Delivery after 4th degree tear – vaginal birth or ceasarian?

[First timemum]

Unfortunately I had a fourth degree tear with the delivery of my first child 17 months ago. I believe that this was as a result of an inconsiderate OB who rushed the delivery (it was 10pm on Boxing day when the OB came to see me and I think that he just wanted to go home!). I was a private patient and my appointed OB was not rostered to work that day so I had his colleague instead unfortunately.

Without going into too much detail, I had an epidural, after which the OB came to see me for the first time and assessed that I was 8cm dilated, that the baby appeared to be in a posterior position (face up rather than face down). The OB decided then to perform an episiotomy (without telling me!) and then instructed me that I would need to start pushing (I was only 8cm dilated but didn’t question the OBs actions feeling that surely he must know what he is doing). Then without even letting me push naturally on my own, the OB decided to use the ventouse vacuum to try to extract the baby which was unsuccessful on first push, then the OB immediately decided to use forceps and pulled the baby out while at the same time rotating the baby’s body which resulted in me sustaining a fourth degree tear!

I had a tough time dealing with this – not only was I in excruciating pain for weeks afterwards, I felt very angry that I sustained a fourth degree tear which could have been avoided. There was no reason provided by the OB for the use of forceps/vacuum which I believe caused the tearing and the fact that my body was probably not ready to push (the baby came out after 10mins of pushing/pulling).

As a result of the tear I experienced gas incontinence and after 3 months went to see a physiotherapist at the hospital who helped over several weeks with pelvic floor exercises and fortunately that helped overcome the gas incontinence. I also found I needed to wear a pad when doing high impact exercise (bootcamp) due to some urinary leakages.

Anyway, I am now 14 weeks pregnant with baby number 2 and have had opposing views on whether I need to have a C-section this time around. My new OB will support whatever decision I make. Whilst I would love to have a better vaginal birth experience I am scared of tearing again and its repercussions.

Any advice would be appreciated.

 

[nov_mum]

I think the risks of a vaginal birth are much lower than the risks associated with a section plus you will be able to care for your toddler as you won't have a section scar/wound. It sounds like the tearing etc was like you say, caused by the OB. It sounds like all the interventions were used for his convenience and caused you and your baby undue distress and suffering. Depending on your views and what you want, I would suggest avoiding an Epi, as you do run in to the greater risks of assisted delivery and damage etc or a slowed labour that results in surgery anyway. I would suggest thinking about what you really want out of this birth and talking it over with your OB or maybe even consider a midwife. Not sure which country you are in but here in NZ MWs take care of most women and some are under shared care of an OB if there are complications or if people wish to pay for private care. We tend to take a laid back approach to medical interventions and birth. Have you watched the Business of Being Born?? I found it useful to help me see the motivations of medicine and how they have an important part in complicated pregnancies but how they can also complicate pregnancies unwittingly.

 

[Ouverture]

Oh my gosh, I'm so sorry hun That doctor sounds awful!

I would say to keep in mind that a c-section is much much worse than another tear. It's unlikely you would tear to that extreme again, especially if you have a supportive doctor who actually knows how to properly deliver babies. The c-section is a guaranteed several-inch long cut through skin, tissue, and possibly even muscle. . .I hear they are really painful and difficult to recover from.

HTH!

 

[RedString]

i suggest watching the business of being born as well. as the above two posters mentioned, with a vaginal birth there's a chance you might tear; with a c-section its essentially guaranteed. Longer recovery times, etc.

I don't suppose there's any way you could go after the doctor for negligence/malpractice is there?

 

[birdiex]

I don't have any advice to offer you but what an awful doctor, he tore you to get your baby out so he could go home? He's in the wrong proffesion!

 

[tweedy]

my sister had a 4th degree tear after her 2nd child (also due to medical negligence), she went into labour about 10 days after the birth of my daughter and i had an emergency section delivery. she was in theatre for over 3 hours being repaired and was in bed for 2 days and in hospital for week, after my section i was on my feet within 10 hours and home the next day. going through the recovery together i would chose my section over hers hands down. she was in agony and so uncomfortable, it was her 2nd so she was still having to look after her 4 year old and a newborn, we laugh about it 2 years on, but we both agree that i was on my feet and back to normal much quicker than her, she had a ridiculus amount of stiches and was advised not to get pregnant again. after my section i got so many messages about how awful it was and people were so sorry to hear i'd a difficult time, once i saw her in her hospital bed, i was like, i had it so easy and am fighting to get a section this time round.

i would say do your research, you know what you have been through and after all a healthy baby is the only focus but if you are comfortable with the support, a natural birth may be achievable, but i wouldn't let people saying a section is worse than what you have already been through put you off, you will bounce back and although the recovery isn't a few hours, if you are ready to get up and get on with it, you'll be back on your feet in no time, i had no complications with my delivery after leaving hospital, after only 36 hours, my sister had months of problems.

 

[ChristinaRN]

Since you have a new doctor, I'd definately give it a go with a vaginal birth. You only ripped like that because of impatience on your doctors part! A c-section is the equivalent to a 4th degree tear (just intentional rather then ripping) across your entire lower abdomen. Given the time to birth properly with a doctor who isn't in a rush, you should have a MUCH better delivery this time.

