Tearing, squatting, epidural, time to push.... How to make things better - Mothering Forums
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#1 of 22 Old 10-19-2011, 04:52 AM - Thread Starter
 
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My first pregnancy I had too much pain, unbelievable. The best thing (at least I thought so) that happened to me was to get an epidural (I can only remember the relieve). So I fell asleep (first time in 30hs) and they woke me up to say I was 10cm already and should start pushing... Now that I think of it, she was not crowning yet (I could not see her at all), but I was 10 cm... I pushed for 45 min. Took an eternity for her head to get out... And finally she came.

I got a 4th degree tearing, and 13 stitches... TWICE, because after stitching once, midwife realized there was something there yet... re-opened, cleaned, re-stitch. Didn't feel stitching (because of epidural), but recovery was tough... And I still have some incontinence. I even gave up my aerobic classes because every time I jump, I pee... Have done kegels but not much results... getting better, but still no impact classes for me...

Now my daughter is 19mo and I am expecting in January.

I have started to wonder how things went "wrong". After reading many many articles, anedoctals, I have a few theories, but no conclusion...

Theory one: epidural made all complicated because I pushed without feeling (at all), probably pushed too early, too soon...or too much at once...

Theory two: we should have waited for her to crown before pushing... And not only start because I had gotten to 10 cms... Most people who had easy deliveries waited until their babies were crowning already. Maybe that would've helped

Theory 3: I should have done squatting vs kegels to help strength or done more kegels...

 

Truth is.. I don't know. All I know is that I dont want to tear that bad again, I want to have bladder control, I have no idea if epidural made worse or not (and can I handle it without one?)... And no idea when is the right time to push...

 

Any ideas????

 

 

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#2 of 22 Old 10-19-2011, 06:30 AM
 
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Did your midwife do perineal massage while you were pushing?  That can swell the tissues and make eventual tearing worse.  

 

Did they instruct you to pant and slow down your pushing while the baby was crowning?

 

Was the baby coming out face-up? (posterior)

 

Even women who deliver via cesarean can experience incontinence post-pregnancy.  The baby itself puts a lot of pressure on your pelvic floor.  And the odds of you tearing that badly again are low.  However I would be doing everything in my power to lessen the likelihood, too, like not getting an epidural so that you can feel what your body is saying to you while you push - only push when you have the urge - slow down during crowning - apply your own counterpressure where it feels good rather than letting anyone else "help", etc.

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#3 of 22 Old 10-19-2011, 07:47 AM
 
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Also, don't push on your back... Gravity helps the baby's head to gently and naturally stretch you open, vs. forced stretching if you have to actually push against gravity.


Happy housewife and mom to big Z, born at home 1/2012. m/c 07/14 @ 5w and happy to get back to trying!  
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#4 of 22 Old 10-19-2011, 07:52 AM
 
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Originally Posted by montessorimama1 View Post

Also, don't push on your back... Gravity helps the baby's head to gently and naturally stretch you open, vs. forced stretching if you have to actually push against gravity.


Due Date club crashing to say, yes on the gravity! My last child came out in three pushes.. I was standing up... no tears.
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#5 of 22 Old 10-19-2011, 08:10 AM
 
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Our natural childbirth class teacher was just talking about this last night - one of her recommendations is to change positions while pushing, every 15-30 minutes. Hands and knees, upright, on your back, on your side. Changing it up changes where the baby's head puts pressure on your tissues, helping to stretch everything evenly.


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#6 of 22 Old 10-19-2011, 09:09 AM
 
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I'll just briefly recap my two experiences - both natural, both in four pushes (basically, both kids shot out of me) in which I was sitting up in a hospital bed so semi-reclined, both had very bad tearing (worse with my second).

 

I don't think an epidural was *responsible* for what happened, but I think there was a lot of things happening that might have not helped the situation.  Coached pushing (when you can't feel your body tell you when to push, but others are telling you to do it), being on your back, having a kid not fully engaged (and, seriously, being 10 cm isn't the end all, be all to getting a kid out - they have to be DOWN there to come out), etc

 

I will say, after my first tear I was TERRIFIED of it happening again because it sucked.  Recovery sucked.  Sex sucked.  Etc.  And my second kid's birth caused much more damage with greater problems.  Earlier in this pregnancy I felt like my uterus was falling out of me and that my kid was just going to come out Monty Python style (there's a thread about it in this forum)...turns out my pelvic floor was just really, really weak.  That might be what's going on with you.  I've always been in (good enough) shape, but added squats to my daily habits and dropped kegels altogether.  I figure - why keep doing something that isn't working?  Kegels weren't helping so screw 'em...I have enough to think about in a day.

