Rhiannah has the birth story no one wants to hear. It involves a 'fourth degree tear'.


For Queensland’s Rhiannah Pohlman, it’s taken a long time to be able to tell her birth story without crying. But it’s a story she wants to tell.

When Pohlman gave birth to her son Noah, she suffered a fourth degree tear during delivery. A fourth degree tear is the worst kind, going through the perineum, all the way from the vagina to the anal canal. Today, four years later, she’s still suffering the effects.

“I deal with faecal incontinence and flatulence incontinence,” Pohlman tells Mamamia. “It really disrupts your quality of life.”

Mums and non-mums answer questions about childbirth. Post continues below.

Video by MMC

She says on bad days, something as simple as a trip to the shops is too much for her.

“Trying to go shopping is horrible because it leaks and it’s painful. If I have a lot of leakage that day and I’m walking around, it’s basically like nappy rash.”

The flatulence is a problem because it’s “so taboo”.

“I can’t not fart, so trying to hold it in – because you want to respect people around you – that’s difficult and it’s painful. You get really bloated.”

Pohlman also has a fistula – a hole between the vagina and rectum – which causes “poo leaking out the vagina sometimes”.


“They say it’s eradicated in developed countries, but I live with that,” she says. “I’m surprised I don’t get too many urinary tract infections or anything.”

Pohlman didn’t know much about the risks of tearing before she gave birth to her son. She was overdue, and was induced.

“That took three days, from being induced to having the baby,” she remembers. “It was a very long process.”

On the third day, when a doctor told Pohlman she was still only 4cm dilated, she asked for a c-section. But two hours later, as she was being wheeled into the operating theatre, she was told she was 9cm dilated and would have to try to push the baby out.

“I was pushing for two hours and they said, ‘We’re going to get the vacuum,’ because nothing was happening. That’s one of the risk factors for a fourth degree tear, the vacuum or forceps.”

After the delivery, Pohlman only got to hold her son briefly before he was taken away with his dad. She was put under a general anaesthetic to have the tear stitched up.

“The way they would say it was as if it was my fault,” she remembers. “They never said, ‘The vacuum’s going to increase your risk of tearing.’ It was never even mentioned. Nothing was done to prevent it.”

Other risk factors for a fourth degree tear include the birth being a woman’s first vaginal delivery, and the baby being large. Noah had a big head circumference. Pohlman also believes being induced was a factor.

After Pohlman was stitched up, she was told that incontinence was a possibility. A physio visited her on the third day.

“She was just like, ‘Oh, just do your pelvic floor exercises.’”


Pohlman wasn’t offered any follow-up care. At her six-week check-up with her baby, she was told she was fine.

In the first few months of being in the “baby bubble”, she didn’t worry too much about the faecal incontinence and other symptoms she was experiencing. But when she returned to work, it was more of a problem.

“I couldn’t go one day because I had really bad diarrhoea. It’s like, ‘Wow, this kind of affects a lot of things.’”

She started looking for information about faecal incontinence online, but kept coming across information about urinary incontinence.

“I’m like, ‘I don’t have any issues with that at all. It’s my bumhole that’s not working.’”

When Noah was eight months old, Pohlman discovered the online support group Mothers With 4th Degree Tears.

“I could see that people were doing things and things were improving for them,” she says.

Still, it wasn’t until two years after the birth that Pohlman went to see a doctor about the effects of the tear. By then she was suffering post-natal depression. Pohlman was referred to a psychologist and also a physio, who was able to help relieve her symptoms. She found out that the pelvic floor exercises she’d been told to do weren’t what she needed to be doing.

“I actually had a too-tight pelvic floor, so I actually had to work on relaxing it,” she explains. “It’s not always just about strengthening that pelvic floor.”

Mamamia’s Executive Editor, Leigh Campbell shares her birth story with Holly Wainwright. Post continues below.

Pohlman was also referred to a colorectal surgeon. She was told that she would have to wait till after she’d finished having kids to have surgery, and that the success rate was not high.


“You think, is it worth it or is it not?”

Pohlman is now 28 weeks pregnant with her second child. It was a “big decision” to get pregnant again.

“I was like, ‘Yeah, not happening, not having any more,’” she remembers.

She won’t be having a vaginal delivery the second time around.

“I’m having an elective c-section.”

In Australia, it’s estimated that four per cent of women giving birth vaginally suffer either third or fourth degree tears. It’s hard to know how many of those women later suffer faecal incontinence, but when Mothers With 4th Degree Tears surveyed its members, 70 per cent reported “enough leakage to soil underwear”.

Pohlman believes tearing and the effects it can have should be discussed at ante-natal classes. She also thinks mums-to-be should do as much research as possible before the birth.

“They should really just educate themselves so much on their options and the risk of everything.”

Pohlman doesn’t know why more women don’t talk about fourth degree tears and faecal incontinence.

“I try to be pretty open about it to anyone, because people need to know. I know negative birth stories aren’t great for first-time mothers, but I wish I had read more than the positive ones.”

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