Vaginal Birth after 4th Degree Tear? - Page 5

[Erdbeer]

Treehugginghippie, that's awful with the urethra tear... have you had the midwife check it out again? Could it be that you tore the vaginal wall?
Just wondering, how big was your second baby? That's great that the scar didn't tear.

[AlmightyIsis]

Wow, can't believe I found this thread. I'm now pg with our little unexpected #3, and all I can think about is exit strategy. My tear was one of the worst my doc had ever seen. I healed well but with some gas incontinence and a much, much smaller perineum. Like it almost isn't there. I really don't know how realistic it is for me to deliver naturally again. I'll be getting consultations.

[Erdbeer]

AlmightyIsis, please keep us updated on what info you get! I am in the same boat as you and am also collecting opinions... going to see my second home birth midwife today and one from a birthing center next week. So far I've gotten varied opinions so I'm hoping to find some consistent advice to make this agonizing decision easier!

Good luck!

[lifeguard]

I'm so glad to read so many positive stories of subsequent births going well. I am sitting here healing from a 3rd degree tear thinking about the next time.

There has been some mention o f waiting 2+ years before ttc again & am curious how far apart those with better suibsequent outcomes have their children spaced. We were hoping to have our children close together.

[Avecilla]

I had a third degree tear with my first birth. It was an unmedicated birth in the side-lying position with no directed pushing and no episiotomy. I'm not sure what caused me to tear so badly, although dd was born with her arm in front of her face, which may have contributed. The recovery was slow and painful, but I didn't have any lasting problems.

My second daughter was born 2 months ago. I had a beautiful water birth, and I could hardly believe it when my midwife looked at me and said I hadn't torn. I think I actually cried tears of joy.

Originally Posted by lifeguard

I'm so glad to read so many positive stories of subsequent births going well. I am sitting here healing from a 3rd degree tear thinking about the next time. .

There has been some mention o f waiting 2+ years before ttc again & am curious how far apart those with better suibsequent outcomes have their children spaced. We were hoping to have our children close together.

Our daughters are 2 years 8 months apart, so we conceived right around her 2nd birthday. Not sure if the 2 years of healing helped or not, but they certainly didn't hurt.

[AutumnAir]

I'm so glad to see this thread - it gives me hope for the future.
I had such a traumatic birth that I'm still not sure if I'll ever be able to have another baby, but it's good to know that other women have successfully birthed babies after similar injuries.
I had a huge episiotomy - here they do medio-lateral which have less chance of tearing into the anus, but are much more painful to recover from. Mine goes all the way back to the ischium (one of two bones in you buttocks that you sit on) about 3-4 inches, so almost all the way up my vagina. And I had a high forceps delivery with a posterior baby. All these are risk factors for urinary and fecal incontinence and together... Well, let's say I always know where the nearest toilet is these days.
Because my injuries were the result of birth rape I haven't been able to bring myself to go to another HCP to get them evaluated. I have been doing lots of pelvic floor muscle exercises and 'training' to improve the incontinence and it's slowly working.
But it still hurts, 10 months PP. I still haven't 'resumed relations'. (Poor DH!)
But as I said it's good to know that others have overcome these types of injuries. to everyone here.

[JenniferH]

I feel lucky that I recovered so quickly. At my 6 wk pp checkup the NP said everything looked really good. I didn't have much pain after the wound healed either.

[wombatclay]

Hugs LisaBee- I hope you find all the healing you need! My OBs told me to avoid penetration of any sort for 6mo (unless I really wanted to and, ummm, no), and that it wasn't uncommon for a mama with a severe tear to wait a full year. I know some mamas in this thread have recovered quickly, but I can say that it was a full year before it wasn't cry out loud painful (and DH didn't want to dtd either since he didn't want to hurt me) and now at 16mo it's still not exactly comfy. Even tampons are uncomfortable, and I can't use my sea sponges or diva at all. I also had incontinance issues and prolapse, so I know some of where you're coming from. Hang in there! (and check out the pelvic organ prolapse thread in birth trauma if you think you have any prolpase issues as well since there are some very informed mamas there, and several with urinary, gas, or fecal incontinance)

[kerryleigh20]

hi im new to this, hope i get it right.

i was only 18 when i gave birth to my daughter who weighed in at a whoopin 8 14 and 55cms long. im only 5'2 and i think that was well over the top, and was left to tear like i did. i sufferd from a 4th degree tear wich ended up tearin all my bowls, i had to go to physio therapy. throughout my pregnancy i was told that she was well over average and had to go for a scan at 30wks to check the growth, they told me that she was measuring in at the size of 33+week old baby and that i had to see a consultant. i never got that apiontment to see the consultant and was jus left to go into natural labour. i was told from a few people ie friends and family that my bump was huge and that she would be big but as i was only young and was my 1st pregnancy i just had to go alolng with it, i didnt know who to go to or who i could speak to about my concerns about being big as my midwife told me at all the appointments that everything was fine.
i went into labour which obviously was very sore, she was back to back. my mum and sister was with me and when her head came out my mum said that the wall seperating the vagina and pack passage 'burst' open. they then decided to get foreceps but was to late as i had pushed her out.
she was born at 9.55pm and i was taken away to theatre and didnt see my daughter till 2.30am because i was away being stitched up.

