Vaginal Birth after 4th Degree Tear? - Page 5 - Mothering Forums

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Old 02-20-2010, 08:44 PM
 
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I just had to come and update - I gave birth to my post 3rd degree tear babe a week ago..... and.... beautiful vaginal delivery, NO TEARING not a single scratch.

I still can't believe it! What a wonderful healing experience

If you have a spare hour (it's very long) here's the full story...

Good luck mamas, I'm so happy to be part of the proof that IT IS POSSIBLE!

Engaged to my sweetheart, Mammy to two beautiful girls
Eden Jade 18.08.06 & Saffron Jo 13.02.10
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Old 02-22-2010, 06:43 PM
 
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Congrats!

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Old 02-22-2010, 11:35 PM
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I had a fourth degree episiotomy, took forever to heal. With my second birth I sought out a mw instead of ob. She didn't promise no tearing, but had my dh and I use olive oil throughout the pg to massage the areas. This was to promote stretching/healing of the scar tissue (the scar tissue was the mw's main concern, as I had a lot). Happy to report that it worked, I had a very minor labial tear with birth number two.

With birth number 3, I had swelling of the cervix. In order to get rid of it, I had to lay on my side for a while to relieve the pressure on it. I think I brought it on, trying to push a bit too soon. I always have a stubborn 'lip' that doesn't want to leave so I thought I would just "push through it". Don't do that. Not worth it. But, with that birth (once my cervix calmed down, I delivered a large baby who had a bit of dystocia resulting in mw hand assisting the shoulder. No tears, but one "skid" mark.

So, if I were you, I would try for a vaginal birth again. But that was me. I would also take fish oil (mercury free of course) throughout the pregnancy and do the perineal massage with olive oil.

Amy

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Old 05-11-2010, 01:57 PM
 
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I too suffered a fourth degree tear with the birth of my daughter 18 months ago. I was 8.5 cm dilated with a lip left on the cervix and the doc said I dilated completely when I pushed so he asked if I wanted to start pushing which I said yes considering I was in labor for 24 hours and ready to get the baby out! It was an unmedicated birth, though at the end when I was pushing the doc offered a local pain shot which I agreed to. I did that pushing where everyone told me how to push and when to push (I was on my back with legs pulled back) - three big pushes during each contraction. DD's head was slightly turned to my left thigh and the doc turned her during one of the pushes.

She started having decels whenever I pushed, but her heartrate would go back up when the doctor stimulated her scalp. At this point the intensity in the room climbed dramatically and all of the nurses/doc/my mom were all shouting PUSH! at the top of their lungs. I was pushing as hard as I possibly could, grunting and screaming like a wild animal. She was born within 45 minutes of me pushing and I ended up with a fourth degree tear.

It took me a year to recover physically due to some scar tissue that caused sex to be painful. I feel fine now though I can still sense where that scar tissue is and I haven't tried wearing thong underwear in a while since the scar tissue would hurt whenever I tried to wear it.

Emotionally the tear took a huge toll on me and I would stay up hours researching all the potential problems I could have from it and whether or not I could give birth vaginally again.

Now that I'm pregnant again (15 wks along), I've had one OB tell me I would absolutely need a c-section and that she's performed 3 c-sections on various patients who had suffered a fourth degree tear, that my repair is good but that she couldn't guarantee a good repair the second time around and that I could end up with a fistula.

Another OB told me I wouldn't necessarily have to have a c-section and that we could wait until labor started and then decide. She did say that I have a small pelvis which may have contributed to it (I'm normally 5'4'' and 110 lbs).

The OB I'm with now (who has been great so far!!!) has me scheduled for a vaginal but said we'd talk more about it as I progress further in the pregnancy. She wouldn't give me an answer one way or the other about whether or not the risks of a c-section were worse than the risks of tearing again. She said we could go the c-section route if that's what I'm most comfortable with but declined to really give me her opinion! She did say I have a very very short perineum which may have contributed to the tear - however I personally think my perineum is shorter now than it was before giving birth.

My biggest concern is obviously tearing again and having irreparable damage, but also I'm worried that giving birth vaginally would result in long-term fecal incontinence when I'm older. I've read on other message boards about women whose colorectal surgeons all said they would NEVER suggest vaginal after fourth degree tears.

Also I've read that even if you don't tear again, you can have damage to the pudendal nerve just from the hours of labor and the baby sitting on the nerve in the birth canal, which could result in fecal incontinence when you are older even if you have no problems now. So my fear is that even if I escape without a tear, I will still suffer the consequences 20 years from now as I age.

Of course, I would hate to have a c-section and then suffer years of pain from internal adhesions or bladder incontinence resulting from the surgery, and I have even read about women who needed a hysterectomy years after their c-section due to adhesions and scar tissue.

I just honestly don't know which poses the highest risk to me and which would result in potentially the worst long-term damage. We aren't planning to have anymore children after this so that is not one of my primary concerns.

