The Sad Reality about Perineal Laceration of Fourth Degree

One day, as I was leaving the hospital, I felt that for some reason I should take another path to the entrance than I usually do. In doing so, I suddenly met a woman who was just standing there. I felt that she was in a great deal of pain. I softly put my hand on her arm and asked her what was going on. She started crying terribly. “My life is over” she cried. “I’m very, very sick”. Tears and tears kept coming. I softly asked her if she could tell me what had happened to her. “It’s since I gave birth”, she told me. “I’m handicapped now, my life is a mess”. She sighed and the tears continued.

“Oh” I thought by myself. I understood. I asked her if she had torn down there while giving birth. “Yes” she replied. “My life doesn’t make any sense anymore. I feel like I’m failing. I would just like to give my son to someone who deserves him”, she cried painfully.

This shows the sad reality of a perineal laceration of fourth degree.  Women suffer from not being able to go to the bathroom in a normal way. On the one hand they suffer from the pain, on the other hand they have to endure the fact that oftentimes stool comes through the vagina. Also, being intimate with a partner is almost impossible.

These women do not only suffer from their traumatic birth experience.  They are faced with pain and a body that doesn’t function in a good and normal way anymore on a daily basis. Psychologically a perineal laceration of fourth degree oftentimes impairs a woman’s self- esteem, her self- image and her self- worth. Many of those affected show signs of depression.

The woman kept crying. “I’m not a good mother. I cannot be there for my son. It would be for the best if I gave someone else so that he will receive all the love that he deserves!”

She had been to a checkup at the hospital after having been operated on once after giving birth in the public hospital. Nevertheless, she was still suffering from the same symptoms as she did before the surgery, which hadn’t worked.

A doctor had offered her to try again at one of the private clinics for an approximate of $1000.

There was no way that she could afford that amount of money. She was a very poor woman from La Moskitia and was now living in La Ceiba in a small house with about 10 other people. Even if she was able to get this much money, she could never be sure of the results of said surgery.

As fate would have it, a very good gynecologist in La Ceiba had just told me that he would start doing one pro-bono surgery every month in emergent cases. He wouldn’t charge the patients for their stay in the hospital, any medicine they might require or for his time working. All he had to do was pay the anesthesiologist who charges about $100.

Therefore I told the woman about a good doctor who might be able to look at her and do the surgery.

Two months later she finally called me. I was able to get her an appointment with the doctor the very next day. Ten days later she received surgery. Her rectum had already adhered to her vagina. The surgery had been very complicated but in the end it had worked out.

As a result she is once again a very happy woman. One month after her surgery she hugged her doctor and told him the following: “You gave me my life back.”

She also called me to tell me that she would never forget what I did for her. She is now a very happy Mom, who has a real chance to live a normal life. She has a wonderful husband. Her family really stands the chance to have a real future!

Still the question remains, how many women suffering from that kind of condition never get that kind of opportunity for help?

At times there is at least one new laceration of fourth degree in the public hospital every other day. Combined with the tropical heat it oftentimes leads to infections.

For this reason we will start a new program for interns, residents and fully trained doctors. Dar a Luz will be organizing the stay here, accommodation and Spanish lessons if desired. The main part of the time will be spent in the public hospitals. On top of that these volunteers will be invited to the pro- bono and to other surgeries of the doctor. The cost for this new program will include the $100 that is needed to pay the anesthesiologist. It will help to make those free surgeries a reality in the future.

Another important goal for the future is to focus more on the overall protection of the perineum during childbirth. We already gave a small workshop on this topic.

But it also has to reach every single medical student, intern, doctor and nurse, which will be a lot of work!

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