In Episode 11 of the Maternity Sewing Podcast, Erin talks to Dr. Hannah about recovering from the common obstetric complication of perineal tears.
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You can find Hannah on Instagram as theemptyuterus. Her account is focused on women’s sexual and reproductive health (and is actually super fun and funny and informative all at the same time!). Hannah was also our guest on Episode 2 where she talked to Erin about postnatal contraceptive options.
For more information on the pelvic floor, Hannah recommends: Continence Foundation of Australia, Pelvic Floor First, The Royal Women’s Hospital, Department of Health. In Australia, you can look here to find yourself a pelvic floor physiotherapist.
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Transcript:[0:11] Welcome to episode 11 of the maternity sewing podcast. Maternity sewing.com is your source for maternity nursing and postpartum friendly sewing patterns. The maternity sewing podcast is we we have frank conversations, share stories, and offer help and inspiration on things like sewing and body positivity, especially during pregnancy and postpartum. [0:32] Hi I’m Erin Weisbart. Today I’m talking with Hannah, a sewist and Senior resident medical officer in Obstetrics & Gynecology. She’s going to talk to us about recovery from obstetric complications, specifically the really common delivery complication of perineal tears. For those of you with family members around, we are discussing medical aspects of pregnancy so if that’s not something you want those around you to, listen to now’s a good time to skip to another episode. [1:02] Hi Hannah. Hi Erin. Yeah so I’ll just introduce myself quickly. As you said I’m a senior resident medical officer In Obstetrics & Gynecology so lots of my work is with women who have suffered unfortunate with some unforeseen complications in their antenatal period or having their baby. So yeah I work in public hospitals over in Australia so I see lots of this stuff. [1:27] So yeah thanks for having me on. Thanks for being here. So what do you mean by obstetric complications? So obstetric complications is a really really broad topic because, I guess from my point of view we consider, you know, things in the antenatal period such as gestational diabetes, preeclampsia, gestational hypertension, all those sort of things that we pick up antenatally, as complications And then there’s also intrapartum complications that we think about. So that can be you know requiring an assisted delivery with forceps or vacuum, emergency cesarean, ruptured uterus, there’s lots and lots of different things that we consider complications. And then in the early postpartum period, things like hemorrhage, retained placenta, and then even along to things like postnatal depression or psychosis come into it as well. So yeah it is a really broad topic. But I guess one of the really common things that we say that women need lots of education about is perineal tears or episiotomy recovery and also cesarean section recovery. They’re probably two of the most common that I deal with on a day-to-day basis. [2:42] Okay and so how likely I mean I know I’m sure this varies, so it’s hard to hard to put it, but you know how likely are tears to happen? I guess I have a bit of a. [3:00] Because I work in a hospital with lots of high-risk women, so you know whether it’s because their weight is high or they have bigger babies or diabetes that sort of stuff, I probably see a lot more of
that sort of thing than is reflective of the population in general. So I don’t have a good percentage. No comment on how common that is, sorry. I guess I see them they happen everyday basically. So I guess it’s a major part of your everyday life and and something that you know a woman should be not necessarily [3:38] scared of happening because it’s it sounds like such a common thing that you’re familiar with it and there to support women through it? Exactly. And I think lots of women hear horror stories about other people having horrible tears and think it’s only the worst of the worst situations when it happens but it’s actually so common. And then I think a big part of it is that we recognize them more now and we we recognize the complications of them down the tracks so we’re more proactive now about fixing the tears and really assessing them and making sure they don’t need fixing in theatre or help from the colorectal surgeon things like that. We’re a lot more cautious now than we used to be just because we know about those long-term complications that can happen. [4:26] So you mentioned colorectal surgeon. What other people might be involved in helping a woman recover from something like a tear and I guess along with that question, it sounds like if you’re bringing in a surgeon that would be a pretty major tear you’d be healing from? Are there you know much smaller tears as well? Is this a spectrum? Yeah there definitely is and we grade them from
sort of 1 to 4. So there are lots of different types of tears and some of them are really straightforward and easy to repair just in the birth suite room right after you’ve had your baby. They become a little bit more complicated if they tear down to the muscle in the bottom that helps you control when you open your bowels and things like that so we really need to make sure that those ones are [5:22] sort of repaired correctly and really well. It is far more rare to require help from people like colorectal surgeons but it is one of the things that we consider with the more severe tears. I don’t want to scare women off with that certain conversation but the large majority are quite easy and straightforward to repair. I guess in terms of who else is involved with the recovery, the midwives are really
