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I hate to say this, but I’m afraid you have a 4th-degree tear.
There’s a sentence I really didn’t need to hear. After a trainwreck labor that did not go as expected, my vacuum-assisted 9 lb 1 oz baby was wriggling on my chest as the doctors had begun to stitch me up.
When I arrived home from the hospital a few days later, I turned to my friend Pinterest to see how other mamas were handling recovery, and I didn’t find much.
I’m hoping this article finds you and helps you through your recovery process and that things go well.
You and I could be in for a long ride. I’ll be checking in all through my first year of recovery to update you on how things are going, so be sure to bookmark this article and check back!
What is a 4th-Degree Tear?
Firstly, for the love of all that is holy, if you are squeamish, DO NOT GOOGLE photos of what it looks like. At least not close to your delivery. Those pictures will give you PTSD.
Here’s a cartoon version that will give you enough visual:
Without getting too graphic, a 4th-degreee tear involves a deep laceration or tear to the perineal muscles, the rectum and/or the anal sphincter. A 4th-degree tear is the most severe type of tearing that can occur during labor. Here is an excellent article you can check out about tearing during delivery.
It is important to take care to make sure the healing and recovery process goes well so that you do not end up with permanent nerve damage or other anatomical unpleasantries (I’ll let your imagination take over here).
ALSO… make sure you follow your doctor’s orders! This post is not meant to be taken as medical advice- it’s my own experience and tidbits that helped me through my recovery.
Repairing the Damage
After finding out that I had a 4th-degree tear, my obstetrician decided to wheel me into an operating theater while he and another surgeon stared at, talked about and came up with a game plan to stitch everything back together.
Since I had already received an epidural, they cranked the meds back up so that I could remain comfortable during the procedure. Thankfully, I didn’t feel a thing the entire 30 minutes it took to stitch things back together.
What about the baby, skin-to-skin and immediate breastfeeding?
My brand new baby stayed in the delivery room with dad and our doula and enjoyed some skin-to-skin with dad.
My doula and husband knew that I didn’t want him to be fed any formula or sugar water, and with his good birth weight, no one tried to offer.
They delayed immediate breastfeeding to do the procedure without any problems. Little Brother latched on without any problems and we are still successfully breastfeeding!
What to Expect: The First Week of Recovery
Days 1 & 2:
If you experience a 4th-degree tear, you should expect to:
- rest (no getting up for you!)
- establish breastfeeding (should you choose to),
- drink plenty of fluids,
- keep up with your pain meds,
- use a LOT of ice packs
- and likely be catheterized for a few hours.
- You may also have a longer than normal hospital stay (I was there three nights).
I finished up in the O.R. and made it to my hospital room by about 8:30 PM the day I delivered. I was SO sore! The nurses helped me into those wonderful mesh panties and changed me into a jumbo-sized pad. I was given regular strength Tylenol and Naproxen for pain and some stool softener immediately.
You can expect to be catheterized (a tube that goes up your urethra and drains your bladder) for the first little bit and therefore bedridden. You’ll need to lean on your Hubby/SO and/or that call button and the nurses on call to do basic care for your new little one. I couldn’t even lift my son out of his bassinet on my own. It was rough!
PRO TIP!: Once the catheter is out, you might notice that you have trouble locating your bladder muscles when you go to empty your bladder. I found that pressing lightly on my bladder and massaging a bit helped me locate and press down to void my bladder. Don’t worry! It took maybe 5-7 days for the feeling to return.
My nurses were pretty stingy with the painkillers- the didn’t want to give me more than Naproxen and Tylenol, I’m guessing because of my doctor’s orders. Everything down below felt very pinchy and uncomfortable. Even lying on my back put pressure on my bum, which I quickly learned to put a little pillow down there to distribute the pressure.
By day 3, I was doing much better, I was taking less Tylenol by then for sure!
Pro tip- Keep those ice packs coming! They really do help with pain and swelling.
Week 1 Recovery
The 10 Commandments for week 1 recovery:
1. Don’t skip the pain meds. Before you start to feel pinching and/or aching down below, make sure you take those pills! You can alternate with Advil and Tylenol or Naproxen and Tylenol!
