Level 4 Episiotomy........

I had the same results. With my second child I did NOT have an episiotomy and everything was just fine. No tearing etc. I think doctors do this and now I think it's silly. I would definately have another vaginal birth and simply refuse an episiotomy. there is an e-mail below re: peaceful birthing. My 2nd birth was 23 years ago but I did self hypnosis and had a wonderful birthing experience. I could have given birth again 5 minutes later. It was fantastic. I would definately look into this if I were you. Good Luck.

Oh my gosh, that sounds painful to say the least. I have an 11 month old and had him by c-section. I would never have had him any other way. I only took 1 pain pill in the hospital(not even because of pain, but because of pulling), was out of the hospital in 3 days, had my staples out in 5. However, I have a pretty high pain tolerance. Plus, the scar is almost gone. I would honestly look into a c-section more.

You can always refuse an episiotomy. There are VERY few instances when an Epi is actually needed, And intentionally cutting a 4th degree Epi is...well unnecessary.

C-sections are rough to recover from too. I've had three very much unwanted c-sections the first was a preventable (failed induction for no reason) the second was unnecessary (coerced into agreeing by the ob) the third was necessary (after laboring, and pushing for 12hours it became necessary) I will not be planning a 4th c-section, rather I am planning to VBA3C when I become pregnant again.

Let me tell you why.

There are several potential complications to the baby during/following a c-section.
1. unintentional prematurity (thinking a woman is 38wks when she's only 36 is a problem)
2. 2-5% of babies are "nicked" during surgery.
3. Respritory distress (ranges from needing extra oxygen to needing intubation and a NICU stay)
4. Children born by c/s are more likely to have asthma and allergies than vaginally born children.
5. Children born by c/s are less likely to be breastfed (because the trauma of the birth on the infant and or mother causes pain/difficulty in nursing) (not saying anything "bad" about women who can't or chose not to breastfeed, other than scientific data shows that breast is best)

Lets not forget the risks to a Woman during/after a c/s which include.
1. High level of blood loss (2-4x's the amount lost during a vaginal birth)
2. Hysterectomy
3. Damage to surrounding organs.
4. Secondary infertility (unexplained misscarriages and stillbirths, inability to become pregnant)
5. Increased risk of Post Partum Depression.
6. Infection which could mean months of cleaning and packing an open abdominal wound.(btdt not fun)
7. Death.

Weeks-Months of recovery time depending on the skill of the surgeon. (all of my c-sections took 2months to 1yr to heal fully, by that I mean it took that long to no longer have pain in/around the scar area, that's not to say I was completely healed as I still have problems with adhesion (scar tissue) pain in my abdomen)

If you would like to talk to other women who are and have had to make the c-section/vaginal birth decision check out the forums on www.ican-online.org (http://www.ican-online.org/forum/index.php)

S., I just wanted to add that if you do opt for another vaginal birth, be sure to shop for a midwife or OBGYN who has a low episiotomy rate. You are the customer, and you have every right to ask before making a decision on a provider.

With my first daughter I had an episiotomy and then tore on top of that. So all told, I ended up with 4th degree tearing/episiotomy also. While the healing wasn't fun, it definitely did not take me as long to heal as it did you. Prior to the birth of my second child I expressed to my doctor that I would really prefer not to have an episiotomy unless necessary. So, with the vaginal birth of my second, I did not have an episiotomy. Instead, my doctor slowed down my pushing when the baby was crowning so her head could naturally stretch me. Also, he did some manual stretching and massage. I still tore some, but not nearly as much as I did with my first. I also was more relaxed during the birth of my second and did not have to push for as long. I think these things helped also. I went on to have a third vaginal birth. Again, no episiotomy, but still some tearing. I would discuss all of your concerns with your doctor. Be honest and s/he can hopefully offer you some helpful advice. A c-section is a pretty major surgery and will definitely take some healing time too.

