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DrasticDreamer's avatar

Pregnancy question for Fluther mothers!

Asked by DrasticDreamer (23983points) October 2nd, 2014

My best friend is about 11 weeks pregnant with her second child and wanted me to ask the moms here a question.

During her first delivery, my best friend experienced a fourth degree tear and because of that, her doctor told her today at her appointment to seriously consider a c-section. She’s pretty worried now and doesn’t know yet what she wants to do. She definitely doesn’t want to experience that kind of tear again, but she also doesn’t want to have a c-section.

So her question is: How many of the moms here experienced a fourth degree tear more than once with a vaginal birth? Or, if you experienced a fourth degree tear with one child, did you choose a c-section for your second child?

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23 Answers

snowberry's avatar

I can’t say how many mothers experience such a thing, but I was asked to be there at a birth to sort of hold a young mother’s hand (English was not her native tongue and she was from another culture). Her birth was horribly mismanaged by her doctor and she received a tear all the way into her rectum. I suppose that’s about as bad as it gets. You don’t want to go through that again, that’s for sure. It’s a pity, because it didn’t HAVE to happen.

gailcalled's avatar

What’s a fourth degree tear?

dappled_leaves's avatar

A fourth degree tear is what @snowberry just described.

dappled_leaves's avatar

Disclaimer: I am neither a mother nor a doctor

I’m looking around and finding a number of forum questions on the same topic – try googling “natural birth after fourth degree tear” or “vaginal birth after fourth degree tear”. You could spend hours reading.

It’s what you’d expect: lots of anecdotes supporting either side. It sounds like a difficult decision. The pros of the C section are mainly that you know there won’t be further tearing (so recovery is easier in that respect) and you have less risk of fecal incontinence with age. The cons of the C section are that you could still have a difficult recovery from the C section anyway, and you don’t get the immunity benefits for the child of a natural birth.

There are various recommendations by midwives for women attempting a natural birth after a bad tear, like perineal massage, soaking, etc. that might reduce the risk of tearing.

But there’s no clear answer, it seems. Risks and benefits to both sides.

Here2_4's avatar

I tore bad with my first. I healed just fine, but I am a very good healer. It was stitched nicely, which drove me insane because of the pain. I felt each stitch. There were only six or eight, but it seemed to go on forever. It was not the doctor’s fault. He had done a snip which should have been sufficient. My son had a head like a grapefruit, just round as could be.
My doctor told me that when women tear like that, they might want a c for the next, but he doesn’t like c’s for anything which is not life threatening. I had two more babies, but no c section. There was a bit of tearing with each one, but not as bad as the first. Healing was a nightmare, but when I thought what healing from an abdominal cut must be like, I did not want to face doing that.
I think it would have to depend on how well your friend tends to heal when she is has cuts or scrapes, and how well was she stitched up the first time. Vaginal birth is supposed to be far more healthy for the baby than c section. It compresses their lungs, which helps to express any fluid which they may have in their lungs, and gives them a better chance of starting breathing on their own.
If I had it to do again, I would still choose the same way.
Tell you friend for me, “Awwwwww!”

DrasticDreamer's avatar

@Here2_4 Thank you very much for your answer! It’s definitely the kind she’s looking for, and I’ll be sure to tell her what you said. :)

JLeslie's avatar

I am not a mom or a doctor, but I do know stories of women tearing badly and then having less tearing on their next delivery. All of them had a different doctor with the next child. However, I also know women who chose to go C section and they are very glad they did.

If it were me, I would see how far along I was getting in my pregnancy, basically, how big the baby is getting. Was her first baby large? I know a woman who delivered twins naturally and then her third baby was a singleton, and she said she was not prepared for how bad the delivery of the singleton would be. The twins were easier, even though she had to deliver two, because they were much smaller. I would absolutely choose a doctor who was willing to go with whichever I wanted to try and comfortable with me deciding at the last minute. I also would choose a doctor who does difficult pregnancy and delivery. My OBGYN does high risk pregnancies, his compassion and skill I would trust completely.

I have had vulva problems for many years. As a young person I never worried about pregnancy and deliver like many young women do. Now that I feel my vulva could tear easily and be extremely painful and possibly never heal correctly I would get a C section even though I think C carries more risk in other ways. I already have long term problems down there I can’t imagine adding more I would go insane.