I am wondering if I did another unmedicated birth, this time with no local antisthetic (sp?), pushed when my body told me and I was fully 10cm, side-lying position, and hired a doula, plus minimal fingers inside me for checking etc., if I could manage to give birth without another 4th degree. Either way I am filled with anxiety at the thought of another vaginal or a c-section

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Old 05-11-2010, 02:24 PM
 
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Hi Ninabear, I don't remember how bad my tear was (he never gave me a number). All I know was that he was tight lipped, it was a lot of stitches and I tore to my anus, so I have scar tissue there. That was 10 years ago.

Almost 6 yrs ago I had a homebirth with a midwife. I was terrified of tearing again, but nothing nearly as bad happened. I truly believe midwives are generally more careful and don't just let things rip.

Have you talked to any local midwives to hear what they have to say? That's what I would do.

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Old 05-11-2010, 08:16 PM
 
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Hi,

I think that if I were in your situation, I would also pursue the possibility of a homebirth with a midwife. I had my first in the hospital in a situation very much like yours (coached pushing and everyone yelling at you, legs held, on back, etc). I ended up with a 4th degree that I think was actually a small fistula from the beginning but I didn't realize it. Long story short, 3 yrs later I was pregnant ("oops" - just before I was ready to schedule repair surgery!)and the fistula was much larger (enough to have stool leakage occasionally).

I found a fantastic midwife whose outlook was that the worst that could happen is I would tear again. I did not want to go through a hospital delivery again, so I went with the waterbirth at home. It was great! Soooo much better than the hospital. I had a great delivery with no complications - no heart monitor - beautiful baby and the tub was awesome. I had the fistula repaired when baby was 6 months old and I really didn't think recovery was all that bad - I'd rather do that again than c-section with a newborn. So my plan for #3, if we are so blessed, will be to have another water birth at home, unless the midwife who delivered my second thinks it's a bad idea. My colorectal surgeon also said I should have a c-section for future births, but this thread has encouraged me to give vaginal birth a try. I'm also starting some homeopathics in July to help soften the scar tissue.

Best wishes! I can certainly relate to your fears. I really appreciated this thread, especially after searching online and finding that most information makes these tears and fistulas seem like a problem of the 3rd world.
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Old 05-12-2010, 03:38 PM
 
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Big hugs!

My choice, after lots of research and soul searching, is a bit different...

I had my 4th degree tear/repair as part of my first vbac. I was thrilled with the vbac, not so thrilled with the tear, repair, and subsequent pelvic organ prolapse. When I became pregnant with my post-tear babe I went crazy with the research! I found a homebirth midwife and started planning a home water birth. Well... I started having panic attacks and after A LOT of soul searching I left the homebirth midwife and signed on with a hospital midwife team. It took a lot of searching and interviewing to find a hospital team that would attend a vbac mama with a historyu of shoulder dystocia, a 4th degree tear, and prolapse but I did it!

Basically, I realized that I needed options. I wanted another VBAC, but not at "all costs". My goal was a happy, healthy, baby and to walk out of the hospital with as much of me still intact as possible. Obviously a c/s has a 100% chance of some major cutting and then various other risks that made it a less than great option. But a repeat 4th degree? I was in pain for a year, had massive scar tissue that affected every aspect of my life, and there were already life long implications. So avoiding that repeat 4th degree was important too. My plan was to give birth in the hospital. If my birth started to mirror that of my dd2 (long pushing, etc) then I wanted to be able to move directly to a repeat c/s. And I selected a major medical center because IF I had another 4th degree tear I wanted the best repair possible, preferably with a colo-rectal surgeon within an hour of the tear. I didn't want to be seperated from my child or face drivign to the ER with a tear and a newborn!

So, I found my hospital, and my midwife team, and my doula, and prepped everyone and everything and worried and planned and... had a beautiful hospital vbac with just a 2nd degree tear along the old scar tissue. It was a great birth (used the jacuzzi for a while, pushed on my side to reduce the risk of tear, no pp seperation from my son, etc). And I have to say that FOR ME and in THIS SITUATION, my panic attacks stopped once I made up my mind to birth in the hospital with a c/s backup plan. It's not the right choice for everyone, and I do mourn that I never had a homebirth but... it was the right choice for me.

So no matter what you decide, make sure it's what YOU decide, ok? You're the one who has to live with the outcome... every option has risks and benefits, and once you've found the balance that works for you it's going to feel a lot better. Honest. But getting to that point can be tough, and it's one of the beautiful things about this thread.

Hang in there, good luck, and happy birthing!

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Old 05-13-2010, 11:52 AM
 
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Quote:
Originally Posted by giddiegoof View Post
Hi,

I think that if I were in your situation, I would also pursue the possibility of a homebirth with a midwife. I had my first in the hospital in a situation very much like yours (coached pushing and everyone yelling at you, legs held, on back, etc). I ended up with a 4th degree that I think was actually a small fistula from the beginning but I didn't realize it. Long story short, 3 yrs later I was pregnant ("oops" - just before I was ready to schedule repair surgery!)and the fistula was much larger (enough to have stool leakage occasionally).

