# Vaginal Birth after 4th Degree Tear?



## Heather R

Hiya all! I'm new here, so I don't know if this has been discussed, but I'm hoping there are others who have faced the same situation and can give advice/opinions.

Background: I had my first child in October. During my pregnancy, I read everything I could about natural childbirth, took Bradley method classes, even switched from a large hospital/OB to a small hospital/MW where waterbirth was an option. I was totally committed to a drug-free, intervention-free birth, and really felt educated about making that happen.

My labour was good; water broke at 3 am, arrived at the hospital (40 minute drive) at 7:30, fully dialated by 9:00 am. I laboured in the shower and pool and didn't even think of asking for drugs.

When it came time to push (ie, I was 10 cm and feeling a *slight* urge), I tried pushing in the pool, but found I couldn't get a good grip with my feet, so I got out. I squatted pretty much from the get go, leaning into my husband for support. My labia got really swollen right away. I'd only been pushing for about 30 minutes when the MW started to say "Here's the head" and "one more push". The MW had her finger in my vagina most of the time while I pushed. At the time, it seemed like this "helped" me push, but maybe it contributed to the swelling?

Anyway, I pushed and pushed and pushed. Eventually I got tired, and had to move to different positions other than squatting. I tried sidelying and semi-reclined, but not hands and knees (which I just didn't think of at the time). I'd periodically go back to squatting, but I just couldn't keep it up for more than a couple contrax.

At some point, I started tearing. The tear was in my vagina, not in my perineum, though. Around the 2.5 hour mark, they called the backup doctor. She tried to use the vaccuum but it wouldn't stay on. By this time my perineum was tearing, too. She then used forceps and had to try several times to get them positioned.







I felt like I was being split in two!! She did a small episiotomy to try to "direct" the tears that were already happening, but it didn't work and I tore into my anus.

Anyway, baby was born healthy at 12:30 pm, after 3.5 hours of pushing. She was 7 lbs 14 ounces. So not too big, really. Oh, and I did go drug-free... Yeeouch! Forceps were meant to go hand in hand with strong drugs!!







:

I had to be transported to another hospital and put under for surgery to have my pelvic floor repaired. The surgery was successful, and I don't have any long lasting effects from the damage. Sex is more or less normal, and I have normal bowel control, bladder control, etc.

The dr who did the repair surgery is recommending a c-section for any subsequent births. He is worried that further damage may not repair as well... that is, just because I've been "lucky" this time, if I tore badly again, I might have long term problems. He does concede that my next birth could go very differently and I might not tear at all.

Sorry for the long recap.... Finally getting to my questions!

If you were in my situation, would you try for a v-birth again, or schedule a section?
If you do recommend trying a v-birth again, what can I do to reduce the swelling in my labia/vaginal canal? Both my MW and I really feel it was a problem of my soft tissue not expanding normally to allow the baby to pass through; instead, I got so swollen, the birth canal was very narrow.
Are there any dietary measures I can take to increase the elasticity of my skin?
Do you think that the midwife's "help" with her fingers during pushing might have contributed to the problem?
I've heard about "labouring down"... do you think that is something I should try next time?
Agh! I have so many questions and so much anxiety about future births, and I'm not even pregnant yet! I guess I just want to hear from other mamas who have torn badly... what did you do for future births?

Thanks in advance!
Heather

Proud mama to Faith Olivia, born Oct 4, 2004


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## doctorjen

I've attended several births after previous 4th degree tears and have never had a repeat. I've had more than one mom birth a larger baby the second time around with no or minor tearing. I think personally I'd take my chances rather than schedule a c-birth.
I'd definitely discuss with my provider leaving the perineum alone entirely during pushing. I do think that perineal massage or frequent exams during pushing encourages swelling and tearing. There are studies that suggest that perineal massage encourages tears, as does the use of lubricants. I used to think perineal massage was helpful. The more reading I've done, the less I do during second stage, and the fewer tears I see. And I almost never see that extreme swelling in someone who hasn't had any exams during second stage.
The best way to avoid tearing is to push only when your body tells you to, in a position you feel comfortable in, and to keep all fingers out of your vagina. Laboring until the head is on the pelvic floor and the urge to push is irrestible is also good.
If you are not certain what to do, you could also, always reserve the right to proceed to cesarean if you feel things aren't going well. Most likely, your second babe is likely to come out faster (not always, but playing the odds, most likely) If you reached a point where it was felt operative vaginal delivery was needed, or if severe swelling and spontaneous little tears were seen again, you could always choose then to have a cesarean. If all goes well and pushing goes quickly, you can give birth vaginally as planned. This of course leaves the uncertainty up to the last minute, but at least then you may feel more like you made the choice based on what WAS happening instead of what COULD happen.


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## ctdoula

I had a 4th degree last time & am about to deliver vaginally soon. I didn't have the same issues (mine was caused by an extension of an epis). But, I wonder if you could also (in addition to the above suggestions) try pushing an a side lying type position instead of the squatting. My tought being that perhaps the blood pooled in the perineum due to the squatting then couldn't escape. I'm no expert, but just seems possible to me.

Good luck!!


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## aprildawn

i had a horrible 4th degree tear with my first. i tore all the way to my anus as well as tearing inside. the OB who sewed me up did a great job, though, and i've also had no problems.

i'm not certain what caused me to tear. i think my mw did everything she could, but stuff like that happens sometimes.

that said, i'll be giving birth to dd#2 any day now, and, hopefully, it'll be another vaginal delivery. i've been scared about tearing again. and i am concerned that when pushing time comes i might freeze up due to the fear. the recovery last time was awful.

i've discussed it with my doctor and she is supportive of me pushing in any position i feel most comfortable. says that's my body's way of preventing injury. she also suggested laboring down, like you mentioned. she even told me to put it in my birth plan in case she's not there when i get to 10cm.

this question on the "ask the experts" section of mothering.com is what started my research into tearing and ways to prevent it http://www.mothering.com/sections/ex...hive.html#tear

i agree with doctorjen, don't get a c-section because of what _might_ happen. lots of things might happen. i know the fear is real because i feel it, but i don't believe it's in my best interest to give into it.

if you remember or even want to, pm me in a couple of weeks and i'll let you know how this birth goes. i know that hearing success stories from some other women has helped me be less fearful. hopefully, i'll have a success story to share with you!


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## Quickening

If you felt a *slight* urge and your body wasn't bearing down then you probably weren't ready to start actively pushing yourself. I have heard many women say that at around 10cm there was only a slight urge or no urge to push and that their bodies got a 'break' of a sorts before they really felt the pushing urge.

Your MW should NOT OF HAD HER FINGER INSIDE YOUR VAGINA!!! That just plain interferes with your body's birthing flow.

If you had a drug-free labour, you should not of needed 'assistance' to push and if you needed that assistance, then it all seems to point to the strong possibility that your body was not ready to push/birth the baby just yet.

Forced/active pushing from the mother as opposed to your uterus pushing the baby out is one of the things that contribute to tearing. Yes, sometimes tears just happen but personally I have never heard of something as extensive as a 4th degree tear in a woman birthing unhindered.

Btw staying on your hands/knees until your body starts bearing down (your body, not you) will keep pressure off your vagina/perineum. When you feel the need to change position into a more upright position, try leaning forward against something, still on your knees. Your body will really let you know when its time for the rest to happen.

As for feeling that your tissues werent expanding 'normally' that could have had something to do with your baby's position or your birthing position. Maybe pressure was exerted on the tissues too early, before they had a chance to gently stretch/expand from the babys head on your cervix. Just because your 10cm doesn't mean you're ready to push, or your baby ready to move down into the vagina!


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## homebirthing

About 95% of 4th degree tears are from episiotomies that have torn too far. Pushing when YOU feel the urge, not pushing when someone else tells you to, and breathing the baby down will all help. Have everyone stay quiet with no counting. Take your time and avoid perineal massage, which can just swell the tissues that are already so delicate. Perineal support is good though! When you are crowning, don't push!! Just pant, or grunt slowly. It is OK to lose a contraction on the crown. It hurts, but it gives your perineum a chance to stretch out around the baby. I was just at a birth where the mother tore to a 3rd degree last time and this time the baby had a hand up there by his face, but she was slow, she had total quiet, and she barely pushed when the baby crowned and she came away with a perfectly intact perineum!! Good luck and happy (barely) pushing!

sarah


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## pamamidwife

Quote:


Originally Posted by *Heather R*
If you were in my situation, would you try for a v-birth again, or schedule a section?

I'd definitely have a vaginal birth. I had a bad third degree that included surgery for a repair at 16 months postpartum. I would never hesitate to birth vaginally again.









Quote:

If you do recommend trying a v-birth again, what can I do to reduce the swelling in my labia/vaginal canal? Both my MW and I really feel it was a problem of my soft tissue not expanding normally to allow the baby to pass through; instead, I got so swollen, the birth canal was very narrow.
Are there any dietary measures I can take to increase the elasticity of my skin?
I don't think that it was a problem with your soft tissues necessarily. Did you do forced pushing? Were you pushing as you needed to or as your body directed you to?

Quote:

Do you think that the midwife's "help" with her fingers during pushing might have contributed to the problem?
Definitely.

Quote:

I've heard about "labouring down"... do you think that is something I should try next time?
I say, push when you want to, as long as you want/need to. Don't let anyone tell you that just because you're complete that you need to push. Your body will do the majority of the work - just get behind it when it's uncontrollable.

It sounds like you were given a specific "time limit" for your pushing.

Here's an article I recently wrote on this topic: http://www.midwifemama.com/honoring.html


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## onlyboys

With my 1st, I had an (completely unnecessary) episiotomy that resulted in a tear into my rectum.

I've gone on to have 2 other births with very minimal tearing. In my experience, there's not a reason to schedule a cesearean birth for a previous 4th degree tear.

Good luck to you.


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## laprettygurl

I would push when the urge is irrestable! My body (I had nothing to do with or no option either) started pushing when I was only 8 cm. I had absoluely no control over it. And it was really rough, violent pushing too. (prosterior baby) I was on my back because I was paralyzed with PAIN. I couldn't even THINK to move to another position. I eventually sat up a bit. I only tore a teeny tiny bit on my perinium.

No fingers inside you either. Your body KNOWS how to push...you don't need anyone to "help" you. I think next time if you can birth in the water that might help too.

I would definately not schedule another c/s. How DARE he even suggest that? Has he ever given birth? Nope.....what does he know?


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## ldsapmom

I hear "laboring down" used most commonly to refer to a mom with an epidural -- they turn the epi down and allow mom to "labor down," which brings baby closer to the perineum versus having her push because she's "at 10!" This encourages mom to push when she really has a feeling to.

I am assuming laboring down without an epi would be allowing your body to wait until you get the cues that it is unmistakably time to push. Many peeple don't realize there can be a resting phase, sometimes quite long, once a women is complete. Practitioners are so dang anxious to get the baby out that once a woman hits 10 they start directing the purple pushing. I firmly believe pushing time is cut down greatly if everyone waits until mom wants to push, until she can't NOT push, and then she is working in combined effort with her body and not trying to do it all on her own because she is being screamed at, lol.

I had a 3rd degree tear, and luckily, the thought never entered my mind while pregnant the next time, that I would tear like that again. I knew I had a horrible OB first time around and I figured with my loving midwives who cared so much for me, it would not be an option...and it wasn't!

Wishing you peaceful vibes, mama!

Stacie


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## Heather R

Wow! Thanks for all the replies!

I'm glad to hear that there is still hope for a vaginal birth, although considering where I'm posting, I'd have been shocked to hear otherwise!














:

I'm surprised that you mostly agree that perineal massage could have had a negative impact on my pushing... well, not that surprised, really, because I feel the same way - but surprised that my MW did it if it was problematic. Though this was in a hospital, this MW is also a homebirth MW who has been attending births for 15+ years and is very well known/respected in the "birthing circles" in my city. I guess I just trusted her to guide me a little more than she did. When I interviewed her, she said less than 10 mamas had had episiotomies in her 15 years experience...

I know next time I will do two things differently: I will hire a doula. I have one in mind that does a lot of VBAC births... I figure she will have lots of tricks to help me avoid a c-birth. Also, I will bring a mirror. Can you believe they couldn't find me a mirror to see myself pushing?! Jeez, in the 3+ hours I was pushing, DH could have ran to Walmart and BOUGHT a mirror! Anyways, I think that would have helped me push effectively.

Pamamidwife: I wasn't given a time limit, per se, but I was just so tired and wasn't pushing effectively anymore.







Plus, at that point, I thought I wanted the dr... I trusted that the mw wouldn't call her unless she was really needed...

Aprildawn: I'll try to remember to pm you in a few weeks and see how things went! Good luck!

