# Unrepaired Fourth Degree tear



## Mama Murphy (Oct 17, 2006)

I hope if I post this here, more people will see it and the women I need to hear from will too.

Long story (as they always are) short: I had a 4th degree tear that didn't get repaired. I don't really want to discuss how it happened, but I'll just say, I didn't know I had this unrepaired tear until my 6 week postpartum apointment after everything had healed "open." Now, after about a year, long story why it's taken so long, but I am finally getting ready to have reconstructive surgery. I am being told over and over again that I must have c-sections from now on. This is really devastating for me.

Are there any women out there who had an unrepaired poorly-healed 4th degree tear that had recon. surgery, then went on to have a natural birth w/o needing further recon. surgery? Please respond or IM me.


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## birthgreeter (Aug 31, 2006)

Mine was not unhealed or repaired poorly, so maybe this does not count, but I did go on to deliver 2 other children with no tears. You can do it too.


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## illinoismommy (Apr 14, 2006)

Oww... I had a 4th degree, but it was repaired... if you did have a health care provider responsible for that mistake, that's something I would sue about. OMG............ it was bad enough repaired.


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## scoobers (Jun 24, 2005)

I had a 4th degree laceration which was repaired but the stitches came out. I did have reconstructive surgery but haven't had any more children. (One main reason is becaues of ds's traumatic birth.) Personally, I wouldn't ever attempt a vaginal birth again. Even after the surgery I will have lifelong repercussions from the vaginal birth. I know that's not a popular thing to say on MDC but it's how I feel. I have heard of others who have successfully done a Vbirth after a 4th degree tear. I just wouldn't take the risk.

I don't think you have to have a c-section if you don't want to. I'm sure you could find a good MW who would work with you to minimize the risks.

Anyway, I just wanted send a hug.


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## PudnHead (Aug 25, 2005)

I'm lurking on this thread to see what others have to say. I had a 4th degree with my first child that did not heal right. I had to have recontructive surgery 7 months after delivery. The doctor who did the surgery (not a OB but a nanal-rectal specialist) said I should have c-sections for future pregnancies. However, he did not say it was imperative or I risk having fecal incontinence all my life (I had it for 7 months not fun). Mostly I should do it so I don't ruin what I had done.

I am now 8 weeks pregnant and I'm trying to decide what to do. My OB said he would give me a c-section if I wanted it, but he didn't push it. So, I am assuming that it is possible to have a vaginal birth again.

Good luck


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## faithhopelove (Feb 27, 2004)

I had 250 stitches after my 2nd child's homebirth. I had to transport and had surgery. It was horrible. I however went on to have an unassisted birth with my 3rd and I only had minor tearing. Well, I do have a flap of perinium hanging down cause I didn't realize I tore that bad, but it hasn't affected anything. I am about to birth my 4th baby anyday now.


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## pamamidwife (May 7, 2003)

I have had a couple women with fourth degrees in my practice, well one with a third degree and one with a fourth degree, that had vaginal births after the repair.

I myself had a bad third degree with reconstructive surgery at 15 months postpartum. I would NEVER consent to a cesarean based on this one issue. I trust that my body would accomodate my baby as it needed to - provided there was nobody with sharp scissors standing by.

Obstetricians have a firm belief that we all could have beautiful, virginal vaginas if we just have cesareans. This is not true. Your vagina is an incredible place - and it will heal and still have elasticity to stretch around another baby's head - though the next time would likely be extremely minor.

Another reason why obstetricians should not be hired to oversee natural birth: they inevitably pick up scissors, perform surgery on our vaginas and end up causing unnatural third and fourth degree extensions from the epsiotomies.

I'm grateful for the OB that "fixed" my vagina.

However, she belongs to the same club as the OB that "broke" my vagina.


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## seeing_stars (May 3, 2005)

First off







s , I struggled with difficult emotions and feelings from my tear for a long time.

I didn't have a 4th degree tear, but I did have a really traumatic upward tear through my labia and clitoral hool. The tear was repaired in the hospital, but the stitches popped out and my tear healed "open", leaving a very painful situation for me to deal with. I had reconstructive surgery 15 months postpardum and things are better, but still not perfect. My OB never even hinted to the possibility of a C-section for this reason. She said that next time we will take things mroe slowly, only pushing when my body tells me to and applying pressure (my husband's hands) to the tear area while I am pushing.


