Anyone have 4th degree tear & deliver again?? - Page 2

[Erdbeer]

Wow, that's encouraging news. Do you know whether she had hospital births or homebirths?

I am interested to hear whether the women who went on to deliver without tearing delivered at home or in a hospital. My bad experience certainly has me thinking a lot about birthing at home the next time around, and I am not sure I would have come to that idea had I not torn so badly the first time in the hospital. I feel like I was so ignorant the first time around, and just took the doctors' words without a second thought. Well, I learned my lesson.

[doctorjen]

I wanted to throw in another positive story here. I just attended a mama's third birth. She had a 4th degree tear with her first birth, a little girl who was 7 lbs 6 oz. She had a repair after the birth, but then needed reconstructive surgery a few months later. I've attended her second and this recent third birth. Her second child was an 8 lb 5 oz boy, born with no tears at all. And this little third baby was a 9 lb 12 oz boy! Born in squatting position, with no coaching or directing his mother, and mom also had no tears and needed no stitches. So even though baby #3 was 2 1/2 lbs bigger than baby #1, no repeat severe tearing, even though there was reconstructive surgery.

[mom2tillie]

thanks for bumping this...

i am currently recovering from a 4th degree cut and extension and it is hideous... i must say worse than my c-section.

i did so much research and preparation to avoid a cesarean this time around and even hired a midwife and did most of the labor in my pool but caved to pressure from my dh and midwife to go to the hospital even though everything was going great and i was calmly dealing with cx.

midwife attended vbacs are not legal in this state and i think she was nervous that i was actually following through with the birth at home

i arrived at the hospital (an hour away) naked and 8 cm dilated. as soon as started pushing ds heartbeat was deceling and the ob said i needed to get him out quick and he was going to help me out from below, then came the forceps and the cut. he was within 5 pushes.

all that preparation i did, 16 hours of labor and another long recovery.

i have two healthy wonderful kids, i had wanted more... i can handle the pain of childbirth but the long recovery is taking an emotional toll.

my dh is not being very supportive at all and thinks i should calm down and just listen to the doctor. no more of this midwife stuff. so if is did have any more babies i would have to do it in the hospital i am sure or go to war with my own dh.

does anyone have recommendations for subsequent hospital births?

[doctorjen]

My number one suggestion for a subsequent hospital birth would be to pick your provider carefully. Pick someone who doesn't do routine episiotomies, is comfortable with a variety of birth positions, doesn't coach pushing, and isn't in a hurry. Pick someone who will keep their hands off your perineum.
When you are interviewing, ask questions like "what do you do while a client is pushing?" or "what position do your clients usually birth in?" or other questions that require some description and listen carefully to their replies. If you ask things like "do you do episiotomies routinely?" you might just get an "of course not" but then it turns out that they do them a lot, for a lot of different reasons, but just not "routinely" Giving them the opportunity to describe some birth scenarios to you gives you the chance to know what their standard operating procedures are.

[1stimestar]

Yep me. First baby was induced due to severe pre eclampsia at 11 days post dates, 9lbs 2oz and an episiotmy that continued from here to there. I was a mess for a long time. It was horrible how this affected the bonding with my baby. Second baby was a homebirth, only 2 oz. smaller but came on her due date. I was a lot healthier and my tissues were a lot less overburdened with fluids as I wasn't sick. Turns out my babies (neither one) rotated their shoulders all the way so I did have a little tear with my second. It didn't even take stitches though. We just put a little glue on it and it was fine.

[Erdbeer]

Mom2tillie, I'm so sorry to hear what you've been through and I can say I know where you're coming from.
I am seriously considering a homebirth for my second birth (whenever I actually get pregnant!) but DH is against it and I know I'm going to have a struggle with him over what the best thing to do is.

I had a checkup with my gynecologist today and addressed some of my concerns. I told her that we are TTC but I am afraid of tearing like I did last time, and before I could finish my sentence, she suggested I get an elective c-section. That threw me for a loop because here in Germany the doctors are usually pro-natural unless there is some serious reason to birth otherwise. I told her I want to AVOID a c-section and am more afraid of that than of tearing, actually. She was totally against a home birth for me, and said it is too risky because I tore so badly last time. She said with normal perineum tears, it would be OK, but cervical tears (which bleed a lot, and which I had last time around), it is much too risky to birth at home.

I am really disappointed with this news... don't know what to make of it.