 

As for the pain of the first.  I was well read and completely comfortable with going natural, but was so unprepared for how that 'ring of fire' would actually feel.  It blew me away because I didn't know what it would FEEL like...I just had an idea from others and from reading.   With my second there was no 'fire' so that pain aspect was just, well, different.

 

You mentioned if you "can do it" without an epidural.  Sure.  You CAN.  But you can also go as far as you want and then request one.  If it gets to the point that you feel as if you want one you can always ask.  I don't have experience with this, but I'm guessing that if you're medicated with an epidural you're also on non-stop fetal monitoring (please correct me if I'm wrong) so you might just tell them that you only want to push at contractions so your body is working more efficiently.


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#7 of 22 Old 10-19-2011, 09:11 AM
 
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Quote:
Originally Posted by futuremamaheather View Post

Our natural childbirth class teacher was just talking about this last night - one of her recommendations is to change positions while pushing, every 15-30 minutes. Hands and knees, upright, on your back, on your side. Changing it up changes where the baby's head puts pressure on your tissues, helping to stretch everything evenly.

That's interesting to me as both kids came out so quickly that there was barely enough time to get in *A* position before there was a babe on my chest.  Your post is making me wonder what the average "push time" is for mothers.


 

 


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#8 of 22 Old 10-19-2011, 09:34 AM
 
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Originally Posted by AfricanQueen99 View Post

That's interesting to me as both kids came out so quickly that there was barely enough time to get in *A* position before there was a babe on my chest.  Your post is making me wonder what the average "push time" is for mothers.

 

 



Well, I pushed for 6 hours of our labor, but now that I've read more I'll probably wait longer this time to start.  I did have the urge to push, and I was really dilated, but it sounds like I may have wasted a lot of effort in the beginning.  I was just reading some similar items in the November DDC (yes, I lurk other places sometimes).  My cousin practically had her two children in the lobby of the birth center they came so fast, but that wasn't our experience at all.  My son turned his head right at a bad point and we ended up with a vacuum assisted birth.  I was instructed to push hard on the next contraction and then keep pushing as hard as I could even if the contraction ended.  I had a 3rd degree tear.  Now first time ladies--don't fear!  A third degree tear sounds awful--45 minutes of stitches--but really wasn't all that painful and healed right up nice as can be.  Only a doctor would even notice any scarring and only if they were looking for it.  It was uncomfortable for sure, and I spent a few days with some fairly intimate ice packs blush.gif and a bit of lydocain cream, but wasn't nearly as scary as it sounds.  (Lets be real though, it sucks, try to avoid it if you can.)

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#9 of 22 Old 10-19-2011, 10:23 AM
 
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I just wanted to chime in and say that you might have torn no matter what, so don't beat yourself up too much.  I had a "perfect" uninterrupted water birth with my daughter.  I was well supported by my midwives and husband, fully aware and I decided when to push and how to position myself.  I still ended up tearing a ton. 

 

I've talked to my midwife about it and she's going to offer more counter pressure and try and help me not tear.  That said, I don't blame my other midwives because they let me do exactly what I wanted, and I still tore.  I think sometimes babies just come fast. . .


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#10 of 22 Old 10-19-2011, 11:05 AM
 
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Here's are my experiences in a nutshell: 

 

Baby #1, hospital birth, epidural at 8cm, pushed while numb for 20 minutes on my back and tore all the way through (4th degree). Horrible recovery--super sore down there for a long time!!!

 

Baby #2 (6 years later), homebirth (half the time spent in the water), stood up in a partial squat while pushing. Pushed for 20 minutes. 1st degree tear---much better recovery

 

Baby #3 (1 year later), homebirth (half the time spent in the water), pushed on all fours for about 30 minutes. Skid-marks--one stitch which wasn't totally necessary but I went ahead with it---much better recovery

 

 

Here's my theory based on my experiences.... I couldn't feel a darn thing with the epidural so when dd#1 crowned, I didn't follow the natural instinct to ease her out in that last push. I pushed her so hard and so fast, on my back and holding my breath....all which go against nature. When nature took its course, I naturally eased baby #2 & #3 out slowly upon crowning and never really held my breath. My body knew just what to do. I never "pushed"...my body just pushed them out!  