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## scoobers (Jun 24, 2005)

Quote:


Originally Posted by *pamamidwife* 
Obstetricians have a firm belief that we all could have beautiful, virginal vaginas if we just have cesareans. This is not true. Your vagina is an incredible place - and it will heal and still have elasticity to stretch around another baby's head - though the next time would likely be extremely minor.

Another reason why obstetricians should not be hired to oversee natural birth: they inevitably pick up scissors, perform surgery on our vaginas and end up causing unnatural third and fourth degree extensions from the epsiotomies.

I'm grateful for the OB that "fixed" my vagina.

However, she belongs to the same club as the OB that "broke" my vagina.

It sounds like you are saying that 4th degrees are caused by episiotomies? I didn't have an episiotomy, she just ripped him out with forceps when he got in distress. Who's to say that wouldn't happen again? To me a lifetime of fecal incontinence and having to go through that surgery again isn't worth the risk, I'd take a c-section over that but my husband and I were both so traumatized by the birth we are probably not having any more children.


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## onlyboys (Feb 12, 2004)

Quote:


Originally Posted by *scoobers* 
It sounds like you are saying that 4th degrees are caused by episiotomies? I didn't have an episiotomy, she just ripped him out with forceps when he got in distress. Who's to say that wouldn't happen again? To me a lifetime of fecal incontinence and having to go through that surgery again isn't worth the risk, I'd take a c-section over that but my husband and I were both so traumatized by the birth we are probably not having any more children.









My fourth degree was caused by an episiotomy extension. A totally unnecessary episiotomy. And I was super fearful that my fourth degree would happen again. But, I had three more vaginal births and never had more than a first degree, but even that was NOTHING compared to the previous trauma.

I don't think that fourth degree tears happen commonly, or without major intervention (your forcep delivery was major intervention, and I'm SHOCKED that they didn't have to cut you to get the forceps on him).







I know exactly what you went through with that recovery; and you must have been terrified!


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## meredithlee (Jan 4, 2006)

I had a 4th degree tear and episiotomy that didn't heal properly. Like most of you, it was a traumatic birth with my babe being in distress and needing to get out in a hurry. At my 6 week post partum check up, my OB repaired it with silver nitrate. It seemed to help the healing process. There still "isn't much there" according to my OB at my appointment a couple weeks ago. His plan for me is a vaginal delivery with a routine epitiotomy to reduce the risk of further damage and to promote healing correctly. It hasn't been a concern of his, just something to look out for.

Maybe mine healed a little better than some. No talk of c-sections. I don't have any big problems from it. I guess sometimes it is difficult to hold in gas, but nothing more serious than that.

It took me a couple months of being pretty down, embarassed, worried and upset before I finally realized that I am ok. I don't have pain anymore and my doctor assured me that although it isn't common, it does happen and it shouldn't be a problem to repair next time around.

Sorry you are going through this right now. I would have a good talk with the doctor and go over any options available for delivery.


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## ldsapmom (Apr 8, 2002)

I had a 3rd degree episiotomy. My baby was not in distress; my OB was tired of standing around while I pushed, so she vacuumed him out. Some of my skin healed on the outside, and that was burned off with silver nitrate.

I went on to have a second baby, born face-up, weighing 9 pounds, 9 ounces. My midwife made a small episiotomy, as per our discussions during prenatals -- although today, I would leave it all alone. At that point, 26 months after my first delivery, I was a lot more worried about what would happen at my scar site. I had no extension of the episiotomy she cut. In the birth video, you can see the white scar line running from my vagine into my rectum.

I had my third baby almost 11 months ago. No episiotomy, no nothing! Great birth







.

I know there is a huge difference between 3rd degree and 4th, though.


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## doctorjen (May 29, 2003)

Quote:


Originally Posted by *scoobers* 
It sounds like you are saying that 4th degrees are caused by episiotomies? I didn't have an episiotomy, she just ripped him out with forceps when he got in distress. Who's to say that wouldn't happen again? To me a lifetime of fecal incontinence and having to go through that surgery again isn't worth the risk, I'd take a c-section over that but my husband and I were both so traumatized by the birth we are probably not having any more children.