Earthbound_Misfit's avatar

For my first child, I had a forceps delivery with an episiotomy and then like @Here2_4 I tore a lot further. I don’t know whether it was second, third, fourth degree tearing but I know it was pretty uncomfortable for quite a while. However, also like @Here2_4, I healed fine and went on to have to further natural births with no tearing or forceps at all. With my first, I had an epidural so perhaps that had something to do with it. The last two, I had a gas and that was all and I was a lot more in control over what happened to me.

I hope your friend’s second birth experience is better than her first.

Aethelwine's avatar

I had to have an emergency c-section with my first child. I then had vaginal births with my other two children. I allowed a student doctor to perform the episiotomy with my second child and he accidentally cut too far. One word you don’t want to hear when getting an episiotomy is “oops.”

I had such a difficult time during the healing process from the episiotomy. It was more painful than the recovery from my c-section. I also developed an abscess along the cut that made the healing process longer. I remember that pain more than any other pain I had during all three of my deliveries.

hearkat's avatar

I had an episiotomy and a really bad tear with my son. I don’t recall them giving it a “degree”, but I do recall them saying it went in more than one direction and having many stitches. I healed up well, and remember being really uncomfortable with the pain for a few days after.

In my case, I believe the tear was because I tried to deliver without an epidural and by the time I was told to push, I just wanted it to be over with, so I got the kid out in three pushes – his head wasn’t even crowned, he looked like a c-section baby. Knowing this, had I carried my next child to term, I probably would have opted for a vaginal delivery, but with an epidural so that I could tolerate the labor pain better.

It’s kind of funny that I have a very high pain tolerance, so the tearing didn’t bother me; but the pain of labor was so completely different and I found it unbearable. So I would suggest that your friend consider all the variables that might have led to the tear, and whether there are steps that might prevent it from happening again.

snowberry's avatar

@Here2_4 My friend got about 70 stitches, and she had to be stitched on two sides, inside the rectum first, and again on the outside. Although she didn’t seem to feel the pain while they were stitching her (maybe they gave her another shot in her epidural), the pain she had afterward lasted for months, and it was very, very bad. My friend couldn’t have been more traumatized than if she had been brutally raped! No exaggeration. Heck, even I was traumatized!

The whole thing was so bad that the event made it through the gossip chain, and the teachers were talking about it over at the community college nursing school. I wish that doctor had lost her license.

Here2_4's avatar

Wow. I am stunned. I had a few extra days in the hospital so they could keep an eye on the stitches, make sure there was no infection or further trauma. I never heard of such a thing as that though. I was torn to and around my rectum, and maybe I remember the number of stitches wrong, but 70 is so excessive, they should have put the doctor in front of a wall with a cigarette and a blindfold!

snowberry's avatar

@Here2_4 There’s no way I could prove it, but maybe the doctor allowed it to happen because my friend was Muslim (from Yemen, wore the hijab and face scarf and all, didn’t speak English well), and was on Medicaid. I don’t want to think that about this woman doctor, but I can’t ignore it as a possibility. My friend is an American citizen, but she was afraid to speak up about it- afraid of reprisal. She was afraid her family might be sent back to Yemen. It’s irrational to think that way, but it’s a real fear for them.

I was stunned too. And I was so traumatized myself that I didn’t think to report the event. It’s too late now because I can’t remember the date or the name of the doctor.

snowberry's avatar

@Here2_4 They also didn’t bother to keep her overnight for observation like they did for your friend. Which is another reason I think it was sort of a cover-up. The doctor tried to make it go away. And it did.

janbb's avatar

I can’t speak to the tearing because I had two C-sections but I can speak to that part. The first was after many hours of unproductive labor and pushing. The recovery was painful for a few days and uncomfortable for a week or so afterward, but the baby and the nursing went fine. The second time I was shooting for VBAC but when it seemed like it would end up a Caesarean any way, I chose to schedule it because then I could be at a hospital with more modern practices. I was able to be awake during the delivery and to hold my second son in the recovery room. The recuperation was similar although I wasn’t so knocked out from hours of labor. Both births were very wonderful.

It’s hard to know how to advise your friend; I guess what I’m saying is that she shouldn’t be afraid of a Caeserean even though it is painful afterward.

