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What about tearing? - Page 3

post #41 of 68
according to the research that i've read about fistulae in sub saharan africa (i'll try to dig up the information) the common causes are 1. FGM and 2. young (very young/teen) women giving birth. often, in many cases, it's a combination of these things.

and, we are functioning under generalizations: if a woman is generally normal, generally healthy, and having a generally normal and healthy birth process, she is not likely to have a fistula or fourth degree tear or any other tear that requires stitches or medical attention.

there are few exceptions to this. women who do tear greatly generally have some form of positioning wrong (uterus,baby positioning) or something like htis which is beyond their control during birth, or a unique abnormality of some sort or some form of injury which would take them out of the 'generally healthy, generally normal' category.

do big tears happen? yes. do fistula happen? yes. do these require medical attention? yes. has anyone stated that people who feel their tears require medical attention should not get that attention? NO.

so, why criticise those of us who want to do things naturally, at home on our own, knowing that we're generally normal and healthy, and that we're not likely to have a large tear or fistula, wanting to discuss the options for not going to the hospital to repair a tear that isn't this extreme?

it's not accusing anyone who does have a problem at birth as being "wrong or bad." they're smply an anomoly. there's nothing wrong with being an anomoly. ok?
post #42 of 68
it should also be pointed out that the american experience of birth and the sub saharan experience of birth are false comparisons.

in this country, the tears seem to be directly related to interventions or rare anomolies.

in sub saharan africa, the tears are directly related to youth, FGM, or other health conditions related OR anomolies.

thus, it's a false comparison.

no one was accusing anyone in subsaharan africa of 'pushing wrongly' though it could be said that many american women, while birthing on their backs in hospitals and being encouraged to push before they have the reflex to do so results in extreme tears that require medical attention.

but i would wager that barring some anomoly in anatomy, a woman who pushes with her own reflex, who has moisture, adequate nutrition, and a generally healthy, normal body, will not have an extreme tear that requires medical attention.
post #43 of 68
oh, and yes, i've been to sub saharan africa (kenya and tanzania).
post #44 of 68
My first had her hand up by her head (nuchal hand sp?) when she came out and I tore bad w/ her even though it was a UC (I was stitched at the hospital). With my recent UC my baby was posterier (sp?) and came out all at once very fast and I'm sure that's why I tore with him (not to mention my labor was less than 30 min). So yes the times I tore there were things going on out of my control that I'm sure contributed if not caused me to tear.
I don't know how bad I tore this last time but I don't think it was beyond a second degree if I had to guess. Anyone know how I could figure it out at this point (13 weeks postpartem)?
post #45 of 68
I had a minor tear that didn't require any special treatment, it healed quickly, much quicker than the hemorrhoids!
post #46 of 68
I just have a couple of things to add to what Sapphire Chan and Zoebird said. First, it's only the most extreme (and least common) forms of FGM that physically impede labor. That's not to say that most FGM isn't still a factor in labor obstruction in terms of the psychological/psychosexual effects of it.

Second, in addition to there being often inappropriate assistance in birth and lack of access to medical care when needed, many women are malnourished. This is probably considered the biggest factor in obstetric fistula in this area of the world -- malnutrition grows a small pelvis. Pair that with women giving birth when they are essentially still children, and you've got a very good recipe for obstructed labor.

The fact that none of us (or few of us) have actually been there is irrelevant, unless we can believe that every single media and academic source is lying about these conditions being present to a higher degree there than in the developed world. It would be completely contrary to reason to conjecture that these conditions do not have a significant affect on mortality and morbidity rates.
post #47 of 68
I thought an obstetric fistula was caused by an obstructed labour?
post #48 of 68

Quick FYI on superglue

Standard superglue, in fact, DOES adhere to moist surfaces. My husband is a big saltwater freak and uses superglue all the time on his very sensitive corals to glue them to bits of seashells and rock... and the coral and rock are soaking wet!

Loctite superglue is his glue of choice.
post #49 of 68
for what it's worth, I had four hospital births (preMDC), delivered on my back with all of them, ranging in size from 7 to 9 1/2 lbs. With the first two, I even had epidurals and couldn't feel a thing as I pushed, but still I only got small "scratches" with each one, no stitches.

So it's not really accurate or fair to generalize and say that someone can control tearing based on how they birth their baby, that they won't tear as long as they birth in a natural position, and follow their instincts as far as when to push, or whatever...if it was really based on those things, I would have torn like crazy and I didn't.

I think tearing depends to a degree on how you push, for sure, but I think it also depends on each individual woman's body and build and their physiology down there, as well as the size of their baby and the baby's head, and whether or not, as previous posters said, the baby comes out arm first or breech or whatever. So I think that thread of this argument is really neither here nor there, and that the OP is really smart to prepare for the what if's because you don't really know if and how bad you are going to tear until your precious baby comes out of there. If you DO tear, it does not mean you did something "wrong."

To the OP, I think whatever is best for your peace of mind is what you should do. I think have a midwife on call "just in case" is a fine idea. I would hesitate to use superglue unless you have a very steady hand. That stuff is not funny if you get something stuck together that you didn't mean to...
post #50 of 68
Quote:
Originally Posted by nznats
I thought an obstetric fistula was caused by an obstructed labour?
Was somebody saying differently?

