Tearing

[lyttlewon]

With DD I tore during birth. What can I do to prevent this in the future? My doctor said it was because of her size 8-12 but I have heard you can prevent it.

[sanguine_speed]

Originally Posted by lyttlewon

With DD I tore during birth. What can I do to prevent this in the future? My doctor said it was because of her size 8-12 but I have heard you can prevent it.

I don't think size necessarily matters, but I suppose it makes sense that it might be a factor sometimes. My 6lber required stitches, my 9lber didn't (though I still tore internally a little bit).
I think I've heard that certain positions, such as upright, squatting, all-fours etc are better for that than supine, for example. I'm not a firm believer in perineal massage or any of that.

[krismarie]

i did like the perineal massage (haven't done it much this time...) but i found that it really helped train my brain to relax when there was pressure on my peri. dh and i did it often in the last month of my pg with ds...i did tear but didn't need to be sutured and my mw thought the massage had worked well.

also, i've heard that loading up on flax oil or cod liver oil helps too.

[SublimeBirthGirl]

I've known women to give birth to 11 pounders without tearing. Push in a position YOU find comfortable, breathe through instead of holding your breath, do your own perineal support (not massage), let your body do most of the work, ease off as much as possible when the baby is crowning.

[MsElle07]

Stay off your tailbone -- birth in the water, on your side, squatting, on all fours. It allows your tailbone to move and gives you up to 30% more space in your pelvis.

Only push when you can't not push, and only push as your body tells you -- request that your care providers not direct your pushing. It allows you to work with your body and gives your tissues a chance to stretch. My first birth I was in a semi sitting position with an epidural and directed pushing, and I tore. My next two were med free births where I did what I wanted in terms of pushing, and I had no tearing at all. These techniques certainly won't eliminate all tears in all people, but they can help limit them.

[Radish4ever]

I had a 10lb, 1oz baby without any tears at all! We didn't do anything special at all prior to the birth (not even Kegals - oops!) - BUT I think that the advice the other ladies gave is WONDERFUL! I think that these things made the most difference in my pushing experience:
Midwife LIGHTLY rubbed warm olive oil around my perineum during pushing and supported it as well....
I pushed in the position(s) that felt best TO ME. My midwives had my husband pull out the box spring of my mattress so that my bed looked like 2 stair steps... and to push during crowning, I had my knees both up on the box spring... but then once the head was out, I put one leg down on the floor and left my other knee up - so I was squatting and then semi-squatting (No one directed my positioning at any point)
I did was I felt i neded to do during pushing - I breathed and pushed how I felt I needed to! THe only real direction my midwives gave me was to keep him pushed "out" so he would fully crown (as opposed to popping back in).....

[hunnybumm]

With DS#1 I was in a hospital, on my back with an epi, the epi wore off when I was 10cm and told it was time to push. I had forced pushing which hurt, I never felt the desire to push. He was 8lb 7oz and I tore 2nd degree plus a 1st labia tear.

With DS#2 I was in a free standing birth center. I tried pushing in a few different positions. Finally I was on my hands and knees on the bed, with a birthing ball in front of my. I would roll back on the birthing ball to where my bottom was almost touching the bed to push, when I felt the need to push. Between contractions I would roll forward on the ball to sleep. The midwives lead me in trying different positions: on my bad (painful), on my side (painful), birthing stool (didn't feel right), then on the bed with the birth ball. I followed my own instincts and rolled forward and back on the ball, positioned myself, etc. He was 9lb 2oz and I had a very slight tear, the mw said it was from him dropping so rapidly.

The pps have given some awesome information. The worst possible position to push in is laying flat on your back. It is easiest for the doctor (most aren't trained to birth any other way), not easiest on your body.

[greengmax]

From my experience, relaxing your jaw helps tremendously. (yes, it's hard to remember to do when you're pushing!) I went to a conference with Ina May Gaskin and I loved her story that in all her years of attending births, she never saw a woman tear who had a smile on her face. I've had three babies of varying sizes (7lb12, 8lb13, 9lb4) and didn't tear. I listened to my body when it came time to push (and gave myself the *time* to push the way I needed to, not the 1-10 count) and didn't tear with any of them. It helped that I wasn't medicated so I could make whatever adjustments in position and such that I needed to. I also requested warm perineal compresses (just warm wet washcloths) which I think helped a great deal and felt wonderful at the time. HTH!