DrasticDreamer's avatar

For my friend’s first delivery she had an epidural and an episiotomy and they also used forceps. I remember hearing how shocked the doctor was at her tear, and they actually called other doctors into the room so they could see it (since it’s apparently not a common thing) and I’ve been scared of having a baby ever since I saw her tear. I’m ridiculous, I know

I know that’s she’s really scared to tear that badly again because healing (particularly when trying to poop) were excruciating experiences for her, but overall, I know she would much rather deliver naturally. I plan to show her everything all of you said, so hopefully some of it might be helpful for her.

Earthbound_Misfit's avatar

I don’t blame her being scared (and scarred). I suspect the level of intervention has a correlation to the level of damage. As I mentioned I had an epidural and then a forceps delivery and I’m sure that’s why I had to have the episiotomy and then tore more. I think she should speak to her doctor/midwife about trying to avoid so much intervention if she can. I really felt the medical staff took over the birth and I didn’t have the experience or the confidence to argue. By the end I was in pain, I was tired and I wanted it over. I went through the public system with my first and had a private gyno with the second and third.

With my second I wanted greater control and I didn’t have an epidural which meant I was able to push and I felt much more in control. I really do think this had a big impact on how things went and the lack of damage to my body. I was up and walking around within 30 minutes and feeling fine.

Tell her to speak to her doctor and midwife. See if there are any groups she can contact to help her get some excellent, but accurate and objective information about how often epidurals/episiotomys and the like lead to these sorts of problems as compared to births with less intervention. The more informed she is, the more in control she will feel and the more able to speak up about what she wants.

DrasticDreamer's avatar

@Earthbound_Misfit Thank you, your answers are also really helpful. The first time around, they were suggesting a C-section because the baby wasn’t right on schedule, and when it was just us two in the room, she started crying because she wanted a natural birth. I had a talk with her and told her to cheer up since the choice was hers, and that no one could force her to have a c-section. Since neither of them were in danger, she ended up telling them that she wasn’t okay with a c-section unless it became medically necessary. Sometimes she has a problem with speaking up for herself, which is why I will always listen and advocate for her, or at the very least, try to get her to use her own voice.

She’ll definitely find your circumstances informative, and I’ll absolutely help her look more into the rate of tears when accompanied by other forms of intervention.

JLeslie's avatar

There are so many stories of bad tearing that for doctors to be surprised is shocking to me. Does she go to a teaching hospital? They call in interns and residents for everything and it means nothing, but sometimes the patient feels like they are some sort of special case.

I think not getting an epidural can help. Someone mentioned that above. But, then you have to deal more with labor pains and the pain of delivery. I would encourage her to ask other women and also ask about different doctors and their successes after a bad delivery.

I don’t know anyone who complains about the pain after c-section, even though it hurts. I know quite a few women who complain about pain, incontenence, stitches, and bad healing after vaginal birth. I also know women who sail through vaginal birth really well. C-section carries some more concern, it is pretty major surgery, with risk of infection and risk of anesthesia screw up. Although, many people get epidurals either way, and they are rarely screwed up. Vaginal birth has risks to, but they are usually different risks.

Seaofclouds's avatar

I was fortunate and did not tear when I had my children. If I was in your friends position, I’d talk to the doctor some more before making a decision. How long ago did she have her first child? How well healed is she from the first delivery. The timing may play an important part of making the decision.

I’m sorry I don’t have better advice for your friend. I hope she can get the answers and information she needs to make the best decision for her and her baby.

DrasticDreamer's avatar

@Seaofclouds She had her first six years ago, so there’s definitely been plenty of healing time. Most of the reading she’s done so far indicates that if you’ve torn that bad once, the chances of it happening again are apparently high. I guess it’s just kind of a gamble in general.

JLeslie's avatar

What is her reluctance to do the C? Is she afraid of surgery? Afraid of the scar? Or, going to feel badly she couldn’t do what women should be able to do? Or, bent on natural the way some people are against using microwaves and will only eat organic veggies?

I don’t mean any of that as a criticism I think we are being poisoned by the environment. I also don’t believe any women should for one second feel badly or like they failed, because they needed a c-section. Extreme reluctance to C can be catastrophic. I’m not saying that is the case for your friend.

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