A Healing Home Birth After a Fourth Degree Tear: Part One

I always knew I would have natural childbirths. My mom had four very fast labors and delivered naturally. My sister followed in her footsteps. Childbirth wasn’t something that I feared. It is a normal bodily function that women have been doing for thousands of years! I would just be another one of those women…

When I got pregnant with my first son, I read Ina May’s Guide to Childbirth. It confirmed for me that childbirth is a normal thing, but it also introduced the idea of homebirth. Before reading it I had already chosen an OB practice that was part of the hospital group that I worked for, so financially it made sense to me at the time to just deliver with them at the hospital. I knew that my mom, who has over thirty years of experience as a labor and delivery nurse, along with my husband would be with me for delivery. So even though I liked the idea of a homebirth, I thought I would just go into the hospital and stick to my guns about having an intervention free birth.

Well the day after my due date, I woke up to my water “breaking” – it was more of a slow leak than a gush. It was a Saturday, so we spent the day doing normal Saturday things. I bounced on my birth ball, went to our friend’s son’s first birthday party, just waiting for contractions to pick up. Around 4pm I had my first decent “gush” of water, so I called the OB to tell her my water had broken. She advised me to go to the hospital, because I was GBS positive and would need to have antibiotics, especially since my water had broken.

We got to the hospital around 6pm. I told them that my water had broken at 4pm, because I wanted to give my body more time for labor to start on its own and I knew I was going to be getting antibiotics anyway, so the chance of infection was greatly reduced. Since it was a weekend my doctor was a first year resident and my OB, who had I met once or twice during my whole pregnancy, was on call for when labor picked up. This wasn’t a huge deal to me, because like I said, I had only met my OB a couple of times; I wasn’t really attached to her. Plus, the nurses are the ones you spend most of the time with anyway.

BUT this resident lost my respect quickly. The first time she came into my room she told me she wanted to start Pitocin immediately, because they wanted babies to be delivered within 12 hours of the water being broken. That did not go over very well with me, or my mom. We knew that the most conservative recommendations are 24 hours, some even going to 48 or 72 hours. She had nothing to say when we pointed out these recommendations. This pissed me off for two reasons – first, because she lied to ME and lost all accountability as my provider, and second, because she has most likely lied to a lot of other mothers who trusted her at her word. Not every woman in labor has a mother with them who has over 30 years of experience in the field.

So I was able to hold off the Pitocin until 6am the following morning when I was only 2cm dilated after walking the halls of the hospital all night long. Luckily labor progressed very quickly after that. I was checked a little before 10am, after contractions got really intense, and was 5cm. About ten minutes later I was pushing! What a relief pushing was! It felt great! It was absolutely exhausting and took all of my energy to push, but it also took away the pain of the contraction.

I had coached pushing. The nurses were counting to ten while I pushed and did that three times during each contraction. Around 7 or 8 I wanted to stop pushing. Every. single. time. It did not feel natural to me to push like that and looking back I wish I would have just yelled, “SHUT UP AND LEAVE ME ALONE!” But I didn’t.

Unfortunately, I just think nurses/OBs/even some midwives just don’t know any better. They think that’s the way it’s supposed to happen. My nurses were wonderful and were not rushing me at all. And my mom, who like I mentioned was a labor and delivery nurse for decades, was even counting, too. With so many people in hospitals having epidurals or pain meds, I don’t think nurses or OBs see a lot of natural childbirth, so they don’t know how it could be if a woman just listened to her body. I pushed and pushed like they were telling me to do for three and a half hours. His head was just not coming. I tried all kinds of positions – side lying, all fours, squatting, squatting while pulling on a rope…I was exhausted. I’m talking like I was falling asleep between contractions, then waking up to push, then falling back asleep exhausted.

The OB came in and said she knew I didn’t want a C-section, but he just wasn’t coming. She thought using a vacuum was the best thing to do. Did I mention I was exhausted? Honestly if she would have walked in the door and said, “We need to do a C-section.” I would have said, “OK.” That is why it is so important to have a birth plan, a provider you trust, and loved ones who know what you want, because in labor, especially at the end, you don’t have the strength to do anything else but labor. I’m not saying I did not need a vacuum at that point, because I did. I had exhausted myself too much to push him out on my own. I was three and a half hours too late for that. If I could go back and change one thing about his birth (there are many, but this is the biggest), I would not have had coached pushing. I would have just listened to my body and pushed with its urges. If I had done that, I don’t think I would have needed the vacuum.

The OB gave me a pudendal nerve block, episiotomy, and used the vacuum to pull him out. I didn’t feel a thing. Nothing. I had my eyes closed while pushing and they had to tell me to open them when he was born. It was 1:26pm. Abram Jonathan (AJ) was 7 lbs 8oz and 20.5 in. I don’t even remember seeing him after he was born. I had asked for immediate skin to skin and delayed cord clamping, but because she used the vacuum she said she had to cut it right away so he could be taken over to the NICU team on the other side of the room to be examined. Again, I was exhausted and had no fight in me, so I said, “Ok.”

It took about thirty minutes to stitch me up because of the 4th degree tear that I had, and almost all of that time, my son was laying in the little plastic box thing, being cleaned, weighed, etc. I’m pretty sure my mom and husband held him before I did. At that point, I honestly didn’t care. I was so exhausted that I was barely awake and I think I might have been in a little bit of a state of shock. It wasn’t until after my second son was born that I really realized how awful my experience was. I mean don’t get me wrong, I knew it wasn’t great, but I didn’t realize how traumatizing it really was.

Emotionally I was somehow fine after his birth. I had such a great support system with my husband, mom, and in-laws that I didn’t go through any postpartum depression. Physically, I healed very well. I think my OB did a great job of stitching me back up, so that really helped with my healing. They had me doing Kegels right away to help the blood flow to the area and promote healing. I also had my mom with me for two and a half weeks after his birth to help around the house. It still took nine months to feel completely “back to normal,” but compared to other moms who have had a 4th degree tear, that isn’t very long at all. Some moms have permanent damage and need multiple surgeries after. Some are still not able to have sex even years later, because it is too painful.

Something that I wish I would have done after his birth was see a pelvic floor specialist and start pelvic floor therapy. I was never referred to a specialist and looking back I think it should be routine for all women who have had a severe tear to see one, and to do therapy. Even though I may feel great now, there is always the thought in the back of my mind about how I might be in a couple of decades. All of our pelvic floors weaken as we get older, so what kind of problems could I be facing later in life?

After my son was born, I knew that I never wanted to have another birth like that again. Even before I got pregnant a second time, I was researching homebirths. A C-section never crossed my mind for my next birth, because I knew that there were things that I could do differently. I trusted my body. I didn’t feel like my body had failed me.

Please visit tomorrow to read part two of this story.