I found a fantastic midwife whose outlook was that the worst that could happen is I would tear again. I did not want to go through a hospital delivery again, so I went with the waterbirth at home. It was great! Soooo much better than the hospital. I had a great delivery with no complications - no heart monitor - beautiful baby and the tub was awesome. I had the fistula repaired when baby was 6 months old and I really didn't think recovery was all that bad - I'd rather do that again than c-section with a newborn. So my plan for #3, if we are so blessed, will be to have another water birth at home, unless the midwife who delivered my second thinks it's a bad idea. My colorectal surgeon also said I should have a c-section for future births, but this thread has encouraged me to give vaginal birth a try. I'm also starting some homeopathics in July to help soften the scar tissue.

Best wishes! I can certainly relate to your fears. I really appreciated this thread, especially after searching online and finding that most information makes these tears and fistulas seem like a problem of the 3rd world.
Quote:
Originally Posted by ninabear View Post
I too suffered a fourth degree tear with the birth of my daughter 18 months ago. I was 8.5 cm dilated with a lip left on the cervix and the doc said I dilated completely when I pushed so he asked if I wanted to start pushing which I said yes considering I was in labor for 24 hours and ready to get the baby out! It was an unmedicated birth, though at the end when I was pushing the doc offered a local pain shot which I agreed to. I did that pushing where everyone told me how to push and when to push (I was on my back with legs pulled back) - three big pushes during each contraction. DD's head was slightly turned to my left thigh and the doc turned her during one of the pushes.

She started having decels whenever I pushed, but her heartrate would go back up when the doctor stimulated her scalp. At this point the intensity in the room climbed dramatically and all of the nurses/doc/my mom were all shouting PUSH! at the top of their lungs. I was pushing as hard as I possibly could, grunting and screaming like a wild animal. She was born within 45 minutes of me pushing and I ended up with a fourth degree tear.

It took me a year to recover physically due to some scar tissue that caused sex to be painful. I feel fine now though I can still sense where that scar tissue is and I haven't tried wearing thong underwear in a while since the scar tissue would hurt whenever I tried to wear it.

Emotionally the tear took a huge toll on me and I would stay up hours researching all the potential problems I could have from it and whether or not I could give birth vaginally again.

Now that I'm pregnant again (15 wks along), I've had one OB tell me I would absolutely need a c-section and that she's performed 3 c-sections on various patients who had suffered a fourth degree tear, that my repair is good but that she couldn't guarantee a good repair the second time around and that I could end up with a fistula.

Another OB told me I wouldn't necessarily have to have a c-section and that we could wait until labor started and then decide. She did say that I have a small pelvis which may have contributed to it (I'm normally 5'4'' and 110 lbs).

The OB I'm with now (who has been great so far!!!) has me scheduled for a vaginal but said we'd talk more about it as I progress further in the pregnancy. She wouldn't give me an answer one way or the other about whether or not the risks of a c-section were worse than the risks of tearing again. She said we could go the c-section route if that's what I'm most comfortable with but declined to really give me her opinion! She did say I have a very very short perineum which may have contributed to the tear - however I personally think my perineum is shorter now than it was before giving birth.

My biggest concern is obviously tearing again and having irreparable damage, but also I'm worried that giving birth vaginally would result in long-term fecal incontinence when I'm older. I've read on other message boards about women whose colorectal surgeons all said they would NEVER suggest vaginal after fourth degree tears.

Also I've read that even if you don't tear again, you can have damage to the pudendal nerve just from the hours of labor and the baby sitting on the nerve in the birth canal, which could result in fecal incontinence when you are older even if you have no problems now. So my fear is that even if I escape without a tear, I will still suffer the consequences 20 years from now as I age.

Of course, I would hate to have a c-section and then suffer years of pain from internal adhesions or bladder incontinence resulting from the surgery, and I have even read about women who needed a hysterectomy years after their c-section due to adhesions and scar tissue.

I just honestly don't know which poses the highest risk to me and which would result in potentially the worst long-term damage. We aren't planning to have anymore children after this so that is not one of my primary concerns.

I am wondering if I did another unmedicated birth, this time with no local antisthetic (sp?), pushed when my body told me and I was fully 10cm, side-lying position, and hired a doula, plus minimal fingers inside me for checking etc., if I could manage to give birth without another 4th degree. Either way I am filled with anxiety at the thought of another vaginal or a c-section
Did you tear on the outside or inside? I tore my vaginal walls but was intact on the outside. Just wondering if thats a "easier tear" to have babies again and not risk the chance of permanent damage??
I was also told I had a small pelvis- but then my midwives said your body doesnt make a baby thats too big for you?? So, I dunno!!
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Old 05-19-2010, 02:28 PM
 
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I talked to the doc some more about the delivery and she wants me to have a vaginal delivery. That is her personal recommendation because I healed so well last time and so she doesn't think I'll have a problem this time. She said a colorectal surgeon probably wouldn't do the scans on me since I'm pregnant (the ones to see how much damage is already done), so that kinda takes away my hopes of determining how much damage I already have to the pelvic floor, etc.