I do think I started pushing prematurely, in retrospect. Right from the time I was admitted, the nurse kept asking, "Do you need to push? Do you feel like you're going to have a bm?" I said no at first, but then as labour progressed, I think I just let her "pester" me into pushing! They checked me, and I was 10, so they said, push! And the thing was, I "knew" not to start pushing too soon, but when you're in labour, and you know it's not going to end until the baby is out







: it's hard not to push when told!

Anyway, I'm glad I posted, because you guys told me what I already knew... that I need to at least try to have a natural birth again... otherwise the what-ifs will really haunt me!

I'm sure once I'm actually pregnant, I'll be on here again to seek advice and encouragement.

Thanks so much!
Heather


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## wasabi

Heather in fairness to your midwife perineal massage is a somewhat hotly debated topic. Some practioners swear by it while others feel it does harm. I haven't seen any studies that prove that it helps or hurts. I've had epis all three times so I have no insight into tearing but I did want to just chime in on that aspect of your question. My DD was my third birth but first non-drugged birth and I also feel that not waiting until I had the urge to push caused us some problems. I will definitely be waiting until I can't help but push this time. I hope you have a smoother birth this time.


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## Heather R

Quote:


Originally Posted by *pamamidwife*
Here's an article I recently wrote on this topic: http://www.midwifemama.com/honoring.html

Pam, what an amazing article! I actually got teary reading it, because it's as if you wrote in response to my exact experience! I will definately save it to read again. I wish you could be my midwife!









Heather


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## nikirj

I tore into the rectum with my first. It was a very standard hospital birth (minus the drugs). My doctor took her time and repaired it well, and while it took quite a while to heal, it hasn't caused me any problems since.

I had a pretty bad second-degree tear with my second, another hospital birth. His head was fairly large (he was a full pound heavier and cm larger head circumference than his sister) and he came out very, very quickly, and I didn't know to hold back.

No tearing at all with my third, a home waterbirth. The water had a bit to do with it but I'm convinced that the critical factors were:

1) my midwife kept out of the area

2) I felt free to feel down there and support and move tissues as she came out


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## UmmBnB

I tore badly with my first. It was pretty nasty. We lost count as to how many stiches it took. Basically, I was laid open from the inside out moving up to my clitoris. It ended there. I knew when I tore....I wanted to push, knew deep down that I shouldn't, but let my desire take hold.

Nothing hurt more than those shots of xylocaine at the base of my clitoris! Healing was long and hard. Even 4 years later, the spot right at my clit would open on occassion. I don't fault the person who did the stiches. I watched with a mirror and it was a dirty job getting it all fit back together. I think she basically pulled things to bit too tight.

I was just sure that I'd tear the second time around. I mean birth one was slow and easy and I tore like crazy and was left with a wound that would open after 4 years with normal sex.

Well, my daughter quite literally fell out < birthstory here (http://www.albegar.com) > and not even a skid mark! The stretching of her birth even seemed to somehow 'cure' the issue with the old wound. I've not had any issues with it opening since her birth.


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## onlyboys

Quote:


Originally Posted by *UmmBnB*
Well, my daughter quite literally fell out < birthstory here (http://www.albegar.com) > and not even a skid mark! The stretching of her birth even seemed to somehow 'cure' the issue with the old wound. I've not had any issues with it opening since her birth.

This was exactly the case with my 2nd birth. It seemed like it healed the issues I had with my previous scarring. Honestly, it made sex way better because I wasn't cringing in pain.

I guess for some, another birth can be physically healing.


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## USAmma

I had a 2nd degree cut with my first baby, and was terrified that I would tear the old scar with my second baby. Not only did the scar hold, but I only tore a tiny bit to the side when her shoulder came out. No stiches required.

After the first birth I ws very tight and sore for a long time. After second birth, well let's just say I stretched out nicely.


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## moonmama22

Okay, please bear with me - I am new at this and somewhat overwhelmed by all the little icons and such... This thread caught my eye, as I have been wondering the same thing since ds was born 9 months ago. Several of you mentioned surgery to repair serious tearing, esp. tears that reached rectum. By any chance, did any of you have a fistula? From what I have been able to gather in my own research, that is what I have. Unfortunately, I have no insurance, so will have to wait to get a definitive answer. Anyway, back to the topic, I am so glad to hear all these positive posts. Though in the last couple hours of labor, and for the first few postpartum weeks I insisted I would never have another, I would be devestated by the thought of not being able to have another baby, and even disappointed by the thought of a c-section. I have to admit, much of it was my fault, as ds was very big (9lbs. 9 oz.) and I continued to refuse induction until the amnio fluid was low, then refused a c-section when one of the drs recommended it (not my own - he said it was unneccesary). I suppose if I had let them induce closer to my dd, ds would have been smaller and possibly prevented the tearing.
Heather - I hear you about feeling yourself "splitting apart". Although I had an epi, it had worn off considerably by the time he was finally born, and I remember thinking, "I know it was not supposed to feel like that!"

So, I apologize for intruding on this discussion, I just had to speak up - it was so good to hear from women who are able to deliver naturally after a bad tear! Thank you!!!


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## Mama25

I had a 4th degree with my first and have had 3 vag births after that with no problems and I had bigger babies too.

Good luck!
Kim Ann


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## wasabi

Erika I don't think you can know that if your son was smaller you wouldn't have torn. For that matter you certain don't know that an induction done earlier would have worked. You could have very well ended up with a c-section then. Two of my three were bigger than your son and I did have epis but they were moderate and I had no tearing. I don't think weight has that much to do with it there are just so many other factors and besides you can have a 9lb 9oz baby that actually pretty skinny. The head size and positioning would be more important when it comes to tearing. I have a friend whose baby weighed three lbs less than mine but his head was bigger than my babes. So don't beat yourself up thinking if only had let them intervene sooner.







:


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## Rainbowbird

Heather, I could have written your post and was about to!

I had a 4th degree tear also. I had no epis., I just tore. I didn't feel it b/c I had an epidural but the pain afterwards was certainly incredible. I was lucky in that my OB is an excellent surgeon and after a very long healing process, I have no long-term problems. I do have a tiny fistula but it's expected that this birth will cure it.

I spoke with the OB who delivered my son and repaired the tear the other day. He laid out my options: 1) C-section, which he didn't recommend; 2) medial-lateral espisiotomy to hopefully spare the rectum this time, just in case i would tear in the same spot and end up with long-term problems (that would be AWFUL!)
3) No medical interventions and just hope that nature takes care of things.

I know I won't do the c-section unless abslutely necessary at the last min. I am not sure what is worse to heal from, a c-section or a 4th degree tear. I will say that my friends who had c-sections were healed and running around a lot quicker than I was. However, I know that c-secs have plenty of their own risks and problems, so I would rather avoid one.

As for an elected epis., I don't know. It might invite trouble, as my OB admitted.

I am just terrified that I'll tear again and end up with long-term problems. I also fear I'm going to have another epidural, b/c I can't imagine going through the pain of a tear without it.

Does an epidural increase the risk of a tear? The doc said no, b/c it slows the urge to push.

Any other thoughts?


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## Rainbow

My first was a horrible 4th degree tear... oh man the pain of that is still fresh in my memory. The pain of recovery was far worse than the pain of childbirth. My 2nd was born in a hospital, 11 pounds, and not in a good position for preventing tearing- and I had only a mild tear. Honestly, Irecovery wasn't bad at all. I'm hoping between the water birth and the altered positioning I won't tear at all this time.


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## onlyboys

I have read that a mediolateral incision is the worst type of episiotomy to heal from. That makes sense since it slices through places in your body that are fleshy and not terribly stretchy.

In listening to this discussion, I've not heard one mama say that she tore so extensively the 2nd time around. At least anecdotally, it seems that perhaps the body is better prepared to *not* tear the 2nd and subsequent times. Either that, or we are avoiding behaviours that resulted in such an extensive episiotomy/tear before.


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## Rainbowbird

Quote:


Originally Posted by *onlyboys*
I have read that a mediolateral incision is the worst type of episiotomy to heal from. That makes sense since it slices through places in your body that are fleshy and not terribly stretchy.


You're right, and my doc said the same thing: that such an episiotomy would be longer to heal and more painful. (hard for me to imagine though). He did say the benefit to it would be avoiding what could be potentially chronic bowel problems down the road.

However, I think you have a point in that no one has said yet that they had a 4th degree the second time around. At this point I think I am going to avoid the episiotomy. And pray!


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## Rainbow

It probably doesn't need to be said, but the "standard" hospital- on your back position with people pushing on your legs to help you push does not aid in preventing tearing. IMO it encourages tearing. I would research alternative positions and birth in ANY other position if you are concerned about tearing.

A clean cut- the episiotomy- will IMO tear in the future more easily than a tear. A tear is jagged and repairs itself in a a puzzle like form- while the epi is straight. Imagine a jagged tear on a piece of cloth and a similar length sharp cut. Which would "continue" ripping the easiest?


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## moonmama22

[ I do have a tiny fistula but it's expected that this birth will cure it.

I'm sorry - are you serious? The birth will cure it??? Wow - I guess that would be a better solution to my situation than surgery!!! Thank you for that bit of info...

I am just terrified that I'll tear again and end up with long-term problems. I also fear I'm going to have another epidural, b/c I can't imagine going through the pain of a tear without it.

I hear this exactly - my epi had worn off by the time I tore, so I felt it, and it was he most horrifying thing ever. I know it's terrible, but seriously - when I do have another - I know that I will opt for the epi. Even though i didn't want one with the first, I can stand the thought of feeling that again.
As far as the medial-lateral epis, I would maybe plan not to, but if the baby has a large head, I think I would probably choose the c-section. That thought scares me also, but as someone else has said, I know a lot of people who recovered from a c-section better than I recovered from the tearing. Plus I would be so worried about a worse fistula, now that I know about the possiblities of that happening.

Just my opinion - obviously biased as to my experiences.


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## Rainbow

I didn't have an epi adn I didn't feel my tears... that is so interesting that you did. I really had no idea of my tears until after teh fact. Funny how the same physical thing can feel different to different women.


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## teachermom

my first baby was on the small side (6/7). his heart tones dropped and the mw did an episiotomie to get him out faster. I tore badly. 4th degree in a big way. I have some pretty serious scar tissue doewn there, though it smoothed out some with hard massage using vit. e. maybe it would have smoothed out on its own with time, I don't know.
I have had three children since, the second almost ten lbs and sunny side up...she also came out with her hand to her face! I needed one stich with her, on the scar line.
I had no tearing with birth three or four.

after the first birth, I set some rules for my labor/births.....

no one is allowed to suggest when I should push, no telling me "you're at ten- time to push" etc. I push when my body says I can't stop it.

no episiotomies

no hands/fingers in/on my yoni, unless they are mine

I deliver in the position *I* choose based on what feels right to me at the time. due to the fear of tearing, I never use a full squat.


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## Full Heart

Quote:


Originally Posted by *wasabi*
I don't think weight has that much to do with it there are just so many other factors and besides you can have a 9lb 9oz baby that actually pretty skinny. The head size and positioning would be more important when it comes to tearing.

Oh, absolutely. My 9lb baby was super skiny (hes still super skiny) and had a little 13 inch head. Which is a whole inch smaller than 3 of my babies who weighed less! I never tore with any of them but I never pushed till I felt ready. With my last I was fully dialated for a good 20 min before I felt the urge. I sat there wondering when I would get the urge. I knew my cervix was gone and still I had no desire to push. I moved to the bed cause I figured well its gotta be time. Finally an overwhelming urge to push and the poor thing flew out of me. Just 2 pushes. I probably would have pushed that whole time if I hadn't been listening to my body. who knows how long it would have taken. Not sure how I feel on perineal massage during labor. I had it in the hospital and it didn't cause a tear but I have never had it at home. I do think hot compresses work though. I also think kegels can work wonders.

Anyhow, just my thoughts. Never tore and never had an episiotomy so can't comment on that directly.

Michelle


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## Rainbow

Even if they aren't skinny, I think positioning (esp maternal pushing position) has more to do with it than size. My 11 pound baby was only 19 inches and very fat adn rolley. Big ole head... and I barely tore- my first (8.8 pound) baby tore something awful. My 2nds head was big enough that the newborn caps they have at the hospital didn't fit her... and the typical gowns they use didn't either. She had to wear the "take home momento" shirts they hand out. And still my tear was very minimal comparatively. I wasn't in a lot of pain PP liek I was the first time.


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## aprildawn

after suffering a bad 4th degree with dd#1, dd#2 was only a minor 2nd degree. yay!! here's the story for anyone who is interested...

http://www.mothering.com/discussions...89#post2895189


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## BrowneyedScorpio

I had an epis with #1 which resulted in a 4th degree wound. It didn't heal right and I had a fistula.







