Dr. Jones: Today, in The Scope studio, we're talking with Dr. Audra Jo Hill. Dr. Hill is a urogynecologist, who specializes in problems with the pelvic floor, the down there that isn't always the same after childbirth. She started a new clinic for postpartum pelvic floor problems. Welcome to The Scope, Dr. Hill. So help us understand a little about this specialty clinic. What made you decide to start this clinic?
Dr. Hill: I think I was going through training and treating patients, I started to recognize unvalidated problem, an unspoken problem that a lot of women experience following childbirth. There's small specialty clinics across the country that really focus on postpartum pelvic floor disorders, but we didn't have anything here in the state of Utah, and helping fix some other problems following deliveries has really motivated me to start the clinic. I find ways to help these women who previously had gone untreated.
Dr. Jones: And they've come to you. They probably came to you even before you formally started this clinic. Is there a story? Is there . . . Not without using anybody's name, but someone who's come, who's had a baby, is overwhelmed, and she can't talk about the fact that either it hurts or she leaks or . . . And it's kind of overwhelming. She's just trying to be a happy mom, but she's not so happy. Is there something that's common?
Dr. Hill: Yes. So following delivery, some women can experience different levels of vaginal tears that can occur. And one story that really sticks out in my mind was a woman who sustained a fourth-degree laceration.
Dr. Jones: That's where the tear went all the way through the muscles around the rectum and into the rectum.
Dr. Hill: Correct. And she was repaired appropriately at the time of her delivery. But about one week later, she called in complaining of increased pain and symptoms of discharge and starting to leak stool through her vagina. And so she presented to my clinic as a new time mom, trying to handle breastfeeding, juggling life, new baby, lack of sleep, but also these problems that were not exactly on her list of following delivery.
Dr. Jones: No.
Dr. Hill: And so we were successfully able to, based on her tissue quality and her examination, to take her back to the operating room on Christmas Eve, and we repaired her vaginal tissues and her rectal tissue so that she was able to be continent. And she now is successfully able to ride her horses, and take care of her baby, and is very pleased that she doesn't have to deal with this as part of her postpartum adventures in motherhood.
Dr. Jones: Wow. You gave her a new year, a brand-new year. We've heard all over the world about the trauma of childbirth that goes untreated. We hear about women with fistulas and leaking urine all their life in Africa or in Bangladesh. But we don't really think about this happening here. And because, of course, we take care of that stuff here, or it doesn't happen here. But it does happen here.
Dr. Hill: Definitely, I think with our more differences is that we have more modern medicine, opportunities to intervene in the vaginal birth process, but the same trauma still occurs. And so women can have, you know, urinary leakage, prolapse or a vaginal bulge after delivery, fecal leakage. And just, you know, those muscles and nerves have had a lot of trauma. And how to help new moms even just understand what happened is a huge part that I think can be very reassuring.
Dr. Jones: Right. It isn't something you usually share with your girlfriends, right?
Dr. Hill: No, this is one of those things that once you start talking about it, it's amazing how many people say, "Oh, yeah, me too. I've experienced that." But it doesn't come up. And, you know, everybody wants to know how their baby is doing after delivery.
Dr. Jones: Right. Well, everybody would share their labor story, how long it was, their pain. They'll talk about how hard they pushed. They'll talk about their breastfeeding problems. But when it comes to down there, they don't talk about it.
Dr. Hill: No. And some people feel it's their price they have to pay for having children, and it's a common thing, and they just have to live with it.
Dr. Jones: Well, you mentioned, as we were talking before we got started, that the resident that was in clinic with you said there are a lot of tears in your clinic. So talk to me about that, about, you know, women who are . . . they're hormonal, they've had a new baby, they just are overwhelmed. Talk about the tears around this difficult issue.
Dr. Hill: As you were saying, it's not necessarily tears of . . .
Dr. Jones: Despair.
Dr. Hill: Yeah. Despair or fear. I think it's a validation and acceptance to tell them this is what happened to you, educating them on their pelvic floor, what this means for future childbearing. Does this change any of their options? Also looking at that telling them, "You're not broken. You're not damaged. You're just different because a baby's been there. And that doesn't mean that this is something that means you're abnormal. You're just differently from your prior normal."
Dr. Jones: That's a lovely way to put it because I always think of a vaginal birth as being a moderately traumatic process from an evolutionary perspective, but I think you've a much healthier way of bringing this process of getting a baby out. That's a good way to put it. Well, can a woman who has these problems call your clinic directly, or do they need a referral from their OB or midwife or a family physician?
Dr. Hill: So I think, though, how we're starting to work on this and, again, there's many bugs as you start to start a clinic is to give our offices a call. And we are currently looking through them to make sure (a) it's one, the appropriate provider for you. Because, again, if it's been three or four years after the delivery, there may be somebody better suited to help treat some of your symptoms. But for right now, it doesn't require referrals because I do not want to hinder patients being able to come in and see us. But primarily, always going back to your delivery and provider addressing these symptoms and concerns and asking, is there anything else that can be done is very helpful because you may not need to come to a specialty clinic. And a lot of these things can be taken care of with your own provider. But if things aren't improving, if there's complications, we are always here to help.
Dr. Jones: Right. There are a lot of women who have either bladder leakage or not being able to empty or your bladder is just not the same, and luckily, sometimes time can help. If women . . . I think women in Idaho who may be far from their own OB and farther from you, but if their own OB can help them understand that things get better. Or they could always call you and say, "This is what I got, you know. What could we do from here?" And sometimes time and things tighten back up a little bit.
Dr. Hill: You are absolutely correct. I think those first six months following a vaginal delivery, there's so much remodeling of the muscles and the tissues, and fluid shifts in the body. And if you're breastfeeding or not, the hormonal status, lots of things can change. And majority of the symptoms actually get better and go away. But I think if they're not getting better, and if you are really bothered and your quality of life is suffering, talk to your provider.
Dr. Jones: Right. Exactly.
