Vaginal Birth after 4th Degree Tear? - Page 8

[Mom3yingels]

Hi! I am the proud mom of 3 adorable boys. And unfortunately I tore 4th degree with each one of my births. The reason for this is because I have a tiny teeny perineum. it is only about 1/4 inch long. I too have my doctors message the perineum during birth, and reading through this thread was the first time I have ever heard that this could have the opposite effects. If i have another child, I think I still would go vaginal, even after all that I went through. (each one of my recoveries took atleast 10 weeks) I am scared stiff over having a c-section and I wonder if the recovery is that much easier. I would love to hear from anyone if they had both these experiences...I just want to say, that I really feel your pain and really know what you went through. It is not easy, and only makes you that much more worth being a mom!

good luck,

Natalie

[bigblues1981]

Hi, I’m new to this thread but I just wanted to chime in and say that I WISH I would have seen this BEFORE I have birth to my second daughter 15 months ago!! I am sad to say that I had a C-Section based on my doctor telling me it was medically necessary after having a fourth degree. With my first labor I was induced and when I was 3cm I got the epi well 20 min after getting it I was 10cm and it was wearing off I pushed for 3 hours and they ended up having to use the vacuum and do an episiotomy. When her head popped out the dr realized she had shoulder dystocia so he had a nurse get on top of me to push my tummy from the outside while he pulled and tugged to get her out. When that didn’t work he reached in and broke her collar bone to get her out!! It was a very traumatic birth for me. When I became pregnant with my second a year later he told me I was going to have to have a C-section because of the first birth and he said more than likely this baby would be bigger and that I had a chance of not being able to hold my bowels if I tore again…Good way to scare me Doc!! LOL  He did not give me a choice he TOLD me I researched on the internet but really didn’t find too much in the end I decided to go with the C-Section…Let’s just say that was the WRONG decision!! I think I would have rather had a 4^th degree again!! An hour after having the C-Section I started throwing up and nothing was stopping it…Do you know how bad it hurts to throw up right after having you stomach cut open? I felt like it was ripping back open…and now looking at the flap of skin hanging over my scar sucks!! I wish so bad I would have seen this forum and seen that women go on  to have another baby without/minimal tearing….Oh how I wish I could turn back time…

[throughNewEyes]

 Well, I too, am Happy this forum exists! My second baby boy (born a year ago- may 2010) was a nightmare hospital labor and delivery. I received a fourth degree tear and, looking back makes me regretful about most of my choices from who my OB was to saying yes to the epidural so late in labor. There were so many factors, so it's hard to know which, if not all, contributed:

1. new OB, still kind of a student and , as I learned afterward, was recommended to me by my friend (a nurse) because of how well he performs c-sections...yeah

2. alot of checking and touching down there before and during 2nd stage of labor. He, at one point, had his entire hand in me trying to turn my baby (he was facing up)

3. of course, saying yes to the epidural is what I blame because I couldn't feel anything which led to purple pushing while the nurses yelled at me the entire time (like I said, nightmare) and were yelling at me about how I wasn't doing anything even though I was trying so hard! I pushed for about 1 1/2 hours and during my purple pushing, baby literally POPPed out! He Flew out of me!! First his head, POP, then just like a fish, his body quickly followed. I thought that was cool, except for NO, it wasn't.

4. They'd also broken my water at 8 cm, but I'm not sure if that had anything to do with the bad outcome.

The good news: After about a couple hours of surgery and all dignity out the window, I healed really well! My OB was smart enough to call in more experienced reinforcements and have me sutured up. He was very concerned about me recovering well and I followed all advice to a T. I didn't find it too painful in the weeks that followed and in actuality, it wasn't much different from the recovery of my first boy, where I only had a small episiotomy and no tearing beyond that.

So after lots of googling and thread searching, here I am a year later and that much more confident that indeed my next will be a vaginal and I WILL have a good delivery with minimal tearing. I shall be back when it happens. I am not even pregnant yet with a 3rd but sometime next year I shall revisit!

[Clover Honey]

Hello everyone, 

I'm so glad that this thread is here.  I've read through over the past few months, and I feel like lots of questions have been answered and there has been much success with subsequent vaginal births after a serious tear.  I still wonder though, if my case might be one that is too iffy.  My first was born via c-section after a disappointing and difficult 24 hr labor, 3 hrs of pushing, visible head, but I was too numb and unable to move baby down anymore.  My second was an unmedicated VBAC, another 24 hr labor, 3 hrs pushing in every position imaginable, extremely hard work, very forceful pushing (but only with natural urge), baby came out slowly and I had a 4th degree tear.

I wonder, with my set of circumstances what my chances might be.  I am only 5'3 and babies were 9 lbs and then 9 lbs 4oz.  Both had a hard time coming, but first was clearly impeded by epidural.  Healing was difficult, a few months.  Urine, gas and occaisional stool incontinence still.  I dread a repeat c-section, and fear that for possible future babies, but stool incontinence or a colostomy is NOT the way I want to live my life.  I have a feeling that maybe in my case, the babies are rather large, my pelvis is small, and my tissues will be weak to handle another large delivery.  I admit that fear of permanent damage is playing a large role in my decision, but I don't want to rule out a vaginal birth.

I worked so very hard to prepare emotionally for and to physically VBAC, but I just don't know if it would be the right choice for me again.  My MW couldn't say what might happen - only that the repeat 4th degree tears she has seen were always blamed on a previous episiotomy.  My 4th degree healed OK, but I have low confidence it would be able to be repaired well again, since I do have lasting effects.  It was severe, and recovery was much worse than the c-section (except for the PPD and PTSD caused by the unexpected surgical birth).  Pamela at the Farm even told me that chances are I would not tear *at all* (I had my doula ask her for me while she attended a training there), but I don't think I want to take any chances at all.  Please help me sort this out.

