Vaginal delivery after 4th degree episiotomy

stlmomof2

This is my second pregnancy. Doctor did a cervical check and although they don't mean much I have started dilating so she wanted to know how I will deliver if I went into spontaneous labor.

I am scheduled to have a c section at 39 weeks because I had a traumatic vaginal delivery with DS that ended with a 4th degree episiotomy. For those that don't know it's a cut from the vagina to the anal sphincter(i believe the muscles that control bowel movement). It was a pretty painful recovery but the OB that delivered me, I never met (on call doctor) and told me I could never have one vaginally again as if I tore I can risk fecal incontinence.

My current OB who will be delivering DD as well believes that since this is a second pregnancy babies usually come faster and easier and believes I can do it vaginally especially now that we know through a growth scan yesterday that DD is measuring small! I'm scared to death though either way. That is my problem. I have never been under such a major surgery... Yet I don't want to risk pooping myself if I tore again. I have expressed my concerns to my OB and she said spontaneous labor = play by ear, c section at 39 weeks if I don't go before then. Deep down I want to try a vaginal delivery but my first labor with DS is haunting me lol.

Any other TB moms have a major tear yet delivered successfully vaginally?

Edit: DS was a large baby 9 lbs and my current OB believes that's why he was hard to push out. I believe the induction process, epidural and Pitocen could of resulted in the episiotomy.

kynbar5

There's a lot that goes into all of this. 9lbs really isn't large. The "growth" scans are notoriously off a lb or two in either direction. I've given birth (vaginally) to an almost 10lb baby with an epidural and pitocin and had no tearing. The only baby I tore with was my 1st. He was only 7lbs. I tore and had an episiotomy. One of my best friends had a 4th degree tear with her 1st and delivered her 2nd vaginally with no problems. This is just one of those things you have to make your own decision and decide what's best for you and if you trust your doctor then go with their advice.

stlmomof2

kynbar5 said:

There's a lot that goes into all of this. 9lbs really isn't large. The "growth" scans are notoriously off a lb or two in either direction. I've given birth (vaginally) to an almost 10lb baby with an epidural and pitocin and had no tearing. The only baby I tore with was my 1st. He was only 7lbs. I tore and had an episiotomy. One of my best friends had a 4th degree tear with her 1st and delivered her 2nd vaginally with no problems. This is just one of those things you have to make your own decision and decide what's best for you and if you trust your doctor then go with their advice.

You're right. I told my OB I knew women that had over 9 lb babies that had no issues at all delivering. So why did it happen to me? She commented on my figure, how I have a petite body frame but whether that is the whole reason, I am unsure.

As time gets closer I am feeling even more anxious about it all. DH isn't helping at all. First he tells me he doesn't know if he can be with someone that poops themself (if I tore) and wants me to have a c section no matter what then just the other day he tells me that it's all my decision, he won't be responsible for what I decide to do.

Good to hear your friend's experience though.

Bigboobsmcgee

This is a tough choice and I'd be a little nervous too.

I had a 3, almost 4th degree tear with my first child and he was 9lbs. I had Pitocin, epidural and pushed for 3 hours with him. The recovery was really bad too. My second child was also 9lbs and I had her in 30 minutes, med free. She literally just slipped right out (well, with a shit load of pain too) but I had minimal tearing with her and the recover was a piece of cake.

Based off experience I know how quickly second babies can come BUT every labor is so different so you can never be truly prepared. You just have to gather all the facts, listen to stories and then make the decision you feel is best. I don't envy you because this decision won't be easy.

skruhmin

So much for better or for worse, in sickness and in health.  If you need to get a second opinion to back up either OB, you might want to do so - for peace of mind. 

Sarcasm101

I wouldn't risk it. Damaging your anal sphincter is a really big deal. You might not be able to ever hold your farts or poop again. Not to mention how painful sex will be. My good friend had a 4th degree tear and is still in physical therapy 10 months later.

I realize a C-section is major surgery and a longer recovery but I would take a 6 week recovery vs a 10+ month recover any day.

DrillSergeantCat

@bigboobsmcgee I've seen you say a couple times that your second came very quickly. This is something I'm mildly concerned about as my hospital is 20 minutes from home and work. Did you have no labor pains except for 30 minutes?

Bigboobsmcgee

DrillSergeantCat said:

@bigboobsmcgee I've seen you say a couple times that your second came very quickly. This is something I'm mildly concerned about as my hospital is 20 minutes from home and work. Did you have no labor pains except for 30 minutes?

My hospital is about that far away too and I always feared I wouldn't make it.

I was induced with my son so I never felt a real contraction before. I started feeling what I thought were BH's at about 2am on the day of my due date with DD. They hurt worse than BH's but they weren't consistent and they kept letting up so the hospital told me not to come in.

At 5am they stopped all together so I watched TV and relaxed then at about 8:30am, BAM! There was no doubting that I was having real contractions and I could barely talk or even walk but they were like 10 minutes apart and again they said DON'T come in. I showered, planned on dropping my son off at my mom's and then go to the hospital but by the time we got in the car, contractions were just minutes apart and I thought I was dying. We went right to the hospital, hubby dropped me off out front and I ran inside and basically collapsed! I checked in at 10am and had my daughter at 10:37am. The labor progressed so damn quickly and I should have gone to the hospital at 2am when it all started.

jess9802

OP, if I were you I would request a referral to a urogynecologist. He or she might give you a much better idea of the risk vs benefit of a planned C-section or a vaginal delivery, how likely you might be to tear again, and what the repair and recovery would be like. Frankly, with a 4th degree episotomy you have a much higher risk of incontinence or prolapse even if you had never had a second baby. The damage often doesn't show up until menopause. I would probably choose a C-section if I were in your shoes. I would not want to risk a 4th degree tear.