I know this thread wasn't to discuss your birth, but I just wanted to respond to this. I feel sad that your birth was so traumatic for you that it would be the deciding factor in having more children. How scary it must have been to make you feel so badly! 3rd and 4th degree lacerations are much more common with forceps, since the forceps greatly increase the diameter passing over the perineum, and are irregularly shaped and hard, putting pressure in a much different way than the relatively round, molded head of a little baby. Spontaneous 4th degree tears (which happen during an otherwise unremarkable, spontaneous birth) are very, very rare. I have had the opportunity to attend quite a few women with previous tears into the sphincter and I have never seen a repeat 3rd or 4th degree laceration. Ever. (and I recently had an 8th time mama who'd had 2 previous 3rd degree repairs, and 7 previous episiotomies birth with me. You'd think if somebody would have weak scar tissue, it would be her!) However, I am very careful with these women. My plan for someone with a previous laceration is to do everything I can to support a spontaneous birth - so no pitocin, no AROM, no coached pushing, no encouraging the mama to push other than encouraging her to listen to her body, no hands on her perineum except perhaps a little support of the perineum/rectal area if it feels good to the mama (but absolutely no perineal "massage" or routine exams during second stage, or any kind of stretching of the skin) and encouraging the mama to assume whatever position feels good to her.
If you decided to have another child, scheduling a cesarean isn't the only option to protecting your perineum. You could do everything you could to reduce the chance of fetal distress (no induction, no augmentation, no AROM, no forced pushing, upright positioning, staying hydrated in labor) and if, on the slight chance, the baby was truly distressed and needed urgent delivery, you could then insist on a cesarean rather than chancing forceps again. True distress rarely happens out of the blue, also (although docs like to claim it does - you can usually point to factors that stress the baby, like induction, pitocin augmentation, forcing mom to lie on her back which reduces blood flow to the baby, stressing the baby with forced, "purple" pushing and reducing blood flow to the baby)
Of course, you'd have to do what felt to you like the best option, but I don't want you to think that you'd just have to have major surgery to avoid such a traumatic outcome again - or that another baby would be in constant danger of terrible distress at any second. You could be proactive and make a variety of choices to minimize the risk, and still reserve the option to go to cesarean if things weren't going well.
Good luck with your future plans.


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## lolar2 (Nov 8, 2005)

In your situation I'd discuss birth options with the colo-rectal surgeons. I know for recto-vaginal fistulae caused by Crohn's disease, C-section is universally recommended, but I don't know about those that are mechanical and repaired.

I do know one woman who had an unrepaired recto-vaginal fistula from a combination of episiotomy and Crohn's disease, and had another vaginal birth 5 years later, but it made her fistula worse and she said she would have a C-section if she had it to do over.


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## Pandora114 (Apr 21, 2005)

Quote:


Originally Posted by *ldsapmom* 
Some of my skin healed on the outside, and that was burned off with silver nitrate.


my eyes watered just reading that....


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## Mama Murphy (Oct 17, 2006)

So many posts to reply to.

I appreciate and congratulate all the women with past tears that went on to have a tear-free vbirth. I am concerned that having an unrepaired tear like mine makes the situation a little different.

My 4th degree tear was spontaneous, as doctorjen calls it. It was an unassisted birth where no one had their hands on me, were directing me, I wasn't on my back, baby was in the right position ect ect ect. Baby was big. This was my 4th baby, and I've torn for all of them- the 1st was an episiotomy (tho they told me I tore, but my husband swears they cut me.) And I had all these babies in 4 years. So, the tissue was probably weak. And my baby got stuck- as I have heard Pamamidwife say, I do agree with her that our body are meant to tear. but mine just tore too much, probably because of all the past trauma, ect.

My tear was unrepaired due to a midwife who did not know what she was doing. I was worried about tearing, per past experience, and had hired her for postpartum care. No, I did not sue her, but I did report her. It was just too dangerous for me to dismiss.

