Advice needed - forceps recovery!

[born&brED]

Morning all!

Have found the topics in this section very useful over the past few months being a first time mum - invaluable in fact! So thank you!

Just wanted some advice and experiences on recovery from forceps-assisted birth and episitomies. It's been 4 months since the birth of my little one, and although I feel well in myself and I have been assured that my cut has healed well, I'm still very much aware of it! I'm pretty sure it's not infected, but have heard that it can take months to feel normal *around there* again and the thought of any more children, ever, scares me! Anyone out there got any words of wisdom for me? I'm presuming anyone who had an episiotomy or tear could relate (or assisted without either!).

I have been completely unprepared for the recovery from this - before giving birth I honestly thought forceps just pulled the baby out, with no further complications. I breathed a sigh of relief when I narrowly escaped a c-section by a couple of seconds, but now I wish I'd been more prepared! I really don't think the antenatal classes I attended (NCT) talked enough about this.

Thank you in advance!

born&brED

[Belle]

Hi there,

not much of use to say except that I had the same and from memory it did take a little while for things to gradually feel better and 'normal' again - I do remember just being aware as you say, eg when I coughed or laughed too hard! poss more relevant early on but something I did get told was that doing the pelvic floor exercises is great for healing down there as gets the bloodflow going. I was pretty religious about these and apart from one flare up needing antibiotics around 8 weeks post partum, I found it did just gradually get better. I guess there's no time limit on this as it'll vary from person to person but worth checking with your GP if you're worried. I was annoyed nobody checked the healing until I complained about the flare up I mentioned, but was then reassured it was all fine. Still think they should do this at the six week check though!

Just to reassure you - I feel totally normal now and have done for months and months (baby 14 months old). I agree though that there isn't much in the way of preparation for t his - I too thought forceps was just a slightly mroe complicated natural birth - didn't realise the potential complications etc. It can be a little traumatic I think.

[Smiler]

Hiya,

Haven't experienced this, but a friend did and eventually felt 100% better, but it took her a year or so to get back to normal. Think that there are some local services, e.g. follow-up checks at Kings (referral from GP), to help. As a new mum it sometimes feels difficult to ask about your own health, but is likely that GPs etc. will be supportive.

[veryseriousgirl]

I also had an episiotomy (ventouse birth rather than forceps) which broke down and meant I spent a couple of weeks on anti-biotics. My daughter is also four months old and I'm feeling nearly back to normal, but still get the occasional twinge. I've been checked out several times by the GP and Kings who say that it's all healed up as it should be, so I guess it's OK not to be 100%, but I would definitely see your GP if you're at all concerned. My daughter was my first baby and, though I had a lot of pain, it wasn't until I asked the midwife who was planning to discharge me to have a look that I found out that I had a relatively bad breakdown.

[pommie]

I also had an episiotomy after having forceps and ventouse and after quite a few months I felt fine. My daughter is now 19 months old and its like I never had the above done now. I must admit after i first had it done, I couldnt look down there to see if it had healed as was too scared.

[fearnpw1]

You have my sympathy. I had a failed ventouse then forceps delivery which ultimately caused a 3rd degree tear - I didn't even know what one of those was or that it was possible when I went in to have my little one. I had bladder control issues and soreness for a while afterwards but its all healed up now. Completely back to normal so try not to worry! You just have to be patient. But you'll get there eventually.

[Indiana]

I too sympathise. I delivered my baby by forceps and episiotomy 5 months ago and was not at all prepared for the pain and discomfort afterwards. I couldn't walk properly for a good 10 days afterwards due to the bruising and pain, and the stitches came away not long after leaving hospital so the cut had to heal naturally which I found quite distressing..now 5 months on the has healed but like you, it doesn't feel quite right. However, I have noticed improvement week on week and the pelvic floor exercises definitely helped. I went and saw a Gynaecologist last month at Kings which also helped so get yourself a referral. My biggest issue post forceps however has been the anal fissure which then developed. I wouldn;t wish that on anyone - unbelievable pain and after lots of drugs and an operation it has improved slightly but still not normal. looking back I now really wish I had a caesarian as I have had so much trouble...

On the plus side - in response to your comment about not wanting another - a friend of mine had a similar experience with her first but had her second a few months ago and said it was an entirely different experience!

[The Nappy Lady]

Hi there,

Saw something on TV recently where a girl was still in a lot of pain following an episiotomy and the doctors prescribed some sort of cream with oestrogen in it which seemed to help massively after just a few weeks of use.

