Lets talk about tearing

[wbg]

I keep wanting to post about this. I have had four beautiful vaginal births, but despite my best efforts I always tear and end up with stitches. Don't get me wrong. I am not upset or grieving that one aspect of my birth. I am just so curious. I keep reading about all these babies being born without any tearing.
My first baby was born with the "help" of an epidural! I tore when his shoulders came out after my very inefficient, epi-pushing!
My second baby flew out of me so fast that I kind of understood the tearing. Seriously...she flew out ! My third was a very short labour, but a very peaceful pushing stage, with lots of support, and I tore pushing out the shoulder again. My fourth was a water birth and again, very calm with midwife supporting the perineum, but I still tore. This time I think when the hand came out alongside the head, but can not be certain. More stitches! I always massaged the area for the last few months with almond oil and tried to push calmly. My babies do come out fairly quickly and my pushing stage is very short. Seriously 3 to 6 pushes and out pops baby, one push for head and then another for body. They have all weighed between 7 and 8 pounds. So any thoughts? I just would love to have had one birth where I did not need an "intervention" even after the fact! The tears have all healed fine. I just wonder if there is a reason or something I missed? Any thoughts?:

[wombatclay]

Hugs mama!

There is a lot of mixed opinion on perineal massage during late pregnancy and perineal support during the birth. A lot of care providers now feel that staying very "hands off" is the best idea in terms of preventing or reducing tearing.

My VBAC OBs suggest perineal massage during the first two trimesters but nothing "extra" during the third trimester, and then only mama's hands on the perineum during the birth. And while they tell mamas to birth however feels right, they do suggest that "quick pushers" experiment with positions that allow for a slower delivery... the butt-in-the-air polar bear position for example. And that mamas with tearing histories and quick pushing avoid positions like the squat where the tissue is "extra stretched" and gravity is pulling the babe along with mama's serious pushes.

So maybe skip the massage, ask your care provider to be totally hands off, and consider moving into a different position when you feel the urge to push? And make sure your diet in later pregnancy is really well balanced and "tissue nurturing"? I wish I had more ideas... but I'm sure other mamas will have more!

Congrats on your little ones, and fingers crossed your next will come without tearing!

[pamamidwife]

I am wondering why we are still looking at tears as something that is wrong with the body.

When our bellies grow with our babies our skin stretches to accommodate the growth. Our vaginas naturally do this, too - and I believe that any outside support (hands on the mother's body that are not the mother's) is negative physiologically. Nobody's hands should be on the mother pulling or stretching or applying pressure to her vagina (though some women like rectal counterpressure) but her own!!!

Smaller tears are the body's way of allowing the skin to give so that there are not huge, catastrophic tears that will affect our reproductive and urogenital health.

I would venture to say that in most spontaneous (no lying on the back, no forced pushing, no stretching of the vaginal tissues by a provider) births, the tears that are present do not need to be sutured. They heal beautifully on their own.

A benefit of some tears at birth? Sure keeps us down with our baby for the first week postpartum. Something that most of us could use.

[kltroy]

Speaking as a biomechanics professor for a moment...
a tear will occur when the stress on the tissue exceeds the strength of the tissue. So some people will tear more because they genetically have less elastic tissues. Other people will tear because they have a stress concentration in some area (for example, if you had a nuchal arm and the elbow stuck out, etc). Also, since all biological tissues are viscoelastic (meaning they will act MORE elastic if they are stretched at lower rates) the rate of stretch affects tearing (ie a quick delivery may have more tearing). From my experience, I would say that simple biologic variation in the elasticity and strength of people's peritineal tissue is probably the biggest reason some women tear and others don't.

[wbg]

Thanks guys. I have to say, I only had someone support the perineum during my last birth. I had mentioned it to my MW as had read it was supposed to help. Have to say...I HATED it!! I think I managed to grunt out "no touching!" during it all, but MW reminded me that she was just trying to provide support. With the benefit of hindsight, I would definitely not do that again! My 3rd birth I tried to stand up to birth and then realised that that was a bad idea and delivered in a semi reclining position. Squatting or standing just seems too intense for me! So my body does seem to tell me what to do, but I think I am just someone who tears! It was very interesting to read your responses and I really appreciate you guys taking the time to post. With regards to the stitches. I guess I have always relied on my HCP to advise whether they needed suturing or not. But I guess you are right...any excuse to bed down with bub is a good one!

[tinyshoes]

Originally Posted by wbg

I think I am just someone who tears!

I think I am, too.

For years I have appricated Pam's opinions about tearing and "who's in charge of the perineum" during a birth. Her experience with the matter, combined with my own experinces and reading shaped my plans for my recent birth.

I was a bit surprised when my mw reported I had a 1st degree tear after this third baby--he was big, 14 1/4 inch head (vs. my other babies' 13 inch heads), but he was perfectly positioned (Gail Tully of Spinningbabies.com was one of my mws!) and my "pushing" stage was 90 min-2 hours, and I breathed this baby out, INTO my hands, slowly.

And I tore.

:

I ate all the proper stuff, I got lucky (no nuchal hands or elbows in the way!), I had a superlong pushing stage, and then, my "little tear" was going to 'heal itself shut.'

But it did not close--the skin is now different. I'm almost over it, esp since DTD feels the same, but I guess I'd like to think that if everything "goes right" then a tear will not result. I'm gunna keep this quote from Pam in mind:

Smaller tears are the body's way of allowing the skin to give so that there are not huge, catastrophic tears that will affect our reproductive and urogenital health.