birthing stools and tearing

[lookingforaname]

When I asked about birthing stools, my doc told me that they lead to a higher incidence of tearing. True? False? Experiences?

My first baby I had on a birthing stool, my second on the toilet, and in both cases I had a good amount of tearing. So I'm pretty open to this being true and just wondering what position I should aim for this time round.

[annekh23]

I wouldn't actually be surprised if overall they did have a slightly higher percentage of tears, because maybe there are some babies that come out with tears when mum uses a birth stool that might have been c-section if she'd been pushing flat on her back. Some counts might give a greater number because of epsiotomies that weren't cut, but had a lesser or equal tear instead.

[durafemina]

I believe there are some studies that show a slight increase in the incidence of tearing when giving birth in a more upright position, but I would ascribe those to reasons the PP suggested.
Personally, I gave birth on a birth stool and had minimal tearing - a 1st degree perineal that was not stitched and a minor labial tear (caused, I think by dd's hand, so birth position was not relevant).

[k9sarchik]

I used a birthing stool some of the time while in labor but I ended up delivering standing up and leaning over the bed. I had a 1 degree tear. But I also had a midwife and midwives are trained to prevent tears.

[boscopup]

I had a first degree tear from my birth stool birth, but it was along my old tear line (purple pushing in normal lithotomy position in the hospital - less than 4 lb baby . I'm going to *try* to do a waterbirth this time, so hopefully I can find out if that helps prevent the tearing.

But I did hear that birth stools have a slightly higher incidence of tearing, but I think that's just in contrast to some other positions like hands and knees maybe? I think you'd certainly tear worse in lithotomy position with purple pushing.

[devon]

My midwife told me that she would actually _not_ have me on a stool/squatting this time. Tearing is a big concern of mine (I had a horrible recovery after #1) and in my past two births, the babies have come super fast (with my body pushing them out by itself almost). She said that I would be more likely to tear if pushing while sitting/squatting because it would increase the pressure down there that I already have a lot of (because of speed). That being said, she also said that if it didn't look like it was torpedo'ing out of me this time, she'd be fine with a stool if that is what felt comfy to me.

I would say that a dr would say that because they also don't necessarily feel comfortable with it.

[lookingforaname]

Interesting.

Well the context is that I live in nowhere's land in terms of natural childbirth, and yet the doctor I finally did find is a family practice doc who used to do back-up care for a midwife in another region (where I live, the closest midwives are 2 hours away. . .) and she tells me that she's been accused of acting too much like a midwife . . . so I think I trust her, just wanted to check with people here.

So actually, yeah, both my kids were super fast at pushing stage (my 1st was MAYBE 10 minutes of pushing max - maybe less - it was a blur! - on a birthing stool with midwives in another city, second was born accidentally at home after only an hour and a half of labor . . . and maybe 3 pushes . . .). So actually, what you say might apply to me too . . .

So what position does she recommend for you?

[mamabadger]

I have known OBs to comment that tearing is more common on a stool or while squatting. However, those doctors still encouraged strong, directed pushing even when the woman was squatting or on a birth stool. Since the birth can be quicker and easier in these positions, I suspect it is important that pushing be spontaneous and self-directed, in order to avoid tearing. I have no stats on this, just a theory.

[devon]

Originally Posted by lookingforaname

Interesting.
So actually, yeah, both my kids were super fast at pushing stage (my 1st was MAYBE 10 minutes of pushing max - maybe less - it was a blur! - on a birthing stool with midwives in another city, second was born accidentally at home after only an hour and a half of labor . . . and maybe 3 pushes . . .). So actually, what you say might apply to me too . . .

So what position does she recommend for you?

My second labor was just like yours - super fast, unplanned HB where he started crowning before I even knew what was going on.

I'm planning a water birth so I will most likely be somewhat upright but we'll see. She said whatever felt comfortable to me, but the less upright could be useful for me if I felt the need to slow it down so as to not tear. I'm only 29w so we haven't talked in depth about positions yet

[sarahn4639]

I had the same experience of lots of tearing and a fast birth on a birth stool. I think my problem was that I had my mind set on using a birth stool and so I did but if I had really listened to my body I would have been on hands and knees. For my last birth I was at home and felt safe to do what I wanted (first was hospital and I was scared that if I got off the stool I'd be forced onto my back) and instictivly went to hands and knees. I have the same issue of very short pushing phase and a very strong fetal ejection reflex so I thin being on hands and knees was helpful in not adding to how fast he was coming. It was still very fast (-2 station to birth in 15 minutes). Another option is sidelying. It takes the aid of gravity away and still keeps your tail bone free to move.

