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Vaginal birth vs c-section after a 4th degree tear


Forum: Labor and Childbirth

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  #1  
December 2nd, 2010, 04:42 PM
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Join Date: Dec 2010
Posts: 2
Hello everyone, I am 24 weeks pregnant with my second child and my OB has asked me twice about having a c-section. With my first child I had all natural child birth and ended with a 4th degree tear. I have not had any complications from the tear and didn't realize how bad it could be until now. My OB has informed me that due to the scar tissue I am more likely to have a 4th degree tear again and if that happens I could end up with urinary and anal incontinence for life. She is willing to deliver however I choose but now I am not sure what to do. I wanted to have a natural childbirth experience with this baby but if I do I take the chance of having a lifetime issue that would just worsen as I got older. I am terrified of a c-section procedure in general. I am afraid of making the wrong decision.
Has anyone had a 4th degree tear and had another vaginal birth with no tear? Has anyone had two 4th degree tears and if so what were the complications for you?
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  #2  
December 2nd, 2010, 04:51 PM
New_England_Girl's Avatar Platinum Supermommy
Join Date: Jun 2007
Location: Chilly New England
Posts: 6,767
I had natural childbirth as well. My first child was posterior (face-up) and she was very hard to deliver. I had pretty extensive tearing with her, but I never heard what degree it was (I don't think it was anything like 4th...maybe second).

I just wanted to ask which position you pushed in and delivered your first baby? Also, did your doctor/midwife do warm oil massages on your perineum as you crowned and delivered? That can reduce tearing and risk of tearing significantly.

Also, what about getting an episiotomy this time around? Not best case scenario, of course, but it's far easier than a c-section and it's controllable, unlike tearing, so it's less likely to damage anything.

Hope that helps! Please ask any other question you want. I'm sure the other girls here will have some advice for you as well.
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Hi, I'm Sara. I used to post here a lot when I was having the kids, but life got busy and it's been years since I was around. Now I'm back, and happy to be here.

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  #3  
December 2nd, 2010, 05:39 PM
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Join Date: Dec 2010
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I delivered on my back. My midwife tried stretching my perineum for two hours (not sure if she used oil or not) and finally had to do an episiotomy in order for the baby the come out and then I tore. I have read that delivering on your side can help prevent tearing. My doctor said if I opt for vaginal delivery she would recommend an epidural because then my pushing could be more deliberate and slower (even though I didn't want this either) but then I read online that could make it worse. I keep reading different things which is why I hoped hearing some real life experiences may help me. At least I have some time to decide.
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  #4  
December 2nd, 2010, 08:16 PM
Gray_baby's Avatar Platinum Supermommy
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Location: Tennessee
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Did your doctor happen to discuss the risks of a c-section with you? If not, do some research and balance the risks for you.
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  #5  
December 3rd, 2010, 05:51 AM
New_England_Girl's Avatar Platinum Supermommy
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Location: Chilly New England
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Delivering on your back makes you MUCH more vulnerable to tearing. I delivered an almost 10 pound baby on my side naturally with no tearing. I don't think the midwife put even one stitch in me. Discuss that with her, for sure! Also ask her about the warm oil massage.

Remember too that your second baby will deliver more easily than your first because those muscles and membranes have already been stretched.

If the whole idea is just making you crazy trying to decide, remember that women have c-sections and recover well every day. Not ideal, for sure, but maybe easier on you emotionally than dealing with all these questions. If you're scared during labor your body will naturally be tense and your membranes won't stretch the way they should. Relaxation is really key to getting a baby out without tearing.
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Hi, I'm Sara. I used to post here a lot when I was having the kids, but life got busy and it's been years since I was around. Now I'm back, and happy to be here.

Married to my best friend for a decade.
Mom to:

Cassidy, 6.5 yrs. Born 10/23/07, 7 pounds 10 ounces, 20 in.

Joel, 4.75 yrs. Born 6/23/09, 9 pounds 12 ounces, 21 in.

Timothy, 2 yrs. Born 3/20/12, 9 pounds 4 ounces, 22.5 in.






































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  #6  
December 3rd, 2010, 09:31 AM
ChicaChels's Avatar Platinum Supermommy
Join Date: Jul 2008
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I personally wouldn't recommend a c-section because you "may" tear. That's just my opinion though - I mean, a c-section is major surgery. I can't imagine attempting to take care of a newborn and another child(ren) after having one, especially one that may not have been necessary.


You can do things to prepare your perineium for labor - perineal massage, kegals, and squatting are all great things to do. Squatting to give birth opens your pelvis up 15%-20% more than laying on your back. Also, laboring (and delivering if possible) in water is VERY helpful because it makes your skin very soft and more "stretchy".

I'd definitely talk to your provider about perineal support while you push as well, to protect your episotomy site. Also ask about them guiding your pushing, if you start pushing too quickly, in order to help the baby come out slowly which allows your body to stretch slower and further.

good luck hon!
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  #7  
December 4th, 2010, 09:21 PM
Super Mommy
Join Date: Oct 2010
Posts: 848
I tore really bad with my first baby -- they wouldn't tell me how bad (I was overseas at the time and there was virtually no patient-doctor communication), but they stitched on me (two doctors) for a LONG time. My second baby was an ounce bigger and I only got two little stitches, mainly just to make sure it healed up well, but the doctor told me I didn't even really need those if I didn't want them.

I say the possibility of another bad tear as a reason to go for a major surgery like a c-section doesn't seem very well thought out from your OB. Obviously a bad tear has risks, but so does a c-section and brings another whole host of issues for if and when you want more children.

I say at least get a second opinion, but I'd go natural, no epidural again!
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  #8  
December 5th, 2010, 01:59 PM
Mega Super Mommy
Join Date: Feb 2010
Posts: 1,741
I had 3rd degree tear with my first. Noah was sideways and they had to use the forceps to get him out. *TMI* My husband said it looked like a meat grinder had gotten ahold of me down there. It took months to heal.. I definately feel your pain and your worry on that. I went on to deliver 3 more kids without tearing at all with any of them... and my second was a pound bigger than my first and third was a pound bigger than my second (my 4th was the smallest of them all). I say that to say that no way would I opt to take on a major surgery because of the POSSIBILITY of tearing again. My advice would be to do a TON of research and figure out what YOU are most comfortable doing.
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