Unplanned UC: When the baby comes really quickly

[nataliej99]

I'm pregnant with my 3rd at 29wks.  My first labor was 3 hrs (water broke, labor started an hour later) in a hospital, drug-free.  My 2nd labor was 50 minutes, baby born at home even though I was planning to go to the hospital.  I'm trying to weigh my options for this birth.

I'm seeing an OB and planning to maybe try to get to the hospital, but it's a 40 min drive from our home.  I don't really want to UC because of the tearing I had in previous labors (4th degree with 1st, 3rd degree with 2nd).  I feel like it's a safe bet that I will tear again and need good post natal care. 

My OB suggested an induction if conditions look favorable a few days before my due date, so that I could deliver with her, she could help minimize tearing, etc.  I'm not generally in favor of induction but I think in this case I'm considering it as an option.   

FYI, I'm not aware of any midwives in my area that would be able to come to my home in a timely manner--if I'm going to end up UC, I might as well take an ambulance ride to the hospital to see my doctor for post natal care instead of waiting for a midwife that I will barely know to come to my house. 

I'm just wondering if anyone has any thoughts or advice on this.  I'm not really sure about what to do this time!

[LilMamiBella]

I had a fast birth with my last baby and I did have some skid marks. I didn't do anything about those but if I were to need stitches I'd rather call a midwife or see a family doctor then to to go the ER. I know here if its not a true emergency I'd be waiting at the hospital for hours till they saw me. Not to mention all the questions/hassle I'd probably get.

[dayiscoming2006]

If it were me, I'd stay home and get a midwife you can call for aftercare in case they don't make it to the birth. I would prefer not to give birth in my car. That just sounds like too much stress. My advice would be to stay home unless something bad happens. Midwives can repair tears. I wonder if you tried different birth positions with your previous births? Just thought I'd mention it. I like hands and knees and if you can manage it, squatting is supposed to be a good position too for prevent tears. Also, if you are blessed enough to get the midwife there in time, maybe she could administer perineal massage (or whatever that's called) to help prevent tearing as best as possible. Tears are supposed to heal much better than episiotomies, so personally unless the baby was in eminent danger from not coming out, I wouldn't want an episiotomy if that's what you were thinking. Anyway, chances are you wouldn't make it to the hospital any quicker than a midwife would make it to your house, depending how far away the midwife is I guess, but yeah, those are my thoughts. Fast labor would mean homebirth to me. I would not induce for just that reason. Induction has serious risks and your reasoning just doesn't seem valid to me. Why give your baby more risks just so you can be in the hospital? Make the decision you feel the most comfortable with but I just wanted to give my 2 cents.

Edited by dayiscoming2006 - 12/20/10 at 10:46am

[Renai]

Originally Posted by dayiscoming2006 

squatting is supposed to be a good position too for prevent tears.

Ok, I heard the exact opposite, especially with fast labors/births. Which is it?

[dayiscoming2006]

A quote I found from another MDC thread...

http://www.mothering.com/community/forum/thread/6646/how-to-prevent-tearing (the whole thread looks pretty good)

Quote:

Sorry to hear about your yucky tear! 
To help prevent tearing (there is no guarantee of not tearing), the midwife or doc should probably know how to use olive oil (or some other substance similar to it) to massage and stretch the perenium while you are pushing. Also, nice warm, wet compresses applied to the perenium can help. Another thing to consider is your position. If you birth in an active upright position, such as standing or squatting, it gives the tissues more room to spread, thus helping to avoid a tear. Delivery of the head should be done slowly and the midwife or doc should know how to stretch and support the perenium. Also, many women, including myself, actually tear with the shoulders being born, so care should be taken to support the perenium during this time, as well. Hope this helps :cool:

I delivered my second with hands and knees position and I had zero tears. Just in my experience. I think upright positions would be best for allowing your body to stretch out and gravity to help you. 

Originally Posted by Renai 

Originally Posted by dayiscoming2006 

squatting is supposed to be a good position too for prevent tears.

Ok, I heard the exact opposite, especially with fast labors/births. Which is it?