With #2 born 2.5 years later I didn't tear at all. Her labor & birth was much faster than with my son. Also, they were the same weight (8 lbs 11 oz) but she was 2 in longer. I'm betting that I have no problems with this one either.


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## Mindful Mom

I also had a 4th degree tear with my first (OB-attended). I used a midwife with my second and delivered with just a tiny skid mark!!


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## Qerratsmom

This thread has been very interesting for me to read as I am about to give birth to my second and am really worried about pushing. I too had a 4th degree with ds and was told to start pushing when I really didn't have the urge. i pushed for an hour with little progress and never could feel what I was supposed to be doing, they finally did a vacuum extraction. I still mourn that birthing experience 9even though everyone was fine in the end and I'm thankful for that) Still I want this birth to be different and heal some of the trauma from the last. I'm definitely going to hold off pushing until I feel the urge I'm jsut worried I'll forget when I'm actually dialated to 10 and wanting the baby out NOW.


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## Mamabug&co.

My first baby ended with an epi. He wasn't terribly big either. Barely 6 lbs. 12 oz. My second was a preemie, tiny, and I tore in a HUGE way. Sex was so depressing and almost a no-go after that. My vaginal wall collapsed, urinary incontinence, and a rectocele. I was perpetually constipated, because my muscles were so weak and damaged. Scar tissue was also in abundance. So, I have my third baby, also a preemie, who weighed amazingly 7 lbs. 2 oz., but not huge either, just long and lean, and I tore again. Not as bad, but enough to hurt. My doctor put in 'just for the meantime' stitches. 6 wks later, she did my repair which she later described as 'extensive damage'. What is is wonderful, is that depite having the WORST pain in my life, worse than all of my childbirths combined, was that I could urinate normally, I could have a bm normally, and had a normal, down there feeling. I did tear open sutures a couple of weeks later, but overall everything healed okay. We have had 3 vaginal births, all of them beautiful despite the pain afterwards. One doctor was horrified as to why I hadn't had a tubal done before the or during the surgery. I just roll my eyes at that







: We are not sure where to go from here either, but I know I would in no way ever want to suffer from another repair to that site. We are praying that God directs my body and mind as to how it should birth. I will be praying for you mama. Only you know what your body is capable of.


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## Qerratsmom

Well I had my dd a week ago. After a 4th degree episiotomy and tear with ds, I had only a very small tear this time even though dd was a pound bigger came out with her hand next to her head and was slightly transverse. I would say dont get an episiotomy or a c-section just let it happen.


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## sarajane

I am seeing alot of posts around that say that babies were born with their hand next to their head and everything was fine. I am curious if this is a common happening? My mw has done two epsiotomies out of her 200 some odd deliveries and one of them was because the baby had her hand next to her head. I have since prayed that won't happen to me cuz I really, really don't want to be cut but am now wondering if it is necessary just because of that? I guess maybe if the baby is a little stressed? Mw said that an episiotomy speeds up birth only by minutes. Do minutes make that much of a difference?


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## Qerratsmom

I really didn't feel that she was ever "stuck" due to her hand being by her head, but my doctor did push the hand back in and then she was able to turn properly and came out with the next push. He also pushed on my vagina to help it stretch and focus my push. I know some people don't like that, but it really helped me.


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## aprildawn

Quote:


Originally Posted by *Qerratsmom*
He also pushed on my vagina to help it stretch and focus my push. I know some people don't like that, but it really helped me.

my doctor did that, too. it really helped me focus on where to push. though, at the time i didn't like it and told her it hurt. in retrospect i'm glad she did it or i might still be pushing. :LOL


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## Full Heart

Quote:


Originally Posted by *sarajane*
I am seeing alot of posts around that say that babies were born with their hand next to their head and everything was fine. I am curious if this is a common happening? My mw has done two epsiotomies out of her 200 some odd deliveries and one of them was because the baby had her hand next to her head. I have since prayed that won't happen to me cuz I really, really don't want to be cut but am now wondering if it is necessary just because of that? I guess maybe if the baby is a little stressed? Mw said that an episiotomy speeds up birth only by minutes. Do minutes make that much of a difference?

I had 2 babies with nuchal arms. With my 2nd the whole arm came out with her head like it was wrapped around it. When it happened with my 4th his arm was born bent next to his head, he was a bit harder to untangle. Then I had 2 babies with their hands in their mouths. I think they were sucking their thumbs, but I didn't feel those. Never had an episiotomy, never tore either. And one of those times was at the hospital with an ob. I never used to think it was very common but I guess it is.

If the baby is distressed then minutes can make all the difference. Sometimes the baby needs to be out _now_ and sometimes an episiotomy can do that.


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## Rainbow

I just had to bump this thread. I was saying how I had a 4th degree tear w/ my first and only mild tearing with my second.

Well, I just had my third... a 12 pound and 8 ounce baby... and had no tearing. I'm still suprised.

I think th ebig thing for me was an alternate position... with my first two I was on my back the "hospital way" with nurses pushing up on my legs. This time I was squatting for most of it, and then on my hands and knees at the end. So insist on moving ino positions that feel right to you, and not what the attendants find easiest.

I didn't do any of the perineal massage or preperations... but as I was pushing my midwife held a warm cloth against the area.


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## ctdoula

I also wanted to give an update. 2 weeks ago I gave birth to a 9 pound 7 ounce baby with just a TINY skid mark (no stitches). I pushed on my back (my choice), and only for 15 minutes. It can be done after a 4th









(also, it's AMAZING the difference in recovery time).


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## mommamiagal

hi. i am 31 weeks preg and my Dr scheduled me for a c section because i had a 4th degree last time , with a shoulder dystocia baby. baby crowned for 5 minutes before i delivered the shoulders with the help of the dr going in to get her out. it was scary. luckily she was OK, i needed an extensive repair. i ripped all the way through and one inch into the rectum. I delivered at home so had to be transported , without my baby, to the hospital for a repair that took about an hour. the recovery was no picnic, i think i sat on ice for a good 2 weeks . i have no problems other than slight gas incontinence and a much smaller perineum. this was my 2nd shoulder dystocia baby, the first one was a 2nd or third degree tear, the next one a 4th.that was 2 years ago, and i am agonizing over what to do. my homebirth doctor recommends a c section, so i was referred out to another OB.i know it is my decision , i just do not know which way to go with this. i totally have trusted my body in the past that is why i birthed at home, but i am thinking that a 3rd shoulder dystocia might not be good for me or baby. what to do. i suppose if it was just about my perineum i would definitely lean toward the vag birth, but i am afraid for the baby being large again. they were both 10 1/2 pounds and i am 5foot 2 110 pounds normally. i have been tested for gest. diabetes and do not have it. anyone else have shoulkder dystocia and 4th degrees together? anyone been told that they have a short perinem with not much to repair if need be? my anatomy has changed forever. i just heard about a product to help build tissue but is it too late? immunocal


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## soratosjc

This is an old thread that I was hoping to revive to get some new feedback.
I had a 4th degree tear with my dd 2-20-03 and was told by OB that I would never be allowed to have a vaginal birth again. I think that there were many things the OB could have controled better to stop this, and many other negative things from happening. My daughter apparantly got "stuck" comming out but isn't that to be expected when you are told to push and the baby's head is facing the inside of my thigh instead of down? She wasn't a big baby at 7lbs 11oz but her shoulders got stuck in my pevic bones becuase she wasn't ready to come out. I was feeling NO need to push. After 2 1/2 hours of pushing, a nurse tugging on my perineum and another nurse pushing on my stomach the DR just reached in with her WHOLE arm and pulled my dd out.
Now that I am more knowledgeable I feel that I could make it a better experience but are the risks too great? Should I just go the route that the Dr's consider "safe" and have a c-section? I didn't walk for 6 weeks after my dd birth, am I brave enought to even risk that possibility again?
Jen


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## alegna

IMO I would not agree to a section. I WOULD stay far far away from OBs and find a nice homebirth midwife who knows how to keep her hands to herself.










-Angela


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## ScotiaSky

Adding my little story..

DS-Unplanned hospital birth-Non emergency transfer.
During a standard induced, epidural pushing on my back and then finally vacuum extraction followed by a epistomy turned tear 4th degree.
6 weeks plus recovery time, the pain was unbearable. Honestly I have never felt any pain like it.

Some background info...at 41 week NST was told there was no way I would be able to vaginally birth a baby of est. 9 lbs 8 ozs and would for sure have a SD.
Recommended a C-section, I declined and 6 days later was induced for other reasons.
During birth the hysteria of this so called large baby and preconceived risk of SD made sure my delivery room was a three ring circus.
I ended up with a 4th degree cut because instead of turning DS's head and the shoulder's following and then baby coming out, the Doctor cut.
DS's shoulder's were never stuck, his postion just wasn't the best.
My midwife witnessed the entire birth it was not SD, not one of the medical staff ever mentioned the word SD to us again.
BTW DS was 8 lbs 10oz.

This pregnancy my midwife's request my medical records from the hospital to check on some things and guess what it saids in bold letters that DS had DS.
Nope never happened...except maybe in the US tech mind at the 41 week US.

Now onto the question asked

I just gave birth to a comparable size baby to my son.
DD was 8 lbs 1 oz and all other stats are only off by the smallest amounts.
Water birth(recommended by midwife to help prevent tearing), pushing on my hands and knees till I squatted at the end and head came out...now any tearing that happened was my fault because instead of listening to midwife to stop pushing after the head came out I pushed and had some small second degree tears from the shoulders. Had some stitches.
These were not painful at all...it was just the normal feeling of swelling and bruising of pushing a baby out.
I was ready to get up and dance within minutes of the birth, gotta love natural childbirth








Also I never did any massages etc to help prevent tearing before hand.

I find it very strange that they would say you need a c-section because of a 4th degree tear alone.







:
If I had scheduled a c-section just because of this reason and this reason alone I would have missed out on the most amazing experience of my life







and a chance to heal from the horrible experience of my first birth.


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## BAILEYBOO

Hi there! I am new to this. I'm not even sure what I'm doing (computer wise), but I need some support. I had a horrible 4th degree tear that extended into my right buttock muscle. It was the worst several doctors have seen. I now have to have Perinioplasty. Have you heard of this or had an experience this bad?


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## aprildawn

Hi Bailyboo. My experience was bad, but not as bad as some of the other mamas here. My advice is to do your research, see other specialists for their opinions, and ask lots of questions. Good luck. Hopefully another mama here will have some experiential advice to offer.


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## amyro

I wish I had the study handy, but I JUST read a study where they looked at the likelihood of recurrence after a previous 3rd or 4th degree tear. The researchers found NO increased risk of a 3rd or 4th unless there was an episiotomy in the second birth. Even in that case, the risk was far from a sure thing, though I can't remember the actual stats. So the take home lesson from that study is definitely to REFUSE episiotomy if you have a history of a previous 3rd or 4th degree tear.

Other things would be to birth in any position other than flat on your back, push the baby out between (rather than with) contractions, and use your physiologic urge to push, not a bunch of cheerleaders counting to 10! All of these are supported by good research. There's some evidence that prenatal perinatal massage helps, too.

So I think these MDC mamas aren't a skewed sample - they reflect what really can happen if you go for a vaginal birth and make good choices about your care.

Great discussion - and congrats to all you mamas who have had successful (and no doubt healing) births after previous trauma!


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## lizabird

I had 4 stitches with baby #1 (laid back birth center atmosphere, waterbirth, no counting, pushed when by body needed to push, etc.) and I've started to wonder about the chance of re-tearing with baby #2. The healing from tearing was way worse than actually giving birth!

Anyway, I have no further insight, but WOW, great thread, great stories, great discussion, thanks for all the positive stories!!!!!!!


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## moonmama22

I'm so glad this thread has been rejuvenated... I was wondering from any of the people who have posted here who have said they had fistulas - did you have them repaired surgically, or let them heal with your next birth? I'm debating that issue right now, and have an appointment with my dr. next month. She is not my OB, but I am hoping she will have some input as to where to go next... Dp and I are still debating having more children. If my OB suggested a c-section (which I doubt he would - he's much more into letting things take their course, why I liked him in the 1st place), I would get a 2nd opinion ASAP. Also, if there is a next time, absolutely NO epis!, no fingers where they shouldn't be, and I am not pushing just because someone says, "you are 10cm, you can start pushing." It was probably 20 minutes after that when I really began feeling the urge to push. And when they say urge, I felt more like it was an irresistable force. There was no way not to push, my body just took over... THAT is what I will wait for next time.

Oh, and my ds had shoulder dystocia also. And they used a vacuum to help him out...
All the positive stories re: births after 4th degree tears are a big boost!!!