Hi S.! I know I am late responding but I had a level 4 episiotomy with my first and did EVERYTHING I could to prevent it. I got a staph infection and had a horrible time healing so I can understand! With my second baby I didn't even need the episiotomy and tore just a tiny bit. I used 10 drops of tea tree oil in my cleansing bottle and healed completely in 2 weeks and had NO PAIN!
I waited 3 1/2 years to have my second and had major anxiety. All for nothing too! My labor with my second was 60 hours shorter and I only pushed for 50 min. instead of 5 hours. What a relief!

I had a good friend with a similar experience, she had a c-section for her second-- it was requested and scheduled. I have 2 c-sections (the first was an Emergency, the second planned). The recovery from the first was HORRIBLE and i was very neverous about doing it again. The second was not as bad, and I was told that the recover is better if it is planned b/c the drugs and procedures are slightly different. I would talk to your dr. about why you had to have the epis and then decide. a c-section isn't a walk in the park either...

Hi S.,
I can understand your aprehension. I had to have a C-section with my daughter. It was NOT what I wanted, but ended up being necessary. Her cord was wrapped 4 times around her neck and she couldn't decend.

Anyway, DO NOT have a c-section if it is not medically necessary. There are so many risks associated with them. A previous commenter has outlined them so well, I will not do it again.

Quite honestly, many MD's would be MORE then happy to offer you a c-section. That's what they do ... they want to control the birthing process instead of letting nature take it's course. If you would like to have another child, I would sincerely suggest you find a practicioner who will help you achieve the type of birth you are looking for. There are some OBGYN's who are supportive of the natural birthing process, although at times it seems they are hard to find.

In addition, most Certified Nurse Midwives are very supportive of a natural birthing process. And finally, a birthing center or home birth midwife would be absolutely supportive. Ask questions of your birthing practitioner. Ask them what their epesiotomy rate is, ask what their C-section rate is. The lower the better obviously. The c rate for MANY doctors is alarminingly over 30%! Ridiculous.

Birth is a natural process. Episiotomies are, in general, not necessary at all. It does mean the doctor has to do a little work, but they are NOT necessary in most cases. I can't speak to your case because I do not know your situation, nor am I a doctor. I just know from my own research and discussions with my Certified Nurse Wife that they are often not needed.

C-sections are not necessarily an 'easy way out'. My incision became infected 1 week after giving birth. They had to REOPEN the incision with just local pain medication. Believe me it hurt like HELL! I cried the entire time. They don't put you out for something like that. They let the incision 'heal open'. Meaning they didn't close it up to let it heal. I then had to go back one more time to the hospital to have it cleaned out again, then have a nurse come to my house and change the packing twice a day. It was extremely painful, I was on antibiotics and pain meds, which obviously caused some reactions with breastfeeding my baby girl. It was 10 weeks of this until it was healed. At some point your insurance says 'no more nurse' and then either you or your spouse has to change the packing and clean out the incision. Fun times.

I'm just telling you all of this to show you that a c-section won't necessarily be an easy peasy recovery. It's surgery. MAJOR surgery. That is never an easy out.

You have other alternatives. Find a doctor/midwife who will discuss those options with you and help you have the birth you desire.

Make sure that you have freedom of movement throughout labor and delivery. Frequently changing positions will greatly reduce your chances of tearing again. Would you consider seeing a midwife and/or hiring a doula?

I haven't had this experience myself, but a friend of mine did. Her 2nd baby's head was not as large so she didn't have such a large episiotomy. I have to think a c-section would be risky as well, as it is MAJOR surgery.
If there was major tearing into other areas though, a c-section would alleviate that risk. A c-section is better than dealing with other injuries from tearing. Have you talked to your doctor about it? Sounds like a tough choice...all the best to you!

I didn't have an episiotomy but had a 4th degree tear with my first. I know exactly how you're feeling, the healing took FOREVER...DS was 14wks old before I could even walk without being in pain. With my second I had a scheduled c-section, it was actually my ob that recommended it, said if I tore that bad again I might need to have reconstructive surgery. The c-section recovery was a breeze, so much easier than healing from the tear, a week after I was feeling totally fine.