[mamaChe]

If I had to make this choice, I would choose birthing at home. I would UC and teach my partner to give warm compress support but otherwise keep his hands of my hoo-hoo. I would use my own hands to ease the baby out, while lying on my side to slow the baby down. I would try to find a back-up midwife to deal with tears. I have no intention of giving birth in a car and it sounds fairly likely in if I was in your situation. The stress of making it to the hossy in time would stall my labor. Also, in the hospital with an OB, I couldn't imagine finding someone that would let the baby come out naturally without pulling/manuevering/perineal massage and stretching.

I would focus research on preventing tears. Squatting actually has mixed results. Yes, gravity helps bring the baby down rather than forced pushing but can make the birth quicker than necessary. Side lying and waterbirthing are successful, especially combined with "breathing" the baby out rather than forced pushing. Keep those knees together to give your perineum more stretch!

You might find the information here helpful:

http://www.glorialemay.com/blog/?p=66

http://www.gentlebirth.org/archives/perinealProtection.html#Chairs

[Pirogi]

I read on another thread here at MDC (so look into this further), that you have a window of about 12 hours after the birth for stitching.  I would personally prefer a midwife for stitching.

[Illiana]

I would also stay home. No reason to risk babies health by inducing or getting stuck on the side of the road. Tears WILL heal on their own. You don't HAVE to get stitches. But if you prefer to get stitches, I'd just go in after baby is born and have your doc or ER stitch you up.

[phathui5]

Is tearing something that was an issue for you with your other births?

[nataliej99]

Thanks for all your responses!  Here's some background about the tearing, since there were some questions.  With my first, my water broke, contractions started an hour later and he was born three hours after that.  It was a typical hospital birth (except I refused drugs), and I was in a semi-reclined position holding my knees toward my chest.  The doctor gave me an epis. even though I had said in prenatal checkups and my birth plan that I did not want one.  I never saw him do it because I had my eyes closed the whole time doing my relaxation excercises and I didn't feel it--I found out later.  Apparently he cut in more than one place--it was basically a butcher job.  After my son was born, he tried to stitch me up but I just couldn't keep my legs still (it hurt!!) so he took me into an ER, I had an epidural, and I was in there for 45 min getting stitched up for 4th degree tears (which means it goes all the way through the rectal wall, ugh).  I hate what that doctor did (it was 8 weeks before I could sit down comfortably!!) but you can't change the past.  Needless to say, I switched doctors and am very happy with my current practice.  They are much more hands-off. 

With my second, I woke up at 10:30 with a contraction, we started getting ready to go to the hosp, called my mother-in-law to come over to watch my son, etc.  While I was getting ready in the bathroom the ctx were really intense, I called my husband and told him the baby was coming NOW--I can feel her head!  He called an ambulance, I was screaming, my son woke up and was trying to get in the bathroom, he started crying, the dog was barking....  I squatted and she came out in 2 or 3 pushes into my husband's hands.  No time for compresses, massage, oil, etc!  Too much chaos!  The ambulance came and took us to the hosp, I still hadn't delivered the placenta when I got there.  They gave me pitocin (I tried to refuse but the doctor said I was bleeding alot and it would be in my best interests so I allowed it).  I delivered the placenta then got stitches for my 3rd degree tears.  Twelve days later the tears turned into 4th degree, I had to go back to the ER in the middle of the night for bleeding, and was admitted for something like 30 hours.  It was awful.

I like the recommendation of UC, lying on my side or hands-and-knees--I would go in the tub, easier cleanup, haha!  I don't know if my husband will agree, though.  I'm not aware of any midwife that would come to my house.  There's a birthing center (still 45 min away) and ones that deliver at the same hosp. but I'm happy with my OB.  I was assured that if I went in for an induction a few days before my due date, they'd give me the minimum of pitocin and quit if things didn't take off.  That sounds like it might be okay and I might go with that, esp. since she said she really thinks she could minimize tearing this time.  But if the baby comes early, I want to be prepared with a plan--try to get to the hosp or stay home?  What position?  Etc.  Your comments have been really helpful for putting together this plan! 

[Bird Girl]

It sounds like your births are so fast, I wonder if you wouldn't even need a full-blown induction, but perhaps just breaking your bag of waters would get things going in a more natural way.