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## runes

thank goodness for this thread!

i didn't have a 4th deg tear but i did have an episiotomy and forceps when dd was born (hospital transport from homebirth







) i ended up with a vesicovaginal fistula (so it was the front wall of the vagina to my bladder, not the posterior wall to the rectum), i had to have it repaired surgically when dd was 3.5 months old as i was totally incontinent to urine (think of a water balloon with a hole in it, i was leaking constantly). at my follow up visit, my doctor literally begged me not to have any more vaginal births. i have since spoken to several midwives as well as the PT that i'm currently seeing (she's a pelvic floor/women's health specialist) and they have all said that there is no compelling reason that i would have to have a surgical birth. my PT has evaluated the scar tissue and general tissue strength/mobility of my vagina. i think that i have several things to take into consideration...

*to take as much time as possible for my body to heal. acupuncturist, midwife and pt have all suggested 2+ years before ttc to allow my body to heal as much as possible before subjecting it to the stresses of pregnancy and birth.

*no purple pushing.

*mindful positioning during pushing. hands and knees would probably be optimal, especially since i also have a cystocele due to dd's traumatic birth.

*breathing the baby out.

*no/minimal vaginal exams during labor.

i'm hoping for the home waterbirth that i planned and dreamed of, if we do in fact have another baby.


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## rufio

Hi all, i had my first birth by forceps and episiotomy with a 4th degree tear. The result was an anal fistula which was repaired 12 months postpartum. I am now booked for a c section, but thanks to reading all the comments here, I may actually talk to my midwife about another vaginal birth.

Would anyone be able to tell me if it will affect my fistula repair as I only had it repaired feb 2005? Also would I get damaged further and have to possible wear a catheter for life, is that one of the other dangers of tearingand then not healing better this time round, has it happened to anyone? all the birth stories on here have been positive, but has anyone experienced another traumatic vaginal tearing which has left permanant damage?

Sorry for all my questions and post being long. Ruth.


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## aprildawn

rufio -- I don't have any knowledge or experience with a fistula. Definitely ask your MW. Hope there's a mom on here who can tell you her experience.


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## moonmama22

I have an appointment in August with my Primary Care Physician/Gyn for annual appt., plus to check for a fistula. Wow - I didn't realize they recommend to wait so much time before ttc again. I wanted to try in a year or so. And I haven't even had an exam, or scheduled a surgery. Should I have the OB I went to when pregnant check for the fistula instead?


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## illinoismommy

Good question... I had a 4th degree tear with my first baby, and so I am maybe a little scared of labor this time. Instead of just a day of pain like "normal" people I couldn't sit without wanting to cry for weeks. no WAY I'll schedule a section though.... I am trying to find some way to avoid a tear this time. I hear in an upright position you have a better chance, or something.... I need to do more reading.


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## sw1ssm1ss

With my first, I had a third degree tear and a vaginal wall tear. Everything was going beautifully birthing according to the Bradley method until we came to pushing. Our doc said, "You studied the pushing exercises?" And we said, "No, we didn't." So we did directed pushing and it felt very unnatural to me. (I'm not athletic and it felt like I was back in 7th grade P.E. class trying to force myself to run a mile.)

When he saw her head, the cord was around her neck, so he pulled her out and I tore. It was very frustrating that the pain and pressure that I had been feeling just did not go away. I thought birth would be hard but that when it was over, all would be well. Instead, I was trying to get dh to stay by my side, not go with dd while the doc examined her!

I never really made the connection, or possible connection, between directed pushing, pushing when I didn't really have the urge b/c people were telling me to, and the tears. I assumed the tears were just b/c of him pulling her out.

I'm due again in November, and I'm going to discuss this thread with dh and then hopefully we'll discuss it with my doc and see if he is amenable to breathing the baby down, pushing when I feel the urge, different positions, etc. He was the one who suggested the Bradley method, so hopefully he will be. If not, we'll have to figure out what to do.

Most of all, I am so GLAD I found this thread and read the encouraging stories of tears not repeating themselves. Recovery was very bad, though I'm sure not as bad as it would have been with a 4th degree tear. Blood loss and resulting fatigue were also not pretty. Here's hoping it won't happen again!


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## REDBREAST

OUCH! You have my deepest sympathy for the hard delivery and I am sure recovery you had! I tore with my first too and he was 7lbs 10 oz. When I had my second, my mw rubbed oil on me which prevented me from tearing again and my second was a full pound bigger! Next time have massage oil rubbed on, as well as letting your body "flow" into pushing, what I mean is do not push if you don't feel it and only push when you do. There is no law that says you have to push when you are told to.

I would definately do more research on this and find a different mw next time. By the way why in the world did mw have her finger up your vagina? That is something I would look into... sounds like it could have made things worse. Also a complete water birth may be waht you have to do next time to prevent tearing as well. I also echo what all the other mamas have already posted!


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## cutie_wutie

I had 2 4th degree tears i had one with my 1st child but i had a 15min labour and it was all so quick i was rushed to threathe for blood transfusion my second child i didnt tear at all but with my 3rd my scar tissues reopen during birth i am now pregnant again and hoping for natural birth and not c section.. i feel for all women that have 4th degree tears xxxxxxxx


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## treehugginhippie

Subbing to read later


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## wombatclay

bumping/subbing









My 4th degree tear, shoulder dystocia vbac babe arrived 2 weeks ago (link in my signature). I'm doing what I can to heal but worry about my future health and delivery options...I'm so glad I found this thread!

Honestly I sort of feel like I won the war (had a wonderful, natural vbac without meds) but lost the last battle (due to the vacuum and tear)...though I know that's putting the famous saying backwards!


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## 19spitfire

I just found out I'm pregnant with my third(suprise!). I had a 4th degree episiotomy with the first and a c-section with major complications with the second. So I did a search for vaginal birth after a 4th degree episiotomy and found this thread. I have to thank everyone who posted their stories for momma's like me. I cried with joy to hear all of the success stories and now I have hope that this birth can be what I imagine in my heart. A sincere thanks to everyone who posted to this thread.


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## jenkuh

Quote:


Originally Posted by *rufio* 
Hi all, i had my first birth by forceps and episiotomy with a 4th degree tear. The result was an anal fistula which was repaired 12 months postpartum. I am now booked for a c section, but thanks to reading all the comments here, I may actually talk to my midwife about another vaginal birth.

Would anyone be able to tell me if it will affect my fistula repair as I only had it repaired feb 2005? Also would I get damaged further and have to possible wear a catheter for life, is that one of the other dangers of tearingand then not healing better this time round, has it happened to anyone? all the birth stories on here have been positive, but has anyone experienced another traumatic vaginal tearing which has left permanant damage?

Sorry for all my questions and post being long. Ruth.

I also had a fistula (an anal fistula) that was repaired in March 2005. I worry about the same thing. I'm and so grateful for this thread - I also cried tears of joy for all the positive stories! However, I am still worried about the repair and the fact that my overall "layout" of things down there are significantly different and I am aware of it. I hope to hear from others here about this as well.


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## mamasunflwr

Bumping an old thread...
Anyone have any updates?? I'd love to know how everyone is doing... Any positive vaginal deliveries after 4th degree tears?


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## Tanibani

I had a hospital birth with my first (2000.) I didn't want an episiotomy. So I tore, bad... 4th degree to my anus. The scar (and my anger at my husband and OB) caused problems - serious constipation. I worked on my feelings (let all the anger go) and went to see an acupuncturist/got Chinese herbs and those 2 things totally cured me.

I went on to have a homebirth with a midwife 4 years later - 2004 - minimal tearing.

I had more of a fear of prolapse than any tearing. In fact, my pelvic floor was always weak... and I was terrified of having a 2nd. That's my main reason for not having a 3rd... fear that I could end up with a prolapse.


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## claire75

This link has been a wonderful source of inspiration to me! and I just wanted to thank you all for taking part in this incredibly important discussion. (I've been meaning to post for soooo long, my boy is now nearly 6 months old!)

I tore with my first to 4th degree, caused by an episiotomy. Thankfully I was repaired very well and healed to have no after effects. When I got pregnant with my second I knew I wanted to deliver vaginally again but I constantly came up against opposition. Such negative energy! So I sought out positive information and this link was sent to me by a wonderful lady that had gone on to birth 5 more children after her 4th degree tear with her first.

In the end after weighing up my options I opted for a homebirth - I felt that no intervention was the best way for me to get the successful outcome I wanted for baby and me.

In preparation I looked into hypnobirthing, directed breathing and I spent some time stretching (very gently) the scar tissue. My main concern was tearing the scar (even though I knew from my research this my pretty unlikely). The best thing about the stretching was in got me back in touch with that area of my body, it had changed so much from the repair that it didn't feel like 'me' anymore. I put a lot of effort into eating the right foods, keeping hydrating and taking supplements.

In the end I got the beautiful homebirth in water I wanted - a lot quicker but manageable, minimal tearing (a slight 2nd - not near the scar and a small graze), drug-free. I felt safe and was supported by my DH, midwife and doula.

It was scary to push out his head but I did it slowly and even missed a contraction to aid the stretching.

I'm really proud of the outcome and this link was one of the first times I realised that even though I wanted it, I might actually be able to achieve it! So thank you, thank you, thank you!!


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## little flower

Hey everybody!! I've been astounded and touched reading all your posts...

I don't know if you might be able to help me too... but I'm expected my third child but have torn both times in past. First time was with an episiotomy and a 2nd dregree tear and then the next time, with two episiotomies and a 4th degree tear. After the second time my confidence was shattered since everything seemed to be going fine. I don't really know what happened but this time round I've been advised to have a C-section which is scary too.

Anyway I have NEVER heard of not having a C-section after a 4th degree tear so I'm in awe of you guys. It would be amazing to have a natural birth and overcome all my fears of the past, but I'm still suffering problems from my tear 2 years later.

Does anybody think that this might be an option for me, despite my history or whether since I've torn twice and still have troubles, a C-section really is my safest option...

Any thoughts would be fantastic... xXx


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## homewithtwinsmama

My first homebirth client ever had a horrific 4th degree with massive infection- following hospital birth- and reconstructive surgery. She too was told to have cesarean the next time. Didn't want to, chose homebirth, had a 9 lb baby (pound and a half bigger than first baby) over intact perineum. She pushed with her urges on a birth stool and we did hot compresses and had her pant head through crowning. Mama had done vit E oil and perineal massage religiously for about two months before the birth.


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## wombatclay

Little Flower- hugs mama. I'm sorry you've gone through this twice! One thing to keep in mind is that episiotomy is a hug risk factor for tearing. One good mental image is to think about a piece of fabric...if the fabric isn't cut you can still tear it, but it takes a lot of effort and usually the tear you manage to make isn't that big. But if you cut into the fabric and pull along that cut you can pretty easily rip the fabric into two piece. The perineum is similar to that fabric, so even though mamas _do_ sustain 3rd and 4th degree tears without episiotomies, it's much less common. Many serious tears are actually episiotomy "extensions", even when that isn't the terminology being used on your medical records.

It's true that some women tear more easily. But you've never been given the chance to birth without intervention (the episiotomies you mention). Unmedicated birth that allows full freedom of movement, the option to labor/birth in water, a care provider who follows your lead and keeps their hands off your perineum, pushing only when you want and in the position/duration/manner you want... these are all important tools to avoid further tearing. Eating a balanced diet with plenty of protein and good fats, regular perineal massage (though many care providers feel that this massage shouldn't be done in the last month or two prior to the birth since it can cause bruising/swelling then), maybe the use of an epi-no to help stretch the scar tissue gently and build your confidence, and the use of a birth tool like hypnobabies (to aid in relaxation and breathing out the babe) can help as well.

Good luck and happy (tear free) birthing!


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## bkbabymomma

Thanks for this thread, it really helped alleviate my fear about impending birth #2 (3rd degree tear with #1). Turns out my midwife this time round did an intensive study of perineal integrity during her schooling, and she agrees both with waiting to push until the urge hits, and being mostly "hands off" (no massage during delivery). I found it interesting that she felt one of the greatest risk factors for tearing was position, saying she would let a woman giving birth vaginally for the first time labor, but not deliver, in a squat. She also assured me that tearing more than once is pretty rare. Good luck mamas!


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## MovingMomma

What position does your MW prefer?


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## bkbabymomma

Kinda anything else but squatting, where gravity is in full force when you might need the brakes on a bit. She mentioned that hands and knees could be very good, although this increases the risk of an anterior tear (rare, and usually small).


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## mntnmom

I had an epi and a tear with my first baby. With #2 , I was scared to death but I got 3 stitches, which now that I know better, I probably didn't even need. #3 and #4, barely an abrasion.
If there's not another reason for a section, I would try for a vaginal delivery, from what I've heard the risks and a recovery for a C-section are to be avoided!!


