Birth After the "6th Degree"

[adopted0105]

Hi all. I delivered my first baby 8 weeks ago, and my labor and delivery went very differently than what I had expected. After 20 hours of natural labor and pushing for 2 hours, my baby girl was born completely healthy, and I thought that all was well. Unfortunately, however, I ended up with an awful 4th degree tear, which was so bad that I had to have a blood transfusion the night after I delivered. My doc told me that it was the worst tear she or anyone in her practice has ever seen. They actually refer to me now as the "6th degree" tear. She told me that she couldn't figure out why I tore so badly because my daughter was posterior, and my pushing was very controlled. Because of this, she said that she fears that any subsequent deliveries would be the same way and recommends c-section. Now, I'm not planning to have another child any time soon, but I was curious if any of you have had a similar experience. Has anyone else torn very badly and been told that she should have a c-section? And if so, did you deliver another baby, and how did that go? I know that we have plenty of time to think about these things, but I'd just like to hear other experiences. This whole thing has kind of made me feel a little alone because of how horrible my tear seemed to be and the fact that I haven't heard of this happening to anyone else. I'm also a little terrified at the thought of trying intercourse again and am curious about what I should expect in that area, as I'd imagine that it would be pretty painful. But I'm thankful that everything turned out so well, and I'm healing quickly, which is great. Anyway, thanks for reading! :)

[47chromosomes]

I've never had a 4th degree tear, but wanted to offer support, if not insight.  Congratulations on your baby, and I'm sorry about that part of your birth that was not as planned or hoped for.  Sounds pretty scary.  I have had a 2nd or 3rd degree tear (can't remember what it was), in the vaginal canal with my first birth.  It nicked an artery, and was difficult to recover from because it was quite swollen for quite a long time, and then there was lots of scare tissue built up which did make intercourse very painful/not possible for six months.  Finally I went to my doctor about it, and her suggestion was to rub vitamin E oil on the scare tissue to soften in, and to use lots and lots of lubrication (which, really, during breastfeeding is a must anyway).  She also said there was a prescription cream she could give me if need be, can't remember what, but we never did need it.  The Vitamin E massages and lube did the trick, and after a bit it was no longer an issue.  I've never heard of a doctor recommending c-section after a bad tear.  I would get a second opinion about that, and try to not let that recommendation plant any seed in your beliefs about your body.  In a subsequent birth it may be important to remember that your tissues have already been stretched out once, they will stretch more easily the second time.  Also, did your practitioner do anything to prevent a tear other than having you push in a controlled way?  That could help in the future as well.  Anyway, those were my thoughts on reading your post.  I hope someone with a more similar situation will have good advice for you.

[mamaofprincesses]

I had a really bad 3rd degree tear with my first. With my second, I had a 2nd degree tear, and with my 3rd, a first degree. Neither of the last two bothered me a bit post-partum - I didn't even notice them. I've never had issues with incontinence or pain during intercourse, not even the first time. I'm not saying that is what to expect, but just that. . .it CAN be fine. The body has an amazing capacity to heal!

I did have DH rub olive oil on my perineum leading up to my third birth. I also push in a kneeling/all fours position now, where I was on my back/side for the first. I don't do controlled pushing at all. I push when I feel like it. With my first, I was trying to do the three-pushes-for-each-contraction thing. All of this is anecdotal, obviously, but there you go :).

[mom2clairenlily]

At the facility I work at, I have seen women who were offered and accepted a c-section after a 4th degree tear.  It is always up to the patient to decide, and I think they are the best judges after their previous experiences.  Of course there are a lot of concerns about pelvic floor dysfunction, pelvis organ prolapse, and bowel issues after a 4th degree tear.  Your provider can probably detail these out better for you, as well as provide with risk stratification for each of the issues.

I am so glad that you had a happy healthy baby!  Congrats and I hope you heal up well.  Good work mama!

[journeymom]

Check out this thread:

http://www.mothering.com/community/forum/thread/266955/vaginal-birth-after-4th-degree-tear

It's a pretty inspirational thread, if not hair-raising.