Homebirth midwife didn't suture; mom needs colostomy

I've written before about homebirth midwives who don't know how to suture and therefore tell women with serious perineal tears that they don't need stitches. Here is an example of the terrible result:

I gave birth at home to a beautiful and healthy 8 pound 4 oz baby in Feb. 2012... After birth I had fecal incontinence (gas) but thought it was really because of the stretching of the muscles after birth. Right after birth my two midwives checked me and said it was just 2nd degree lacerations and that I was ok, no need to stitch, just keep my legs together and it will heal by itself.

As I've explained previously, major perineal tears will not heal by themselves:

A torn sphincter will not heal itself because the torn ends are usually far apart from each other after the muscle fibers retract. The superficial layers of the tear will heal and it may look like everything is normal, but the woman will not be able to control her bowel function and will definitely need an involved surgical repair under anesthesia.

The story continues:

Four months later, I went to the OBGYN because I thought there was something wrong with me. The opening was just too big and literally I dont have a perineum.

The obgyn told me I had 4th degree lacerations and I needed a procedure called sphincteroplasty and that I would never be able to have any babies vaginally any more. I left the office crying hysterically and called my midwife. I told her that didn't sound right and she agreed, that Dr. must've been wrong. My midwife referred me to another MD, that was midwife friendly.

But the result was the same:

I visit the referred MD and he agrees that I need a sphincteroplasty and referred a colo-rectal [surgeon]. I go to the colo rectal. Not only I have a 4th degree laceration that needs to be repaired with an sphincteroplasty but also a recto-vaginal fistula. In order to have success in this delicate surgery I need to previously have a colostomy surgery before the sphincteroplasty surgery, to open the colostomy and after to close it in order to divert the feces from the area of the surgery, to avoid infection...

What is a 4th degree perineal tear?

A fourth degree tear extends down from the bottom of the vagina, through the tissue separating the vagina from the rectum, through the sphincter (muscle) that controls bowel continence, right through into the rectum itself. The result is that the vagina and rectum form one continuous space.

Why was suturing absolutely necessary?

... [B]ecause the rectum itself has been torn, the possibility exists that the tear may heal improperly and leave a hole (fistula) between the vagina and rectum with consent leaking of feces from the vagina.

That's exactly what happened to this unfortunate mother. Now she needs 3 separate surgical procedures: surgery to create a diverting colostomy; surgery to repair the rectum, rectal sphincter, and entire perineum; and surgery to reconnect the colon diverted in the colostomy.

As the mother explains:

Recovery time is 4 months or more depending if there is no complications. My family is all abroad, I am by myself SAHM, I am 29 years old and my baby is 5 months old. I'm not going to be able to take care of him while I'm having all these horrible procedures because my midwife couldn't identify that I had a 4th degree tearing...

Moreover, all future births will need to be C-sections because a vaginal delivery would destroy the repair.

The mother feels devastated:

I am soo sad and upset, I have been crying for the last week. Every time I see my baby I wonder about the risk of undertaking this type of surgeries... I don't want to have a colostomy for 2 months. I don't want a scar in the middle of my stomach. I have never had any kind of surgery. This is all very unnecessary. If she could've just identify my 3rd-4 tearing and take me right to the emergency room I wouldn't be tonight telling you this horror homebirth story.

I was sold on the homebirth movement, not anymore. Go with ... a professional that can identify the type of laceration you have, one who can identify emergencies and finally a professional that keeps your perineum intact. Your perineum is important in your reproductive life. I'm so lost.

Babies are not the only ones hurt by homebirth.