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## mamasunflwr

*bumping*


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## stacyann21

Quote:

The best way to avoid tearing is to push only when your body tells you to, in a position you feel comfortable in, and to keep all fingers out of your vagina.
I agree. A tense environment also contributed to my tearing (up my vagina and into my perineum). I did not do any perineal massage and my mw was mostly hands off during my delivery. Not sure what happened there. Hope it doesn't happen again next time. The next several weeks of pain and breastfeeding problems were almost more than I could handle.


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## MauriMama

Hi everyone,

Thank you so much for all of your posts, I have read every last one of them. They have given me hope that I too can have another vaginal birth for any future babes after my 4th degree tear.









I had a home birth with my DS who is now just over 2 years old.

During one of my squats my MW checked for the head and she told me to reach up and feel and that I should push if I wanted to. Well, I didn't want to, but at that point I knew that it would be over sooner if I just pushed. It makes me so angry to look back at how much they were encouraging me to push without actually telling me to. Even though I had been very clear about not wanting her to guide me at all during all our prenatal visits.

I ended up with a BAD 4th degree tear. Some doctors that saw it said that it was worse than a 4th degree tear, although I don't know how that's possible. I tore through the anus 3/4 of the way back, through the internal and external sphincter.

My MW stitched me up and my stitches came apart 1 week later and my MW referred me to an Ob/Gyn who stitched me up in her office 2 days later. I would have rather delivered 10 more babies without drugs than have gone through that. Especially because the stitches came apart again 3 days later.

At that point I knew I couldn't go through that again. I spent the next two years interviewing OBs, colorectal surgeons, MWs. I even asked Ina May Gaskin her opinion on the matter. I researched countless articles about pelvic floor injuries during birth. How they happen, when they happen, what are the chances of their happening again. It seemed that a home birth without intervention was the least likely way to end up with a 4th degree and yet, I had one. I started thinking it was my body's fault, that my perineum was too small. Every OB and surgeon I spoke to said that I would definitely need a c-section for subsequent births if I had the repair. Every MW said...I would be fine and could avoid another tear. Although many of them had not attended a birth following a 4th degree tear, without a subsequent tear. I didn't know what to think!

When I talked to my MW about it she agreed that squatting might not have been the best position for me, and that I didn't have any swelling to indicate that I might tear.

I finally, somewhat reluctantly, agreed to surgery, in January 2008. I knew that I could not continue with the fecal and gas incontinence, and I was afraid that delivering a subsequent baby without any perineum to slow the baby down could cause more damage to my pelvic floor.

My surgeon was worried about the outcome of the surgery because he felt like my tissue had been so damaged with the two previous repairs. He did an overlapping repair on the anus, sphinteroplasty, perineoplasty...anyway, that's what it says on the report. The recovery was almost impossibly painful. And three months later when he said I was completely healed I thought he must be joking. I was in so much pain.

I had a short perineum to begin with, but now, I feel like it's almost non-existent. I'm currently seeing a pelvic floor PT, and I'm getting great results in terms of scar mobilization, pain relief (almost pain free!!) and pelvic floor strength.

I'm feeling much more positive about getting pregnant again and delivering my next baby vaginally and at home again (with a different midwife!), especially after reading so many positive stories.

Thank you again for your posts and for being a safe place to discuss something like this.

M







:, mother of







:L,














:







:, loving husband D


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## JenniferH

I had 2nd deg epi and a 4th deg tear. It never occurred to me that I would have to have a c-section. I had minimal pain and healing time after mine though. I heal really well, and was actually up sprinting down the hall a few hours after having the stitches (long story).

At my 6 wk checkup I was pretty much completely healed, and the NP checked vaginal integrity and said everything looked fine. Neither she nor the OB ever mentioned a c-section.

I think the fact that I didn't have sex for more than 4 months after she was born helped (I was single when she was born). I had plenty of time to heal completely.

I don't expect any problems. My scar is smooth, and I can't feel any hardened scar tissue on the inside. We shall see, if I ever have any other babies.


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## loulie

mauri mama my heart goes out to you. I had a 3rd deg which took 2 hours of surgery to repair. two days later, after a blood transfusion to replace what i lost during the surgery, my stitches also came apart, not the whole way though. The Ob/gyn decided NOT to stitch me up again, so I was left to heal 'naturally'. I think I was lucky after hearing what you went through, but I'd never heard of stitches coming apart before and I know how painful it was so can't begin to think how hard it must've been for you.

It's good to hear you're feeling more positive now - as am I - and this thread has definitely helped me in that respect.


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## Erdbeer

Just reigniting this thread because there are so many informative stories in here and I'm sure there must be some posters with severe tears who went on to birth vaginally again.

If so, can you chime in and let us know how it went?

I had a 3-4th degree perineal tear, vaginal tearing all the way up to my cervix, which also tore, during the birth of my son (7lbs even, head circumference 34cm). I am now pregnant 4 years later and have heard every bit of advice from "get a c-section" to "no way you should birth outside a hospital after tearing your cervix" to "you were doped like a racehorse with pitocin to birth faster the first time, next time do a homebirth" and I am swimming in my thoughts.

Hearing your stories are really helpful and I'd love to read more.


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## treehugginhippie

I posted to read later but now I can post my experience...thanks Erdbeer for bumping









I had hospital birth w/ dd1 and I ended up w/ a 4th degree tear.

This time (did it the 1st time...didn't matter anyway) I didn't do perineal massage because....well...it hurt too much! I did massage olive oil mixed w/ wheat germ oil (I read it's good for scars...I only mixed a very sm amount in the olive oil) on my perineum just before bed the last 4 weeks of my pregnancy.

Well, I had a home waterbirth and pushed on my hands and knees. I didn't have any tearing but a skid mark that my mw stitched cause she said I'd be more comfortable. BUT because I was feeling the "ring of fire" up high instead of at my perineum I tore my urethra or someting cause it still burns when I pee sometimes at 6 weeks pp. My mw didn't see this I think.

Much better than before and I'm soooooooo happy I didn't tear my perineum again but still a PITA to still have some pain. From what I've read it can take several months to feel normal again.


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## Erdbeer

Treehugginghippie, that's awful with the urethra tear... have you had the midwife check it out again? Could it be that you tore the vaginal wall?
Just wondering, how big was your second baby? That's great that the scar didn't tear.


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## AlmightyIsis

Wow, can't believe I found this thread. I'm now pg with our little unexpected #3, and all I can think about is exit strategy. My tear was one of the worst my doc had ever seen. I healed well but with some gas incontinence and a much, much smaller perineum. Like it almost isn't there. I really don't know how realistic it is for me to deliver naturally again. I'll be getting consultations.


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## Erdbeer

AlmightyIsis, please keep us updated on what info you get! I am in the same boat as you and am also collecting opinions... going to see my second home birth midwife today and one from a birthing center next week. So far I've gotten varied opinions so I'm hoping to find some consistent advice to make this agonizing decision easier!

Good luck!


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## lifeguard

I'm so glad to read so many positive stories of subsequent births going well. I am sitting here healing from a 3rd degree tear thinking about the next time.

There has been some mention o f waiting 2+ years before ttc again & am curious how far apart those with better suibsequent outcomes have their children spaced. We were hoping to have our children close together.


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## Avecilla

I had a third degree tear with my first birth. It was an unmedicated birth in the side-lying position with no directed pushing and no episiotomy. I'm not sure what caused me to tear so badly, although dd was born with her arm in front of her face, which may have contributed. The recovery was slow and painful, but I didn't have any lasting problems.

My second daughter was born 2 months ago. I had a beautiful water birth, and I could hardly believe it when my midwife looked at me and said I hadn't torn. I think I actually cried tears of joy.

Quote:


Originally Posted by *lifeguard* 
I'm so glad to read so many positive stories of subsequent births going well. I am sitting here healing from a 3rd degree tear thinking about the next time. .

There has been some mention o f waiting 2+ years before ttc again & am curious how far apart those with better suibsequent outcomes have their children spaced. We were hoping to have our children close together.

Our daughters are 2 years 8 months apart, so we conceived right around her 2nd birthday. Not sure if the 2 years of healing helped or not, but they certainly didn't hurt.


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## AutumnAir

I'm so glad to see this thread - it gives me hope for the future.
I had such a traumatic birth that I'm still not sure if I'll ever be able to have another baby, but it's good to know that other women have successfully birthed babies after similar injuries.
I had a huge episiotomy - here they do medio-lateral which have less chance of tearing into the anus, but are much more painful to recover from. Mine goes all the way back to the ischium (one of two bones in you buttocks that you sit on) about 3-4 inches, so almost all the way up my vagina. And I had a high forceps delivery with a posterior baby. All these are risk factors for urinary and fecal incontinence and together... Well, let's say I always know where the nearest toilet is these days.
Because my injuries were the result of birth rape I haven't been able to bring myself to go to another HCP to get them evaluated. I have been doing lots of pelvic floor muscle exercises and 'training' to improve the incontinence and it's slowly working.
But it still hurts, 10 months PP. I still haven't 'resumed relations'. (Poor DH!)
But as I said it's good to know that others have overcome these types of injuries.







to everyone here.


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## JenniferH

I feel lucky that I recovered so quickly. At my 6 wk pp checkup the NP said everything looked really good. I didn't have much pain after the wound healed either.


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## wombatclay

Hugs LisaBee- I hope you find all the healing you need! My OBs told me to avoid penetration of any sort for 6mo (unless I _really_ wanted to and, ummm, no), and that it wasn't uncommon for a mama with a severe tear to wait a full year. I know some mamas in this thread have recovered quickly, but I can say that it was a full year before it wasn't cry out loud painful (and DH didn't want to dtd either since he didn't want to hurt me) and now at 16mo it's still not exactly comfy. Even tampons are uncomfortable, and I can't use my sea sponges or diva at all. I also had incontinance issues and prolapse, so I know some of where you're coming from. Hang in there! (and check out the pelvic organ prolapse thread in birth trauma if you think you have any prolpase issues as well since there are some very informed mamas there, and several with urinary, gas, or fecal incontinance)


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## kerryleigh20

i was only 18 when i gave birth to my daughter who weighed in at a whoopin 8 14 and 55cms long. im only 5'2 and i think that was well over the top, and was left to tear like i did. i sufferd from a 4th degree tear wich ended up tearin all my bowls, i had to go to physio therapy. throughout my pregnancy i was told that she was well over average and had to go for a scan at 30wks to check the growth, they told me that she was measuring in at the size of 33+week old baby and that i had to see a consultant. i never got that apiontment to see the consultant and was jus left to go into natural labour. i was told from a few people ie friends and family that my bump was huge and that she would be big but as i was only young and was my 1st pregnancy i just had to go alolng with it, i didnt know who to go to or who i could speak to about my concerns about being big as my midwife told me at all the appointments that everything was fine.
i went into labour which obviously was very sore, she was back to back. my mum and sister was with me and when her head came out my mum said that the wall seperating the vagina and pack passage 'burst' open. they then decided to get foreceps but was to late as i had pushed her out.
she was born at 9.55pm and i was taken away to theatre and didnt see my daughter till 2.30am because i was away being stitched up.

i am now 33 weeks pregnant with my 2nd daughter and keep choping and changing my mind wiether to have a c section or go natural. iv had midwifes tell me to have a c sec because the wall wont b as strong as it should b and the skin is more sensitve, but iv had registras telling me that i should go natural because of the rest i will need after a c section. i dont know what to do but i do know that i am petrified and dont want to go into labour scared that it might happen again. but i want to be a hands on mum from the word go but wont b able to because i was told that i ouldnt b able to be after a c section. could any1 help me or reasure me that 2nd time round might or wont b no where near as bad even if u have tore loike myself.
thanks


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## Moonflower77

I just had my little guy in August and I had a vaginal birth. It was my third vaginal delivery and by far the easiest. I will keep this brief but I came out with only perhaps a stitch or two even though I was told it was maybe a skid mark! I think the doc put one in just for peace of mind. I made sure it was the same doc that stitched me up for my last baby.

Now, I did get induced 5 days before my due date I think in my case it helped because my first 2 babies were over 9 pounds and my second had a 15 inch head--whereas, my third was 7lbs. 6oz. and had a 13.5 inch head.

With my first beautiful boy in 2004 I was induced on my due date--we were very healthy but I had been having really bad hip problems and awful water retention and he just felt really big-my gut instinct told me he needed out! I ended up with horrendous back labor and he got stuck at the shoulders and had to be pulled out--1 3rd degree tear down and 3 2nd degree tears up! OUCH! 9lbs 1 oz--he was assessed to be 42 weeks gestation and very healthy. I had a tough time with the recovery but the joy of having a baby helped a lot.

