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pushing and tearing question

1K views 29 replies 26 participants last post by  ColwynsMommy 
#1 ·
OK, as a follow-up to the length of labor thread.... those of you who had short pushing stages, did you tear? I labored with dd for 9 hours and pushed for 1 hour, with only a minor first degree tear that didn't require stitching. I've heard that those blessed with "three pushes and she's out!" may have more tearing. True or false?
 
#3 ·
With my last I did the three pushes and he was mostly out, had to stop becuase the cord was wrapped around his neck twice, but I tore in 4 places and only needed 1 stitch in 3 tears and 2 stitches in one. However I had an episiotomy with my first and the little tears in comparison were NOTHING to the espisiotomy, which I will definately refuse again! The tears are just enough, where as they usually cut more than necessary.
Donna
 
#4 ·
I think tearing has more to do with forced pushing or not, positioning and the knowledge of the mother/care provider about natural 2nd stage.

I've had two babes and no tears ever. Never even needed a Peri bottle to pee. My son was my first and he was posterior (never did turn) with his hand up when I pushed him out. He wasn't huge, but his positioning has often been cited by others for the reason for their tears. He was a little over 7 lbs. My daughter was perfectly positioned and 7 1/2 lbs. Again, I don't have huge babies, but I do konw of many women that birth really big babies with no tears.

Pamamidwife has some really gigantic 12-14lbrs girls and boys she's helped out. And, as I recall no tears from them. That's why I say I think it has more to do about knowlege and letting the body push naturally than about time or size or position.
 
#8 ·
Quote:

Originally Posted by Spark
I think tearing has more to do with forced pushing or not, positioning and the knowledge of the mother/care provider about natural 2nd stage.
ITA. If a mom isn't laying or sitting on her tailbone (which reduces the pelvic outlet by 30%), isn't doing directed pushing, being told how to push, how long to push for, etc., and if she follows what her body tells her, she minimizes her chances of tearing, no matter how long she pushes for. My first baby was with an epi in a semi-upright position, I pushed for 45 mn. Tear that required three stitches. Second baby, unmedicated birth, pushed in the position I chose and pushed only when I had no choice but to listen, baby was out in five pushes, no tearing at all.
 
#10 ·
My shortest pushing time was the one with no tears. It was a water birth and I actually didn't actively push. I just tried to help her out by going with the contractions and involuntary pushes. When I consciously pushed, it hurt. Plus, I had a major tear with my first and was scared to push.
There is an article somewhere on line that says "don't push the river" and it's about not needing to push.
I think that pushing is more likely to cause tearing when it's done before the body is ready or directed by someone else.
 
#12 ·
Ditto to everything that was said about tearing being more related to listening to your body versus directed pushing.

I've never done perineal massage but I think that it probably does help out some too.

DS#1 I felt my labor was taking too long, at nine cm I decided I was ready to push though I had no urge to I was just ready for the whole ordeal to be over with. I had no feeling, numb from epidural, MW's directed me. I had a 3rd degree tear, had to have surgery to repair all the tears in vaginal wall, plus a transfusion. Definitely not the first labor I expected, but I blame that on the epidural, oh I also pushed almost flat on my back.

With DS#2 unmedicated I had strong urges, pushed with my body although I pretty sure I held back some cause of fear from 1st labor. DS was posterior and I had one minor tear, Mw said that I probably wouldn't have torn otherwise.

I guess the best advice is to listen to and trust your body.
 
#13 ·
I tore a lot more with my second than with my first. I ended up needing about 10 stitches, I think. I only pushed for 20 minutes, and I could have let it go a lot more easily, but once I realized she was coming and I could feel the pressure, I really did try to push her out as quickly as I could. I had this idea of just breathing through it all and letting my body do the pushing without the conscious attempts at pushing, but once I got past a certain point, I gave up on that.

I could feel this bearing down happening in my body, but I wasn't trying to push. I mentioned it to my doula and midwife. At that point I hadn't had a cervical check. I got up and went back into the shower, and when I came back to the bed, my midwife checked me and said I was fully dialated and could push. Well, those first two contractions hurt worse than the ones where I wasn't trying to push, but once I felt the head moving, I really decided to concentrate on the bearing down to help with the pain. I was on my side, then moved to my hands and knees. Her shoulders got wedged in there and the midwife and to put her hand in there and help her out. I think the tearing happened sometime in there.

