When my doctor spoke next she said "Christie, you've torn. I need to check you before I get the gynecologist on-call to do the repair." This didn't really surprise me, I always knew I would tear. I figured it would be a second degree tear, but the fact that she would need a gynecologist to do the repair surprised me.
"How bad is the tear?" I asked.
"Third degree," she replied.
Okay, worse than I thought, but not as bad as a fourth degree tear, I can live with that. The gynecologist came in and examined me as well. That's when my second "REALLY? NOW?"-moment happened.
"I'd like to give you some Fentanyl while I repair your tear," She said after examining me.
"REALLY? NOW??" I've just gone through my whole labor and delivery without a drop of analgesia, and now you want to give me a pain-killer? I thought about how stupid that was: I'd specifically gone through labor without anything, for my child's sake. Now it was going to be all for naught, because they wanted to give me a strong narcotic that would pass into my breastmilk - albeit in very tiny quantities - anyway. I tried to say "no" but they insisted that it would be very painful and that a narcotic would be beneficial. "Aren't you going to give me a local anaesthetic anyway?" I asked.
"Yes," she replied "but it isn't going to help very much at all"
I gave up and let them push 100 mcg of Fentanyl. She was right. Even with the Fentanyl on board the pain was excruciating. Maybe worse than labor, maybe not quite, I can't really remember, but worse than I ever imagined.
As she started the repair, the gynecologist started to give me instructions, "Now, with a fourth degree tear..."
"I thought it was only a third degree tear," I interrupted.
"No," she replied firmly, "it's definitely fourth degree." I must have heard incorrectly.
The repair took an hour to complete. I didn't have to go to the operating room, likely because of the gynecologist's expertise in this area. I was very blessed to have her. She was actually a locum doctor from Calgary, the very best pelvic floor specialist in all of Alberta. She "just happened" to be on-call in our town that morning. I marveled, in weeks that followed, that God would have me tear so badly, and then provide the very best person to do the repair.
I barely got to hold my daughter during that time, even though I asked for her over and over and tried to convince them that the pain would be less severe if I could have her to distract me. I think that they were concerned the Fentanyl might have made me too loopy and drowsy to hold her without the potential of dropping her tiny fame. Trust me, any potential loopiness from the Fentanyl was strongly counteracted by the severity of the pain I was experiencing. I didn't even make it through the whole repair before I was asking, please, for another dose of Fentanyl. They gave it to me willingly, and that dose, piggy-backed on the previous one, relieved the sharp edge of the pain.
Perhaps worse than the length of the repair was the fact that throughout the whole procedure both physicians were giving me a ton of information on this type of tear. They talked about caring for the tear, follow-up visits, possible complications, the need for pelvic-floor physiotherapy (who's even heard of such a thing!), and even touched on what the next pregnancy-labor-delivery might look like for me. Here's a bit of information on 4th degree tears, if you're curious http://brochures.mater.org.au/Home/Brochures/Mater-Mothers-Private-Redland/Recovering-from-3rd-or-4th-degree#5
The general consensus had been that my daughter's shoulders had caused the tear, due to the fact that I had been unable to keep my body from pushing through that final contraction. I felt so guilty, and I kept apologizing... to A., because I'd felt like I'd ruined my body; to my whole medical team who had coached me so well throughout my labor, for not being able to do the one thing they'd asked of me; and to the gynecologist, because I'd taken up her time and because I could not stop my legs from shaking uncontrollably.I cried a lot, for days, after that. I don't think that I can explain, in a way that would make sense to anyone, why this was so unbearable for me. The months, maybe years (we have yet to see), of healing ahead of me overwhelmed my mind. The guilt hit hard whenever I thought of that moment when I said "I'm not, I'm not... I'm not pushing!" The idea that I had forever ruined my body kept coming back to haunt me, even when A. and my mom assured me I
hadn't. I hurt. A lot. Nursing my daughter was harder for it. I couldn't sit up, so I had to learn to nurse her side-lying right from the start, and not having as good control of her head from that position made learning an already difficult skill, that much harder. I believe that this was also the beginning of my
depression. Not that it was the complete cause of it (it's just not that
simple), but that it was the start of the cycle of guilt, anxiety,
pain, remorse.I discovered a few weeks later what the look of horror had been on my doctors face: She is a fairly new family practitioner, and had seen only a couple severe tears during her residency. One such tear had spontaneously dehisced (opened) weeks after the repair. She was likely shocked by the extent of the tear and reminded of the severity of potential complications.
One thing I was glad of: The birth of my daughter and the fourth degree tear I had endured remained completely separate in my mind. I had given birth to a beautiful baby girl. I had torn very badly. Those two things, the good and the bad, did not coexist in my mind. Because of this, I never once blamed her - her abnormally large head, her shoulders, or her weight (8lbs, 6oz)- for the tearing of my body.
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