This is going to be a complicated surgery, I've been told, and the one doctor who can do it in my town has refused, will only do it when I'm done having children. It was already difficult to find a doctor (she's an anal-rectal specialist) that would do it now, and they told me twice, when they set up the appt and when they called to remind me of it, to agree to c-sections or cancel my consultation, which is this week. I can't go hunting all over the country to find a doctor who will do it again should I need it. My children need to eat.

Pudnhead- you know what i have been dealing with this past year. It has been tough. If you have an OB who will support you in a vbirth, how blessed you are.

Scoobers- I am so sorry for you. I hope you find healing after everything you've been through.

I actually had a premonition that I would not have any more children after I had my baby. I felt this emptiness in my womb, and I still feel it. I want to have another baby- I want to birth! I know I don't have any other choice but sections now, I don't know why I'm posting here hoping that someone out there has been down this road and can give me hope. I guess I'm just greiving this loss and I don't want to let go of my ability to birth. I know it might seem silly to some people, I know some would say I'm lucky to "have" to have c-sections now, but this is really devastating for me now. Going from being a UCer to a schedualed c-section-er. When my body is strong and healthy. To not be able to bring my baby into the world in a way that was so sweet and peaceful, I don't know that I want to physically have anymore children. I know we can adopt, we are thinking about it. I guess I never thought I would adopt, you know, four kids in four years, but I know I will love my children no matter where they come from, but this is where I am now and it stinks.

Thank you for all the posts and support.


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## kalisis (Jan 10, 2005)

Mama - I couldn't read and not post. I don't have much experience at all with this subject, but my heart goes out to you. What a scary situation. My one tiny little fissure and tiny labial tear seem like nothing now.








s and I hope you can find the peace and healing you need.


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## savithny (Oct 23, 2005)

I have a friend who tore horribly during a delivery - no episiotomy, no forceps, unmedicated delivery. Not sure what position she was in, but she pushed for 3 hrs....

ANyway, her midwife described it as "shattered," -- it was like her perinium exploded. 200+ stitches. That midwife told her that she'd never seen anything like it -- except in women with previous eating disorders. My friend didn't have an eating disorder at all, but apparently has some sort of issue with skin elasticity. That's her theory anyway. She's a redhead and wondered if that played into it as well.


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## faithhopelove (Feb 27, 2004)

Quote:


Originally Posted by *savithny* 
I have a friend who tore horribly during a delivery - no episiotomy, no forceps, unmedicated delivery. Not sure what position she was in, but she pushed for 3 hrs....

ANyway, her midwife described it as "shattered," -- it was like her perinium exploded. 200+ stitches. That midwife told her that she'd never seen anything like it -- except in women with previous eating disorders. My friend didn't have an eating disorder at all, but apparently has some sort of issue with skin elasticity. That's her theory anyway. She's a redhead and wondered if that played into it as well.

That sounds like my 1st hb. Over 200 stitches as well. I actually heard my perinium explode. Was horrible.

I just had my 3rd homebirth today and I can sit without pain







I think I tore a bit but I'm not even swollen at all.


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## savithny (Oct 23, 2005)

Quote:


Originally Posted by *faithhopelove* 
That sounds like my 1st hb. Over 200 stitches as well. I actually heard my perinium explode. Was horrible.

I just had my 3rd homebirth today and I can sit without pain







I think I tore a bit but I'm not even swollen at all.

Congratulations!







And I'm glad to hear it didn't happen again!

My friend never tested the "tear once doesn't mean you'll do it again." I don't think the tearing was the reason; she was over 30 and her DH was 10 years older than her, with teenagers from his first marriage. They decided one for the two of them was enough. So she didn't find out if she's just got tearable tissue.


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## moonmama22 (Mar 31, 2005)

OMG that perineum shattering story made my stomach turn!!! It sounds like there are a bunch of different opinions out there - I've been really looking into this for a while now. I had a 3rd degree tear with mine over 2 years ago. Long story, but couldn't get it looked at, so is obviously unrepaired. No incontinence, but I can sympathize with the pp about the gas!








I thought maybe this thread would help me out a little - my first birth was so traumatic and scary but I so desperately want another baby, and really really don't want a c-section. Lots of support and hugs going out to everyone with these issues - it's horrible and frustrating and pisses me off, but the posts in here gave me some hope for future vaginal births! THank you!!!


