Having a vaginal delivery after a 4th degree tear - Mothering Forums

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#1 of 5 Old 06-09-2009, 01:10 PM - Thread Starter
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Hi, ladies,

I'm new to Mothering, but felt this was the best place to come to for help with having a vaginal delivery with my second child after experiencing a 4th degree tear with my son.

My son is going on 3 years old. I don't have much lasting effects from the 4th degree tear (albeit never being able to get a "clean wipe" most times). Otherwise, I feel fine.

My OBs office said this time around I would be offered the option for a "pelvic floor preservation" C-section: basically, an elective C-section to prevent further damage from the previous tear.

I'm torn (excuse the pun! lol) about this, because I wanted to delivery naturally (no meds) again, same as I did with my son. But I also don't know very much about what my risks and chances will be of another big tear. I would hate to think that later on I may sneak and totally crap all over myself because of damage caused from another vaginal birth. Then again, I would hate to think that I took the easy way out and opted for a c-section when I may not have even tore as bad the second time around.

Considering the community that I am posting in, I can guess which way the general opinion will sway. What I looking for is:

1. What can I do to help prevent another bad tear should I decide to deliver naturally again?

2. Is there anyone here who opted to have another vaginal birth and ended up with another bad tear that created lasting effects?

3. Would it be recommended to use a doula, who may be effective in helping me prevent tearing this time around?

Any thoughts, opinions, advice is welcomed!!!


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#2 of 5 Old 06-09-2009, 01:35 PM
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What were the circumstances of your tear the first time around? What position were you in, did you have an epidural, did you have an episiotomy cut that tore further, were you being directed to push instead of pushing based on what your body told you, was the baby's hand or elbow up at his face so you had to push an even larger body through your vaginal outlet? These are common reasons for women to tear.

Some of this stuff, you can avoid/mitigate, some of it you can't (like nuchal hands).
If you go for a second vaginal birth,
- try to do it without an epidural as it gives you maximum control and sensation so you can move during the pushing phase and can also feel everything that's going on.
- Give birth in a gravity neutral position (hands/knees, side-lying) and DO NOT BIRTH FLAT ON YOUR BACK. Squatting I would also avoid just because it's gravity assisted, and you want the baby to come slowly.
- Try to let the baby come out SLOWLY, giving tissue time to stretch, don't try to get the baby out fast unless there's a medical necessity to do so.
- Don't let anyone touch or mess with your vagina or perineum in any way while you are pushing (though you may want to touch it to contol how fast the head crowns).
- Don't let anyone cut an episiotomy without an immediate, emergency, baby must come out NOW reason.
- Birth in water if you can.

Maybe go see a pelvic floor specialist (physical therapist or gynecologist who doesn't necessarily do OB work) if you want an assessment of the current strength of that area and a neutral party's opinion about whether it would tear so badly again. A PT might also be able to help with strengthening exercises before the birth to increase your chances for an intact pelvic floor.

Also, here's an article from Gloria Lemay on birthing with an intact perineum.

I think I'd choose the unknown risk of a vag. delivery over the known risks of major abdominal surgery. Good luck making a decision.

Doula, WOHM, wife to a super-fun papa, mama to the Monkey ('07), and his little brother, the Sea Monkey ('09).
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#3 of 5 Old 06-09-2009, 02:15 PM
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Of course, you'll get more informed replies from other ladies here, but as for personal experience: I had a 4th degree tear with babe number one. I have had 3 since. the WORST damage I had was a couple stitches with the rather medical birth of number 2.
It definately is possible. Learn as much as you can, it'll help.

Mom of 4 aspiring midwife "Friend"ly seeker
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#4 of 5 Old 06-09-2009, 02:40 PM
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I love KCparker's suggestions above. I'd also suggest seeing another dr or even a mw for this birth. A good CP can help prevent you tears from being as bad.

My sister had a 4th degree tear in her first birth (42w, pit induced, 10#); she had a second degree tear with her second baby (42w, no pit, 10#4oz, bigger head I think but I don't recall the number). with her second birth she clearly remembers the dr telling the resident to "put pressure there" to keep from tearing. They were both military hospitals.

My best friend had a 4th degree tear with her first & a second degree tear with her second - also a bigger baby, but neither of her kids were even 8#. She had different drs for each birth; her first dr (the one on call that day) just "let her rip" b/c she refused the episiotomy (she knows it was deliberate b/c he bitched at her for refusing). As with my sister, her second dr applied pressure to keep the tear from being as bad.

They can do repairs on your pelvic floor if you need them; having had 2 c/s and a subsequent vag birth I'd take the vag birth over major abdominal surgery that could result in my death any day. Even with a c/s there's no guarantee the pregnancy won't weaken your pelvic floor, or they might nick your bladder. According to one person to whom I know that happened, it's never the same.

Stinkerton 12/10/01 9lbs8oz, induced to c/s; Little Man 5/20/03 7lbs11oz, r c/s, fear of another labor; Jillybean 11/18/07 10lbs8oz 37cm head, induced VBA2C; and the Wee Beastie, 9lbs8oz, 35cm head, rpt VBA2C
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#5 of 5 Old 06-10-2009, 09:20 AM - Thread Starter
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Thanks so much, ladies, for these suggestions, and the link to remaining intact during delivery. I am leaning towards having another vaginal birth. I will definitely deliver without meds, just as I did with my son.

I wasn't sure if I was tearing FIRST and THEN my dr. cut....or vice versa. I just called my hubby and he said that I was tearing, and then the dr. cut me. I never thought that maybe because of that cut that it could have contributed to the 4th degree tear.

I did labor on my back, as well. At some point, I was trying to use a squat bar, but was getting very fatigued, so she had me lie back down on my back. I will try to avoid that position this time around.

Thanks for all the suggestions!!
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