Postpartum Patient Education is Lacking


Tearing during childbirth is fairly common. It is estimated that about 90% of first time mothers will tear to some extent, but only about 6% have severe tears (3rd and 4th degrees).

A 4th degree tear (4DT) has been referred to as a “vaginal c-section”. A woman is cut and/or torn from her vagina all the way to her rectum. The recovery from this type of tear can take months or years, while some women never fully recover.

A disturbing trend we are noticing in our 4DT Facebook support group, is that women are not being told what to expect during this recovery period. Some of them are not even being told by their doctors that they have a 4DT! These women are being discharged from the hospital in two or three days after birth with little information or resources, and they are not seen again until 6 weeks postpartum. Even then some of them have to ASK to be examined, instead of it being standard procedure.

Here are a few of the responses from the support group when asked what their follow up care was like immediately postpartum:

“I was not told what happened. I was cut with scissors from what my husband says. The doctor never told me that happened, the nurses told me I tore.”

”My doctor didn’t even tell me I had a 4th degree tear or what it was. As they changed shifts, I heard my first nurse telling the second nurse that I had a 4th degree tear. I asked what the worst tear was and she said 4th degree. I had to google what it meant.”

”Nobody explained anything to me. Terrible information and follow up.”

”The only way I even knew was hearing the doctor tell the nurse when she was charting. She asked about the tear and he said he gave me a medio-lateral 2d episiotomy and I tore the rest of the way to a 4th. Which meant nothing to me at the time.”

”Honestly I didn’t even know any of this until I joined this group. I knew I had a 4th degree tear from reading my records. No one told me anything. All I thought was I had a tear that took a lot to stitch up.”

”Nope. None of that. I didnt even know I tore that bad until the next day when my friend who was a nurse there when I delivered told me.”

”All the “doctor” told me was if we wanted more children I would have to have a c section. That’s pretty much it.”

”I never got any information from anyone about what to expect or a recommendation for PT (physical therapy). I didn’t get PT til 5 years later. The first time I mentioned wanting pt to one of my midwives she made a face like I was crazy. I didn’t ask again for three or four years. I was so embarrassed. Later I asked a different midwife and she was enthusiastic about the idea. And it helped tremendously. The only thing they did was tell my husband that I’d need a csection for any future babies.“

”No, but was misdiagnosed with 2nd then 3rd and eventually told 4th! Found a private physio myself and have had to do all the research myself x”

”Mine didn’t inform me what the complications were either! I didn’t even understand what it was until 2 days after when one of the nurses explained it to me. I felt stupid for not knowing what to do or where to go for help.”

”Me too! Nothing was told or told what to look out for.”

“I agree. Did they not inform us in order to not scare us? I knew what a 4th degree tear was (during the birth process) but had no idea of the life long consequences. I felt someone should have come in to at least give us information or a pamphlet that we could store away and read if we did have problems, or after the whole overwhelming newborn phase was over. Not once was pelvic floor physical therapy mentioned to me.”

”My doctor told me I had received a 4th degree tear…but nothing more, I too wish I was given the run down and some things to watch for….ive had to self diagnose and reassure.”

“I feel like you are writing my story… it took me 9 years to finally stand up and say enough is enough! I cried happy tears when the ultrasound showed my muscle wasn’t connected. So many doctors made me feel like it was in my head!”

”I was told that I would be back to normal in 2 weeks. {I was told} to think how fortunate that in this country we have stitches, in other countries they heal naturally but they heal. And remember to pat not wipe. For weeks the gross “joke” was you just can’t pat poop away. I was not seen again till 6 weeks where she did a full exam. I said is it weird I don’t feel ready for sex yet, she said I’d be fine.”

”No one explained what it meant. They just said I had a 4DT and had hemorrhaged. By that point I was so exhausted from birth and the hour of stitching and just wanted to hold my baby so I didn’t ask any questions. My OB didn’t ask anything special about it at my six week checkup. She wasn’t even going to look at my stitches I had to ask her to.”

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