having another vaginal birth after a bad tear, did you tear again?

[loveandgarbage]

Hey all, I'm looking for some statistics and advice! I had a great labor with DS2, the only downside was the 3rd degree tear. I healed remarkably well and haven't had issues since. But since I have another baby on the way I am curious about how much I might tear this time. Would anyone like to share their tearing (ouch!) stories and how it affected subsequent births?

DS2's head was 14.5" and I was forced to push on my back. I will be pushing in a MUCH better position this time hopefully as I'm having a homebirth. At my last US the baby's head was measuring large, and I looked up some growth charts-- if it continues to grow at the same rate I'll be looking at a 14.5-15" head this time.

[moving toward]

oh I hope someone answers too - I had a 3rd deg with my first and I'm a bit worried for this time. My backup midwife walked in on me and the obgyn just as she was informing me that I could have an EC because of it so that was awkward!!! Have decided for a water birth though anyway. Have to admit I was a bit pissed that I wasn't at least advised of my options by the mw and had to find out by accident (I was referred to obgyn at 30 weeks for threatened deleivery) anyway over it 

[Rana Sylvestris]

No one can tell you definitively what will happen. I'm not a doctor, but have heard (and believe) that having a third degree tear does increase your risk of having another severe tear. Anything could happen: you could have a perfectly simple, uneventful delivery with no further problems or you could end up with another tear that might be the same or worse as the pervious one. I'm not sure that birthing positions alone can be relied upon to prevent more damage. Some people believe certain positions are better; others say that it makes no differences and in certain cases the more upright positions can actually cause more tearing. It's hard to know what to believe. A serious anal sphincter injury or permanent incontinence is a horrible thing to deal with, so you might check with a specialist to see if he or she has any specific recommendations for your situation. It's a difficult situation and you'll want to go into it with eyes wide open. Best of luck!

[loveandgarbage]

Good to know about birthing positions. I guess my biggest fear is that I'll tear toward the front or sideways because I've heard those tears are harder to heal. I'll definitely be talking more with my MW about it as I progress.

[MissMuffet]

I was recently searching for answers to a similar question.

What I came away with is that pushing position does matter in trying to avoid a tear, as does having a strong fer (fetal ejection reflex), which is best brought about when a birthing woman is left well alone, is comfortable, has privacy, warmth, etc.

Michel odent's answer to a similar question:


I recently suffered a 4th degree tear, 1 centimeter into the rectum, it was repaired by a surgeon. This began as a wonderful homebirth labor, the delivery was tough though, nuchal arm, shoulder dystocia, 10.6 baby. The doctor realized that it was out of his scope and I was transported to the hospital for repair. What are my chances of another natural birth?

Most obstetricians will advise you to have a c-section for the birth of the next baby. However the vaginal route might be possible if you are given the opportunity to give birth in complete privacy, for example with nobody else around than one experienced, motherly, low-profile and silent midwife. In such a context, if you don't feel guided, it is highly probable that you'll have a powerful 'fetus ejection reflex' and that you'll find spontaneously a position that is not dangerous for the perineum (usually an asymmetrical kneeling posture).

http://www.waysofthewisewoman.com/dr-michel-odent-notes-obgyn-studies.html

[allisonrose]

My personal experience: I had a third degree tear with ds1 (pushed flat on back with an epidural and coached pushing). With ds2, I tore less severely: no one told me the degree but the insurance paperwork listed it as first degree (also flat on my back - wanted to move but couldn't verbalize the desire - no epidural and despite the OB counting at me, I listened to my body more than him). I believe that ds2's head was bigger than ds1 (14.5 vs 14).

[CountryMommy]

My first was a 3rd degree tear and my 2nd was a second degree tear. I labored in the same position both times, was coached to push during #1 and allowed to push when I felt ready with #2. #2 was also born posterior. I am pregnant with #3 now and am also wondering about tearing this time...

[loveandgarbage]

Thanks for sharing, ladies. Is it weird that I have never heard of fetal ejection reflex before?! And I consider myself pretty knowledgeable about birth!

[cinderella08]

I'm hoping for a better outcome this time.  I had 3rd and 4th degree bilateral cervical tearing and cervical lacerations.  Definitely hoping to avoid that this time.

[dovey]

I don't know if that makes you feel any better, but here's a reassuring data point:  with my first, I tore significantly - enough to need stitches, although I don't know the degree.  With my second, I tore, but didn't need stitches.  With my third, I didn't tear at all. 

[dovey]

I forgot to say, the second and third births were in the water, so that might have made some difference. 