I know it's possible to not tear with the second if you did with the first, but it wasn't a chance I wanted to take, there's no way I could care for a preschooler and a newborn if I wasn't even able to walk.

Hi S.,
I teach HypnoBirthing, an excellent birthing method for you with concerns about tearing again/not wanting an episiotomy. My website is www.YourPeacefulBirthing.com.

HB is a way to gently, safely and easily birth your baby, usually without medication and pain. I used this method to birth both of my kids and it rocked! I just attended a birth in June of someone who took my classes, this was her 2nd birth. In her 1st birth (not HB) she tore to at least a 4 and was rushed to surgery immediately following the birth. This time using HB she did not have any trauma to the old tear site whatsoever. Plus, she did have to have Pitocin to induce due to a special circumstance and she used her HB practice did EXTREMELY well with that. The Dr's and Nurses were amazed at how calm Mom was. I am sure this Mom would not hesitate to talk to you about her experience to give you a reference for these HB classes.

Please be in touch after taking a peek at the website and let me know if I can help you in any way!

TONIGHT at Whole Foods in Rochester I am giving a free talk at 7pm about the Advantages of HypnoBirthing if you are interested in attending to learn more. See my homepage for Whole Foods address and RSVP information.

J.

Sometimes an earlier episiotomy make it more necessary to repeat it in later pregnancies...but sometimes not. The scar tissue is far less elastic. I would def. try the perineal massage...it can't hurt! ;) But some women just don't tear no matter what they do, it may not have anything to do with the massage. My 3rd baby was c-section, and after having 2 previous episiotomies, I healed SOOOO much faster from the c-section!

Weigh your options, but know that there may be trade offs with both!

Good luck!

~L.

Hi S.! I can completely relate to your fear of having to go through that again. I, like you, took over a year to heal and feel a little normal again. I am pregnant now, due in March and am totally freaking out about having to go through so much pain and discomfort again. I am hoping this time around I will be able to heal better than before. With having a previous child, I would hope it would be better for us. I am not opting for a c-section this time, unless it is necessary. Talk to your health care provider to get his/her opinion on your specific situation. Maybe this could ease your mind and limit your anxiety. Good luck to you! I just wanted you to know that you are not alone.

I don't think you have to have an episiotomy. I didn't have one with my daughter. I tore up rather than down though. I'd just make sure to tell your doctor you'd rather not have an episiotomy this time.

I had two residents deliver my first baby because instead of paging my doctor, they called her office and there was miscommunication. Anyway, my doctor didn't make it in time and the two residents ended up giving me a 4th degree episiotomy. The recovery was awful and the muscles did not end up healing right. I had to have reconstructive surgery of the muscles around my rectum when my daughter was 18 months old. The doctor that did my surgery said that I should not have anymore vaginal births because I was more likely to tear along the original episiotomy and there was a good chance that the muscles would not be able to be repaired again. If that were to happen, I would be incontinent for the rest of my life. Needless to say, I have had three more children by c-section with NO COMPLICATIONS! None of my children have asthma or any other complications associated with the c-section. You have to do what is right for you, but the most difficult recovery I had from giving birth was from my vaginal delivery, and a million times worse was the recovery from my reconstructive surgery. I would not wish that surgery on anyone!

First of all....your best bet is to discuss all of your options and fears with your OB. I had an episiotomy with my first child and then his shoulder tore me all the way back to my rectum. It did eventually heal up and I had a second child 14 years later. I had another epesiotomy with the second child but not the tearing. It's impossible to say exactly what will happen with a second child.

Good luck.

T.

I did not have an episiotomy with my son but I did tear with him. I have a fourth degree tear and the Doctors had to put my rectum back together.(By the way there was no Doc. there to deliver him he came out way to fast.) Anyway I am due in about 3 1/2 weeks for my second and the Doc's that I have now are talking about an episiotomy but instead of up and down doing it side to side. It sounds very painful but after being in pain for over a year after having my son I am hoping it will be fine. Just discuss your concerns with your OB and I am sure they will take care of you. GOOD LUCK!!

