Vaginal Birth After 4Th Degree Tear

I had all 3 of my babies completely drug free and didn't tear at all with any of them. Just some food for thought. =) Good luck.

You're exactly right! Women who get an epidural are at a MUCH higher risk of tearing because they can't feel where they need counter pressure and they push way too hard.
My cousin had a 4th degree tear with her first for the same reasons - everyone yelling "PUSH" she pushed as hard as she could, the doc didn't do anything to support the perineum and she tore badly. Then her second they got there too late to get an epidural! She was so scared after tearing that she didn't want to push. She held in the urge and her body did all the work really slowly. She pushed at the very end as the baby crowed and she popped out - not even a 1st degree tear! She also had a different doctor who did support the perineum as the baby was crowning.
What you need to do is 1) find a new OB or midwife who is VERY natural-friendly, will support the perineum as a matter of course, rubbing it with KY jelly or oil and using a warm, damp wash cloth for counter pressure. 2) Hire a doula who can help you get through the pain of labor so you don't need the epidural.

Please PM me if you want more information on anything or help finding a doula or care provider. Good Luck!!

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You can also prepare the area by doing massage throughout your pregnancy. Google "prenatal perineal massage" for instructions.

Oh girl go for it and get a good midwife, You wouldn't believe this but I tore so bad with my second, they literally had to stitch my flaps back on (what ever they are called...lol) it does not look the same down there, anyhow I had an amazing midwife with my third which I delivered 2.5 months ago and wow not a single tear or stitch needed. My hubby said it was amazing what she was doing down their when I was pushing the baby out. Now I delivered all of my babies without any drugs, so I know you can do it!! My third I had three years after my second. To give you a full walk through I had an epesiatomy with my first, none with second and a horrid tear issues, over 50 stitches and 1 hour+ of fixing up. And NOTHING with my third. First two were with OB's last was with a midwife!

A friend of mine had a 4th degree tear with her first and likely last pregnancy. She had to have more surgery later to repair the tear since it didn't heal properly and it has caused her a great deal of pain and angst. She too had an epidural and couldn't feel anything when she pushed and feels that contributed to the severity of the tearing. She has done some research and found only a very small percentage of future pregnancies after a tear like this result in another one.

I would recommend if you do decide on a third baby going with a midwife attended birth. There are also ways like water birth and non traditional pushing poses to further reduce the risk. You will need extra encouragement and soothing since I'm sure the thought of pushing is scary after having gone through a trauma like you've had.

Good Luck.

I would stop talking and birthing with a doctor and see a midwife.
I am not a friend ob OB/GYN care, but I also do not want to bash them. They play an important role in caring for women with complications and high risk pregnancies.
But providing you with a satisfying birth experience and protecting you from birth injury and trauma is NOT their first objective! Their objective is to have a fast, economically managed birth with two living patients at the end, no matter what the cost, especially if it's something a "minor" as a tear that can be "repaired".
Some midwives specialize in helping women that have had difficult birth experiences, birth injuries or other traumatic experiences. I would strongly suggest that you just meet with one (or a few until you find one that works for you) to discuss your options and how they can help. They will meet with you before you are even pregnant, often at no cost for an initial consult.
Good luck!

it is most definitely possible! A friend of mine had bad tearing with her first 4 births and with her last had a completely natural, unassisted birth at home with no tearing. I would also suggest just talking to a midwife, especially if you are considering going natural. They are pros at helping you stretch and coaching you to take your time when pushing to avoid tearing and cutting. I know Molly Germash (my midwife) would be happy to talk to you about it. You can find her at http://www.heartsdesiremidwifery.com/ A midwife in general will be more patient and not have you on a time frame when laboring and pushing. They will also be able to offer you hands on comfort measures (if you are going natural) that they can not do for you at a hospital. Good luck with everything!

I didn't have an epidural and trust me felt everthing and still had a 4th degree. I also delivered with a midwife. So, just goes to show you don't ever know. I feel for you though, i'm contemplating how to go about number 2. From what I understand, every birth is different, but the odds of tearing go up after something as traumatic as a 4th degree.