[gypsymomma4]

This is my first post on these forums, though I have read them off and on for awhile. This thread stuck home with me, because I tore so badly with my first, that I didn't think I would even be able to have more children much less ever have sex again. My water broke at just over 37 weeks, and when I arrived at the hospital, I was immediatly hooked up to an iv of pitocin, because contractions hadn't started yet-unfortunatly I didn't know any better then to ask them to wait. What followed is kinda of a nightmarish blur. Within the hour I had rolling contractions and back labor. the first nurse told me to calm down, this was only the beginging and left. and hour later, the next nurse told me I needed to have an epidural because I was scaring the other patience with my noise, and although I said i didn't want one, they set about ordering one anyway, as they said, with there being a likely 12 more hours of labor or more, I needed to be being more quiet. about a half- hour later, and they come in to try and administer the epidural, which I still am saying I don't want, they make me get into the bed and get on my side, at which point I tell them I need push. Not really believing me, the anesthiologist, tells them to check, I was fully dialated. My doctor wasn't there, and there wasn't another doctor even around. The nurses all left trying to find a doctor. so I got into a squat position, and the next thing I know my then husband is screaming for a nurse because he can see the head. Some doctor rushed in from the hall, and with not but two more pushes out comes my dd, face up. She weighed 7 pds. 5.4 oz. When my doctor finally arrived, they were trying to give me oxygen, and get me to lay down, the next thing I know, I am being wheeled into surgery and knocked out. 4 hours later, I wake up numb from the waist down. My tears were up through the labia-which had to be completely reconstructed on one side, and up the vagina about 3 inches. As this was nearly 14 years ago, I don't remember the exact stich count but it was over 150. recovery was long and at times painful. I have three other living children now, and am expecting another in nov. I have not torn with any of my other children. They were all born in hospitals, though not that hospital, nor with that doctor. I also know much more know about my rights, and have more confidence in asserting them.

[Erdbeer]

Gypsymomma, thanks for sharing your experiences.
Your tearing sounds similar to mine, I also tore my labia on one side, and perineum, and vaginal walls all the way up to and including my cervix. Recovery took forever and I still get choked up when I think about it.

I wish I could get someone to tell me that this happened as a result of the epidural and pitocin I was given, so that I can move on with more confidence in my own body. Still, I have never been able to get a straight answer from doctors who have examined me since as to how this could have happened, and until I do, I am not sure I am going to be able to fully relax next time around. That's because I still have this bit of doubt and wonder whether it was a total fluke, and I would have torn with or without pitocin.

The good news is the doc tells me I have healed up wonderfully and my scar tissue is very elastic, even more so than some women who have never torn.

[mothercat]

Went through this this week with a client. Not a big baby and the initial tear started just as the head was visible. There was a nuchal hand but the damage was done before that came into play.

We transferred to the hospital for the repair and the doc with no bedside manner told her that the next baby "should only be born in the hospital, only with an OB, and only by C/sec". This from a man who had a 35% C/sec. rate 10 years ago.

This baby was a VBAC and mom told me later that if C/sec was her only option, she wouldn't be having more babies. The pain from the repair and recovery were so much more tolerable than what she had with the C/sec. We had a short discussion on the need for lots of protein and close attention to nutrition to help the tissues heal well and strong and provide elasticity for the next birth.

[cathicog]

Originally Posted by tsume

Both born in the water (a 'proposal' squat and full squat) and both times my body pushed on it's own without me deciding t push at all. My hands were supporting my perinium as my girls were born into my hands.

Both times were about a 30 minute pushing stage. My second my body pushed 3 times (with me snoring between by body pushing) when her head came out. My third it seemed like my body beared down the whole time until her head came out.

I think waterbirth is key to not tearing. (that, and "breathing the baby out"). I know a lady who had her baby at a home waterbirth, and it was over 12 lbs, and she didn't tear at all! But even if you birth on land, so to speak, you can use hot/warm compresses on your yoni and that will help warm it up and stretch it out well...

[cathicog]

Originally Posted by Erdbeer

I told her that we are TTC but I am afraid of tearing like I did last time, and before I could finish my sentence, she suggested I get an elective c-section. That threw me for a loop because here in Germany the doctors are usually pro-natural unless there is some serious reason to birth otherwise. I told her I want to AVOID a c-section and am more afraid of that than of tearing, actually. She was totally against a home birth for me, and said it is too risky because I tore so badly last time. She said with normal perineum tears, it would be OK, but cervical tears (which bleed a lot, and which I had last time around), it is much too risky to birth at home.

