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Peer support for 3rd and 4th degree tears

This week's blog post is a companion to Season 2, Episode 3 of the Mother Wit Podcast. If this topic is of interest to you and you haven’t listened, do so now and then come back to this after hearing Katrina's story. These are suggestions based on her personal experience. This is peer-to-peer support but I can honestly say that I stand behind every suggestion she has made. Just know that there is no one-size-fits-all solution and these are merely suggestions, things to try if and when your well has run dry.

For those of you who may be reading this and are still pregnant, especially with your first baby. Please know that 4th-degree tears are rare, and you don’t need to read on if it doesn’t feel right for you. However, I think it is important that people understand why you should build your team, and your circle of support, because you can’t foresee your future no matter how hard you may try. While most labors and births are straight forward, decisions and plans we make (or don’t make) impact us, our experience, and outcomes and sometimes, our planning and decision making had nothing to do with the outcome. So, if you are planning a pregnancy, currently pregnant, recovering from your birth or planning another birth, this way of thinking about things may (or may not be) applicable to you.

In my opinion, Katrina is uniquely qualified to provide advice on this topic, not only because she has navigated this but because she works in healthcare, specifically the improvement of healthcare experiences and outcomes. Meet Katrina.

4th degree tear tips

Medical Follow Up and Pain Management:

  • Insist on being seen by your provider as needed BEFORE the six-week mark.

  • Be honest with your care team about your pain level. They have strategies to help get your pain under control and they won't give you too much!

    • Be sure to ask about options for short and long-term pain medication options.

  • Consider a postpartum doula.

  • Bring in other specialists as needed.

Depending on your symptoms, you might consider consultations with gastrointestinal/colorectal specialists, urogynecologists, mental health therapists, Pelvic Floor PTs, etc.

Social Media Considerations:

  • Find online support groups.

    • Since 4th-degree tears are so rare (occurring in approximately 1% of births) I didn’t know anyone directly who had experienced this.

    • The “4th Degree Tear Support Group” on Facebook is a treasure trove of support and resources. This group was pivotal for me feeling less alone.

  • Don’t google too much about your injury.

    • I outsourced this task to my mom. She has a medical background, and I was too fragile to comb through the details myself in the early weeks. She was able to research and share parts of what she learned with my husband so they could better support me. They would share with me only the parts that were appropriate for my stage of physical and emotional healing.

  • Curate your social media feeds appropriately.

    • Unfollow pregnancy/birth accounts that are triggering. Some of the accounts that provided me with great insights for pregnancy became very triggering in postpartum.

    • If you don’t want to unfollow the accounts forever you can “mute” their posts on Instagram, so they don’t come up, while still being able to access the account when you choose.

Essential Recovery Supplies:

  • Stock every bathroom in your house with the essential supplies.

    • Frida mom postpartum recovery kit

    • I did a sitz bath each night

    • I used "Water Wipes"-brand wipes (these were the gentlest on my bottom when I could start wiping again, and I still use these today!).

    • I preferred room temperature water in my Frida squirt bottle since it was hard to get the warm water temperature just right. This was also handy because since I wasn't using warm water, I could pre-fill the squirt bottle after each use and leave it there filled up in my bathroom kit ready to go for the next use.

    • Peeing while in the shower was preferable in those early weeks for me and didn't require clean-up so I would try to time a shower and pee together! :)

  • Soft, gel reusable ice packs were a life saver.

  • Store your tucks pads in the fridge.

    • Keeping these chilled adds an extra degree of soothing comfort. I would line several tucks pads on top of my pad/postpartum underwear.

Positions That Accommodate Your Injury:

  • Get creative with nursing/bottle feeding positions.

  • Use pregnancy and/or nursing pillows for custom cushioning.

    • I rolled my long pregnancy pillow up into coils with a hole in the middle to alleviate pressure while sitting. Eventually, I transitioned to sitting on my daughter’s “Boppy Newborn Lounger”. Basically, I was making a super soft, cushy donut to sit on.

  • Consider babywearing while seated or side-lying (using pillows as needed for support).

    • This allows for snuggling and bonding with the baby but with much less pain than traditional standing/walking and wearing.

  • Be strategic about where the baby and other support people sleep.

    • My partner slept on the bassinet side of the bed because I couldn’t move well enough or fast enough to get the baby in and out.

  • Consider a hammock, if you have access to one.

    • While hard to get in and out of in the early days, this was a very comfortable seated option for me when I had very few comfortable ways to sit or rest.

  • Keep a rolling cart/basket station in positions where you spend the most time.

    • Stock it with snacks, water, remotes, phones, headphones, chargers, etc. to minimize movement once settled.

Self-Care Strategies:

  • Prioritize your mental health.

    • Consider therapy to support your psychological recovery and heal from the traumas that may have arisen for you before, during, and after your birth experience.

  • Keep milestones small.

    • I remember notably the first shower I took without crying and how huge that felt. Take note of any progress, no matter how small (i.e. a short walk without pain for the first time; successful babywearing for the first time, etc.).

  • Find small ways to pamper yourself.

    • Since I couldn’t take baths in early recovery, I discovered shower steamers (like bath bombs for your shower). I would dim the lights, light a candle, and use the steamer to create some moments of solace.

  • Eliminate unnecessary chores and delegate newborn care tasks.

    • Use paper plates for a little while.

    • Have your partner/support team take over the changing of diapers, stroller walks and babywearing.

I sincerely hope that you find these tips helpful. If you have experienced a 3rd or 4th-degree laceration and would like to speak to me, please send me a request through Instagram @kphurricaine, and in your note, tell me that you listened to this podcast episode. I would be happy to speak with you.

With respect,

Katrina Fields


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