Prepare for a confident birth – The Birth Class

Episode 491

Louise – 3 births, spontatous, induction, 3C perineal tear, planned caesarean

Today’s episode is a beautiful example of doing your research and making an informed choice, even if it’s not your first birth preference. Louise works as an osteopath and opted for public hospital midwifery care.. Her first birth was very straightforward and her second labour was incredibly quick, resulting in a 3C tear that she recovered from without symptoms, thanks in part to regular pelvic floor exercises and guidance from a physio and colo-rectal surgeon. In her third pregnancy she sought the opinion of five different health professionals who all agreed that a caesarean birth was the best option to avoid further perineal trauma. She takes us through this process, along with her caesarean recovery and the scar massage that has assisted her physical and emotional recovery.

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“All my pregnancies were planned and I was lucky that I conceived easily. I’m an osteopath so I work closely with pregnant women and I attended all my sister’s births so I had a really good understanding of what care model I preferred and which ones I wanted to avoid. I went public with all three pregnancies and births because I had faith in the system.

“Because of my work I’d been privy to high-risk and worst case scenario situations. For example, I didn’t want an epidural because I’d seen what can happen when it goes wrong and I didn’t want to have a c-section because I see so many women with scar sensitivity and i really wanted to avoid those things but also, there’s so much you can’t avoid in birth.

“I’ve been very fortunate that I don’t get morning sickness, I just get really, really tired. I went to Monash Hospital with my first pregnancy and I didn’t have continuity of care but I didn’t mind. I’m also very low risk and had no complications and I quite like being left to my own devices. I did hypnobirthing which I really like and it worked really well.

“I went into spontaneous labour at 38+1 which I just didn’t think would happen because no one in my family had ever had a baby before 40 weeks. Were doing some last minute shopping when my waters broke – it was a hind water leak and it just kept coming. I stayed quite calm, bought a new pair of pants, got a coffee and went home to get my bag and then went back to the hospital. I was in labour but I couldn’t really feel anything so they sent me home and I was told to rest and start hand expressing to get labour going. Every ten minutes a contraction would come and I’d walk around the house a breath and then I’d lie back down.

“When I went back to hospital the midwife thought I looked too calm to be in labour so she planned to induce me. I insisted she check me and she was very surprised that I was six centimetres already. Being at my sister’s births I really learnt the importance of standing up and advocating for yourself. They induced me because they were so busy but I was so sensitive to it that I had a continual contraction for twenty minutes and they had to give me a muscle relaxant to calm it down….and then my labour stopped for an hour. They needed to hook me back up to the syntocinon and I was really clear that once my contractions were regular again, I wanted the drip turned off.

“I went through the last transition and told them I couldn’t do it anymore and that’s when they said: You’re definitely having a baby. For most of the pushing phase I was kneeling and leaning over the bed. I had to lie on my back and that’s when we realised she was sideways and her shoulders were getting stuck on my pelvis. I ended up having an episiotomy to help her out and she came straight to my chest and I cuddled her for about four hours which was so nice.

“We moved before I fell pregnant with my second daughter so I went to Box Hill hospital and had the same model of care but a very different experience. I really wanted to have a water birth because I didn’t get to do it the first time but I was also very open to whatever would happen. I finished work at 35 weeks presuming I would have her before 40 weeks but then I didn’t have her till 41+5.

“I was induced and I felt really pushed for time but I also understood the reasoning behind it. When they went to break my waters I was already 5cm and she was so far down that they knew she would come really quickly. I’d had some contractions on and off but they weren’t any more intense than the braxton hicks I’d been having. I was surprised that I was so far along. Five hours later there hadn’t been any progress so they started the syntocinon drip but they knew my history and reservations so they started me on a really low dose and I only needed it on for 10 minutes before they turned it off again. It kick-started labour very quickly. I chose to have the fetal scalp monitor on because I wanted to stay really active. Thirty-five minutes after the drip started it was so intense that I took myself to the bathroom to be alone and I had a huge contraction that was so incredibly painful and strong. I had another one and then told them I needed an epidural and that’s when the midwives were getting their gowns on and she was born five minutes later.

“I wanted to be crouching but I didn’t make it; I was standing and she was born in two contractions. It was very quick. I had a 3C tear and it felt more painful but the contractions were so intense that I hadn’t realised what damage had been done. I held her straightaway and lay on the bed andI went into shock immediately; I was shaking and my teeth were chattering. I only lost 300ml of blood which wasn’t too bad considering.

“The obstetrician came to check me and confirmed it was a 3C tear and she told me it would be best to stitch in theatre. However, they really gave me time to have skin to skin with Heidi beforehand. I had to have the spinal block before they started stitching which I wasn’t happy about but it was better than having a general. The tear went up to the bowel wall and potentially into the sphincter itself. I started thinking a lot about my recovery because I knew I’d need to do a lot of pelvic floor repair. I stayed for two nights in hospital because the spinal block took longer to wear off and they needed me to be up and moving.

“At six weeks I saw a women’s health physiotherapist through the hospital. I had two appointments, I attended a perineal care clinic and I had an appointment with a colo-rectal surgeon. Even when I was in theatre getting stitches they told me I’d likely need a caesarean birth for future births but I wanted to consult with the surgeon first. It was a really positive experience and she checked my muscles and sphincter. Surprisingly I didn’t have any symptoms but I also started activating my pelvic floor as soon as I had sensation back. I recovered really well. The surgeon recommended a caesarean birth because she wasn’t confident that I could have another vaginal birth and not have perineal trauma on the scar tissue or on the unaffected tissue which could easily lead to faecal incontinence.

“I was exceptionally conflicted in my third pregnancy because I really didn’t want to have a caesarean. As soon as I was pregnant I sought advice; I saw an obstetrician straight away so I could discuss my options. I also saw a women’s health physio and then another one for a second opinion and they both recommended a caesarean. So that was five health specialists telling me to have a caesarean but I still didn’t feel confident. Ally wanted to do a maternal assisted caesarean but Box Hill doesn’t do them….and on the day, I wasn’t in a good headspace so I’m not sure I could have done it anyway.

“I was worried about the pain post-surgery and the recovery and every time a doctor spoke to me I cried. I was 39+3 on the day of the caesarean and once the spinal block was in, she was out within ten minutes. Straight after I felt fine; in theatre I had a bleed and didn’t feel very well and then in recovery….I actually don’t remember it. I only stayed for two nights but in retrospect, it would have been nice if it was a bit longer. I was in more pain than I anticipated and I had significant bruising, swelling and fluid retention. I treated my own scar and saw a myotherapist for scar relief which helped a lot.

“As soon as the dressings were removed I used silicone strips and a cream and roller to help break down the scar tissue. It feels very strange, numb, and weirdly sensitive because your nerves have been disrupted but I really encourage people to do some self-massage because it helps benign sensations back and move the fluid. It also helps to desensitise it and the more you leave it, the more sensitive it can become.”

Topics Discussed

3C perineal tear, Induction, Planned caesarean, Public hospital, Spontaneous labour, Three babies

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