I first met Cassandra when she was 3 weeks postpartum with her first baby, a girl named Korina. Cassandra brought her mom with her to the consult and as they sat down, I noticed that Cassandra was moving quite purposefully. She took her time to slowly lower herself into the chair and as she sat I thought to myself,, either she is healing very slowly from her cesarean section or she has had a pretty significant 3rd or 4th degree tear from a vaginal birth that is slowly healing. For the uninitiated to vaginal tearing, a 1st degree tear is a thin tear of the perineal skin with no muscles involved. a 2nd degree includes skin and muscle, a 3rd degree is quite significant with the tear going through the perineal muscles and includes a layer of muscle surrounding the anal canal, and a 4th degree tear goes all the way into the canal or rectum. As one could imagine, this is quite painful and the healing can be several months.