Quick births can put some pressure on the baby--if they need a little extra suctioning or some oxygen, I wouldn't want to be 40 + minutes from that.

[Pirogi]

Wouldn't an ambulance have the ability to give oxygen to a newborn during transport?  I am in the same situation ... possibly fast birth, closest "big" hospital is 40 minutes away.  The hospital here in town has a whopping 25 beds! 

[sunshinemoma]

Hi Natalie!  I'm also new here.  Well kind of, I have been reading for months and months- putting off registering..until I read this post and I just HAD to comment.  

First of all I am soo sorry about your 'butcher job' and the subsequent pain that must have caused you both physically AND mentally.  I'm sorry about the pain you suffered after your first home birth as well.  I just teared up imagining that scenerio..sad toddler, dog.. panic....I'm so sorry. I am impressed with your courage and strength to go on having more kids!

I feel I can relate just a little.  First of all, DS1 was delivered in hospital 3 hours after I arrived- I had felt labour come only about an hour prior. So pretty fast.  The doc cut 2 episiotomies, the second I remember the sound as he kept cutting..snip snip snip. 3X.  UGH.  I hate what he did to me.  During labour I had refused any pain killers just to end up being sent to the OR and given a spinal so the surgeon could do the repair on my 4th degree tear (aka "episiotomy extension" or in the surgeons words "gong show").  It took him longer than his usual 30min slot for that type of surgery.

I know midwives can do stitches and tears heal on their own, but, correct me if I'm wrong, but when skin, layers of different muscles AND ligaments are cut through they need a special type of repair that perhaps midwives don't deal with enough to repair optimally.  Mind you, midwives rarely "cut" and episiotomies are the biggest cause of 4th degrees.  If no episiotomies are involved it is very uncommon to tear so bad. Risk factors would be: forced pushing or speedy births (not speedy labours as much as speedy second stage-this is because your perineum, which has amazing potential to stretch, needs adequate time to open as wide as your baby needs it to) Picture your other muscles and their ability to stretch given proper warm up and continually stretching to that point of resistence and then easing off until your ready to comfortable stretch a little further.  I could do the splits but it would take me at least 5 minutes of warming up, some lunges and hamstring string stretching,  then some more working out and then slowly easing into the splits.  If the next day someone was like, "you can do the splits? Sweet. show me!" And I immediately dropped myself to the floor I'm almost positive I would have torn something.  In fact I think that exact thing happened when I was in Highschool!  Anyways back to Labour.  Your body needs time,  But it CAN do it given the proper warming up and gradual stretching..and in Labour you have the added bonus of your body's natural release of hormones/chemicals that make you even stretchier down there.  For one relaxin is a hormone your body starts releasing the moment you conceive and releases in huge amounts as labour progresses.  This helps your body safely birth your baby!

IMO anything that reduces fear, increases relaxation and slows down the pushing stage would be the very best in terms of increasing your chances of keeping your bottom intact :)  For me this would be:

-at home no stress of commuting

-easy access to bed, shower, birthing pool, toilet without the restrictions that i found in the hospital

-support person to help me change position IF i feel the need but dont have/want to use the energy

-position that slows exit during second stage such as side laying or hands and knees.  NOT squatting as this SPEEDS. Yes it MAY speed stretching due to the direct pressure on perineum BUT on my compromised tissue full of scar tissue I WONT risk putting too much pressure.  UNLESS i am in water and it feels comfortable- the water's counterpressure might be enough to keep things slow and gradual- I would assess this at the time but expect i will be most comfortable in a hands and knees like position in the birthing pool.

-no massage during second stage.  Unless i am doing it (basically easing my own tissue if i feel the need)  Someone else's hands simply cannot do what mine can even if they have the view and the best intentions they CANT have the sensory feedback as its impossible for them to feel what your perineum is feeling.  Think: would you prefer someone else to insert your tampon cause they can SEE things properly??  NO.  Much more comfortable and efficient to use your own hands cause you can immediately stop stretching or putting pressure on any area the moment you feel it hurts too much rather than having to say "stop" or "move to the right, no not your right, MY right" sorry if tmi  but you get my point? 