I'm sorry I can't remember more about it, but this may be worth mentioning/discussing with a doctor.

Molly

[EDmummy]

Poor you. It may take a few more months but it will all feel normal soon! I am surprised about the number of episiotomies mentioned by others here. I had been told by my midwife that it was much better to tear than to cut as the tissue mends better. Two tears, both 3rd degree, and back to normal within a month or so. Was never going to be able to avoid this happening as both babies were whoppers (9lb and 10lb).

[Belle]

edmummy - not sure about others but know in my case the forceps necessitated the episiotomy - baby was stuck so didn't get to the 'tearing' stage if you see what i mean. think often the two go together (forceps/ventouse and episiotomy I mean) though don't know a lot about it. I knew nothing and remember the midwives asking if I'd been to the loo etc with concern but nobody explained t hat it might be a bit fragile etc and i remember being really scared when I figured it out, and not wanting to go to the loo! Also had an Obs tell me I could have laxatives to make it all , ahem, easier, but midwives refused!

[Indiana]

Yes - edmummy - the episiotomy is necessary to allow the forceps when the baby is stuck as Belle said. Unfortunately my fissure was then caused by the midwives not giving me laxatives when I was discharged with a bag of drugs (codeine, dicolofenic etc etc). Not good.

[EDmummy]

To clarify my post, I knew you needed an episiotomy for forceps but both of my ventouse births were delivered without this procedure. I stated clearly each time that I wanted to tear and not be cut and the doctors allowed this to happen. I am so sorry you all had such a bad time.

[born&brED]

Oh wow! Thank you so much, everyone! I feel so much better already, just knowing there are and have been plenty more in the same boat who now feel normal. I will just have to learn to be patient! However, I may mention it to my GP if that's advised. I too was prescribed laxatives and stuff for *ahem* the other end too. Found that so awful while trying to get to grips with feeding and looking after the little blob at the same time.

One thing I did hear at NCT is that atear is better than a cut - this, however, didn't seem to be an option at Kings. I knew I was being 'sewn up' after the birth but it didn't twig til the next morning that it was an episiotomy. Was never explained to me.

Just about to google search what a fissure is :-$ Still learning all these terms!

[born&brED]

EDmummy - I'll obviously need to state that (about not being cut) in my birth plan next time! Good tip

[Fuschia]

b&B, I think a cut IS needed, so the forceps can get to the baby's head

.

I had a second degree tear and a small no of stitches with baby no 1, and it was about a year before I could no longer detect a slightly puckered tender spot.

[ljs]

Hi ladies, with my first child I have a failed ventouse delivery which then resulted in an episiotomy and forceps delivery. I quite clearly remember being cut and it wasn't a pleasant experience at all.... I think I likened it to Edward scissorhands being down below at the time...

I think I felt sort of normal after 5 mths, but I do remember the first few months being just awful.I found lots of long soaks in the bath helped.

It couldn't have put me off too much as I was pregnant with my second child after 6 months and went on to have a drug free natural birth with only a small tear and a few stitches.....

It will get better.

[Indiana]

ljs - wow = thanks for your post = there is hope then that the next one will be different!

[veryseriousgirl]

One thing I did hear at NCT is that atear is better than a cut - this, however, didn't seem to be an option at Kings. I knew I was being 'sewn up' after the birth but it didn't twig til the next morning that it was an episiotomy. Was never explained to me.

I think I learned that ventouse and forceps were automatic episiotomy territory on my NCT course - my husband remembered enough to cover my ears so I didn't hear the snip sound. But ventouse without episiotomy was definitly not offered - must remember to write no episiotomy in my birth plan next time!

[Dulwich Born And Bred]

I had ventouse with episiotomy even though I stated in my birth plan that I would much prefer to tear but alas I did not get any say in anything and thus I was cut. As I had an epidural I naturally didn't feel anything at the time, though I do remember a lot of tugging where he was stitching me and I remember thinking when the drugs wear off I am going to be sore!

Well I WAS sore!!! I did not think in this day and age such a pain was possible and that it just feels so brutal to be stitched up like that. My stitches were tight and I mentioned it was tight to my midwife but they said it looked fine. Off I go home with lots of painkillers and laxatives and I had a horrible 4ish months. My stitches came undone as it was tight, I got a bad infection that meant I had to spend time in hospital with my newborn ( I was breastfeeding) I was given antibiotics via a drip, I had lots of medical people having a peep down there and was told that it was too infected to stitch back together and that it would have to remain an open wound and heal naturally.

