Can I Avoid a Tear Next Time?

[adopted0105]

I had my first baby 16 months ago after a long (but typical) labor. My DH and I had taken Bradley classes in preparation for the birth, and this method helped me to achieve my goal of delivering my DD without any medication. However, I suffered a severe 4th degree tear that took me months to recover from, and I still feel occasional discomfort from it even today. According to my doctor, this was no normal tear because it severed through all the tissue and the muscle. In fact, she said that it was the worst tear that she or anyone in her practice had ever seen, which is why they referred to me as the "6th degree." A few hours after delivery, I even had to be put in CCU to receive a blood transfusion because of all the blood loss. Thankfully, I healed amazingly well because my OB told me (well after I had mostly healed) that she had fully expected me to need further surgery in order for my body to function properly. But even though I did heal really well, knowing how severe this tear was and what could have happened really scares me in thinking about having another baby.

My OB, of course, has told me that she thinks that I should have a c-section with any other children because she can't see a reason for my tear. She said that my pushing was controlled and that there was nothing to indicate a reason for this awful tearing. Therefore, she believes that my body would do this every time. The problem is that I've been reading a lot of different material about birth because I'm studying to be  Bradley teacher, and this just doesn't match up with anything that I'm reading. So, I'm beginning to think that maybe there was something that could have been done to prevent my tear. However, I'm still terrified of this happening again, regardless of what I do. My DH wants to try to have another baby in the next several months (and I want to as well), but I just don't know how I could get through it if this (or even worse) happened again. Have any of you experienced severe tears with your first baby, but had better experiences with subsequent deliveries? Is there a certain pushing position or technique that you believed prevented a severe tear? Thanks so much for reading. 

[sere234]

How did you push? I think I tore because I had to push on my back due to DS's position and such. After his head was out, I squatted to push him out the rest of the way. Next baby I certainly plan on pushing upright, I think it would help tremendously. Also, I'd like to wait until I feel the urge to push; with DS I had no pushing urge for hours due again to his positioning. Did you have a pushing urge?

From what I've read, pushing upright when you FEEL like it can prevent tearing. Hth!

[adopted0105]

Yeah, I've though that my pushing position may have had something to do with it. I did have a strong urge to push, even before I was fully dilated. I started out pushing in a side-lying position, then moved to more of a traditional sitting squat position, but I'm not sure that the bed was elevated as much as it should have been. I also pushed for two hours, and my DD was crowning for like an hour of that, which was really strange. Thanks for your response! :)

[lifeguard]

I had a 3rd degree with ds & a 2nd degree with dd which was really due to the scar tissue. Before the birth of my next child I will be getting my ob to assess how the scar tissue is organized to see if it will cause real problems again.

[kalin verona]

I'm hoping to learn from this thread as well. I had a home birth 18 months ago with 3rd and 4th degree tears. I am now 5 months pregnant and very concerned about another tear. I would rather have an episiotomy this time ( scheudled this time to in a birth center where I can request one this time) in hopes to preserve the current repair. 

[kalin verona]

I'm hoping to learn from this thread as well. I had a home birth 18 months ago with 3rd and 4th degree tears. I am now 5 months pregnant and very concerned about another tear. I would rather have an episiotomy this time ( scheudled this time to in a birth center where I can request one this time) in hopes to preserve the current repair. 

[adopted0105]

Kalin, may I ask why you want an episiotomy? I've gotten such conflicting information on them, and I know that most doctors no longer perform them routinely. But I was just wondering if you had maybe found some information somewhere that I haven't. Because I've wondered if an episiotomy would have helped me as well. The thing is, though, the main source that I've read on it claims that episiotomies can actually contribute to worse tearing and are themselves often worse than natural tears. But I can't imagine anything being worse than what I had, and I'm sure you feel the same! Anyway, I was just wondering if you knew of some resources that discussed the benefits of episiotomies. 

[lifeguard]

Episiotomy - with my 2nd my doctor thought he might need to cut but I was VERY against it. What he did do though was freeze my perineum where the scarring was really bad in preparation for a possible cut. Then (according to my mom who was watching) he used his fingers to really stretch the scar tissue. She said he actually worked pretty hard at it (baby was coming quickly & the scar tissue was really blocking her exit). I ended up tearing slightly but I am sure an episiotomy wouldn't have been better, but I do think the freezing helped just because the amount of stretching he was doing would have been pretty darn painful. I'm sure others would say he shouldn't have touched it but I feel content with the care I received.

[nicholemarie]

Hi All, I am a Natural child birth assistant as well as a child birth educator. I have had 3 home births and am Due in October as well.

A word on tearing, It is much better to tear naturally because the wound is a jagged tear which allows the tissue to create a much better bond when healing! An episiotomy which is a clean cut will take much longer to heal, will not form the same bond because of the smooth edge that is made from the cut, and they are known for causing rectal tears!! If you grab a piece of white computer paper and hold it long ways at each end and try to tear it you will find it very difficult to make a tear. The tear that is made will be jagged and easy to piece together. Now take a new piece of paper and cut about a half inch in the center of the length of the page and pull again! Our vaginal tissue works the same way!!

To avoid tears in the future or for first time mommas I wold recommend some of the following:

• Do perineal massage during the last month of pregnancy using your fingers to apply pressure to the Perineam.

• Ask your support team to help you guide the baby out slowly, avoiding "Purple Pushing"!! There is no reason to bush your brains out once you have fully dilated. For most woman the urge to push will come if they are allowed to be in a squat or upright position. Allow your baby to come slowly. Ask for your support to hold baby's head in place as it begins to crown so it moves slowly and easily through your vagina.

• Again SLOW DOWN!!! The best way to keep from tearing is to be reminded to slow down during pushing allowing adequate time for the skin to stretch to its full potential!! Holding your breath to the count of ten and pushing is not a good way to push!! breath naturaly and bear down only as much as you would for a stubborn bowl movement

• Get off your back!! Be forcefull with Doctors if birthing in a hospital there is no law that requires that you birth on your back :) IF you have an epidural laying on your side will be the only next best choice!!

[kalin verona]

It is very important to me to maintain my current repair. My tear has left me with long term effects including loss of feeling and extensive internal scar tissue both vaginal and rectal. I am unwilling to chance having that scar tissue tear again which may lead to more issues worse than what I am dealing with now (such as bladder or bowel incontinence)

[AndtheStars]

Good thread!

I had a 3rd degree tear with DS that was badly repaired.  The doctor basically sewed my labia and vagina together so that my vaginal opening was really constricted.  At 6 months, I went back in for surgery to fix it.  The surgery left me with a lip of skin and scar tissue that my midwife has already said will probably have to tear to birth #2. 

Interesting discussion on the episiotomy.  I was considering it but, lifeguard, the freezing and stretching thing sounds really interesting.  I will bring it up to my midwife.  I, like you, would feel very comfortable with any measures that a healthcare provider would take to prevent tearing or unecessary cutting. 

I did push on my back and had no pushing urge at all.  I'm very much hoping that positioning and waiting til I actually feel like pushing will go a long way to preventing the damage I had before but I'm sure that I'll tear some what.     

[lifeguard]

andthestars - I had no desire to push with ds & did almost all my pushing while on all fours. With dd I couldn't have stopped my body pushing if I tried, I was on my back & they even tipped the head of the bed down in an attempt to slow her down to give things more time to stretch out.