Vaginal Birth after 4th Degree Tear? - Page 3

[Rainbow]

I just had to bump this thread. I was saying how I had a 4th degree tear w/ my first and only mild tearing with my second.

Well, I just had my third... a 12 pound and 8 ounce baby... and had no tearing. I'm still suprised.

I think th ebig thing for me was an alternate position... with my first two I was on my back the "hospital way" with nurses pushing up on my legs. This time I was squatting for most of it, and then on my hands and knees at the end. So insist on moving ino positions that feel right to you, and not what the attendants find easiest.

I didn't do any of the perineal massage or preperations... but as I was pushing my midwife held a warm cloth against the area.

[ctdoula]

I also wanted to give an update. 2 weeks ago I gave birth to a 9 pound 7 ounce baby with just a TINY skid mark (no stitches). I pushed on my back (my choice), and only for 15 minutes. It can be done after a 4th

(also, it's AMAZING the difference in recovery time).

[mommamiagal]

hi. i am 31 weeks preg and my Dr scheduled me for a c section because i had a 4th degree last time , with a shoulder dystocia baby. baby crowned for 5 minutes before i delivered the shoulders with the help of the dr going in to get her out. it was scary. luckily she was OK, i needed an extensive repair. i ripped all the way through and one inch into the rectum. I delivered at home so had to be transported , without my baby, to the hospital for a repair that took about an hour. the recovery was no picnic, i think i sat on ice for a good 2 weeks . i have no problems other than slight gas incontinence and a much smaller perineum. this was my 2nd shoulder dystocia baby, the first one was a 2nd or third degree tear, the next one a 4th.that was 2 years ago, and i am agonizing over what to do. my homebirth doctor recommends a c section, so i was referred out to another OB.i know it is my decision , i just do not know which way to go with this. i totally have trusted my body in the past that is why i birthed at home, but i am thinking that a 3rd shoulder dystocia might not be good for me or baby. what to do. i suppose if it was just about my perineum i would definitely lean toward the vag birth, but i am afraid for the baby being large again. they were both 10 1/2 pounds and i am 5foot 2 110 pounds normally. i have been tested for gest. diabetes and do not have it. anyone else have shoulkder dystocia and 4th degrees together? anyone been told that they have a short perinem with not much to repair if need be? my anatomy has changed forever. i just heard about a product to help build tissue but is it too late? immunocal

[soratosjc]

4th degree tears

This is an old thread that I was hoping to revive to get some new feedback.
I had a 4th degree tear with my dd 2-20-03 and was told by OB that I would never be allowed to have a vaginal birth again. I think that there were many things the OB could have controled better to stop this, and many other negative things from happening. My daughter apparantly got "stuck" comming out but isn't that to be expected when you are told to push and the baby's head is facing the inside of my thigh instead of down? She wasn't a big baby at 7lbs 11oz but her shoulders got stuck in my pevic bones becuase she wasn't ready to come out. I was feeling NO need to push. After 2 1/2 hours of pushing, a nurse tugging on my perineum and another nurse pushing on my stomach the DR just reached in with her WHOLE arm and pulled my dd out.
Now that I am more knowledgeable I feel that I could make it a better experience but are the risks too great? Should I just go the route that the Dr's consider "safe" and have a c-section? I didn't walk for 6 weeks after my dd birth, am I brave enought to even risk that possibility again?
Jen

[alegna]

IMO I would not agree to a section. I WOULD stay far far away from OBs and find a nice homebirth midwife who knows how to keep her hands to herself.



-Angela

[ScotiaSky]

Adding my little story..

DS-Unplanned hospital birth-Non emergency transfer.
During a standard induced, epidural pushing on my back and then finally vacuum extraction followed by a epistomy turned tear 4th degree.
6 weeks plus recovery time, the pain was unbearable. Honestly I have never felt any pain like it.

Some background info...at 41 week NST was told there was no way I would be able to vaginally birth a baby of est. 9 lbs 8 ozs and would for sure have a SD.
Recommended a C-section, I declined and 6 days later was induced for other reasons.
During birth the hysteria of this so called large baby and preconceived risk of SD made sure my delivery room was a three ring circus.
I ended up with a 4th degree cut because instead of turning DS's head and the shoulder's following and then baby coming out, the Doctor cut.
DS's shoulder's were never stuck, his postion just wasn't the best.
My midwife witnessed the entire birth it was not SD, not one of the medical staff ever mentioned the word SD to us again.
BTW DS was 8 lbs 10oz.

