Internal Scarring

Hi Takecare

Wow, you have really had a nightmare birth experience, that has left you with a lot of unresolved questions. I can now see that you are trying to make sense of it all, and work out why the gynaecologist is saying you only have minor celes after this delivery, with the ongoing pain that you are experiencing.

Understandably, the doctor has told you that you are lucky to be alive. Historically postpartum haemorage has cost the lives of many women. It does rather cast him in the role of hero. We can all do with a hero occasionally. However, as you can see from this website, http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Uterine_i... , there are several factors which could have caused it either on their own or in combination, and the information that you have put in your topic suggests that the doctor has told you nothing, except what a wonderful job he did. And you and the baby are both here (I hope) to tell the tale, so he is probably right. It would probably have been pretty distressing for him too. Usually it is related to applying traction to the umbilical cord before the placenta has detached.

When you think how big a pregnant uterus is, it is not a big stretch of the imagination to see how complete inversion can happen without causing devastating damage. There is so much extra tissue in there so it just keeps coming out. There is actually nothing holding the uterus in at the point of delivery. That is why cord traction is not considered to be good practice.

You can be assured that all these tissues take two years to revert, and the sooner the uterus is replaced, the easier it is for the body to do that initial reversion of the first couple of days, that is so important. I remember being told after the birth of my first baby that my uterus was back to almost normal size about two days after the birth, which blew me away, but DS1 was such a little piranha that I wasn't really surprised! ;-)

You have the right to be de-briefed thoroughly, now the acute crisis/trauma has passed. It will be helpful for you to know what happened. Otherwise you may live the rest of your life wondering, "what if ...?"

Let's see if we can help you to work out what happened, the cause of your pain and how you can best move forward to lessening your pain and helping your body to recover.

I have just gone over the topics you have created, looking for some more details. I cannot find any account of your pregnancies, other than the account of the birth of your firstborn. Perhaps I didn't look thoroughly enough?

Can you tell us if you only had the one baby?

How old is the baby now, ie how long since the birth?

Was the labour induced or did you have any medication during the labour or birth, other than not having pain relief?

All this information will be in your hospital and/or medical record. If I were you I would want to know exactly what happened, and why things were done, right back to when you arrived at the hospital during labour, or before labour started. It might still be a bit emotionally raw. You might not be ready to embark on this task.

You may need to use the Freedom of Information Act to get access to this information, and you will need to know what information to ask for.

I was quite surprised when I phoned King Edward Memorial Hospital seeking to find out some details about my episiotomy with my first birth, that I was passed on to their Litigation Department, even though litigation was, and still is, not even on my agenda. It does show how well hospitals have their information protected, so as to only release as little information as they need to. You really need to know the right information to ask for, and it might take some time after application to get the information. I didn't bother in the end as it has no bearing on my response to the resulting 'celes. However, I had previously accessed some information about an antibiotic I was given after a miscarriage D&C many years ago, and yes, it took some time.

I don't want to alarm you about this. I hope you are able to get the information easily, and hopefully without having to resort to FOI. You have the right to know exactly what was done, but you will have to go through the appropriate process to get it. The Australian Federal FOI Act is not designed to keep legitimate information away from people, but it can seem like wading through mud, trying to access it.

Your computer trick is an intuitive solution. Moving your pelvic organs in and forwards is the thing which will normalise the positions of these organs. You can amend the way that you use your body during exertion so that you are always protecting your pelvic floor from being pushed out, and your organs being pushed back and down.

It will take time to get them right. You may experience improvement for years. You may not completely heal but the body is truly amazing the way it can compensate for damage.

Posture, and keeping your intestines freely moving are the keys to this .

Louise

Nothing substantial to say, just a big hug. Your story is very moving. It reminds me of my little sister's giving birth and afterwards hemorrhaging. The doctor told me that if my sister died or lost her uterus, it would be my fault for encouraging her not to have an iv (for a quick way to get pitocin into her blood stream so the uterus contracts and stops gushing blood). Thank God neither happened, but her husband and I were both sobbing at her bedside as she lay white, unconscious, and bleeding, her new baby screaming nearby. Wishing for you peace and closure.

Hi Chickaboom

Isn't it strange that the doctor, who is in charge of medical care at the time would blame a bystander, who at worst made a naive assertion, which he should have disputed because of his duty of care, if the risk was unacceptable for his patient?

Playing the blame game is really just a form of self-defense and passing the buck. I guess he was trying to frighten you because you challenged his 'authority' and threatened his control of the situation, which may have ended tragically.