[moving toward]

Ok found out in my case yes I will tear again. Did everything "right" quiet dim waterbirth exp midwife positional techniques etc and still got 3 rd deg tear. I prob pushed a bit too hard at one point but I guess I wasn't thinking about it at the time. Anyway healing nicely and managed to have a plastic surgeon sew me up so hopefully no long lasting effects. Was advised though any future natural birth would severely compromise my rectal health

[1babysmom]

Originally Posted by loveandgarbage 

Hey all, I'm looking for some statistics and advice! I had a great labor with DS2, the only downside was the 3rd degree tear. I healed remarkably well and haven't had issues since. But since I have another baby on the way I am curious about how much I might tear this time. Would anyone like to share their tearing (ouch!) stories and how it affected subsequent births?

DS2's head was 14.5" and I was forced to push on my back. I will be pushing in a MUCH better position this time hopefully as I'm having a homebirth. At my last US the baby's head was measuring large, and I looked up some growth charts-- if it continues to grow at the same rate I'll be looking at a 14.5-15" head this time.

My son had a whopping 15.5" head, and I pushed him out in two very quick pushes and did not tear.  I was upright, and in my bathtub, though.  He was my 3rd baby (I only tore with my 1st, and she only had a 13.25" head, but I pushed her out on my back over the span of an hour).

[herbsgirl]

1st 2nd degree tear  pushed on my back 1 1/2 hours 8 lb 3 oz

2nd no tear, skid marks if any  pushed 15 minutes or so   8 lbs  6 oz

3rd no tear  pushed 15-20 minutes  6 lb 15 oz

4th no tear pushed 3 minutes  6 lb 5 oz
 

[pbjmama]

I tore with my first, pushed for 3 hours mostly on my back. As I recall his head as 14.5 and he was a 9.5. Recover was very difficult and I used premarin cream from week 6-8pp.

With my second I was very very very scared of tearing. I was able to 'push' on my side as recommended by my ob to avoid tearing. But the truth is I didn't even really push...my body was pushing but I was resisting most of the time because of my apprehension about tearing. I did give one small push. All together less than 10 minutes of pushing. I did still tear but not as badly as with my ds. Dd was 13.5 head and 8.10.

I know that my skin elasticity is almost non existent. I have stretch marks all over my body, most from pregnancy. My mother had plastic surgery after extreme weight loss and the surgeon told her that her skin was some of the worst elasticity he had ever seen.

[etsdtm99]

i tore pretty badly with my first - partly due to having an episiotmy and an epidural .. her head was 14.5 in, my OB told me it wasn't that bad 2/3rd degree, my midwife said my scar tissue indicated a 4th degree - baby was still behind my pubic bone and shot out in one push after the epi so i think that caused the tearing.. 
 

my 2nd, i had a tiny episiotmy, again pushing on my back with an epidural, pushed for 2 hours and baby was crowning before they did the epi - 15 in head..  this required just a few stitches on my old scar tissue and recovery was a breeze ..

my 3rd - 13.75" head, homebirth, pushed on my hands and knees/squatting - pushed for over 2 hours,  she wasn't presenting right - forehead presentation i think, her head didn't mold like it should (no cone head at all) she got stuck after her head was mostly out and my midwife had to reach in and pull her out, i had a tiny tear on my old scar, but i tore on the side pretty badly - recovery sucked for about 2 weeks but after that it has been 100% fine, no lasting issues ..

[JudiAU]

I had a third degree tear with my first that was "very shallow." Epidural, pushed on my back. Recovery was shocking to me but I didn't have any long term pain. My first had a huge head.

Second birth was very short, unassisted by accident, and no tears or even skid marks. Gave birth on my toilet. Three pushes. Second had a tiny head. 

Third birth who knows. I am 40w tomorrow. I was sort of horrified to *see* the weird scarring/slightly flappy thing because there is so much pressure right now on vulva and rectum. Had to look when I did the GBS screening.  

[nettlesoup]

I've been wondering about this too. I had a second degree tear with my daughter, but that tear led to a haemorrhage, something I worry about for the future.

But if it's any help, apparently drinking a lot of bone broth helps with skin elasticity, so maybe it would help prevent tearing.
 

[liberal_chick]

I had a 2nd/almost 3rd degree tear after ds2 that didn't heal correctly and had to be stitched up at 9 weeks PP by an OB.  My MW worked like a beast to keep me from tearing with ds3.  She could tell that the position I was most comfy pushing in was going to lead to a tear along the same line and encouraged me to move.  She also did the olive oil on the perineum thing from the minute I started pushing.  I only had a skid mark after pushing ds3 out, and not even in the same spot.