Vaginal Birth after 4th Degree Tear? - Page 6

[spmamma]

I am so glad I found this thread.

I had a third degree tear during my last (and first) birth. Today, I had my first OB appointment (I'll be at 13 weeks tomorrow) and the NP said, "I see you had a third degree tear last time. Well, the doctor may want you to have a c-section this time."

Whaaaaaaa?

Hours later and my head is still spinning. Now I have to wait until my next appointment - a full month from now - to talk to my actual doctor about this.

What's made this so hard is that I never really had a painful healing process with my tear. I had some gas incontinence, but at the time didn't know that it likely had to do with the tear. That went away after a few months.

I loved my birth experience. I was induced, but didn't take any pain meds and came out feeling like a hero. It's devastating to think about having to go through a c-section on account of something like this. But, on the other hand, I don't want to make a mistake by being stubborn and end up with permanent bowel issues.

[aprildawn]

spmamma -- sorry you were told you might need a c-section. Unless there are other factors, I just can't see how you'd "need" a c-section. If you've read the whole thread (it's loooooong!) you've already seen there are many, many stories of women who had 4th degree tears and later had a vaginal birth. I'd get a second opinion. Maybe you can find another provider in your area who is a bit more open minded.

I had a 4th degree tear with my first and went on to have a second vaginal birth with only a 2nd degree tear (barely). It was such a difference. I had a family practioner for my 2nd birth.

Good luck to you!

[JessicaTX]

I had a 4th degree tear with my first, a 7 pound ten ounce baby. I had a 10 pound baby with a huge noggin next, and only needed 4 stitches. In my experience you will not need a c-section because of the first birth =)

[spmamma]

Originally Posted by aprildawn

spmamma -- sorry you were told you might need a c-section. Unless there are other factors, I just can't see how you'd "need" a c-section. If you've read the whole thread (it's loooooong!) you've already seen there are many, many stories of women who had 4th degree tears and later had a vaginal birth. I'd get a second opinion. Maybe you can find another provider in your area who is a bit more open minded.

I had a 4th degree tear with my first and went on to have a second vaginal birth with only a 2nd degree tear (barely). It was such a difference. I had a family practioner for my 2nd birth.

Good luck to you!

Thanks aprildawn! I did read the entire thread last night before posting, and it gave me hope. It's nice to know that so many mamas out there were able to go through subsequent births without bad tears the second time around.

At this point, I'm going to wait and see what my OB says. I'm trying hard not to get worked up over the opinion of one Nurse Practitioner in the office. She also recommended that I wean my daughter (without providing a legitimate reason, of course), so I'm trying to take everything she said with a grain of salt.

[wombatclay]

Just noticed this was addressed to me

Definitely try the Gaskin maneuver before anything else in case of shoulder dystocia.

With my shoulder dystocia birth we tried the Gaskin manuever twice (my OB trained with Ina and had her own first birth on the Farm). It didn't work either time. We also tried a few other position changes to no luck. The Gaskin manuever is a wonderful tool, but it only works about 80% of the time. Which is better than most techniques for resolving SD, but...well... it's not a silver bullet.

So having had a SD that didn't resolve with positional changes makes me a bit more leery about a repeat SD resolving "easily" (the SD happened while I was squatting, we tried several position changes, eventually the OB had to manually rotate and pull which is what caused the 4th degree tear).

But I'm still planning a vaginal delivery. Just not a "no holds barred" vaginal delivery.

[giddiegoof]

Hi,

I posted before about being pregnant with a rv fistula... tomorrow I see the surgeon to find out about the possibility of being repaired before I'm due (8/30). Anyone out there who prays, I'd appreciate prayers for strength and peace for that appt! I tend to get really emotional when I'm stressed! Thankfully, I have a homebirth midwife who doesn't have a problem delivering whether I am repaired or not, although she'd rather have me repaired before delivery - I'd rather be intact, too. I may even have a water birth at home! Unless this surgeon gives an extremely convincing reason for a c-section, I'm sticking with home birth.

I'm hoping to be able to post back some good news, both after tomorrow's appt and after delivery. I am so thankful for all the honest stories on this thread!

[wombatclay]

Good luck!

[illinoismommy]

Originally Posted by illinoismommy

Good question... I had a 4th degree tear with my first baby, and so I am maybe a little scared of labor this time. Instead of just a day of pain like "normal" people I couldn't sit without wanting to cry for weeks. no WAY I'll schedule a section though....

Update... I've had two vaginal births since I wrote this and had no tearing in one and just a little in the other, I think I got one stitch.

[wombatclay]

Yay! Thanks for posting that update! My post-4th degree babe should be arriving (hopefully via another vbac) in just a few weeks and I'm getting pretty nervous about a repeat tear.

[wombatclay]

And my update!

