Anyone else have 4th degree tearing with prior pregnancy?

[Anonymous]

I had a fourth degree tear with baby #1. While quite painful initially, I have healed well and have no lingering issues. I am now pregnant with #2 and very much want to try to deliver vaginally again. I had vacuum/forceps with #1, so the tearing was due to the episiotomy. I have talked to my doctors about what to expect this time (I am seeing new OBs this time). They said that women with 4th degree tearing are offered an elective c-section if desired (which is consistent with what I heard from my old OB). They also said that women with 4th degree tearing may tear again in the second pregnancy and have incontinence issues later. I don't want to end up with serious issues, but I am also not interested in the least in an elective c-section.

Anyone have a fourth degree tear previously - what did you do for subsequent pregnancies - did you tear again - any issues? Do I have any hope of delivering vaginally? I really do not want a homebirth and prefer a hospital birth with an OB (in case I tear again, I want a surgeon stitching me up). I would like to deliver at Virginia Hospital Center - any recs on docs who would support vaginal birth after 4th degree tearing?

Thanks in advance!

[Anonymous]

I have not had this myself, but wanted to let you know that my good friend had a 4th degree tear with her first and then went on to deliver twins vaginally with her second pregnancy. She tore again, but not nearly the same amount, so it can be done. Good luck!

[Anonymous]

So sorry you had this experience. You will lessen your chances of tearing if you push in a vertical position (ie, squatting), or even on all-fours, rather than in a reclining position. And don't get an epidural because that greatly increases your chances of needing vaccum/forceps. A waterbirth would be helpful. You can have a waterbirth at the DC Birth Center.

[Anonymous]

I agree with the PP. Use a midwife who will know how to 1) help you have a natural childbirth so that you have far less chance of needing forceps in the first place (it is almost always the introduction of drugs into the birthing process which leads to the fetal distress which necessitates instrumental delivery) and 2) will help you birth in a position which reduces tearing and 3) knows how to support the perineum so you don't tear. Also, the DC Birth Center is the only place in washington DC where you can have a water birth. Water birth is shown to greatly reduce the risk of tearing. You could make a deal with them that if you wind up tearing, that they transfer you to the hospital for a surgeon to stitch you up. But in all likelihood, you will not tear at all if you take care in choosing a provider who has the skills to keep you from tearing in the first place.

[Anonymous]

OP, your story with #1 scares me, would you mind sharing the name of the doctor who delivered you? Thanks.

[Anonymous]

To answer your question, I can't say for sure which doctors would proceed with a natural birth after 4th degree tearing. But Dr. Crowther and Certified Nurse Midwife Karen King at Arlington Women's Center (at VHC) would probably both be very open to it, based on my interactions with them.

They both are strongly supportive of natural births. For example, Dr. Crowther is one of the only OBs in this area who will delivery twins vaginally. I really like them both, and I love the practice overall.

Two additional points - first, you would need to discuss delivering with Dr. Crowther (and no one else) with her directly. They have an on-call rotation, and she only "guarantees" to deliver very unique or special patients (like the twin example above), so you might want to make sure you fit within that category or else you will have no way of knowing who will deliver you.

Second, even if you want an OB to stitch you up, don't rule out Karen King. She told me that does her own stitching if it's a mild tear, but for anything more significant, she has the OB do the stitching. And once you get to know her, she's very receptive to discussing things like this, so you could always ask if the OB could stitch you up no matter what. The midwife/OB combo might be a great way to accomplish all of your goals.

Good luck!

[Anonymous]

Anonymous wrote:OP, your story with #1 scares me, would you mind sharing the name of the doctor who delivered you? Thanks.

How insensitive!

[Anonymous]

Anonymous wrote:To answer your question, I can't say for sure which doctors would proceed with a natural birth after 4th degree tearing. But Dr. Crowther and Certified Nurse Midwife Karen King at Arlington Women's Center (at VHC) would probably both be very open to it, based on my interactions with them.

I had a third degree tear during my first delivery and was very pleased with the extensive repair work that my OB (Julian Martinez) performed right after delivery. He used to work in the same office as Dr. Crowther and Karen King, but is now w/ a new practice that delivers at Fairfax. He and Karen both assured me that I'd have no trouble delivering #2 vaginally, although, frankly, I'm not sure whether I'm going to take the risk. I had a minor issue w/ controlling gas right after delivery that (THANKFULLY!) went away by my 6-week follow up. However, that may have shell-shocked me enough into a c-section for #2. I healed much better than I feared I would and I just don't know if it's worth tempting fate. Although, I've heard of women who have taken months for any issues to resolve, though they DO generally resolve. For me, that would be a LONG couple of months of waiting.

