Vaginal Birth after 4th Degree Tear? - Page 2

[Rainbowbird]

Heather, I could have written your post and was about to!

I had a 4th degree tear also. I had no epis., I just tore. I didn't feel it b/c I had an epidural but the pain afterwards was certainly incredible. I was lucky in that my OB is an excellent surgeon and after a very long healing process, I have no long-term problems. I do have a tiny fistula but it's expected that this birth will cure it.

I spoke with the OB who delivered my son and repaired the tear the other day. He laid out my options: 1) C-section, which he didn't recommend; 2) medial-lateral espisiotomy to hopefully spare the rectum this time, just in case i would tear in the same spot and end up with long-term problems (that would be AWFUL!)
3) No medical interventions and just hope that nature takes care of things.

I know I won't do the c-section unless abslutely necessary at the last min. I am not sure what is worse to heal from, a c-section or a 4th degree tear. I will say that my friends who had c-sections were healed and running around a lot quicker than I was. However, I know that c-secs have plenty of their own risks and problems, so I would rather avoid one.

As for an elected epis., I don't know. It might invite trouble, as my OB admitted.

I am just terrified that I'll tear again and end up with long-term problems. I also fear I'm going to have another epidural, b/c I can't imagine going through the pain of a tear without it.

Does an epidural increase the risk of a tear? The doc said no, b/c it slows the urge to push.

Any other thoughts?

[Rainbow]

My first was a horrible 4th degree tear... oh man the pain of that is still fresh in my memory. The pain of recovery was far worse than the pain of childbirth. My 2nd was born in a hospital, 11 pounds, and not in a good position for preventing tearing- and I had only a mild tear. Honestly, Irecovery wasn't bad at all. I'm hoping between the water birth and the altered positioning I won't tear at all this time.

[onlyboys]

I have read that a mediolateral incision is the worst type of episiotomy to heal from. That makes sense since it slices through places in your body that are fleshy and not terribly stretchy.

In listening to this discussion, I've not heard one mama say that she tore so extensively the 2nd time around. At least anecdotally, it seems that perhaps the body is better prepared to *not* tear the 2nd and subsequent times. Either that, or we are avoiding behaviours that resulted in such an extensive episiotomy/tear before.

[Rainbowbird]

Originally Posted by onlyboys

I have read that a mediolateral incision is the worst type of episiotomy to heal from. That makes sense since it slices through places in your body that are fleshy and not terribly stretchy.

You're right, and my doc said the same thing: that such an episiotomy would be longer to heal and more painful. (hard for me to imagine though). He did say the benefit to it would be avoiding what could be potentially chronic bowel problems down the road.

However, I think you have a point in that no one has said yet that they had a 4th degree the second time around. At this point I think I am going to avoid the episiotomy. And pray!

[Rainbow]

It probably doesn't need to be said, but the "standard" hospital- on your back position with people pushing on your legs to help you push does not aid in preventing tearing. IMO it encourages tearing. I would research alternative positions and birth in ANY other position if you are concerned about tearing.

A clean cut- the episiotomy- will IMO tear in the future more easily than a tear. A tear is jagged and repairs itself in a a puzzle like form- while the epi is straight. Imagine a jagged tear on a piece of cloth and a similar length sharp cut. Which would "continue" ripping the easiest?

[moonmama22]

[ I do have a tiny fistula but it's expected that this birth will cure it.

I'm sorry - are you serious? The birth will cure it??? Wow - I guess that would be a better solution to my situation than surgery!!! Thank you for that bit of info...

I am just terrified that I'll tear again and end up with long-term problems. I also fear I'm going to have another epidural, b/c I can't imagine going through the pain of a tear without it.

I hear this exactly - my epi had worn off by the time I tore, so I felt it, and it was he most horrifying thing ever. I know it's terrible, but seriously - when I do have another - I know that I will opt for the epi. Even though i didn't want one with the first, I can stand the thought of feeling that again.
As far as the medial-lateral epis, I would maybe plan not to, but if the baby has a large head, I think I would probably choose the c-section. That thought scares me also, but as someone else has said, I know a lot of people who recovered from a c-section better than I recovered from the tearing. Plus I would be so worried about a worse fistula, now that I know about the possiblities of that happening.

