Ezra’s Story

"You're leaking." "What?" I said, as I gazed at the ceiling in my midwife's office. Just two weeks earlier, I had given birth to my first baby at home. The labor was quick and intense. We had waited to find out the gender, so as I helped pull him out of the water, I breathlessly pronounced that my 9 lb 9 oz baby was a boy. Exhaustion and weakness set in. I don't really remember being helped into my bedroom during the hemorrhaging. A shot of Pitocin in my leg, an IV drip in my arm, and the black clouds in my vision started to clear. I lay on my bed being stitched up and heard my midwife tell me that I had torn a little more than she thought, and the tear extended to my rectum. This is the story of my journey with a fourth-degree tear and rectovaginal fistula.

The two weeks since I had given birth had been awful. I was exhausted, overwhelmed, and in pain. As I sat in my midwife's office, I asked her what she meant by saying that I was "leaking". She proceeded to tell me that I had a small hole between my vagina and my rectum, causing me to leak fecal matter through my vagina. She then told me that she might be able to fix it by stitching me back up again in her office. At twenty-two years old, for the second time in two weeks, I was stitched up. I had wondered why I felt like I could never get clean, but everything was so sore, I just thought it was part of healing from having a baby. I started leaking again almost immediately. My midwife referred me to a local urogynecologist, and I was told that sometimes these things just happen, but that this doctor would be able to fix everything. It was Christmas, so I had to wait a couple of weeks to be seen. I traveled, celebrated, and for the most part looked like everything was fine. I carried around baby wipes everywhere, thankful I had a baby to conceal the other reason why I needed them. I just wanted to be clean. I never felt clean.

During my first appointment with the urogynecologist, I was told that I needed surgery. In the previous few weeks, I kept hearing the word "procedure" from my midwife and thought this was something simple that could be fixed in an office. The doctor offhandedly told me that if I had any more children, I should have C-sections. I went into the bathroom and cried.

Anxiously, I waited for the nurse who scheduled surgeries to call me, but the soonest they could operate was in two months. While I waited, I spent some time searching the internet trying to figure out what had happened to me. I finally figured out that what I had was called a rectovaginal fistula, but I only found information about women in developing countries who had experienced this birth injury.

After I woke up from surgery, I was told that the damage had been worse than the doctor had thought, and he had to do a sphincteroplasty as well as the fistula repair. The recovery was more painful than right after I had given birth. I went home the same day and went right back to caring for my baby with the help of my husband.

Four weeks after surgery, I realized I was leaking again. I was scared, confused, and so anxious. My doctor told me that it must be the stitches dissolving because he could not see a fistula anymore, but I knew that wasn't true because I recognized all the symptoms. He gave me estrogen cream, told me to take fiber, and that it would hopefully close on its own. After a couple of months of no results, he tried an expensive experimental shot. For two weeks, I didn't leak; I even told a couple of friends that I thought I was healed. But I started leaking again, and eventually I gave up. I was tired of seeing doctors, I was scared to have another surgery, and I just wanted to rest from it all.

My family moved across the country, and I got used to living with a fistula. My first surgery had made the fistula much smaller, and it was bearable. It was still annoying, but many people live with things much worse. I found a Facebook group called "Living with Obstetric Fistula". It is a group of women in developed countries who live with obstetric fistula, typically from severe tears. Many of these women have had multiple surgeries, some have ended up with colostomy bags, and some have been healed. I followed all the obstetric fistula non-profits on Instagram. I was encouraged by the healing of other women and loved to see the work these organizations did. I also decided that if I ever did attempt another surgery, I wanted to find someone who had a lot of experience with obstetric fistula repairs. That's when I found Worldwide Fistula Fund. One day, I saw a picture of Dr. Richter doing work in Africa and saw in the caption that she also worked in Birmingham, AL. After a consultation visit, we scheduled surgery. I remember her holding my hand as the anesthesiologist put me to sleep. My surgery went well, and this time I stayed overnight in the hospital and was given specific instructions for post-operative care. I was no longer nursing, so I was able to recover at my parents' for two weeks while my husband looked after our family.

I spent about a year and a half fistula free. With the blessing of my surgeon, I had my next baby about one year post surgery via c section. She was beautiful and so much smaller than my wonderful first born son. As much as I grieved the natural home births I imagined I would have with all of my children, recovery from the c-section was actually easier than recovery from my natural birth that wrecked me. A few months after my first daughter was born, I realized I was occasionally leaking again. As far as I can tell, I probably have some granulation tissue that builds up to cover my fistula and then occasionally breaks down after a lot of pressure from pregnancy or a bad cold (blowing my nose a lot).

It truly does not bother me any more, I feel extremely blessed that I am not in pain and I am used to the small annoyances my fistula occasionally brings me. I do not typically have any problems holding bowel movements except in very rare circumstances.

Nearly eight years have passed since I gave birth to my first born, my son. He is still a very big boy and I can't wait to see the amazing man he will grow into. Since then, I have had two baby daughters via c-section and both deliveries have gone perfectly well. As I type this, I am scheduled to have my third c-section with my fourth baby this week. Every time before the delivery of a new baby, I remember that twenty-two year old girl who felt like her body failed her. I remember other women telling me that they pushed out ten and eleven pound babies "with no tearing at all!" Though I am no longer drowning in it, I do grieve the births I thought I would have with all of my children. Sure, I could try again and maybe things would go perfectly well. I still think home births can be great for many people, but education on what can go wrong and having a good plan for that is exceptionally important. I feel convicted that after several doctors' opinions, c-sections are the safest way for me to grow my family and protect my body to be able to care for my other children. I am about to have my fourth child and vaginally have already been stitched up four different times after one vaginal birth.

I have exclusively breastfed, I have had to bottle feed, I have had a planned home birth, I have had scheduled c-sections. None of these things make me a "successful" or "unsuccessful" mother. I have hoisted around tantrumming two year olds, I have trained for races, I have had a healthy, loving marriage (though we did struggle after injury, but that is a story for another time.) If you have suffered a traumatic birth injury, you are not alone. Your body did not fail you. You did not do anything wrong. We live in a world full of pain and suffering and sometimes birth does not go the way we wish it would. I pray you are healed, but that most of all you can see all the joy that still is to come.

"The world is indeed full of peril, and in it there are many dark places; but still there is much that is fair, and though in all lands love is now mingled with grief, it grows perhaps the greater." - J.R.R. Tolkien