I helped a lady many years ago and she tore a little in her cervix(was pushing and there was a lip and niether of us knew it) but she got it stitched up and went on to have more children with no problem. Cervix is muscle, and can heal just like any other muscle.

For the optimum birth experience with least pain (usually) I would do a waterbirth, at home. Or in a hotel, if for some reason you couldn't be home. But first you would have to convince your hubby....and that's the rub.

[MommaLauraRN]

I had a 4th degree with my first...emergency forceps for a prolonged decel (I'm an L&D nurse and it's truly one of the worst strips I've seen--great looking baby with good variability and accels then with my very first push went down to 50-60 and flat...didn't resolve with any of the usual intrauterine resuscitaion measures, my CNM backup MD delivered me. He cut an epis and did forceps, I pushed with 7 contractions and it was 18 minutes from first push to delivery, and only one big push with the forceps applied. I broke my tailbone having him. I had a great repair that healed well, the only pain was from my tailbone and that lasted for months. My CNM said I did the strongest 6wk pp kegel of any patient, nevermind having healed from a 4th degree. (I had a fundal placenta and a baby with a short cord and I was a great pusher which caused all that excitement apparently!)

With my second, he was only 3 ounces bigger (9-4) and I pushed well again, but he had the perma-crown-he literally sat on my stretched perineum for 45 minutes of pushing. My birth photos clearly show the thick white strip of scar tissue from my first delivery/repair that was not going to stretch anymore. My midwife didn't want to cut an episiotomy and had her backup MD come in to assess. (They were doing hot wet compresses and oil all along too) The back up MD didn't want to cut me either so I kept pushing and he didn't budge. Finally they decided they needed to cut that band of scar tissue and I pushed him out with two more pushes. My CNM and her backup (both awesome ladies btw) supported my perineum and this cut didn't extend, it was a second degree that again healed well.

I don't know of too many of our patients who have a 4th degree tear, and I've never heard of one of our patients having a repeat 4th degree. I wonder if the doc had done forceps without cutting an epis if it would have been any different...I'll never know!) I would not have considered a primary c-section even with my history of 4th degree/fractured coccyx/large baby--I actually even had a doc who would have done a vag del if he had stayed breech (A wonderful old doc who has been around awhile!)

[redsoxdoula]

I had a repeat 4th degree. My response to the second birth/recovery was very positive and it was a very beautiful birth. We are not planning on more children but if we were surprised with one more, I wouldn't want to go through with a c/s, but I know it would be important to consider it. I won't lie;it COULD be an option. To be totally honest, I have heard more stories of sucess with previous 4ths than stories, such as mine, with repeats. You just don't know what can happen. Controlling the birth is impossible...ask yourself the hard questions though. If (and that is a very big "if") you tore to a 4th again, would you be disappointed. Look, I didn't want another 4th....but I went through a very lengthy process of accepting whatever happens before the birth took place...and with that surrender/acceptance I found complete joy in my birth...Dad even got to catch the 10pound 12 ounced baby! So as nuts as this might sound...give another vagianal birth a try! I am really glad I did.

[1stimestar]

Originally Posted by Erdbeer

I wish I could get someone to tell me that this happened as a result of the epidural and pitocin I was given, so that I can move on with more confidence in my own body.

Actually they ARE both factors that contribute to increase tearing.

[tlcdoula]

I didn't have a tear, but did have an episiotomy with my second child that they said was a fourth degree (he was born 18 yrs ago when episiotomies were standard care). With my next child who was 2 lbs lighter I had another episiotomy (still in a time when they were pretty standard as care) and then went on to have four more with nothing - no tearing, no episiotomy (thanks to a different care provider who no longer believed in them). I am currently pregnant with my 8th child

In all honesty it was never suggested to me to have a cesarean and I have had four different healthcare providers over the years and am on my fifth (loved my last doctor but she is no longer catching babies).

[Erdbeer]

Redsoxdoula, I know it's been a while since you posted, but maybe you'll see this and respond...

Just curious about your second birth- were you in the hospital? What was the birth like (water/not?, position you were in? precautions to prevent tearing again? Epi/pit?).

I ask because I'm now expecting in the beginning of March and have received so much differing advice about how to avoid tearing next time... consistently I've heard to spend a lot of time in the water, don't get an epidural/pitocin, and try a side-lying position.