What To Expect When.. You Have An Episiotomy Scar Refashioned
I promise, I did try to think of a nice title for this blog post, but apparently there is no nice way of talking about a scar in my intimate area, nevermind a problem scar that didn’t heal the way it was intended to, so I decided to speak up and speak loud about it just as it is.
I had surgery on my vagina a couple of weeks ago, following an episiotomy a year and a half ago in childbirth.
An episiotomy is when an incision is made to your perineum, between your vagina and anus in childbirth.
I delivered my baby without needing one, but ended up having the incision made to deliver the placenta. An episiotomy is done to avoid tearing and to allow the baby to come out more easily, such as if labour has gone on for a lengthy amount of time, or if the baby’s heart rate isn’t right. There are lots of different reasons why they have to happen and it’s really common to have one – the NHS website states that 9 out of 10 first time mothers will have one. If you want to read more about an episiotomy on the NHS website, please click here.
My first episiotomy was done in a hurry. My placenta had a weak cord and the doctor was unable to deliver it without making an incision. The doctor knew I was struggling and exhausted from having my baby and I was also in a lot of pain (and making it well known! – I was moving around a lot). I hold nothing against the doctor that delivered my daughter, delivered the placenta and gave me my episiotomy.
I actually didn’t like the second midwife I had during labour and the doctor came in right when I needed her and did what she thought was best for me, after a difficult few hours. She gave me my baby girl safely and I’m so very grateful for the care and aftercare I also received from her in particular – she came to visit me on the ward the day after labour, to explain to me why she had to give me the episiotomy and to make sure I was doing well.
My episiotomy scar is incredibly thick and is also angled at much more of a downwards angle towards my bum than it should be. I’ve had problems with my scar since I had my daughter. It has caused me discomfort and sometimes pain, sometimes after something as little as a short walk. It can hurt when I use the toilet, or during or after sex.
My cut was infected when I left the hospital with my half a week old baby. I took my antibiotics and received no further aftercare. I was discharged from the hospital about having my daughter and it’s never been right since. I received one phonecall from the hospital to ask how I was doing, about 3 weeks after discharge and was told to discuss my problems with my health visitor.. Who I only saw twice, before she disappeared!
When you have a baby, especially a premature one, you forget to look after yourself. I guess I kept putting it to the back of my mind and everything else kept taking priority over the pain in my scar.
I first asked a nurse to have a look at my scar during my smear, around a year after birth, and she said it didn’t look right. She put a request in for the doctor to refer me to gynaecology. The GP called me a few weeks later, upon receiving the request, and told me that it sounded perfectly normal to have a long healing time following childbirth. I pushed against this. It isn’t normal to have a sore scar over 12 months after you’ve given birth. The doctor then took a proper look at my medical notes to see that I did give birth early last year. It would have been helpful if she’d done this before the call!
You shouldn’t have to press to be taken seriously by your doctor. It seems to be the automatic reaction, if you tell someone you had a traumatic birth of any kind, for people to either say, “it can take a while to heal”, or, “well, at least you got your baby”, as some kind of token gesture. I got my baby, yes, but I have a painful scar coming out of my vagina and it shouldn’t be accepted as a ‘norm’.
Women deserve better medical care in general. Heavy, painful periods, long periods, missing periods, pain during sex, traumatic childbirth, problems healing after childbirth, hormonal problems, side effects of birth control – these are just a very short list of some of the problems that women are expected to put up with and to be quiet about.
Thankfully, the gynaecologist (who was also my surgeon for the refashion) that I was referred to took me seriously, had a look and then a closer look under general anaesthetic.
My gynaecologist is absolutely wonderful. I was never made to feel like I was being unreasonable in any way about my episiotomy scar being sore. We had a brief phonecall before my appointment and then he invited me into his clinic so he could examine me, which he did so with a nurse (and student!) chaperoning, so I felt completely at ease, with three people in the room all reassuring me that what I was feeling wasn’t normal and wouldn’t just be brushed under the carpet.
The surgeon recommended that I go under general anaesthetic so he could have a closer, longer look and also inject some local anaesthetic directly into the scar tissue, in the hope that this could tackle some of the pain from the inside out. The odds of this working, however, were not great. He said it could work forever, months, weeks, or not at all. He said that in his opinion, I would probably have no relief from re-opening the wound and closing it again, as I would end up with more scar tissue, which was already very thick as it was. The thickness of the scar is a major contributing factor to the pain, as well as the direction of the scar. When I consented to having my scar looked at, I also asked him to please do any corrections he could do whilst I was under the anaesthetic. This covered the injections, but also meant if he found any scar tissue that needed refashioning, he would be able to do this. He said if he found something much different than expected, he would have to wake me up before discussing this with me again, which I agreed to.
Several weeks later, under general anaesthetic, the surgeon injected a steriod and a local anaesthetic directly into the scar. He also found a piece of scar tissue had grown just over the very bottom of the opening of my vagina, which he had to cut again and give me two more stitches. He advised he would see me again after an eight week healing period to check on how I was doing.
I wasn’t expecting the second episiotomy cut exactly the way it happened.. but neither was the surgeon! It wasn’t something easily seen on a physical examination when I was a bit sore to touch and probably really tense in anticipation of pain!
We had discussed that if there was any excess scar tissue found that was causing a problem, I’d be happy for this to be removed, but we didn’t expect there to be any from the previous examination, but I’m so glad I’d consented to this already, so it was done whilst I was already under.
When I woke up from the general anaesthetic, when I stood up to go for my first wee, I was bleeding and, even though I was being looked after by a couple of nurses, I had to wait for the surgeon to come in to see me, to explain exactly what had happened in theatre. When I realised I was bleeding, I knew he’d done more than injections, but I wasn’t sure what. However, I was on plenty of painkillers and I was confident in my doctor, so I wasn’t worried about this at all. I waited for him to come and see me, which was a few hours after I’d come around – after a sandwich and a couple of brews, a chat with my partner via text and a lot of lying around being glad it was possibly (fingers crossed!) the end of my troubles.
So here we are.
One baby. One year and a half of discomfort. Two episiotomies.
It’s a bit different this time round, as my baby isn’t a five pound newborn anymore, but a year and a half old little terror who can run away from me! I have to rest for a few weeks and wait for my check up in a couple of months.
If you’ve had a baby and you had a tear or an episiotomy and you don’t think it has healed correctly, please go see your doctor and ask for a referral for a gynaecologist. If you are denied this onwards referral, please fight back against this.
I have written a blog post about escalating your concerns at your GP practice, which you can read by clicking here.
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