Super short perineum Yikes!!! C-section??

[pineapplehorse]

HI guys,

    I am freaking out just a bit. My husband and I are going to start trying to get pregnant soon and I am deathly afraid of having a 3rd or 4th degree tear. I just really dont want any permanent dysfunction. I have a very very short perineum <1.5 cm yes cm not inches and I am wondering if anybody has had any experience with this and can offer any insite or advise??? HELP !

Thanks guys!

[XanaduMama]

I've never heard of anyone even knowing their perineal measurement (I sure have no idea how long or short mine is!), but I'm pretty sure that length has nothing to do with whether or not you tear. There are things you can do to protect your perineum during birth: pushing carefully once baby is crowning; birthing upright, not on your back; having a waterbirth (the warmth and support of the water supposedly help the tissues stretch); having good perineal support from your birth attendant (I'd recommend a MW for this, as for everything, rather than an OB)... And then I think a lot of it, if you've got an ideal birthing environment (see above), is just luck. Perineal massage is something people do ahead of labor, but I don't know whether there's evidence that it actually helps.

In short: I wouldn't worry about your perineal length! Welcome to MDC and enjoy trying to conceive!

[APToddlerMama]

I've never heard of anyone knowing the length of their perineum... I know mine is short only because my OB commented on it.  Less than 5% of women will experience a third or fourth degree tear so I wouldn't get worried about it.  I've had two third degree tears.  They sucked but I'm 8 weeks post partum with my second baby and doing fine.  Most people are.   It is true that a short perineum can make it more likely to have a third or fourth degree tear but there are lots of things to do to prevent it.  Had I known that with my first I doubt I'd have torn as badly... There will be a million things to worry about in pregnancy.  I wouldn't get too focused on this.  Good luck

[pineapplehorse]

Thanks for the feedback guys. I am well aware  that people do not measure their perineum and it is something most people do not even think about. Thing is if yours was really really short you would definately be aware of it , because for instance the distance btw my 2 openings is about a finger nail width wide.... noooo room for any tear or it will be a sphincter tear! I'm assuming this is pretty uncommon. But I apprectiate the replies!

[mysticmomma]

I have a shorter peri than you do and didn't tear with any of my 10lbers.

[blessedwithboys]

If I had to choose between a 1mm tear on my perinuem and a foot long gash on my stomach, I know what I'd choose.  But then again, I'm just a wee bit bitter.  :)

[pineapplehorse]

Thats fantistic mystic! Thanks so much! Its not the actual perineum tear that I care about.. I dont want to have problems with moving my bowels for the rest of my life.  Im not worried about pain or scaring I just dont want any permanent dysfunction.

[Katie8681]

Hey! I don't have any personal experience with short perineum, but I definitely understand that it might worry you.  I would not want to go through a whole pregnancy and birth carrying that kind of fear- that would be miserable. I would find a midwife or doctor who would be VERY VERY UNLIKELY to cut an episiotomy. I am not aware of any support for the idea that birthing in a squatting position makes you less likely to tear. The research I have seen has the lowest rate of perineal trauma among women pushing in a side-lying position, and birthing the head slowly, between contractions. 

Your care provider will actually be able to SEE your anatomy, and will be the one making suggestions at the birth, so I would really look carefully for the right person, who will hear your fears and talk to you about them. I have never heard of someone having a planned c-section due to a short perineum, but if, say, it came down to using forceps or a vacuum (not that that is likely, just speaking hypothetically), you might go with a c/s versus those options, since they are strongly associated with 3rd and 4th degree tears.

