Amanda’s Story

In January of 2020, I found out I was pregnant with my first child. From the beginning, there were some minor complications that required a few extra doctor's appointments along the way. The pandemic also began early on in my pregnancy so most of our pregnancy was colored with additional health anxiety and uncertainty. I was diagnosed with placenta previa in the first half of my pregnancy and experienced low amniotic fluid issues in the second half. I felt a little bit lucky because during a time of heightened anxiety, this also meant I got to see my baby on ultrasounds a lot more often than the average person. However, it was disappointing that my husband couldn't be present for these amazing experiences, like the first time I heard her heartbeat.

With the on and off low amniotic fluid, I was called into the office a few extra times to make sure my baby was safe. When I called about my symptoms one night, it was suggested that I go to the emergency room because it was my due date anyway.

It was confirmed that my amniotic fluid was quite low, so the doctor suggested we stay in the hospital for induction that night. The alternative, we were told, was that going home with this fluid level and waiting for my c-section next week would put our child at risk of stillbirth. We chose to stay. We were really excited to meet our child (we did not know if they were a boy or a girl!). We got a room and started CERVIDIL, which was extremely uncomfortable. I settled in for the night and didn't get much rest, but everything was going smoothly.

The next morning my doctor came in and said after reviewing my file more carefully, she was concerned about my patent foramen ovale, which is a small hole between my heart atria. Sometimes the blood will kind of just circles around in my heart instead of taking the proper circuit out through the ventricle. This can be a problem in unique circumstances. For example, I'm a scuba diver so it makes the sport a little bit more dangerous for me and I need to be extra cautious with my safety stops. Similarly, there could be reasons for concern medically, so the doctor decided to have Cardio do a bubble test to make sure that I could withstand laboring and pushing. The bubble test was positive, but the doctor decided it wasn't enough of a reason to avoid labor, so we continued induction with Cytotec that afternoon.

On the fourth round of Cytotec at 11pm, I texted my mom and said if this round did not work, I'd ask for a C-section. I was so uncomfortable, had not slept, and hadn't eaten in over 36 hours. But my water broke at 2:00am and labor was immediately extremely intense. I was able to get an epidural by 4:00am which helped, but I was still moving along quickly. By 6:45am, I needed to push. The doctor came and my baby was born at 7:09am. It took just twenty minutes and very few pushes to get my daughter out. Before she was out, the doctor informed us that I was starting to tear, and she tried manual perineal massage. My daughter was nearly nine pounds, and her head measured in the 99th percentile. Given how quickly my induction went, how short the pushing was, and how large her head was, I think I was destined to have a fourth-degree tear despite anyone's best efforts. The only risk factor I had for a 4th-degree tear was that it was my first pregnancy, so this had never crossed my mind. I had slight concerns about tearing when I took my prenatal courses, but I didn't even know that a fourth degree was possible. I certainly never believed I would be the statistic.

It took over ninety minutes for two OBGYNs to stitch me up. During that time, I began hemorrhaging and was unfortunately allergic to the medication they gave me to stop the hemorrhage. I vaguely remember holding my daughter for a short amount of time before saying I was going to be sick. After being stitched up, I passed out. When I woke up, I was assisted to the restroom, and I passed out on the way there. The next time I woke up, I recall seeing extreme concern on my husband's face and hearing him tell our nurse that this was not like me. I was slurring my words, I could barely string together a coherent sentence, I couldn't keep my eyes open. My anesthesiologist held my hand and paged for a stroke to my room. In a matter of seconds, my room was flooded with dozens of doctors. I was in and out of consciousness for the rest of the day. I hazily remember waking up inside an MRI machine and again by myself in a hallway waiting to be brought back to my room. I vaguely remember my husband and a nurse holding my daughter to my chest to breastfeed while I was receiving an EEG.

In the early months of postpartum, these memories made me deeply sad and hot with rage. I have no photos enjoying a golden hour with my daughter. We didn't take any videos together as a family. I was alone and scared and unconscious. No mother should spend the first twenty-four hours of her new baby's life like that. It took a lot of work and time, but I look back on all this three and a half years later with gratitude for my husband's advocacy and care. He remembered my wishes and did everything he could to advocate for me when he knew something was off.

Despite all the tests that day, there was very little concluded about why I had such a reaction. I'm sure a big part of that is purposely keeping things vague, but what I do know for sure is that I received absolutely no education regarding a 4th-degree tear. In fact, I left the hospital thinking this was normal because it wasn't discussed again after I was stitched up.

When I got home and the four OxyContin pills were gone, I realized I was in an extreme amount of pain. I called the OBGYN who delivered my baby to ask for more and was forced to come into the office to be lectured about addiction. I was begrudgingly given a few more doses, plus extra-strength ibuprofen. Even then, I struggled to walk a few steps without feeling extreme heaviness in my pelvis and I simply could not sit because the pain was too much. It became evident to me after a month of no relief that something was not quite right.

Despite my best efforts to find resources online and search for information about 4th-degree tears, it just didn't exist. I searched 4th-degree tear, obstetric laceration, birth tear, birth laceration, obstetric anal sphincter injury, the list goes on. And while there's tons of information about the definition of a tear, there is absolutely nothing about risks, healing, treatment tips, prognosis, or outcome. The only resource I could find was a Facebook support group of women talking to other women about their experiences. I spiraled downward into an internet abyss of worst-case scenarios and lifelong complications without any hope.

