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

If you haven’t read Part One of this story, please start here.

The choice for me to have a homebirth was easy. I was emotionally and physically healed from my 4th degree tear, and BOTH are necessary to deliver vaginally again, which I call a VBAST (vaginal birth after a severe tear). For others who have had a 4th degree tear, the choice of future deliveries is not so easy. I am in a Facebook support group for mom’s who have had a 4th degree tear (which is the ONLY active support group for us!) and the decision to have a VBAST, or to even get pregnant again, is a terrifying one. Some women have had PTSD from their deliveries and emotionally cannot have another vaginal delivery. Some, like I mentioned before, physically cannot have another vaginal delivery because of ongoing problems like incontinence.

Others, like myself, feel like they have to have another vaginal delivery to emotionally heal from their 4th degree tear. I wanted to prove to myself that my body could do it all by itself. I wanted the birth that I wasn’t able to have the first time. There are risks to this of course. You could have another severe tear and cause more damage. The risk of another severe tear is small, about 7%, but that is higher than other moms who haven’t had a severe tear, about 1-2%. However, I was willing to take that risk. I did A LOT of research on ways to decrease the chances of another tear and I felt like the best way for me to do that was at home, which I also did A LOT of research on.

To avoid another severe tear, I wanted to avoid an epidural and pain meds (easy to do at home!), because those would lead to the next two things that increase the risk – coached pushing and pushing in the lithotomy position (on your back with feet up in stirrups). I also did not want, under any circumstances, an episiotomy or assisted delivery (vacuum or forceps). I chose to have a water birth, because the water softens the perineum and makes it easier to stretch during delivery. I also watched as many natural birth videos on YouTube as possible! These really helped me to inspire and motivate me, and to see what worked for other women.

I am extremely lucky to live in an Amish area, so homebirths are common. I had a lot of options for a homebirth midwife, but one midwifery group really stood out to me. Their practice has been around since 1978 and has a very good reputation in the area. They also provide all options in one place – you can deliver in their free standing birth center, at home, or at one of the local hospitals. It is rare that you are able to find a midwife group that provides all three of those. The peace of mind knowing your midwife would still be able to be with you should you have to transfer to a hospital was priceless.

With my second son I was due on a Sunday, so my mom drove the 13 hours from Georgia on the Wednesday before to be here for the birth. There was one stipulation from my husband for us to have a home birth – my mom had to be there! After having some crampy contractions for several nights in a row, I was worried the baby was not going to wait on my mom. But he did! That Wednesday night I woke up at 2:30am to use the bathroom and realized I had been “dreaming” that I was having contractions. When I laid back down I had three contractions that were seven, then four minutes apart, so I woke up my husband and said, “Sorry, but I think we might have a 9/11 baby.” Neither one of us had wanted a September 11th baby and my husband had a couple of important meetings at work that day, but he didn’t make it to those appointments…I also woke up my mom and told her the baby must have been waiting on her.

We spent the next two hours doing some last minute cleaning and setting everything up for the birth, including the birth pool. Contractions were four minutes apart, but not strong (I had a pregnancy full of Braxton Hicks and these were definitely different, but not strong yet). After we set everything up I laid down to sleep for two hours and contractions spread out to about 10-15 minutes. After I got up, I called the on call midwife, Autumn, at 8am to tell her I wouldn’t be making it to my 9:15 appointment, because I was in labor. I kept busy the rest of the morning and contractions stayed around ten minutes apart. I started having bloody show at 10am. At 2:30pm I asked my mom to check my dilation before I called to update Autumn (remember, my mom is a labor and delivery nurse). I was 4cm, 80%, and -1 station.

The next few hours the contractions continued to get stronger and closer together, but still not bad. We continued to keep busy by making a big pot of soup and warming the water in the birth pool. I decided to call Autumn at 5:45pm to come over, because contractions had been every five and a half minutes for the past hour and I knew she was 45 minutes away. She got to our house just before 7pm and the nurse, Diane, arrived shortly after. Autumn checked me soon after she got there, but I did not want to know my dilation from that point on (after delivery I found out I was 8cm at that point! I DID NOT think I was that far along).

Over the next couple of hours the contractions picked up some, so I had to walk around and breathe though them. One thing that really helped was someone rubbing a hot pack on my low back while I rubbed my stomach during a contraction. Around 8:30pm there was a change in the midwife’s shift, so Lori came and took over for Autumn. All three of them, Lori, Autumn, and Diane, had very calm and relaxing vibes. They sat at our dining room table taking notes and making conversation. Other than the occasional monitoring of the baby’s heartbeat, there was no other poking or prodding going on.

Around 9:45pm I was getting tired and mentioned possibly getting in the tub, but I didn’t want to get in too early and stall things. Lori encouraged me that she did not think things would stall and I should get in the tub. Again, I had no idea how dilated I was, but she knew I was at least 8cm.

In the tub, my back was really bothering me, so I decided to get on my knees and lean over the edge. I spread my knees apart to really open up my pelvis and after a few contractions I felt a “pop” during a contraction and things got really intense. I thought it was my water breaking, but Lori said it didn’t. I think it was his head moving down. The next couple of contractions I got a little nauseous and started getting the urge to push. One of the things on my birth plan was that I didn’t want any coached pushing – I wanted to just trust my body’s lead. It was a good thing, because my urges were all over the place. There’s NO WAY I would have been able to push the typical way – counting to ten three times during a contraction. She checked my dilation again and I was 9cm and fully effaced and could be stretched to 10cm (she didn’t tell me).

Lori monitored his heart rate and got a reading of 100 on the Doppler and was worried for a short time, but we eventually realized it was the placenta pulsing and not the baby. During that time though, I changed position from my knees to my back. She checked me one last time to make sure I was fully dilated and didn’t have a cervical lip. After pushing so long with my first son, I didn’t want to take the chance of pushing against a cervical lip this time! I got the all clear to push and within 10-15 minutes he started crowning.

Wow, is that intense! With my first I had the pudendal nerve block, so I didn’t feel a thing when they used the vacuum to pull him out. So crowning/ring of fire was all new to me and had been my greatest fear the whole time – along with having a bad tear again. I was somehow able to breathe through crowning and push him out slowly over about 4 contractions. I was making a bit of noise during this time and right before Chase was born our dog came over and put her head on my shoulder. It was the sweetest thing ever! I gave her a big kiss and she went back to lying on the couch like she had been doing throughout my labor.

The next contraction Chase Benjamin was born at 10:40pm. It was the most incredible feeling in the world! I just looked at him and said, “I cannot believe I just did that!” I did end up with a 2nd degree tear right along the episiotomy scar, but I expected some tearing and the recovery was so much easier compared to my first son. He was 7lbs 11oz 20 1/4in and looked a lot like his big brother.

Choosing a home birth with a midwife has been one of the best decisions of my life. It was a beautiful, healing experience after my first delivery. I want anyone who has had a 4th degree tear to know that another vaginal delivery IS possible if they want one!