Hope this helped  :)

[pineapplehorse]

That actually helps a lot! Thanks.so.much.Katie

[APToddlerMama]

Originally Posted by blessedwithboys 

If I had to choose between a 1mm tear on my perinuem and a foot long gash on my stomach, I know what I'd choose.  But then again, I'm just a wee bit bitter.  :)

You know that is sort of rude to those who have experienced third and fourth degree tears. My second tear was fine...first not so much but I don't want to scare op because all turned out fine.  However my recovery was much much longer than it would have been with a cesarean.  It isn't about the length of the tear itself...when the muscle tears you can end up with incontinence.  I'd rather have a c than poop on myself for the rest of my life. Just sayin... Also very rude to minimize saying a 1mm tear.  I required a full hour of stitching with my first.  I know someone who tore so badly it took 3 hours in an OR to repair... Fear not, OP... That's probably as likely as being struck by lightening. 
 

[pineapplehorse]

Well put toddlermama! I actually have a medical background and have prob seen too much which is y I'm worried. I ve done enough pelvic exams to realize that my anatomy is way off. And I also have dealt with enough pts who have had rectal surgery to know the risk that come along with a sphincter tear. I am well aware this is not the place to come for medical advice and I do plan on having a serious screening process for my ob ...I was just wondering if anyone out there had a similar issue :)

[pineapplehorse]

Well put toddlermama! I actually have a medical background and have prob seen too much which is y I'm worried. I ve done enough pelvic exams to realize that my anatomy is way off. And I also have dealt with enough pts who have had rectal surgery to know the risk that come along with a sphincter tear. I am well aware this is not the place to come for medical advice and I do plan on having a serious screening process for my ob ...I was just wondering if anyone out there had a similar issue :)

[naturalbirthoff]

A short perineum does not automatically equal tearing. Even if you did tear it would be a quicker recovery and less long-term effects than an elective c-section.

Once pregnant there are ways to soften the perineum to aid in stretching. You can do perineal massage, which husbands tend to like helping once you have a hard time reaching past the belly. Using evening primrose capsules in the vagina overnight helps soften the perineum and the cervix, but should only be used in the last 4-6 weeks of pregnancy. Contrary to the rumor, evening primrose does not induce labor!

Avoiding coached or "purple pushing" helps ease baby out gently, allowing the perineum to stretch. Do not let your caregiver tell you when to push, how hard to push, or how long to push. This can rush baby out and actually causes unnecessary tearing. Just push when you feel the urge. Avoiding an epidural helps you feel when to push and eliminates the need to be told when. I had a natural birth and pushing felt good. You do not need an epidural for pushing.

Having a warm compress held against your perineum while pushing aids in softening and relaxing tissues.

When the baby begins to crown, stop pushing for a contraction or two. This allows the perineum to stretch slowly.

My best friend is a size zero with a short perineum. She birthed a 12lb 14oz baby with no drugs and no tearing. So, if she can do it, you have no worries. ;-)
 

Originally Posted by pineapplehorse 

HI guys,

    I am freaking out just a bit. My husband and I are going to start trying to get pregnant soon and I am deathly afraid of having a 3rd or 4th degree tear. I just really dont want any permanent dysfunction. I have a very very short perineum <1.5 cm yes cm not inches and I am wondering if anybody has had any experience with this and can offer any insite or advise??? HELP !

Thanks guys!

[Katie8681]

Originally Posted by naturalbirthoff 

Even if you did tear it would be a quicker recovery and less long-term effects than an elective c-section.

You have no way of knowing that.

[smeep]

Serious tears are VERY rare in births where mom follows her body's signals and needs, and where she's not told when or how long to push, "purple pushing", etc., and is not laying on her back. An out-of-hospital birth would definitely be your best bet for avoiding a tear; or, worse, an episiotomy, which is far more likely to result in a severe tear.

[blessedwithboys]

Originally Posted by APToddlerMama 

You know that is sort of rude to those who have experienced third and fourth degree tears. My second tear was fine...first not so much but I don't want to scare op because all turned out fine.  However my recovery was much much longer than it would have been with a cesarean.  It isn't about the length of the tear itself...when the muscle tears you can end up with incontinence.  I'd rather have a c than poop on myself for the rest of my life. Just sayin... Also very rude to minimize saying a 1mm tear.  I required a full hour of stitching with my first.  I know someone who tore so badly it took 3 hours in an OR to repair... Fear not, OP... That's probably as likely as being struck by lightening. 
 