Thankfully it all ended well.

But my, my, don't these horrible memories stick around and haunt us? I wouldn't mind guessing that the doctor has not forgotten it in a hurry, either. Hopefully he is a better doctor for it.

Louise

Hi Takecare

You have been trying to resolve this for such a long time. Just reading it again made me realise how much medical fear and medical anger would have been in that delivery room twenty years ago, with an obstetrician trying to fix up a GP stuff-up, causing an immense amount of damage and pain, and nearly losing their patient. It sounds like the doctors concerned were very lucky too. No wonder they closed rank and wouldn't speak, and no wonder the nurses were 'unable' (not allowed) to speak about the birth with you. You really were isolated! And the doctors would have been feeling very guilty that it had happened at all. It certainly does sound like a medically induced problem, doesn't it?

I do not know how you tackle this hospital records dilemma. I have never before heard of a WA private hospital being *unable* to produce records. I am wondering if there are other ways of getting these records? The State Department of Health have them listed in their directory, http://www.health.wa.gov.au/services/detail.cfm?Unit_ID=1224 . That would be a good place to start your hunt. They will soon refer you to the appropriate place to start searching. Surely, records don't just evaporate because the ownership of a hospital changes!

The GP and the specialist obstetrician may have retired, but they might also be options to follow up. Is the gyn you saw 6 years ago still practising? He would have records of what he observed. I would be going back to ask him some questions too. It sounds like he told you nothing either. He probably doesn't want to drop the other doctors in the poo . I would suggest written questions in an initial letter. If he doesn't reply to the letter you can probably apply some pressure to get answers, especially if it is just for the sake of getting answers. If you ask verbally it is more difficult to get answers that you understand, and there is more chance of missing information and misunderstanding. Sadly, but understandably, Australian doctors seem to be getting more litigation shy than they used to be. All it does is make it difficult to get information about our own bodies out of them.

From your initial topic, your description of a tearing sensation, and the incarceration of your uterus during your second pregnancy, it sounds like there was some uterine support damage during the first delivery, which may have healed in a strange way.

The uterus is normally enfolded in the peritoneum that is between the abdominal and pelvic cavities. The body of the uterus may have come away from that peritoneum, or may have dragged the peritoneum, or the underlying fascia / ligamenous structures, down with it when the uterus came out. This may have been the rippng you felt See this video animation, http://www.youtube.com/watch?v=pRd_AQ1nOvI . Maybe the uterus never got back properly into its fold of peritoneum and became retroflexed or retroverted, down between the uterus and rectum, and after the reversion of your tissues from the first pregnancy it was unable to rise up out of the pelvic cavity? Have you ever felt that your uterus was retroverted?

I noted in my googling that sometimes uterine suspension is done straight away, after the replacement of the uterus. This is probably why. Who knows whether or not it would have been a better outcome? There probably wasn't a lot they could do without an operating theatre. Probably getting you to stay in this rather undignified position (butt in the air) during your subsequent pregnancy, to get your uterus to come up, was the best thing they could have done under the circumstances. This is exactly the same principle as we would suggest for a woman in the same circumstances - lots of time on elbows and knees.

I can only think that the obstetrician was trying to remove the placenta so he could get out of there, and get back to what he was doing before being called away to this emergency. There may have been more than a little medical panic in the whole process!

No wonder you were bruised and battered. Of course, serious bruising does sometimes cause scarring too. I was hit in the upper arm by a boat winch handle many years ago. The bruising took three months to disappear, with the aid of daily arnica massages, and even now my masseuse comments on the lumps that are still there. so you may have some fibrous scarring in your pelvic cavity as well.

I think that even now, using inversion exercises like firebreathing, nauli and spending time on elbows and knees, might improve the way your pelvic organs are arranged, and alleviate some of your pain. As you found during the subsequent pregnancy, allowing the weight of your uterus, bladder and rectum to sink them further into your body, worked then. It could work now.

Your pelvic organs have positions that they 'want' to be in. If you allow them to seek these positions out it will take some pressure off your perineum and give those nerves a break. It will take time, and you might not get much improvement, but if you don't try it, you will never find out. You might get more improvement than you thought possible!

The real question is whether or not hysterectomy will improve the pain, or whether it may not leave you any better off in the longer term. The other question is which other procedures they may want to do at the same time, and I doubt that they would commit themselves on that at this stage.

Out with your pen and paper. Lots of questions need answers. I suggest that you take someone you know well, and trust, to the consultation with you, to help you through it all, and ensure that you get the answers you need.

Stay in touch.

Louise