4th degree Laceration..ouch!

1. Hi all...
   
   Just wondering if there is any way the docs can prevent a 4th degree laceration/tear? Just curious...i've never personally experienced one, but i'm sure it hurts!! thanks!
2. 

   About nurse79

   Joined: Sep '06; Posts: 157; Likes: 11
   RN
   Specialty: 8 year(s) of experience in Mother/Baby;L/D

   21 Comments

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3. 
   Jan 27, '07

   Joined: Feb '06; Posts: 148; Likes: 4

   Evidence wise, don't cut an episiotomy.
   and learn from someone that's good with intact deliveries.
4. 
   Jan 27, '07

   Occupation: RN Specialty: High Risk In Patient OB/GYN ; Joined: Apr '06; Posts: 738; Likes: 160

   yeah, what tiny said.
   
   That, and (unless it's a true emergency) don't yank the baby out.
5. 
   Jan 27, '07

   Occupation: RN Specialty: 20 year(s) of experience in ICU, PICC Nurse, Nursing Supervisor ; From: TX, US ; Joined: Apr '04; Posts: 5,001; Likes: 1,902

   Ive had a 4th degree laceration and let me tell you..yeeehhhhaaa it does not feel good. I was rushed all through delivery...it was a horrible experience.
6. 
   Jan 27, '07

   Occupation: RN Specialty: High Risk In Patient OB/GYN ; Joined: Apr '06; Posts: 738; Likes: 160

   Oh, and stop this birth-on-your-back-with-legs-in-stirrups junk.
   
   It sounds simplistic, but most 4th degree tears are actually CAUSED by the MDs (or in more rare cases, CNMs).
7. 
   Jan 27, '07

   Occupation: Nursery I & II Specialty: 20+ year(s) of experience ; Joined: Oct '06; Posts: 441; Likes: 97

   Don't cut and epis
   (which weakens the tissue and predisposes mom to a bigger tear.)
   
   Continuously support the perineum as the baby emerges - especially if a small epis. has been cut.
   
   Don't use stirrups.
   
   Use a midwife instead of an OB.
   (my midwife, after delivering 300 babies had only cut 3 episiotomies and had never had anything worse than a 2nd degree tear)
8. 
   Jan 27, '07

   Occupation: RN Specialty: 8 year(s) of experience in Mother/Baby;L/D ; Joined: Sep '06; Posts: 157; Likes: 11

   hmm interesting tips to consider when i watch OBs deliver. Thanks!!..i was just wondering bc i did see an MD cut an epis..but the pt did tear to a 4th degree. she had been pushing for a good 3 hrs prior..but not as effectively (due partly to exhaustion no doubt)
9. 
   Jan 27, '07

   Occupation: Nurse of course! Specialty: NICU, PICU, educator ; From: US ; Joined: Feb '04; Posts: 1,838; Likes: 1,115

   I experienced on first hand...one of my kids was stuck by her cord and was deceling to beat the band...I had 2 epis so they could try to get to the cord and then basically she was yanked out.....I had a vaginal c-section to say the least! It was a horrible recovery...took a lonnnng time. Now my pelvic floor is shot, so in the future, I am sure that will need some attention. I spent a lot of time in a sitz bath with that dermaplast spray!
10. 
    Jan 27, '07

    Occupation: Midwife-RN- L&D-Clinical Nurse Manager Joined: Apr '04; Posts: 366; Likes: 67

    I am or was a uk midwife who was at 150 to 200 deliveries a year for seven years I only ever did epis for fetal distress- my total number of 4th degree tears was three and two of them was in my first two years. As a unit the yearly total was very low but in the uk we only do epis for fetal distress or assisted delivery even then I known of suction dels done with only a small graze and no epis.
11. 
    Jan 27, '07

    Joined: Feb '03; Posts: 388; Likes: 153

    We have an OB that will cut an RML if he feels there isn't enough room for a midline without risking 4th degree. But then again, if he did all of the above he wouldn't have to worry about it in the first place.
12. 
    Jan 27, '07

    Occupation: RN Specialty: 8 year(s) of experience in Mother/Baby;L/D ; Joined: Sep '06; Posts: 157; Likes: 11

    yea my aunt was a midwife in england and i think the majority of oBs there prefer to do mediolateral epis' to help prevent 4th degrees..i seldom see mediolateral episiotomies cut here....
13. 
    Jan 27, '07

    Joined: Apr '02; Posts: 38,771; Likes: 16,375

    Our OBs rarely cut epis.
    
    And I can count on ONE hand the number of 4th degree lacs I have seen on our unit (staffed with ALL MDs) in the last 5 to 6 years.
14. 
    Jan 27, '07

    Occupation: Mom, critical care nurse, NP student, all around wackadoo! Specialty: ICU, CVICU ; From: US ; Joined: Jul '05; Posts: 679; Likes: 216

    One of my fellow nursing students was talking about the 4th degree epi she saw at clinical and how all the doctors she saw cut epis. I was appalled but then our nursing professor started talking about how common it was. Is it me or is that just wrong information? I was under the impression that it is rarely done anymore.

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