This pregnancy my midwife's request my medical records from the hospital to check on some things and guess what it saids in bold letters that DS had DS.
Nope never happened...except maybe in the US tech mind at the 41 week US.

Now onto the question asked

I just gave birth to a comparable size baby to my son.
DD was 8 lbs 1 oz and all other stats are only off by the smallest amounts.
Water birth(recommended by midwife to help prevent tearing), pushing on my hands and knees till I squatted at the end and head came out...now any tearing that happened was my fault because instead of listening to midwife to stop pushing after the head came out I pushed and had some small second degree tears from the shoulders. Had some stitches.
These were not painful at all...it was just the normal feeling of swelling and bruising of pushing a baby out.
I was ready to get up and dance within minutes of the birth, gotta love natural childbirth
Also I never did any massages etc to help prevent tearing before hand.

I find it very strange that they would say you need a c-section because of a 4th degree tear alone. :
If I had scheduled a c-section just because of this reason and this reason alone I would have missed out on the most amazing experience of my life and a chance to heal from the horrible experience of my first birth.

[BAILEYBOO]

Hi there! I am new to this. I'm not even sure what I'm doing (computer wise), but I need some support. I had a horrible 4th degree tear that extended into my right buttock muscle. It was the worst several doctors have seen. I now have to have Perinioplasty. Have you heard of this or had an experience this bad?

[aprildawn]

Hi Bailyboo. My experience was bad, but not as bad as some of the other mamas here. My advice is to do your research, see other specialists for their opinions, and ask lots of questions. Good luck. Hopefully another mama here will have some experiential advice to offer.

[amyro]

a study about how often 4th degree tears repeat

I wish I had the study handy, but I JUST read a study where they looked at the likelihood of recurrence after a previous 3rd or 4th degree tear. The researchers found NO increased risk of a 3rd or 4th unless there was an episiotomy in the second birth. Even in that case, the risk was far from a sure thing, though I can't remember the actual stats. So the take home lesson from that study is definitely to REFUSE episiotomy if you have a history of a previous 3rd or 4th degree tear.

Other things would be to birth in any position other than flat on your back, push the baby out between (rather than with) contractions, and use your physiologic urge to push, not a bunch of cheerleaders counting to 10! All of these are supported by good research. There's some evidence that prenatal perinatal massage helps, too.

So I think these MDC mamas aren't a skewed sample - they reflect what really can happen if you go for a vaginal birth and make good choices about your care.

Great discussion - and congrats to all you mamas who have had successful (and no doubt healing) births after previous trauma!

[lizabird]

I had 4 stitches with baby #1 (laid back birth center atmosphere, waterbirth, no counting, pushed when by body needed to push, etc.) and I've started to wonder about the chance of re-tearing with baby #2. The healing from tearing was way worse than actually giving birth!

Anyway, I have no further insight, but WOW, great thread, great stories, great discussion, thanks for all the positive stories!!!!!!!

[moonmama22]

I'm so glad this thread has been rejuvenated... I was wondering from any of the people who have posted here who have said they had fistulas - did you have them repaired surgically, or let them heal with your next birth? I'm debating that issue right now, and have an appointment with my dr. next month. She is not my OB, but I am hoping she will have some input as to where to go next... Dp and I are still debating having more children. If my OB suggested a c-section (which I doubt he would - he's much more into letting things take their course, why I liked him in the 1st place), I would get a 2nd opinion ASAP. Also, if there is a next time, absolutely NO epis!, no fingers where they shouldn't be, and I am not pushing just because someone says, "you are 10cm, you can start pushing." It was probably 20 minutes after that when I really began feeling the urge to push. And when they say urge, I felt more like it was an irresistable force. There was no way not to push, my body just took over... THAT is what I will wait for next time.

Oh, and my ds had shoulder dystocia also. And they used a vacuum to help him out...
All the positive stories re: births after 4th degree tears are a big boost!!!

[runes]

thank goodness for this thread!

i didn't have a 4th deg tear but i did have an episiotomy and forceps when dd was born (hospital transport from homebirth ) i ended up with a vesicovaginal fistula (so it was the front wall of the vagina to my bladder, not the posterior wall to the rectum), i had to have it repaired surgically when dd was 3.5 months old as i was totally incontinent to urine (think of a water balloon with a hole in it, i was leaking constantly). at my follow up visit, my doctor literally begged me not to have any more vaginal births. i have since spoken to several midwives as well as the PT that i'm currently seeing (she's a pelvic floor/women's health specialist) and they have all said that there is no compelling reason that i would have to have a surgical birth. my PT has evaluated the scar tissue and general tissue strength/mobility of my vagina. i think that i have several things to take into consideration...