She had another patient who had a fourth degree tear and went on to have corrective surgery since it didn't heal well, and she told that woman to have a csection next time since she had so many problems the first time. So this makes me feel like she isn't afraid to recommend a csection as a result of tearing if she thinks the patient needs it.

She was shocked to learn I didn't have an epidural, and I told her if we do it again I don't want one this time either so she put it in my chart. She said let's hope this baby isn't bigger than Emma since she said Emma was very large for me.

So at this point I'm scheduled for a vaginal delivery, though I'm still not sure how I feel about it!!!! Out of the 3 different OBs I consulted with, 2 said I should do vaginal and 1 said I should have a csection, so I'm praying the odds are in my favor if this is the route we go.

When I mentioned side lying position to prevent tearing she kinda brushed me off. I'm planning to hire a doula this time and hopefully she can advocate for me if that's the best way for me to push and the doc is trying to force me on my back with my legs up?

Oh, and as for midwives, there only appears to be one in my insurance plan in the area? I really like this OB so far so I may just stick with her.

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Old 05-27-2010, 04:35 PM
 
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Thank you ladies for all of your support! I've been thinking endlessly about this, and finally determined that I need to try for a home birth. I'm hiring my friend who is a doula, and if I go with her recommended midwife, my other friend will be the homebirth nurse! This feels so right to me, I figure I can't control if I tear again but I can at least put myself in a situation in which I feel safe and supported during the delivery.

If I get another 4th degree and have to be transfered to the hospital (5 minutes away) for suturing at least I'll have had a good birth experience. If anything, being in the hospital fighting against all the interventions the nurses and OBs want to impose will merely serve to add more stress and anxiety, not what I need to relax and help my body open up!

With a home birth in mind, I'm actually starting to feel excited about the birth instead of scared and defensive and skeptical of the docs.

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Old 05-27-2010, 07:05 PM
 
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Yay! It sounds like this is the balance you need and that's going to make sooooo much difference. Happy birthing, I can't wait to read your success story!

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Old 05-29-2010, 06:40 PM
 
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I'm glad to see this thread has been updated. I am due in 6 weeks with my second - with my first, I tore badly, with a resulting fistula. I have chosen not to have it repaired, because of the poor success rate, and I have not had any stool leakage, just gas. My OB is very supportive of me having another vaginal birth, saying there is no increased risk of it worsening this time. However, I have anxiety issues normally, and now with no anti-anxiety medication, the panic attacks regarding this have been more and more frequent as my due date gets closer... I have several friends who are trying to still my fears about c/s, because the baby is still breech at this point as well... I'm trying so hard to be positive and go for a vaginal birth, but i've had friends recover from c/s much more quickly than I recovered from my last tearing...

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Old 05-29-2010, 06:54 PM
 
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Hugs moonmama! It's true that a "good c/s" will generally be easier to recover from than a "traumatic" vaginal birth. Of coursem the reverse is true too and a "good vaginal birth" is generally a heck of a lot easier to recover from than even a "good c/s". In my book, trauma is trauma, but I'd rather shoot for the good vaginal birth since in a c/s you are garunteed to have some serious physical trauma (due to the nature of surgery) while in a vaginal birth you at least have a chance to birth without trauma.

Obviously everyone in this thread knows that vaginal birth can be pretty dang traumatic with serious lifelong consequences. But so many mamas here have gone on to have vaginal births with little or no trauma! It can happen! Just keep thinking positively, do what you can to prepare, and have a backup plan and/or cesarean plan just in case. I hope you'll be updating this thread with another beautiful birth after 4th degree tear story in a few weeks!

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Old 05-31-2010, 09:30 PM
 
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Thank you wombatclay!!! I'm still having lots of anxiety about it, but everyone seems to think I'm going to have her early, which hopefully means she will be somewhere closer to 7 lbs. than 9.5 lbs. like my son was!!!

I'm also using EPO and doing perineal massage, so hoping that helps too!

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Old 06-05-2010, 10:14 PM
 
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and she's breech right now. Ob does not seem concerned but highly recommended NOT delivering her breech, with an unrepaired fistula. I think if she hasn't turned, I might be in agreement. I think at that point I'd be freaking out too much...

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Old 11-03-2010, 08:09 AM
 
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I came across this thread a few days ago and have been reading it on and off since then!

I had my little boy 2 and half yrs ago....had 3rd degree tear from an episiotomy, which healed well and wasnt overly uncomfortable during healing. I actually found my back hurt more after I'd had him, initially i thought this was due to the injection for the spinal, but later i've found out it's because my pelvis was dropped off the table whilst i was being stitched up and my muscles in my back "forgot" how to work!!

