Vaginal Birth after 4th Degree Tear? - Page 4

[wombatclay]

bumping/subbing

My 4th degree tear, shoulder dystocia vbac babe arrived 2 weeks ago (link in my signature). I'm doing what I can to heal but worry about my future health and delivery options...I'm so glad I found this thread!

Honestly I sort of feel like I won the war (had a wonderful, natural vbac without meds) but lost the last battle (due to the vacuum and tear)...though I know that's putting the famous saying backwards!

[19spitfire]

thanks

I just found out I'm pregnant with my third(suprise!). I had a 4th degree episiotomy with the first and a c-section with major complications with the second. So I did a search for vaginal birth after a 4th degree episiotomy and found this thread. I have to thank everyone who posted their stories for momma's like me. I cried with joy to hear all of the success stories and now I have hope that this birth can be what I imagine in my heart. A sincere thanks to everyone who posted to this thread.

[jenkuh]

Originally Posted by 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.

I also had a fistula (an anal fistula) that was repaired in March 2005. I worry about the same thing. I'm and so grateful for this thread - I also cried tears of joy for all the positive stories! However, I am still worried about the repair and the fact that my overall "layout" of things down there are significantly different and I am aware of it. I hope to hear from others here about this as well.

[mamasunflwr]

Bumping an old thread...
Anyone have any updates?? I'd love to know how everyone is doing... Any positive vaginal deliveries after 4th degree tears?

[Tanibani]

I had a hospital birth with my first (2000.) I didn't want an episiotomy. So I tore, bad... 4th degree to my anus. The scar (and my anger at my husband and OB) caused problems - serious constipation. I worked on my feelings (let all the anger go) and went to see an acupuncturist/got Chinese herbs and those 2 things totally cured me.

I went on to have a homebirth with a midwife 4 years later - 2004 - minimal tearing.

I had more of a fear of prolapse than any tearing. In fact, my pelvic floor was always weak... and I was terrified of having a 2nd. That's my main reason for not having a 3rd... fear that I could end up with a prolapse.

[claire75]

This link has been a wonderful source of inspiration to me! and I just wanted to thank you all for taking part in this incredibly important discussion. (I've been meaning to post for soooo long, my boy is now nearly 6 months old!)

I tore with my first to 4th degree, caused by an episiotomy. Thankfully I was repaired very well and healed to have no after effects. When I got pregnant with my second I knew I wanted to deliver vaginally again but I constantly came up against opposition. Such negative energy! So I sought out positive information and this link was sent to me by a wonderful lady that had gone on to birth 5 more children after her 4th degree tear with her first.

In the end after weighing up my options I opted for a homebirth - I felt that no intervention was the best way for me to get the successful outcome I wanted for baby and me.

In preparation I looked into hypnobirthing, directed breathing and I spent some time stretching (very gently) the scar tissue. My main concern was tearing the scar (even though I knew from my research this my pretty unlikely). The best thing about the stretching was in got me back in touch with that area of my body, it had changed so much from the repair that it didn't feel like 'me' anymore. I put a lot of effort into eating the right foods, keeping hydrating and taking supplements.

In the end I got the beautiful homebirth in water I wanted - a lot quicker but manageable, minimal tearing (a slight 2nd - not near the scar and a small graze), drug-free. I felt safe and was supported by my DH, midwife and doula.

It was scary to push out his head but I did it slowly and even missed a contraction to aid the stretching.

I'm really proud of the outcome and this link was one of the first times I realised that even though I wanted it, I might actually be able to achieve it! So thank you, thank you, thank you!!

[little flower]

Hey everybody!! I've been astounded and touched reading all your posts...

I don't know if you might be able to help me too... but I'm expected my third child but have torn both times in past. First time was with an episiotomy and a 2nd dregree tear and then the next time, with two episiotomies and a 4th degree tear. After the second time my confidence was shattered since everything seemed to be going fine. I don't really know what happened but this time round I've been advised to have a C-section which is scary too.

Anyway I have NEVER heard of not having a C-section after a 4th degree tear so I'm in awe of you guys. It would be amazing to have a natural birth and overcome all my fears of the past, but I'm still suffering problems from my tear 2 years later.

