--by Rachel Brinker
I am so sorry this happened to you.
I am so sorry you have to deal with this.
Fourth degree tears are rare, but I am in this club with you. In 2013 I birthed a ten-pound baby and ended up with a deep fourth degree tear. I also lost a lot of blood and blacked out. I had a blood transfusion and didn't get to hold my baby until seven hours after the birth. It was scary.
But I'm ok now.
Recovering from a fourth degree tear is not fun, but it's different for every person. May your recovery be speedy and complete. May you have the support you need so that you are able to rest fully in the first weeks postpartum and allow your body the space and time to do the healing it needs to.
In hopes that you will be comforted in knowing that there are other women out there who have gone through this, I offer some observations from my own experience:
It WILL NOT feel like this forever, but you really do need to rest and let yourself heal. The pelvic floor is so important for your continued lifelong health and wellbeing--don't overdo it right now. There will be time to "get back to normal." Really limiting your movement and activity is the right thing to do for now.
Bearing weight with a compromised pelvic floor is not a good idea. Try to limit this as much as possible for the first forty days or so. I made the mistake of being too active too early (going to the Farmer's Market at three weeks postpartum and walking around for more than an hour, and carrying my baby in his car seat just two weeks postpartum--too much weight! I also felt a compulsion to vacuum sometime in those first few weeks--even that was too much.) I would think that I could do something, but then it only took a few minutes for painful pressure to build up, my body's cue to back off from doing so much.
My doctor advised me to hold off from doing Kegels for six weeks. They also mentioned to not sit cross legged for a few weeks. But there are some simple and gentle movements that will be really helpful for your core/pelvic floor stability and reconnecting with your body "down there." Sliding one heel as a time away from you while you are in bed while focusing on keeping your pelvis stable is a great place to start. Go slow.
There are people who specialize in pelvic floor physical therapy, which can greatly improve your healing and your pelvic floor health. If I were going to recommend just one thing to you, it would be to get a referral to a pelvic floor or women's health physical therapist and begin seeing them as soon as your provider recommends (usually six weeks postpartum). You may also be at an increased risk for developing pelvic organ prolapse issues, so if you are dealing with any kind of incontinence or pelvic pain/pressure after six to twelve weeks, please seek help. You do not need to suffer with pelvic pain.
Itching will be a normal part of healing and the stitches dissolving. Bothersome, but normal.
Did you have a lot of blood loss from the birth? If you feel like it might be a factor for you, ask your doctor about having your iron levels checked, whether or not you had a blood transfusion. Low iron levels can contribute to fatigue, slows your body's ability to heal, and leaves you with less reserves, mentally and physically. You have a lot of healing to do, plus you have a little baby to take care of, so make sure your healthcare provider is looking carefully at any nutritional deficiencies you might have.
The first poop. It sucks. You will get through it and it will get better. Make sure that your doctor/provider talked to you about whether or not taking stool softeners are right for you. If you have to take iron supplements, make sure you maintain your stool softener use. and ask your provider if you need to increase your dose when taking iron, because iron can contribute to constipation and harder stools--something you definitely want to avoid.
Because you have such a major injury to deal with on top of everything else that comes with new motherhood and childbirth recovery, doing everything you can to care for your mental health is a good idea. Anything that can reduce inflammation in your body will also help with both mental health and healing your injury. Mood issues don't just end at feeling "depressed" after birth. There are many other mental health struggles that new moms commonly deal with, and are treatable. Having a traumatic experience as part of your birth experience can increase your risk for mental health issues. These are conditions just like breaking your arm, in that it is not your fault, it has nothing to do with you being a good mom/good person, and you deserve proper medical treatment. Check in with your provider if you are having trouble sleeping, eating, feeling really irritable, or having scary or intrusive thoughts.
And check out these great online resources:
New Mom Mental Health Checklist
Postpartum Progress International
Postpartum Support International
Have you found a comfortable nursing/feeding position? I found a side-lying position to be the most comfortable, and when sitting up, I found I needed to sit on the side of my hips with me legs curled up under one side as it was too much pressure to sit directly on my perineum. Nursing takes up a lot of hours, and just the act of sitting puts a lot of pressure your injury. Prop yourself and the baby in whatever position is most comfortable for you. Ask for help with this. Gentle stretching of your shoulders and upper spine can help ease the tension you'll likely develop from "holding" yourself up away from your perineum when you're sitting and nursing. Another thing that will help ease the pressure is trying to breathe with your ribcage as much as possible, rather than doing big belly breaths (belly breathing pulls your diaphragm way down into your abdominal cavity and puts extra pressure on your perineum. Side stretches can help get more space between each rib-- this will make breathing easier. Think about inhaling into your middle back and into your side-ribs, rather than into your belly.
Again, I am so sorry to hear that this happened to you. Every woman's experience is different, but I do understand some of what you are going through. If your experiences from birth feel traumatic, find someone you can talk to about it, either in person or online. There are so many things about postpartum recovery that our culture doesn't talk about, but I firmly believe that talking and sharing our experiences is powerful and healing. Don't hesitate to reach out. :)
All the best,