I delivered my post-4th-degree-tear kiddo yesterday and the only "damage" was a 2nd degree tear along the scar. I gave birth side lying with the doula holding my upper leg and pushed for about an hour. He was 9lbs 8oz with a 14.25 inch head and slightly sticky shoulder so he certainly wasn't "tiny" . It was a very fast birth and very intense... I think that if it had been a bit slower his head would have molded a bit more and I might not have torn at all, but compared with a 4th degree this 2nd degree seems like nothing! And I'm thrille to have had a relatively trauma free vbac this time round.

Good luck to everyone... a prior 4th degree tear can be a big hurdle to remaining positive in your next birth, but as this thread shows, there can be a happy ending!

[babymonster]

Ladies - can anyone help me in a hurry?
My MW is throwing a hissy fit about my homebirth after 4th degree tear last time. She wants me to have my scar looked at by an OB TOMORROW
Can anyone suggest some info I can print off to support my case that I am not a huge risk for repeat 4th degree like she thinks I am? I am particularly interested in the research someone mentioned a few pages back which suggested no greater risk in the 2nd birth...
Thanks!

[milansmommy]

Originally Posted by babymonster

Ladies - can anyone help me in a hurry?
My MW is throwing a hissy fit about my homebirth after 4th degree tear last time. She wants me to have my scar looked at by an OB TOMORROW
Can anyone suggest some info I can print off to support my case that I am not a huge risk for repeat 4th degree like she thinks I am? I am particularly interested in the research someone mentioned a few pages back which suggested no greater risk in the 2nd birth...
Thanks!

I'm sorry your midwife is giving you a hard time I don't have any good sources but I hope that someone can provide you with some good information. I had a 4th degree tear with DS1 which was a typical hospital birth and my midwives were not at all worried about it with DS2. DS2 was 12lb 6.5 oz and I only had a 1st degree tear. He was almost 2.5lbs bigger than DS1.

[babymonster]

milansmommy - I can't tell you how much I love hearing stories like yours I have found some pretty interesting research studies, I will share them later in case anyone else needs them!

[Erdbeer]

wombatclay, congratulations to you! So happy everything went much more smoothly this time.

[NewMamma28]

Nice site!!!

Hello everyone, thank you for sharing your experiences.

I wanted to give a little background then had a couple of questions.

Background:

Two months ago, I delivered a 6 pound 15 ounces baby boy at the hospital. My OB used the episiotomy method (did not really give me a reason of why she decided to do that – except that he was really low). My boy was not big and his heart rate did not drop either.

After reading everyone's experiences, I went back and tried to remember what happen in the delivery room that lead to a 4th degree tear and now fistula.

As I recall, the nurse that was helping her was using something warm (I assume oil) and her finger to stretch the vaginal area during the delivery process. After an hour of pushing and no baby, my OB decided to use the scissors. After the cut and a couple of pushes, I gave birth to beautiful healthy boy.

Weeks later, I started to notice stool in the vaginal area so I called my OB which lead to multiple CT Scans. I was told that I had a fistula (opening between my vaginal and anal area) and needed to see a surgeon. My OB referred me to a rectal specialist.

The specialist examined me and told me that the tissue was still healing and that there were multiple small openings between the vaginal and anal area. She had also mentioned that I tore the muscle that controls my bowel movements (so far I have not had any issues with my bowels – she stated that it may affect me in the future). The specialist then emphasized that I do the following (either): Nothing (leave it and live with it) or have reconstructive surgery. She would have open me up again and reconstruct everything; that would mean a catheter and an overnight stay at the hospital.

After all that, I was then told that I could not have anymore vaginal deliveries for it would tear again. C-Sections were the way to go with my next pregnancies.

The reconstructive surgery is only a 70% success rate!!!

I was devastated (left the office crying). I do not want to have to go through another painful experience. Recovering from a 4 degree tear was awful! And the thought of having to go through another surgery and recovery brings tears to my eyes not to mention a financial burden (no insurance).

Questions:

The specialist told me that it has been two months and the fistula has not healed, it will not heal, and that it has to be repaired, is this true or is it too early to tell?

The specialist told me that a bomb went off inside making the lower part of my muscle weak. If I opt not to do the surgery, is it possible to strengthen the muscles to make sure I don’t lose my bowels in the future?

The specialist told me NO MORE VAGINAL DELIVERIES because it would be worse the second time around, any input or advice would be appreciated.

Has anyone experienced long term affects of a 4th degree tear and fistula without surgery or with surgery and what were they?

Thank you!!

[wombatclay]

Big hugs, congratulations on your babe, welcome to mdc, and I'm sorry you "found us" because of a 4th degree tear!

Some of your questions really will depend on the specifics of your medical record... can you see a second (and possibly third) specialist for their opinions? Low estrogen levels (like you have while breastfeeding and before your menstrual cycle resumes) can cause slow tissue healing. Diet can also impact healing. I put together a big list of "how to heal from a 4th degree tear" so let me know if you'd like a copy.