I think birth stools are great tools in assisting babies down and out but for a woman that doesn't need that assistance it can be too helpful and lead to very quick birth and tearing because the body isn't given time to stretch.

[heatherweh]

I've been reading about birth a lot lately and it seems that there may be a higher incidence of tearing while squatting or on a birth stool, but this risk can be lessened by not pushing the baby through, but rather using panting and letting baby come out on his own. One book recommended changing to side lying or all fours or prostrate position once nearing crowning.

This is just based on what I've read, not personal experience. I did lithotomy on a hospital bed and ended up with an episiotomy and am hoping to avoid it this time with some of the aforementioned techniques!

[lookingforaname]

Originally Posted by mamabadger

I have known OBs to comment that tearing is more common on a stool or while squatting. However, those doctors still encouraged strong, directed pushing even when the woman was squatting or on a birth stool. Since the birth can be quicker and easier in these positions, I suspect it is important that pushing be spontaneous and self-directed, in order to avoid tearing. I have no stats on this, just a theory.

Hmm. Well in both my previous births, they were TOTALLY spontaneous pushing times - with my first, I got out of the tub, walked across the hall to the birthing room, and immediately gravitated towards the stool - no one told me to sit there or when to push, I just did - and there were other options in the room too. Then with #2, I actually thought I had to poop, and that's why I was on the toilet! Had no idea I was pushing until I yelled to my midwife over the phone "I think I'm pushing!"

So . . . I think my body DOES gravitate towards that sitting/squat position, but I do think I might aim for a different position this time to slow myself down a little and maybe lessen the tearing problem . . .

Thanks for the advice! I'm happy to hear more suggestions for positions too!

[dancindoula]

I second the rec for hands/knees or side-lying. Both positions help reduce the effect of gravity and help you go a bit more slowly. If you can be in water it might help too, both for the softening of your tissues and for the ease of movement in can provide.

[StephM76]

I personally had a much easier time with the birthing stool than any position I've tried. I tried lying on my side and hands and knees, but I felt like it wasn't effective. Once I tried the birthing stool my DS was born in 2 minutes with no tearing at all.

[kangaroomum25]

Is there a higher risk of tearing because it's harder for the dr to cut you when you're on a birthing stool then in the lithotomy position? I'd take a tear over a cut anyday.

[hapersmion]

I used a stool and had a second degree tear, but I also had a big-headed breech baby. It was worth it, I really liked the upright position.

[Gena 22]

Used a birth stool for my twins, and no tears! I really liked the position.

[chumani]

I prefer a birth stool. With my first my midwives had me in lithotomy position and directed pushing, I didn't tear but had some very uncomfortable skid marks. With my next 6 babies I have used a birth stool, I have never had a skid mark since! My babies have ranged from 6 lb 3 oz frank breech to 9 lb 4 oz posterior baby, my newest babe was 6 lb 10 oz with a compound presenting hand- all without so much as a skid mark, just basic bruising/swelling.

So from my experience I love a birth stool, my midwife is great as far as letting me push when I feel and then reminding me to slow down, especially when she saw a hand.

Best wishes for a tear free birth!
Sarah

[marrymeflyfree]

I labored on a birth stool for quite a while...the midwife suggested I move to a different position before the birth though, saying that she'd have no control over my perineum on the stool. I ended up in a semi-fowlers for the birth. Her head came out sideways and with both fists up by her temples, and I had just a small skid mark. I'm glad I had the stool for labor, though...my pushing stage was quite long, and the stool really helped her descend!

[Keeper at Home]

I labored on hands and knees and began pushing while standing/leaning. Then I went to a birth stool and baby was born very fast - 10 min, 15 min tops. I did end up with a 2nd degree tear, but I really liked the position a birth stool gives. I probably could have ended up with more minor tearing or not at all had I breathed the baby down more and eased up during crowning. I was just too eager to get it all over with.