Quote:
So it's not really accurate or fair to generalize and say that someone can control tearing based on how they birth their baby, that they won't tear as long as they birth in a natural position, and follow their instincts as far as when to push, or whatever...if it was really based on those things, I would have torn like crazy and I didn't.
Or it means is that your body is exceptionally resilient and efficient. Resistance to tearing is based on several factors, including genetics, diet, environment, style of birth management, degree of disturbance of birth process, position and type of pushing, etc. Nobody is saying that every woman who gives birth in a hospital on her back with an epidural will tear, but generally speaking women who do so are statistically more likely to tear than women who give birth under more natural circumstances.

Quote:
If you DO tear, it does not mean you did something "wrong."
No, but it might. A more accurate statement, then, would be that it does not necessarily mean you did something wrong (or had something wrong done to you.)
post #51 of 68
I breathed through pushing and did my own perineal support. I had a little tiny tear/skid mark at the same place I tore w/ my first (I think). It burned when I peed for a day and was a little swollen for a week or so (didn't hurt though). I got stitches w/ my 1st but I'm sure now I didn't need them. My plan if I tore was to sit with my legs crossed a lot for a few days. The skin down there heals well and quickly. If I'd torn really terribly (which I didn't think would happen), there was a HB midwife I could call to come take a look. But it'd have to have been a VERY severe tear for me to get stitches.
post #52 of 68

Dermabond

Cascade sells a single-use Dermabond "pen" that is very easy to use and works well for perineal tears. To keep the area as dry as possible during the application, roll up a sterile guaze to use as a tampon, use sterile water and more sterile gauze to clean and dry the perineum, and then apply the Dermabond to both sides of the area that you are piecing back together. There is the risk of applying too much (almost like that infamous "extra stitch"), so be sure that whoever is applying the glue can see well where the tissues approximate. As with any tear, you still have to be careful about spreading your legs (especially on the toilet), and have someone monitor (or use a mirror yourself) the area every other day or so to make sure that the perineum is healing well.

At $42, it is pretty expensive, but a wise investment (IMHO) for any UCer who is concerned about perineal tearing.
post #53 of 68
Thread Starter 
Oh man, I totally forgot to mention ds was born sunny-side up with a nuchal hand. I'm sure the extensive tearing had something to do with that.

For the pp who asked, I was in the tub when all of a sudden my body began pushing like I was having a big bm. I was not consciously doing it. I got scared and asked the mw to check me. She did a quick check while I was still in the tub (I didn't even feel it) and informed me I was at 10 cm. That's all

I really think it's unwise to assume you will have no tearing and not even think about what you will do if it happens. I mean severe tearing that MUST be repaired. If I would have left the tear I had alone I would probably have three vaginas right now.
post #54 of 68
I really don't have anything new to add except that I thought I would mention that I tore MUCH worse with my 2nd birth (unassisted) then I did with my first birth (medicated hospital). Go figure. It just goes to show there are no hard and fast rules and there are many factors that play into whether or not you will tear and how badly you will tear. I do think it helps to do some perineal streching during labor, although I'm sure that could be debated. Also how fast the baby's head comes out too.
post #55 of 68
Quote:
Originally Posted by nznats View Post
I thought an obstetric fistula was caused by an obstructed labour?
Quote:
Originally Posted by fourlittlebirds View Post
Was somebody saying differently?
I think she was confused by what you said here:

Quote:
Originally Posted by fourlittlebirds View Post
This is probably considered the biggest factor in obstetric fistula in this area of the world
post #56 of 68
Sorry, I'm still not following.
post #57 of 68
derma bond will only glue minor tears-- muscle tissue will take a bit more holding-- how to see if you have an in the muscle tear is do a kegel- if everything comes together it isn't in the muscle or isn't in the muscle much- if the tear separates then it is in the muscle and every time you kegel or move your muscles you will be pulling them away from healing together.
as been said before- there is a mixture of elements that go into tearing/not tearing- tissue quality and health- if you have warts they do not represent healthy tissue- yeast infections change tissue health and repair/circulation and other infections do too.
not everything is under your control- like a nuchal hand/arm/elbow- unflexed heads brow presentation-
something you can do is feel and be aware- don't just push to get it over with- and yes it feels like forever those last few cm when a baby sits there backs up a bit and everything is burning- but wait wait for that stretch- feel with your hands- say yes and open-
I had epis and tore with my first 2 hospital births and my first homebirth smallest baby 9lbs I tore with her but I did not tear with my 12 lb UC baby and it was because even during the ejection reflex- it is not constant- you still have contractions- and a break between the contractions- take your ease during that break- think of yourself the end is near don't rush-
post #58 of 68
i dunno about anyone else but here are the options that i've seen out there:

minor tear (most common type in homebirth in general)--leave alone or treat with dermabond-type material.

major tear (requiring medical attention--rare, but does happen)--contact midwife to see if s/he can handle such things or transfer to hospital within 4-6 hours to have the tear repaired.

no one is talking about being unprepared or ignoring that it might happen.
post #59 of 68
Thread Starter 
Quote:
no one is talking about being unprepared or ignoring that it might happen.
Actually a few people basically said it doesn't happen unless you do something "wrong" which I actually find quite insulting and completely untrue.
post #60 of 68
What people were saying is that tears are *less* likely to happen when birth is unhindered.

That tearing isn't something to worry about because
a. it's less likely to happen
and
b. it can be easily handled if it does happen.
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