MississippiCatfish

I had a significant tear (never asked the degree) with an anal fissure after my first childbirth that I still struggle with at times. It was so very painful for the first several months - couldn't sit in the chairs at church for months, for example. I had spasms that were the worst part - so painful. All that to say, I would imagine it's nothing compared to what you've been through. I was unable to hold in gas for a while and it was really embarrassing. I think I had one or two episodes of incontinence. If I were in your situation, I would choose a c-section. I would personally rather deal with the more standard procedure, even though recovery can be tough, than face that unknown. But that is just my personal decision. Best of luck to you.

stlmomof2

Thank you. I am sticking with my induction date but even though with a 4th degree tear.... I never got the symptoms as everyone experienced. I was walking to the bathroom on the same day, didn't poop for a week but was still able to with slight pain. I only took Tylenol when I got home even though they prescribed me oxycodone. I never had a problem holding in gas or my poop. I think they did a great job at stiching me back up.

The unknown is definitely scaring me. My current doctor says she's I'll do whatever I wish but sincerely believes I will be okay doing another vaginally. She did tell me there is always a chance of tearing again... Something that doesnt sit well with me.

MamaRoni

That's a hard call...
My sis had a 4th degree into the rectum with her first and recovery was TOUGH. With her second 8 years later.... she had a very minor cut and did fine. However. .. 16 years later (now) she has uterine prolapse and bladder issues that needed surgical correction. She's great but swears it's all linked...
I had a tear that literally only needed one stitch with my first but was forced into a csection with my twins. My first delivery was a breeze with no complications. ... my csection surprisingly was too. It's a matter of choice

jenniferamcooper

I have a friend that had a 4th degree tear and dealt with pain and recovery for about 6 months. I know it was 6 months because I had my baby via emergency c section and I made the comment that I'm finally feeling healed and she said "you know what, me too". It broke my heart.
My c section recovery wasn't too bad. I had issues surrounding pain management, if I was 30 minutes late taking my pain meds during the first week I'd shake uncontrollably. It was weird but not painful. I had a lot of help at home after baby was born and felt back to myself after about 5 weeks but honestly did short walks after 3 weeks. Just thought I'd share my story to let you know what a c section is like. It's not ideal but they're not all awful.

clairemwalker

My sister in law had a 4th degree tear with her 8.4lb firstborn, and had issues with the healing and scar tissue. she also suffered bladder prolapse since that delivery but she says that the prolapse had more to do with the traumatic labour (posterior presentation, hours of pushing after an epi) she also needs surgery to correct the scar tissue but decided to wait until after subsequent children . . The delivery of her 8.11lb second born was very quick (1.5 hours from onset) but she didnt tear at all. They gave her a small episiotomy but she said the healing from that was a breeze compared to before. She says she was glad that she did not opt for the c section (number two was late so she would have had the c section on her due date if she had gone for it) but maybe she would be saying differently if the second delivery had not gone well. Could you see a specialist regarding you situation? My SIL did and it helped her made the decision to try naturally, but she went in there knowing that if he recommended c section that she would do that. Sorry for the ramble, i hope things go well for you!

fourtsixand2

This is just my personal opinion, and only that, since I'm a first time Mom.
If it were me, I wouldn't risk it.  
My sister has 3 children, all of which were forced cesarean sections, which she did not want.  I know she always felt a little saddened that she wasn't able to deliver vaginally, but for the sake of her health and each of her babies, she went with the recommended birth plan.
4th degree tearing is pretty traumatic.  I would just hate for you to risk something even more traumatic happening.  Definitely a difficult decision, but if you are having your own worries and concerns, please go with what your gut tells you.
Best of luck to you!

shelbibrooke82

stlmomof2 said:

There's a lot that goes into all of this. 9lbs really isn't large. The "growth" scans are notoriously off a lb or two in either direction. I've given birth (vaginally) to an almost 10lb baby with an epidural and pitocin and had no tearing. The only baby I tore with was my 1st. He was only 7lbs. I tore and had an episiotomy. One of my best friends had a 4th degree tear with her 1st and delivered her 2nd vaginally with no problems. This is just one of those things you have to make your own decision and decide what's best for you and if you trust your doctor then go with their advice.

You're right. I told my OB I knew women that had over 9 lb babies that had no issues at all delivering. So why did it happen to me? She commented on my figure, how I have a petite body frame but whether that is the whole reason, I am unsure. As time gets closer I am feeling even more anxious about it all. DH isn't helping at all. First he tells me he doesn't know if he can be with someone that poops themself (if I tore) and wants me to have a c section no matter what then just the other day he tells me that it's all my decision, he won't be responsible for what I decide to do. Good to hear your friend's experience though.

Seriously, Wedding vows of for better or for worse?! I'm hoping he is just nervous!  I think it is all up to you!! If I'm not mistaken (which I could be...) you can get an emergency C-section if you choose to go vaginally! If at any point the OB feels that you can't proceed you should be able to go have the emergency C-Section and all be well! I would def. talk it out a little more with your doctor and make sure you and your husband are on the same page...on everything!! You need NO STRESS going into this!! Keep your head up..only you know how your body feels and you will eventually know what the best way to go is!! Cheers to a healthy baby!