birth options after 4th degree tears

[cdenuccio]

Hi!

Both of my children were born in planned homebirths. Wonderful powerful births (the second was unintended unassisted--wow!!) Both births resulted in 4th degree lacerations (meaning perineal tears extending into the rectum). I know this is very rare, esp. with midwifery care, but it happened. Apparently I have a short perineum!

I am now pregnant with my 3rd child and exploring my options for birthing this time. I've consulted 2 OBs and have an appt with my midwife coming up. One OB gently urged a c-section to prevent any further damage to my perineum and rectum. The other presented some options for helping reduce the risk of tearing, but did say because of my anatomy I am at high risk for another 4th degree tear. Now, I'd rather avoid a c/s but I also need to take care of my body and don't want to end up incontinent or otherwise impaired at this point in my life (or ever really!!)

Does anyone have any experience with this? Feedback in general? Other places I could look for research or advice? No one is going to force a c/s on me but I want to make a choice that is best for my body and for my baby. Thanks in advance for your help!

[alegna]

:hug What a difficult decision.

There have been a couple of threads on this a few months back- you might search and see what you find.

That said- have you investigated possible reasons for tearing? What position did you birth in? Did you wait for the urge to push? Did you birth in water? (I've heard that water reduces the chance of tearing) I would consider all of those things first and see if there is a way that you could reduce the chances. Then I would talk to some midwives- several different ones. Of course an OB will suggest a section- they're surgeons. If midwives suggest it too then I'd consider it.

good luck!

-Angela

[Cyneburh]

:yeah:

I second Angela... see if you can figure out why your perineum tore (other then that it's somewhat designed to tear) and try to eliminate those things and then go for a homebirth again. I tore with my first (4th degree) and didn't even need stitches with my second. Many, many ob's will suggest or even insist on a cesearean after a 4th degree tear. The way I see it though was that the perineum was designed to tear if need be. And the tear heals *much* better then a cut!

[MinnieMouse]

I had a 3rd degree tear with the birth of my daughter...it was all but a 4th degree. In addition, I tore UP, and inside along both sides. (I had a 4hr labor w/ a forceps assisted delivery).

I'm REALLY nervous about this happening all over again and have talked about it AT LENGTH with my various midwives at our birth center.

They are totally confident that I can deliver without tearing this time. There were a few things that they said that might help.

First, they aren't going to let me push really quickly..lots of perineal massage during the birth and a slow exit for the baby.

Second, they are recommending that I try to give birth on my side. This will put the least amount of pressure on my perineum as well as my scar.

The last was that if it looked like I would tear down my scar (which they said the probability of which is QUITE slim) they would make a small cut on the side.

At my last appt, the midwife actually shared that there was a mom that had a serious 4th degree tear w/ her first child and she had just had her second with no tearing whatsoever.

Hugs...

[pamamidwife]

I just had a client who experienced an episiotomy and fourth degree with her first. She was confused as to what to do, but ultimately chose a homebirth and birthed her baby into her husband's hands without anything but a slight tear inside near the top. Nothing repaired.

No perineal massage (I don't believe it helps and often feel like it's distracting and intrusive), nothing. Just belief and gentle pushing that she directed listening to her body.

Here is an article I wrote on the subject that you may find interesting:
http://midwifemama.com/honoring.html