I have an extended family member who had a 4th degree tear with her first, she had her second child vaginally within two years. I believe she had an episiotomy with the second but the overall healing process was better for her. I never heard that her first tear was a cause of concern with future deliveries. I suppose it could be a concern based on how well the intial tear healed? I had a 3rd degree with my first, which was a medicated, vacuum suction birth and minor, superficial tearing with my second, which was a homebirth.

I would talk to your Dr. Good Luck on having a 3rd. No Drug Births are the way to go, I had my second all natural and it was the greatest thing ever.

Obviously I would talk to your doctor about the options. I will say this though, I had an epidural with my first and was given an episiotomy. My second came naturally and I tore with him. I could feel everything and still tore, which took much longer to heal, than with my first when I could not feel. I think you've gotten some great suggestions: have your doctor give you an episiotomy in a different location, take your chances, or try some other methods like possibly a a midwife. I have also heard of doing some type of vaginal or labial massages to stretch the tissue out some prior to delivery? Don't know details, but again could be worth asking. I would talk to your doctor and find out your options, but I would hate for you to have to give up on your plans of having 3 children. As someone else said, there really is no guarantee that you won't have to have an emergency c-secion, so it's a calculated risk either way. Just get all the information so you can make an informed decision.

I had a fourth degree episiotomy with my first. I had my second child vaginally two years later and my third vaginally about two and a half years after that. I ended up with episiotomies with all three children. The first two I had an epidural and my last I barely made it to the hospital and gave birth naturally. (Which I had always hoped to be able to do) But, I still needed an episiotomy. Unfortunately scar tissue doesn't stretch as well.

Now I have a urethral prolapse which I think may be due to that first fourth degree episiotomy.

With the birth of my first child, I, too, couldn't feel a thing and it resulted in not being able to push him out without help. So, when I went in for my second child's delivery, I told the anesthesiologist about my previous problem and he worked with me to get the dosage exactly right. I could feel everything, but most of the pain was gone. I had no problems with the delivery except that I had a very large baby that resulted in lots of tearing. I did heal and am considering having a third. My suggestion is to talk to the doctors and let them know of your prior experiences. As far as in and out of consciousness goes, I've never heard of that with an epidural and you can never be sure a c-section won't have to be performed in case of an emergency.

with my first, I had a midline episiotomy with a tear almost to my rectum. My second, I had a very small tear that did not even require a stitch and the third was delivered intact. So, I guess the answer would be yes, it is possible. There were 15 months difference in the first 2 babies. I haven't ever used an epidural.

My first was a 4th degree tear. I tore to a 2nd degree with the 3rd and didn't tear with the last 2. I never did an epidural and I never had a c-section.

You'll do fine. It's just nerve wracking thinking it will be that bad. I was so relieved after the 2nd birth when I realized I was OKAY.

I had a 4th degree tear with number one and didn't tear as much with number two. Both births came without an epidural (I wanted one, but I just deliver too quickly!) I've healed and never had any further problems.

Your concerns are understandable, but don't let it stand in the way of getting your dream family. Talk to your doctor, or look into a midwife. I think in your case, a water birth sounds idea.

Good luck with your decision, it's a tough one. Let us know what happens!

I had a 4th degree episiotomy with my first after the dr. broke my water and I had a heavy epidural. I went on to have 2 natural births with absolutely NO tears and no medication. I also had midwives with the other two babies.

Call me for advice on care providers obs and midwives. I am a Certified Birth Doula and a Bradley Method® Childbirth educator. I can help!!

Your choices of care are your key to helping you achieve your dream. Don't give up on having your third child.

K. Voigtsberger
www.wholeheartbirth.com
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S.,
This is totally out in left field, I know, but I read at one time that eating lots of fruits and vegetables builds up collagen in your skin and reduces the chances of stretch marks and tearing. I thought, that I didn't have anything to lose and so ate 8 fruits and vegetables per day as a preventative measure. Genetics have a big part to play too. Might help. Can't hurt.