I also have to say, that I completely sympathize with you on this! Everyone has battle wounds. Maybe you should ask your OB for a referral to a gastroenterologist-- just a thought-- but maybe they can look at the scar tissue and help you make a more informed decision.

[Anonymous]

PP here-- didn't mean to make my reply look like a long quote... Oops!

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP, your story with #1 scares me, would you mind sharing the name of the doctor who delivered you? Thanks.

How insensitive!

I don't think it's insensitive at all. If I had had a bad experience with a doctor, I would tell other people about it to make sure that the same thing does not happen to them.

[Anonymous]

Get a midwife to help with the delivery. I got lucky when I delivered at Reston Hospital in Nov 2007. My nurse used to be a midwife and b/c of all her hard work, I did not need an episiotomy nor did I tear but a little. I credit the midwife, not the OB as she did nothing.

[Anonymous]

OP here - I REALLY appreciate the information PPs have provided.

For the inquisitive PP - as far as the OB for #1, it was an on-call doctor (whose name I don't remember) from a different practice than my own (they did practice sharing). Other than the fourth degree tearing, I thought the OB was very attentive (better than the doctor from my own practice who was there earlier) and took over from my normal OB practice (which I was fine with, because I didn't like the OB from my practice who was on call). The situation was went like this... I was doing fine - had been in labor for 15 hours, finally decided I needed an epidural, labor slowed (typical side effect that I knew was a possibility), needed pitocin, finally dilated to 10 cm after 2 hours, then started pushing. Pushed for over 2 hours with baby doing fine. Baby's heart rate started to drop, so they attempted vacuum extraction, which failed, and then they reverted to forceps. They used some kind of special forceps (can't remember the name), but baby surprisingly had a beautiful head and no marks/bruises. My pediatrician was shocked when I said baby was forceps delivery. The OB was very careful with stitching.

I was VERY tender for several weeks post-partum, but what helped was icing for 2-3 days - and getting a new icepack every hour. The nurses at Fairfax gave me plenty of supplies to take home. My normal OB office suggested baths in epsom salts (instead of letting it all hang out in the sitz bath) and that made a huge difference and was much more comfortable. Literally, I sat in the epsom salts for a couple of hours a day. I have also been religious about Kegels. I have been fortunate not to have issues with incontinence or gas.

At this point, I am going to talk to my practice again, but consider talking to Crowther/Kane. Call me crazy, but I really want to try for a vaginal delivery again and am optimistic it will go better. Was hoping to hear from anyone else who might have gone through this in the past.

Thanks again!

[Anonymous]

Had 4th degree tearing plus MRSA staph infection in episiotomy after delivering my first child. I elected to have a c-section for a number of reasons, and while my doctor fully supported me he certainly did not push me towards that decision (we talked about the pros and cons of both a vaginal and c-section and then I made the call -- and he fully supported me). While recovering from the tearing and staph infection wasn't fun, my decision for the c-section was prompted by the actual vaginal delivery. The doc needed to use a vacuum to get the baby out -- my bone structure is on the smaller side (even though I'm 5'8" and not petite) and the baby kept getting stuck each time I pushed. It wasn't fun -- it was scary. My first was only 7.2 (delivered at 38.5 weeks), and I felt like baby #2 was much larger. I didn't want to try vaginally and then get into a scary situation requiring an emergency c. After I made my decision, my doc was fully supportive. He told me that because he sees older patients as well (women in their 50s, 60s and beyond), he knows the toll that multiple vaginal deliveries can take on a female body. I agreed. FWIW, baby #2 arrived via scheduled c-section at 39 weeks and weighed nearly 9.5 lbs.

[Anonymous]

OP, it sounds like you had quite a nice recovery, especially for a 4th degree tear. Just for the sake of comparison - I had a c-section, and it hurt (not just soreness, but actual pain) to get out of bed for about 2 MONTHS after the surgery. (And yes, I know there are many women, including those who post here, who heal much faster).

[Anonymous]

OP here - thanks last poster for your info. It is hard to compare healing times on something you have not had, but I am concerned about a long recovery from a c-section. The 4th degree tearing sucked (and I did not want anyone going near there for MONTHS), but I did heal and I know I could do it again, but the doctors freaked me out when they said I had a 10 percent chance of having further damage that may result in incontinence - yikes!