Background
Methods
1. | With which baby did you experience a third or fourth degree perineal tear? Can you tell me about your experience? |
2. | Following the birth, at what stage were you told that you had sustained a third or fourth degree tear? |
3. | Did anyone explain to you how to care for your tear and what treatments you may require in hospital? |
4. | Did you have antibiotics? |
5. | What advice were you given when you were preparing to discharge the hospital? |
6. | Did you see an early childhood nurse/midwife following discharge? Was the third or fourth degree tear spoken about? |
7. | What symptoms did you experience that you feel were due to the tear? |
8. | How did these symptoms affect your ability to care for your baby? Do household chores? Go out? |
9. | How did this experience impact upon your relationship with your partner? How long was it before you felt comfortable to have intercourse? Was it uncomfortable? |
10. | What services did you access/ do you access for support or treatment of these symptoms? |
11. | Next babies: Have you had any more children following the third or fourth degree tear? Were these babies vaginal births or caesarean? Who made the decision to have a vaginal birth/caesarean? Were you given an episiotomy? |
12. | How do you feel about the support you were given in hospital? |
13. | Is there anything you would like health workers to know that might help them when they care for women like you? |
14. | What do you wish you had known? |
15. | How do you see yourself as a person now? |
Results
Name | Age | Ethnicity | ATSI | Number of children | Birth no. SPT | Degree of trauma | Level of education | Model of care | Time since incidence of SPT |
---|---|---|---|---|---|---|---|---|---|
Ava | 32 | Australian | No | 1 | 1 | 3rd | Year 12 | Standard | 1 year |
Sophie | 28 | Australian | No | 1 | 1 | 3rd | Year 12 | Caseload | 18 months |
Matilda | 32 | United Kingdom | No | 3 | 1 | 4th | University Degree | Standard | 7 years |
Annabelle | 33 | Australian | No | 3 | 3 | 3rd | University Degree | Private midwife | 13 months |
Chloe | 32 | Australian | No | 2 | 1 | 3rd | University Degree | Group midwifery | 10 years |
Grace | 39 | Australian | No | 1 | 1 | 3rd | Tafe | Private midwife | 5 months |
Samantha | 34 | Australian | No | 2 | 1 | 3rd | University Degree | Private obstetric | 11 years |
Indie | 35 | Australian | No | 1 | 1 | 3rd | Tafe | Private midwife | 7 weeks |
Poppy | 33 | Australian | No | 2 | 2 | 3rd | University Degree | Standard | 5 years |
Lola | 39 | Canada | No | 3 | 1 +2 | 3rd x 2 fistula | University Degree | Standard | 12 and 10 years |
Scarlett | 43 | United Kingdom | No | 1 | 1 | 3rd | Tafe | Standard | 3 years |
Asha | 37 | Australian | No | 3 | 1 + 3 | 3rd x 2 | University Degree | Private obstetric/Standard | 5 years and 13 weeks |
Average: | 35 | 1.4 |
The abandoned mother
Vulnerable and exposed–“I felt like a piece of meat”
I was left lying–I just felt like a piece of meat lying on the bed… they gave her to me–it felt like two seconds–and they took her away and wrapped her all up and they spent more time with her and my husband than what they did with me. He (husband) was all wrapped up and cosy with her up in the nice ward upstairs and I was left… (Scarlet)
I’m guessing they were midwives, they never actually introduced themselves to me, they just came in and propped my legs up and got the stitch, the needle and thread out, and they had a look, made a couple of attempts and went “the skin just keeps on tearing” and I’ll never forget she, the one woman said to the other, she said “Doctor made this mess, she’ll have to clean it up herself”. And they left me, they didn’t say anything. (Matilda)I’m kind of insignificant in this whole, you know–I remember these conversations going on around me, I don’t remember anyone physically having a conversation with me. (Samantha)
And [the doctor] didn’t really want to talk, she just had this disgusted look on her face when she was doing it. It was horrible … she could have said “look it’s not that bad” or something. There was none of that, she just looked like she was someone who was doing her job and not really enjoying it, like “oh (sighed), I can’t believe I have to do this”. (Ava)
I don’t remember their faces which is weird. Yeah I don’t remember their faces at all. (Matilda)I don't know if it was him or the doctor but someone said, man she's just given birth and she’s just cracking jokes like nobody’s business. I think it was my way of coping as well. (Grace)
“If only they had told me”
I’m really trying to think of what they did on postnatal ward, I’m trying to think when they actually told me it was a third degree tear. Yeah, I don’t think anyone ever volunteered that information. And if they said a third degree I would have said ‘well what’s that?’ you know. Not knowing about the different levels… (Chloe)
…my midwife had been with me the whole time and yep she explained like when it happened that I had torn really badly. And then it was later that day when I was feeling a bit better that my midwife had come back in to check on me as part of the program there and she went through it all with me again, she was really great, she went over it all with me that day.” (Sophie)
The fractured fairytale
You have this fairy tale where you have your baby and you take it home and everything’s wonderful and then you go round and show it off to everybody. For me it was an effort. It was like I’m too Uncomfortable I can’t be bothered going anywhere. (Scarlet)
A broken body
I couldn’t go to the toilet. I couldn’t sit in the car. And I basically couldn’t do anything–I was standing up and I was so tired, I could barely even lie down, it hurt that much that I just couldn’t think of anything else. (Matilda)
