On all fours and tore anyway - how do I avoid it this time?

[dianna11]

When I birthed DD, I was instinctively on all fours the whole time. I keep reading that it is "extremely unusual" to tear in this position - and although DD didn't have a freakishly gigantic head, I had a second degree tear.

Granted, I was only pushing for 10 minutes or less before she flew out of me.

What could have lead to the tearing? How can I avoid it again?

[mytwogirls]

Maybe your babe was just too big for your body?? Also, if he flew out of you like you said, maybe it was just too fast of a delivery and you could not stretch enough? I didn't labor on all fours so I really couldn't help ya out that way much.

[mytwogirls]

Oops, I said, "he" I meant "she"..sorry!

[Mama Poot]

I read that lack of antioxidants and omega 3's can contribute to weak skin. I would start taking vitamin E regularly, cooking with beneficial oils like safflower and olive oils, eat more salmon and other foods high in omega 3's. Gentle perineal massage with olive oil during the pushing phase can help as well. You hear so much about the importance of lubrication during intercourse, its no different when giving birth-except that its MORE important because you're pushing out a baby!

[Shanana]

I tore on hands and knees too ... one first degree tear, one second degree tear. I only pushed for 21 minutes, and dd was "normal" sized -- 7 lb 10 oz, and I don't remember her head circumference offhand, but it wasn't anything outrageous. My guess is it was due to the really short pushing time, which didn't allow the tissues to stretch. They also told me to stop pushing when dd's head was halfway out so they could start suctioning her :, but that's a whole different complaint. I'm sure it didn't help matters any with the tearing, though, having her head sit like that for a period of time.

I had been in hard labor for 36 hours and was desperate for the birth to be over, so I was pushing with all my might. I also never got an urge to push, so I was pushing without any guidance from my body. I think if I hadn't been so exhausted, and had been able to wait for my body to be ready to push and pushed more in that kind of rhythm, things probably would have gone better.

Anyway, I'm doing a homebirth this time, and I actually feel intuitively that I'm going to tear again. I think this is because they stitched the 2nd degree tear, and it has just never felt "right." I don't have any pain, it just feels different in a way that I can't explain. Every time I think about this upcoming birth, I feel that I will tear again, but only enough to allow my body to heal on its own so that the area will come together properly again.

I don't know if this helps any , but I think a slower/longer pushing phase might help things. I also know that a position like a squat tends to shorten the pushing phase, so you might want to avoid that. But really, I would push in whatever position feels intuitively "right" to you.

[dogmom327]

My MW applied pressure to that area while I was pushing and I also had warm wet washclothes and olive oil on hand in case I got out of the pool. I did still tear but I am confident that it was because DS having his hand on his head for the trip down...silly baby.

[proudmamanow]

I also gave birth on all fours, in the water and ended up with a 2nd degree tear. And I pushed for close to two hours...I've also wondered about preventing tears in a future pregnancy, good to hear about the supplemetn suggestion. I don't actually remember, but apparently my midwife was providing some perineal support. I read recently that 70% of moms tear (if not given episiotomies, I guess) and that made me feel better (in a way...tearing is still *very* painful).
Sorry not to be more helpful & good luck!

[maxmama]

Sidelying can be good position -- allows better control of the head.

[dianna11]

Wow, so it sounds like tearing on all fours isn't as rare as "Unhindered Living" made it sound That's good to know, I thought I was a freak or something.

I will definitely look into the supplements, but I think there is a good amount of zinc in my prenatals already.

THe olive oils sounds god too, I imagine we didn't do that last time because it was a midwife assisted hospital birth, and we didn't have any on hand.

[gcgirl]

Originally Posted by dianna11

Wow, so it sounds like tearing on all fours isn't as rare as "Unhindered Living" made it sound That's good to know, I thought I was a freak or something.

I'm not a birth expert, but I was reading on a midwives' forum the other day - just out of curiosity. Several of the more experienced midwives were saying they're convinced there's not much you can do to prevent tearing, in ANY position. Aside from getting an episiotomy, of course, which is a guaranteed tear.

Another interesting thing I learned - one of the midwives was saying that western women don't squat the same way Asian and some tribal women do, and that our odd squat posture contributes to tearing. I think she meant because we don't squat regularly, like sitting for meals and etc, we have a different alignment. Interesting stuff to think about.

[jennica]

From what I've read, tearing can be perfectly normal. Usually a tear wont go through the muscle like an episiotomy will, and with a tear the skin usually fits back together like a puzzle piece, so it is easier to repair. The best ways to avoid a tear are to birth in a position that you feel comfortable in and drawn to, keep everyone else's hands off of you and if you feel you need some support use your own hands, and consider birthing or laboring in water.

[Ligeia]

I would guess that it was just too fast. When I was birthing dd, the midwife has me stop through one or two contractions and just rest because I was pushing so hard and so fast, that my skin needed time to deal with it. I think she also rubbed some oil onto my skin during that time. I didn't end up tearing at all but I'm sure I would have if allowed to continue at that pace. Perineal massage a few weeks beforehand helps to stretch it out too. My midwife gave me a pamphlet on how to do it that was very helpful.

