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[csbwhite]

Hi,

I am strongly considering a second UC. However, this time, I will need information regarding how to avoid tearing. I want to avoid a trip to the hospital, dang it. I've had two homebirths. One with midewives and one UC. I needed to have tears repaired both times. (My midwife was unable to repair the tear in my first homebirth because of the type of tear.) My UC tear was a 1-2 degree tear. It is a real joy-suck for the whole homebirth exerience to have to deal with the hospital and all the crap that goes along with it. I hope to get to know everyone here!

Susie

[zoebird]

Hi!

No guarantees, of course, but there are a lot of things that do help -- such as massaging the area with oils during pregnancy so that the skin becomes more soft/stretchy; and also using oil or hot water compresses and supporting the area while birthing; or birthing in squatting/half-squatting positions. 

Also, scarring can make it tougher to get the elasticity that you need, too, so it might be tougher now than for your first. 

[labortrials]

Wouldn't squatting put more pressure on the perineum?  Can't remember.  I think one of the better 'do not tear' positions is side-lying, but personally I hate that position.  If you have precipitous labor and/or a super strong 'expulsion reflex,' that'll certainly lead to more tearing.  I think the massage/oils might help you, and also doing what you can in the pushing phase to slow it down.  (Easier said than done, I'm sure!!!!)

Oh and welcome to the UC forum!

[ElizabethE]

I've always heard that squatting and all fours were actually really good for not tearing. And, like you, the side-lying I also heard. But definitely don't lie on your back if you are trying to avoid tearing.

My UC gave me a 1-2 degree tear too, CSB, but I let it heal naturally and didn't go in for stitching or anything and all was well.

Unfortunately the scar issue is for real. Previous scarring can make tearing much more likely. :/

[sunshinemoma]

Hi Susie, I also want to avoid tearing:)  I have some compromised(aka scarred) tissue down there and I'll try anything to avoid the need for stitches again.  Here's some of my plans:

-during second stage use positions that slows exit, such as side laying or hands and knees.  NOT squatting as this usually SPEEDS up second stage. 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 simply because they can SEE things properly??  NO.  Much more comfortable and efficient to use your own hands cause you can immediately stop stretching/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.  I won't resist my body's pushing (which would restrict the tissue from optimum stretching) but I will not voluntarilly contribute to it...UNLESS my goal is not to keep things slow and gentle on my bottom.  It might change if for any reason I know it is vitally important to get babe out asap I will do all I can stand/squate assist my body in pushing.  I don't anticipate that need will arise but if it does, I obviously will put my bottom's best interests 2nd to baby's best interest, kwim :)

I look forward to more mamas with input.  Anyone here with thick scar tissue go on to birthing intact?