[lyttlewon]

Originally Posted by SublimeBirthGirl

I've known women to give birth to 11 pounders without tearing. Push in a position YOU find comfortable, breathe through instead of holding your breath, do your own perineal support (not massage), let your body do most of the work, ease off as much as possible when the baby is crowning.

What do you mean by perineal support?

[Jenlaana]

I know that wasnt directed at me, but Perineal Support is, I believe, when someone uses their hand and holds it firmly against the outside of your perineum while you are birthing the baby. It gives the tissues extra support that is supposed to make it easier to push w/out tearing.

My DD wasn't very big, 7lbs 5oz, but she was my first vaginal birth (my DS was born via scheduled cesarean w/out labor). I didn't tear at all and only had the smallest of skidmarks. I birthed at home, and I think the things that helped me the most were

1) being in water, really helped me relax and helped the tissue be more pliable
2) giving birth on my knees/squatting allowed maximum space for her to pass through the birth canal
3) THE MOST IMPORTANT IMO - I didn't push hardly at all. I really pushed for MAYBE 3 contractions, and I let my body do the rest. If it wasnt for the really gross feeling (to me) of my hips being pushed apart from the inside, I wouldn't have pushed at all, but that was the point when I finally really wanted the baby OUT.

Believe it or not, even a woman in a coma could give birth vaginally. The body will push the baby out on its own, with or without mom's help. The more you push, the more stress you put on your perineum. I hate those shows where you hear someone in the birthing room going "puuushhhh! push push push puuuuuushhhhh!!!!! PUUUUSSSSHHHHHH!!!!!" I watched Birth Day yesterday and wanted so badly to reach into the TV and just slug that woman. If it was my birth, I would have.

[riomidwife]

Originally Posted by MsElle07

Only push when you can't not push, and only push as your body tells you -- request that your care providers not direct your pushing. It allows you to work with your body and gives your tissues a chance to stretch. My first birth I was in a semi sitting position with an epidural and directed pushing, and I tore.

I actually think in terms of potential for tearing, semi-sitting is worse than being completely flat on your back. I also think squatting is GREAT for pushing but IME not the best postion to reduce likelyhood of tearing. Side-lying would get my vote for that. But like the pp said, following your body's rhythm is a big part of it. Waiting for the head be nice and low, that's when the urge comes, and gives the tisuses a chance to stretch on their own. And gently easing the head out rather than blasting it out! (if possible).

[luckymamato2]

I was semi-sitting and tore. I was not comfortable on my hands and knees and the mw was unwilling to let me find a comfortable position on my own. I really wanted to lay on my side and have my face on the bed. Sortof on my stomach, but my legs weren't wide open enough for them. Needless to say, I won't be going back to them. I am happy that I got through the ordeal med-free.

[SublimeBirthGirl]

Right, perinneal support is pressure on the skin to help reduce tearing. IMO it's most effective when done by the mother herself, who can feel what's going on and where support is needed.

[dex_millie]

Originally Posted by greengmax

From my experience, relaxing your jaw helps tremendously. (yes, it's hard to remember to do when you're pushing!) I went to a conference with Ina May Gaskin and I loved her story that in all her years of attending births, she never saw a woman tear who had a smile on her face. I've had three babies of varying sizes (7lb12, 8lb13, 9lb4) and didn't tear. I listened to my body when it came time to push (and gave myself the *time* to push the way I needed to, not the 1-10 count) and didn't tear with any of them. It helped that I wasn't medicated so I could make whatever adjustments in position and such that I needed to. I also requested warm perineal compresses (just warm wet washcloths) which I think helped a great deal and felt wonderful at the time. HTH!

I just wanted to quote this to say although you try everything there can be a possiblity of tearing. I did everything mentioned in the quote. My labor was at home and very easy (only 2 hours). I stood and squat. Followed my instinct for everything and still got a 3rd degree(no purple pushing). Could it be prevented. Maybe. I don't know. I tore with the shoulders. The head came out without any tear.

I read the Ina May guide to childbirth. I was not scared, nervous, tense, nothing, it just flowed like natural, wouldn't change a thing (except the tear) - it was almost to easy to believe. My jaw and whole face was relax but I wasn't smiling, maybe I'll try that next time.

I sometimes wonder why I tore so badly when I did everything natural. And it took me 3 months to heal. The tear itself didn't really bother me, sometimes I didn't feel like a tore. But I do wonder why.


I like all the above advices. And believe that you can minimize a tear, maybe even prevent it. But tearing is also just a natural thing that can happen during birth.