C-section After 4Th Degree Tear

I had a second child after a 4th degree tear and only had a small episiotomy. She was only 4 1/2 lbs, but came out folded in half (feet, head, hands all at the same time) and it was a very small cut. I would say go for it, c-section will take 6 weeks to recover from either way, with a vag. delivery you have a chance to come out with a less invasive situation. I would definitely talk with your ob about anything you can do now to stretch the skin out too.
Good luck!

I had a pretty good tear from the first baby.. Her head was sideways and they ended up using the vaccum. I recovered but it was a rough and painful week or two..

My second child was almost 2 pounds larger but he was lined up perfect for birth.. My labor was 5 hours long start to finish.. I pushed for 10-15 mintues... it was a breeze..

After the frist baby my first words were that really hurt.. after the second baby my first words were that was easy..

So... your second birth will be totally differnt .. it will probably be sooo much easier.. do talk to your dr. but dont worry.. it will most likely be super easy..

your so far along I am not sure if you can do it. But worth a try I don't what hosapital you go through but crititten offers hypno birthing it is awesoem it is where you hypnotize or actually meditate out your baby. Go to the book store by Hypnobirthing the Mongan Method. I have a cousin who ripped not as severe as you but she was at a level 2 rip. She is doing this with her second. Also Don't take this the wrong way but each child is different. I have had four with 5 on the way each delivery has been different along with every pregnancy. This is your second it could go fast and quick or slow and long or medium and normal. Because what happened with your first is not what will happen with your second. Fear is in everyone don't let fear over come you. There are oils you can use along with a perineal massage. You can do stretches and excersise to give birth so its better on you. I use and essential oil from Young living but you can use Virgin Olive oil, Sweet oil, Almond oil, Apricot oil, or any lubercating gel. Your husband can help you if you can't do it because of your size. If you have not been doing this since 12 seeks get to it now I would do it they suggest once a day but if you haven't been doing do it twice to three times to get ready. Put a little oil all over you first two fingers and thumb. Insert you finger to the first to second nuckle of you hand gently push and smoothout the perineal area your perineum, vagina area, and your whole lip area. Also start doing frog swats and sit on your bumb and do butterfly stretches to help stretch you lower area. Aslong as you fit and ready you will be good. I would do these excersise once a day the book i mentioned has all this in ther for you. Good luck and will keep you in our prayers.

I have not been through this, but I had a c-section as my delivery was rough. I was six weeks early and baby was not in a happy place. My body was SO NOT READY to give birth... Not a good situation all around basically.

I would venture to say you may have scar tissue, right? Have you consulted your OBGyn to see what their opinion is and what your options are? Also, as unpleasant as it seems, massage to the perineum assists in allowing you to stretch if you prefer a vaginal delivery. I think you could ask the OBGyn about it and I know some L&D nurses do this as well at delivery time. (of course, by that time, tearing occurs more.).

There may be a few options if you look around, but I am not sure other than what I suggested.

Congratulations D. on Baby#2! A couple of questions to consider as you decide...How is Baby's growth rate? On track to be another 8 pounder? What does your Birth consultant say about your pelvis now that you've delivered one? Do you have gestational diabetes or a lot of weight gain?

About the perineal massage...it is very helpful! and something best started now. I can help you find an oil that will make it even more effective if you'd like.

You've received good informative advice about the pros and cons of both sides...make the best choice you and your husband can and decide not to stress over it. The stressing is hard on all of you.
warmly, M.

Depending on how well you healed after your tear (and considering any symptoms you continue to have as a result of the tear) you may be able to have a vaginal delivery without the same problem occurring again. I just wanted to point out that physical therapy for the pelvic floor muscles (by a therapist specially trained in this area) can be very effective in helping you to regain your strength and muscle function (continence, sexual, etc)either before, during, or after the pregnancy. Before you decided to deliver vaginally again, though, you may want to get your scar tissue assessed to determine whether it is strong enough to tolerate another delivery. Good luck!

You probably have more than enough information to go on, but I'll just add my two cents as well.

