As a Pelvic Health Physical Therapist, I am thrilled that this type of care is…
My Rectovaginal Birth: How a Pelvic Health Specialist Approached Recovery of a Fourth Degree Tear Physically & Emotionally
October 25, 2021 • By Alissa Alter
Some housekeeping and a trigger warning. This article, my story, does include anatomical names of body parts used to vaginally give birth to the next generation. This is a story that includes a birth injury and birth trauma resulting in PTSD. With that said, this is also a story of a new mom, me, rising from the ashes like that GD Phoenix in Harry Potter, or like Daenerys riding a dragon in Game of Thrones, and finding her purpose.
I had been working as a pelvic health specialist for about five years before getting pregnant. I’d worked with pregnant people, postpartum people, and people with no kids experiencing pelvic floor dysfunction.
I’d helped countless women stop peeing when they sneezed, have easier labors, prepare for and recover from cesareans, have pain-free sex, and avoid tearing during vaginal deliveries. My extensive Pilates training, yoga practice, pelvic floor studies, plus professional dance career left me feeling prepared and confident.
The expectation was that I’d basically sneeze and this baby would appear. But…as you may have guessed, that’s not my story.
I knew something had gone wrong when I felt my doctor start poking my B-Hole. She told me I was going to be ok and got to work. Later, when the dust had settled and the air was clear-er, I learned that I had experienced a fourth-degree perineal tear during childbirth.
A quick glossary of the possible degrees of tearing during childbirth:
- A first degree tear usually includes some of the vagina itself and maybe a little bit of the vaginal opening. It may not even require any stitches and heal on its own. Or one or two stitches and you’re all set.
- A second degree tear extends past the vaginal opening and into the perineal body. This kind of tear can also extend to the front of the vaginal opening and toward/through the urethral sphincter.
- A third degree tear rips through the perineum and into the muscle of the anal spinchter.
- A fourth degree tear keeps going THROUGH the sphincter and also tears your actual rectum. It extends from your vagina to your rectum. You are torn in two. Literally.
I experienced what I now call a rectovaginal birth. Others call it a vaginal c-section.
Immediate surgical repair is needed to reconstruct the rectum, anal sphincter (v important to keeping poop and farts IN and letting them out only when we decide to let them out), perineum (which is made up of 3 different layers of muscles), AND the vagina itself.
I can’t tell you how long that surgery took because after asking my doctor “Why are you poking my a**hole?” I told Jeremy I didn’t think I should be holding the baby and promptly started vomiting and then passed out.
If I were aware enough I would have been scared I may not survive. Luckily, I wasn’t conscious. So Jeremy got to hold the fear alone. Holding our newborn. Thinking he may now be a single dad.
When I finally came back, I was high on pain meds and didn’t understand what had happened. Apparently there had also been some hemorrhaging and I’d been given medication to stop the bleeding. This medication it turns out liquefies your insides and, after being fully numbed from the waist down, resulted in my finding myself in a puddle of feces multiple times. Just as the nurse cleaned me up, it would happen again.
I was completely out of control. I didn’t know what had happened or what was happening. I just knew it wasn’t safe for me to hold my baby.
Long story short, my OBGYN did a brilliant job on my surgery. I have no long-term physical symptoms or complications. And as I approach the two-year anniversary of this event, I am clinically-speaking fully recovered. All the parts do their jobs well except if I’m really gassy for any reason, I definitely can’t control my farts all the time. But that may not have been much different before birth. Thanks, IBS.
While things are healed physically, I am still struggling emotionally. I have PTSD from my stay in the hospital. No one was upfront with me about what happened, what was going on, what to expect, and there was a nurse at the hospital who did NOT take care of me.
I felt alone, discarded, and terrified.
And I went into all of this with way more knowledge than the average person! I was consumed with feelings of “This isn’t supposed to be my story.” I had failed.
Here’s what helped me move through it all and heal physically and emotionally from my rectovaginal birth, my vaginal c section, my traumatic birth.
Staying horizontal as much as possible
This was both difficult and easy. Difficult because no one around me understood the extent of my injury and I couldn’t articulate it. Easy because when I was upright for too long it felt like all of my organs weighed 100lbs and were about to tear me open again.
Whether or not you have zero tearing or all the tearing, your pelvic floor needs rest after birth. You are also recovering from pregnancy. You need to literally UNLOAD your pelvic floor and let it heal. You can read more about how and why you need to give your pelvic floor TLC postpartum in this article.
