University Hospitals Womens Health Launches Enhanced Recovery After Delivery Clinic

ERAD clinic to address care of healing complications after vaginal delivery

UH OBGYN Update | June 2022

Maternal birth injury and traumatic deliveries are common, but often they are not discussed. These can leave women suffering from pelvic floor disorders during a time that can already be a complicated mix of joyous and stressful. Despite bothersome symptoms, often these healing complications go unrecognized in the immediate postpartum time, which can lead to long term pelvic floor disorders.

Anne Sammarco, MD, MPH

Some common maternal birth injuries include third and fourth-degree tears, which are also called Obstetric Anal Sphincter Injuries (OASIs) because they damage the anal sphincter. These are prone to infection and complications with healing, and can leave women with difficulty controlling stool, gas, and chronic pain. There are a variety of other pelvic floor disorders that can arise after a delivery including urinary leakage or difficulty emptying the bladder, pelvic organ prolapse, and fistulas, which are abnormal connections between the vagina and the bladder or rectum.

To address these issues, Anne Sammarco, MD, MPH, OB/GYN-Female Pelvic Medicine and Reconstructive Surgery, has created the Enhanced Recovery After Delivery (ERAD) clinic. “These birth injuries and pelvic floor disorders can be embarrassing and difficult for patients to discuss. In the postpartum period, there is often so much going on with the infant and the expanding family that women sometimes put their own needs second. This clinic is designed to focus on healing and recovery after a traumatic delivery, in order to identify and address problems early. Delayed diagnosis and treatment leads to decreased quality of life and sometimes harder to treat problems down the road. Our mission it to expand knowledge and care to women in some of their most vulnerable times.”

Purpose of Enhanced Recovery after Delivery (ERAD) Clinic

• Early identification of OASIs and other postpartum healing complications including wound breakdown, infection, poor healing
• Early intervention
• Early opportunity for Edinburgh Postnatal Depression Scale screening in patients who have had a traumatic delivery
• Counseling for future deliveries, if applicable
• Return to routine OB/GYN care

Who We See

• Any 3rd or 4th degree perineal laceration (OASIs)
• Complicated tears
• Urinary incontinence or retention
• Bowel leakage, including gas and/or stool
• Rectovaginal fistula
• Vesicovaginal fistula
• Infection and abnormal healing
• Pelvic organ prolapse
• Painful intercourse
• Continued perineal pain after delivery
• Other healing concerns within 1 year of delivery

When and How to Schedule

• Located at UH Ahuja Rainbow Center for Women and Children (Midtown), 3rd Friday of each month
• Patients should be seen within 2-4 weeks of delivery
• All other referrals within 1 year of last delivery