we had our baby this morning

So many hugs to you and your precious baby son! Please rest now, Alemama. You are one amazing mama. Lots of love, Christine

huge huge congrats on the arrival of you new angel.
please rest and enjoy your babymoon, and think of us much much later... we'd love to hear your story, but we are very happy to wait whilst you enjoy your family and look after yourself.

How wonderful a new baby to love and enjoy. Best wishes.
Flora

Congratulations!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Congratulations on your new little angel! Best wishes to you and your family.

Goldfinch

Congratulations on your new bundle! Get some rest! You deserve it!

Mellie

What wonderful news! I hope everyone is happy and healthy. I wish for you an excellent sleeper so you can get some rest!..........Like Kiki said, we'd love to hear your prolapse perspective, but we can wait until you are nicely settled.....Happy snuggling!

A new baby to love! Congratulations to all of you!!!

~Mae

Oh wonderful news. You were right. You were very close, after all. Looking forward to hearing all about your labour and his birthing. Enjoy the babymoon. I am so happy for you. Hope the POPs are behaving.

Love from Louise

Deep congratulations! Enjoy that baby and get some well-deserved rest!

Blessings and joy for a smooth transition for you all!

Love, Marie

I hope you are enjoying this precious time with your little one!

Glad you and the little one are doing ok. I will be interested to hear how labor and delivery went. Take care, Connie

congrats to you and your family! and welcome to the world, little boy!
so sweet : )

can't wait to hear the birth story and all his stats. take good care of yourself, mama, rest up and enjoy your babies

Bless your heart, Alemama. I know you are in good hands and that you know your body well. You will likely need strong antiseptic care - yes? Please make sure an expert evaluates your wound for possible treatment. I don’t know that the Odent quote about keeping legs together was referring to anything greater than superficial perineal tears.

Your little one sounds amazing and I’m glad to hear he is nursing heartily. I’m thinking of all his siblings gathered around mama and baby-brother, wide-eyed at the wonder of life’s mysteries. So, so sweet...

So sorry Alemama. You know you'll be in our thoughts and prayers. Please keep us posted.

Hugs,
~Mae

Bless you dear, strong, brave Alemama. You will heal through this. Love and prayers, Christine

you are one awesome mama
that sounds like a tough delivery and you sound like you had it so together.
my biggest baby (number two) was also 8 lb 1 oz, also posterior, and also got stuck (not shoulders, but on a cervical lip). I'm pretty sure that's when I did most of my tearing too.

I hope you heal well. sending lots of {{{{{hugs}}}}} and healing vibes your way.

and he sounds perfectly perfect :)
I'm sure you'll fatten him up in no time at all.

sending you lots of healing vibes alemama. This will all be over soon.

(unsolicited advice follows...please ignore if you are overwhelmed with it!)

according to wonderful advice i got post birth with tears, essential oils of cypress (promotes new skin cells and prevents scarring), frankincense (healing and prevent scars), and lavender in the bath help healing. when i started using them it was a turning point, and perhaps might help to speed up your healing after the repair (along with Arnica, which is also good for emotional shock).

i'll be thinking of you and wishing that you are back home with your family very very quickly.

Kiki

I'll be praying for ya Alemama, and will put you into our prayer circle for healing and a good longterm outcome. S*** happens. Stay calm. You just do what you have to do and take one day and one challenge at a time. Baby steps. So glad the little guy is so lovely. How could he be anything else.

Isn't it just amazing when they open their eyes in the semi-dark for a secret peek at the world outside of the womb? He is so lucky to have you as his Mum.

Love from Louise

Saw you signed on a couple of times today and I know you'll fill us in when you can. Just know how anxiously we await news of your well being. Also sending warm and snuggly vibes to your littlest darling! C.

I'm glad to hear that you are healing as well as possible. From my limited knowledge of you through your posts, I think you must have a wealth of "money in the bank" when it comes to your potential to come through this just fine -- of all people, you have set your body up for success in this with your healthy lifestyle and other choices. I hope I don't sound too weird or pervy here, but you are a bit of a hero to me, and I'm cheering you on. Best wishes!

I was delighted to read your post! You have been in my thoughts (and in a lot of others I know) a lot lately. Every time I sign on I look for a post from you like this one.

I pray you will continue to get better quickly. I am sure you are anxious to get your life back to normal. Thank goodness you are able to get the rest you need to help with the healing.

