Ellie’s experience of a 3b tear

Trigger Warning: Induction, Ventouse Delivery, Episiotomy, 3b Tear, Secondary Postpartum Haemorrhage, Hysteroscopy, D & C, Fissure

I had what I thought to be a low-risk pregnancy until 35 weeks gestation when my foot slipped on the tiles in the bathroom and my baby bump hit the basin. I didn’t think much of it but I called the Maternity Unit and they told me to come in for some monitoring and tests and it turned out the fall had caused baby James’ blood to get into my blood and this scored me an induction at 39 weeks.

At 39 weeks I had an induction with the balloon in the evening and was so excited the next day to have my baby but when they checked my cervix it was shut for business so I went home a bit sad and felt like my body had failed. I wish someone had told me that the balloon induction doesn’t always successfully dilate the cervix. Then at 4 pm I returned to the hospital and had the Cervidil inserted and was told I may experience some cramping overnight. I wasn’t really cramping much so at that point I was expecting the Cervidil may also not dilate my cervix.

Then at 7 pm I started cramping and at 8 pm asked for Temazepam to get some sleep. The cramps were getting pretty intense so I asked for some Panadeine Forte and the midwife said to let us know if the pain gets worse “… we don’t want you to have your baby on the ward”. The cramps were actually contractions, lasting 1 minute and coming every 2-3 minutes. I was transferred to Birth Suite at 10 pm and the Midwife said she could feel a head. This was an absolute whirlwind for my mind as only that day my body had not dilated with the balloon and the cervix was very much shut at 4 pm and I had also had Temazepam on board.

My response to the pain was to move and make some noise …. I just could not sit still…I felt a bit out of control. I got to 10 cm well but remember pushing for hours and begging for help and some hope. The obstetrician came in, up into stirrups I went, in/out urinary catheter, episiotomy and 4-5 pulls later on the ventouse and James was born with a large head hematoma and some skin missing on his head. Then the placenta was delivered fairly easily.

I was on cloud nine, so happy in the moment and high on love and oxytocin. I was informed I had torn and they would take me to theatre to get repaired (in my head… I was like no biggie, quite normal to hear women tearing from childbirth).

I asked the midwife if I could see my placenta as I had been told I had a marginal cord insertion on a third-trimester ultrasound and also I had a history of reduced fetal movements and some of James’s blood had gotten into mine. The midwife said she would make the placenta all pretty and then show me. For whatever reason, I never got to see my placenta and I understand maybe it was just a lapse in memory and or because I was in theatre getting repaired and missed my chance to see it but I really struggle that I never got to see it as it was actually found to be a rare Velamentouse Cord Insertion.

After the repair was completed I remember the obstetrician saying something briefly about me maybe experiencing some faecal incontinence and something about a 3b tear … again I was naive and like yeah yeah in my head when can I see my baby and a 3b tear meant nothing to me at that stage. I remember being mortified when I spontaneously farted on the Postnatal Ward and could not feel it coming.

Once the urinary catheter came out I was very incontinent of urine and that was hard trying to hide and manage it and still to this day my mother, partner and other close people don’t know the extent of that and although 1 year on it has majorly improved through physio, I still continue to suffer from urinary incontinence. I managed to open my bowels fairly ok at 2 days postpartum and since then I have bowel urgency but have thankfully only had a few incidences of a small amount of faecal incontinence.

At 5 days postpartum I experienced a large amount of rectal bleeding. My GP thought I would need a query another repair and the Maternity Unit said I would have to attend the Emergency Department (ED) to get reviewed and this distressed me greatly as I didn’t want to bring my unvaccinated baby into the ED. I got reviewed by the ED and the rectal bleeding eventually ceased.

At 10 days postpartum I had a secondary postpartum haemorrhage at home and was distressed and once again left my baby with my partner and attended the ED to get reviewed. An outpatient ultrasound showed I had retained products. The OBGYN team was so busy that I never got followed up and I had to keep calling them until finally, I went into the Birth Suite to get reviewed.

I had a D & C for the retained products at 2 weeks postpartum and I went home. I continued to have vaginal bleeding on and off and at 2.5 months postpartum I had a hysteroscopy and a small something removed from the uterus and my cervix was nicked and required a suture. I also had a fissure, which caused ongoing bleeding and discomfort that healed with the use of Metamucil by approx 6 months.

I could write a book on my traumatic experience and the above is a very condensed version. I am one year postpartum and was told a high percentage of women will be symptom-free from the 3b tear by now and I am not one of those women. The main things I find traumatic about my experience are that I have consented and undergone 26 examinations in my vaginal/rectal area since childbirth a year ago, including an endoanal ultrasound.

I had to really advocate for myself to get followed up and debriefed with. Leaving my baby for the procedures and reviews was very distressing for me. I worry my uterus and cervix may have scarring from the D and C / hysteroscopy, which could affect my future fertility. My entire life has changed r.e. managing incontinence and unable to have the same control over my bowels that I had prior to childbirth and I manage this with physio, Metamucil and specialist input. I have some postnatal depression and anxiety, which is managed with Sertraline and ongoing counselling.

Not a day has gone by where I don’t think about my birth and postnatal experience. I love James so much and I am so grateful to have him in my life, but my birth trauma has definitely had an impact on my start to motherhood and any future pregnancies and deliveries I may have.

Thank you for reading my story and thank you to the Australian Birth Trauma Association for their ongoing awareness, health professional education, and support for women and their families affected by birth trauma.

Ellie