When I had my first child the doctor asked if I wouldn't mind letting some students/interns (whatever you call the doc's in training) attend the birth. She let one of them do my episiotomy and it was a disaster. It did take a while to heal and they kept me in the hospital 4 days longer because of it. I had absolutely no problem with my second child. Different Hospital and different doctors - but the experience had no impact on delivering my second child - it was 5 years after the first though. Talk to your doctor and get the advice from them. However, from experience - it wasn't an issue for me.

S. ~
I'm an OB nurse, so hopefully can help some.
A 4th degree extension of episiotomy happens sometimes when the baby is large or sometimes a hand delivers with the head. First babies always have to make room for following babies.... Odds are you may not even need any episiotomy with a second baby (depending on it's size), or maybe a small one. That tissue has all been stretched out now and has more give to it. Sometimes they will cut an episiotomy with a second baby if it looks like it's going to tear - sometimes it will tear right along the old line. I have had patients that had a c-section with their second one when the first one was large or they had a difficult delivery. It depends on the doctor, though.
Good Luck!
D.

S.- With my first son, I didn't have an episiotomy, but I did tear. I ended up with 57 stiches, and they still had to use the vaccum to get him out. It was a long gruelling recovery for me. I couldn't even get out of the bed to get the baby. I was totally realiant on everybody around me. Much to my disbelief, I went on to have 2 more vaginal births. I Had great births, and not even 1 stich. Just because you had the episiotomy last time, doesn't mean that you would have to get one next time. When you decied to have another baby, talk to your doctor. They should be able to help you with your concern. As far as the c-section, I never had one. They wanted to give me one twice, and I refused. for me a vaginal birth is a different kind of bonding. I'm not saying that people that have to have c-sections aren't bonded with their children, I'm just saying ME personally. If you want to have a c-section, that's another thing you will have to talk to your doctor about. I'm not sure if they will give you one without a medical reason. I hope this helps, and good luck.

Hi S.~ Not sure if this is helpful for you to know or not, but when I had my first baby, the Dr. did an episiotomy twice, and I still tore really bad...all the way. Seriously from front to back- COMPLETELY. My baby's shoulders turned diagonal at the last second while she was coming out fast, and she was a big baby- 9 lbs. 9 oz. Well, my Dr. said that the tear luckily was a straight line (not jaggedy) so when I was stitched up it went well, and they anticipated it healing well. It did heal well; of course I was sore and tender for awhile but today you wouldn't even know it. Now that I have had 3 babies, looking back I realize how lucky I was to have healed as well as I did; because I didn't know any better or what to compare it to that first time. My last 2 babies, I didn't tear at all! I was surprised that I didn't with the 2nd one; I totally expected to. With my 3rd baby, I had a midwife rather than an OBGYN, and she did massaging down there during the delivery process, which was very significant and it was awesome; It really helped things 'move along' smoother. What I got from her was awesome compared to the OBGYN's I had before. I believe that my birth went as well as it did because of my midwife; She helped me be much more relaxed- just her bedside manor and way of doing things. That may be something you'd want to look into- I don't know if having a midwife rather than an OB would be significant to you or not, that was just my experience. Also, they do say that your first baby/labor/delivery is usually the hardest. I also did not have an epidural with my first, and I did with my next two. Each birth experience can be totally different for you- I don't think you should have to expect to have things be as bad, but you could definitely ask your Dr. (or a midwife) their opinion. I hope you are able to feel peace about whatever decision you make as to weather or not to have another baby- Blessings!!