I hope you feel good enough to be enjoying your precious new one! We'll look forward to hearing from you again soon.

Sending lots of {{{hugs}}} and good vibes your way!

~Mae

i have been keeping you in my thoughts and prayers....congratulations on the birth of your new baby. Im hoping for you to have lots of healing in the coming months.
~Amanda

Who, but you, would think to plaster seaweed on your bum? Brilliant! No doubt the microminerals are aiding in your spectacular recovery. I'm living proof that with a decent anal sphincter you can live well with Very little perineum. Was so-o-o-o worried when it looked like yours was compromised - but this latest news is hopeful indeed. Be careful with promises of a "new" perineum, a concept that remains pretty elusive.

I was wondering if perineoplasty (or colpoperineoplasty - the word I found for plasty of both perineum and vagina), which Alemama mentioned, is really so easy to do as the doctors tend to describe it? I cannot really imagine how this can be done without cystocele/rectocele repair in case a woman has a prolapse. Christine, could you please enlighten me? Oh, just to make things clear - I don't consider the surgery, I'm just curious.

Alemama, I'm so happy to hear you are getting better.

Hi Karolka,

An intact perineum is the most important aspect of pelvic organ support. You can correct posture and breathing, but an inadequate perineum is directly related to difficult-to-reverse pseudorectocele and stress urinary incontinence. I say pseudorectocele because the lowest aspect of the rectum might not have blown forward if its major support structure hadn’t disappeared. Doctors can tell the difference because pseudorectocele is characterized by normal rectal caliber, angulation and tone, whereas actual rectocele has lost those qualities. They rarely make the distinction though, because episiotomy has remained basically uncommented upon by ob/gyn/urogyn.

When an episiotomy or large tear occurs at the midline, the muscles that surround the vaginal opening (yes, we have a vaginal sphincter and it is very important) retract laterally. These transverse perinei and bulbocavernosus muscles are the ones that are referred to when doctors talk about repairing a epi/tear “completely”. The goal is to locate these retracted muscles and bring them back together at the midline. The problem is the nerves supplying the muscles have also been severed and further nerve damage can result from stitches placed into the “belly” of these muscles. These repairs may (or may not) be good for several years, but many of us experience over time the disintegration of all muscle at the midline and are left with only a bit of thin skin between vaginal opening and anal sphincter.

Surgeons have two choices in perineorrhaphy. They can bite into the deeper pelvic floor muscles or go much more laterally and superficially, and carefully try to find remnants of the vaginal sphincter layers. Drawing the pubococcygeus together results in a bumpy band of scar tissue that is often painful with intercourse. Defecation can also be affected, because it’s difficult for the muscles to relax when they are sewn together. Some surgeons talk about locating and suturing only the fascia surrounding the pelvic floor muscles, but I don’t know how practical this is or how often it is successfully accomplished.

Basically a perineorrhaphy is the same procedure as an episiotomy repair and it carries with it all the same issues. Some women may be more fortunate than others regarding amount of nerve and muscle damage as well as how much the area eventually disintegrates over time. But I think there are enough of us who have had large episiotomies to concur that “repair” is basically a misnomer. The area eventually thins out, a process that is greatly accelerated at menopause.

I was thinking this morning...if human birth needs to be “managed” in any way - and the perineum is the major area of the maternal body to be concerned about - does it make sense to encourage all women to birth on hands and knees in water? Really - many animals have gone back to water after having learned to survive on land. Perhaps we need to consider what some of our most ancient relatives figured out long ago. I have a bias here...my daughter birthed this way and ended up with a tiny tear just to the side of the front midline. Her perineum was unscathed and her pelvic organ support remains as good as ever.

Thanks for carrying on this very important conversation.

Christine

so what happens as the "repaired" perineum thins in menopause? this is all new concepts to me, and just trying to understand what i have to look foward to! ;-) (or not as i carefully look after my body...).

glad to hear you are healing alemama. you've been in my thoughts, and glad to hear you are getting to rest and sound good.

thinking of you and sending healing vibes your way.
I am very interested about the seaweed, later when your back in the swing of things I will bombard you with questions.
for now, keep those legs together and rest rest rest.
{{{{hugs}}}}

its something I think about from time to time, whether its possible to accomplish, what it would sacrifice and if I'd ever trust a surgeon to do 'just' that and leave the prolapses where they are.

and thanks,christine, for the description of the 'pseudorectocele'. wouldn't be surprised if that's what I've got going on.