i am now 33 weeks pregnant with my 2nd daughter and keep choping and changing my mind wiether to have a c section or go natural. iv had midwifes tell me to have a c sec because the wall wont b as strong as it should b and the skin is more sensitve, but iv had registras telling me that i should go natural because of the rest i will need after a c section. i dont know what to do but i do know that i am petrified and dont want to go into labour scared that it might happen again. but i want to be a hands on mum from the word go but wont b able to because i was told that i ouldnt b able to be after a c section. could any1 help me or reasure me that 2nd time round might or wont b no where near as bad even if u have tore loike myself.
thanks

[Moonflower77]

I had 3rd and 4th degree tears...

I just had my little guy in August and I had a vaginal birth. It was my third vaginal delivery and by far the easiest. I will keep this brief but I came out with only perhaps a stitch or two even though I was told it was maybe a skid mark! I think the doc put one in just for peace of mind. I made sure it was the same doc that stitched me up for my last baby.

Now, I did get induced 5 days before my due date I think in my case it helped because my first 2 babies were over 9 pounds and my second had a 15 inch head--whereas, my third was 7lbs. 6oz. and had a 13.5 inch head.

With my first beautiful boy in 2004 I was induced on my due date--we were very healthy but I had been having really bad hip problems and awful water retention and he just felt really big-my gut instinct told me he needed out! I ended up with horrendous back labor and he got stuck at the shoulders and had to be pulled out--1 3rd degree tear down and 3 2nd degree tears up! OUCH! 9lbs 1 oz--he was assessed to be 42 weeks gestation and very healthy. I had a tough time with the recovery but the joy of having a baby helped a lot.

2006 my 2nd pregnancy and I was reaaaallly scared to birth again but did and did so at a birth center with midwives. Another induced labor at about 42 weeks--I knew it was a big baby and I knew I was increasing amniotic fluid exponentially. I labored and delivered fast on knees--9lbs. 6 oz -15 inch head and a 4th degree tear. My baby girl came into the world on a giant wave of amniotic fluid. I had a great experience but never expected to tear that badly. Recovery was a beast but I did heal well. Doc did a great job stitching me up but it was a looong time before I felt like myself.

2008 third pregnancy-a boy and I was MORTIFIED about another possible tear. I did a ton of research and soul searching and decided I did not want to go as far over dates with my third. I wanted to be induced either right after my due date or during the week before. I felt that size of head/baby coupled with speed of delivery had a lot to do with my tearing and I knew that I did not want to have a c-section. I had a wonderfully easy pregnancy. I chose to get induced during my 40th week--I was very sure about my dates. Yes, I hated having to be induced and being hooked up, etc. but I ended up having a very good experience with no birth trauma to my baby or me!

I am leaving out a lot of details-mainly those about how I was treated (good/bad) by the midwife group I was with before opting for the hospital - but that is because ultimately you have to educate yourself as much as possible and then go with YOUR mommy gut instinct.--Yes, there is a lot of fear-but even in the midst of that fear I knew what I wanted for myself and my baby. I made the best decision after weighing all options. For my baby and I it worked out very nicely!

In MY experience there is a lot of insensitive treatment by SOME Midwives/Docs/nurses of mothers who have had bad tears--mainly because we do not fall within the norm of birthing/tearing, etc., and they are not sure how to handle us because you can not predict birthing outcomes like the degree of spontaneous tearing.(ie no epis., no forceps, etc.) A couple weeks after my 4th degree tear I was actually told by a nurse that was NOT present at the birth of my 2nd child that the reason I tore so badly was because I "blew" the baby out --meaning I just forced the baby out with a massive push--I was furious and hurt that my privacy had been violated and that I was treated so poorly by someone I had never met. I was treated like *I* had screwed it up somehow--when I knew and the MW delivering knew that I only pushed with my contractions. That is why these forums are so important.

I have been following this thread since I became pregnant with my third baby. You all have inspired and helped me so much. I knew I needed to post my experience because I *know* how scary it is. I wish you all the very best in you future birth experiences. I hope my post was helpful. I actually tried to be brief by leaving a lot out~sigh~


-Moonflower
Mommy to three amazing gifts

[giddiegoof]

pregnant with fistula (oops) - any ideas?