Just my opinion - obviously biased as to my experiences.

[Rainbow]

I didn't have an epi adn I didn't feel my tears... that is so interesting that you did. I really had no idea of my tears until after teh fact. Funny how the same physical thing can feel different to different women.

[teachermom]

my first baby was on the small side (6/7). his heart tones dropped and the mw did an episiotomie to get him out faster. I tore badly. 4th degree in a big way. I have some pretty serious scar tissue doewn there, though it smoothed out some with hard massage using vit. e. maybe it would have smoothed out on its own with time, I don't know.
I have had three children since, the second almost ten lbs and sunny side up...she also came out with her hand to her face! I needed one stich with her, on the scar line.
I had no tearing with birth three or four.

after the first birth, I set some rules for my labor/births.....

no one is allowed to suggest when I should push, no telling me "you're at ten- time to push" etc. I push when my body says I can't stop it.

no episiotomies

no hands/fingers in/on my yoni, unless they are mine

I deliver in the position *I* choose based on what feels right to me at the time. due to the fear of tearing, I never use a full squat.

[Full Heart]

Originally Posted by wasabi

I don't think weight has that much to do with it there are just so many other factors and besides you can have a 9lb 9oz baby that actually pretty skinny. The head size and positioning would be more important when it comes to tearing.

Oh, absolutely. My 9lb baby was super skiny (hes still super skiny) and had a little 13 inch head. Which is a whole inch smaller than 3 of my babies who weighed less! I never tore with any of them but I never pushed till I felt ready. With my last I was fully dialated for a good 20 min before I felt the urge. I sat there wondering when I would get the urge. I knew my cervix was gone and still I had no desire to push. I moved to the bed cause I figured well its gotta be time. Finally an overwhelming urge to push and the poor thing flew out of me. Just 2 pushes. I probably would have pushed that whole time if I hadn't been listening to my body. who knows how long it would have taken. Not sure how I feel on perineal massage during labor. I had it in the hospital and it didn't cause a tear but I have never had it at home. I do think hot compresses work though. I also think kegels can work wonders.

Anyhow, just my thoughts. Never tore and never had an episiotomy so can't comment on that directly.

Michelle

[Rainbow]

Even if they aren't skinny, I think positioning (esp maternal pushing position) has more to do with it than size. My 11 pound baby was only 19 inches and very fat adn rolley. Big ole head... and I barely tore- my first (8.8 pound) baby tore something awful. My 2nds head was big enough that the newborn caps they have at the hospital didn't fit her... and the typical gowns they use didn't either. She had to wear the "take home momento" shirts they hand out. And still my tear was very minimal comparatively. I wasn't in a lot of pain PP liek I was the first time.

[aprildawn]

after suffering a bad 4th degree with dd#1, dd#2 was only a minor 2nd degree. yay!! here's the story for anyone who is interested...

http://www.mothering.com/discussions...89#post2895189

[BrowneyedScorpio]

I had an epis with #1 which resulted in a 4th degree wound. It didn't heal right and I had a fistula. With #2 born 2.5 years later I didn't tear at all. Her labor & birth was much faster than with my son. Also, they were the same weight (8 lbs 11 oz) but she was 2 in longer. I'm betting that I have no problems with this one either.

[Mindful Mom]

I also had a 4th degree tear with my first (OB-attended). I used a midwife with my second and delivered with just a tiny skid mark!!

[Qerratsmom]

This thread has been very interesting for me to read as I am about to give birth to my second and am really worried about pushing. I too had a 4th degree with ds and was told to start pushing when I really didn't have the urge. i pushed for an hour with little progress and never could feel what I was supposed to be doing, they finally did a vacuum extraction. I still mourn that birthing experience 9even though everyone was fine in the end and I'm thankful for that) Still I want this birth to be different and heal some of the trauma from the last. I'm definitely going to hold off pushing until I feel the urge I'm jsut worried I'll forget when I'm actually dialated to 10 and wanting the baby out NOW.