Not sure about this, but I think the definitive symptom of "true" rectocele is trapped stool and difficult defecation. Thinned perineum is just that - very little tissue - just skin - at the back vaginal opening.

I’ve searched and searched for an image for this - will do some more digging because a good illustration does exist on one of the medical image databases - I saw it a while back, but can’t find it at the moment. So, try to picture this:

In the congenital condition you describe below - where no perineum exists - the only thing to build a perineum out of would be the back vaginal wall. If you drew the vaginal wall together and sutured it at midline, it would create sort of a perineum. This would distort the vagina even more, however, by bringing the cervix and the cul-de-sac closer to the introitus.

The image I was looking for shows an anterior and posterior repair where basically the (hysterectomized) vagina is almost obliterated and the entire thing lays out like one long, sutured perineum front to back. This may sound like a reasonable deal in the woman who is no longer sexually active, but that scenario - where the vagina no longer invaginates so that it can fold down upon itself - sets women up for bowel evisceration. Intraabdominal pressure is unrelenting and organs keep following the path of least resistance toward the genital hiatus, which is the opening in the pelvic floor muscles that surrounds the vagina. If the vagina is gone, the hiatus is still there, unless they do a complete vaginal obliteration where the pelvic floor muscles are sutured shut. This is not a panacea either, because the surgical scar distorts the urethra, leading to significant urinary incontinence. I suppose complete vaginal obliteration plus a sub-urethral sling might be the ultimate ticket if unpredictable adhesions weren’t also a reality.

I truly don’t know the best answer, only that the situation is extraordinarily complicated.

well, i'm just glad to hear christine that you live happily with almost no perineum. i have almost none as well. surgeon we saw said my last tear could be opened and resutured just to snug things up, but wasn't really necessary--so he didn't seem bothered that i'm perineumless. i've never really thought about it till it got mentioned here! i read recently that the average perinueum is over 4cm! eek, i'd be luck if i was at 1.5
oh well, gotta love the body we're in ;-)

kiki

Which brings us back to ...

Leave well alone, do Wholewoman management and wait a couple of years.

Alemama, I wonder if the doctor meant that the surgical *repair* of the perineum would be only cosmetic (which makes sense to me), not that the *perineum itself* is cosmetic? This doctor sounds very sane and rational to me. I think you have a good one.

Cheers

Louise

I am pretty sure now that my rectocele is 'pseudo'. It always stays inside the labia, does not get bigger at all when I bear down, my gyn did not notice it at all last time, I don't have any problems with defecating, the stool does not get trapped in it + the doctor spent barely 5 minutes 'repairing' episiotomy! My vaginal opening seems quite big (I was complaining about my 'stretched' vagina some time ago) and my perineum is only about 2 cm. Christine, could this all mean that I have pseudorectocele rather than the real one?

Hey...I didn’t create the terminology - lol. Both of them are real, no doubt about it. I think it’s interesting that doctors do not recognize these differences - as I said earlier, probably because of the implication that episiotomy can easily lead to loss of the perineum. Both are manageable. I think Alemama’s observation is right-on about the female body being equipped to cope with an astonishing amount of injury. Start altering the shape of the vagina, though, and the whole game changes.

Sooo..what do we think here?? If Alemama had her baby in a hospital would they have done a C-section because of the position of the baby? Is the position why she tore so badly? Would she have been better, or perhaps worse off, if she had a C-section??

Just wondering..thinking about my DD who will give birth soon. Scary..and lots to think about...

Regards,
~Mae

iirc, alemama said the baby's shoulders got stuck. sounds like shoulder dystocia. at that point, its too late for a c-section, as the head is already out. I asked my mw about this, it was my Big Fear, and she was very nonchalant about it. said she's seen it happen and she gets the mother moving and into some other positions and the baby 'tumbles out'. 'course my doula, who's been with the mw at one of those births said it was alot more drama than that. but if you do some quick online reading, you'll learn the major differences in management between OB and mw. the first problem with an OB is that typically a woman is on her back and numb from waist down. so they are limited in what they can do. I believe they try various maneuvers in some order or another, depending on where they studied. maneuvers ranging from assistants holding moms knees up over her ears, to reaching in for baby's arm to twist him, to fracturing the baby's clavicle, to fracturing mom's symphysis pubis (last resort I believe).
mw's usually have the advantage of an active mother. so the first thing a mw will do (I was told anyway) would be to get the mother on hands and knees and then put on foot flat on the floor. this kind of rotates the pelvis (and baby) and widens the outlet. I honestly did this research years ago, so I don't know if its totally accurate or still current.

