Autoethnography and Severe Perineal Trauma

An Unexpected Journey From Disembodiment to Embodiment

Holly S. Priddis

Disclosures

BMC Womens Health. 2015;15(88) 

In This Article

My Story

My First Baby

My first baby arrived when I when I was 19. Now, 20 years later, I am unable to recall every part of my son's labour and birth. I remember feeling overwhelmed and alone, even though my family were in the room, and requesting pain relief. I remember pushing on my left side, one midwife holding my leg in the air and the other midwife saying "You are tearing, we need to cut you". I didn't feel the episiotomy; following this my son was born, not breathing. I remember bells and alarms and a resuscitation, and after a scary amount of time he was brought to me, my 7 lb 1 oz wrinkly little boy. And then I remember the suturing by a doctor I did not know. It was so incredibly painful, and frightening. And even with the sleepless nights, the cracked nipples and mastitis, what I most vividly recall is the suturing.

The women in this study described that feelings such as vulnerability, discomfort and fear were directly related to the way in which they were cared for by their midwife, obstetrician, and the health professional undertaking the repair. Women described these interactions as often inappropriate, recalling the facial expressions and the way health professionals often did not communicate directly to the women but discussed her perineum between themselves:

"And [the doctor] didn't really want to talk while she was suturing, she just had this disgusted look on her face when she was doing it. It was horrible, it wasn't nice…" (Ava)(, [35] p. 4).

My Second Baby

When I became pregnant with baby number two, 5 years later, those memories were still fresh and raw. It was important to me that those experiences weren't repeated, that my baby was born safely, that my body was supported to give birth without trauma. I found a midwife in a birth centre that I connected with, who provided the care that I needed. I carry her name forever in my heart, and she ultimately became one of the core reasons I became a midwife. Following a long labour when I reached second stage, I had an overwhelming urge to push and an instant relief. My 9 lb 5 oz daughter was born following a 9 min second stage.

I didn't feel the tear. After some skin to skin, attempts at breastfeeding and bleeding that would not settle, my midwife examined me and looked concerned. She bought a doctor in who did a second examination and then explained to me that I had a 4th degree tear, down to and through my anal sphincter. I was shocked. I was then taken to a treatment room. I left my new daughter with my husband, and multiple injections of lignocaine and excruciating pain later, had the fourth degree tear of my perineum sutured. What got me through this experience was the most beautiful student midwife who came in with me, held my hand, and murmured comforting words to me while I cried in pain.

Women may experience fear around the anticipation of pain during the suturing process, the damage sustained to their perineum, and that they may be sutured incorrectly resulting in further perineal damage.[7,43] For some women, they described how they also experienced pain during the process of perineal assessment and suturing:

"…there was a doctor that came and had a look. She was quite rough, I thought. She was really poking and shoving gauze in there. I was screaming my head off. It was really awful." (Indie)

I went back to the hospital two weeks after my daughter was born. I remember discussing my breastfeeding issues, but nothing else. I had my 6 week check up with my GP, who read my notes, put his finger into my anus—remarked that it felt fine, and I was sent home.

In this study, women described the value of receiving comprehensive information and compassionate care following the birth, however these appear to be lacking in the current system.[7,35]

"I think [the doctor] could have definitely told me who to call if I had any problems. I wasn't given any numbers or information or anything. Maybe just some recovery tips, or I think they could have told me what happened. I think the system let me down, I think it did. I'd like to think that other women who go through this have a lot more support…" (Lola).

My Leaking Body

Three months after my daughters' birth I had a dentist appointment. I remember parking the car, going up the escalator into the shopping centre where the dental rooms were. I was walking along when I felt something run down my legs. I quickly ran to the toilet, thinking perhaps I had gotten my first period. But I was horrified to see that I had become incontinent for faeces. I remember sitting in the toilet, crying, wondering what on earth to do. I threw my underpants out, and I tried to clean myself, luckily I had nappy wipes in my handbag and I used those to clean myself the best I could. Once I composed myself I went into a chemist and used one of their sample perfumes to spray myself, I was completely paranoid that I smelt of faeces. I still had to go to the dentist appointment but the whole time I lay there praying that I didn't smell and that no more would run out. I have never forgotten that day, or the absolute disgust that I felt with myself that I had no bowel control.

'A leaking body' is described in the literature as immature;[44,45] this link was reflected in the words of women who described uncontrollable bodily functions, particularly faecal incontinence, as being dirty like a toddler, or a naughty child.[35,46] Studies also report the efforts women make to conceal body functions, including menstruation, urinary and faecal incontinence, to conform to cultural and societal norms.[47]

"…part of me thought '[my best friend] will judge me if I tell her that I'm poohing my pants'. Not that I think she would've thought any less of me, I'm sure there would have been sympathy, but I thought it was disgusting so I didn't want anybody else to judge me for that…" (Matilda)

Over time I developed strategies for dealing with the episodes of faecal incontinence. I always had spare underpants and nappy wipes in the baby bag that I carried with me. I drank minimal amounts of water, I found being constipated an easy way to manage bowel control. I saw my GP but he just suggested doing more pelvic floor exercises, but with minimal control over my pelvic floor I struggled to do more than two at any given time.

In my study women described how they were required to manage their daily living activities, such as sporting activities and recreational outings, as they risked experiencing an unexpected episode of urinary or faecal incontinence. Management strategies include avoidance, or limiting activities and outings to places where there were easily accessibly toilet facilities.[7,10,48] Further management strategies that women have reported include the style of underwear and clothing that they were required to wear to camouflage the use of incontinence pads, and to avoid further irritation of the perineum and associated pain.[7,10]

"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) [35]

More Babies and More Symptoms

Over the next two and a half years I had two more children by caesarean section. Each pregnancy made my symptoms worse. Throughout my fourth pregnancy my perineum felt heavy, weak and the inability to complete bowel movements occurred with every trip to the toilet due to a lack of control that remained of the anal sphincter muscles. Now a mother of four, I was becoming nervous about leaving the house following the memory of the trip to the dentist all those year ago, and the fear of being incontinent. But I put up with it. I looked after my babies, commenced my midwifery training, and did all the things mothers do. After attempts at repairing the damage through surgery, then developing a temporary fistula as a co-morbidity, to this day 14 years after my fourth degree tear, I have ongoing incontinence of flatus, and difficulty holding onto faeces for any length of time. I experience pain in my perineum and anal sphincter.

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