Vaginal Birth after 4th Degree Tear

[NoNo'sMom]

Hi! I was just hoping that I could get some input on this. I had my DS two years ago and delivered him vaginally and I received a 4th degree tear {he was 10 pounds }. I look back on the recovery and I don't recall it being very bad. I haven't had many problems down there...I recovered fully and have been fine ever since.

Well, I am having my 2nd baby in 2 WEEKS and I have been planning on having another vaginal birth. Since the beginning of my pregnancy, the doctors have been giving me the option of having a c-section if I didn't want to do another vaginal birth, just in case I tore again. Having a c-section is not what I want to do, but I am of course willing to do it if neccessary. Anyway, the doctors have told me that if I do have another 4th degree tear during this delivery, then I could have some major problems down there {pretty much saying that my bowel muscles are going to be shot}. I am scared to death that I am going to tear badly again, but I still want to try for a vaginal birth. Has anyone experienced this??? How was your second delivery?? Did you tear as badly with the second delivery? Maybe I just need to relax, but this past week I have been so incredibly worried about this because I don't want to ruin my muscles down there and have permenant damage.

Thank you for your input...I really appreciate it!!!

[mytwogirls]

Hi mama. My first girl was 9lbs 2oz and I had a fourth degree tear as well. I healed just fine and then I delivered a second girl vaginally 16 months later. She weighed 9lbs 8 oz and had only a minor tear which requires only a couple stitches. I work labor and delivery as an RN and I see mamas come in nervous like you hoping like hell they don't tear. Most of the time they don't tear as badly again because their body has been stretched down there before and knows what to do. You also have a better idea of how to push and hopefully your OB is smart and will tell you when to breathe and when to push. I would NOT go for a c-section just to avoid tearing again. Please! IF you do tear extensively again, I still think you might be ok, just check it out before you consent to a c-section. The time spent healing is a LOT more with a section than even a fourth degree tear.

[s_kristina]

I did not have a 4th degree tear, but I had multiple tears including ones going up either side of my urethra. I barely tore with my 2nd child even though I had people warning me that scar tissue makes it more likely to tear as it doesn't stretch as well. A couple things I did that I think really helped to not tear are to get a midwife and to not have an epidural. I was able to move around during labor and that really helped my ds to have a better position. Being able to push in a position that wasn't laying on my back helped as well. I also didn't have any one coaching me to push. When it got to the point I couldn't stop my body from pushing I told my mw and she basically said just do what you need to. I did have a nasty recovery after my dd's birth which led to me researching many things I had done with her. That led to not having an epidural and having a mw rather then ob. My recovery after having ds was so much quicker and easier even though I had massive blood loss with him.

[janasmama]

I haven't had any major tears but I did have a 10 pounder for my second birth.

Have you considered stretching your perineal muscles...starting around 34 weeks? We did this, my husband and I. We would use some lubricant and he would put his index and middle fingers gently inside me a couple of inches and apply gentle pressure on the perineum at 5 o'clock and 7 o'clock. He would continue to apply pressure until I felt a slight burn, I would communicate this and he would hold there for about 10 seconds. Repeating this for 5 minutes or so each day.

[amyaebi]

I received a 4th degree tear after my first delivery (baby was 9.5 pounds). For my second I decided to not get an epidural so that I would have the option of pushing in a different position and would push only when I had the urge. That did the trick. I pushed on my side (no perineal pressure) and actually didn't "push" at all -- my body did it for me. I tore very minimally along my old scar, had two stitches, and recovered amazingly. Like you, I was terrified that I might incur permanent damage.

The key is not to push on your back -- think of all of the pressure it puts on your bum to push that way.

Amy

[anne1006]

I had a 4th deg tear and was told to only have c/sections after that. It was horrible and I had nightmares for a long time and was really worried when I got pregnant again and had 2 more providers tell me to have a c/s too. I found a homebirth midwife and delivered with no tearing or bruising, and she was only 4 oz smaller than my first. I had a waterbirth and applied a lot of perineal support with my hand, and it made all the difference!

[maxmama]

Originally Posted by amyaebi

I received a 4th degree tear after my first delivery (baby was 9.5 pounds). For my second I decided to not get an epidural so that I would have the option of pushing in a different position and would push only when I had the urge. That did the trick. I pushed on my side (no perineal pressure) and actually didn't "push" at all -- my body did it for me. I tore very minimally along my old scar, had two stitches, and recovered amazingly. Like you, I was terrified that I might incur permanent damage.

The key is not to push on your back -- think of all of the pressure it puts on your bum to push that way.

Amy

I've seen pretty explosive tears in squatting too. Sidelying is a great position to control the head!

[ripcurlgirl26]

Has anyone experienced this??? How was your second delivery?? Did you tear as badly with the second delivery?

Relax mama! Chances are you will not tear like that again. I have a 4th degree (well, episiotomy turned 4th degree tear) with my first and the recovery was horrendous and worse than the labor. I do believe that plain out tearing is better than being cut obviously, as you heal faster than with a clean laceration. Anyways, when I got pregnant with my second, no one mentioned anything about a c-section due to the tear. I think I would have been bowled over if they had!

My last birth, almost a month ago, was a water birth. My midwife was very confident that I would probably not tear at all, and that helped me out. Being in the water for 2.5 hours definitely helped the skin in that area stretch, and I only had two tiny tears that didn't need stitches. The recovery between my two births is seriously like night and day! Is it possible that you can have a water birth?

[so_blessed]

I had a major tear with #1, then no tears with the next three.....You will probably be fine!