 

[mafiamom]

i dont think you can just use a blanket statement to say a c-section has a longer recovery time. if you havent had a traumatic vaginal birth, then yes, a section recovery is much longer and more painful. my vaginal birth was extremely traumatic. tearing all thru the birth canal as well as a 3rd degree tear externally. they had to call a surgeon in to sew me up and the recovery was 2.5 months long.

i am BEGGING for a section this time around b/c there is no way in this world a section recovery could be any worse then the vaginal recovery i had to endure.

every persons birth experience is different. you cant just out and out say a section is worse then a vaginal delivery. it so totally depends on the birth you experience.

GL on your decision. i understand your fears completely.

 

[Eternal]

i would spend some time talking to your new doctor, express your fears and ask any questions you have.

I just had a third degree episitomy, and it took almost an hour to stitch me up after the birth, the thing that i fear most about giving birth is the stitches, they hurt so flippin much. i figure either way ill need stitches with a twin birth, but hopfully less with a vaginal birth. But there is no way of telling and your best approach would be to talk it through with your doctor and make an informed choice.

It comes down to could you bear to go through it again? you know you will be in pain and have stitches and scars if you have a section, but for some women after a tramatic birth i can understand their choice to have a section.

 

[Jellybean0k]

I'm sorry to hear about what happened to you, what a complete arse he is.

I would like to disagree with some of the posters with regards to recovery after a c section though. I had to have an emergency and recovery time was only a day or 2, however, this time around, I will be having an elected c section, and have been told the procedure is much less traumatic.

 

[lynnikins]

its shocking what happend to you hun

i would get some good advice from your OB about how they will manage the birth firstly and if you trust your body you would likely only get a 1st maybe at worst 2nd degree tear if there was no medical intervention at all,
i got cut with my first and tore 3rd degree with my second stiching both times took over an hour to do but im going back for another natural birth this time caus ive learnt alot and hopefully my MW this time will help me more with guideance on when to push and when to pant and let things stretch, im likely to get a small tear due to scar tissue i already have but hoping it wont be too bad, i believe i only tore with ds2 caus he came flying out at such speed and not once did the MW tell me to hold back on pushing for a moment to let things stretch ( she wasnt even in the right place in the room it was a student who caught him lol my MW was still putting on her gloves ) but i think i know now when to just let my body do it and not push so hard

 

[aussi]

Hi,
I sympathise with you. I too had a fourth degree tear with the birth of my daughter and am now pregnant again. How to deliver your second child is a very, very personal decision and has caused me more than a few sleepless nights. I think that unless you have experienced the trauma and horror of a fourth degree tear it is very hard to comment on choosing a vaginal birth over a c-section for your next delivery. Only you know how you will cope mentally, physically and emotionally with another vaginal birth and the potential of a similar scenario. There are also other long term risks associated with another vaginal birth to consider. After searching the literature(and there's not a lot) and many discussions with my loved ones who helped me walk that long road to recovery and my caregivers I have decided to have a C-section for my second delivery. This is the best decision for me and I wish you luck in making your decision. At the end of the day you have to be happy with the decision you make as you are the one that will experience it - it doesn't matter what anyone else thinks.

 

[TiredNurse27]

What a difficult decision to make, there must be some research out there somewhere.

Personally, I would rather have an abdominal scar, than one that goes through my sphincter muscle, I would find that very difficult to deal with mentally and it sounds like you've made a great recovery thankfully

 

[Septie]

I had a section with my first - very uneventful recovery, didn't even take pain meds after leaving the hospital. Will get another one this Wed - a bit worried, of course, especially as I now have a toddler around as well, but hoping for an equally good recovery.
Would the fact that you had such a severe tear make another tear more likely? If so, I'd personally go with a section...It's a much more controllable environment.

 

[Irishmammy]

I had an emergency csection with my first after many hrs of labour, I had a long slow recovery and my scar still causes me some pain. When I fell pregnant with my second I was adamant I was not having a section, through a very supportive consultant and experienced midwife I achieved my VBAC two weeks after my due date. I did end up with a third degree tear and quite a bit of time stitching back up but I found this pain more bareable than that of the section where I could not move about and requiring eventual physiotherapy.
A friend of mine however has has better experiences of sections.
My advice would be do your research I bought and loaned books from libraries and did lots of research til I was happy with my decision, I felt it was best for me and my family. Despite the tear I found my second birth a much more pleasureable experience, so much so that it didn't put me off number 3 due in January.

Do your research, very clearly and firmly explain what you want to the people present at your birth and make sure your partner knows because sometimes it's easy for
Medical staff to confuse them too. I bet you whatever you decide you will have a much better experience this time, mainly because you know what's going to happen. xxx

 

[citymouse]

Poor thing! What a horrid, inconsiderate doctor. If I were you I would have a really good talk with your doctor and see what he/she says. Is there a way you can specify that you want minimal intervention regardless of who's there to deliver the baby? It seems like if you know going in that you are protected against impatience, you might feel better on an emotional level.

Physically, I can't say, as I've never been through birth.