*to take as much time as possible for my body to heal. acupuncturist, midwife and pt have all suggested 2+ years before ttc to allow my body to heal as much as possible before subjecting it to the stresses of pregnancy and birth.

*no purple pushing.

*mindful positioning during pushing. hands and knees would probably be optimal, especially since i also have a cystocele due to dd's traumatic birth.

*breathing the baby out.

*no/minimal vaginal exams during labor.

i'm hoping for the home waterbirth that i planned and dreamed of, if we do in fact have another baby.

[rufio]

Hi all, i had my first birth by forceps and episiotomy with a 4th degree tear. The result was an anal fistula which was repaired 12 months postpartum. I am now booked for a c section, but thanks to reading all the comments here, I may actually talk to my midwife about another vaginal birth.

Would anyone be able to tell me if it will affect my fistula repair as I only had it repaired feb 2005? Also would I get damaged further and have to possible wear a catheter for life, is that one of the other dangers of tearingand then not healing better this time round, has it happened to anyone? all the birth stories on here have been positive, but has anyone experienced another traumatic vaginal tearing which has left permanant damage?

Sorry for all my questions and post being long. Ruth.

[aprildawn]

rufio -- I don't have any knowledge or experience with a fistula. Definitely ask your MW. Hope there's a mom on here who can tell you her experience.

[moonmama22]

I have an appointment in August with my Primary Care Physician/Gyn for annual appt., plus to check for a fistula. Wow - I didn't realize they recommend to wait so much time before ttc again. I wanted to try in a year or so. And I haven't even had an exam, or scheduled a surgery. Should I have the OB I went to when pregnant check for the fistula instead?

[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.... I am trying to find some way to avoid a tear this time. I hear in an upright position you have a better chance, or something.... I need to do more reading.

[sw1ssm1ss]

Really, REALLY glad I found this thread!

With my first, I had a third degree tear and a vaginal wall tear. Everything was going beautifully birthing according to the Bradley method until we came to pushing. Our doc said, "You studied the pushing exercises?" And we said, "No, we didn't." So we did directed pushing and it felt very unnatural to me. (I'm not athletic and it felt like I was back in 7th grade P.E. class trying to force myself to run a mile.)

When he saw her head, the cord was around her neck, so he pulled her out and I tore. It was very frustrating that the pain and pressure that I had been feeling just did not go away. I thought birth would be hard but that when it was over, all would be well. Instead, I was trying to get dh to stay by my side, not go with dd while the doc examined her!

I never really made the connection, or possible connection, between directed pushing, pushing when I didn't really have the urge b/c people were telling me to, and the tears. I assumed the tears were just b/c of him pulling her out.

I'm due again in November, and I'm going to discuss this thread with dh and then hopefully we'll discuss it with my doc and see if he is amenable to breathing the baby down, pushing when I feel the urge, different positions, etc. He was the one who suggested the Bradley method, so hopefully he will be. If not, we'll have to figure out what to do.

Most of all, I am so GLAD I found this thread and read the encouraging stories of tears not repeating themselves. Recovery was very bad, though I'm sure not as bad as it would have been with a 4th degree tear. Blood loss and resulting fatigue were also not pretty. Here's hoping it won't happen again!

[REDBREAST]

OUCH! You have my deepest sympathy for the hard delivery and I am sure recovery you had! I tore with my first too and he was 7lbs 10 oz. When I had my second, my mw rubbed oil on me which prevented me from tearing again and my second was a full pound bigger! Next time have massage oil rubbed on, as well as letting your body "flow" into pushing, what I mean is do not push if you don't feel it and only push when you do. There is no law that says you have to push when you are told to.

I would definately do more research on this and find a different mw next time. By the way why in the world did mw have her finger up your vagina? That is something I would look into... sounds like it could have made things worse. Also a complete water birth may be waht you have to do next time to prevent tearing as well. I also echo what all the other mamas have already posted!

[cutie_wutie]

I've had 2 4th degree tears

I had 2 4th degree tears i had one with my 1st child but i had a 15min labour and it was all so quick i was rushed to threathe for blood transfusion my second child i didnt tear at all but with my 3rd my scar tissues reopen during birth i am now pregnant again and hoping for natural birth and not c section.. i feel for all women that have 4th degree tears xxxxxxxx

[treehugginhippie]

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