S. - I agree with M L, with my first son I had a 4th degree tear..after an episiotomy...I feel your pain and your nervousness. I had another son 4 months ago and it was with a different doctor. He was AWESOME, he had a mid-wife with him during the whole delivery and he spent time helping me stretchout and helping the baby come out gently. I only had to have a very small episiotomy (because he was coming out sunny side up). The difference in healing from 1st to 2nd baby was amazing! I say if you can find a doctor who tends to lean towards the mid-wife techniques (or get a mid-wife if you are comfortable with them) you will enjoy your 2nd birth 100 times more!

Good luck - send me a private message if you want to know my doctor's name/information.

L.

S. -

I don't have the time to read everyone's posts, so I apologize if someone has suggested this already.

***THE FOLLOWING PARAGRAPH CONTAINS EXPLICIT CONTENT***

When I was pregnant I was shown a technique you can do during your third trimester that will help ease the stress of having a vaginal birth by reducing the risk of tearing. You (or if you're not flexible enough to do it, your husband) take a damp warm towel (or damp warm green tea bags) and practice gently "stretching" your vaginal walls, a little bit at first and gradually stretching more and more as you get closer to your due date. You literally put your thumbs into your vagina and use your flat palms to hold your vaginal lips open and to the sides(so your hands form a "W" or a "butterfly"), as you gently move your hands up and down and around (like an "open parenthesis" for the left hand and a "close parenthesis" for the right hand), stretching a bit more with each pass.

My husband did this for me (because I couldn't reach) during my last month of pregnancy and I didn't tear at all! I delivered a 9lb 3oz baby boy in 15 minutes vaginally, and he was my first child! I also apparently have a high pain tolerance because I didn't use an epidural and only had two shots of Stadol (one after six hours of labor, and the other four hours later). I labored for a total of 12 hours, but I was shocked at how much birthing didn't hurt. After all I'd been hearing virtually all my life, I expected to be gut-wrenching pain, but it wasn't that bad. At least, it didn't hurt until three days later, after I came home and I was sore from top to bottom. But that went away in a couple of days and I'm sorry, but I just realized that I strayed off the subject terribly and the moral of the story is I DIDN'T TEAR when I gave birth vaginally and I totally credit it to those stretching exercises my husband helped me do during my last month of pregnancy.

Sorry my post was so long, and I hope this helps!

I was the same way with my first. I ripped all the way into my rectum...very painful and was told I will need surgery to fix it when I'm done having kids. Like you I was terrified with having a second. Well my second child was 9 1/2 lbs and I only had to have one stitch. The delivery was completely different. The day I had my second child I was up walking normal, going to the bathroom. I was ready to go home that day I felt that good. With the first, I ended up in the hospital for an extra day simply becuase I couldn't move. Any ways, my point is, you never know how the birth will go. I would stick to the vaginal birth, just because c-sections are a major surgery! Good luck on number 2 :)

I just wanted to give you encouragement, and tell you like many others that even though you had a epis. with your first does not mean you have to have another. In nursing school they teach that they are mostly unnessesary, and that it bascially just speeds delivery by about 10 minutes. I had 4 kids, and didn't have one with any of them. I tore with a few, but nothing major at all.

I can certainly understand why you would be concerned to have another after 9 months! Remind your Dr. you do not want one, and tell your husband to as well, in case you are otherwise preoccupied with giving life.

Blessings!
H.

Just because the labor and recovery were difficult for the first baby doesnt mean it will be difficult for the second baby.

DONT WORRY.

My first baby was small - but her head was sideways - so it was over an hour of pushing and a large tear. They did use forecepts The dr let me tear instead of cutting me.

My second baby was large BUT his head was in the right position so about 10 minutes of pushing and he was out. The dr did a very minor cut so I did have a couple of stitches but it was no big deal.

Dont worry the second pregancy and labor and delivery will not be like the first. It will be totally different.