Well, im now 32/33 weeks pregnant with 2nd child, another boy! When i went to my 12week scan i was offered a c section. I was shocked, i cried and didnt know what to do. I assumed a normal delivery would be on the cards again. My midwifes' response was "well if they offer it to you, grab the chance with both hands"
I spent a lot of time thinkin about the best decision for me. Basically my doctor says i have to weigh up the consequence of having a scar from the section (with my road-map stretch marked stomach i dont think this is much of an issue!!), with the possible loss of bowel control if i was to tear again.

After doing a bit of research i figure that a tear in one labour doesnt mean a tear in another. I take that. But i have read that an episiotomy in the first increases the chance in the 2nd. So, going by the fact i tore from my episiotomy, where does that leave me chance-wise if i was to try natural birth??

Im so confused! I dont know what to do, im worried if i choose a c section its a selfish choice putting me and my baby at risk, but if i choose natural labour and tear, then i could suffer with loss of bowel control and i'd never want to leave me house again!!

I would really appreciate any suggestions on what any of you would do in my situation
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Old 11-03-2010, 11:59 PM
 
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I had my baby! Here is a link to the really long birth story (home water birth): http://emmaceline.blogspot.com/2010/...ome-birth.html

I'm really sorry to say I had a 3rd degree tear this time, better than a 4th but I was really hoping for no tearing! The birth itself was therapeutic though, and I'm so grateful for the experience.

Good luck to the rest of you who are hoping for a tear-free vaginal birth after a fourth degree tear!

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Old 11-04-2010, 01:43 PM
 
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Congrats Ninabear! I'm sorry for the repeat tear, but hopefully you'll heal quickly and enjoy your babymoon!

Welcome shinylittlestar! There's a lot of info in this thread and on the mdc boards... but in the end you're the one who has to live with whatever decision you make. I wish it was an easy balancing act, but unfortunately it rarely is. I know mamas who lost bladder control due to injury during their c/s, and women who lost bowel control due to fistula after 4th degree tearing. I know women who have had serious injury during c/s and mamas who had serious injury from vaginal birth. And I know how stressful it can be to try and balance the negative "what ifs".

For me, it felt like the up-front risks of a repeat c/s outweighed the possible risks of a second 4th degree tear. It's true that the chances of a bad outcome increase with each tear, but a repeat tear isn't a sure thing... but the risks of a repeat c/s are kind of unavoidable. (I don't mean the big/rare risks, I mean basic stuff like the unavoidable wound, organ displacement, etc). But I did plan for a rc/s and spoke clearly during my pregnancy with all my providers about what risks I was willing to take.

Big hugs to you!

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Old 01-03-2011, 11:29 AM
 
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Oh it's been a long time since this thread was updated!  My baby girl is almost 6 months old, and I just realized I never updated anything on here!  My daughter's birth, though initially followed a similar path as my son's, ended up being dramatically different!  I was scheduled to be induced, just three days after my due date, because i had such a large baby the first time, and the difficult birth resulted in a minor fistula.  I went in on the evening of July 13 for the "cervical softener" before the induction the following day.  I had been having some contractions all day, but had already gone to the hospital two weeks prior with false labor, so really thought little of it.  However, when I got there this time, I was indeed in labor, and while I was waiting for my doctor, my contractions were 2-3 minutes apart.  He gave me the option to skip the softener, but said that it could possibly shorten my labor and so I went ahead and let him administer it.  After an hour, I was released, and told cheerfully by my wonderful nurse that she might see me later in the middle of the night if I progressed quickly, but they sent me home to get some dinner and some rest while I could.  I was only 2 cm at that point.  By the time I got to the car, I was stopping with each contraction.  We stopped at Olive Garden to pick up food, and I was having very strong contractions by the time we left there.  My wife asked if we should go back to the hospital (i was clearly uncomfortable...) but I thought since they had sent me home, they must have thought I had a while.  20 minutes later we got home.  I was in serious pain with each contraction, and couldn't eat.  My wife called the hospital and the nurse told her to have me try to rest and come back if we thought it was necessary.  I had had an epidural with my son, and so had never gotten to this point the first time.  I had no idea how I should be feeling or when I should go back, and my water had not yet broken. tried to lay down and relax,I tried to take a warm bath, I tried sitting on my exercise ball. It was about 8:30 pm.  My wife was on the phone in the other room talking to her mother, who was watching our son, and I started yelling at her that we needed to go immediately.  I was half-crying, and very upset about having to endure another 20 minute car ride back to the hospital.  I could barely walk to the car.  I remember her trying to talk to me during the trip there, and I opened my window and stuck my head out, to drown out her voice, yelling at her to just get me there so I could get an epidural.  We got to the hospital and I could hardly get out of the car I was in so much pain.  They brought out a wheelchair and brought me up to maternity.  I know i was moaning and making a lot of noise because they got me into a room right away.  It was about 9:30 by now.  The nurse checked me out, and said I was 8 cm.  Although I had told her 2 hours ago that I wanted to try for a natural birth, I was begging for an epidural at this point.  They couldn't get the IV in and had to call a phlebotomist, and my doctor came in to check on me, then left to get prepped for delivery, telling me I really didn't have time for an epidural - she was coming quickly.  At this point, I was spontaneously pushing, and the nurses frantically called my OB back.  The rest of the birth was fantastic.  Once I started pushing the pain was bearable.  My doctor was calm and reassuring, and the whole mood of the room was so much less frantic than it had been when I delivered my son.  My daughter was born at 10:39.  She was 7lbs. 9 oz. - 2 full lbs. less than my son.  Though I did tear because she came so quickly, it was only a 2nd degree, and did not make my fistula any worse.  It was such a spiritually healing experience, and I am so glad that I was unable to have the epidural because I had really wanted a natural birth in the first place.  I am so thankful to my OB, who had encouraged me to have a natural birth, and assured me that it was possible and then helped that to happen.


