Spare Me The Gory Gee Tales - On perineal care during pregnancy, birth and postpartum.
[This blog post is graphic, it discusses vaginas, vulvas, pelvic floors, tearing, episiotomies and bowel movements. Disclaimer: also based on personal experience and is not medical advice.]
To say I was preoccupied with finding a way to protect my perineum on this second pregnancy and birth is an understatement, I became obsessed. Anything to avoid the deeply unpleasant postpartum experience I had after my first child: I had a pretty positive birth but unfortunately had a bad second degree tear (I birthed lying down and a very fast second stage - both contribute to perineal tears). I’ve always had what my mum jokingly calls a “shy bowel”, I need conditions to be just so to go, I like to be at home or somewhere I feel comfortable, I don’t like to think anyone can hear, you know the score, I’m sure I’m not alone… and I sure as heck don’t like to think that I might bust open a recently stitched and painful wound. So I didn’t go. For ages. Like, two whole weeks ages. I mean, I tried, but I was so sore and so scared and then it got to the point where I couldn't go. It was grim, it was agonising and it was not a nice way to feel when you’re already vulnerable, anxious, trying to establish breastfeeding (which, if you’re already a reader/follower, we all know was a horror show in its own right) and get used to the life bomb that is your first child. I never wanted to go through that again.
And you know what, since perineal damage became a topic I like to discuss on the reg, because, quite frankly, fuck not talking about it, it is a huge women’s issue, I’ve discovered that I actually had it much easier than a lot of folks! I had a tear and stitching that healed pretty well, I didn’t have to be cut, I know episiotomy is very common and sometimes necessary (but not always - our rates are stupidly high in this country, it’s a big issue and I think some day could be looked back upon similarly to the symphysiotomy scandal) but they sound absolutely brutal. I shudder at the thought of those… meat scissors. My god, who’d be a woman? So, yeah, I had it pretty easy and it was still horrendous.
Though I’d had no major issues after that horrible postpartum time on my first (bar a once off enlightening incident with a trampoline and a beautiful silk jumpsuit), once I was pregnant with my second baby I started suffering with stress incontinence in the second trimester, I’d pee myself if I sneezed or laughed or coughed, it wasn’t good, and I wasn’t going to accept it as my lot. This meant educating myself and seeking out my own treatment and help for it, unfortunately not a thing was provided to me by the HSE maternity system. There doesn’t even seem to be a leaflet about it. Is there? I never saw one! So I did lots of reading, I decided to visit a (very expensive!) physiotherapist specialising in women’s health and pelvic floor. And you know what she told me? She told me that it’s not normal, and that it’s an epidemic, and that if men gave birth they’d find a way to stop this damage pretty sharpish. Yup, hard agree sister!
I did lots of perineal care during this pregnancy, mainly visits with the physio for work to release my hypertonic pelvic floor, relaxation exercises, massage, I even tried the Epi-No (a balloon type contraption that you insert into the vagina and expand slowly to stretch the perineum: it wasn’t for me). All of this took time and money, two things I’m privileged to have enough of, many don’t. It also could have been avoided if I had a better understanding and relationship with my vagina, vulva and perineum from an early age, I truly believe it should be part of sex education and healthcare from puberty on. In the end, I still tore birthing my second child but it wasn’t half as bad as it could have been and I was somewhat in control too. I birthed him upright, which gives you 30% more space in your pelvis than lying on your back and I had the attending midwife apply warm compresses that I’d brought with me during transition, two things that are proven to be most effective and helpful in avoiding or minimizing perineal damage during childbirth. My second stage was extremely fast, about four minutes, and he was a big baby (10lbs 4ozs) so these obviously factored in why I tore, but it was a manageable tear, *and* I pooed two days after birth this time YAAAAAY!! I dread to think what state my vagina could have been in had I not been prepared or had the knowledge about being upright and using warm compresses etc.
I’m six weeks postpartum now and at my follow up appointment I insisted on my perineum being examined, I knew it was still a bit raw and tender, something wasn’t right. And I was right, the wound was granulating and not healing correctly, this is something easily sorted if spotted early but can lead to very painful granulomas, discomfort during sex and aesthetically many women find it embarrassing and unpleasant, all which have a psychological knock on effect too. My consultant used silver nitrate on the wound, which chemically cauterizes it, that’s right: FIRE IN THE HOLE! It’s not nice and while I was lying there I did think “who’d be a woman?” for the gazillionth time since I got pregnant but that searing burning pain for a short time is worth it because it was seen to and seen to early. Once discharged many women never get a follow up check on their wounds. I am lucky.
Women are suffering in silence, or having their concerns minimized by their doctors, or being told “oh, incontinence? Ah, that’s just what happens when you have babies”, or making jokes about it (I get this, I really do, if we didn’t laugh we’d cry, but I can’t help thinking we’ve been socialised to make light of it so we won’t rage about how we shouldn’t be left in these sort of states!! Patriarchy strikes again, yay!). Pain during sex, stress incontinence, extra flaps of skin appearing on your vulva, the resulting psychological damage, all things we’ve been told to just suck up and tolerate… well, IT’S NOT RIGHT AND IT’S NOT NORMAL.
Our healthcare providers need to do better, women need to know about perineal exercises, and not just kegels and strengthening because many women have hypertension in their pelvic floor and kegels make it worse, in this case you need to relax not tighten it. We should be getting focused care that takes each individual and their pelvic floor needs into account. We need follow ups and checks if we have had stitching. We need advice on wound care, we need to know what’s normal and what’s not. We need to not be in pain or wetting ourselves or feeling embarrassed or all three. Instead we’re just sent off into the wild to suffer alone, and post-birth when we’re exhausted and drained and run down, and left to fend for ourselves with these poor damaged vaginas. NO!! It makes me so mad. Now that we’ve repealed the 8th amendment and shown that we’re a country who just maaaaybe, might actually give a damn about women and our health, I really hope our health service can improve in this area (and many others too, obvs!). In the meantime, if you’re reading this and suffering, please don’t, demand to be seen and sorted, get out there and advocate for you and your precious beautiful perineum. We all deserve better.