length of the vagina on the left, until the cervix. On the right I have a scar the entire length of the perinium until the anus. I learn that we only have 2 inches between the vagina and anus.
The first time I went in to discover the extent of the [right] scar -b/c the fissure pain was so bad- I worked on the muscles there much the same as I had worked on the muscle higher up. It worked; I got rid of the internal sphincter spasms. This anterior right fissure is gone for good. But I awakened a couple hrs later with terrible pain in my sacrum. Just like after the baby. Only worse. It went on for 72 hrs with a lot of swelling and then for a few days I felt like I have been in a terrible car accident. I alternated heat and cold and am eventually mobile at times.

So, where does this leave me now? At this point in my life I have swelling and pulling across the right butt cheek adjacent to the sacral area there that is all irritated from this secondary injury 4 months postpartum. And I also have pain posteriorly up my left through the descending colon as it spasms after a BM, is tender all the time, and the bottom (sacral) part hurts more if my rectum is full. And I get fissures alternately in the posterior right or left, depending which side is pulling more at the sacral level. And the more edema there is, the more scar tissue there is that builds up, which perpetuates this whole cycle. Usually the least uncomfortable position is laying face down with a pillow below my lower abdomen so that there is less pulling and swelling in the back.

So now I understand that it is actually a miracle that both my son and I are alive. That my son is perfectly fine other than right sided tightness in the diaphragm which causes reflux. And my dr certainly not only lied to me, but in the hospital records as well, which note a ‘first degree laceration’!!!????!!!!!

And I understand that this is all b/c I was allowed to push w/o ever being checked by anyone!!!! Now it makes sensed to me why none of the things a dr should do with a CP were done; they usually try to pinch the hand to get the baby to retract his hand; if they think the baby can fit through b/c the baby is very small and/or the mother large they may cut a medio-lateral episiotomy; if all else fails or the cord is caught on the hand-whether from the get-go or from the baby retracting his hand and getting the cord caught then, they do an emergency c-section.

I understand that not only did I have a total third or possibly fourth degree tear, in addition to the long vaginal tear on my left (which in hindsight was the cause of my persistent left-sided burning with urination), but I may have ripped through other things too. What about the cervix? Or any part of the uterus? [After all, I was bleeding bright red blood for about 75 minutes before he was born.] And most certainly the GI superior to the anus.

I have now read though numerous case reports. I know that the only way for the baby to have come out with a spontaneous vaginal delivery is if I tore through the rectum. And that my son’s hand had to tear through somewhere in the rectum so as to get down into the anus. And that since he was so posterior during labor, who knows where that is.

So I am figuring that I had a tear rectally, and now it retore 4 months later (immediately after I worked on the sphincter muscles), probably b/c it wasn’t sewn at all though possibly b/c it wasn’t sewn properly, and now I have new scar tissue and adhesions sticking this part of the rectum posteriorly (I have had a partial bowel obstruction from adhesions years ago so I do know what they feel like!). I chronically feel like I have a stomachache in my back, from the descending colon and down.
.
I have had great success with the vaginal and perineal/anal scar tissue work with a great PT but doubt she can help with the underlying cause of the sacral area pain.
Though obviously we have to first know what’s going on.
The MRI shows fluid in the posterior cul-de-sac and inflammation in the perineal area. The transrectal u/s showed a small defect in the internal sphincter on the right near the tip of the anus. A radiologist I spoke to told me a CTt-scan with contrast is needed to show a tear on the rectum. The urogyn I saw (the top around who thought this was all perfectly normal except that she was totally stumped in explaining away the sacral swelling and then took me somewhat more seriously and) recommended a flex-sig to find occult tears or granulation.
From what I’ve researched a transvaginal and transperineal ultra-sound should be helpful in providing some more info.

So that’s my story. Any advice would be more than appreciated. Other than getting myself a good lawyer ;)

June 7, 2007 | Unregistered Commenterrobin

That is some story. You have obviously already done your homework and know your own story and your own body. You've seen the doctors, have a plan and I believe there is very little I could say to add to your story.