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#11 of 22 Old 10-20-2011, 07:37 PM
 
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I've only ever heard of one or 2 birth stories where women didn't push until crowning. It's really rare for the baby to be that close to being out before pushing. On the other hand being "10" isn't a good reason to push either. Some places encourage mothers with epidurals to "labour down" for a couple hours before pushing after hitting the magic '10'. It seems to make a huge difference, especially if they lower the epidural.

 

45 minutes is perfectly good amount of time to be pushing. Your body & baby were obviously ready. I pushed 15 hours with ds2 (not continuously & after several hours we discovered he was stuck, so some of that was getting him unstuck & some was due to ineffective pushing because I was wiped) & about 25-30 minutes with ds3. I never got a pushing urge, just increasingly painful contractions which were only relieved by pushing.

 

I didn't tear with either of them. I believe mostly because I could feel what I was doing & when I felt the ring of fire, I very consciously stopped pushing until the next contraction. I'm not going to lie, 'uncomfortable' doesn't cover it, but it was worth it to me to give myself lots of time to stretch naturally instead of tearing.

 

Even if you do have an epidural, allowing it to wear off before pushing or labouring down and having someone let you know when you're crowning so you can stop pushing to allow stretching can definitely help decrease tearing.

 


mom to all boys B: 08/01ribboncesarean.gif,  C: 07/05 uc.jpg, N: 03/09 uc.jpg, M: 01/12 uc.jpg and far too many lost onesintactlact.gifsaynovax.gif

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#12 of 22 Old 10-21-2011, 11:54 AM
 
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I, too, ended up with an epi (I was already stuck in bed since my water had broke), and on my back. I also had to push harder/faster due to DS being in distress (or at least they were yelling at me to not stop pushing). It wasn't a natural thing (even though the epi was wearing off), and I tore. I'm in the same boat w/ hoping, praying and preparing for a much different experience this time. If you have a chance (and like to read), I've been reading Ina Mae (?May) Gaskin's Guide to Childbirth. It's been a real eye opener (for me) about birth. I was prepared from the medical side of things (I have a medical background), but it puts labor and delivery in a whole new light and has really helped me understand things... I really wish I had read it before DS1!


aj- married to JA and mami to Bug (11/09) and Critter (1/12)!

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#13 of 22 Old 10-21-2011, 04:07 PM
 
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Curious why you would be stuck in bed just because your water broke? Even when I went to the hospital with ds1, they sent me to walk around to try to get contractions started. And staying home with ds2, I was doing laundry. Think I even went grocery shopping after my water broke with ds3.

 


mom to all boys B: 08/01ribboncesarean.gif,  C: 07/05 uc.jpg, N: 03/09 uc.jpg, M: 01/12 uc.jpg and far too many lost onesintactlact.gifsaynovax.gif

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#14 of 22 Old 10-21-2011, 06:28 PM
 
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some hospitals have ridiculous rules, like you can't get out of bed once your water is broken because of "the risk of cord prolapse" 

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#15 of 22 Old 10-22-2011, 05:34 AM - Thread Starter
 
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I was also told that once water is broken you cant do anything else, because of risk of infection.

Actually, question... I was told I couldn't take a shower or bath for the pain (my room had an awesome jacuzzi) because my water broke and baby would get infected.

How does that go in tub delivery then?

Didn't make sense for me.

In the end, pain got unbearable, I could do nothing else than bite the rag I was biting, and ended up with an epidural. wonder now if that jacuzzy would have helped or not.


What are other pain relieve options other than epidural (to at least alleviate a little)???

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#16 of 22 Old 10-22-2011, 07:30 AM
 
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I would totally recommend reading the birth stories on here.... both hospital and home birth. There is alot of info on there. Go back in the archives.... there are alot of great natural birthing stories on here that could encourage you.


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#17 of 22 Old 10-22-2011, 07:42 AM
 
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Originally Posted by sandykassia View Post

In the end, pain got unbearable, I could do nothing else than bite the rag I was biting, and ended up with an epidural. wonder now if that jacuzzy would have helped or not.

What are other pain relieve options other than epidural (to at least alleviate a little)???


Even if you can't go into the water (which seems ridiculous, since many women labor and deliver in water after their water breaks), you can refuse the monitor and IV so that you can be mobile (research shows that birthing outcomes DO NOT improve with the use of the monitor, and it can actually lead to false readings of distress that might have you ending up with a c-section).  Laboring in different positions is very helpful for managing pain.  I agree with the previous poster: read natural birth stories, learn more about your options... now, before you're back in the same situation.

