Episiotomy and tearing, healing

I have a beautiful son who will be 3 in 2 months.  When he was born I had an episiotomy and I tore through that and completely through my rectum, took as long to stitch me up as it did to push him out.  I was told I had 4th degree vaginal tearing and was still in a great deal of discomfort at 6 months postpartum.  Last year my Dr. sent me to a physical therapist to help with pelvic floor relaxation and nerve damage, she asked me to hold off getting pregnant for at least 6 months to get everything under control.  It's been almost 3 years since my son and the pain is much better, but I am still pretty tender.  Has anyone else been through this and should I expect with my next pregnancy?  My last one was a m/c at 11 weeks, so I never got to a point where I had a lot of pressure on my scar tissue, but I'm a little nervous.  My Dr. has assured me I should be fine to carry and deliver vaginally, they will just monitor the size of the next one.  Any advice or stories would really help, thanks!

[duehring]

I have had 5 babies. With my first 2 babies I tore all the way also.(4th degree) There was no pain down there with new pregnancies. With my last 3 babies I did not tear at all. I think I had to have 2 stitches with one of them.

I had a different doctor with my last 3 babies and I honestly believe that made the difference.

[Trentonsmom]

I appreciate you asking this question as I never would have even thought about it being an issue. I had a 3rd degree episiotomy with my first son (he was 9lb, 3oz  with a 15 in round head). I just know that the Dr. said they would most likely induce me two weeks early next time due to his size. They had estimated that he would only be around 8lbs and at the midpoint ultrasound he was under the 50% for size. Now I know not to take their word for it when it comes to the size of the baby.

[Crritter]

Really, did they approach it differently?  I love my Dr. and am looking forward to having her deliver my other babies in the future, but they just never caught the size in time, till he was coming out.  I guess my little guy was so active that in the end he turned breech to vertex to breech and back.  It was different each week till the end, I was told that big babies don't turn and it's extremely painful, which it was, but I never went in to complain.  Did it take a long time to heal from the pain, when I squat down or sit for too long it hurts, and intercourse isn't always that fun either.  I'm hoping that my experience is more like yours next time, well after the second 4th degree tear...

[Crritter]

Thank you, I'm so glad to know I'm not the only one.  My Dr. had told me with this last pregnancy that they would induce a good 2 weeks early too if all looked good.  I ended up having a m/c, but she was very upbeat telling me to go ahead and try again as soon as I was ready.  My son was 10 lbs. 3 oz., not sure on the size of his head though, but they were all shocked when he crowned, they called in the NICU Dr. to look him over at birth and had to run tests because of his size.  Turned out he was just big.  I'm just worried that it will be painful during the pregnancy now.  Has it been okay for you, if you don't mind my asking?  Oh, and congrats!

[Trentonsmom]

I don't know if I would call my delivery normal. They had already tried Stripping my membranes on two separate occasions plus a half a day in the hospital trying to get me dilated with the use of Gel. I was at a hospital where they had no problem giving my drugs up until the very end. I had to be induced 1 day after my due date because I was only dilated to a 3:
7:30a - Pitocin (sp)
9:30a - Broke Water
1:30p - dilated to a 5 - started Epidural (total of 4 bags in the end)
6:30p - Threw up all over my husband (all water-Gotta love those icechips!!!)
When I got sick on my husband the nurse told me that is possibly nature's way of saying that i am ready. She was right, I was fully dilated
Due to all the epidural in my system I could feel a thing. I finally decided that at 7:30p I wanted this child out so I called the nurse in.
After the episiotomy, the vacuum, Tongs?, and oil I delivered my son at 8:13pm.
As far as healing it took me at least one week to pass a bowel(sp) movement, and I remember it burning when I urinated for a while, but I know that the pain did not extend beyond my four week check because I remember that everything was fine by then.

[Crritter]

Wow, it sounds like you had a very difficult time.  I got an epidural too and couldn't feel a thing, but pushed my baby out in under an hour.  It took me a good week for the first bowel movement too, but I was in so much pain at my 6 week check up after my son that they didn't even do an exam.  I had to return several times after that to get more repair work done, they had to keep removing scar tissue.  I'm glad to hear that the pain went away.  Are you feeling okay now?  Does it ever bother you?

