Fourth Degree Laceration

[redsoxdoula]

Has anyone homebirthed after a fourth degree laceration???
Did you tear...again?
In your opinion, how did you get your fourth?
Did you freak out during your second stage when birthing at home?
Tell, tell....:

[redsoxdoula]

Just curious b/c I had a difficult labor that ended with a fourth. I'm dancing with the hb idea and I would just like to talk with someone who has been there, done that.

[pamamidwife]

I have seen one woman after a fourth degree (that involved perineal reconstruction after the birth!) and two after third degrees due to episiotomies.

All three birthed at home beautifully, no more complaints about second stage than any other woman and all birthed their babies without any tears that needed repairs!

It can be done, definitely!

[Lucky Charm]

Mama, I had a 4th degree tear with a significant repair with my second child and did not tear with my third, not even a "skid mark"

FTR, I did not have a homebirth, but wanted you to know that I did not tear after having a 4th degree.

Good luck.

[faithhopelove]

I tore BAD during my homebirth with #2. I had to transport and go under surgery. I received about 250 stitches inside and out. LIke we are talking vaginal muscles and all that jazz.

Malachi was born after 3 1/2hrs of pushing and had a nuchal hand. My perinium was so swollen it just "popped". I actually heard it pop. Shiver.

I was nervous about tearing with #3. I did end up tearing some along my old scar tissue but I didn't realize it till later. Wondered why I was so swollen but dh told me it didn't look like I tore. Could have used some stitches cause I have a flap of perinium hanging down from it. I thought it was a hemmoroid all this time, hey... it is far back there since my perinium is only like 1/2in now LOL. Oh and this was my UC.

With this one... I am just trying not to think about it. I have a midwife who if I decide to UC again, will come out after to check me out and I know I will be ok even if I tear again.

Crystal

[bhawkins]

Well, I haven't homebirthed but I did have a 3rd degree episiotomy with DS1 and even though DS2 didn't come until 10 yrs later I was still worried about it. I only had a very small tear (1st degree) with DS2 and almost no down time. So, it's possible.

[Electra375]

I'm right here with you in the fear of a worst situation than last time. I had a 2nd degree, almost 3rd inside and said NO to stitches. I have scar tissue in the perinum area, but did not tear there, I did bruise quite deeply and swell to what felt like a grapefruit in my hand. I tore up by my clit - yes ouch! My inside tear was a pop as her shoulders dropped -- she is 'girthy'. TO this day she is still very broad and thick through the chest, a solid little thing.

Anyway, I am hoping the perinum will stretch enough, but it is just so fiberous I'm worried I will either beg to be snipped to let the baby out or I will rip more up near my clit again (that skin flaps a stitch would not have held it either they way it tore, it does not bother me know, it made sex very sensitive for a long time -- okay way TMI... )

I've used calendula oil on my yoni for 2 yrs in hopes that the fiberous feeling would yeild to a smooth stretchy feeling again -- no such luck. I'm not sure what else I can do to prepare the skin in that area for stretching.

[chrissy]

i had a 4th degree tear with my first in the hospital. i think it was 100% due to an episiotomy, though i must add that my son was 10 lbs 6 oz.

i had my second at home. it was a super super fast birth and i only had a teeny tiny little tear that my midwife stitched up at home without even a local anesthetic.

i'm planning to have my third at home in may!

best of luck to you!

[Paige, CPM]

Hey there RedSoxDoula,

Not a Yankees fan I guess?

I have not seen a client that had a previous 4th degree but I have had enough clients to know that just because one tore before does not mean they will again.

Some of the reasons someone might tear more besides bb positioning, perineal support, and slow or fast pushing, have to do with vaginal tissue health at the time of birth. For example infections during pregnancy, or even just one close to the birth (yeast, std’s or bv) can all cause the tissue to be more friable.

We had a client once who had multiple yeast infections and she tore pretty badly (not to mention nuc hand and lrg bb). She had a third degree that when into the anal tissue but not the anal muscle band, so technically, it was still a third degree. We decided to transport her for suturing with a surgeon, just to make sure it would all be perfect (although we do suture most things with confidence). This same client went on to birth again without any major tearing 2 years later. I would be aware of your vaginal health and be on top of any infections if I were worried about that aspect.

If you decided to interview midwives for a homebirth (there is a list of them, if you don't already know, at www.massmidwives.org) you may want to have one of your questions be about their suturing skills and what they would do in different tearing scenarios.

Also, if you are having babies very close together this may effect the possibility of the scar tearing as well.

Best of luck, Paige

[Max'sMama]

I had a 4th: with my first child. It was due to the use of Forceps and an episiotomy which tore further. My second was a homebirth, laboring in the water, delivering 'on land'. I did tear along my scar line, but the tear was a second degree that the midwives stitched with no problem and I felt TERRIFIC: after 2 days. Yes a touch sore for a few weeks, but I was sitting on hard kitchen chairs after 2 days, so.... not too bad.

[ctdoula]

HUGS! 4th degrees suck! I was traumatized by mine w/dd (baby #1). Mine was due to an extension of an episiotomy.

With my ds (baby #2), I had just a tiny skidmark, no stitches at all & he was over a pound bigger (9lbs 7oz).

[mommy2madison03]

I had a 4th degree with my first due to episiotomy and then tearing the rest after a fast delivery of the head with vacume extraction. I too was terrified of tearing with my last delivery but I only had a very small 1st degree tear. I'm actually glad I tore a little because I believe it has healed me actually. The way my OB sutured me was horrible and even sex was painful. Now I feel like I did before kids! Thank goodness I switched to a midwife!