Breathing with intention
This was and continues to be my everything. Breathing intentionally, deep diaphragmatic, pelvic floor breaths, helped me feel into my body. I could feel my pelvic floor muscles responding to my breath, reassuring me I wasn’t actually broken.
Breathing calmed my frazzled nervous system (Zoloft did an even better job of this) and helped me find my way back to myself when I was spinning.
Breathing like this also kickstarted my healing, rehabilitation, and recovery by promoting circulation to my surgical site and encouraging the coordination of my pelvic floor, transverse abdominals, multifidi, and diaphragm. This gave me a sense of my physical stability and centering.
Definitely invented by someone who actually birthed another human. A gift from the heavens. The ice helped calm the heat of my stitches, numbed some of the pain (the Percocet helped with that too), and gave me relief.
My husband became a skilled ice diaper maker and always made sure I had a new one before the current one got too warm. This is romance, my friends.
Going to the Doctor Before My 6-Week Appointment
My 6-week appointment was my 4th or 5th time seeing my OB postpartum. I went to have my stitches checked every time I felt something new or different. One time I went purely for reassurance it was healing and I would be ok.
I wasn’t ready to look at it myself, I knew I couldn’t handle it emotionally. Plus, I’ve never seen that before so I wanted a professional to track my progress. I’d read so many horror stories of things healing improperly or a stitch opening without realizing it leading to a cascade of complications and I wasn’t interested. So I went to the doctor often and called even more often.
Demand the care you need.
For one of the first times in my life, I didn’t care about how my feelings affected anyone else. I felt everything. Whenever, wherever I needed to. I wasn’t good at communicating my needs outside of waiting until I exploded into tears and word vomited everything at once. My favorite example is when my husband asked what he needed to do to care for the baby and I replied, “F*CK HIM! He’s fine! I’m not!”
I always felt better after. In fact, research shows that not all tears are created equal. And the tears we cry from emotional reactions release Oxytocin and Endorphins. Feel good hormones. So feeling good after a good cry is legit.
Showering BY MYSELF every single day
A perfect place to get some crying done. You don’t need tissues because you can just let the snot flow.
My husband understood that when I took a shower it was a sacred time for me. He did not interrupt me. He kept the baby soothed going to extraordinary measures when needed. I’m not sure anyone has bounced on that birth ball as much as he did since I couldn’t. I would time these showers between feeds so I didn’t feel a need to rush.
I cried, I breathed, I did light stretching for my aching body. Eventually, I started to feel my stitches which helped me again feel more connected to and safe in my body.
I bought sugar scrubs, masks, and things that smelled wonderful.
I used this time to reset and cleanse my whole self. It’s also when I started a skincare routine because the ritual made me feel like I was really caring for myself.
Writing about everything helped me process my birth experience, my postpartum experience, and the realization that I had been through something supremely, and uniquely traumatic. It was through my writing I realized that I needed additional support and got on medication and started therapy again.
I received my diagnosis of PPA/PPD and PTSD and it felt like a huge relief. It felt like a roadmap and permission to prioritize myself and my health. And while I wish I could have come to that conclusion with my anal sphincter in tact, that’s not my story.
And while my OBGYN did a brilliant job with my repair, and I’ve completely healed physically, emotionally I am still torn. It ebbs and flows and I continue to spend time horizontal, breathing with intention, I’ve traded ice diapers for Yin yoga, I cry when I need to, and I’ve up-leveled my solo showers with candlelight. That’s right. A candlelit shower. Try it, it’s incredible.
Physical therapy and emotional therapy. This has by far been the most complicated, drawn-out part of my recovery. Because while my muscles were expertly sewn back together, emotionally I am still torn.
My physical recovery, while scary and painful, was uncomplicated. I have full function and no pain which I am grateful for every single day.
I do have PTSD and PPA/PPD which has made me feel unsafe and fearful living in my body.
AND it’s all getting better. When I realized I really wasn’t ok and my emotional state wasn’t just a little anxiety paired with a pandemic, I went on medication, started weekly therapy, and started physical therapy again with the amazing Eliza Etter at Beyond Basics, NYC.
She even wrote a fantastic article about what to expect at Pelvic Health Physical Therapy.
My goal in all my therapies is to feel safe again. To trust again. To come home to the body I love so much.
Now would be the time to wrap this all up in a beautiful bow and say “It was all worth it.” Right? I don’t feel that way. If I had known what was going to happen, I would have had a cesarean. And I don’t believe that any of this makes me a bad or lesser mom.