Like you, I had a 4th degree tear and episiotomy with my first baby. With the second I had only a couple of minor stitches and with the third, fourth and fifth, I had absoulutely nothing done and super quick recovery times. There are never guarantees with either method of delivery. But most likely, you will find that a second vaginal birth will be completely different and so much better.

And as some of the other moms have said: perineal massage really helps. My doctor actually used massage during the labor as the babies heads would come down and I think that really helped me to stretch gradually.

Good luck!

You have a lot of good comments already but I wanted to let you know about my experience and hopefully ease some stress...

With my first son I pushed for 2 hours had to use forceps and ended up with a 4th degree tear - it was awful as you know!

I too was very nervous with my second child however my doctor's were very good at reassuring me that every birth is different and that the second time around won't be as bad. Whether it was becasue my body had done it before or the fact that the doctor I had the second time was not as old school as the second, he was so good and did a lot of things to help me deliver the baby including trying to help stretch the perinium (sp?)during delivery. I still pushed for 2 hrs but after 2 hrs he gave me the smallest episiotomy and I had a healthy baby and I was 1,000,000 times better then the first (no tearing at all)!

So what I am saying is be strong in your delivery, hopefully you have a doctor who is willing to help you, if you think he/she won't then look into getting a midwife (my doctor actually worked along side one during my whole delivery - think she was in training she was just observing). He is just the kind of doctor what wants mom AND baby to be healthy - when I told him about my first deliver he said "I don't do that"!

After having such a wonderful 2nd deliver I pregnant with baby #3 right now!!!

There is only ever one reason for a 4th degree tear, and you got it: episiotomy.

Find a doctor who knows why they happen and how to avoid them (including the labour management that stops women from EVER having to 'push' for more than 2 hours --that's ridiculous).

Genuine tears heal more quickly and more effectively, and have no muscle-related side effects, like those you mention.

C-section side effects include many muscle-related problems, plus the risks of the drugs and the surgery itself (including higher mortality rates in children and mothers --the single reason the US now has a mortality rate equivalent to India and China, and rapidly increasing.)

Although I can not comment on the 4th degree tear... I wanted to tell you this. Most drs don't mention this fact.

The first child is the hardest. Your body did not know what was happening to it.
I am currently preggers with my 4th child. My 1st I did have an episiotomy (2nd degree tearing also) and a vacuum assist after 3 hrs of pushing and 22 hrs of labor (time from the water broke). healthy 8lb 3oz girl.
2nd child... No episiotomy no rips, vacuum assist (he had a big head and they just helped guide it down)45 min of pushing after a 10 hr labor (from time water broke). Healthy 9lb 7oz boy.

3rd child. No episiotomy (dr did put in one stitch for "looks") no vacuum. 7 pushes over 15 min. after a 5 hr labor. Healthy 10 lb boy.

My suggestion is the tub.... With both of the boys I was in the tub for a while during labor. The warm water relaxes you, speeds up the labor, and loosens things up down there.
Your body knows more about what is going to happen so you will recognize the signs of transitioning more and you will be more relaxed thru the whole process... I had both boys with NO drugs at all.

I am not one to automatically suggest people sign up for c sections... but it is a personal decision that only you can make. Yes, there COULD be risks... and of course the dr wants you to take the easy way of a scheduled 15 minute delivery... But do what YOU feel lead to do.
Good luck and happy delivering!

Congrats! Only you can make this decision -- but remember every birth experience is different.

My story:
1st baby: pushed for 3 hours, vacuum delivery, 4th degree tear AND fistula infection afterwards. Painful!! Long revovery!

2nd baby -- terrified, but went w/ vaginal delivery. I was induced just 3 days early due to the large head size. Pushed for 20 minutes and NOT ONE TEAR!! Unbelievable after that firstexperience!! I was so glad we didn't opt for a C-section!

3rd baby -- pushed for 1/2 hourm and minimal tearing -- just a few stitches.

Funny thing is -- each baby had larger heads than the previous one, yet the 1st was by far the hardest!

Best of luck w/ your decision and a safe delivery!!

