Case Study: Treating Perineal Tears in the Postpartum Body
Perineal tears can cause both physical and emotional scars which can impact your client’s quality of life. Knowing how to work with the body on a holistic level can give you the skills you need to fully address these issues and get them back to feeling like themselves again.
Today’s case study was submitted by a student and Certified Birth Healing Specialist through the Institute for Birth Healing. This case study focuses specifically on the skills and training learned through the Holistic Treatment of the Postpartum Body course to address the postpartum body and support both physical and emotional healing.
Client History and Birth Story
The client is a 30 year old female and is 10 weeks postpartum with her first child. She reports being healthy and active. The client had a 32-hour labor and had to push during two different intervals over a 3 hour period. The lip of the cervix was preventing baby from birthing with the first round of pushing. The client experienced a 4th degree perineal tear. She stated she had hemorrhoids, but reported that they were not that bothersome. She is complaining of pain with intercourse and stated that it “feels like I am splitting in two”.
Assessment and Findings
Upon assessment the following restrictions and imbalances were discovered in the postpartum body. Her liver, stomach, and diaphragm were shifted superiorly. She had an open birthing pelvis with her left ischium superior to the right and more lateral than the right ischium. Her left pubic rami was harder than the right side. Her left ASIS was anteriorly rotated and her right sacral base was superior. She had lower abdominal right sided tightness. She had one finger shallow Diastasis Recti.
The client reported tenderness in her left pubic bone. Her bladder was shifted to the left. She had pelvic clock right lower quadrant tightness. She had a flattened urethra on the right side. There were tight adhesions on the area where the perineal tear occurred and little tissue mobility along the scar line.
External and Internal Treatment
To treat these restrictions and imbalances, the treatment session started with external work. First, restrictions in the liver, stomach, and diaphragm were released followed by a liver and stomach rebalancing. After, the lower abdominal release, uterine release, and bladder release externally were done and decreased tightness in the right side as well as increased uterine mobility.
Next, the open birth pelvis was address and the ischium bones closed from a full hand width apart (approximately 6 inches) to approximately 3 inches apart. Sacral mobility and sacral rotation corrected right sided imbalance in the sacral base. Ischium mobility released restriction in the right ischium. Next, the PSIS and ischium rebalance technique was done with both ischium bones. Pubic rami mobility and pubic bone mobility were also treated.
After the external work, the treatment session focused on internal work starting with the internal release of right lower quadrant tightness. Then, the focus was on rounding out the right side of the urethra and releasing restrictions on that side, guiding the bladder back to midline followed by bringing the cervix back to midline.
I asked the client permission to work on the perineal tear. The client agreed. Slow soothing work was done on this area. The client had some physical tensing and averted gaze. I brought the client back with “bring your breath to where my fingers are”. She was able to bring back her focus and started talking about how scary sex is now and how she feels she is letting her husband down. As she talked, her tissues around the perineal tear had a nice release.
I continued work on the scar tissue from the perineal tear and was drawn to the anal sphincter. I asked permission to work in this area, and we had talked about how this could help with the hemorrhoids. The client agreed to this work. I did the anal sphincter release and my thumb was sucked up to the internal sphincter.
Release Work
The client started crying with the perineal tear work, specifically the anal sphincter release, stating she didn’t know why she was crying. I encouraged her to feel her emotions like a wave and let them wash over her and flow away. I told her “You are safe. You and your baby survived and are safe. It is over. Release all trauma from the tissues.” Tears poured down her face.
Follow Up
I spoke with client the next day and she stated she felt like “herself again.” She said she felt great. I spoke with the client, again, 3 weeks after the session when she texted to say she had intercourse and experienced no pain. She stated she was no longer fearful of sex.
Learning How to Work with the Postpartum Body
There is so much that happens during labor and birth that gets held in the body, both physically and emotionally. The Holistic Treatment of the Postpartum Body gives you 40+ techniques to work with the postpartum body and teaches you how to work with your clients at a deeper level to truly get to the root cause of pain, imbalance, and dysfunction. Check out the first ever online group cohort for this course – the first live group call kicks off on September 30, 2024.
About the Author: Lynn Schulte is a Pelvic Health Therapist and the founder of the Institute for Birth Healing, a pelvic health continuing education organization that specializes in prenatal and postpartum care. For more information, go to https://instituteforbirthhealing.com