Mum Hadn't Heard of a Fourth-Degree Vaginal Tear Until She Had One
Fourth-degree vaginal tears are the most severe. They extend through the anal sphincter and into the mucous membrane that lines the rectum (rectal mucosa).
A Fourth-degree vaginal tear usually requires repair with anaesthesia in an operating room, rather than the delivery room, and sometimes needs more specialised repair.
Kathy Fray, senior Midwife and best-selling maternity author, explains: “Imagine your perineum and its adjoining pelvic floor is like a vase that had been dropped and broken, but then was carefully glued back together, and now closely resembles the original vase, and is fully functional and watertight, just with a few subtle cracks in it.”
The perineum and pelvic floor
Four years ago, when I gave birth to our first baby boy, I chose to have a natural birth without an epidural (I don’t know what I was thinking!). The pain was unbearable.
During the labour, the midwives noticed that my baby’s little hand was on his face, so they considered the need to perform an episiotomy in order to help prevent vaginal tearing. However, by the time they figured out the ‘solution’, my boy was out.
My baby was born after five hours of labour. Only five hours, which was short in comparison to what I’d heard from other mums. That was one of the main factors in how I suffered a fourth-degree vaginal tear – my labour was too short.
Generally, a baby is supposed to come out gradually, but my baby came out so fast, which caused the perineum to stretch, plus his hand was on his face making his head seem bigger. When the doctor told us that I needed surgery immediately, we were absolutely shocked. It was already challenging for us to look after a newborn without family support; everything was on my husband when I had surgery after labour.
Surgery after labour
I was in recovery until midnight following the operation, which was just four hours after my labour.
I imagined my husband trying to settle our baby. I missed my newborn, and I wanted to hold him. I thought I could be a ‘hero’ after natural birth but unfortunately I couldn’t even get up and hold my baby.
It took six months to full recover with weekly physiotherapy sessions. I struggled a lot going to the bathroom, and just like the doctor had warned, I had to wear nappies to prevent unexpected accidents.
The worst thing was that I couldn’t get up to breastfeed my baby. I had to lie down on the bed with him so that I could breastfeed. My husband got me a doughnut cushion to assist me, but it didn’t help much to reduce the pain, so I had to lie down to minimise muscle stretches. This continued for about six months.
I had severe anxiety and depression due to this. Some mum friends suggested I seek legal advice, suggesting the hospital should not have hesitated to perform an episiotomy.
“They are wrong,” says Fray. “It is now very ‘old school’ and no longer ‘best practice’ in obstetric care to do prophylactic episiotomies – preventative ‘cuts’. That intervention was performed a lot for some time thought as being an effective way to ‘prevent bad tears’, but the outcomes were very conclusive that overall doing so habitually created more problems for women.”
“In general terms these days, unless the perineum is extremely taut and unyielding as I have seen with the likes of palates instructors and horse-riders, and so long as the baby’s heart-rate isn’t in foetal distress, then routine episiotomies should not be done as statistically, they do more harm than good.”
Pregnancy after a fourth-degree tear
When my baby was just six months old and I had just recovered physically, we discovered I was pregnant again. While it was welcome news, it was a surprise to us both.
Fray explains: “That means a healthy sign that sexual function was returning to normal.”
We had been advised to plan our next pregnancy carefully, and to allow for a minimum of 18 months between births for my body to heal. By falling pregnant so soon, I had put myself at risk again, so the doctor insisted we book in for a planned caesarean.
“Giving birth vaginally again could be like intentionally dropping that vase again, but we won’t know until it happens, but it could be left with irreparable damage,” Fray says.
“The doctors wouldn’t have been keen for the growing size of your womb to be adding weight onto your healing pelvic floor.”
Surprisingly, I had a speedy recovery after the second birth. At just one month postpartum, I was able to hold my two babies.
I think the doctors and midwives had done a great job. And despite the physical injuries, I have never regretted having a vaginal birth the first time around.
As a mum, I truly understand what “no pain no gain” means. By the end of the day, it is all worth it!
This article was first published in Kidspot and republished on theAsianparent with permission.