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Old 03-25-2011, 02:00 PM
 
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this is such a great thread!

 

i'm 21 weeks on my second birth. my first birth was rough like many of yours. over 3 hours of pushing, use of vacuum (that came off my poor litle ones head after two people tugging), real bad pain on my right side while pushing and they pushed my leg further back and that made the pain worse! but the result was a great baby boy! my recovery was terrible it took me a month to properly sit. sex forget it! i'm amazed we are pregnant! and i'm am so sad and embarrassed to admit i can't hold in my gas. and while being pregnant it has become harder to hold anything in! i'm so sad. 33 and incontinent just plane sux!

 

Has anyone had this before that can give me any advice? while pregnant it seems to be getting harder to hold things in. what did you do?

 

i went to a specialist and he said that i need to have everything repaired. That i should just go ahead with a vaginal birth b/c the damage is already done. one OB who is against C/S said to have one. my OBs are supportive no matter what i choose. but I'm so torn and confused on what to do. I'm scared to have another tear and i'm scared to have surgery (even though many people say it isn't bad at all).

 

i have to get the repair surgery so, my current feeling is this... go vaginal for this baby, get the surgery on all my bits, and if we have more have a c-section.

 

thanks for listening.

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Old 05-17-2011, 10:04 PM
 
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Hi! I am the proud mom of 3 adorable boys. And unfortunately I tore 4th degree with each one of my births. The reason for this is because I have a tiny teeny perineum. it is only about 1/4 inch long. I too have my doctors message the perineum during birth, and reading through this thread was the first time I have ever heard that this could have the opposite effects. If i have another child, I think I still would go vaginal, even after all that I went through. (each one of my recoveries took atleast 10 weeks) I am scared stiff over having a c-section and I wonder if the recovery is that much easier. I would love to hear from anyone if they had both these experiences...I just want to say, that I really feel your pain and really know what you went through. It is not easy, and only makes you that much more worth being a mom!

 

good luck,

Natalie

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Old 05-19-2011, 02:17 PM
 
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Hi, I’m new to this thread but I just wanted to chime in and say that I WISH I would have seen this BEFORE I have birth to my second daughter 15 months ago!! I am sad to say that I had a C-Section based on my doctor telling me it was medically necessary after having a fourth degree. With my first labor I was induced and when I was 3cm I got the epi well 20 min after getting it I was 10cm and it was wearing off I pushed for 3 hours and they ended up having to use the vacuum and do an episiotomy. When her head popped out the dr realized she had shoulder dystocia so he had a nurse get on top of me to push my tummy from the outside while he pulled and tugged to get her out. When that didn’t work he reached in and broke her collar bone to get her out!! It was a very traumatic birth for me. When I became pregnant with my second a year later he told me I was going to have to have a C-section because of the first birth and he said more than likely this baby would be bigger and that I had a chance of not being able to hold my bowels if I tore again…Good way to scare me Doc!! LOL  He did not give me a choice he TOLD me I researched on the internet but really didn’t find too much in the end I decided to go with the C-Section…Let’s just say that was the WRONG decision!! I think I would have rather had a 4th degree again!! An hour after having the C-Section I started throwing up and nothing was stopping it…Do you know how bad it hurts to throw up right after having you stomach cut open? I felt like it was ripping back open…and now looking at the flap of skin hanging over my scar sucks!! I wish so bad I would have seen this forum and seen that women go on  to have another baby without/minimal tearing….Oh how I wish I could turn back time…guilty.gif

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Old 06-04-2011, 12:59 PM
 
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 Well, I too, am Happy this forum exists! My second baby boy (born a year ago- may 2010) was a nightmare hospital labor and delivery. I received a fourth degree tear and, looking back makes me regretful about most of my choices from who my OB was to saying yes to the epidural so late in labor. There were so many factors, so it's hard to know which, if not all, contributed:

 

1. new OB, still kind of a student and , as I learned afterward, was recommended to me by my friend (a nurse) because of how well he performs c-sections...yeah

2. alot of checking and touching down there before and during 2nd stage of labor. He, at one point, had his entire hand in me trying to turn my baby (he was facing up)

3. of course, saying yes to the epidural is what I blame because I couldn't feel anything which led to purple pushing while the nurses yelled at me the entire time (like I said, nightmare) and were yelling at me about how I wasn't doing anything even though I was trying so hard! I pushed for about 1 1/2 hours and during my purple pushing, baby literally POPPed out! He Flew out of me!! First his head, POP, then just like a fish, his body quickly followed. I thought that was cool, except for NO, it wasn't.

