Episiotomy question - Page 2

[fiddledebi]

Originally Posted by doctorjen

Many times, though, crowning is a nice slow process, particularly if you are not also yelling/counting at the mom. It was hard to learn that the perineum would stretch, even in those cases where only 1 millimeter of head more was visible with each push. The perineum feels like a tight band of tissue around the baby's head in a lot of women, and it doesn't necessarily feel like there is any give there. But lo and behold, if you leave a woman alone, the perineum very slowly stretches. I was surprised over and over that what felt like firm tissue holding up the birth slowly gave and allowed the baby to slowly emerge.
If you have never seen that process first hand and are used to the quicker birth that happens with an episiotomy, it is hard to get used to.
Like I said, it is not an excuse. In fact, to my mind, there is no excuse for not learning what a normal birth looks like, but there are a lot of docs who've never taken that opportunity. As a result, they think that the head distending the perineum for 20 minutes or more must be harmful.

doctorjen, thank you very much for this thoughtful explanation!

I actually have a question, though, about the "slow stretching." I experienced my daughter's crowning as the single most painful sensation I can remember. It was horrific. I naturally let out with a high-pitched screech that hurt my throat for hours afterward. My midwife put her hand on my knee (I was semi-seated because of a mostly-worn-off epidural) and told me that I should try not to scream like that because it would not help me focus -- and she suggested a lower pitch moan. I responded by sobbing and telling her, "I'm tearing in half, oh my g-d, help me, I'm ripping in half!" She insisted that I was NOT tearing in half, that I was doing fine, but I found it so much worse than any contraction or other labor discomfort that I insisted, against her recommendations, on pushing my heart out on the next contraction to get that head OUT before I collapsed from the pain. I ignored her suggestion that I stop pushing and let myself stretch, and gave it everything I had. She did not cut an episiotomy (I don't think she would have done that under almost any circumstance), and I had 2nd degree tears down, as well as a tear above my clitoris, requiring 2 stitches.

I don't mean to be melodramatic, and I also loved my midwife and think she was wonderful, but I highly doubt I could have coped through 20 minutes of slow stretching unless someone had knocked me unconscious. Am I missing something? Wouldn't that much stretching on a perenium be terribly painful?
I mean, a ring of fire for 20 minutes?! OUCH! How do you cope with that, as a birth attendant or a laboring mother?

[WinterBaby]

Originally Posted by fiddledebi

I don't mean to be melodramatic, and I also loved my midwife and think she was wonderful, but I highly doubt I could have coped through 20 minutes of slow stretching unless someone had knocked me unconscious. Am I missing something? Wouldn't that much stretching on a perenium be terribly painful?
I mean, a ring of fire for 20 minutes?! OUCH! How do you cope with that, as a birth attendant or a laboring mother?

Oh, that sounds awful - I don't think all of us experience it that way though. I was probably crowning for better than 20 minutes and there was some buring, an "oooo" sensation, but nothing horrifying. Perhaps experiencing it that way could be related to having it occur as your pharmacutical pain relief wore off, before your natural endorphins could work their way back up to pick up the slack? That's a shot in the dark on my part, but I'd be interested to hear experiences of women who also had epidurals wear off right before crowning.

[NoraB]

WRT supporting the tissues...can anyone give me a more detailed explanation of how to support the tissues myself and "cradle the baby's head." Will I just know what to do when the time comes or are there effective techniques that I can start visualizing now?

[cottonwood]

Actually, WinterBaby, I think that makes a lot of sense.

Also, since you had an epidural, I'm assuming that you were voluntarily pushing for some time up until she crowned? If so, I want to suggest something else -- that sometimes pushing phases are long and arduous for the simple reason that the tissues are really not ready to admit the baby. If you wait until the body is ready (that is, when the body is moving the baby down,) the crowning stage is going to be shortened considerably. Even more so if you are in a vertical position.

[littlest birds]

FWIW,

I had an unplanned hospital birth. When asked to sign papers upon entrance, I wrote in that they had to ask my permission for ALL procedures unless I was unconcious. I told the doctor (just once) quite loudly and clearly during labor that he could not do an episiotomy--period. I do not know if I covered everything legally with that, but I did not have an episiotomy and the possibility was not brought up even.

(Actually, they thought I was very odd because I was happy and smiling and had this positive attitude throughout my labor but didn't do what I was told/supposed to do and was also distrustful/on-guard. This attitude may have had something to do with getting my way too, as it is not so easy to interfere with a happy ecstatic birthing woman having no problems but who does not want to be interfered with. I also had my homebirth midwife acting as a doula along with my partner, so there were witnesses.)

[doctorjen]

See, I think not everyone experiences the crowning sensation the same. I definitely see women who feel an overpowering urge to eject the baby as fast as possible - and many times these are the women who are really feeling the ring of fire and have that tearing-in-half sensation.
I also see women who never feel any burning (and I myself never did with my first birth with no pain medication) They still sometimes push their babies out quickly, but sometimes not.
I also see women who describe crowning as very painful, and their reaction is to back off and push just short little grunts that really slowly ease the baby out. I even see women in upright postions who push spontaneously sometimes have the baby sit on the perineum through several contractions, especially if I don't do any coaching and the nurses keep quite, too.
I do think pain medications change the way folks perceive sensation and pain in general. Having your pain medication wear off during intense birthing sensations is a lot different experience than having the intensity build naturally.

[Ellien C]

Originally Posted by WinterBaby

Oh, that sounds awful - I don't think all of us experience it that way though. I was probably crowning for better than 20 minutes and there was some buring, an "oooo" sensation, but nothing horrifying. Perhaps experiencing it that way could be related to having it occur as your pharmacutical pain relief wore off, before your natural endorphins could work their way back up to pick up the slack? That's a shot in the dark on my part, but I'd be interested to hear experiences of women who also had epidurals wear off right before crowning.

I didn't have an epidural. My doc told me that the crowning would be a very, very intense pain, but it wasn't any worse than any other part of the labor. I remember her saying that it would be the worst pain you've ever felt, (and after 18 hours of labor in the hospital and 4 at home, I'm thinking how much worse can it get?). But it wasn't bad at all. I had a doula in the hospital with me. And let me tell, you I'm a pain weenie!