I can only respond to your concern about a second c-section. I had my first daughter c section and didn't want another one for the reasons you can read below. Everyone told me how risky it was, etc. I ended up feeling like a failure if I didn't deliver vaginally. However I never went into labor. I effaced, but didn't dialate all three times. I have had three healthy children by c section. The recovery has been fine and the only problem I have is that I have had 3 children over 10 pounds. Since they are large babies, they want me to go in earlier than I should have. Stand your ground and wait as long as you can.

remember to take into consideration the amount of children you plan on having. If you plan on having more, and you have a csection this time, the risk go up with future csections.

I posted this same question months ago! I am as we speak recovering from my csection (3 weeks ago) and it is a world of difference from the fourth degree tear!! The healing the first few days is just as bad, but then you recover much quicker. You have to take it easy of course, but last time it took me four months before I could even go out in public and walk more than a few minutes. And a full year to feel as good as I do now after a mere 3 weeks post csection.

Pain aside, most people who advise against the risks of csections have never had a fourth degree tear. There are innumerable risks with that too that they don't know about. I was not ready to be incontinent for the rest of my life at 29 yrs old... I was lucky I didn't have permanent damage the first time! Would I be as lucky the second time, I wondered? Is it worth the risk to tear again when "you'll probably be okay and not tear like that again"...? "Probably" wasn't good enough for me. Especially when csection risks are lower and lower these days, the doctors do several a day now. I was in and out of there in 18 minutes.

If you have more specific questions about the pain, the meds, the surgery etc...feel free to pm me. I was just in the same boat as you!

D.
GO Vaginally!!

I went through the same thing. 27 hours of labor and pushed for 3 hours. They used the vacuum AND Thongs to get my baby out. I had 4th degree tears and it took an hour to stitch me up after delivery. My beautiful girl just now turned 3.

I was pregnant again 4 months later. Second delivery: 9 hours of labor, pushed 20 minutes and out with only an episiotomy.

Go for it. Your body knows now what to do, it will go much smooother the second time.

GOOD LUCK!

D.,

I had a 4th degree tear also. I disagree with the woman who said that you only get that with an episiotomy...I disagree, I've watched my video, no episiotomy, 4th degree tear! I tore so bad, I was in surgery for 1 hour for them to sew me up. And that was 2 surgeons sewing at the same time.

I am 14 weeks and at my last appt talked to my OB about this same issue. She stated it was my choice she would support either way.

One thing that complicated my 1st delivery is that I had 2 injured ribs that literally did not allow me to push. I was hoping that they would be healed enough for this birth but I am already starting to feel some pain with the added weight in front. I guess that's probably because my son is only 11 months old!

I will not tell you what to do, but I will tell you what I am going to do. I am going to make a birth plan that states I want a vaginal delivery but if at any time I change my mind (unless it would be a danger to me and my baby) I will switch to a C-Section. I know what I can and I can't handle now, and my last birth I can't handle again.

Good luck, let me know what you decide and how the 2nd birth goes, I would be very interested to know. God bless and take care.

I was very scared after my 1st DD was born to have another. I pushed for 5 1/2 hours thy tried a vacuum 6 times then my placenta didn't deliver and they reached in 5 times o get out all the peices. I didn't start to heal from the episiotomy/tear for 6 months and that was after going though physical therapy. Intercourse still hurts and I have problems with incontinence as well. My 1st was only 6lbs 9oz but was posterior. I was so worried that I researched how to not have another episiotomy. I would recommend doing perineum massage I really think it help. With my 2nd I pushed for 2 1/2 hours she was sunny side up as well and weighed 7lbs 4oz but I only had a very small tear. My Dr. agreed we would not do an episiotomy unless it was an emergency situation. I would check to make sure your Dr. agrees to not do one as well. Good luck.

Your first delivery was the same as mine. I know exactly how you felt. You couldn't walk, sit or do anything, or at least I couldn't for like 2 months, it was horrible. I don't know if you ripped into your rectum or not, but I did, which made it even worse! With my second baby, who was only 18 months after my first, I had no problem. I went into labor, no problem, pushed for like 30 mins and out popped a 9.5lb baby. I did rip just a tad, but it was nothing. I didn't do anything special leading up to the delivery, or during the delivery. The dr. said my skin was so stretched from last time that it has enough play this time that I didn't damage anything. I personally wouldn't do a c-section just due to the complications and recovery time. After my second child, I was up and walking around no problem 3 hours after birth. I remember feeling great and wanting to go home the next day. It was completely different birth with each of them, but I would highly recommend staying away from c-section. Good luck with it!