I had to go to Kings for check ups, my midwife also kept me on her books longer so she could visit me at home and check my wound.

I found having sea salt baths with lavender/tea tree oil twice a day helped lots, I used an hairdryer to dry down below in order to aid healing so my wound could somehow stick together and heal.

I found that I could NOT sit on the toilet, it was too painful when my urine hit my wound, so I had to wee in the bath with the shower on my wound!!! Ouch ouch but not as ouch as on the loo with urine hitting raw open flesh!! I dried myself after going loo with a hairdryer once I showered the area.

It was virtually impossible to get fresh air to it with the lochia so could do not this.

I did feel robbed of my first few precious months with my son as I was in so much pain that I cried lots, and was completely drugged up, I refused visitors as I was just in too much pain to be able to have company. I could not find a piles ring at the time so was making do with rubber swimming aid rings but these did not help much, and trying to breast feed a baby that had constant growth spurts ( and would feed an hour a time) whilst sitting on an open wound was hell.

I have to say that I had a liquid diet when I came out of hospital and only ate food that would not bulk up, plus I took laxative every day as I was SO scared about going for my first poo, and I have to say that it did not work, it was still painful and horrible! I cried and cried then too! ( I was advised next time to go in the bath as it helps loosened it and make it more easily...don't think that would go down well with family members,,,it was bad enough weeing in the bath!)

7 months on, I have no pains now but I am finding going number two painful but not up for being prodded and poked again as I had so many people doing that at the beginning!

I do my pelvis floor exercises too. All I can say is that time IS a healer. I find it hard to believe that months ago I was in so much pain and so miserable and that it was never going to heal.

edited for spelling errors!

[EDmummy]

veryseriousgirl Wrote:

-------------------------------------------------------

> One thing I did hear at NCT is that atear is

> better than a cut - this, however, didn't seem to

> be an option at Kings. I knew I was being 'sewn

> up' after the birth but it didn't twig til the

> next morning that it was an episiotomy. Was never

> explained to me.

>

> I think I learned that ventouse and forceps were

> automatic episiotomy territory on my NCT course -

> my husband remembered enough to cover my ears so I

> didn't hear the snip sound. But ventouse without

> episiotomy was definitly not offered - must

> remember to write no episiotomy in my birth plan

> next time!

Veryseriousgirl, I was not "offered anything" but demanded not to have an episiotomy for both of my ventouse deliveries. This decision was supported by my midwife. I did not have an opportunity to discuss my choice with the doctors beforehand as both were emergency procedures so as soon as I heard them say they were going to do an episiotomy I shouted my preference for a tear. Maybe things have changed in the last few years.

[born&brED]

Thank you, both ljs and HeidiHi for your encouragement - there IS hope - hooray! HeidiHi, that really sounds horrific - I can't say my experience has been that bad at all. Although I have sat on the loo in tears many times! I also remember that awful tugging sensation as I was stitched up (cannot for the life in me imagine that without pain killers which I've heard some ladies have - honestly, WHY put them through that?). Not sure why I wasn't told there and then that I'd been cut - thought I'd just torn! And how dreadful to then have infection too - I really hope you're feeling much better now!

Think these posts should be published into a book for new mothers -

On the subject of being offered an episiotomy or not, I guess they would never give a choice outright, but a strong will and back-up from a good midwife would probably help, like EDmummy said. That's if you have any strong will left in you - definitely in my case, after 46 hours of labour, I would have said yes to any question on the planet! And because baby's head was stuck, I would have given in to anything the doctors said...

[sillywoman]

poor you born&brED,

you should definitely speak to your GP about the continuing discomfort as it may need checking out to make sure all is healing as it should.

Warning having just re read before I posted - the rest of this post may not be for the faint hearted or anyone who doesn't want to know about tearing or episiotomies in any detail.

Just to clarify re the episiotomy or tear debate. Like all things to do with childbirth there's really not much in the way of 'one solution fits all'. To the best of my knowledge the current situation is as follows; with a ventouse delivery it is possible to request no episiotomy, with a forceps delivery an episiotomy is always done. Contrary to popular opinion an episiotomy isn't usually done to fit the forceps in, or get a big baby out, or make the entrance to the vagina bigger in any way. It's done to direct any severe tearing away from the anus and toward the inner thigh. It's done if it looks like the Mum may be going to tear very badly to help avoid or prevent 'poo' problems later. Hence why some of you were given it as standard and others not.