essential in those first few days after you have your baby and have a tear because they help you a lot with wound education and you know how to look after a tear that’s hard to see and hard to look after. A really important I guess other group is the physiotherapists because there’s a lot of implications for continence and things like that with perineal tears. It’s really good to link women in with a physiotherapist before they leave hospital if it’s the 3rd or 4th degree tear. Those more severe end of the spectrum tears we also ask them to say see physio as an outpatient just to make sure that they’re doing pelvic floor exercises regularly and yeah recovering well. [6:41] And so it sounds like you have a whole team there that can be involved if it’s something more extreme and and needing more intervention but an average woman experiencing you know would probably be experiencing a minor tear and it wouldn’t be something that you need to be scared of. It would just be something you just make sure you keep an eye on. Exactly and I think one of the really good things to do because it is, like I said it’s an awkward place to have it an injury, I guess because you can’t see it and you’ve never had an injury there before and you don’t really know what’s normal and most women don’t look at their vulva anyway. [7:24] I always tell women and not everyone is comfortable doing this but it’s a really good idea after you’ve had a tear and it’s being repaired to have a look at it with a mirror. Some women feel really uncomfortable doing that because obviously they’ve just had a baby and I think it all looks really awful but I think it’s really helpful because if you know what the tear looks like you know if something changes and it’s getting worse, if it’s not healing well. Because some women if [7:53] If I think they’re starting to have complications like maybe an infection or you know it’s just not healing together well, that’s when they will have a look at it and that’ll freak them out out cuz they haven’t seen it before. So a lot of the time we review a really well healing tear but they just get really freaked out because it all looks really new because they have never really looked at their vulva even before the tear. So speaking personally, I had some tearing when I had my daughter because her birth was so fast. I had a precipitous birth and she was actually born in the front seat of the car, we didn’t even make it to the hospital. So I didn’t have any assistance from the midwife to help ease her out and so I had some tearing. And you know I remember I actually remember getting the same advice you know look in a mirror and keep an eye on it right now and then you can see as it heals and as it changes and you can make sure that it’s [8:54] You know so you have a baseline. And that’s great advice but personally I remember looking at being like I don’t even recognize myself down there after having just given birth for you know everything is swollen and bruised and so it certainly was a little bit scary looking even when even when I had just been told by the midwife you know “I just looked there everything is fine” and then I look and I’m like “Aaah what’s going on?!” So I think that’s great advice and certainly something. [9:30] Yeah certainly something I was glad that I had been told. It’s really terrifying if you look later on on a day that you’ve not been reassured by health professional that it’s normal. It can be really stressful. So where else could a woman get more information about recovery from I guess obstetric complications in general but it specifically you know we’ve been talking about tearing. Where else what other resources could a women get besides this quick introduction we have here in this podcast? So hopefully if you’ve had a tear before going home you’ll get I know here in New South Wales we we like to give lots of written information for women to refer to. I don’t actually know of many good online resources specifically about perineal tears, but there’s lots of good websites about pelvic floor in general that sort of show [10:34] women how to exercise the pelvic floor to help with that recovery. And then in terms of the I guess recovery from the wound itself, a GP is always a good place to start. Here in Australia we are always happy to review our postnatal women up until that 6-week mark. We always get them to come back to us if there’s any complications with the wound itself because we would rather know and be able to address it if there were any concerns. [11:04] Great. Well thank you so much for sharing your expertise and we really appreciated talking to you today. Thank you it’s been fun. Thanks Hannah, bye. That’s it for today’s episode of maternity sewing podcast. You can find maternity sewing at maternity sewing.com. You’ll find are curated pattern shop of maternity, nursing, and postpartum friendly sewing patterns, our blog where we have sewing tutorials and inspiration for pregnant, nursing, and postpartum sewists, and the show notes from all of our podcasts. I’m Erin Weisbart, your host today and co-owner of maternity sewing. You can find me at Tuesday stitches.com and on Instagram as Tuesday stitches. Today I talked with Hannah. You can find her on Instagram as the empty uterus, an account focused on women’s sexual and reproductive health. Hannah was also our guest on episode 2 where we talked all about postnatal contraception, what some of your options are, and what things you need to consider specifically in the postnatal period. Check that episode out too. You can look at our show notes and on our website and maternity sign.com/podcast for links to everything we talked about as well as all the ways you can stay in touch with maternity sewing like our Facebook page and Facebook group. You can also find us on Instagram as maternity sewing.