[Mamabug&co.]

My first baby ended with an epi. He wasn't terribly big either. Barely 6 lbs. 12 oz. My second was a preemie, tiny, and I tore in a HUGE way. Sex was so depressing and almost a no-go after that. My vaginal wall collapsed, urinary incontinence, and a rectocele. I was perpetually constipated, because my muscles were so weak and damaged. Scar tissue was also in abundance. So, I have my third baby, also a preemie, who weighed amazingly 7 lbs. 2 oz., but not huge either, just long and lean, and I tore again. Not as bad, but enough to hurt. My doctor put in 'just for the meantime' stitches. 6 wks later, she did my repair which she later described as 'extensive damage'. What is is wonderful, is that depite having the WORST pain in my life, worse than all of my childbirths combined, was that I could urinate normally, I could have a bm normally, and had a normal, down there feeling. I did tear open sutures a couple of weeks later, but overall everything healed okay. We have had 3 vaginal births, all of them beautiful despite the pain afterwards. One doctor was horrified as to why I hadn't had a tubal done before the or during the surgery. I just roll my eyes at that : We are not sure where to go from here either, but I know I would in no way ever want to suffer from another repair to that site. We are praying that God directs my body and mind as to how it should birth. I will be praying for you mama. Only you know what your body is capable of.

[Qerratsmom]

Well I had my dd a week ago. After a 4th degree episiotomy and tear with ds, I had only a very small tear this time even though dd was a pound bigger came out with her hand next to her head and was slightly transverse. I would say dont get an episiotomy or a c-section just let it happen.

[sarajane]

I am seeing alot of posts around that say that babies were born with their hand next to their head and everything was fine. I am curious if this is a common happening? My mw has done two epsiotomies out of her 200 some odd deliveries and one of them was because the baby had her hand next to her head. I have since prayed that won't happen to me cuz I really, really don't want to be cut but am now wondering if it is necessary just because of that? I guess maybe if the baby is a little stressed? Mw said that an episiotomy speeds up birth only by minutes. Do minutes make that much of a difference?

[Qerratsmom]

I really didn't feel that she was ever "stuck" due to her hand being by her head, but my doctor did push the hand back in and then she was able to turn properly and came out with the next push. He also pushed on my vagina to help it stretch and focus my push. I know some people don't like that, but it really helped me.

[aprildawn]

Originally Posted by Qerratsmom

He also pushed on my vagina to help it stretch and focus my push. I know some people don't like that, but it really helped me.

my doctor did that, too. it really helped me focus on where to push. though, at the time i didn't like it and told her it hurt. in retrospect i'm glad she did it or i might still be pushing. :LOL

[Full Heart]

Originally Posted by sarajane

I am seeing alot of posts around that say that babies were born with their hand next to their head and everything was fine. I am curious if this is a common happening? My mw has done two epsiotomies out of her 200 some odd deliveries and one of them was because the baby had her hand next to her head. I have since prayed that won't happen to me cuz I really, really don't want to be cut but am now wondering if it is necessary just because of that? I guess maybe if the baby is a little stressed? Mw said that an episiotomy speeds up birth only by minutes. Do minutes make that much of a difference?

I had 2 babies with nuchal arms. With my 2nd the whole arm came out with her head like it was wrapped around it. When it happened with my 4th his arm was born bent next to his head, he was a bit harder to untangle. Then I had 2 babies with their hands in their mouths. I think they were sucking their thumbs, but I didn't feel those. Never had an episiotomy, never tore either. And one of those times was at the hospital with an ob. I never used to think it was very common but I guess it is.

If the baby is distressed then minutes can make all the difference. Sometimes the baby needs to be out now and sometimes an episiotomy can do that.