2. DON’T LOOK DOWN THERE YET! I’ve always been one to look, but it’s a war zone. Wait for a little while longer, even if you’re not squeamish.
3. Sit down and get up S.L.O.W.L.Y. – you will likely be able to feel stitches pulling a bit when you move too much or too suddenly.
This beauty followed me around for a couple of weeks after delivery:
4. Stay in your housecoat and don’t do any housework. Just focus on looking after your newborn and yourself.
Make sure it’s cozy!
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5. Hydrate- Drink 2-3 liters of water per day to help keep your body hydrated to recover, breastfeed, keep your bowels hydrated and to detoxify your body!
I kept this water bottle on hand at all times!
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6. Eat good, nutritious food and snacks often.
I stocked these at all my nursing stations and ate a lot of fresh fruit- apples, oranges & pineapple were favorites!
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7. Set up nursing, bathroom and diapering stations on all floors of your house.
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8. REST! Aim to take at least one nap during the day- perhaps your hubby or a visitor could hold your little one so you can rest. This is so important, as you will not be getting the night sleep you need!
9. Practice excellent hygiene- make sure you change your pads, rinse with your peri bottle and do sitz baths often!
10. Learn how to Poop Without Fear.
- Make sure you stay on the laxatives/stool softeners your doctor prescribes.
- Sit up and forward or with a stool or squatty potty under your feet. You want to find a good position for your bowel movements to make their quickest exit.
- Rinse, rinse, rinse with warm water in your peri bottle
- BLOT to dry- DO NOT wipe! (I’ve also heard some ladies use baby wipes, but I like a dry feeling)
- Follow with a Tucks Pad or some witch hazel on a cotton pad
One Month of Recovery
Hey, guys! I’m a month postpartum now, and here are a few things I can tell you about how the first month went:
- The biggest challenge has been managing stool softeners and laxatives. Sometimes they work a little too well and create what my husband and I call “Poop Emergencies” where I almost wouldn’t make it to the toilet!
- Then at almost a month postpartum, I got diarrhea (just being real) and went off both the laxative and stool softener. I went once an hour for 48 hours and I’m pretty sure I burned parts of my bottom. Not fun. Thankfully it healed quickly and hasn’t had any adverse affects as far as I can tell.
- It’s now been over 48 hours since I’ve had a bowel movement and I’m legit scared. I’ll update you soon. If I haven’t gone by morning, I might try one pill or some serious fiber intake. Make sure you stay hydrated, friends!
- Driving didn’t happen until about 2 weeks postpartum. If you know me, you know what a sacrifice this was!
- I enlisted help for the first week and a half at home. My mother-in-law, mom and sister (all angels btw) cooked, cleaned, looked after my 3-year-old and kept me on the couch. Without them, I would not have done so well in that first week!
- Be at peace with the rubber donut thingy! It’s a lifesaver!
- Oddly enough, even lying in bed was uncomfortable for the first 2 weeks. I had just as many pillows in bed as while I was pregnant!
- My postpartum bleeding was less. I’m not sure if this has been a second-time-mom thing, or an “every pregnancy is different” thing. Though it has been drawn out, see my next point.
- Taking things slowly has been my mantra. My house is not as clean as I’d like, but it’s a good excuse to sit on the couch and snuggle with my 2 kiddos. Any time I’ve tried to press too hard physically, my postpartum bleeding picks up and my stitched area aches and pinches. Our bodies do a great job of letting us know to slow down!
- Mentally, I’ve been doing fine, mostly because I think I did a good job preparing for my birth and for the postpartum period.
- Most of all, my postpartum recovery plan became very important because I had even more recovering to do than I initially expected. I’m so glad I took the time to think it all over before it happened!
That’s about all I can tell you about my recovery so far. I’m going to check in after my 6-week postpartum checkup with my OB/GYN to let you know how things are healing and if she gives the “all clear” or not!
Thanks for reading my post and taking in all the TMI facts and experiences with major tearing following a delivery. I hope you only read this out of interest and not of necessity. If you’re here because you have experienced it… can we start a club?
Do you have a similar experience with a 3rd or 4th-degree tear? What is your biggest piece of advice? Please let me know in the comments below!