yes, birth can be scary. but you have to have faith in the mothers body and in nature and in a higher power, if you believe in that sort of thing. we can never know if we'd have been better off one way or another. a friend of mine had her 5th baby via c-section and had severe pain at the site of incision for over a year. she scarred terribly and that's just on the outside. who knows what scars or adhesions developed on the inside?
you have to do what you can and hope/pray for the best.

wishing your dd a gentle and joyous birth

Hi Mae

Yes DD's time is getting closer, and no doubt you are right in there with her, the devoted Mom you are. It is natural to worry. She is your daughter, right?

Just to reassure you, my DS2 was born in hospital was a posterior labour, lots of walking between contractions, and getting down on hands and knees (on a plastic-covered double mattress we had arranged to take in with us), leaning on seated DH's lap for the contractions, with pelvic tilts. It was all getting a little out of control at transition, then DS suddenly flipped into normal presentation. I eventually got onto "The Table" with no urge to push at all, but did anyway after a while at the midwife's request, cos I figured there really wasn't any other way!

I was kneeling on the lowered, bottom half of the the delivery table, with my hands on the higher part as he came out ("You can't have your baby in that position, dear!" "Yeah? You just watch me!"), clatter, slither, plop, into DH's waiting hands, just like the letter through Mole's mailbox in Wind in the Willows.

It was truly the best birth of all three, spontaneous, assertive, successful. A really joyous birth for all of us, except the midwife who just sulked and cleaned up, and the doctor who finished umpiring his basketball match before turning up in time to grin widely and cut the cord.

So you see, posterior is not necessarily the end of the world. I think you just gotta go into it informed, and with a flexible plan, and go with the flow. Expect the unexpected and be prepared to compromise, and hope for the best.

Pregnancy and childbirth are still the life-threatening process they has always been for both mother and baby, and we need to be mindful of that, but with good quality care mostly it goes just fine.

Driving your car from point A to point B is pretty life-threatening too!

Cheers

Louise

Hey Whoa back Alemama

Sounds like you're already champing at the bit to go for number 5!

Love L

Wow! You sound fantastic Alemama! So good to hear all that. Enjoy, enjoy!

Thanks for the input from you, G-mom and Louise. I am sure you all will be glad when my dd has this baby and I can talk about something else. Sometimes I wish I didn't know as much as I do because, as they say, ignorance is bliss and right now I could use some of that! lol!

Just out of curiosity, why is a C-section bad for the baby? Not that I want her to have one (I pray she doesn't need one) but I heard that it's not a bad thing for the baby because they don't have to go through the trauma of the birth. Do I really want to know the answer to that question? Didn't I just say ignorance is bliss? Tell me anyway...guess I just think I don't want to know these things!

~Mae

My understanding with regards to c-sections being "bad" for babies is that their lungs don't get the beneficial squeezing coming through the birth canal during contractions. This action serves to clear the lungs and stimulate them into functioning "on land." I've not come across any studies to back this up, but I would bet that the huge increase in childhood asthma is related in part to the huge increase in c-sections.

Alemama, so glad you are feeling so good about your birth!

My older granddaughter now 2 1/2, had the cord around her neck twice and looped under her arm during my daughters labor. Her heartrate dropped suddenly and IF my daughter wouldn't had an emergency c-section the baby would have died. She had CPR right after she was delivered and started to breath own her own fairly quickly. My daughter had an ultrasound 12 hours before going into labor and the cord was fine. It must have gotten wrapped around her neck during labor. Thank God she was in the hospital where she was monitored and the problem didn't become a tragedy. She breastfed great and now she is healthy and a very bright two year old. My daughter became pregnant again 8 months later, so much for breastfeeding being a birth control method! Her second daughter was also born by c-section by my daughters choice and again breastfed great and is healthy and also very bright for her age. Everyone will have a different story, your daughter will do what is right for her. I thank God everyday for those two little girls, they are here and healthy thanks to a great doctor and hospital. My daughter returned to work, 40 hours a week, after only being home for 4 weeks after both sections. She had very little pain and zero complications. We are blessed! Connie