4. They'd also broken my water at 8 cm, but I'm not sure if that had anything to do with the bad outcome.

 

The good news: After about a couple hours of surgery and all dignity out the window, I healed really well! My OB was smart enough to call in more experienced reinforcements and have me sutured up. He was very concerned about me recovering well and I followed all advice to a T. I didn't find it too painful in the weeks that followed and in actuality, it wasn't much different from the recovery of my first boy, where I only had a small episiotomy and no tearing beyond that.

 

So after lots of googling and thread searching, here I am a year later and that much more confident that indeed my next will be a vaginal and I WILL have a good delivery with minimal tearing. I shall be back when it happens. I am not even pregnant yet with a 3rd but sometime next year I shall revisit!

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Old 06-06-2011, 11:09 PM
 
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Hello everyone, 

I'm so glad that this thread is here.  I've read through over the past few months, and I feel like lots of questions have been answered and there has been much success with subsequent vaginal births after a serious tear.  I still wonder though, if my case might be one that is too iffy.  My first was born via c-section after a disappointing and difficult 24 hr labor, 3 hrs of pushing, visible head, but I was too numb and unable to move baby down anymore.  My second was an unmedicated VBAC, another 24 hr labor, 3 hrs pushing in every position imaginable, extremely hard work, very forceful pushing (but only with natural urge), baby came out slowly and I had a 4th degree tear.

 

I wonder, with my set of circumstances what my chances might be.  I am only 5'3 and babies were 9 lbs and then 9 lbs 4oz.  Both had a hard time coming, but first was clearly impeded by epidural.  Healing was difficult, a few months.  Urine, gas and occaisional stool incontinence still.  I dread a repeat c-section, and fear that for possible future babies, but stool incontinence or a colostomy is NOT the way I want to live my life.  I have a feeling that maybe in my case, the babies are rather large, my pelvis is small, and my tissues will be weak to handle another large delivery.  I admit that fear of permanent damage is playing a large role in my decision, but I don't want to rule out a vaginal birth.

 

I worked so very hard to prepare emotionally for and to physically VBAC, but I just don't know if it would be the right choice for me again.  My MW couldn't say what might happen - only that the repeat 4th degree tears she has seen were always blamed on a previous episiotomy.  My 4th degree healed OK, but I have low confidence it would be able to be repaired well again, since I do have lasting effects.  It was severe, and recovery was much worse than the c-section (except for the PPD and PTSD caused by the unexpected surgical birth).  Pamela at the Farm even told me that chances are I would not tear *at all* (I had my doula ask her for me while she attended a training there), but I don't think I want to take any chances at all.  Please help me sort this out.

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Old 06-07-2011, 12:27 PM
 
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Hi all,

 

i'm writing to update. i haven't had my baby yet but i have made some decisions from all the advice on this post and a lot of soul searching.

 

my doctors have been really supportive of my back and forth between section and vaginal. After going to a specialist to check all my bits it seems i will need work done down there anyway. Once i get all that fixed i don't want to mess it up again.

 

So my current plan is to have this baby vaginally, get myself all fixed up from the first birth (and what ever happens with this next one), and if we have another (which i hope to) have a planed section. 

 

I am totally nervous too. my family thinks i'm crazy to go through it all again. my doctors have been very patient. So fingers crossed!

i wish you all well. if anyone wants to chat and get the nerves out i'm all ears and could use a bit of chat myself!

 

 

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Old 06-08-2011, 11:49 AM
 
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Big hugs to everyone and good luck to the mamas expecting their post-tear babes!

 

I had a c/s after a long labor with dd1, a successful vbac with dd2 that unfortunately included a serious shoulder dystocia for her and a 4th degree tear with pelvic organ prolapse for me, and a successful vbac with ds that did include a 2nd degree tear but which otherwise was totally fine.

 

Of those, DD1 was 9lbs6oz.  DD2 was 9lbs even.  DS was 9lbs8oz.  So it was my smallest babe who got stuck at the exit and cause the most damage.

 

I'm pregnant again, due in early Sept, and planning another VBAC.  It's a tough (and very personal) process to find a good balance between risks.  For me, I plan a vbac but with a rc/s "clause" built in.  I want a vbac, it's the better option (in general) for mom and babe, a c/s is hell to recover from even in the best cases, but I do NOT want another tear.  So I am very clear with my support people and providers that if things seem even a little sticky, slow, or abnormal we WILL move to plan B.  I'm fortunate that my 4th degree was repaired by a pro (an OB who actually teaches classes in repairing 3rd and 4th degree tears!) and fortunate that my prolapse is fairly minor.  And I know that there is no way to remove risk from pregnancy/birth.  But for me, a planned vbac with a rc/s plan built in is what works.