Hello,

I have a 2 mm fistula resulting from my son's birth almost 3 yrs ago. I had a 4th degree internal tear toward the rectum with his birth (nonmedicated, hospital birth with 8 minutes of coached non-stop pushing since his heartrate went down anytime I wasn't pushing). I didn't realize I had a fistula until he was about 9 months old, and at the time I realized was w/o insurance or money for repair. I was diagnosed at a percent-of-income clinic by a resident who obviously had never heard of a fistula before, and scared me so bad about being repaired ("sometimes a colostomy bag is needed") that I couldn't bring myself to have surgery until I did a lot of research and tried any alternatives I could find. I also have some negative emotions toward male drs, mainly because the OB who stitched me after birth told me I didn't have a fistula when I saw him again after first suspecting, and sent me off to the percent of income place telling me I could see a specialist. Do you know how hard it is to find an experienced female colorectal surgeon?

Late last year I was finally beginning to come to terms with the idea of surgery and how to promote best healing & recovery naturally, etc, so I made an appt with the best colorectal surgeon in the area (a male). I couldn't find babysitting for my son, so had to reschedule, and voila! oops, in between appts realized I am pregnant.

Any ideas of what to do? I am meeting with a midwife next week, and considering seeing a surgeon to see if anything can be done while I'm pregnant. I know the surgeon will tell me to have a c-section, but is there any chance I can still have the beautiful non-interventive homebirth I dreamed of? Would it be better to try for home and have surgery for repair after birth if I tear more, or c-section surgery? I know that no one can really tell me what to do, but any thoughts would be appreciated.

I have read lots of stories of birth after tearing that had convinced me to go ahead with homebirth after I was repaired, but of course I intended to be repaired before ttc. I know I've waited too long to seek out treatment, but it's water over the dam at this point. Thanks for any encouragement that can be offered.

[mommamiagal]

hi. i am so sorry you are going through this. i did have a 4th degree tear that went into (1 inch) the rectum, but it was repaired within a few hours of the home birth. i guess that was a good call on my homebirth doctor. they sent me to the hospital and i had a UG specialist do it. i have not had any trouble with it, however , i was , many second and third opinions too, advised not to have another vaginal birth due to the trauma that i had suffered in that area. the space between my vaginal opening and the rectal opening is very small. i did have a c section with my next baby , and am planning another c section with my current pregnancy. of course i am not happy with this outcome but i have no choice, with the shape of my anatomy and the large size and shoulder dystocia with my babies. as far as getting your repair before the delivery, that will need professional opinion. i would have a c section if it were me, since repairing tears is a lot harder than repairing a c section incision which is a straight line vs. the kind of tear that we suffered which is very hard to put back together. my c section was a much easier recovery than the 4th degree tear. with the abdominal incision , i really babied it and allowed it to heal , whereas with the vaginal tear, you still have to make sure it is clean to prevent infections , from going to the bathroom , etc.... good thoughts with you. good luck.

[aprildawn]

giddiegoof -- I'm so sorry to hear about your fistula, but congratulations on the new baby!

If I were you I'd seek multiple medical opinions. Seems an unrepaired fistula isn't something you'd want to risk making worse. If you gather a few opinions from doctors and/or midwives you may find a common thread you can follow for this birth.

I hope you are able to be at peace with whatever the outcome is.

[giddiegoof]

Thank you. I know that ultimately this is up to my husband and I to decide... I will be meeting with a midwife this week and probably a surgeon in a couple weeks. Any other thoughts would be most welcome. Of course we just want a safe delivery for baby and me, but I've been so freaked out by everything I've read about c-section and have been so committed to natural birth in the past that it's really difficult for me to consider that direction.

[Erdbeer]

Well, I'm back to report the outcome of my second birth after a 3rd, almost 4th degree tear with extensive vaginal tearing, torn labia on the left side, a cervical tear and torn artery with extensive blood loss last time around (4.5 years ago).

I did a ton of research and soul-searching and asking the mothering forums before finally deciding about 25 weeks into my pregnancy that I would try for a home birth. I talked though my issues with a few midwives, and agonized a bit over which one to choose. In the end, I went with the one who had been home birthing the longest and who was very hands-off. In the end I am not sure I wouldn't have been better off with one that was a bit more proactive, but I can't change that now and will never really know...

My first baby was 7lbs even with a 34cm head, which is pretty average, maybe even a bit on the small side. I am not a tiny person either. My labor was in a hospital, with epidural and pitocin, I pushed twice and the baby flew out. I felt the meds were much too strong for me.

I was advised this time to go to an osteopath who could massage my perineum over the course of several appointments and get my scar tissue to soften up. Honestly, the thought of this freaked me out, and I decided to try perineal massage myself but ended up doing it only twice before taking some midwives' advice that the perineum will eventually open up no matter what.

