My Natural Birth after Rectovaginal Fistula: a Redemptive Birth

My Birth History

Now, my first and second births couldn’t have been more different even though they were both natural hospital births. My first baby was under 8 lbs, but my second over 11. My first birth was filled with an endorphin fuelled haze and progressed beautifully. The second labor stalled. I had a very natural-minded nurse and midwife with my first birth who gently coached pushing, but my second had nurses prompting me to push very aggressively and quickly. I got a second degree tear in my first birth. But my second birth resulted in a fourth degree tear. That’s the most severe, and it was accompanied by a hematoma that had my OB struggling to stitch the repair properly. That hematoma ended up contributing to something that is pretty rare in the Western world’s modern birth climate: a rectovaginal fistula. Without getting too into it, if you’re unfamiliar with the injury, this is essentially a hole between the rectum and vagina, and, as you may imagine, comes with a host of uncomfortable and embarrassing symptoms.

When my baby was about 4 months old, I underwent surgery to repair the fistula. Unlike many women in my situation, I was very blessed with a wildly successful surgery that healed beautifully. There were minor symptoms remaining that are very common with those who have suffered a Fourth Degree tear, but none of the RVF symptoms remained. I was so grateful. I still thank God frequently for the absolutely amazing surgical team and relatively easy recovery. I started considering a natural birth after rectovaginal fistula with my next baby, but I didn’t know if it was even an option.

Pregnancy after RVF Repair

I waited a little longer to attempt to grow our family than I would have had I not had a RVF (rectovaginal fistula). I didn’t get pregnant until Logan was two. The pregnancy was pretty normal, but I had a lot of pelvic pain (which I also had with both of my other pregnancies, although more with my second). I wondered if this was a sign my baby was going to be big again, but my OB didn’t seem overly concerned. We had a lot of conversations about what happened with my previous labor and delivery, what could have gone differently, and how we could learn from those missteps for the next birth. Pros and cons of each type of delivery were discussed in depth, and he inspected my repair.

Ultimately, it was my choice on what type of birth I wanted, he said. But he thought I could definitely be a candidate for another vaginal delivery. If a natural birth after rectovaginal fistula is something you desire, I definitely recommend making sure you have a provider who will support it. Which, honestly, is probably going to be very hard to find. I had a unicorn of an OB, and he’s extremely supportive of physiological childbirth. Your provider is going to make or break your birth plan, whichever you choose, so choose wisely.

Preparing for a Natural Birth after Rectovaginal Fistula

I did make sure to prepare as much as I could for this natural birth after rectovaginal fistula. Chiropractor care throughout the pregnancy was wildly helpful for the pelvic pain especially. Throughout my third trimester I consumed Red Raspberry Leaf tea. I purchased some evening primrose oil and did my perineal massages (don’t let the name fool you- they’re not pleasant), and learned the miles circuit. At the end of pregnancy I focused on pelvic floor exercises, practiced breathing, and a lot of visualization.

I opted not to have an ultrasound to determine baby’s size. This might surprise a lot of people. I fully intended to at first, but as I got further along in pregnancy and got more confident in my decision to birth naturally, I just didn’t feel the need to.

Also, it was very important for me to hire a doula this time around. This gave me a lot of confidence. With both of my previous births, i learned that the nursing staff will make or break your birth experience, and I wanted someone to help guide the nurses if necessary. I also signed up to have her bring a birth pool to the hospital and requested a hospital room that could accommodate that. The pool didn’t even get set up or filled up before baby came, but I’m getting ahead of myself.

Labor History

With my second, however, I was 38 weeks when I eventually delivered. I was in prodromal labor off and on for 3 days before the real thing kicked in. I also realized, after the fact, that I had a slow leak in my waters and it had probably been leaking for a full day at least before he was born. Whoops. At the peak of Covid in December of 2020, we finally headed into the hospital. Then things stalled after a few hours of labor. My nurse kept wanting me to get pitocin, which I didn’t want to do unless necessary. My OB didn’t think it was needed, but offered to check my dilation. I agreed, and my water burst when he did. Things picked back up, and Logan was finally born after a couple more hours.

Going into Labor

Because my labors were so different, I didn’t know how this one was going to go. Unfortunately, it started out a lot more like Logan’s than Claira’s. I hoped this wasn’t a bad sign, but kept my breathing and rested as much as I could. I had days of prodromal labor once again, also at 38 weeks. I just hoped it wouldn’t be weeks of “false labor” like I’d heard some women experienced.