Hi S.,
I had a difficult labor and a 4 with my first child after being delivered with forceps and I feel your pain! The healing process was awful! When I was pregnant with my second child a friend of mine almost insisted I have a C-section, but I really didn't want that route unless absolutely necessary. Remember a C-setion is the equivalent of major surgery. They are cutting through all the layers of muscle and tissue. When I was pregnant with my second child they doctor said they would keep an eye on the size of my baby, that of course is no guarentee but a seven lb baby is easier to deliver than a 8-9 lb baby. On a happy note, my second child was delivered in 3 pushes in about seven minutes with only a tiny cut. Healing went well. I know this is no guarentee for you, but it is possible to have a good experience the second time around. Good luck!
K.

Hi S.. I had a 3rd degree episiotomy with my 1st, and my second birth was just a small cut (and she was 13oz. bigger than my 1st), so just because you had one the 1st time doesn't mean it'll be the same. Also I would express VERY LOUDLY to your doctor that you want to minimize/eliminate your Episiotomy, he/she will most likely do everything they can to make sure you have a better experience this time around. I hear you on the how horrible the healing process is though, in my opinion that was worse than having a C-section, I had a C-sec w/my 3rd. Good luck!

Hi mom, I am a nurse and worked in labor and delivery for 5 years. If you work at stretching and softening your perinium you maybe able to go completely without an epis. Many women that had to be cut with the 1st child were fortunate to avoid it the next pregnancy. Vitamin E capsules work great on softening, just poke the end with a pin, squirt the liquid onto your finger and rub into the area between your vagina and rectum everyday from about 6 months on until delivery. I had a fairly large episiotomy with me 1st child and the next 2 I had none. The experience was wonderful not having to deal with the pain of stitches. Also gently stretching below your vagina will help especially when you are pregnant and your hormones are increased. I hope this helps you, if you have any questions feel free to email me back. M.

Well, not the exact situation, but similar. I had an episiotomy with my first delivery, but ended up with a vacuum delivery and still tearing so badly -- a 4th degree tear, through the rectal muscle. The recovery was terrible, as I also had an infection at my 6 week checkup. Not fun at all.

so needless to say, last year I was ready to deliver my second child and I was terrified!!! The doctor induced me 3 days shy of my due date because of the head size and hopefully we'd avoid the same issues. You wouldn't believe it -- I had a vaginal delivery with NO stitches!! No episiotomy, no tearing, NOTHING! It was unbelievable and such a great experience! And my baby's head was even 1/2 inch larger than the first! CRAZY!!

So you NEVER know. I was so pleasantly surprised. Even the doctor said "You deserved this one!" because of my rough first delivery.

Good luck!!!

Hi S.,

My doctor called mine a 4th degree tear, with my first child. I was a nervous wreck when I was induced for my second. My blood pressure was rising and the nurse had asked what was going on, and I told her about my first birth experience. She informed my doctor and together we decided that a c-section was the best route for me. The doctor told me that if I were to tear again, I could become incontinent and need surgery to repair my rectum. The recovery from the c-section, was SO much easier than the recovery from the tear.

Good luck to you and whatever you decide to do!

S.-your best bet is to request a c-section. I had the level 4 episiotomy also but mine didn't heal right so I have rectal fistulas now. (tiny holes that go from rectal wall to the vaginal wall) These holes we have tried every thing to fix it and nothing happens. Because it took you so long to heal the first time there is no way you are going to want a vaginal birth after that. I would discuss it with your OB that if you do get pregnant again would they automatically go for the c-section. I healed faster from my c-section with my second child then I did vaginally with my first. I hope this helps!

I have 3 kids! 8, 5, 7months.
I had 2 pretty rough episiotomys with the first two. and yes it took a real long time to heal. And with each, down there become a little more deformed and sensitive to healing.
I had a c section with my 3rd. because he got stuck after a full labor and pushing. But I want you to remember that a c section is not a walk in the park either!!!
You will ultimately be in a lot more pain in the beginning it is a very serious surgery and you will have a larger incision, maybe with staples (yuk)!! Healing time is not a fast process. it sounds like your body may heal on a slower level to begin with. Iv seen other women's scars and their almost unnoticable . my scar on my belly is still healing and its been 7 months its still raised, sore, red and itchy. and the area around still is very sensitive at times. But I find it alot easier to have a sore tummy than a sore whoha. also with the c section their is no unforeseen tearing. the cut is precise and planed!!!
hopefully you will be able to plan the c-section and not have to go through labor. just voice your concern to the doctors, make your opinion known and considered. I'M sure your choice of a c-section would be a valid option!