This time we set up a pool in our apartment, I talked a lot about laboring and possibly birthing in the pool, and this is what ended up happening. My labor was fast, the midwife arrived at 11PM and I was at 6cm, and the baby was out at 12:15. During pushing, I was hyper-aware of what was going on because I was so afraid of tearing badly and losing as much blood as last time. I felt the baby's head move from what felt like my butt-area, forward to my perineum, and then even further up with most pressure upwards towards my labia. I felt the perineum and it was not giving! It felt like it held tight and neither tore nor stretched. The head was pressing forward and I felt I was starting to tear. I told the midwife, and she said "no, you are fine, you will not tear, just relaaaaaaxxxxx....." I felt she was not really "with it" at this time, and was just going through the motions of telling the woman in adrenaline-fueled transition to take it easy. I told her again "no, my perineum is not stretching, I am tearing forwards!" At that point I felt a bit humored and thought to myself "this woman is not helping me, my husband doesn't know what to do, I have to decide now to either push this baby out and take the tear, or sit here in limbo!" So I pushed against the pressure of the baby's head and tried to guide it downwards as I pushed. After about 4 pushes, she popped out. I felt the sting of the upwards tear contrast with the relief and gentle feeling on my perineum as she came out.

I ended up tearing my left labia almost clear off, and had maybe one stitch in my perineum. None of the places I tore last time (which was pretty much everywhere else) were affected this time. It is now 10 days after the birth and I feel pretty much back to normal. Last time it took me 8 months to feel no more pain.

All in all, I am glad it went so much better than last time but still a bit disappointing that this birth did not heal my fears about tearing. I keep wondering if I am just a "tearer" and this will happen with any subsequent birth. In any case, I am so glad I went for a home birth. I feel that being at home allowed me to heal so fast, and I realize now how much of those first few days of my son's life I missed by being drugged up in the hospital.

[cristinaberger]

Trying to avoid another tear

I had a 4th degree tear in November 2007, it took me about 10 weeks to completely heal. My husband was swabbing my tear every night with peroxide and honey. I had an induced labor with epidural, 3 hours of pushing on my back (never felt the urge to push) and ended up with an episiotomy and vacuum extraction. The baby was 8.14 lb.
I am due in 10 weeks with my second baby. I was thinking to start massaging the perineum and then try to deliver the baby laying sideways, as slowly as I can. Do you think this will work in order to prevent another tear?

[bramblevine]

Originally Posted by cristinaberger

I had a 4th degree tear in November 2007, it took me about 10 weeks to completely heal. My husband was swabbing my tear every night with peroxide and honey. I had an induced labor with epidural, 3 hours of pushing on my back (never felt the urge to push) and ended up with an episiotomy and vacuum extraction. The baby was 8.14 lb.
I am due in 10 weeks with my second baby. I was thinking to start massaging the perineum and then try to deliver the baby laying sideways, as slowly as I can. Do you think this will work in order to prevent another tear?

No to the peroxide! It can actually inhibit healing. For the honey though. Yes, massage is good. I find the key though, is lubrication. Have your midwife use an oil (some like olive, some like arnica -which is usually carried in olive anyway-) to lubricate you as the baby is crowning, and sometimes they'll help stretch you, but my preference is lube me, and leave me.

ETA: Water births are even better for this most of the time.

[AlmightyIsis]

I posted here months ago, and am still looking for the bet way to birth this baby. I'm 33 weeks. Doc says I should try a vag birth, but I am not so sure. I think he really needs to look at my body before making that final determination. I guess I know I don't need to make a decision today, right now, but my anxiety is building.

[wombatclay]

My OB suggested waiting till labor was underway to make a decision... my 4th degree happened after a shoulder dystocia that came after a very long pushing stage. In that birth the decision was to try the vacuum first, then go to a repeat c/s. This time if the pushing stage goes the same (slow, little progress, etc) then we'd skip the vacuum and go directly to surgery. It's not ideal, and my hope is that this time pushing/delivery will be uncomplicated, but it has been helpful for me at least to keep in mind that the decision can wait till we see how this specific birth with this specific babe shapes up.

Big hugs to you (and congrats on the new babe Erdbear!)

[cristinaberger]

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

Originally Posted by wombatclay

My OB suggested waiting till labor was underway to make a decision... my 4th degree happened after a shoulder dystocia that came after a very long pushing stage. In that birth the decision was to try the vacuum first, then go to a repeat c/s. This time if the pushing stage goes the same (slow, little progress, etc) then we'd skip the vacuum and go directly to surgery. It's not ideal, and my hope is that this time pushing/delivery will be uncomplicated, but it has been helpful for me at least to keep in mind that the decision can wait till we see how this specific birth with this specific babe shapes up.

Big hugs to you (and congrats on the new babe Erdbear!)