 


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Old 03-02-2012, 09:39 PM
 
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Posting with an update...  I had posted a couple (or more) years ago.  Ds was 9lbs. 9oz., long labor, vaccuum extraction, shoulder dsytocia, 4th degree tear.  Weeks later I realized after much internet searching that I had a resulting fistula - small but annoying...  I was terrified to have another vaginal birth, but even more terrified to think of a c/s.  My OB was VERY supportive and completely confident that a vaginal birth would be fine, until dd was still breech at 37 weeks.  She finally turned at that point, but I was so anxious...  In summary - they planned to induce me at 40 weeks 3 days, to avoid another big baby, and when I went in to be induced, I was already in early labor.  I was sent home at 2 cm. and told to relax, have something to eat, get some rest and they'd "probably" see me in the early morning.  However, on the way home, my contractions were strong enough to be quite painful, and 20 minutes later, at home, I was having major contractions.  Tried to get in the bath, but felt like she was right there and so went back to the hospital.  Got there at 8 cm, they got the IV in while I was pushing, no time for any concerns - she arrived about 2 hours after they sent me home the first time...  Completely unmedicated, small epis. b/c she came so quickly, but only minor 2nd degree tear.  My OB stitched me up really well (and like pp said, after all my dignity was out the window!).  Did not correct the fistula, but did not worsen it in any way either.  It is so small that surgery would be more likely to worsen it than fix it, so at this point I have decided against it. 

 

So - DO NOT let your doctor, or any doctor, tell you you "need" a c/s.  I birthed my dd so quickly there wasn't even time for my perineum to stretch much, and I still came out of it just fine.  And the recovery was SO much easier than with my ds... 


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Old 05-23-2012, 05:07 PM
 
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Hi to everyone visiting this thread!

 

I posted an update on my third childbirth back in 2008 in this thread.  It was a wonderful tear-free birth of our second son.  

 

Now, I would like to post an update because we had our 4th child in Feb. 2011!!!  I know how important it is for all of us to share our successes and good birthing experiences after having a birth injury like a 4th degree tear.  Here is a mini-version of our birth story.

 

This is for all of you!

 

Our daughter was born at home at exactly 42 weeks.  We had a very supportive and skilled MW.  She was our biggest baby weighing in around 10 pounds 6 oz!  Not really sure about exact weight because the weight between the midwife's spring scale with sling and the doctors scale were off-with our baby weighing less at 2 weeks than when she was born!  But we are sure she was closer to 10 rather than to 9 lbs.  

 

Regardless, she was our biggest baby:)  I labored with my husband applying pressure relief to my hips because they were taking the brunt of the pain.  I could feel double peaks in my contractions. The MW stayed up by my head being supportive.  I took my time with crowning and we had the MW come over to take a look and we soon learned she was also a compound presentation with her little fist up by her chin/ear.  WoW Right? No matter how many times the MW tried to push the fist back she kept putting it right back where it was.  Finally, we decided I had stretched enough because I announced she needed out NOW and I gave the final push and she was out.  I had a weird side "maybe" skidmark and some soreness that made recovery a little trying for a while because I was bruised by the compound presentation.  Most importantly, I had no tears!

 

I believe it is so important to birth in a calm and peaceful environment.  It is also very important to have supportive and skilled birth attendant(s).

 

You can go on to have babies without tearing again.  You can! 

 

Big hugs to all,

 

Moonflower

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Old 06-12-2012, 09:32 PM
 
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Alright, it's been a year I think since I read this thread and contributed my story. My second son was a bad 4th degree tear. I am now pregnant with my 3rd and due December 2012. I am getting nervous! I found a really great Ob/Gyn recommended by a dear friend with 7 children and he is very nice and was appalled to learn about my 4th degree tear. He said there is nothing in my history and story and suggests I need a C-section (as highly recommended by the Ob-Gyn I tore with) so I think that is good but at the same time and for some reason, I am still nervous about the whole hospital part. I REALLY dislike I.V's and I don't think laboring on my back is going to be the best way to avoid a repeat 4th degree tear. It just makes sense to me to squat or do a waterbirth. I am looking into the midwives here and will make sure to update whatever happens on here with what hopefully is great news ;)

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Old 06-26-2012, 01:00 PM
 
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Yikes, these stories are absolutely awful. I am feeling sick to my stomach just imagining tearing to the 4th degree. There are some strong women here to have the courage to try again after that kind of trauma! I only tore to the 2nd degree with my first (8 stitches) and the recovery time was terrible for that. I only pushed when I really felt the urge and I was pushing for at least an hour, so I know it wasn't speed or timing that hurt me there. She was born in the caul, but I don't know if that makes a difference.

 

My second was extremely fast but I only had a tiny skidmark. I really think it's the first one that's normally the worst! (At least, that's what I'm telling myself... watch my 3rd one rip me open this December! lol.gif)

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