Yes, if the choice is between a 1st or 2nd degree tear (flesh, or flesh & muscle tissue) or an episiotomy then most experienced midwives would suggest it's better to tear as the delicate perinneal skin heals itself very effectively along its natural fibre lines - so reducing the amount of scar tissue. But if a midwife is recommending an episiotomy then I wouldn't hesitate to go with it. She/he can see what you can't, & it may be that she(he)'s seeing that the baby is coming quickly (as with ventouse or forceps deliveries) so the perinneum doesn't have to time to soften & stretch, meaning you're running the risk of a 3rd or 4th degree tear up to or into the anus. Ooouch. This is one of those situations where I would usually caution my Mums to take the advice offered by the medical professionals. But like everything in life - that's a personal decision & you have to do what you feel is right for you, EDMummy being a classic example of successfully making an 'informed decision'.

Sorry - boring lecture over :-$. I just can't help it. I find all this stuff so interesting. There must be something wrong with me . . . .

[SBryan]

Hi there,

Sorry to hear that you've had a difficult recovery time, but I want to reassure you that, as long as you don't have any other problems eg with your bladder or bowel, then things will eventually feel normal again.

I had a forceps delivery (with episiotomy) 5 months ago, and felt fine from about 6 weeks onwards....... however, my big declaration of interest comes: I'm an obstetrician and gyanaecologist, so I knew all the right things to do in the immediate postnatal period to speed up my recovery.

I think that sometimes this advice is lacking as all the healthcare professionals think the other is supplying it; some hospitals have physiotherapists who do the best job of all. There is also very little information provided in antenatal classes (often none), which is criminal given that over 90% of first time mothers having a vaginal delivery will need some kind of stitches. The most important thing to realise is that having had a vaginal delivery, you are very likely to have another one, and this will probably be uncomplicated, so your first experience is very unlikely to be repeated.

Look away now if you don't like gory detail, but I just wanted to clear up a few misconceptions about episiotomies / tears (although Sillywoman has made some very good points above).

In the old days of patriarchal medicine, every woman used to get an episiotomy in the mistaken belief that the routine use of them would prevent third and fourth degree tears..... this was found to be untrue. Thankfully, the movement went towards natural tearing instead, which is often better as the small tears don't need suturing, which episiotomies always do. However, this is in uncomplicated, normal deliveries, when the baby's head has stretched the perineum over the course of 5-10 mins pushing making the tissues more elastic and the baby's head is in the right position, and coming out on it's own (ie without baby's little hand or elbow alongside it, or a pair of forceps alongside. In second time mothers, the tissues are already more elastic, making tearing less likely. However, if an experienced midwife (and I promise, it will always be someone senior) advise you to have an episiotomy, then it's because they think it's likely to cause LESS trauma than tearing and, although it's up to you, I'd take their advice!

With a forceps delivery, you have to have an episiotomy as the forceps add an additional cm to the diameter of the baby's head, and the baby comes out a lot quicker than a normal birth. Not cutting an episiotomy would cause severe trauma.

With a ventouse delivery, as correctly stated, you don't have to have an episiotomy, but it depends on the circumstances surrounding the ventouse; there are a number of different procedures done for very different reasons and they're not all the same. Generally I will aim to perform them without episiotomies, but will end up with a cut in 40-50%, (rarer in second time mothers) as long as the woman is happy with it .... again because I think it will cause less trauma, and therefore better healing. Some of the worst tears I've seen have been in women who declined an episiotomy when having an instrumental and it's heartbreaking to see the subsequent suffering that might have been avoided. So, again, my advice would be to do whatever your healthcare professional advises at the time, but of course, it's up to you!

And, finally, anyone who's had a baby should do their pelvic floor exercises religiously...... particularly after an instrumental, it will promote healing and prevent long term bladder problems. Right, lecture over.... hope that helps.

[The Nappy Lady]

This is really interesting stuff - thank you SBryan for contributing.

I now realise how mega lucky I was with my first, who despite being born with her hand up by her head left me with just a tiny cut too small to even stitch, and second time I didn't tear at all.

My question is, do you think perineal massage makes a big difference? My Mum swore by it, and I was religious about rubbing oil in down there during the last trimester.

Also, do you think things like the Mamasure (if you have heard of it) help with pelvic floor strength later? This for me has been the worst 'hangover' of two fab natural births. Fine normally but heaven forbid I get a bad cough, so depressing.

Edited to add, my heart goes out to those who have to deal with tears and cuts post birth, it must be so hard. Xx

Molly

[anna_r]

I really don't think there's one best answer. I hope you recover soon born&brED - lots of helpful advice here as usual x