No offense was intended.  I meant to type 1cm, not 1mm, and that only bc the OP gave her perineal measurement.  Let's not get into a game of "my c-sec recovery was worse than your 4th degree tear".  You poop on yourself and I can't feel anything between my belly button and pubic bone.  I can't imagine the horrors you experienced, and you can't imagine mine.  But I can express my personal opinion.  Which is what I did.  So, nope, not rude at all.  :)

[APToddlerMama]

Originally Posted by blessedwithboys 

No offense was intended.  I meant to type 1cm, not 1mm..... Let's not get into a game of "my c-sec recovery was worse than your 4th degree tear".  

Eye roll.  Really? Well thank you for being a fine upstanding member of mdc.  Pretty sure I was pointing out it is rude to minimize the experience of those with bad tears and was not saying a cesarean is a piece of cake. 

My tear was not 1 cm... Clearly you don't understand what a third or fourth degree tear entails. 
 

[Youngfrankenstein]

Originally Posted by smeep 

Serious tears are VERY rare in births where mom follows her body's signals and needs, and where she's not told when or how long to push, "purple pushing", etc., and is not laying on her back. An out-of-hospital birth would definitely be your best bet for avoiding a tear; or, worse, an episiotomy, which is far more likely to result in a severe tear.

Well I think this could be a big consideration if mom chooses an epidural.  I think that's why she's asking ahead of time.  I don't think an out-of-hospital birth makes her less likely to tear in and of itself.  If she chooses vaginal birth, she may want to be in the hospital setting based on what she and her OB decide. 

[TCMoulton]

Originally Posted by blessedwithboys 

If I had to choose between a 1mm tear on my perinuem and a foot long gash on my stomach, I know what I'd choose.  But then again, I'm just a wee bit bitter.  :)

Wow, you must have had a seriously emergent c/s to have a one foot incision on your stomach because I know that mine is just a few inches long and is well hidden beneath my pubic hair.

Regardless, there is no way to know if recovery will be easier for a serious perineum tear than it would be for a c/s.

[APToddlerMama]

Originally Posted by naturalbirthoff 

A short perineum does not automatically equal tearing. Even if you did tear it would be a quicker recovery and less long-term effects than an elective c-section.

Once pregnant there are ways to soften the perineum to aid in stretching. You can do perineal massage, which husbands tend to like helping once you have a hard time reaching past the belly. Using evening primrose capsules in the vagina overnight helps soften the perineum and the cervix, but should only be used in the last 4-6 weeks of pregnancy. Contrary to the rumor, evening primrose does not induce labor!

Avoiding coached or "purple pushing" helps ease baby out gently, allowing the perineum to stretch. Do not let your caregiver tell you when to push, how hard to push, or how long to push. This can rush baby out and actually causes unnecessary tearing. Just push when you feel the urge. Avoiding an epidural helps you feel when to push and eliminates the need to be told when. I had a natural birth and pushing felt good. You do not need an epidural for pushing.

Having a warm compress held against your perineum while pushing aids in softening and relaxing tissues.

When the baby begins to crown, stop pushing for a contraction or two. This allows the perineum to stretch slowly.

My best friend is a size zero with a short perineum. She birthed a 12lb 14oz baby with no drugs and no tearing. So, if she can do it, you have no worries. ;-)
 

I'm sorry but this is ridiculous.  So those of us who have torn have done something wrong since your size zero friend gave birth to a huge baby with no tears?  I had a posterior baby which was a huge reason I tore. And the vacuum which was necessary because after 2.5 hours baby's heart rate was decelerating.  Yes there are things to do to minimize risk of tearing, but you can do all those things and still tear or end up in a situation where you are choosing between greater risk of tearing and your baby's safety. 

And it is definitely not true that all tear recoveries are easier than c recoveries.