Tearing again after a 4th degree tear? - Mothering Forums

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Old 04-09-2010, 12:54 PM - Thread Starter
 
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I delivered my daughter two years ago. With her delivery, I had an episiotomy and a 4th degree tear.

I am now in my first trimester of my second pregnancy and my worry right now is that the scar tissue from my first delivery will not stretch well when I have to deliver this baby. What is your experience? Anything I can do to prevent another 4th degree tear? I know a perineal massage is recommended, but how often?
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Old 04-09-2010, 04:37 PM
 
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I don't have any personal experience, but I had a 2nd degree tear with my first & am curious to see what happens with my second baby.

I think for you, avoiding an episiotomy would be a place to start. Talk about it with your caregiver, be sure you're choosing a practitioner who will support your desire to not be cut.

As far as the scar goes, it may or may not tear. I've heard that ingesting & topically applying vitamin E may help. Be sure you're well-hydrated & getting lots of healthy fats in supplements or in your diet.

Good luck!!
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Old 04-09-2010, 04:44 PM
 
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I have taken care of a handful of women with 4th degree tears. We know from research that having an episiotomy is a huge risk factor for a 4th degree tear. I would recommend avoiding an episiotomy, considering a waterbirth, and working with your care provider to have a slower pushing phase, ie, at least 20 minutes instead of the 5 minute pushing phase that many second time moms have. It's good to have time for the tissues to stretch, especially as the head is emerging.
Although anecdote is not the same as research, I have never had a client have more than a 2nd degree tear the second time. Several have had no tears that would require stitching. Researching after a bad tear is definitely one of the things that brings women to homebirth, so I see more than you'd expect.

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Old 04-09-2010, 10:05 PM
 
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Hi there! I have personal experience with this. My doctor SWORE that I would tear with future bubs because my episiotomy tore beyond into a 4th degree laceration.

With my second, my bub was posterior - with NO TEARING - not even a skid mark

With my twins, my bubs gave me no problems at all.

With my last, a BIG BUB (compared to my others), even when he experienced shoulder dystocia and had to have my mw get 'hands on', I still only had a few TINY skid marks that didn't necessitate any stitching. I think what helped with him is that I literally horse-lipped through my 'pushing' with him.

I used EPO and Tea Tree Oil on my perineum throughout late 2nd and 3rd trimesters - perhaps this helped?

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a mama of 5, wife of one, doula, MW apprentice, and childbirth educator
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Old 04-09-2010, 10:31 PM
 
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I have this worry too. I had a third degree tear with my daughter and I would do anything to avoid it again. In my case I had a lot of perineal swelling during labor and my DD came out very fast. My mw said my skin just kind of disintegrated in front of her eyes, she said she's never seen anything like it. The strange thing is I've never had problems with my skin or healing etc. She wants me to eat very healthy and get my omega fatty acids (I did last time too, fwiw). I'm really hopeful for a home water birth this time. The one good thing out of it is the doc who did my stitches did a very good job and I haven't had a single problem since, thank goodness.

Laura mummy to my two sweet little girls (April 08) and (Nov 10)
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Old 04-10-2010, 12:51 AM
 
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There is a really good thread around here somewhere about 4th degree tears - very informative.

I had a 3rd degree tear & have this worry but my ob reassured me that it's very unlikely to happen again as severally.

Surviving sleep deprivation one day at a time with dd (Oct '11) & ds (Oct '08).

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Old 04-10-2010, 11:10 AM
 
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I had an epi and a bad 3rd degree with my first baby. I got a couple stitches with #2, but don't know that I needed them, and haven't torn with #3, 4, or 5. Look into the causes of tears. I know someone will post some good info. Talk to your care provider about your concerns. And don't worry too much. Oh, and Congratulations!

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Old 04-10-2010, 01:43 PM
 
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I had no episiotomy, but did get a very nasty 3rd degree tear with my first birth.

Second birth, I had a not-so-bad 2nd degree tear. Felt like NOTHING compared to the first experience. I was afraid it would be like the first time again, but nope...I think my body was more able to handle the stretching. My dr. said that's normal.

This time I'm hoping for 1st degree or no tear.

RedOak ~ Momma to DS (8) , DS (4) , DD (3) , & DD 9/10 ~
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Old 04-10-2010, 04:31 PM
 
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Check out the "vaginal birth after 4th degree tear" thread for LOTS of perspectives.

In my case, I had a 4th degree tear following a true shoulder dystocia (I was unmedicated, pushing with urge, squatting, gaskin and mcroberts did not resolve the sd). I had my first post-4th-degree-tear birth this past August and although it was intense (no breathing the babe out!) I delivered on my side after laboring for a while in the tub and although I had a small 2nd degree tear along the scar tissue, that was it! A few stitches and I felt fine. The stitches were a bit sore, but compared to the hundreds of sutures after my 4th degree tear? Not even in the same ballpark.

Happy birthing!

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Old 04-11-2010, 04:42 AM
 
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Quote:
Originally Posted by Apricot View Post
working with your care provider to have a slower pushing phase, ie, at least 20 minutes instead of the 5 minute pushing phase that many second time moms have. It's good to have time for the tissues to stretch, especially as the head is emerging.
Okay I you've got my attention. I gave birth two month ago and had three second degree tears, one from vagina to anas, one on my left inner labia and one on my right inner labia that went into my vagina. I pushed three times before my LO was out, first was the ring of fire, second her head came out and the third contraction the rest of her.

Now here's my question... I was blessed with a quick birth although itcaused a full seven weeks for recovery. How on earth could one draw out a pushing phase? I mean, my body just did what it did and it didn't seem like there was any stopping it. I'd like to hear more.

Organic eating, cloth diapering, no vaxing, cosleeping, breastfeeding mean machine.
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Old 04-11-2010, 05:29 AM
 
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I'm sorry you tore - that is never fun. I am glad you're healing well.
It's not always possible to slow down pushing. But it can help to not push voluntarily with the involutary pushes. It can also help to do the stupid heeheeheehoo breathing to disrupt the pushing a bit so it's less coordinated and less effective. Also, another person can actively work to slow down the birth by pushing back. I use a warm washcloth to provide extra push back on the perinuem to slow the birth. There's no randomized clinical evidence that perineal support helps prevent or minimize tearing. But it's also not shown to be harmful to mother and babe, so with mother's permission, I'll try it.
One more thing that sometimes helps - holding the baby's arms tightly to the body to prevent tearing from elbows that fly outward. Nuchal hands (up at the face and neck) are sometimes a sneaky source of tears.
Finally, some bad tears begin prior to the birth.of the head. I do not think these tears are preventable. There just isn't anyway to offer any type of support.

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Old 04-11-2010, 12:23 PM
 
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slowing pushing- I know that with ds I was completely out of control in terms of voluntary vs involuntary pushing. I went from "closed/hard" cervix to babe in arms in about 4 hours and it was insane! Hypnobabies worked with dd2's birth but went right out the window with ds, and the contractions were so strong/constant I couldn't even roll over on my own. (though I seriously felt fine as soon as ds was out, and an hour or two later I could hardly believe I'd had a baby).

However, I'd already discussed post-tear pushing techniques with my OB/Midwives, my DH, and my doula. So even though I was out of it, they made sure I was using positions that had a better chance of keeping things together.

Side lying and hands/knees (and hands/knees with the chest down and the bum up) are good for providing a slower exit since gravity isn't pulling the babe along too. Obviously a lot depends on what is going on at the time, but if the goal is to slow things a bit then those positions may help. Of my 4 hour birth, about an hour was pushing so the position really did slow things down and the only tear was along the old scar.

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