HI S.
I didn't have an episiotomy and only had a tiny bit of tearing. I was told to massage evening primrose oil on that sensitive skin down there the last week few weeks of pregnancy. The point is to gently stretch the skin yourself is it's more ready. A hot wash cloth compress while waiting for labor to fully kick in helps relax, and soften that area as well.
I also have an issue with laying on the back delivery's. I don't see why the doc's would want to fight gravity, and make delivery that much harder for both the baby and mom. I insisted on being as upright as I could. I'd planed on squatting but when the time came I was to shaky. But thats a very natural position that works with gravity. Any way if your interested in more info mothering.com is a great web site for natural birth and mom info.
Good luck, A. H

Hi S.,
I don't have any advice about the episiotomy-fortunately, I only had a little tear. Just wanted to say "good for you" for being a stay at home Mom- that is the best for your child. You are so lucky to have a terrific, supportive husband. Enjoy every day because before you know it, your son will be graduating from high school and you will wonder where the years went. I hope you are successful in having another baby.
Best Wishes,
M.

You've already gotten some great advice so I'll be brief. I also had a 4th degree episiotomy with my first baby and I've gone on to have four more children with nothing even resembling that first experience. With my 2nd and 3rd I had tiny episiotomies (like 1 or 2 stitches) that healed quickly. With the 4th and 5th I didn't have any epi or tearing and the recovery was SO fast. My doctor is a big believer in perineal massage and during the labor we just took it slowly and she kept massaging to keep it from tearing. Definitely check around with different doctors and find one who will only do an epi if there is no other choice. And if this is the only reason holding you back from having another child, I say relax and go for it. Chances are, you'll never repeat your previous experience.

You will notice a huge difference this time around. You have to remember that you were giving birth for the first time and you were not "stretched" out. Since you have had a child now, you shouldn't have much of a problem. Also, ask your doctor to stretch you during labor. My doc did this for me the 2nd time and I only needed a very slight episiotomy. Good luck! :)

I did not have that level of a episiotomy but I did have one with both my children but they are also 8 years apart. While I was reading this I remember somthing I had read or heard I hope this helps if you plan on having another. First there is a massage you can do to strech the perineum : http://www.femininehygiene.com/perineum_massage.htm
I am not promoting this web site it is just a good explaination on how to do it from what I remember and two do Kegel exercises.
http://www.babycenter.com/0_kegel-exercises_###-###-####.bc
That is suppose to make the delivery easier. I am not one to ask because both my children came very quickly. Less than 4 pushes but I also have been doing Kegels for quit a while there is a history of bladder issues in our family.
Also the Babycenter.com has tons of great information for babys and children.
Also to heal faster increase you Vit C in take and talk to your doctor about why you took so long to heal.

a friend of mine tore really bad with her first, and when she got pregnant again she told the doctor she wanted a c- section and they honored it. now i had a c- section with my first and was very adament about not having another one becasue it was a horrible experinece for me( almost an emergency c- section) i would say let your body heal a little more i know a lot of peopel liek their kids to be close in age, but for me 4 years differnce helped a lot becasue my daughter was very independent by then and a great help.

S.,

It's completely possible to have another vaginal birth after that. This is why a lot of doctors choose not to do episiotomies anymore; the healing process sucks! Muscle heals much faster when it's been torn rather than sliced or cut. I had a level three tear when I gave birth to my daughter and yes, it hurt like nothing you'd ever believe, but it healed beautifully by 12 weeks. There are ways to stretch the perenium naturally if you'd rather avoid the tears, too.

Good luck!