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## nonnymoose (Mar 12, 2004)

Quote:


Originally Posted by *seeing_stars* 
I didn't have a 4th degree tear, but I did have a really traumatic upward tear through my labia and clitoral hool. The tear was repaired in the hospital, but the stitches popped out and my tear healed "open", leaving a very painful situation for me to deal with. I had reconstructive surgery 15 months postpardum and things are better, but still not perfect. My OB never even hinted to the possibility of a C-section for this reason. She said that next time we will take things mroe slowly, only pushing when my body tells me to and applying pressure (my husband's hands) to the tear area while I am pushing.


I had similar tearing with my first son (without the complications, fortunately, although I would've gladly given birth again to avoid getting sewn up). Just so's you know, I got a grand total of one stitch with DS2, and that was in the back. I had a tiny tear up front, nowhere near the previous ones. I changed positions in mid-push because I felt too much pressure in the front, and squatting *really* helped. Taking it slowly makes all the difference in the world.


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## Mama Murphy (Oct 17, 2006)

I had my consult with the colon/rectal specialist, and I thought I would share what she told me. She told me that subsequent repairs could be more difficult. She totally left the choice up to me, didn't bully me into it or anything.

And she told me, when she saw I really didn't want to have c-sections, that I could put off the surgery for a while if I could live with the situation, and have another baby or two. I hadn't considered this and I was ecstatic when she suggested it.

What do you experts out there think of that recommendation? Would you have any concerns about a pregnancy in someone with a completely unrepaired 4th degree tear, who is otherwise totally healthy?


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## mntnmom (Sep 21, 2006)

Wow that's rough. As I'm sure you see, there are possibilities either way. I would talk to as many specialists as I could, both now and when you get pregnant again. I was lucky that my 4th degree was very well repaired at the time it happened (mine was caused by an episiotomy). But the pain was horrible and I can imagine what you're going through. I wish you the best. And if you want a baby, a C-section isn't the end of the world either.


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## Ndsmom (Oct 31, 2006)

I just started researching what to do about my lingering problems from my 4th degree tear. I had an anal ultrasound and found that my sphincter muscle is still torn even though I was stitched up for 45 minutes after delivering my baby. My doctor told me based solely on the fact that I tore that bad that she would flat out insist that I have a c-section next time. She did not know for sure that I was still torn when she said that. Now I am looking at having some sort of surgery or doing physical therapy. I have not met with my doctor yet to decide. So I thought I'd look stuff up on the good old internet before meeting with her so I'd have some opinions of my own.

I'm a little concerned that she did not do the right thing in the first place. I know she cut me first and I remember feeling her pulling down with her fingers to make more room for the baby's head. I've always felt like her pulling down made me tear as bad as I did. I feel like she rushed things because I did not want to push anymore and she had 3 other mother's she needed to deliver at that time.

My other doctor, the one I usually see that wasn't there to deliver at the time said I would never tear that bad again. She seemed unconcerned and just wanted me to do Kegal excersizes. I don't know who to believe.

I feel like something has been taken away from me when I was told I should not have another vaginal delivery and at the same time I do not want to feel that pain again. I also do not want to be in depends for the rest of my life if I tear that bad with my next child.

My mother has lived with this problem her whole life. I think before women were just embarrased to talk about it. Too sad.


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## onlyboys (Feb 12, 2004)

ndsmom,









I was also harmed by a hurried doctor and an episotomy extension into my rectum. It was incredibly painful. The two times I had to be "fixed" were excruciating. And yet, I still had three more vaginal births with minimal tearing.

I totally understand your fears. I had them too. I was terrified that I would tear along the scar line, right into my rectum, but it didn't happen.

I wish you well.


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## phoebemommy (Mar 30, 2006)

Quote:


Originally Posted by *savithny* 
I have a friend who tore horribly during a delivery - no episiotomy, no forceps, unmedicated delivery. Not sure what position she was in, but she pushed for 3 hrs....

ANyway, her midwife described it as "shattered," -- it was like her perinium exploded. 200+ stitches. That midwife told her that she'd never seen anything like it -- except in women with previous eating disorders. My friend didn't have an eating disorder at all, but apparently has some sort of issue with skin elasticity. That's her theory anyway. She's a redhead and wondered if that played into it as well.