[round2011]

Hi all,

i'm writing to update. i haven't had my baby yet but i have made some decisions from all the advice on this post and a lot of soul searching.

my doctors have been really supportive of my back and forth between section and vaginal. After going to a specialist to check all my bits it seems i will need work done down there anyway. Once i get all that fixed i don't want to mess it up again.

So my current plan is to have this baby vaginally, get myself all fixed up from the first birth (and what ever happens with this next one), and if we have another (which i hope to) have a planed section. 

I am totally nervous too. my family thinks i'm crazy to go through it all again. my doctors have been very patient. So fingers crossed!

i wish you all well. if anyone wants to chat and get the nerves out i'm all ears and could use a bit of chat myself!

[wombatclay]

Big hugs to everyone and good luck to the mamas expecting their post-tear babes!

I had a c/s after a long labor with dd1, a successful vbac with dd2 that unfortunately included a serious shoulder dystocia for her and a 4th degree tear with pelvic organ prolapse for me, and a successful vbac with ds that did include a 2nd degree tear but which otherwise was totally fine.

Of those, DD1 was 9lbs6oz.  DD2 was 9lbs even.  DS was 9lbs8oz.  So it was my smallest babe who got stuck at the exit and cause the most damage.

I'm pregnant again, due in early Sept, and planning another VBAC.  It's a tough (and very personal) process to find a good balance between risks.  For me, I plan a vbac but with a rc/s "clause" built in.  I want a vbac, it's the better option (in general) for mom and babe, a c/s is hell to recover from even in the best cases, but I do NOT want another tear.  So I am very clear with my support people and providers that if things seem even a little sticky, slow, or abnormal we WILL move to plan B.  I'm fortunate that my 4th degree was repaired by a pro (an OB who actually teaches classes in repairing 3rd and 4th degree tears!) and fortunate that my prolapse is fairly minor.  And I know that there is no way to remove risk from pregnancy/birth.  But for me, a planned vbac with a rc/s plan built in is what works.

[moonmama22]

Posting with an update...  I had posted a couple (or more) years ago.  Ds was 9lbs. 9oz., long labor, vaccuum extraction, shoulder dsytocia, 4th degree tear.  Weeks later I realized after much internet searching that I had a resulting fistula - small but annoying...  I was terrified to have another vaginal birth, but even more terrified to think of a c/s.  My OB was VERY supportive and completely confident that a vaginal birth would be fine, until dd was still breech at 37 weeks.  She finally turned at that point, but I was so anxious...  In summary - they planned to induce me at 40 weeks 3 days, to avoid another big baby, and when I went in to be induced, I was already in early labor.  I was sent home at 2 cm. and told to relax, have something to eat, get some rest and they'd "probably" see me in the early morning.  However, on the way home, my contractions were strong enough to be quite painful, and 20 minutes later, at home, I was having major contractions.  Tried to get in the bath, but felt like she was right there and so went back to the hospital.  Got there at 8 cm, they got the IV in while I was pushing, no time for any concerns - she arrived about 2 hours after they sent me home the first time...  Completely unmedicated, small epis. b/c she came so quickly, but only minor 2nd degree tear.  My OB stitched me up really well (and like pp said, after all my dignity was out the window!).  Did not correct the fistula, but did not worsen it in any way either.  It is so small that surgery would be more likely to worsen it than fix it, so at this point I have decided against it. 

So - DO NOT let your doctor, or any doctor, tell you you "need" a c/s.  I birthed my dd so quickly there wasn't even time for my perineum to stretch much, and I still came out of it just fine.  And the recovery was SO much easier than with my ds... 

[Moonflower77]

Hi to everyone visiting this thread!

I posted an update on my third childbirth back in 2008 in this thread.  It was a wonderful tear-free birth of our second son.  

Now, I would like to post an update because we had our 4th child in Feb. 2011!!!  I know how important it is for all of us to share our successes and good birthing experiences after having a birth injury like a 4th degree tear.  Here is a mini-version of our birth story.

This is for all of you!

Our daughter was born at home at exactly 42 weeks.  We had a very supportive and skilled MW.  She was our biggest baby weighing in around 10 pounds 6 oz!  Not really sure about exact weight because the weight between the midwife's spring scale with sling and the doctors scale were off-with our baby weighing less at 2 weeks than when she was born!  But we are sure she was closer to 10 rather than to 9 lbs.  

Regardless, she was our biggest baby:)  I labored with my husband applying pressure relief to my hips because they were taking the brunt of the pain.  I could feel double peaks in my contractions. The MW stayed up by my head being supportive.  I took my time with crowning and we had the MW come over to take a look and we soon learned she was also a compound presentation with her little fist up by her chin/ear.  WoW Right? No matter how many times the MW tried to push the fist back she kept putting it right back where it was.  Finally, we decided I had stretched enough because I announced she needed out NOW and I gave the final push and she was out.  I had a weird side "maybe" skidmark and some soreness that made recovery a little trying for a while because I was bruised by the compound presentation.  Most importantly, I had no tears!

I believe it is so important to birth in a calm and peaceful environment.  It is also very important to have supportive and skilled birth attendant(s).

You can go on to have babies without tearing again.  You can! 

Big hugs to all,

Moonflower