I rested whenever I could, but also practiced the miles circuit periodically. I also walked and showered to see if that changed my labor patterns. Once things started feeling a little more “real” I called my OB who suggested I wait just a little longer. It just didn’t seem like the contractions were intense enough yet. Once they were intense and frequent, I called back and he said to go ahead and head that way. I live over an hour from the hospital, and it took about an hour to get the kids squared away before we left.

My Doula had given me a comb to squeeze to help with labor pains, and I swear that’s the only thing that got me through that car ride. Contractions were getting intense. I was starting to get vocal before we even left the house. This had my husband a little concerned because I didn’t usually get that vocal until it was close to baby time.

At the Hospital

Once we arrived to the hospital, I was the only one on the floor. I had some amazing nurses who were very supportive of unmedicated births, and that makes all the difference. They were attentive but also left me to it, which was a fantastic balance. When we got there I asked her to check my dilation to get an idea of my progress; I was about 5 cm dilated. I had honestly hoped I was further along based on how I was feeling, so I settled in for what I thought would be a lot longer.

My Doula got a flat tire on her way to the hospital, so I labored alone with the nurses and my husband. He was great at getting me anything I needed. I was really starting to question my decision to do this again after a short time. Things were just so intense. In retrospect, I was definitely in transition. It came a lot sooner than I expected!

Then I started feeling “pushy”. I surrendered into my contractions, but didn’t actively push. Even though I was starting to feel an urge to push, I didn’t feel the tell-tale pressure that tells you that baby is coming. This mirrored how I felt my first labor, and I just thought I had a while to go. My Doula still wasn’t there with the birth pool, but she had texted my husband that she was close. The doctor wasn’t there, yet, either.

Controlled Chaos: my natural birth after rectovaginal fistula

Suddenly, I felt an uncontrollable urge to push while I sat on the birth ball. And my body did. Purely on reflex, my body pushed and my water broke. My husband call the nurse, and when I stood up, I felt her. Baby was coming. Now!

I gripped onto the side rails of the bed. I focused on deep breaths into my stomach through my nose, and slowly out my mouth. “My body was made to do this. I can do this,” I repeated over and over again. I felt her crown. My Doula texted my husband that she just parked, and he told her not to worry about bringing the pool.

The nurses helped me onto my knees as the on-call doctor rushed into the room and gloved up. I continued to breath. Positioning my knees inward, feet out, to create space, I focused on pushing gently and slowly.

Once her head was out, the on-call doctor urged me to push a little harder than I had been. I didn’t want any coached pushing, so they tried to be calmer than my previous experience. But they still coached pushing this time around. I did as they asked but made sure it was not “purple pushing.”

Josephine has arrived!

With one final push, I felt the sweetest relief as Josephine entered the world. The nurses helped me turn over as they laid her slightly purple (and huge!) body on my chest. I was a little concerned about her coloring, and she was a little floppy, but nobody was panicking, so I stayed calm. The nurse helped me to stimulate her, and she gave a big beautiful cry as she slowly turned pink. With a tuft of dark hair, and the sweetest sleepy face, she immediately latched on and started nursing like a champ.

I was in awe. That was such a calm, controlled, and miraculous delivery. It made me fall in love with birth all over again. My natural birth after rectovaginal fistula was the most beautiful redemption of my previous experience, and my husband and I just stared at each other wide eyed as this sweet little baby snuggled on my chest.

My doula walked in the room just as they were discussing clamping the cord, and she immediately jumped in to make sure I was ready for that. She wasn’t with me during my labor or birth, but preparing for my natural birth after rectovaginal fistuala was so much less stressful knowing I had a doula. The on-call doctor and nurses were inspecting for tears as my OB walked in.

“You’re just in time for the repair!” the on-call doctor said cheerily, and he froze mid-step. “It’s only a second degree,” she assured him and he let out a sigh of relief. He had been so worried that he had possibly advised me wrong.

Conclusion about a natural birth after rectovaginal fistula

In my case, the fistula was very large and low lying. It was repaired well, and my OB actually believed that the manner in which it was repaired reinforced the tissue to help prevent a worse tear. Someone else’s situation may not be the same.

I’m not a medical professional, and I’m not trying to sway anyone one way or another. I am simply a mom passionate about physiological birth who has experienced wonderful births as well as physically traumatic births. And I hope my story can help someone else somehow.