Vaginal birth or C-section after 4th degree tear?

[Allie84]

This will be my second baby. With my DS, I had a 4th degree tear and I pushed for 4 hours and he had to be vaccuumed out in the end. He was healthy but I had a pretty bad tear- 4th degree.

At first my old OB and now new OB (we moved) said I would need a C-section as that is protocol. Now my new OB is changing his mind...he says if I really want to try for vaginal, I can do a trial of labor.

Has anyone else delivered vaginally after a 4th degree tear?

The risk is obvs mostly for me, having a worse recovery than last time (which was actually fine....no issues at all after healing).

He also said I am a candidate for elective C-Section given prior 4th degree.

Really looking for any input?!?! So unsure.

 

[Zephram]

My SIL has a fourth degree tear with her first and went on to have an elective c section with her second.

I had an emergency c section with my first and went on to have a VBAC with my second - it ended up being a forceps birth and I got a third degree tear. I found the recovery from the tear much easier than the recovery from the c section (though obviously it was not as bad as yours was!) and for that reason with my third I’m going for another VBAC. My midwife has suggested labouring in water as the water helps soften the skin and allow it to stretch which can reduce the likelihood of tears. She also said that because your body has done it before it knows what it’s doing better and you are less likely to tear as badly, especially if you don’t get assisted by vacuum/forceps. It’s really the vacuum/forceps that causes the mega tears - they pull the baby out so fast that the skin doesn’t have the chance to stretch slowly and naturally.

So it’s uo to you really- you could trial labour and see how you go with the aim to avoid assistance in the pushing stage. You could also try perineal massage in the last few weeks before birth. I’m going to try this his time around too.

 

[Allie84]

Thank you so much for the information and tips! That's helpful.

Good luck with your VBAC. Sounds like you are really prepared.

 

[WackyMumof2]

Pushing position can help too. Avoid birthing on your back if you can and aim to be on all fours, squatting, kneeling, bithing stool etc. Doctors only want woman on their backs for their convienience which is unfair. Pushing against gravity rather than using it to your advantage to help with a vaginal birth makes the whole process not only unpleasant, but longer and harder than it should be. We should feel proud of our bodies growing and birthing a baby and that should also be allowed to happen without intervention or restrictions. I loved giving bith to my last 2 and that's because it was MY experience and my midwife allowed ME to have control.

 

[Bonnie11]

My sister had a 4th degree with number 2 and ended up with and elective section 3rd time around. She didn't have any assistance but it ended up being a quick labour and he just shot out awkwardly. She weighed up pro's and cons and ended up on the section as you can do permanent damage to your bladder and bowel continence with another bad tear so she didn't want to risk that. It's great that your bad tear healed well last time but if it happened again your scar tissue etc would likely not heal so well. At the end of the day it's totally up to you to weigh up for and against but if it was me I would go for th section and not risk it xx

 

[Allie84]

My sister had a 4th degree with number 2 and ended up with and elective section 3rd time around. She didn't have any assistance but it ended up being a quick labour and he just shot out awkwardly. She weighed up pro's and cons and ended up on the section as you can do permanent damage to your bladder and bowel continence with another bad tear so she didn't want to risk that. It's great that your bad tear healed well last time but if it happened again your scar tissue etc would likely not heal so well. At the end of the day it's totally up to you to weigh up for and against but if it was me I would go for th section and not risk it xx

That's what my doctor was telling me as well. That even though I healed well, it's no guarantee a second time. I'm just SO SCARED of a C-Section, I guess because it's the unknown and even though vaginal carries risk for me, at least I've been there and no what to do.....

 

[Bonnie11]

Honestly c sections are fine. I was dreading it when they said I had to have one last time but it was fine, and I recovered more quickly than a friend who had an episiotomy around the same time! As long as you have some help at home for the first couple of weeks you're good. I was out walking about a week later and driving after 3 weeks with sign off from the doc. I had an emergency section too which is worse than a planned, slower recovery. Some people I know were out and about after 3/4 days.

Not to scare you at all but another friend had a bad bad tear and ended up having to have a vaginal mesh to rebuild the wall between as it couldnt heal properly. It was a long time ago and there may be other ways to heal it now so it's worth asking what the worst case scenario would be if you did tear badly again, would they be able to repair it easily? to be left with permanent damage to your continence is a big risk, it's just up to you whether it's one worth taking xx

 

[Allie84]

Thank you! Yeah that sounds pretty scary.

I talked to my high risk doc today and I think I've decided to go for the C-Section. It just sounds so much less risky in the long run for my health.

 

[Bonnie11]

I think you have made the right decision. Just make sure you have some help at home for the first week or so but honestly recovery is a lot quicker than you expect (though you won't feel like that the first few days!) but you do heal amazingly quickly.

Good luck xx

 

[Eleanor ace]

I opted to try to deliver vaginally, my consultant OK'ed it and it went well. I had very small 1st & 2nd degree tears with my 2nd which I didn't get stitched (I was given the option of having a couple of stitches put in but declined -the novelty of stitches wore off after having my entire undercarriage sewn back up - ) and with my 3rd LO I again opted for a vaginal delivery and only sustained a 1st degree tear, no need for stitches.
6 months after delivering my 1st LO (and getting the tears) I had tests to check rectal/sphincter/muscular control and see how well I'd healed. The tests showed that I'd recovered really well and I felt confident that the risk of incontinence was lower than it could have been which helped me decide to try for a vaginal delivery (I was already very keen to avoid a c-section because I was terrified of that option because I'm a needle wuss). Have you had any tests done?

 

[Allie84]

I haven't had any tests done! I didn't even know tests existed! Hmmmm.

 

[Teri7489]

I had a 4th degree after pushing for 2 hours then an urgent forcep delivery. I needed around 370 stitches so was quite a bit of damage and now I am incontinent if I can't get to the loo quickly. With my 2nd I was advised to have a section as there is an increased risk of tearing again due to scar tissue not having elasticity in it. With 4th degree tears the sphincter muscles are damaged too so it's possibly to have an endoanal ultrasound to check the amount of scarring to see the risk of damage with next delivery. This is what i had done which showed around 70% scarring (hence the incontinence) so I opted for a section as I didn't want to risk another tear.

A section was an absolute breeze compared to my first delivery. I had my son Tuesday early morning and was home Wednesday afternoon. Hubby stayed home for a week but then went back to work and it was me and 2 kids. Was absolutely fine!

 

[CB33]

First and second degree tears are very different from 4th degree tears. 4th degree tears can often carry a large risk of permanent damage whereas 1st2nd while uncomfortable generally heal quickly and quite well. 4th degree tears go into the rectum which is the big problem and it can cause incontinence and other major problems. This is why a consultant will offer an elective section with 4th degree tears but rarely 1st and 2nd degree tears.