2006 my 2nd pregnancy and I was reaaaallly scared to birth again but did and did so at a birth center with midwives. Another induced labor at about 42 weeks--I knew it was a big baby and I knew I was increasing amniotic fluid exponentially. I labored and delivered fast on knees--9lbs. 6 oz -15 inch head and a 4th degree tear. My baby girl came into the world on a giant wave of amniotic fluid. I had a great experience but never expected to tear that badly. Recovery was a beast but I did heal well. Doc did a great job stitching me up but it was a looong time before I felt like myself.

2008 third pregnancy-a boy and I was MORTIFIED about another possible tear. I did a ton of research and soul searching and decided I did not want to go as far over dates with my third. I wanted to be induced either right after my due date or during the week before. I felt that size of head/baby coupled with speed of delivery had a lot to do with my tearing and I knew that I did not want to have a c-section. I had a wonderfully easy pregnancy. I chose to get induced during my 40th week--I was very sure about my dates. Yes, I hated having to be induced and being hooked up, etc. but I ended up having a very good experience with no birth trauma to my baby or me!

I am leaving out a lot of details-mainly those about how I was treated (good/bad) by the midwife group I was with before opting for the hospital - but that is because ultimately you have to educate yourself as much as possible and then go with YOUR mommy gut instinct.--Yes, there is a lot of fear-but even in the midst of that fear I knew what I wanted for myself and my baby. I made the best decision after weighing all options. For my baby and I it worked out very nicely!

In MY experience there is a lot of insensitive treatment by SOME Midwives/Docs/nurses of mothers who have had bad tears--mainly because we do not fall within the norm of birthing/tearing, etc., and they are not sure how to handle us because you can not predict birthing outcomes like the degree of spontaneous tearing.(ie no epis., no forceps, etc.) A couple weeks after my 4th degree tear I was actually told by a nurse that was NOT present at the birth of my 2nd child that the reason I tore so badly was because I "blew" the baby out --meaning I just forced the baby out with a massive push--I was furious and hurt that my privacy had been violated and that I was treated so poorly by someone I had never met. I was treated like *I* had screwed it up somehow--when I knew and the MW delivering knew that I only pushed with my contractions. That is why these forums are so important.

I have been following this thread since I became pregnant with my third baby. You all have inspired and helped me so much. I knew I needed to post my experience because I *know* how scary it is. I wish you all the very best in you future birth experiences. I hope my post was helpful. I actually tried to be brief by leaving a lot out~sigh~

-Moonflower
Mommy to three amazing gifts


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## giddiegoof

Hello,

I have a 2 mm fistula resulting from my son's birth almost 3 yrs ago. I had a 4th degree internal tear toward the rectum with his birth (nonmedicated, hospital birth with 8 minutes of coached non-stop pushing since his heartrate went down anytime I wasn't pushing). I didn't realize I had a fistula until he was about 9 months old, and at the time I realized was w/o insurance or money for repair. I was diagnosed at a percent-of-income clinic by a resident who obviously had never heard of a fistula before, and scared me so bad about being repaired ("sometimes a colostomy bag is needed") that I couldn't bring myself to have surgery until I did a lot of research and tried any alternatives I could find. I also have some negative emotions toward male drs, mainly because the OB who stitched me after birth told me I didn't have a fistula when I saw him again after first suspecting, and sent me off to the percent of income place telling me I could see a specialist. Do you know how hard it is to find an experienced female colorectal surgeon?

Late last year I was finally beginning to come to terms with the idea of surgery and how to promote best healing & recovery naturally, etc, so I made an appt with the best colorectal surgeon in the area (a male). I couldn't find babysitting for my son, so had to reschedule, and voila! oops, in between appts realized I am pregnant.

Any ideas of what to do? I am meeting with a midwife next week, and considering seeing a surgeon to see if anything can be done while I'm pregnant. I know the surgeon will tell me to have a c-section, but is there any chance I can still have the beautiful non-interventive homebirth I dreamed of? Would it be better to try for home and have surgery for repair after birth if I tear more, or c-section surgery? I know that no one can really tell me what to do, but any thoughts would be appreciated.

I have read lots of stories of birth after tearing that had convinced me to go ahead with homebirth after I was repaired, but of course I intended to be repaired before ttc. I know I've waited too long to seek out treatment, but it's water over the dam at this point. Thanks for any encouragement that can be offered.


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## mommamiagal

hi. i am so sorry you are going through this. i did have a 4th degree tear that went into (1 inch) the rectum, but it was repaired within a few hours of the home birth. i guess that was a good call on my homebirth doctor. they sent me to the hospital and i had a UG specialist do it. i have not had any trouble with it, however , i was , many second and third opinions too, advised not to have another vaginal birth due to the trauma that i had suffered in that area. the space between my vaginal opening and the rectal opening is very small. i did have a c section with my next baby , and am planning another c section with my current pregnancy. of course i am not happy with this outcome but i have no choice, with the shape of my anatomy and the large size and shoulder dystocia with my babies. as far as getting your repair before the delivery, that will need professional opinion. i would have a c section if it were me, since repairing tears is a lot harder than repairing a c section incision which is a straight line vs. the kind of tear that we suffered which is very hard to put back together. my c section was a much easier recovery than the 4th degree tear. with the abdominal incision , i really babied it and allowed it to heal , whereas with the vaginal tear, you still have to make sure it is clean to prevent infections , from going to the bathroom , etc.... good thoughts with you. good luck.


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## aprildawn

giddiegoof -- I'm so sorry to hear about your fistula, but congratulations on the new baby!

If I were you I'd seek multiple medical opinions. Seems an unrepaired fistula isn't something you'd want to risk making worse. If you gather a few opinions from doctors and/or midwives you may find a common thread you can follow for this birth.

I hope you are able to be at peace with whatever the outcome is.


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## giddiegoof

Thank you. I know that ultimately this is up to my husband and I to decide... I will be meeting with a midwife this week and probably a surgeon in a couple weeks. Any other thoughts would be most welcome. Of course we just want a safe delivery for baby and me, but I've been so freaked out by everything I've read about c-section and have been so committed to natural birth in the past that it's really difficult for me to consider that direction.


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## Erdbeer

Well, I'm back to report the outcome of my second birth after a 3rd, almost 4th degree tear with extensive vaginal tearing, torn labia on the left side, a cervical tear and torn artery with extensive blood loss last time around (4.5 years ago).

I did a ton of research and soul-searching and asking the mothering forums before finally deciding about 25 weeks into my pregnancy that I would try for a home birth. I talked though my issues with a few midwives, and agonized a bit over which one to choose. In the end, I went with the one who had been home birthing the longest and who was very hands-off. In the end I am not sure I wouldn't have been better off with one that was a bit more proactive, but I can't change that now and will never really know...

My first baby was 7lbs even with a 34cm head, which is pretty average, maybe even a bit on the small side. I am not a tiny person either. My labor was in a hospital, with epidural and pitocin, I pushed twice and the baby flew out. I felt the meds were much too strong for me.

I was advised this time to go to an osteopath who could massage my perineum over the course of several appointments and get my scar tissue to soften up. Honestly, the thought of this freaked me out, and I decided to try perineal massage myself but ended up doing it only twice before taking some midwives' advice that the perineum will eventually open up no matter what.

This time we set up a pool in our apartment, I talked a lot about laboring and possibly birthing in the pool, and this is what ended up happening. My labor was fast, the midwife arrived at 11PM and I was at 6cm, and the baby was out at 12:15. During pushing, I was hyper-aware of what was going on because I was so afraid of tearing badly and losing as much blood as last time. I felt the baby's head move from what felt like my butt-area, forward to my perineum, and then even further up with most pressure upwards towards my labia. I felt the perineum and it was not giving! It felt like it held tight and neither tore nor stretched. The head was pressing forward and I felt I was starting to tear. I told the midwife, and she said "no, you are fine, you will not tear, just relaaaaaaxxxxx....." I felt she was not really "with it" at this time, and was just going through the motions of telling the woman in adrenaline-fueled transition to take it easy. I told her again "no, my perineum is not stretching, I am tearing forwards!" At that point I felt a bit humored and thought to myself "this woman is not helping me, my husband doesn't know what to do, I have to decide now to either push this baby out and take the tear, or sit here in limbo!" So I pushed against the pressure of the baby's head and tried to guide it downwards as I pushed. After about 4 pushes, she popped out. I felt the sting of the upwards tear contrast with the relief and gentle feeling on my perineum as she came out.

I ended up tearing my left labia almost clear off, and had maybe one stitch in my perineum. None of the places I tore last time (which was pretty much everywhere else) were affected this time. It is now 10 days after the birth and I feel pretty much back to normal. Last time it took me 8 months to feel no more pain.

All in all, I am glad it went so much better than last time but still a bit disappointing that this birth did not heal my fears about tearing. I keep wondering if I am just a "tearer" and this will happen with any subsequent birth. In any case, I am so glad I went for a home birth. I feel that being at home allowed me to heal so fast, and I realize now how much of those first few days of my son's life I missed by being drugged up in the hospital.


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## cristinaberger

I had a 4th degree tear in November 2007, it took me about 10 weeks to completely heal. My husband was swabbing my tear every night with peroxide and honey. I had an induced labor with epidural, 3 hours of pushing on my back (never felt the urge to push) and ended up with an episiotomy and vacuum extraction. The baby was 8.14 lb.
I am due in 10 weeks with my second baby. I was thinking to start massaging the perineum and then try to deliver the baby laying sideways, as slowly as I can. Do you think this will work in order to prevent another tear?


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## bramblevine

Quote:


Originally Posted by *cristinaberger* 
I had a 4th degree tear in November 2007, it took me about 10 weeks to completely heal. My husband was swabbing my tear every night with peroxide and honey. I had an induced labor with epidural, 3 hours of pushing on my back (never felt the urge to push) and ended up with an episiotomy and vacuum extraction. The baby was 8.14 lb.
I am due in 10 weeks with my second baby. I was thinking to start massaging the perineum and then try to deliver the baby laying sideways, as slowly as I can. Do you think this will work in order to prevent another tear?


No to the peroxide! It can actually inhibit healing.







For the honey though. Yes, massage is good. I find the key though, is lubrication. Have your midwife use an oil (some like olive, some like arnica -which is usually carried in olive anyway-) to lubricate you as the baby is crowning, and sometimes they'll help stretch you, but my preference is lube me, and leave me.









ETA: Water births are even better for this most of the time.


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## AlmightyIsis

I posted here months ago, and am still looking for the bet way to birth this baby. I'm 33 weeks. Doc says I should try a vag birth, but I am not so sure. I think he really needs to look at my body before making that final determination. I guess I know I don't need to make a decision today, right now, but my anxiety is building.


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## wombatclay

My OB suggested waiting till labor was underway to make a decision... my 4th degree happened after a shoulder dystocia that came after a very long pushing stage. In that birth the decision was to try the vacuum first, then go to a repeat c/s. This time if the pushing stage goes the same (slow, little progress, etc) then we'd skip the vacuum and go directly to surgery. It's not ideal, and my hope is that this time pushing/delivery will be uncomplicated, but it has been helpful for me at least to keep in mind that the decision can wait till we see how this specific birth with this specific babe shapes up.

Big hugs to you (and congrats on the new babe Erdbear!)


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## cristinaberger

Definitely try the Gaskin maneuver before anything else in case of shoulder dystocia.

Quote:


Originally Posted by *wombatclay* 
My OB suggested waiting till labor was underway to make a decision... my 4th degree happened after a shoulder dystocia that came after a very long pushing stage. In that birth the decision was to try the vacuum first, then go to a repeat c/s. This time if the pushing stage goes the same (slow, little progress, etc) then we'd skip the vacuum and go directly to surgery. It's not ideal, and my hope is that this time pushing/delivery will be uncomplicated, but it has been helpful for me at least to keep in mind that the decision can wait till we see how this specific birth with this specific babe shapes up.

Big hugs to you (and congrats on the new babe Erdbear!)


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## spmamma

I am so glad I found this thread.

I had a third degree tear during my last (and first) birth. Today, I had my first OB appointment (I'll be at 13 weeks tomorrow) and the NP said, "I see you had a third degree tear last time. Well, the doctor may want you to have a c-section this time."

Whaaaaaaa?

Hours later and my head is still spinning. Now I have to wait until my next appointment - a full month from now - to talk to my actual doctor about this.

What's made this so hard is that I never really had a painful healing process with my tear. I had some gas incontinence, but at the time didn't know that it likely had to do with the tear. That went away after a few months.

I loved my birth experience. I was induced, but didn't take any pain meds and came out feeling like a hero. It's devastating to think about having to go through a c-section on account of something like this. But, on the other hand, I don't want to make a mistake by being stubborn and end up with permanent bowel issues.