[Crritter]

Thanks so much!  I did put this on the open forum and was hoping to hear a little more, which I have and it has been so nice to get feedback and support.  I wouldn't worry about the tearing, you may not tear, or it might not be bad.  I recovered from my episiotomy much better than I did from the tearing.  I don't have any friends who have been through this, so I had no idea if this was very common or not, don't think it's too common though.  I hope my next delivery goes better too, and my Dr. didn't stitch me up enough, so there's a good chance I won't need a cut or tear.  I will have to be sewn up after though, but it can't be too bad.  Hope you have a smooth delivery too, and don't let my story scare you out of a vaginal delivery if you are thinking of one.  It was still an amazing experience and witrh my epidural, didn't feel a thing, and now I can't wait to do it all over again.

[mandymoo1983]

yes i have heard the same myself that it may be better to tear a little and i agree with my first i had 4 stitches that was last year the girl next to me had an episiotomy she had to have surgery later to correct hers and had so much trouble with everything like you wouldent beleive.
well i delivered my daughter on the 14th of this month it was less then a year since my last birth my stitches site from my previouse birth were still sore and i was so scared that i would tear again the doctor basically told me it all depends on the midwife if there telling you when to start/stop pushing at that point to avoid tearing you should be right well i delivered my 8lb14.5once baby girl 2 weeks early with just a little tiny tear no stitches at all the pushing was more controlled with my first i only pushed 4 times she was a big girl to 8lb9onces i was very releived i had a bit of discomfort this time round with the little tear but its been nearly 2 weeks and it feels ok also i felt every bit of the labour tear ect as i had a med free labour had nothing at all never again good luck to you.

[nikita2477]

I just wanted to say that although I have not had a vaginal delivery, I am glad you decided to post this question (saw your comments yesterday), because I don't think it is talked about a lot around here. Also, I'm sorry for what you went through, it sounds so painful!!! That is the part that scares me about a vaginal delivery because I have experienced some small tears during intercourse at times and that is bad enough. I want a vaginal delivery next time, but I wonder if I am predisposed to tearing and I know it could be a WAY bigger tear than I've ever had! Hope your next one is a piece of cake! :)

[Trentonsmom]

I have heard that it might actually be better to tear than to get an episiotomy. With a tear it is natural and with a cut, you cut through muscle possibly.
As I am currently 8 weeks pregnant I am starting to feel to strain of constipation, but so far it hasn't been too bad for me.

[scott365z]

"Reducing the rate of episiotomy could avoid tens of thousands of instances of anal sphincter damage at vaginal delivery each year. "

"Women who had midline episiotomies were nearly 50 times more likely and women who had mediolateral episiotomies were over eight times more likely to suffer a severe laceration than were women who did not undergo an episiotomy. Midline episiotomy was associated with statistically significant 4.2- and 12.8-fold increases in the risk of lacerations among primiparous and multiparous women, respectively. We conclude that the risks and benefits of midline episiotomy should be evaluated in a randomized clinical trial that compares policies of "usual" versus conservative use of episiotomy. "

http://www.greenjournal.org/cgi/content/abstract/75/5/765?ijkey=b21904df9ccf2674e38a93add4d502bf78bfbda6&keytype2=tf_ipsecsha

[Crritter]

Scott, thanks for the interest and resources, I really didn't have much choice of the episiotomy though.  My son was over 10 lbs. and was stuck, they had to get him out.  Sceond baby they were very careful with though.  Carson was just so big, he tore through and I had lacerations and bruising all along my thighs from delivering him.  I would have preferred no cutting, but trust my Dr. she assured me she only does it when necessary.  Would not have done it with the second, but scar tissue doesn't stretch well I guess.  Can I ask how you are so knowledgable in this?

[Scrblgal76]

I had a very similar experience. Back in 1976, I gave birth to an 8 LB 14 oz. baby girl. I went  to the hospital at 6:30 pm Sunday night, through 14 hours of labor/ 1/2 minute apart contractions, and was only dialated 3 cm. At almost 8 am the following morning my own OB showed up, did a pelvic exam, and had to re-position my daughter's head, which was pushing posterially against my spine. He also put in a knitting needle and broke my water. He was awsome, he decided I had already been through too much(I was trying to go natural, no drugs- but he convinced me to get the spinal shot, and said as her head was so large, he would like to do an episiotomy.  Eleven minutes later my daughter was born. As you said, the location is very sore, to help the healing I took baths in epsom salts, and sat on a donut tube for three months.The bowel movement issue is common, but you can avoid that by eating high fiber veggies and fruits. I have quite a rigid scar in that area, but otherwise it's fine. I cannot help and the issue of future births, as I only had one child.