Does anybody think that this might be an option for me, despite my history or whether since I've torn twice and still have troubles, a C-section really is my safest option...

Any thoughts would be fantastic... xXx

[homewithtwinsmama]

My first homebirth client ever had a horrific 4th degree with massive infection- following hospital birth- and reconstructive surgery. She too was told to have cesarean the next time. Didn't want to, chose homebirth, had a 9 lb baby (pound and a half bigger than first baby) over intact perineum. She pushed with her urges on a birth stool and we did hot compresses and had her pant head through crowning. Mama had done vit E oil and perineal massage religiously for about two months before the birth.

[wombatclay]

Little Flower- hugs mama. I'm sorry you've gone through this twice! One thing to keep in mind is that episiotomy is a hug risk factor for tearing. One good mental image is to think about a piece of fabric...if the fabric isn't cut you can still tear it, but it takes a lot of effort and usually the tear you manage to make isn't that big. But if you cut into the fabric and pull along that cut you can pretty easily rip the fabric into two piece. The perineum is similar to that fabric, so even though mamas do sustain 3rd and 4th degree tears without episiotomies, it's much less common. Many serious tears are actually episiotomy "extensions", even when that isn't the terminology being used on your medical records.

It's true that some women tear more easily. But you've never been given the chance to birth without intervention (the episiotomies you mention). Unmedicated birth that allows full freedom of movement, the option to labor/birth in water, a care provider who follows your lead and keeps their hands off your perineum, pushing only when you want and in the position/duration/manner you want... these are all important tools to avoid further tearing. Eating a balanced diet with plenty of protein and good fats, regular perineal massage (though many care providers feel that this massage shouldn't be done in the last month or two prior to the birth since it can cause bruising/swelling then), maybe the use of an epi-no to help stretch the scar tissue gently and build your confidence, and the use of a birth tool like hypnobabies (to aid in relaxation and breathing out the babe) can help as well.

Good luck and happy (tear free) birthing!

[bkbabymomma]

Thanks for this thread, it really helped alleviate my fear about impending birth #2 (3rd degree tear with #1). Turns out my midwife this time round did an intensive study of perineal integrity during her schooling, and she agrees both with waiting to push until the urge hits, and being mostly "hands off" (no massage during delivery). I found it interesting that she felt one of the greatest risk factors for tearing was position, saying she would let a woman giving birth vaginally for the first time labor, but not deliver, in a squat. She also assured me that tearing more than once is pretty rare. Good luck mamas!

[MovingMomma]

What position does your MW prefer?

[bkbabymomma]

Kinda anything else but squatting, where gravity is in full force when you might need the brakes on a bit. She mentioned that hands and knees could be very good, although this increases the risk of an anterior tear (rare, and usually small).

[mntnmom]

I had an epi and a tear with my first baby. With #2 , I was scared to death but I got 3 stitches, which now that I know better, I probably didn't even need. #3 and #4, barely an abrasion.
If there's not another reason for a section, I would try for a vaginal delivery, from what I've heard the risks and a recovery for a C-section are to be avoided!!

[mamasunflwr]

*bumping*

[stacyann21]

The best way to avoid tearing is to push only when your body tells you to, in a position you feel comfortable in, and to keep all fingers out of your vagina.

I agree. A tense environment also contributed to my tearing (up my vagina and into my perineum). I did not do any perineal massage and my mw was mostly hands off during my delivery. Not sure what happened there. Hope it doesn't happen again next time. The next several weeks of pain and breastfeeding problems were almost more than I could handle.

[MauriMama]

4th degree tear followed by 3 repairs

Hi everyone,

Thank you so much for all of your posts, I have read every last one of them. They have given me hope that I too can have another vaginal birth for any future babes after my 4th degree tear.

I had a home birth with my DS who is now just over 2 years old.

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.

At that point I knew I couldn't go through that again. I spent the next two years interviewing OBs, colorectal surgeons, MWs. I even asked Ina May Gaskin her opinion on the matter. I researched countless articles about pelvic floor injuries during birth. How they happen, when they happen, what are the chances of their happening again. It seemed that a home birth without intervention was the least likely way to end up with a 4th degree and yet, I had one. I started thinking it was my body's fault, that my perineum was too small. Every OB and surgeon I spoke to said that I would definitely need a c-section for subsequent births if I had the repair. Every MW said...I would be fine and could avoid another tear. Although many of them had not attended a birth following a 4th degree tear, without a subsequent tear. I didn't know what to think!