[dianna11]

Originally Posted by jennica

From what I've read, tearing can be perfectly normal. Usually a tear wont go through the muscle like an episiotomy will, and with a tear the skin usually fits back together like a puzzle piece, so it is easier to repair. The best ways to avoid a tear are to birth in a position that you feel comfortable in and drawn to, keep everyone else's hands off of you and if you feel you need some support use your own hands, and consider birthing or laboring in water.

That's the thing - on all fours is just what my body wanted to do! The whole reason we even went to the hospital was to take advantage of their unlimited hot water supply, so I could labour in the water, but I wanted nothing to do with water once I got there! I had a private midwife, so the only time we saw hospital staff was the reception staff waving us through to use the birthing room. The midwife's hands were pretty much only on me to massage my back, and ultimately catch the baby (she didn't even feel the need to pop my bag of waters, which was still in tact and over DD's head when she was born - so I guess she did have a water birth on dry land anyhow ) I also thought I would want to squat, but my body had other ideas about the position I should be in.

It was true that the tear seemed to fit right back together easily, but it was painful and took a LONG time to heal.

I think the things that may have contributed to the tear were - as I mentioned the SUPER-fast 10 minutes of pushing (my body pushing - not my will). I believe I completely zoned out during this time, I was still waiting for my water to break, and had no idea that the baby could be born without it breaking, so I thought I still had a while to go. The crying tipped me off that my presumption was wrong I don't know if the midwife was applying pressure or anything, I was in "labourland"

I will ask my midwife about what they do about helping prevent tearing, I'm sure all of them do it a little differently. I have a new midwife for this birth, because my previous one will be away too close to my due date, but may be there if I go to 39 weeks :

[kythe]

I had 2nd degree tears with both of mine, despite pushing in upright positions. Both times, my midwives said it had to do with the length of my pushing stage. With my first, I pushed for 3 hours and my perinneum had been stretched too tight for too long by the end. My second popped out with hardly any pushing at all. They said I tore because there wasn't enough time for the perinneum to really stretch at all in preparation for the baby.
Something in-between these two extremes might have been better in that way.

That said, I didn't feel the tears either time. As much as people fear natural tears, I found it painless and even though I had stitches, healing was fast.

[Shanana]

Oh yeah, I forgot all about dd's nuchal hand . I'm sure that didn't help things either.

Originally Posted by dianna11

It was true that the tear seemed to fit right back together easily, but it was painful and took a LONG time to heal.

I was in excruciating pain after birth even though, like you, I pushed only a short period of time (and also tore). My doula brought me an herbal bath that I started using about 3 days post-partum. WOW!!!! is all I have to say. I did it three days in a row ... after the first bath, the pain was reduced by at least 75%. But the third day, it was gone. Totally gone! I couldn't believe it! You better believe I won't be waiting three days to get into one of those baths this time around . I highly recommend them. Can't guarantee everyone will have the same experience, but it sure helped me tremendously.

[klg47]

This is interesting. It would seem that I have all the factors that would cause tearing, yet I didn't tear (much). I have very dry skin & terrible stretch marks. I have a small frame (5'3" tall, size 30 band on bras), so I would assume that baby-having parts would be normal to small.

Baby #1: typical American diet, pushed 3.5 hours flat on my back, baby's head was in the 95th percentile = 1/4" labial tear

Baby #2: somewhat better diet, pushed 2 hours in birth tub, baby's head was huge = no tear

Baby #3: OK diet, pushed 1 hour in and out of tub, baby's head was huge = no tear

[dianna11]

Originally Posted by Shanana

Oh yeah, I forgot all about dd's nuchal hand . I'm sure that didn't help things either.



I was in excruciating pain after birth even though, like you, I pushed only a short period of time (and also tore). My doula brought me an herbal bath that I started using about 3 days post-partum. WOW!!!! is all I have to say. I did it three days in a row ... after the first bath, the pain was reduced by at least 75%. But the third day, it was gone. Totally gone! I couldn't believe it! You better believe I won't be waiting three days to get into one of those baths this time around . I highly recommend them. Can't guarantee everyone will have the same experience, but it sure helped me tremendously.

What was in this fabulous herbal bath?!?! I would love to try something like that, my tear was so painful for ages!

[Shanana]

Here's a current thread about herbal baths, and I list the ingredients there. Unfortunately, it's only available locally, and I don't know the proportions, although I imagine you could just do equal parts of the herbs and figure something out. You can also buy them online -- several are mentioned on that thread. I also know that Earth Mama Angel Baby sells one too, although if I recall correctly, the ingredients were very different from mine.

Good luck!

[erin_brycesmom]

Please read this article - http://www.midwiferytoday.com/articles/honoring.asp This MW is right on .

[dianna11]

Originally Posted by erin_brycesmom

Please read this article - http://www.midwiferytoday.com/articles/honoring.asp This MW is right on .

...right, so that pretty much explains how what I did should prevent tearing - yet I tore. Hence my question

Great article though