Definitely go vaginal. The 2nd one really does come easier and faster. I had similar concerns with my 2nd one, since after the long long pushing (2.5 hours) with my 1st child I ended up with a rectal fissure! I delivered my 2nd baby vaginal with no complications.
Good Luck and congratulations

I had a very similar situation with my first child: pushed for 3.5 hours, baby in distress, vacuum assist and a 4th degree tear. Then, of course, the weeks of healing.

I had talked to many women that went through similar situations that now have trouble with incontinence and are going through physical therapy to rebuild their muscles.

I was so scared about my second delivery. When I went into labor the dr gave me all the pros and cons of each, vaginal and c-section. We went with a c-section and it was way better than what I experienced with my first baby. I was able to enjoy her in the hospital and care for her more because I felt like a totally different person. I was even discharged from the hospital much earlier than with the first baby. And my recovery time was much less.

The thing to remember is that every woman is different and every delivery is different. You may not have the same issues that you experienced the first time. Or it could be similar. Unfortunately, it can't be predicted. You have to way your options and decide what is best for you. Good luck!

HI D.,

Rest assurred that the second delivery will be nothing like the first! You've already gone through the hard part and the 2nd one will be so much easier, because now your body knows how to handle it. I also had a 4th degree tear with my first, and I don't even remember tearing with the second or third. The 2nd was so much easier all the way around, so try not to be afraid of it. One of my doctors said that no woman should ever have to go through a first labor/delivery, because in many ways that is the hardest on the body, but the miracle is that your first paved the way so it is easier for the 2nd!

D.,

I too had a 4th degree tear after a difficult delivery with my first born child (over 9 lbs). I also had an episiotomy and a vacuum delivery. My recovery was a very slow painful one, I had trouble even walking for a couple of weeks, I refused to carry my son for the first several days for fear I would not be able to! I should probably mention that he was induced at 41 weeks.

Needless to say I was VERY concerned about my second pregnancy, but much to my surprise my second one came a LOT easier, although still past 40 weeks, but I was not induced. I didn't even have time for an epidural as she came very quickly. They did not do an episiotomy and I tore just a little, but the recovery was day and night different. I carried her out of the hospital after 24 hours in her carseat (she was 7lbs, 15 oz) and was able to sit and play on the floor with my 20 month old the day after I got home from the hospital. So hopefully your second one will go a lot easier, I think you should probably try as the C-section recovery has got to be worse and would slow you down (especially with two small children at home).

Best of luck to you!

D.,

You have gotten a lot of good advice. But I would like to tell you my story.

Child #1 Had him suction out tore so bad I lost a lot of blood and had to had a blood transfusion and took months to recover. Still to this day have urinary inconstancy.

Child #2 was the easiest birth I ever had. went in at 12:30 had him at 3:00 with only a mild pain relvier and only tore a little.

Child number#3 was 10.82 lbs sunny side and they could not get him in the birth canal had c-section. I was allergic to the tape and had a huge infection over my stomach I could not even wear underwear or pants without hurting It took me just as long to recover if not longer. Now I was recovering from a broken arm. But I found it very painful just to sit up and feed my baby it was not like that with child number 1. If I had a choice I would definitely go with natural. My stomach muscle will never be the same a again.

But that is your chose and only you can choose.

Hi D.! I had a very similar experience with my first birth. I pushed for 5 hours, had a 4th degree tear and then developed a staph infection in my episiotomy site that lasted 3 months.
We waited 3 years to have another because I was so terrified. My second birth was AMAZING!!! My labor and delivery was literally 60 hours shorter than the first time. I only tore a tiny bit and pushed for forty minutes!
I couldn't believe the difference! I was so stressed about delivery for the couple months of my pregnancy that my body itched uncontrollably. If I had only known! :)
Congratulations on your upcoming baby and I hope and pray that your second experience is as wonderful as mine was! Blessings!