So afraid of tearing again...advice?

[mt_gooseberry]

As my pregnancy progresses, I find myself getting more and more anxious about the birth.  I know that fear plays such a huge role in pain and being able to do things naturally, and I have to get this under control.  I am afraid of only one thing:  that I will tear like I did the last time.  I will never be the same because of the tearing I had with my first birth, and I don't know what I will do if it happens again.  I WANT ANY AND ALL ADVICE RELATING TO THE PREVENTION OF TEARING!  With my first I was in a hospital, on my back, with an epidural.  I was told when to push even though I felt no urge.  My daughter came out after pushing through just four contractions.  I have extensive scarring.  This time I will be having a water birth with a midwife in a birthing center.  I have some info on perineal massage, but I would appreciate any and all suggestions on whatever I can do to avoid (or minimize) busting open again.  Also, I have severe low platelet count (only 40,000) and so a bad tear could be potentially life threatening this time around....

[MommyofHero]

Rub evening primrose oil on your perineum every day til birth. But most importantly, visualize stretching. Breathe and visualize yourself opening easily and relaxing. If you are completely relaxed down there, you won't tear. Visualization and relaxation WORK.

[sagesmothertree]

I don't have any advice on not tearing but can empathize with how you feel. I had a similar delivery and also tore.  It's been two years but things still aren't the same down there.  :(  The primrose oil suggestion is interesting; I hadn't even thought of preventive measures.  Let me know if you find out anything else and good luck! :) When are you due?

[changingseasons]

Originally Posted by MommyofHero 

Rub evening primrose oil on your perineum every day til birth. But most importantly, visualize stretching. Breathe and visualize yourself opening easily and relaxing. If you are completely relaxed down there, you won't tear. Visualization and relaxation WORK.

I'm sorry, but that (the bolded part) is utter and complete B.S. And REALLY not a very helpful thing to post in the birth trauma forum (by implying that it's the mother's fault that she tore, because she wasn't "relaxed" enough.)


Sorry OP- I wish I had some advice for you. I just had a HBAC that resulted in extensive tearing. The recovery was (and still is) quite traumatic. I went into the birth with no fears, and consciously worked with my body in the pushing stage (breathing through the pushing urge as much as I could, letting things go slowly so the tissue could stretch, etc.) I just happened to have a large baby that had a fist up by her head and elbow out to the side...

[MommyofHero]

Originally Posted by changingseasons 




I'm sorry, but that (the bolded part) is utter and complete B.S. And REALLY not a very helpful thing to post in the birth trauma forum (by implying that it's the mother's fault that she tore, because she wasn't "relaxed" enough.)

 

Oh dear, I certainly didn't mean to imply anything negative by my comment.  I can totally relate to feeling worried about experiencing a tear again!  The OP says that she is very much "afraid," and in my experience, releasing fear in preparation for birth is crucial in order to completely relax the body, and even a small amount of tension or resistance in the vaginal opening can result in damage. It takes a lot of practice and repetition to learn how to completely relax and breathe with awareness-- especially during a potentially stressful event such as birth-- but I believe that this is the key to tear prevention. (And the OP was asking for advice on what she can actively do to prevent tearing... if the baby's position causes tearing, I don't think there is much that the mother can do beforehand to prevent that.)
 

[taubel]

My experience: First baby was c-section (breech). Second was a very FAST (panicked nurses and staff, etc.) hospital birth with no drugs. On my back. Only four pushes because I pushed as hard as I could since I heard them saying they might have to use forceps! I ended up with a third degree tear into my anal sphincter muscles. Very long and painful recovery, but I am fine now (this was 7 years ago).

I was VERY scared of tearing the next time around. I did find that it helped me a lot to watch as many birth videos as possible so that I could see what was going on and then try to push slowly and calmly. My third baby was almost a pound less than the one I tore with. He was also a relatively fast hospital birth (on my back), but with an epidural this time. The OB was very familiar with my fears of tearing. He gave careful instructions on how and when to push and supported my perineum. I did not tear at all! Just a "skid mark" which was no big deal at all!

I don't think the epidural kept me from tearing, but it certainly kept me calmer. I probably could have gone natural and not torn. It was a great birth, with no trauma or long healing afterwards. If I was going to have a fourth child, I would go for the natural birth and I would feel pretty confident about not tearing again. 

I think you are much less likely to tear the second time around. That's what I found from my research. Also, although I do not think visualization kept me from tearing, having a better understanding of the female anatomy and the birth process was SO helpful. I was able to push slowly and confidently, without rushing or "freaking out" like I did the first time!

Best of luck to you. 

[Bird Girl]

I had a third degree tear with my first child. Her head circumfrence was in the 90% percentile, so even though she wasn't very large, her head was huge. She was well positioned, and I pushed her out slowly over three hours. My skin isn't very stretchy, and I got tons of stretch marks, and I think those two things contributed way more to my tear than any nonsense about visualization. The good news is that with my second child, I tore, but much less--I only needed a few stitches. The midwife that delivered him recommended that I have an epidural, and then "labor him down" rather than push him out--and that strategy seemed to work, even though he weighed two pounds more than my DD did. I healed much more quickly the second time.  I would definitely talk to your care provider about ways that they minimize tearing, put it in your birth plan, and talk to your L and D nurse when you get to the hospital or birth center.  Best of luck to you with your second birth--I bet you will have a better recovery, even if you still have more minor tearing.

[scottishmommy]

Since you're planning a water birth, this may not work for you, but I've heard great things about side lying pushing. I'm planning on doing that for my next birth. I would imagine that a water birth would help relieve pressure though. Also, when you're in the tub, try to avoid tucking your butt in. That way your perineum has a chance to get out of the way. Good luck! BTW there is a thread somewhere in birth and beyond on vaginal births after a fourth degree tear.