Classifying a tear

[ed_tricia]

I had posted this elsewhere and someone recommended trying here.

So, I see people refer to 2nd, 3rd, and 4th degree tears during childbirth. I did have an episiotomy, but I think I tore also. My doc didn't give me any classification, and I know it doesn't really matter, I'm just curious. I did try looking it up, but I wasn't able to figure it out. So are the key indicators for deciding what it was? Or is it possible to have a major episiotomy and there be no natural tear at all?
Part of what makes me think I tore badly:
I had between 20 and 30 stitches. Everyone I know that had an episiotomy had 3-5 stitches.
It took months!!!! to heal. At my 6 week check, I was still sore and it was over 6 mos. before I didn't want to cry attempting to DTD (DH was nice, we took our sweet time, just so he doesn't look like a jerk)
I had a lot of swelling and it was several weeks before I could climb in/out of bed w/o a step stool
I thought the long healing and the lots of swelling were normal, but the more I read here different ppl's stories, it sounds like there are many women that don't have that?? I didn't understand that anyone could be capable of DTD at 4-6 weeks pp, much less want to, based on my experience, but again, starting to think that may not be standard.

In case you are pg and reading-it was tough but I would do it again in an instant! I didn't have an epidural, but I did have an IV pain med that lasted 45 min and wore off 4-5 hours before birth. If I could do it again, I would have skipped the IV rather than opt for the epi, even knowing what I do now, so don't let me scare you!

ETA: From a post on my other thread, it wasn't a 4th degree tear! Wow!

[MsBlack]

I am thinking that you could get a copy of your birth record to see notes on the tear and suturing. It sounds as if it might have been a complicated tear--not a single line of some depth into the muscle, but perhaps multiple lines of tearing. This does happen sometimes. But for your own information and future reference (it could make a difference to how you handle future births), I would definitely want to see the record/notes on it.

[maxmama]

Generally, your provider will tell you about a fourth degree tear, because the anal sphincter is completely separated.

The "degree" sometimes correlates with length of repair and pain, but often not. I've seen second degrees take longer to repair (and end up more painful) than a fourth-degree, jsut because of how the tear was. A complicated repair doesn't necessarily equal a deep tear, and some providers use more suture than others.

[doctorjen]

For the sake of classification:
1st degree - a tear through the skin and submucosal tissue only, no muscle involved

2nd degree - a tear through the skin and perineal or vaginal muscles underneath

3rd degree - a tear involving the skin, the perineal/vaginal muscles and the anal sphinter

4th degree - a tear involving the skin, the perineal/vaginal muscles, the anal sphincter, and the rectal mucosa (the tissue between the vagina and rectum)

An episitomy is a second degree injury - but can extend and tear from where the cut was made and turn into a 3rd or 4th degree. Not all episiotomies extend, but having an episiotomy makes a 3rd or 4th degree extension more likely.

I doubt folks with episiotomies are having 3 or 4 stitches. Many docs (myself included) do perineal repairs with a "running" suture. This means you place the initial stitch, tie a knot, and then use the same length of suture to loop over and over for the next stitches, not tying a knot each time. 3 stitches would not really be enough to hold an episitomy together - sometimes I think docs tell people all sorts of odd things about their suturing. On the other hand, if someone asks me "how many stitches?" I'm not always really sure because I tend to use the one piece of suture and run several stitches with it. Often, if it is a second degree tear, I use a second piece of suture for the skin after repairing any muscles. I don't know if I should say "2 stitches" because I used 2 pieces of suture, or more like 15, because that is how many loops of suture are holding the repair together. On the plus side, since I don't do episiotomies, frequently the answer is "no stitches!"

[ed_tricia]

Thanks!
I think I will try to get a hold of my prior doc's office. Despite the episiotomy & rough recovery, I had a good delivery and my doc was great. I would totally go w/ him again if we hadn't moved 600 miles away! I'm currently searching for a new provider here.
Ms-how could knowing how I tore impact my next birth(s)? I know now, and actually did then just didn't do anything about it, that there are things I could have done to minimize or prevent "damage", so I will need to be more diligent about those. (perineal massage, kegels)

[Jane]

Lots of women that tear with #1 don't tear with #2 without doing anything different. Just as the labor is often shorter, the passage out is often less tramatic to the tissues.

In your case, I'd recommend good nutrition, avoiding a second episiotomy, and having a good raport with your midwife to try to slowly birth this next baby. I don't think slowly birthing the baby really prevents tears, but it's one thing to try.

Kegels are never a bad thing. I don't think they prevent tears, but they are good for you!

I don't think tearing with your first really impacts your next birth, as long as it wasn't a 4th degree tear, and you got good function back in the area. If you still weren't healed, that would be a concern, but a complicated repair is unlikely to occur again, expecially w/o an episiotomy.