The six-week mark when most women get cleared for sexual activity came, and I told my doctor that I couldn't feel any sensation when I had to go to the bathroom. I would just realize I went. I was referred to a colorectal surgeon at 12 weeks postpartum to let the inflammation and swelling go down more. At that appointment, I was told I had significant nerve damage and virtually no muscle tone so anytime I needed to go to the bathroom, only the conscious muscle contractions of my external sphincter would save me from having an accident because my internal sphincter was defunct. It was suggested I do pelvic floor physical therapy to help my strength in holding it, but I was told there was no fixing this. My repair was done beautifully from an aesthetic standpoint, but functionally there was nothing to be done. Long-term solutions included an electric stimulator device with surgery, but I feared using this option too soon, knowing that as I age, things will probably continue to deteriorate.

This was the same time I had to go back to work. I was scheduled for an additional surgery to remove tissue that was refusing to heal. A peer on my team who delivered at the same time as me was given an additional 2 to 3 weeks to heal on leave, but I was not. When I tried to educate my Human Resource representative about fourth-degree tears, I was told that if I needed more time off, I would need to pay back my maternity leave and use PTO. So, I returned to work with a fully open wound that was not healing, without the ability to sit down at my desk, battling full fecal and urinary incontinence - on top of just delivering a baby anyway and the healing that comes with such an event.

The nature of my job required me to be always available via phone to clients during my shift, which induced a whole new type of anxiety because I didn't have free access to go to the restroom and turn my phone off. When I asked about my rights under the Americans with Disabilities Act, it was suggested that I use charcoal to mask the smell if I had an accident at work. No accommodations would be made. My metrics began to significantly decline because I didn't think that was a suitable solution to fecal incontinence, and I turned my phone off to use the restroom or clean up after an accident. This was bringing down my metrics. In less than six months, I went from being one of the top performers in the department who was chosen for exceptional professional development training opportunities, to someone who was barely meeting the minimum success metrics and in fear of losing my job.

These additional complications began taking a toll on my mental health. I wasn't sleeping, I was having nightmares and flashbacks. I fantasized about driving away in the middle of the night. I was experiencing hypervigilance around my daughter's health. I was terrified that if I closed my eyes, I wouldn't wake up again. I was terrified about everything she did, and absolutely obsessed with “what ifs”. Reluctantly, I started working with a therapist who diagnosed me with postpartum PTSD and postpartum anxiety.

One year postpartum, I switched to a new primary care physician after feeling like my original doctor wasn't understanding my concerns as a woman. She referred me to a urogynecologist. Immediately, the urogynecologist began making up for lost time. I finally received medical testing to confirm my anal sphincter injury. I never really put a lot of stock into diagnoses before, but hearing her explain my body, draw pictures to educate me, and point out the numbers from the manometry testing that proved without a shadow of a doubt things weren't working right was so incredibly validating. I felt like I had been pressured by work, society, male doctors, and others who were simply uninformed about fourth-degree tears so much that I had begun gaslighting myself into thinking I was making it all up. I felt like I finally had permission to admit I was not okay, and I was not being dramatic. We are subtly and consistently told, “women give birth all the time” and, “our bodies are meant to do this”, and I felt like a failure because mine didn't do this “right”. I felt like my body failed me and was continuing to fail me. But now I could see on paper that I wasn't broken.

It took nearly 4 months for me to be able to sit on a special tailbone pillow for an hour without significant amounts of pain. It took a year and a half before I felt like pelvic floor physical therapy was making any difference. It took almost two years before I could exercise in a way that felt like actual exertion without triggering any painful symptoms. In two and a half years, I saw more than a dozen doctors and specialists as I clawed against a system and lack of information to get my health and life back. Multiple OBGYNs, pelvic floor PTs, colorectal surgeons, urogynecologists, mental health providers, primary care physicians, registered dieticians, chiropractors. In all this, I learned how to advocate for myself and speak up when something feels wrong. I learned to ask a lot of questions, and not let myself feel rushed into making decisions about my health just because it would be convenient for a provider, or for insurance, or for my workplace.

At the time of my daughter's birth in 2020, I was in my final two semesters pursuing a Master of Public Health degree. I had access to medical journals and was preparing to complete a capstone project. The only requirement was that the program proposal benefited underserved populations or under researched health problems. I dedicated the remainder of my studies to drafting a program proposal for an organization that would educate and empower those suffering severe obstetric anal sphincter injuries in the United States because this was a gap I experienced personally. The number of women suffering these tears annually is on the rise and it's just not acceptable that we should be told to mask the smell of sitting in bodily fluids or worry about losing our jobs if we dare to clean ourselves up on the clock. We work hard to bring life into this world. And for those of us who suffer birth trauma and birth complications like me, we are fortunate that we made it through alive where others don't. We deserve to heal and feel whole. We shouldn't have to settle for bodies that are broken in a system that is broken. That's why I'm so thankful I came across SOLACE. As soon as I saw what Caroline started, I knew I wanted to be on the team and help further the mission. SOLACE is everything I dreamed up all those years ago - sitting in class on a special cushion in pain and exhausted holding my newborn - and more. I believe the more people who get involved, the more women who share their story, the more we educate, empower, inspire, research, and advocate, the more lives we can change.