When I talked to my MW about it she agreed that squatting might not have been the best position for me, and that I didn't have any swelling to indicate that I might tear.

I finally, somewhat reluctantly, agreed to surgery, in January 2008. I knew that I could not continue with the fecal and gas incontinence, and I was afraid that delivering a subsequent baby without any perineum to slow the baby down could cause more damage to my pelvic floor.

My surgeon was worried about the outcome of the surgery because he felt like my tissue had been so damaged with the two previous repairs. He did an overlapping repair on the anus, sphinteroplasty, perineoplasty...anyway, that's what it says on the report. The recovery was almost impossibly painful. And three months later when he said I was completely healed I thought he must be joking. I was in so much pain.

I had a short perineum to begin with, but now, I feel like it's almost non-existent. I'm currently seeing a pelvic floor PT, and I'm getting great results in terms of scar mobilization, pain relief (almost pain free!!) and pelvic floor strength.

I'm feeling much more positive about getting pregnant again and delivering my next baby vaginally and at home again (with a different midwife!), especially after reading so many positive stories.

Thank you again for your posts and for being a safe place to discuss something like this.

M:, mother of:L, ::, loving husband D

[JenniferH]

I had 2nd deg epi and a 4th deg tear. It never occurred to me that I would have to have a c-section. I had minimal pain and healing time after mine though. I heal really well, and was actually up sprinting down the hall a few hours after having the stitches (long story).

At my 6 wk checkup I was pretty much completely healed, and the NP checked vaginal integrity and said everything looked fine. Neither she nor the OB ever mentioned a c-section.

I think the fact that I didn't have sex for more than 4 months after she was born helped (I was single when she was born). I had plenty of time to heal completely.

I don't expect any problems. My scar is smooth, and I can't feel any hardened scar tissue on the inside. We shall see, if I ever have any other babies.

[loulie]

mauri mama my heart goes out to you. I had a 3rd deg which took 2 hours of surgery to repair. two days later, after a blood transfusion to replace what i lost during the surgery, my stitches also came apart, not the whole way though. The Ob/gyn decided NOT to stitch me up again, so I was left to heal 'naturally'. I think I was lucky after hearing what you went through, but I'd never heard of stitches coming apart before and I know how painful it was so can't begin to think how hard it must've been for you.

It's good to hear you're feeling more positive now - as am I - and this thread has definitely helped me in that respect.

[Erdbeer]

Just reigniting this thread because there are so many informative stories in here and I'm sure there must be some posters with severe tears who went on to birth vaginally again.

If so, can you chime in and let us know how it went?

I had a 3-4th degree perineal tear, vaginal tearing all the way up to my cervix, which also tore, during the birth of my son (7lbs even, head circumference 34cm). I am now pregnant 4 years later and have heard every bit of advice from "get a c-section" to "no way you should birth outside a hospital after tearing your cervix" to "you were doped like a racehorse with pitocin to birth faster the first time, next time do a homebirth" and I am swimming in my thoughts.

Hearing your stories are really helpful and I'd love to read more.

[treehugginhippie]

I posted to read later but now I can post my experience...thanks Erdbeer for bumping

I had hospital birth w/ dd1 and I ended up w/ a 4th degree tear.

This time (did it the 1st time...didn't matter anyway) I didn't do perineal massage because....well...it hurt too much! I did massage olive oil mixed w/ wheat germ oil (I read it's good for scars...I only mixed a very sm amount in the olive oil) on my perineum just before bed the last 4 weeks of my pregnancy.

Well, I had a home waterbirth and pushed on my hands and knees. I didn't have any tearing but a skid mark that my mw stitched cause she said I'd be more comfortable. BUT because I was feeling the "ring of fire" up high instead of at my perineum I tore my urethra or someting cause it still burns when I pee sometimes at 6 weeks pp. My mw didn't see this I think.

Much better than before and I'm soooooooo happy I didn't tear my perineum again but still a PITA to still have some pain. From what I've read it can take several months to feel normal again.