4th degree Laceration..ouch!

tinyscrafts · Jan 27, 2007

Evidence wise, don't cut an episiotomy.

and learn from someone that's good with intact deliveries.

KellNY, RN · Jan 27, 2007

yeah, what tiny said.

That, and (unless it's a true emergency) don't yank the baby out.

txspadequeenRN, BSN, RN · Jan 27, 2007

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.

KellNY, RN · Jan 27, 2007

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).

33-weeker · Jan 27, 2007

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)

nurse79 · Jan 27, 2007

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)

BittyBabyGrower, MSN, RN · Jan 27, 2007

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 lady partsl 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!

Belinda-wales, RN · Jan 27, 2007

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.

htrn · Jan 28, 2007

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.

nurse79 · Jan 28, 2007

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....

SmilingBluEyes · Jan 28, 2007

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.