Vaginal birth after 4th degree tear???

Question

Okay so with my first baby I had a fourth degree tear and my doctor that I absolutely loved said it would be my last vaginal delivery as it would be difficult to repair a second time. Fast forward to being pregnant with my second and my OB with my first baby no longer delivering. My current OB who to say the least I don’t really care for and I have tried to switch providers but all the doctors near me are too full for me to switch over. So sticking it out with my current OB I mentioned that I would prefer vaginal but my last OB said it was too risky and she seemed to act like that was absolutely ridiculous and that I would be just fine having another vaginal. I’m so nervous because I don’t really like/trust this OB so I don’t know what to do has this happened to anyone else? Should I call my old OB and get their opinion?

Answer

How did u deliver if u dnt mind sayn?? mindset is a huge part of a controlled almost pain free labour. My first was a water birth on my hands n knees.. no tears jst a graze.. 2nd one was easier and had him again with my knees on the ground and arms leaning on the bed, no tears. Gravity helped a ton and not being scared so I ddnt push too hard or too soon. Going with your body may help you not to tear. I also put evening primrose oil in my vag as soon as I hit 37wks. Maybe perineal massage prep might help with an easier birth experience. Are you able to get a midwife instead of an OB.?? They are amazing.

Answer

This is directly from ACOG (and OASIS stands for obstetric anal sphincter injuries):
• How should women with perineal lacerations be counseled about delivery in subsequent pregnancies?
Interventions in a subsequent pregnancy may be advantageous to reduce the risk of further perineal trauma and the associated morbidities. To date, no prospective trial has evaluated intervention for ensuing pregnancies in women who have previously sustained OASIS (75). Although the risk of OASIS is increased in women who had an OASIS at a previous delivery when compared with women without (OR, 4.2; 95% CI, 3.9–4.5), the absolute risk is low (3%) (72, 73). Large retrospective studies have shown that 67–90% of women with a previous OASIS undergo a subsequent vaginal delivery (76, 77). Although screening methods such as endoanal ultrasonography and anal manometry have been used to determine if women with previous OASIS should attempt a repeat vaginal delivery or undergo cesarean delivery, no differences in fecal urgency, anal incontinence, or bowel-related quality-of-life measures were demonstrated in women after a vaginal or cesarean delivery compared with before parturition. (78).
When deciding on the mode of delivery, women should take into consideration the increased morbidity associated with cesarean delivery and balance it against the low risk of OASIS recurrence. Women need to be aware that once a cesarean delivery is performed for this indication, it would become a recurrent recommendation and consequently compound the morbidity of subsequent deliveries. Expert opinion suggests that in a woman with a history of OASIS, a cesarean delivery may be offered in subsequent pregnancies if any of the following is noted: she experienced anal incontinence after the delivery, had complications including wound infection or a need for a repeat laceration repair, or expresses suffering psychological trauma and requests a scheduled cesarean delivery. Thus, the management of a subsequent pregnancy will depend on symptomatic and clinical evaluation. Women who have a history of OASIS should be counseled that the absolute risk of a recurrent OASIS is low with a subsequent vaginal delivery; however, it is reasonable to perform a cesarean delivery based on patient request after advising of the associated risks. Asymptomatic women without any evidence of sphincter compromise may be allowed to have a vaginal delivery (1).

Answer

I had a 4th degree with my first and then I had my 2nd baby 16 months later vaginally with no issues. I was never told that I couldn’t deliver vaginally but who knows. I am pregnant now with my third and nothing has been said.

Vaginal birth after 4th degree tear???

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