Sorry if I'm missing something, but why would her being a redhead cause this? (asks a redhead...)


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## Erdbeer (Dec 17, 2007)

I just thought I'd revive this old thread because the question from phoebemommy has not been answered and I (another redhead) would also like to know whether there really is a connection between redheads and elasticity. I was told that redheads do not have very elastic tissue, and this may have been the reason for my 3rd degree tear as well as the tearing of an artery during delivery of my son.

Anyone have any ideas?


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## wombatclay (Sep 4, 2005)

Well... (as a mama with a 4th degree tear, red hair, and a red haired dd2 who caused the tear in the first place...)

Some studies suggest that people with naturally red hair react differently to analgesics, are at greater risk for some cancers, and may bruise more easily than non-redhaired individuals. But some studies point one way, some point others.


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## Erdbeer (Dec 17, 2007)

Well, I've heard about redheads bleeding more and longer during/after birth, and needing more meds than non-redheads, but I have never heard anything before about our tissue not being stretchy and therefore tearing like paper. After my birth, I thought this may have been an excuse from the doctors who I felt tried to speed up my birth by pumping up the pitocin so that my son would be born before shift change at the hospital. I pushed twice and he flew out, tearing me up inside, tearing an artery, and leaving me with at 3-4th degree tear. I have always felt that this was a doctor error but could never really prove it.


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## MsBlack (Apr 10, 2007)

Mama Murphy--

So sorry that you are dealing with such a painful thing on so many levels. Healing on those various levels can take time, a lot of time, and I hope that you will be generous with yourself in giving that time and all the TLC and support from others that you may need.

Not sure how this may fit--or not--but in reading your posts, the word that kept coming to mind was 'forgiveness'. So....for what it may be worth...for you I wish for forgiveness. forgiveness of yourself, the pp care provider who seems to have let you down, and any others involved--perhaps forgiveness of birth itself, for being, in this one rare case, something that brought so much pain along with the joy of a healthy baby.

And remember, healing keeps going on and on. I can't help but believe that (along with whatever other circumstances contributed) having so many babies so close may have played its part in depleting your physical resources and thus possibly contributing to the degree of your tearing. This is NOT to assess blame--only to say that perhaps you can see it as a blessing at this time to feel timid about future conceptions/births, because it is giving you more time to replenish yourself. A restoring of the self/body that is all the more needed in view of the healing from that wound...but one that would likely have been needed anyway, for your own health and that of your children. The healing IS ongoing, body and mind, and you can support that in all kinds of ways. Whether or not to have another child/ren does not need to be answered just yet....just to restore/replenish yourself, and continue to support healing for now. Including perhaps, the healing power of forgiveness.

all the best on this journey.


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## MsBlack (Apr 10, 2007)

Oh shoot!

I didn't look at the dates on that thread....sometimes the resurrected old threads fool me this way!


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## Erdbeer (Dec 17, 2007)

MsBlack, I wouldn't worry too much about answering what someone wrote long ago... Maybe they will come back to read their old threads. If not, there is sure to be someone else with a similar issue and your comment not only encourages the original poster, but everyone reading the thread. Thanks!

BTW, I often subscribe to threads I started a while ago and am thrilled if I get an answer, even months later!


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## JoyfullySubversive (Feb 9, 2008)

Ok, here is some down to earth input for you.

I have had three vaginal births. Preparing for my fourth. Birthing naturally is of the utmost importance to us. My DH and I are very against c-sections. Me personally, I loathe the thought of being cut open. Truly, it scares the hell out of me. And even a 4th degree tear would not make me get one, BUT...
That being said, if I had a 4th degree tear that went untreated, and then I had re-constructive surgery... that changes things. This is my yoni. My special parts. Parts I have to live with, and hopefully enjoy, for the rest of my life. If I sustained that kind of damage, I would A: not plan anymore children, and B: if fate said otherwise, I would have a c-section. And, my husband, who is so anti c-section, it would amaze you, would support me. He would not want me to risk going through any of that, or worse again. I do not advocate c-sections. But my answer is honest, and perhaps you'll find it useful.







I wish I could just make it all ok for you. It's scary to think I might not be able to give birth vaginally. I would be daunted in your shoes.


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