I do not know that doctors or midwives pinch baby's hands to try and make them retract their hands when they have their hands coming out first. In fact, if they/we did that, it could impact the baby even more. Delivering a baby with a nuchal hand isn't a dramatic event at all and rarely causes anything more than a skid mark more than would have happened otherwise.

I *had* a mediolateral episiotomy and it was horrifying - not as horrible as your experience, but disgusting, nevertheless. My incision went into my thigh muscle... I couldn't sit for over 6 weeks, it got infected with green pus, antiobiotics, systemic yeast for me and the baby, pain to this day when I have sex (24 years later). Mediolateral episiotomies have fallen out of favor for a very good reason - they HURT and damage a LOT of muscle and tissue.

I also want to say, just from my experience, not that this will help you at all or not, but with my first, after he was born, I was so constipated, when I went several days later, I tore my colon. Then, when his sister was born 19 months later, I tore it again while pushing. And when their sister was born 23 months later, I tore it again, also while pushing. Each time, the doctors wanted to do surgery to repair it, but I refused. The third time, instead of the blood oozing out, it became bubbles inside my posterior cul de sac and continued growing, filling me up, threatening to pop. (We didn't know what they were at the time... they looked cancerous on the archaic ultrasounds of the day.) I had surgery to remove them when my youngest was 12 weeks old - a laparotomy 13 inches long.

Anytime I get constipated or severe diarrhea, the tear opens up again. I have to be meticulous with my bowel habits so I don't bleed. And no doctor did it to me. Well, it could have been the demerol I was given in labor, but that was my request.

I am extremely curious about several things.

Who in the world told you you could deliver on hands and knees with an epidural? I haven't met ONE person ever who has been able to do that in 20 years. Epidural = on your back in my world.

What kind of labor coach is doing vaginal exams? What kind of labor coach is having you come to here house? What kind of labor coach is NOT LISTENING TO YOU?!?!

I am so sorry about your experience. What a sad, sad painful experience for you to have to live through. I am so sorry you are having to work through everything - just to make it through being able to poop and pee. My heart goes out to you.

June 8, 2007 | Unregistered CommenterNavelgazing Midwife

I've had to ask myself that the last week as I am 39 weeks and baby is flipping and flopping around, and we are unsure how baby will present in labor. Breech I will do, but yes, anything else is for the safety of the baby I suppose will be a c-section. As much as it scares me, what choice do I have?

May 17, 2010 | Unregistered CommenterKathryn

The first baby I caught ( of my friend who was going to have a home birth anyway) had a hand up over the head and the cord wrapped around arm, neck, and head, so the hand couldn't have been pushed up even if I were up there trying to do that, which I wasn't. She was born in the caul, and was about 9 1/2 pounds, about a pound more than any of the mother's previous babies. Mother pushed for three hours. Not only that, at one point she passed a large blood clot, but then there was no further bleeding. I pulled the father out in the hall and told him I thought the blood clot might mean there was a partial separation of the placenta. He shrugged. I told him that if a placenta separates all the way, the baby dies. I told him I thought if there was no more bleeding, that probably wasn't happening, but that there was no way he should count on what I knew. He said, don't worry about it. I went back to being with the mother. She labored and pushed lying on her left side in a state of immense calm. This was astonishing to me as I am someone who walks and walks in labor, perhaps stopping and leaning at the height of the contraction. I am still amazed when I think of it. But it was hard even to get her to get up and go to the bathroom, and she shook her head when I tried to get her in a more upright position to birth. I knelt by the side of the bed, stared at her perineum and prayed for three hours! The baby finally emerged, covered in the membranes like a kitten or a puppy, and not looking very alive until I managed to tear them off, then she moved and cried and pinked up just fine. I knew we had dodged a dangerous bullet with the blood clot, but didn't realize that the compound presentation could have caused a lot of difficulty. I knew in retrospect that it was the reason it took three hours to push out the baby, an eighth baby in a mother who had had one of her earlier babies in two hours total. But I never thought the baby wouldn't come out. My fear was that it would come out not alive. I sure learned that all the reading I had done, and it was pretty extensive, did not substitute for experience!
Susan Peterson

August 16, 2010 | Unregistered CommenterSusan Peterson

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