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## aprildawn

spmamma -- sorry you were told you might need a c-section. Unless there are other factors, I just can't see how you'd "need" a c-section. If you've read the whole thread (it's loooooong!) you've already seen there are many, many stories of women who had 4th degree tears and later had a vaginal birth. I'd get a second opinion. Maybe you can find another provider in your area who is a bit more open minded.

I had a 4th degree tear with my first and went on to have a second vaginal birth with only a 2nd degree tear (barely). It was such a difference. I had a family practioner for my 2nd birth.

Good luck to you!


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## JessicaTX

I had a 4th degree tear with my first, a 7 pound ten ounce baby. I had a 10 pound baby with a huge noggin next, and only needed 4 stitches. In my experience you will not need a c-section because of the first birth =)


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## spmamma

Quote:


Originally Posted by *aprildawn* 
spmamma -- sorry you were told you might need a c-section. Unless there are other factors, I just can't see how you'd "need" a c-section. If you've read the whole thread (it's loooooong!) you've already seen there are many, many stories of women who had 4th degree tears and later had a vaginal birth. I'd get a second opinion. Maybe you can find another provider in your area who is a bit more open minded.

I had a 4th degree tear with my first and went on to have a second vaginal birth with only a 2nd degree tear (barely). It was such a difference. I had a family practioner for my 2nd birth.

Good luck to you!

Thanks aprildawn! I did read the entire thread last night before posting, and it gave me hope. It's nice to know that so many mamas out there were able to go through subsequent births without bad tears the second time around.

At this point, I'm going to wait and see what my OB says. I'm trying hard not to get worked up over the opinion of one Nurse Practitioner in the office. She also recommended that I wean my daughter (without providing a legitimate reason, of course), so I'm trying to take everything she said with a grain of salt.


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## wombatclay

Just noticed this was addressed to me









Quote:

Definitely try the Gaskin maneuver before anything else in case of shoulder dystocia.
With my shoulder dystocia birth we tried the Gaskin manuever twice (my OB trained with Ina and had her own first birth on the Farm). It didn't work either time. We also tried a few other position changes to no luck. The Gaskin manuever is a wonderful tool, but it only works about 80% of the time. Which is better than most techniques for resolving SD, but...well... it's not a silver bullet.

So having had a SD that _didn't_ resolve with positional changes makes me a bit more leery about a repeat SD resolving "easily" (the SD happened while I was squatting, we tried several position changes, eventually the OB had to manually rotate and pull which is what caused the 4th degree tear).

But I'm still planning a vaginal delivery. Just not a "no holds barred" vaginal delivery.


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## giddiegoof

Hi,

I posted before about being pregnant with a rv fistula... tomorrow I see the surgeon to find out about the possibility of being repaired before I'm due (8/30). Anyone out there who prays, I'd appreciate prayers for strength and peace for that appt! I tend to get really emotional when I'm stressed! Thankfully, I have a homebirth midwife who doesn't have a problem delivering whether I am repaired or not, although she'd rather have me repaired before delivery - I'd rather be intact, too. I may even have a water birth at home! Unless this surgeon gives an extremely convincing reason for a c-section, I'm sticking with home birth.

I'm hoping to be able to post back some good news, both after tomorrow's appt and after delivery. I am so thankful for all the honest stories on this thread!


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## wombatclay

Good luck!


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## illinoismommy

Quote:


Originally Posted by *illinoismommy* 
Good question... I had a 4th degree tear with my first baby, and so I am maybe a little scared of labor this time. Instead of just a day of pain like "normal" people I couldn't sit without wanting to cry for weeks. no WAY I'll schedule a section though....

Update... I've had two vaginal births since I wrote this and had no tearing in one and just a little in the other, I think I got one stitch.


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## wombatclay

Yay! Thanks for posting that update! My post-4th degree babe should be arriving (hopefully via another vbac) in just a few weeks and I'm getting pretty nervous about a repeat tear.


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## wombatclay

And my update!

I delivered my post-4th-degree-tear kiddo yesterday and the only "damage" was a 2nd degree tear along the scar. I gave birth side lying with the doula holding my upper leg and pushed for about an hour. He was 9lbs 8oz with a 14.25 inch head and slightly sticky shoulder so he certainly wasn't "tiny"







. It was a very fast birth and very intense... I think that if it had been a bit slower his head would have molded a bit more and I might not have torn at all, but compared with a 4th degree this 2nd degree seems like nothing! And I'm thrille to have had a relatively trauma free vbac this time round.

Good luck to everyone... a prior 4th degree tear can be a big hurdle to remaining positive in your next birth, but as this thread shows, there can be a happy ending!


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## babymonster

Ladies - can anyone help me in a hurry?
My MW is throwing a hissy fit about my homebirth after 4th degree tear last time. She wants me to have my scar looked at by an OB TOMORROW








Can anyone suggest some info I can print off to support my case that I am not a huge risk for repeat 4th degree like she thinks I am? I am particularly interested in the research someone mentioned a few pages back which suggested no greater risk in the 2nd birth...
Thanks!


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## milansmommy

Quote:


Originally Posted by *babymonster* 
Ladies - can anyone help me in a hurry?
My MW is throwing a hissy fit about my homebirth after 4th degree tear last time. She wants me to have my scar looked at by an OB TOMORROW








Can anyone suggest some info I can print off to support my case that I am not a huge risk for repeat 4th degree like she thinks I am? I am particularly interested in the research someone mentioned a few pages back which suggested no greater risk in the 2nd birth...
Thanks!









I'm sorry your midwife is giving you a hard time I don't have any good sources but I hope that someone can provide you with some good information. I had a 4th degree tear with DS1 which was a typical hospital birth and my midwives were not at all worried about it with DS2. DS2 was 12lb 6.5 oz and I only had a 1st degree tear. He was almost 2.5lbs bigger than DS1.


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## babymonster

milansmommy - I can't tell you how much I love hearing stories like yours







I have found some pretty interesting research studies, I will share them later in case anyone else needs them!


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## Erdbeer

wombatclay, congratulations to you! So happy everything went much more smoothly this time.


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## NewMamma28

Hello everyone, thank you for sharing your experiences.

I wanted to give a little background then had a couple of questions.

Background:

Two months ago, I delivered a 6 pound 15 ounces baby boy at the hospital. My OB used the episiotomy method (did not really give me a reason of why she decided to do that - except that he was really low). My boy was not big and his heart rate did not drop either.

After reading everyone's experiences, I went back and tried to remember what happen in the delivery room that lead to a 4th degree tear and now fistula.

As I recall, the nurse that was helping her was using something warm (I assume oil) and her finger to stretch the vaginal area during the delivery process. After an hour of pushing and no baby, my OB decided to use the scissors. After the cut and a couple of pushes, I gave birth to beautiful healthy boy.

Weeks later, I started to notice stool in the vaginal area so I called my OB which lead to multiple CT Scans. I was told that I had a fistula (opening between my vaginal and anal area) and needed to see a surgeon. My OB referred me to a rectal specialist.

The specialist examined me and told me that the tissue was still healing and that there were multiple small openings between the vaginal and anal area. She had also mentioned that I tore the muscle that controls my bowel movements (so far I have not had any issues with my bowels - she stated that it may affect me in the future). The specialist then emphasized that I do the following (either): Nothing (leave it and live with it) or have reconstructive surgery. She would have open me up again and reconstruct everything; that would mean a catheter and an overnight stay at the hospital.

After all that, I was then told that I could not have anymore vaginal deliveries for it would tear again. C-Sections were the way to go with my next pregnancies.

The reconstructive surgery is only a 70% success rate!!!

I was devastated (left the office crying). I do not want to have to go through another painful experience. Recovering from a 4 degree tear was awful! And the thought of having to go through another surgery and recovery brings tears to my eyes not to mention a financial burden (no insurance).

Questions:

The specialist told me that it has been two months and the fistula has not healed, it will not heal, and that it has to be repaired, is this true or is it too early to tell?

The specialist told me that a bomb went off inside making the lower part of my muscle weak. If I opt not to do the surgery, is it possible to strengthen the muscles to make sure I don't lose my bowels in the future?

The specialist told me NO MORE VAGINAL DELIVERIES because it would be worse the second time around, any input or advice would be appreciated.

Has anyone experienced long term affects of a 4th degree tear and fistula without surgery or with surgery and what were they?

Thank you!!


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## wombatclay

Big hugs, congratulations on your babe, welcome to mdc, and I'm sorry you "found us" because of a 4th degree tear!

Some of your questions really will depend on the specifics of your medical record... can you see a second (and possibly third) specialist for their opinions? Low estrogen levels (like you have while breastfeeding and before your menstrual cycle resumes) can cause slow tissue healing. Diet can also impact healing. I put together a big list of "how to heal from a 4th degree tear" so let me know if you'd like a copy.









Anyway, your provider is right that fistulas don't generally heal on their own. However, there may be options that fall between "do nothing" and "reconstruct now". A PT trained in women's health and pelvic floor health could help. Estrogen cream/pessaries may help. A support pessary (kind of like a "donut" inserted vaginally to hold support weakened tissue) and/or girdle may be useful too.

For future pregnancies... the opinions are split and there are no great researcxh studies. Basically, if you've had a severe tear and/or poor healing, you are more likely to tear again. And a second tear is generally harder to repair with more risks. On the other side of the balance is the fact that the hormone shifts and pressures of the pregnancy itself can damage internal tissues. And c/s is major surgery with risks to both the mother and the babe. So it boils down to "increased chance of repeat tear with greater permanent damage to mom" versus "100% chance of surgical incisions with greater risks to mom and babe". It's not an easy choice.

I balanced things in my mind by having my post-tear babe at a major medical facility, with midwives and a doula who knew my history and were willing to work with me. And I had a healthy, big, happy baby despite a history of c/s, 4th degree tear, and pelvic organ prolapse. I had him vaginally and haven't had any additional trauma as a result of the birth. But I thought a lot about it (I'd been told c/s only by several providers) and had plans in place to give me peace of mind. And other women go the other way and birth at home in a very hands off manner.

I'm rambling. I remember feeling so broken and hopeless after my dd2 arrived... I was thrilled at my vbac but so upset at the "future kiddos by c/s" statements. I even thought about sterilazation because my c/s had been such an emotionally devastating experience I just couldn't imagine doing that again. I did a lot of soul searching, a lot of physical healing work, and when I got pregnant I decided to assume a vaginal birth and see. But you have more "quality of life" issues... fistulas are serious. And you may have some prolapse issues too if the tissues are weak (there's a support thread here for POP/pelvic organ prolapse). That's why it's worth getting a few opinions and taking things one step at a time.

I hope you continue to heal, that one day you'll have a "birth after 4th degree" story to share too, and no matter what... congrats on your babe and welcome to mdc!


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## BlackSheepPDX

I just wanted to chime in with thankfulness for this thread. I'm unexpectedly expecting in August, and had a 3rd degree from my June 2007 birth. It's been my greatest fear in both. And now, reading this thread, I hear a lot about my first birth (not feeling pushy in the beginning, feeling like maybe I should have rested, needing "help" from my midwife to feel what pushing should be, doing the counting thing) that perhaps I can learn from and apply in my second and I am very hopeful for a good outcome. Thanks to all who have shared this and I look forward to reporting back in August!


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## mrscompgeek

This is a great thread!!!
3 months ago I had my first baby born at home with a midwife. It was supposed to be a water birth but Ki's heartrate kept dropping when I pushed in the water (which now im wondering if maybe the fact that i dont remember feeling a undeniable urge to push, i just pushed cause the midwife said i could had anything to do with her heartrate maybe) but anyways I pushed on "dry land"







and ended up with a BAD vaginal tear. I dont know what degree but I do know that the OB that stitched me at the ER said it was pretty much both sides of the vagina tore. I had no external tears though, completely intact outside, only internal. I have healed pretty well now and dont feel much pain/stinging at all anymore. (although the first 3 weeks after giving birth I was so swollen down there I couldnt walk right.)
Now I am terrified to think of birthing anymore babies. BUT reading this thread and doing lots of research and im seeing that chances of this bad of a tear with the next baby is VERY SLIM so that helps me relax a bit.
Would LOVE to hear any more stories of mamas with vaginal tears having more babies.


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## loulie

well I guess I'll be the next to update - my post 3rd deg tear babe is due a week today. Unfortunatley for me, this one is posterior, as was DD so I'm very very scared. Wish me luck ladies, and anybody who has any positive updates please post them - it definitely helps to keep up my confidence that I'm doing the right thing...


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## modadan

Wow I could have written this! Especially the manipulative midwife









Except I left my epi&tear to heal by second intention. I was over all those "experts" near my yoni and was too traumatized to be re-stitched. All seems OK except I seem to have lost most of my perineum.

I am due for #2... so glad I found this thread, it has given me confidence to have a vaginal birth. Fingers crossed I come out the other end with just some minor tearing. No tearing would be a miracle!









