Natural Birth
Vaginal Delivery After 4th Degree Tear??
Hello! I am 24 years old and had a baby June 2011. I was 4 cm and 75% effaced for 3 weeks before my due date. My doctor highly recommended an induction, fearing that my water would break without true labor. I was induced the next day. After an episi and having to use the vacuum, my 9 lb 4 oz little girl was born. Subsequently, I had a nasty 4th degree to my rectum and through the muscle. At my 6 week check up, I was bleeding pretty heavily through my rectum and the doctor said if it didn't stop within a few days, I would need corrective surgery. Fortunately, the bleeding stopped the next day. However, my doctor highly recommends never giving birth vaginally again. My husband and I plan to try again in approximately 5 months, but before we begin TTC, I would like to figure out what our options are for the next delivery so I can either stay with my current OBGYN or start looking for another. I really don't want to have a c-section unless there is a medical emergency. I don't know if I plan on trying to go natural. My concern right now is tearing 4th degree again, possibly causing permanent damage or having to have the corrective surgery next time.What are the chances my next child will follow suit and be a larger baby? With the trouble I had delivering my first, I worry that a baby any larger would end up in a c-section. Both my husband and firstborn run/ran in the 90th percentile for weight, and above the 97th for height and head circumference. I was an average size baby. I know its taboo and I don't want to do an induction again either, but do you think inducing early if I am dilated to 3 or more may help avoid a c-section? I'm open to all suggestions that could lead to a vaginal delivery, especially if there is a way with little to no medical intervention. I want to do all I possibly can to avoid a c-section while keeping my baby's safety my first priority. Also, if you live in the St. Louis region (I posted this on local boards already and got no responses), any suggestion on a natural friendly OBGYN who might work with me or give a second opinion?Thank you!
**JustAnotherMommy**
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Re: Vaginal Delivery After 4th Degree Tear??
Just from what I've read, an induction and esp. the vacuum would make chances of tearing much higher. I really don't think it was the size of your baby, but the vacuum thing they used to be frank. you were on your back the whole time right?? If you get to the pushing stage for your next babe, try a different position... just squatting or kneeling can make SO much more room, and can totally eliminate the need for a vacuum or forceps. There are also things the doctor can do to help the tissues be softer during pushing, hot cloth compresses and olive oil massage (sounds gross, but my midwives did it and i didn't even notice or if I did I just knew it helped with the 'ring of fire'.) Also, pushing slowly, not trying to get the baby out fast... like having the mom stop pushing for a minute or two as baby is crowning to help the skin stretch better can make a big difference. Maybe try googling 'how to prevent tearing in labour' or something. Just be informed, have a birth plan, if financially possible look for a doula to help you in your labour time, they are so great!
Finally, I didn't tear as bad as you but I did tear internally pretty harsh - it was his elbow.. there was nothing we could have done to prevent it, silly boy! and it took almost a full year for the last bits of tenderness to go away, like I knew exactly where the stitches used to be although it didn't really hurt.. I just knew the deepest tissue was still a bit 'raw'. Now, with DS at 2 1/2 I have no clue where the damage even happened, everything is 100% back to normal! So... maybe waiting a bit longer before trying will help make sure everything is healed up fully? Just a thought.
I am very sorry you had such a rough experience, but can I be blunt? I think pretty much the whole reason you tore is because your Dr. induced you in the first place.
The reason for your induction was bogus. Being 4 cm does not mean your water would break without labor. There is no medical science that backs this claim up- he basically just pulled it out of his ass. MANY women walk around at 4 cm for weeks. This alone would make me run far far away from your OB.
Now your labor and birth-- You were induced before your body was ready to give birth-- which lead to getting an epidural-- which lead to you giving birth on your back (a horrible position to give birth in- it actually makes your pelvis smaller)-- which lead to your (obviously happy intervention) Dr. to think he "needed" to use the vacuum-- which again forced your baby out before your body was ready-- thus you ended up with a very painful PP experience.
And then he goes onto blame YOUR body for this experience and makes your next birth under his care an even easier experience for HIM-- planned c-section = easy scheduling and more $.
Now, I am not saying that you wouldn't have torn in a different situation (I had a 3rd degree tear from my natural birth that came very close to my anus), however I feel very confident saying that you probably wouldn't have torn as bad.
I think you REALLY need to look into finding a new care provider...your OB, IMO, is not only unethical, but also dangerous. There are natural birth friendly OBs out there or also you might consider seeing a MW? My MW would NEVER tell a woman she shouldn't give birth vaginally again after a 4th degree tear. She reassures me regularly that my experience this time around will most likely be easier even if my baby is the same size because my body has been through this before and will remember what to do. In the end the actual size of the baby has a lot less to do with the size of the baby than you would think.
Also, I would do a lot of research about positioning during labor and consider giving birth on your hands and knees- which opens your pelvis up, pushing your baby when you feel the urge (and not when the Dr. tells you to) and to take everything nice and slow (breath the baby down).
Finally, I would suggest you not get induced again unless medically necessary (and a big baby is NOT a medical reason for an induction).
I am sorry if my post comes across as harsh, but I am very angry for you and pretty much want to give your OB a beat down (and I am usually a very non-violent type).
::hugs:: and welcome to the board. There are lots of very knowledgeable women here who can offer you a ton of great information. I wish you the very best for gentle future birth(s).
" After an episi and having to use the vacuum, "
Do you mean you got an episiotomy? I thought that meant epidural before but read it over and wondered? Here is the illustration we were given in my prenatal class. Try to tear a peice of cloth. it's hard. Now put a small snip in the cloth with scissors and try to rip again. Much easier. You rip right along the line where that snip was. It is MUCH MUCH better to tear naturally than to have it 'helped' along by an episiotomy! The stats and info we got from our lamaze teacher was that most natural tears don't go beyond 3rd degree, so the majority of 4th degree is actually associate with episiotomy. This is why I actually thought most docs knew not to do this anymore, because of the research.
Your body heals better when you tear along natural tissue/muscle lines, it looks jagged but heals faster. an episiotomy is easier for the doc to stich because it's straight... but it also rips a lot farther... and takes longer to heal.
Just thought you should know, if your OB still does this, you should find a new one.
I am not trying to negate anything that the other posters said, but I just want to share my experience.
My OB was very natural-birth friendly, anti-induction and interventions. My labor was spontaneous. I delivered on my side (my choice). My OB controlled the delivery of the head, no tearing. Then, whoops, DS whipped his elbow up on his way out and I got a horrible 3rd degree tear. No, it did not get to my rectum, but all the muscles of my perineum had to be put back together. It took almost 2 hours and I have no idea how many stitches. Recovery was bad.
It's not a size thing, though. DS was 7.5 lbs, and his head circumference was too small to even make the chart. It was his elbow--a fluke. It's really hard to predict what might happen, and no one who wasn't there can say why you tore like that.
You need a new OB. There was no reason for you to be induced. There is no reason you can't have a vaginal delivery for LO#2. And I would be majorly pissed about the episiotomy.
Also, you have a higher risk of c-section when you are induced because your body and your baby aren't ready yet.
I hope you heal up well and congrats on your LO!
For what it's worth, my mother had a similar 4th degree rectal tear with my brother (doc did an epi cut without her consent). She went on to have both me and my sister vaginally without such serious tearing (but she wouldn't let the next doctor cut her).
Most doctors these days won't cut unless is life-threatening not to. I'd be worried about an OB that does them routinely.