I mean I couldn’t even sit properly on the lounge. I couldn’t get on the floor and do things with him, like I couldn’t sit on the floor and change a nappy. (Poppy)
I think people need to know that birth isn’t this pretty picture. It isn’t the Home and Away birth of three pushes and you’re out and you’re up and you’re glamorous the next five seconds. (Asha)
Achieving a vaginal birth
And I’m glad I had the experience, I’m glad I had a vaginal birth, I’m glad I didn’t end up in going for a caesarean, I’m glad I birthed him through my own vagina. I can say that even though all of that happened, I did it. And it was horrible in the moment but I can say now that even with all of that I was strong enough. (Matilda)I guess it was a badge of honour (having a vaginal birth after a caesarean). I had a third degree tear, but I did it. So psychologically that’s how I dealt with it. And I probably, looking back on it now, didn’t give it as much acknowledgement as I should have…’cause yeah, I still tried to do everything as I normally would. (Poppy)
The contaminated uncontrolled body
Like when you’re a kid if you pooh your pants, there’s this kind of stigma that you’re dirty and lazy. And even when you’re an adult every time it happened I was just like–oh this is filthy, I’m in my twenties and I can’t control myself. I didn’t want to talk to anybody about it, I didn’t even want to talk to the doctor about it. (Matilda)
I remember when I was being sutured I had wind and I was like oh my god. But I think in that first couple of days maybe once didn’t make it to the toilet–urinary. But I didn’t dare tell anyone because how embarrassing… (Poppy)
Like with (my first baby), despite the postnatal depression I was quite happy to go out and do things, all of a sudden I didn’t go ‘cause it was all a bit too hard. ‘Cause what if (my toddler) falls asleep in the car and I can’t pick him up? So yeah maybe I did feel a bit isolated–‘cause I did start to develop postnatal depression when (the baby) was about seven months old… (Poppy)
They lived happily ever after
It’s almost like trying to do it for the first time…and I’m almost in tears because I’m so scared. He’s so patient but he does go, maybe tonight we can try and I’m like sure. I was so anxious about it–I made myself really sick. I get migraines and I gave myself a massive migraine–the worst and I was vomiting. How classy is that? I’m like all this because I’m thinking I want to have sex. (Grace)
I used to joke–I used to have to have pain relief to have sex, so you know a couple of panadeine, or something stronger if I could find it–nurofen plus was good (laughs). Isn’t it terrible? I mean it’s easier now, I don’t usually take it now before, but after. (Poppy)
Six weeks without sex that’s the little magic number you hear, but to still be eighteen months down the track and it’s very rare that we can achieve intercourse… so it certainly has impacted on our relationship because you know he thought things would be back to normal by now. (Sophie)
I do remember having sex a few times and going, I really need to go and being actually really worried about it, and wanting to finish asap and then just I have to go the toilet quickly. Going in and going oh phew, thank God nothing happened, nothing came out. (Lola)
I think he would probably understand that it’s a sensitive thing. I think that if I had to have surgery I think he’d probably be really sad that I’ve hidden it. Not that I can’t tell him I just don’t really want to right now. Because I’m walking around normally and everything seems quite normal, I don’t think I need to rock that boat. (Lola)
A completely different normal
I mean at this point I can still cope with it. I’m scared that if they go in there and do something that they might mess it up and make it worse. It doesn’t impact on my life 90 per cent of the time. That other 10 per cent it does, but I can make adjustments to my life to compensate for that. (Lola)
I don’t find it a traumatic thing, now. It’s just what happened. Can’t change it, and really okay I’ve complained about it and figured out well that’s not really doing much and here you go try this tablet, here you go try this cream, but is it just a shut up mechanism? Bandaid affect, that’s how I feel about it. You know what? If these doctors that I’ve spoken to, and they’ve got no answer, then there’s obviously no answer. So deal with it. (Poppy)
Defining a new sense of self
Because I’ve kind of compartmentalised that point in my life as my experience of birth. I’m just of the opinion that you just have to draw a line in the sand sometimes and just say I can choose to look at it negatively or I can choose to look at it positively and see what came out of it. (Matilda)
Time went on and I just kind of changed a few things, like stopped wearing G-strings and carried wipes and spare undies around. I just adapted my lifestyle to it. (Lola)
No I don’t think that my body has let me down. I think it’s just happened. I think it’s probably just bad luck and these things happen. My babies were not that big. It’s a pretty small hole. I’m not surprised. (Lola)
… because in a heartbeat I’d do it all again, because she’s my world, but yeah I guess it does make me really sort of upset, I felt I did everything right, but then my body didn’t follow through with what should happen. (Sophie)I don’t think I’m as confident probably in certain areas. Like I’m always aware of it. I never forget about it. It gets me down sometimes. I just think why can’t everything have just gone normally and healed up. Then on the other hand at least I’m not leaking all the time. It sucks. (Lola)