-I will have warm compresses and warm oils on hand in case it ends up that i prefer to be out of water.  I will have my support person aware that altho i prefer hands off I MIGHT want them to gently apply warm compresses and towards the end very gently slather the oil as lubricant but no pulling or massaging unless i direct them too.  Which i might if they are very gentle and it feels good.

-no forced pushing.  Breathing calm and peacefully to keep my body as relaxed as possible throughout the "uncontrollable" pushing

-keeping a clear open mind and open to change of plans should I realize it is needed- not out of others' fears. But if my body tells my mind that plans need to change I will trust that and act

accordingly.  I do trust I will know and that a calmness will help me and my support person do what is necessary should an emergency arise.

-After baby is safely born I will assess things.   Hopefully my bottom will feel/look good.   I think I will know If I need to go in for repair and If so, we will have planned for me to be transferred with very minimal movement on my part. If surgery is again needed I will not try to walk more than necessary, I wont try to suck it up and sit just cause i want to feel like i'm normal.  I will lay out for another month+ if I have too.  I will take it easy and be very gentle and kind with myself, giving that tissue the time/nutrition to heal well.

Anyways I think I understand your concern.  You had TWO 4th degree tears!  That is a very serious injury with far reaching affects that most people cant quite understand the severity of.  I am really sorry.  I would be weary of induction First because nothing can guarantee that baby is truly ready to leave that gentle first home and be ready to breath on their own.  And second because that first intervention can affect your body's own coping mechanisms such as the the chemicals that can be released specifically to help you stretch enough.  I wise doc once warned me how quickly interventions (such as pit EVEN in low doses) can snowball resulting in awful further interventions that were now necessary but most likely wouldn't have been if the first intervention had been avoided.  And THIRD because I don't believe it will increase your chances of staying in tact.  But only you know what you feel best about and if that is truly the choice that feels best for you.  Good luck with everything!  I look forward to hearing how everything goes for you :)

[noahs.mom06]

I have heard the same as a PP said, that squatting and other upright positions actually increase the risk of tearing. Hands and knees and side-lying are supposed to be the two best positions for prevention, besides being in water. I would try to be prepared for the possibility of a UC, based on your history, and avoid induction if possible... is it possible to stay at a hotel closer to the hospital for the last few days of your pregnancy? If you did decide to go with an induction, one option to look at that doesn't involve drugs OR breaking your water prematurely is a Foley induction. Basically they put a Foley catheter (the same thing they use in your bladder) into your cervix and inflate the balloon, and it puts extra pressure on your cervix and stimulates the natural release of prostaglandins, and dilates you to the point of about 4 cm, when it falls out. Many times by that point your body is contracting on its own and you are in labor... Just something to consider if that's the route you decide to go, I had to very seriously consider induction with DD because of her condition, so I had a totally drug-free induction all planned out. Luckily, she was born the day before they were going to induce me!

[jessielove]

Originally Posted by phathui5 

Is tearing something that was an issue for you with your other births?

She says in her OP that she had a fourth degree tear with her first birth and a third degree tear with her second.  Large tears like that will not 'heal on their own', as stated by a PP.  They require stitches and careful care to avoid extreme pain, discomfort and scarring.  I had a 4th degree tear with my first and a 3rd degree with my second.  Each required over 100 stitches.  That?  Is not going to heal up by itself.  That said, I had only tiny skid mark tears with my next three births. 

I've had three inductions, one natural hospital birth and an unplanned UC.  My precipitous birth, with whom we were planning a homebirth and wound up with a MUCH faster labor than we expected and a midwife who got stuck in traffic and didn't make it until a few minutes after he was born, was in respiratory distress a few hours after his birth and spent the next week in the NICU due to pneumonia caused by retained fluid in his lungs.  In a precipitous birth, the extremely short amount of time spent in the birth canal and the speed at which labor progresses causes the fluid to not be squeezed out of the lungs as well as it should be.  When there is fluid retained it can quickly grow bacteria, causing a baby to very rapidly go from fine and dandy to extremely ill.  With quick medical attention though, this can be prevented. 

