I am almost 9 weeks pregnant with my second baby. I delivered my first via pitocin induction with no epidural. I had bad tearing- termed 4th degree in my medical records although I recall they said I was borderline 3rd/4th degree. 3 and a half years out I have no lingering side effects from the delivery - maybe mild prolapse and I did some pelvic floor PT, but feel pretty good these days.
So, I met with my midwives yesterday who said they offer a c-section to all women who had high degree tears in earlier deliveries. I intend to dig into this more with them but I was kind of surprised and didn't really follow up at the time. It hadn't occurred to me that another vaginal delivery would be dangerous. Now I'm reading somewhat that there are risks that if you did tear as bad again, it could not heal as well, leaving lingering issues (incontinence etc, unpleasant stuff).
Anyone been in this position? I'm inclined to another unmedicated birth, hopefully without pitocin this time, but now I'm second guessing and wondering what would be best.
cantaloupe / 6869 posts
I had a 3rd degree tear and episiotomy with my first. No one mentioned a c-section/long term complications and I would not have gone for a c-section anyway unless the indication was that my second would be much bigger than my first (9 lbs 5 oz). Growth scans looked good and they estimated an 8.5 lb baby. In the end, I had an incredibly quick, unmedicated birth with natural 2nd degree tearing (baby was 7 lbs 10 oz). It was a walk in park compared to the 3rd degree. I was up and walking unassisted within a couple hours whereas with my first I had problems walking for weeks. I was very happy with my second birth experience. I also don't think I've had any complications (although I'm only 4 months pp so I guess time will tell).
grapefruit / 4545 posts
I had a third degree tear with my first, mostly due to how quickly I pushed her out (2 contractions worth of pushing). No episiotomy (my Dr recommends tearing naturally). My daughter was very normal size - 7lbs 2oz, 20inches. I healed well - no noted long term issues.
My second, I was induced. Again, I pushed her out very quickly (like 3 pushes) and tore again (third degree). She was also normal sized, 7lbs 3oz and 21 inches. I recovered way quicker the second time.
honeydew / 7444 posts
My delivery with #2 was so much easier, even though he was almost 1.5 pounds bigger than #1. With #1 she was sunny-side up so labour was extremely long and eventually i had an episiotomy (3rd degree tearing). Recovery was long and painful, and i saw a post-partum PT for a few months. With #2 i laboured at home for quite a bit and by the time i got to the hospital i was already 6cm dilated. I got to the hospital a little after 8:30am and my DS was delivered at 10:18am. Since he was positioned better, it took about 15 minutes of pushing and i had 2nd degree tearing.
I would consider a c-section in your case, but it would really depend on how the pregnancy was progressing.
grapefruit / 4042 posts
@Revel: I'll be following this because I'm a fellow 4th degree tear mama. Yikes! I can't believe you endured that without an epidural. My tear has healed up quite nicely and now, at 20 weeks post partum, I don't seem to have any lingering issues. I really hope you can have the birth you desire for your second baby. Best of luck!!!
@MrsKoala: Good to know you had a lesser degree tear with your second! And do you think some new complications could pop up in the future? I'm 20 weeks out from my first delivery and think/thought I was in the clear.
@Mrs D: I didn't know that pushing the baby out so quick could be the cause of tearing. My girl came out in 4 pushes after 37 hours of labor and super slow dilation. Good to hear that you healed quicker the second time despite the same degree tear.
pear / 1563 posts
@MrsKoala: @Mrs D: @Freckles: thanks for sharing! I've seen some stats that it is something like a 10% chance of a high degree tear in subsequent deliveries.
@agold: i actually don't remember the pain of the tearing, then they gave me fentanyl for the stitches so I was feeling fine. I was ineligible for epidural because of low platelets.
So, I distinctly know I rushed pushing because I just wanted her out - I was not waiting for my body and each contraction. Wondering if I could control that this time. I also was able to walk right away, use the toilet right away, and recovered pretty quickly so it's not that I doubt my chart I'm just wondering if it was a "not so bad" 4th degree? Not to be too graphic but I thought 4th degree had to involve a tear through the rectum and wouldn't I have known about that?
GOLD / wonderful apricot / 22276 posts
3rd degree tear with my first and very minimal tearing with my second.
grapefruit / 4545 posts
@agold: When I was induced with my second I asked my Dr to please make sure I had a local before any stitches this time (the stitches were the hardest part of my first delivery since my Epi had been turned off for some time) - she agreed and noted it on the white board! After I delivered my second she said "you tore again - looks like a 3rd degree - will require a few stitches" I replied with "damnit - how can I prevent this going forwrd" and she said "probably not push them out so fast - your body isnt given the time to ease into it"
DD1 - I def didnt progress SUPER fast (about 1cm an hour...then like I said pushing for 2-3 contractions).
DD2 - I was induced. They broke my water at like 3pm (I was 5cm and she wasnt not completely lowered), she was out at 3:40pm....so I think it just all happened so fast - my skin stood no chance.
cantaloupe / 6869 posts
@agold: I haven't really done any exercise as of yet so I'll reserve judgment regarding my pelvic floor until then! Other than that, recovery was worlds better this time around.
grapefruit / 4291 posts
I had an episiotomy with my first (long, medicated labour and ventouse delivery) and tore badly during my second labour (much shorter, "natural" labour but 9lb 12 baby!) and have healed nicely both times so will be aiming for another natural delivery with my third. Having said that, I do gave a friend that tore badly and suffered an awful haematoma with her first child and she's opted to go with an elective c-section for her second baby because her first recovery was awful!
wonderful kiwi / 23653 posts
3rd degree tear and episiotomy with my first, same with second, great recovery both times with no mention of doing anything differently.
eggplant / 11714 posts
@Revel: I don't know how well you will be able to control the pushing part, if you are going unmedicated. I had an unmedicated birth the second time and don't think I could have stopped the pushing any more than I could stop a freight train. Also, I didn't get to the maternity ward until 10 minutes before I had my 2nd, so that might have something to do with it.
coconut / 8483 posts
@Revel: they offered me a c section after my first and I took it. Recovery was a lot better.
hostess / papaya / 10219 posts
I didn't really tear at all with my second, but she had to make a small incision because the area that tore with my first developed scar tissue and wasn't stretching enough to allow baby's head. She had to recut the area with scar tissue and restitch. In the end that was better because it hadn't healed correctly the first time.
nectarine / 2987 posts
FWIW, I was able to manage my pushing without being medicated. Also, my midwives said eating lots of protein helps with tearing and skin integrity/elasticity, as does laboring down.
cherry / 217 posts
Similar story here-- I had an unmedicated, pitocin-augmented labor with my first and had a 3rd/borderline 4th degree tear. Recovery was very hard and I was so scared of tearing badly again with my second. My second labor went pretty quickly and i delivered in much fewer pushes than my first, but thankfully I only had a 2nd degree tear and recovery was a breeze! I'm glad I decided to go ahead with another unmedicated vaginal birth with my second.