What Is A Fourth Degree Tear? An Expert Demystifies The Condition Women Most Fear

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I have never had an easy recovery from childbirth. An episiotomy finally brought my stubborn firstborn son into the world, and the scar tissue tore mightily again with my nearly 10-pound boy the next time around. It's hard not to envy women who bounce back from delivery a day or two later, but I also know my luck could have been way worse. Women who endure fourth degree tearing are the real heroes, and I bow down before their goddess selves with my face in the dust. So what is a fourth degree tear? If you don't already know, brace yourself.

According to Dr. Sherry Ross, expert on the MedAnswers platform and author of she-ology, a fourth degree tear occurs in childbirth when pushing the baby out results in tearing of, "The deeper layers of the vagina, muscles surrounding the anal sphincter, and extending right through to the rectum."

Unfortunately yes, you read that correctly. As if your vagina tearing during delivery is not horrifying enough, it is actually possible for the tearing to extend all the way back to your rectum.

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I know.

The good news, Ross tells Romper, is that this condition is pretty rare and a small tear is much more likely. Susceptibility to fourth degree tearing is heightened with vaccum or forcep-assisted deliveries, occiput posterior births (baby is face-up), expediting delivery due to fetal distress, uncontrollable pushing, a larger than normal sized baby, first-time births, and severe vaginal swelling due to prolonged pushing.

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Although the above factors increase a woman's risk of experiencing a fourth degree tear, it's important to keep in mind that they certainly don't determine it. For example, my first son's birth included three of those elements — occiput posterior positioning, first-time birth, and swelling due to prolonged pushing — but my tearing with him thankfully did not extend to the rectum.

So is there any way to prevent a fourth degree tear? Sometimes. Ross says, "If you can control the pushing phase of labor to allow the vagina to stretch slowly, this helps reduce the likelihood of it happening. Some women use a warm compress applied to the perineum (the area between the vagina and rectum) during the pushing phase."

Another popular method of prevention is perineal massage, which requires frequent massaging of the base of the vagina with oil or a water-based lubricant. Ross tells Romper perineal massage is thought to soften the tissue to improve its flexibility, but that studies show it is only effective in reducing vaginal tearing in six percent of cases. Still, it doesn't hurt to try.

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If a fourth degree tear is present, the stitches required are a bit more involved than in cases of mild tearing, and require a delicate and thorough closure involving multiple layers. Because the injury is more extensive, a woman's recovery period will obviously take longer. In a worst-case scenario, they can cause pelvic floor dysfunction and prolapse, urinary incontinence, fecal incontinence, and sexual dysfunction.

In order to prevent this kind of extensive tearing, episiotomies used to be given routinely to laboring women. The medical community is largely moving away from the protocol now, as it has become apparent that the extent of damage to the vagina is usually less and recovery is easier if natural tearing occurs instead since, again, a fourth degree tear is unlikely.

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Although the prospect of this kind of birth injury is a small possibility, there is really no reason to fear or anticipate it. Much more common are the small tears that the average woman recovers from in a week or two, but there are also plenty of instances of women not tearing at all. Don't waste time sweating this statistically unlikely possibility — my bet is you've got plenty of other worries on your mind.

Check out Romper's new video series, Romper's Doula Diaries:

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