Quote:


Originally Posted by *MauriMama* 
During one of my squats my MW checked for the head and she told me to reach up and feel and that I should push if I wanted to. Well, I didn't want to, but at that point I knew that it would be over sooner if I just pushed. It makes me so angry to look back at how much they were encouraging me to push without actually telling me to. Even though I had been very clear about not wanting her to guide me at all during all our prenatal visits.

I ended up with a BAD 4th degree tear. Some doctors that saw it said that it was worse than a 4th degree tear, although I don't know how that's possible. I tore through the anus 3/4 of the way back, through the internal and external sphincter.

My MW stitched me up and my stitches came apart 1 week later and my MW referred me to an Ob/Gyn who stitched me up in her office 2 days later. I would have rather delivered 10 more babies without drugs than have gone through that. Especially because the stitches came apart again 3 days later.


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## loulie

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!


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## wombatclay

Congrats!


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## AAK

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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## ninabear

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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## Tanibani

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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## giddiegoof

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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## wombatclay

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!


----------



## mrscompgeek

Quote:


Originally Posted by *giddiegoof* 
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* 
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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## ninabear

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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## ninabear

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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## wombatclay

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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## moonmama22

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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## wombatclay

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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## moonmama22

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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## moonmama22

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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## ShinyLittleStar

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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## ninabear

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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## wombatclay

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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## moonmama22

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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## round2011

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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## Mom3yingels

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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## bigblues1981

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&#8230;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&#8230;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&#8230;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&#8230;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&#8230;.Oh how I wish I could turn back time&#8230;


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## throughNewEyes

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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## Clover Honey

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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## round2011

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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## wombatclay

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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## moonmama22

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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## Moonflower77

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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## throughNewEyes

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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## mercii

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!







)


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## Clover Honey

Came back to update - another VBAC, only a small 2nd degree tear!!! Baby was even larger. Took lots of care and my time pushing, slowly and breathing deeply. Paused through many contractions with no pushing and just let baby move down slowly (that fetal ejection reflex really kicked in if I relaxed) until it was time to do the hard work. Then was careful and slow, but still powerful pushes; especially when getting her head past my pelvis. I still had a partial bulging bag in front, so we went ahead and ruptured and then she came down nicely and turned. When head crowned (I made sure to use a large mirror so I could see exactly what to do), I stopped and let the stretching happen several times. Nurse held hot compresses to my bottom for counter pressure, and other than that there were no hands/fingers on my perineum at all. Listened to Hypnobabies Pushing Baby Out track on repeat with one earbud in and never took it out. It was my best birth ever! I would have cried with joy if I had gotten a 3rd degree this time too  I highly recommend Hypnobabies to prepare your mind ahead of time, and seeing a PT for pelvic floor strengthening/relaxation/alignment. She had seen lots of tears/scars and told me how excellent mine had healed, how to do extremely gentle perineal massage and that she expected no more than a 2nd degree tear this time, if any.

(btw mercii, I was unmedicated when I had my big tear, and didn't even know it happened; I also had no ring of fire, I really didn't feel anything other than the pressure of pushing (I needed to push so hard, in positions that the baby would move down in - and they were not ideal positions; we tried everything for a few hours. The recovery is very hard, and my MW told me right away it would be similar to a c/s recovery or harder, and she was right. It's certainly not the worst thing that could happen, but of course no one wants any lingering effects from an anal sphincter tear)

Good luck to anyone making a decision - I think it's a difficult process and as long as you are comfortable with your decision then it means it was the right one for you. You know your body and yourself better than any Dr., statistics or anyone giving advice.


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## Trisha-bo-bisha

@ Ninabear: How did it go? I just joined this forum, very late, but I am very curious. I, too, had a 4th degree tear, the result of a sunny-side up baby and forceps and I am heavily thinking it all through when we go to have our next one. The more I think about it, the more I want to try, but I fear my husband would rather play it "safe" with a c-section, though we all know the amount of risk and complications involved with that! I think that had he been born in a typical way, I wouldn't have torn, or no where near as bad at least...but he echos the words of our midwife/doctor who said that I needed a c-section the next go around. So...how did you do?


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## ninabear

Hello again! I posted in this thread years ago, I had a 4th degree tear (hospital birth) with my daughter, and a 3rd degree tear (home birth) with my son. I'm pregnant again, and hoping for a better outcome!!!

This time I'm going to try birthing on my side and breathing the baby down. With my son he came out in one huge push, this time I want to slow things down. I'm going to start the hypnobabies home study program to train myself to calm the heck down cause I get so anxious at the end of labor.

It was encouraging to come back here and read the stories of women who were fine in subsequent births! Maybe this will be the healing experience I'm looking for. It sucked because with my son, I had to go to the hospital for stitches, and walking into the hospital I felt like a million bucks (despite having the big tear!). I could BARELY walk out after over an hour of being stitched up. It's the stitches and healing afterwards that are so hard - I had a small taste of what it would feel like to be free down there without so many stitches on that short walk inside, and now I want a recovery like that!!!


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## twoturtledoves

Yes, I had thoughts like this too, but honestly, another vaginal birth might heal, rather then hinder. If anything, the c-sec might just be more pressure down there,without your body getting the chance to heal.

I was in the same boat, and after my second baby (almost 10 lbs!) I was so fricken ecstatic I chose to birth the way I did. (At home, and no one touched me) I literally felt great after her birth. I pray this for you as well.


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## Leiflowerchild

I am so grateful I found this forum! I had a not too bad tear (I wasn't told what degree at the time, but after researching and reading other experiences I would say around a 2nd degree) with my 1st birth. But then I developed a hemotoma, which had to be ruptured and sown back up. I lost so much blood I had to get two blood transfusions. The recovery was tough, approximately 6 weeks. I had a very hard time getting around for the 1st couple of weeks, I was so sore! The midwives I had at the time told me I would have to get a c section if I had another baby. Which I never want to do. I had a fairly smooth labor other than that. Natural and no real pain until I hit 7 1/2 - 8 cm.

All of that took place almost 5 years ago and I am pregnant with baby #2 ! I'm older now and much more knowledgable about overall healthy living. I plan on doing a home birth this time around and was worried I would run into trouble and would have to be wisked away to a hospital.. But ladies, you have inspired me! Thank you for sharing your war stories (lol) it has given me a newfound strength and I am determined to have a healthy, fulfilling, peaceful birth


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## trishafarmer

*I did it!!! And it was perfect!!!*

I had an amazing home birth with a supportive midwife! After a doctor told me that I could never deliver vaginally, and that I should have a cesarean (after he cut an episiotomy which caused me to tear through my rectum and sphincter, causing incontinence for months), I DID IT! I delivered a 9 pounds 7 ounce baby at home, with no meds, and had no birth trauma!

I had a beautiful home birth last year, Sept 22, 2013. I had a lot of therapy (EMDR) to help with the birth trauma, and I believe it took the fear out of giving birth. I also took childbirth classes with my husband (the Bradley method) because I knew my best chances for a vaginal birth were it to be done naturally. So, we committed to it and we did it! We learned everything we could, we learned about all the things done in hospitals that are routine based, not evidence (like episiotomy) and we learned how to cope through labor and transition. I have to say, it was amazing. I wasn't afraid of birth, like I was in my first. Every time I had a contraction and saw blood, I focused, told my body to "open" and I knew it was doing it's job. I had no fear. I knew that each contraction was about a minute in a half and that half way through the wave would be the highest but I would come back down...and I did. Each time. I wasn't afraid and I wasn't in pain. I was focused on staying loose and limp and just allowing my body to birth this baby.

My labor was just 2 hours!! And it was awesome! And hour and 15 minutes into labor, my water broke, but up until that time, I was texting my girlfriends and letting them know what was up in between contractions. I was at ease and it was beautiful.

We had tried to do perineal massage, but it just felt silly to have my husband do it, so we didn't. I was worried that not doing it, would have caused me to have problems but it didn't.

Sheryl, my midwife, who has been attending births with the Amish for over 30 years with no running water or electricity, had seen enough that she knew that 4th degree tears just don't happen....someone always causes them....and she knew that my body could do what it was designed to do. She did give me some tips though. I made sure we had warm compresses available for whenever the time was ready for her to support my perineum. She also wanted olive oil to help him slide a bit more. She also didn't allow me to birth in any position that would cause stress on the perineum or have it not be supported, so I gave birth on hands and knees. Being on your back causes your pelvis to close and is too painful. And a squat does cause too much pressure. Hands and knees was best for us and it was perfect.

As he crowned, I breathed. I knew from my childbirth classes that if I pushed too fast, I could cause a tear because my body needed to stretch to give birth. So, I breathed. I breathed my baby out. At one point, he had a nuchal hand, which meant him arm was up by his face, and this caused him to get stuck. For about a minute and a half, Sheryl worked to get him out, using every trick in the book. She was aggressive, but not in a mean way, in how she was trying to get him out because his cord was compressed. Because of this, I did get a 2nd degree tear, but it was minor and the recovery was nothing like not being able to control your bowels and crapping on yourself (which is just too awful to describe or go into detail, which is also why I had ptsd and needed to get help for.)

It was absolutely perfect in every way and I encourage every mama to do what she feels is best for her. If you need a second opinion, go get one. If you feel that you want to give birth, find someone who will support you. Ladies, the choice is yours.

Also, I have my birth video on hands and knees, showing Sheryl supporting my perineum, for anyone to view if they want. Find me on facebook https://www.facebook.com/trisha.stock and I'd be more than happy to share it. Peace, love and happy birthing to you ladies!!


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## trishafarmer

Trisha-bo-bisha said:


> @ Ninabear: How did it go? I just joined this forum, very late, but I am very curious. I, too, had a 4th degree tear, the result of a sunny-side up baby and forceps and I am heavily thinking it all through when we go to have our next one. The more I think about it, the more I want to try, but I fear my husband would rather play it "safe" with a c-section, though we all know the amount of risk and complications involved with that! I think that had he been born in a typical way, I wouldn't have torn, or no where near as bad at least...but he echos the words of our midwife/doctor who said that I needed a c-section the next go around. So...how did you do?


I forgot I already had a profile! I'm trisha-bo-bisha. Scroll down to todays date and hear my awesome story!!


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## trishafarmer

Rainbowbird said:


> Heather, I could have written your post and was about to!
> 
> I had a 4th degree tear also. I had no epis., I just tore. I didn't feel it b/c I had an epidural but the pain afterwards was certainly incredible. I was lucky in that my OB is an excellent surgeon and after a very long healing process, I have no long-term problems. I do have a tiny fistula but it's expected that this birth will cure it.
> 
> I spoke with the OB who delivered my son and repaired the tear the other day. He laid out my options: 1) C-section, which he didn't recommend; 2) medial-lateral espisiotomy to hopefully spare the rectum this time, just in case i would tear in the same spot and end up with long-term problems (that would be AWFUL!)
> 3) No medical interventions and just hope that nature takes care of things.
> 
> I know I won't do the c-section unless abslutely necessary at the last min. I am not sure what is worse to heal from, a c-section or a 4th degree tear. I will say that my friends who had c-sections were healed and running around a lot quicker than I was. However, I know that c-secs have plenty of their own risks and problems, so I would rather avoid one.
> 
> As for an elected epis., I don't know. It might invite trouble, as my OB admitted.
> 
> I am just terrified that I'll tear again and end up with long-term problems. I also fear I'm going to have another epidural, b/c I can't imagine going through the pain of a tear without it.
> 
> Does an epidural increase the risk of a tear? The doc said no, b/c it slows the urge to push.
> 
> Any other thoughts?


yes, yes an epidural increases chances for a tear because it is a very hard position to birth in and there is no support for the perineum! Laying in lithotomy position (with stirrups on your back) was not made with laboring women in mind, rather for the ease of doctors. The best thing you could do to avoid a tear is to deliver on your hands and knees. It is the position with the least about of pressure on the perineum, but to do this, you cannot have an epidural. I must say that my home birth with no meds was 1000x easier than my hospital birth with epi (that didn't take) and painful. Moving while you labor is the best way to manage pain.


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## Trisha-bo-bisha

*support group*

Hi Ladies!! I found a wonderful support group online if you would like to share your great stories with other women who are in the same situation you once faced  If you had a tear and a positive birth after, we'd love to hear from you! if you had another birth later and tore or had a section, we'd still love to hear from you! Birth is powerful no matter how you birth your baby and we welcome all stories and want to celebrate such strong women!

Mothering dot com won't let me paste the link here so if you search "4th degree perineal tears support group" you should find it. Peace and love!


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## Lilian35

If i were you I'd seek multiple medical opinions. Seems an unrepaired fistula isn't something you'd want to risk making worse. If you gather a few opinions from doctors and/or midwives you may find a common thread you can follow for this birth.


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