 


Happy housewife and mom to big Z, born at home 1/2012. m/c 07/14 @ 5w and happy to get back to trying!  
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#18 of 22 Old 10-22-2011, 03:05 PM
 
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I think the best thing to do for managing pain is just move and get through it.  I had excruciating back labor with my daughter and absolutely would have had an epi had I been in the hospital.  It hurt like h3ll.  I moved around a lot and DH offered counter pressure, but it was just something I had to get through because there weren't other options- I was having a baby, there weren't any drugs, and I needed to just get it done.  I'm not sure if that makes sense. 

 

Once she turned and my water broke and the back labor stopped, it was a breeze and hot water from the tub was wonderful. 


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#19 of 22 Old 10-22-2011, 05:25 PM
 
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 It used to be standard advice not to have a bath after your water broke because it was believed the bath water would enter the vagina & cause infection (have no idea why showers would be included in that). Actual research has shown this belief to be completely wrong, but the advice still persists.

 

Moving is great for helping with pain & helping baby get into a better position. Most breathing techniques are basically just ways to distract you, which can work for awhile. A lot of women swear by hypnosis. I used Hypnobabies a little bit in my last labour and it did seem to help, but I wasn't listening to it during labour & when things got hard, I didn't even thing to use it.

 

I spent a lot of time in the shower. Which sadly isn't going to be an option this time since we moved & don't have unlimited hot water anymore.


mom to all boys B: 08/01ribboncesarean.gif,  C: 07/05 uc.jpg, N: 03/09 uc.jpg, M: 01/12 uc.jpg and far too many lost onesintactlact.gifsaynovax.gif

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Quote:
Originally Posted by Devaskyla View Post

Curious why you would be stuck in bed just because your water broke? Even when I went to the hospital with ds1, they sent me to walk around to try to get contractions started. And staying home with ds2, I was doing laundry. Think I even went grocery shopping after my water broke with ds3.

 



They said it was hospital policy, but in my trying to get checked in and deal w/ the cntrxns I didn't think to ask why :( I'm going to a different hospital (that allows mobilty after your water breaks this time. If I had known it was a "rule" there, I would have stayed at home much longer. There was alot I didn't think to ask about their rules b/c it didn't occur to me that they would have them...


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#21 of 22 Old 10-24-2011, 06:33 AM
 
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Even if you end up on the monitors for some reason, you still can (and should!) remain mobile if at all possible.  Here's a great gallery of women laboring on monitors.  Also some hospitals offer telemetry monitoring which is wireless, so you can go even further :)

 

http://www.icanofatlanta.com/?page_id=159

 


Christine, mom to C(7.5) - E(5) - J(3) - B(10 mos)

Doula, childbirth educator, Co-leader of ICAN of Atlanta

 

"Never miss an opportunity to make others happy, even if you have to leave them alone in order to do it." ~Anonymous

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#22 of 22 Old 10-24-2011, 06:54 AM
 
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Originally Posted by sandykassia View Post
What are other pain relieve options other than epidural (to at least alleviate a little)???

I found that I needed two completely different approaches for both my kids.  My daughter's labor was fine (12 hours from first contraction to her on my chest) and I was able to "ramp" up as needed - when I got to transition/discomfort I *needed* to focus.  Ironically, my "focus" was on the second airing of Conan's show...and I can't stand Conan, but staring at him allowed me to think over the pain.  My son's labor was much more furious (3 hours from first contraction to him on my chest) and I basically blew through all ten centimeters quickly.  The ONLY thing that worked was sitting on the toilet.  And it had to be the toilet and not a chair so I just had perimeter support - plus, my bowels massively cleared themselves over the course of these hours so being naked in the bathroom was the best bet.  Even when we got to the hospital I went straight to the toilet...my water broke there and my body immediately started pushing.  I called out to my husband and the nurse (who hadn't even had time to learn my name or introduce herself as I walked straight in and shut the bathroom door) to let them know the pushes started and she literally yanked me off the toilet.  I *did* try focus to work through the pain for my son's birth, but it just wasn't working.

 

For what it's worth, during the course of 15 hours of laboring I've tried walking, squatting, birth balls, water, etc and the ONLY things that worked for me are listed above.  So, in my opinion, you have to have a bunch of tools in your back pocket and be willing to throw them out if they aren't helping.
 

 


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