Wednesday, December 23, 2009

Reply To Alyce

Anonymous said...

Dear Dr Jason,

I delivered my baby March this year via natural with forceps. My baby weighted 3.7kg at birth.

Until now my Episiotomy wound/scar is still pain every time I move my legs apart or squat down. FYI, my doc tried twice before managed to delivered my baby with forceps. I remember the 1st attempt, I was pulled down the bed. Could this be the reason my wound still hurts or this is normal?

I always wanted to know what is the standard/maximum diameter of the baby that can successfully pass through the birth canal? My baby head circumference was 34cm at birth.

Thank you and have a nice day!


Forceps delivery


Hi, Alyce,

Sorry for my late reply due to tight schedule.

Let me summarise your problems:

1) Unpleasant birth experience caused by forceps delivery.

2) Persistent episiotomy scar pain despite more than 6 months after delivery

Forceps delivery is more traumatic due to extensive injury to your birth tunnel. Sometimes, the episiotomy wound is extended to become longer in forceps delivery due to the extensive tear in the skin and muscle. Therefore, the duration of recovery is longer than expected in the extended episiotomy wound.

However, your childbirth is more then 6 months now. I expect your episiotomy wound is completely recovered by now.

There are few possibilities to explain the persistent pain:

1) Extensive scarring in the stitching site and caused the vaginal tunnel to be narrowed and distorted. In this situation, you may have pain as well during sexual intercourse with your husbnd.

2) Injury to the symphysis pubic joint due to the size of your baby (3.7kg) and forceps delivery.

Symphysis pubis is a joint between 2 pelvic bones

3) The pain maybe psychologically related to the unpleasant forceps delivery. The unpleasant birth experience left a bad memory to you and you relate your bad experience to the pain in your private part.

To determine the cause of pain, you need to visit the gynae doctor again for detailed examination.

In my own practice, I usually encourage my patient to go for Caesarean delivery if the predicted birth weight is more than 4.0kg.

If the predicted birth weight is between 3.5kg to 4.0kg, I will NOT perform forceps / vacuum delivery if the labour is prolonged. Usually I will proceed to emergency Caesarean delivery to prevent complication.

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