If I were to have another baby I might still plan a homebirth, but I would be very sure that the midwife could get here in time and would have a back up plan in place, just in case.  We live about 40 minutes from a hospital now, and I understand your concern.  If you feel safer and more comfortable planning an induction, that might be the best for you.  If you can find a midwife nearby it might be a better plan to get to know her well while you're pregnant, either as the main plan {to homebirth with a midwife} or as a back up plan {in case labor begins before your planned induction date}.

Early induction comes with its own set of potential issues, so be sure to carefully research that with information from unbiased sources before you make a decision.  Precipitous birth can be so scary, and I completely understand wanting to be prepared and to avoid that if possible. 

[nataliej99]

Hi everyone--just wanted to end the thread with what ended up happening...

I decided to have an induction 6 days before my due date.  The OB broke my water at 8:30AM, and we waited for awhile.  I wasn't feeling any contractions.  Then at 11:00AM she started a very low dose of pitocin.  I started having contractions maybe 20 minutes later, and they kept building in intensity until I felt the urge to push.  I pushed maybe 4 times and my son was born at 12:38PM.  Still a fast labor but he is perfectly healthy, and I ONLY HAD 2nd DEGREE TEARS!!!!!  YAY!!!!  The OB applied counterpressure on my perineum while I was pushing and whatever else she did, it did the trick.  I can't express how thrilled I am to be able to get around easily just 5 days after the birth.  I will be able to enjoy this maternity leave instead of being in pain and in bed for weeks.  Not to mention, this was WAY less stressful for my husband than delivering the baby on his own.

Thanks for all your responses.  Induction may not always be a popular choice, and I certainly agonized over it, but in my case it turned out way better than expected.

[ElizabethE]

Glad you were happier with this result than previous ones... 

[EngineeringMama]

Congratulations mama!

This thread opened my eyes to a few things, I've had 2 precipitous births, the second an unplanned unassisted homebirth.  I am planning a third child and the thought of another unassisted birth makes me a bit anxious. I had no idea that a fast birth like that could be problem for baby.  This is certainly something I'm sure to discuss with doctor or midwife and I'll be sure to educate everyone in my house about the potential for the breathing/fluid issues.  Of course i believe in my body and my baby but we were not prepared for a UC and we value the knowledge and guidance a trained attendant could provide to me and the baby. I hadn't thought about using a Foley induction to maybe control this with a homebirth or even hospital birth. I'm not a fan of this, as a HypnoBabies mom, I believe that babies choose their birthdays, but I also know that my fear and unease can hinder a peaceful easy birth for both of us which in the end my be a less attractive prospect for all involved than an attended, nudge birthing time..

[dayiscoming2006]

Maybe since you know how fast it could be, you can simply prepare yourself in case of an UC? I'd be concerned about inducing. I'm glad things worked out for this mom but there are known risks to pitocin, for instance. As far as a natural type induction, I guess, but I wouldn't want to induce baby before they are ready to come out as I think that would be even worse for baby's health than being born quickly. I know it's a bit scary but if you were well informed on how to UC, I think you'd feel better about it. If you can afford it, you could hire a homebirth midwife and even if they didn't make it in time, they could check you and your baby out after everything if it makes you feel better. Just my personal thoughts.

Originally Posted by EngineeringMama 

Congratulations mama!

This thread opened my eyes to a few things, I've had 2 precipitous births, the second an unplanned unassisted homebirth.  I am planning a third child and the thought of another unassisted birth makes me a bit anxious. I had no idea that a fast birth like that could be problem for baby.  This is certainly something I'm sure to discuss with doctor or midwife and I'll be sure to educate everyone in my house about the potential for the breathing/fluid issues.  Of course i believe in my body and my baby but we were not prepared for a UC and we value the knowledge and guidance a trained attendant could provide to me and the baby. I hadn't thought about using a Foley induction to maybe control this with a homebirth or even hospital birth. I'm not a fan of this, as a HypnoBabies mom, I believe that babies choose their birthdays, but I also know that my fear and unease can hinder a peaceful easy birth for both of us which in the end my be a less attractive prospect for all involved than an attended, nudge birthing time..

[strongrad]

With my last birth I put my hand on DDs emerging head and held it in to give myself time to stretch.  I found that help a lot.  Also look into water birth.  Even if it's only in the tub.  

I would rather get a hotel room close to the hospital near my due date then do an induction.