[wombatclay]

I had a 4th degree tear while squatting (well, her head came out while squatting, but then shoulder dystocia took over... the actual "tear" happened while side-lying BUT it wasn't like I was pushing on my side out of choice at that point!).

My OBs actually teach a class for midwives on how to suture 3rd and 4th degree tears (I was their first client to have a tear like this in more than 10 years, but they get called into the hospital/homes to repair tears pretty ofter) so they have a good knowledge base and I asked lots of questions. They said that it's true... a second tear can have a "worse" outcome just because there is already scar tissue, the muscles/sphincters have already lost some elasticity during the previous repair, and the tissue may not heal as well. SO if you've had one tear AND you have another your risk for complications is higher than it would be for a woman with her first tear. Sort of like a mama having a second c/s is at higher risk for complications than a woman having her first c/s.

However, they reassured me that the risk of tearing really isn't that much greater. Your body already knows how to relax that area, you're already a bit looser, your body has already learned how to respond to the birth hormones and sensations. They are big natural birth advocates and do suggest avoiding spinals/epis UNLESS you feel like a low dose epi would allow you to avoid pushing until your babe is really really right there... they'd rather have mama mobile and responding to her body but have had some luck with mamas who were really nervous about a repeat tear using the low dose epi to avoid any early pushing...sort of letting the babe breathe out a bit.

Hmmm... what else? Oh yeah. They said to wait and see how the birth was going... that a c/s could be done just about any time and there's no reason to sign up just in case. In my case I pushed for a looooong time and dd2 kept flipping around before getting "caught". They said that IF my next birth had a long pushing phase and IF things seemed wonky towards the end THEN we could go right to the OR if that's what I wanted. But they didn't think it would be a problem.

Oh, there is A LOT of debate about massaging the perineum, especially near birth or during birth itself. Many care providers feel that it can actually cause tears by bruising/interfering with the tissue. One middle ground I've heard is to do the massage during the second trimester but not the third, and to make sure nobody touches your perineum during birth except yourself.

Happy birthing! I hope you have a beautiful and tear free birth!

[cj'smommy]

Originally Posted by wombatclay

They said that it's true... a second tear can have a "worse" outcome just because there is already scar tissue, the muscles/sphincters have already lost some elasticity during the previous repair, and the tissue may not heal as well. SO if you've had one tear AND you have another your risk for complications is higher than it would be for a woman with her first tear. Sort of like a mama having a second c/s is at higher risk for complications than a woman having her first c/s.

However, they reassured me that the risk of tearing really isn't that much greater.

This is what I'm afraid of. I had a 4th degree tear and also tore my sphincter muscle out of place. It took at least 6 months for me to have some control back there, now it's much better but not like before I had him.

[sarah_kaye]

I am also completely terrified of having another 4th degree tear. I've been doing heaps of research but i cannot find anything like my situation. I actually tore on my second birth. As far as i can tell i was in a good position not to tear either. I was drug free with a wonderful midwife, I was on all fours and pushing didn't go too long or quick. When the pushing began another midwife came in to calm me and coach me along with breathing and what not which was wonderful while the other mw got ready to catch. I felt great after the birth even though i had to go straight to surgery under general anaesthetic for an hour and a half to be stitched. The OB who stitched me is great with an impeccable reputation.

So after all that the OB tells me at my following check-up that i will require a c/s next time because i risk having permanent damage to my bowels. I am now 29 weeks pregnant with my 3rd and trying to decide what is best for me and my baby. The only reason i can think why i tore with my 2nd was because he was big - 9" 4 ounce. Maybe i am just susceptible to tear.

Although i do not have any extreme problems with my bowels things certainly have not been the same since i had no. 2. I'm worried no. 3 just might tip the scales and make things a whole lot worse when they are kinda teetering on the edge.

Any advice???

Mum to 2 DS 17 Oct 2002 and 18 Feb 2005

[cj'smommy]

Originally Posted by sarah_kaye

I am also completely terrified of having another 4th degree tear. I've been doing heaps of research but i cannot find anything like my situation. I actually tore on my second birth. As far as i can tell i was in a good position not to tear either. I was drug free with a wonderful midwife, I was on all fours and pushing didn't go too long or quick. When the pushing began another midwife came in to calm me and coach me along with breathing and what not which was wonderful while the other mw got ready to catch. I felt great after the birth even though i had to go straight to surgery under general anaesthetic for an hour and a half to be stitched. The OB who stitched me is great with an impeccable reputation.

So after all that the OB tells me at my following check-up that i will require a c/s next time because i risk having permanent damage to my bowels. I am now 29 weeks pregnant with my 3rd and trying to decide what is best for me and my baby. The only reason i can think why i tore with my 2nd was because he was big - 9" 4 ounce. Maybe i am just susceptible to tear.

Although i do not have any extreme problems with my bowels things certainly have not been the same since i had no. 2. I'm worried no. 3 just might tip the scales and make things a whole lot worse when they are kinda teetering on the edge.

Any advice???

Mum to 2 DS 17 Oct 2002 and 18 Feb 2005

Hi! Welcome to MDC!

I talked to my OB since my post and he helped put some of my fears to rest. He pretty much said what wombatclay said.

He told me that just because I tore once, doesn't mean I will again. If I do, it shouldn't be as bad. I also had a 9 pounder and since the baby went through the birth canal things really are stretched down there. He said if my sphincter muscle tore again, it would give them a chance to get there and re-align it again. He told me that many people will do a c-section after a 4th degree tear BUT he doesn't think it always needs to be done and said it's up to the patient.


Hope that helps some!