Anyway, your provider is right that fistulas don't generally heal on their own. However, there may be options that fall between "do nothing" and "reconstruct now". A PT trained in women's health and pelvic floor health could help. Estrogen cream/pessaries may help. A support pessary (kind of like a "donut" inserted vaginally to hold support weakened tissue) and/or girdle may be useful too.

For future pregnancies... the opinions are split and there are no great researcxh studies. Basically, if you've had a severe tear and/or poor healing, you are more likely to tear again. And a second tear is generally harder to repair with more risks. On the other side of the balance is the fact that the hormone shifts and pressures of the pregnancy itself can damage internal tissues. And c/s is major surgery with risks to both the mother and the babe. So it boils down to "increased chance of repeat tear with greater permanent damage to mom" versus "100% chance of surgical incisions with greater risks to mom and babe". It's not an easy choice.

I balanced things in my mind by having my post-tear babe at a major medical facility, with midwives and a doula who knew my history and were willing to work with me. And I had a healthy, big, happy baby despite a history of c/s, 4th degree tear, and pelvic organ prolapse. I had him vaginally and haven't had any additional trauma as a result of the birth. But I thought a lot about it (I'd been told c/s only by several providers) and had plans in place to give me peace of mind. And other women go the other way and birth at home in a very hands off manner.

I'm rambling. I remember feeling so broken and hopeless after my dd2 arrived... I was thrilled at my vbac but so upset at the "future kiddos by c/s" statements. I even thought about sterilazation because my c/s had been such an emotionally devastating experience I just couldn't imagine doing that again. I did a lot of soul searching, a lot of physical healing work, and when I got pregnant I decided to assume a vaginal birth and see. But you have more "quality of life" issues... fistulas are serious. And you may have some prolapse issues too if the tissues are weak (there's a support thread here for POP/pelvic organ prolapse). That's why it's worth getting a few opinions and taking things one step at a time.

I hope you continue to heal, that one day you'll have a "birth after 4th degree" story to share too, and no matter what... congrats on your babe and welcome to mdc!

[BlackSheepPDX]

I just wanted to chime in with thankfulness for this thread. I'm unexpectedly expecting in August, and had a 3rd degree from my June 2007 birth. It's been my greatest fear in both. And now, reading this thread, I hear a lot about my first birth (not feeling pushy in the beginning, feeling like maybe I should have rested, needing "help" from my midwife to feel what pushing should be, doing the counting thing) that perhaps I can learn from and apply in my second and I am very hopeful for a good outcome. Thanks to all who have shared this and I look forward to reporting back in August!

[mrscompgeek]

This is a great thread!!!
3 months ago I had my first baby born at home with a midwife. It was supposed to be a water birth but Ki's heartrate kept dropping when I pushed in the water (which now im wondering if maybe the fact that i dont remember feeling a undeniable urge to push, i just pushed cause the midwife said i could had anything to do with her heartrate maybe) but anyways I pushed on "dry land" and ended up with a BAD vaginal tear. I dont know what degree but I do know that the OB that stitched me at the ER said it was pretty much both sides of the vagina tore. I had no external tears though, completely intact outside, only internal. I have healed pretty well now and dont feel much pain/stinging at all anymore. (although the first 3 weeks after giving birth I was so swollen down there I couldnt walk right.)
Now I am terrified to think of birthing anymore babies. BUT reading this thread and doing lots of research and im seeing that chances of this bad of a tear with the next baby is VERY SLIM so that helps me relax a bit.
Would LOVE to hear any more stories of mamas with vaginal tears having more babies.

[loulie]

well I guess I'll be the next to update - my post 3rd deg tear babe is due a week today. Unfortunatley for me, this one is posterior, as was DD so I'm very very scared. Wish me luck ladies, and anybody who has any positive updates please post them - it definitely helps to keep up my confidence that I'm doing the right thing...

[modadan]

Wow I could have written this! Especially the manipulative midwife

Except I left my epi&tear to heal by second intention. I was over all those "experts" near my yoni and was too traumatized to be re-stitched. All seems OK except I seem to have lost most of my perineum.

I am due for #2... so glad I found this thread, it has given me confidence to have a vaginal birth. Fingers crossed I come out the other end with just some minor tearing. No tearing would be a miracle!

Originally Posted by MauriMama

During one of my squats my MW checked for the head and she told me to reach up and feel and that I should push if I wanted to. Well, I didn't want to, but at that point I knew that it would be over sooner if I just pushed. It makes me so angry to look back at how much they were encouraging me to push without actually telling me to. Even though I had been very clear about not wanting her to guide me at all during all our prenatal visits.

I ended up with a BAD 4th degree tear. Some doctors that saw it said that it was worse than a 4th degree tear, although I don't know how that's possible. I tore through the anus 3/4 of the way back, through the internal and external sphincter.

My MW stitched me up and my stitches came apart 1 week later and my MW referred me to an Ob/Gyn who stitched me up in her office 2 days later. I would have rather delivered 10 more babies without drugs than have gone through that. Especially because the stitches came apart again 3 days later.