I still feel kind of inadequate about the fact that I tore, isn't that funny. Like if I had done it right, I wouldn't have torn. But she was a big baby with a good sized head, it was fast, I didn't get to do it in the water, and the midwife had to help get her shoulders unstuck, so I figure all that contributed to it. I healed pretty quickly and am happy with the way things turned out.
 
#15 ·
Pushed for an hour and a half, had a "lacerated labia," and a couple stitches. Was using a squat bar at the end of the bed. I really felt a need to push hard and get the baby out...that was my instinct, misguided or not, so I have no idea if I "caused" the tear, of if I would've no matter what. Baby was average size.
 
#16 ·
I pushed for 1.5 hours with my dd and had a episiotomy, and required 9 stitches. With my second dd, she was out in like 5 minutes, was 12 oz bigger then my first, and I had no tearing at all. With her I let my body do the work, I didn't actively try to push her out until the last one because I was trying to push through the "ring of fire".
 
#17 ·
It's hard to say with my first, I pushed for over two, maybe close to three hours, I didn't tear but then was cut so my doctor could use his vacuum. I don't know what would have happenned if I had been left alone. If they didn't make me get the epidural I don't know if I would have pushed that long, I also don't know if I would have tore if he hadn't cut me. I swear all those interventions cloud everything.

I pushed 15-20 minutes with my second birth and didn't tear at all.

I've never done any of the perineal massage stuff. For some reason I just don't buy it that is helps. I just don't think our bodies are meant to be fiddled with and stretched during pregnancy inorder to be effective.

I too think that the tearing is in most cases more related to the forced stuff. People telling mom how to push, when to push, how long to push, plus the lithomy and related positions. I hear way less tearing stories from people who followed their own bodies' lead.
 
#18 ·
I'm really not sure, but I think I pushed somewhere between 45 min and 1 hour, and I had a big tear. I was in the water, and apparently the midwives said that was more common in the water because they had less control over the baby coming out.
 
#19 ·
In my case, listening to my body is what contributed to my tearing, so I don't necessarily believe directed pushing is to blame for tearing. There are some good doctors & nurses out there who do know what to do.

I had an epidural and still had a tremendous urge to push starting at about 7 cm. I didn't consciously push until I was given the "okay" but I could feel my body pushing on its own. When I was fully dilated, I pushed once (as long and as hard as I wanted) with the nurse there, she told me to stop and ran to get the doctor. Luckily I wasn't contracting while she was out of the room so didn't feel the urge anyways. During the second contraction, I pushed again with the doctor there.. just letting my body do what it wanted - which was to push. The doctor left the room for a second in between that contraction and the next, and I started pushing before she got back. The nurse was telling me that I had to stop or I would tear, that I needed to give myself time to stretch, but there was no way I could stop my body from pushing. The doctor barely made it in time, and ended up catching the baby barehanded. I did tear upwards and I believe there were some "skidmarks" inside.. I don't remember how many stitches were required.

In my case, I let my body push whenever it wanted rather than stopping to let myself stretch. I did try to stop, but it was almost like having a really bad case of diarrhea, and being already on the toilet, and trying not to go. I know that's graphic, but there really was just no way for me to stop the baby from coming out. I was aware for (and felt) the whole thing, but it was almost like my body was doing all the work and I couldn't've controlled it if I'd wanted to. The tear wasn't horrible to deal with, but I think that if I had been able to follow the nurse's instructions to not push, I could've gotten away either without any tears, or with a smaller one.

All that said, I loved the birth and the only thing I would have changed was to slow the delivery down a bit.. not so I wouldn't tear, but so I would have more time to mentally process what was going on.
 
#20 ·
My first son was a section and I pushed for an hour in a half, then doctor said he was too big for my body. He was 9lbs11oz. That was 1995

My second son was a homebirth, and I pushed an hour in a half again, with one small tear straight to the back, and a skid mark. The skid hurt more than the tear, but it was so bad. I never did get stitches and I feel fine. He was 9lbs13oz. That was 2004

My third son was a homebirth, and I pushed about one hour, I HATE PUSHING! I didnt tear and no skid marks. YEAH!!! He was 10lbs10oz. That was 2005

I am pregnant again due in Jan. 2006.

So with all my babies even my section I went with my body and pushed. I dont know, all women are different. Both my homebirths were laying on my left side while dh held up my leg, I guess that helps to open up my pelvis, because with my section I never felt him moving down at all, and I of course was flat on my back, legs up in whatever those things are called, and being told when I could push and not to push because I was 10cm.

I hope this next time I dont tear. And I am praying its a shorter push time, truly I hate pushing!!! Worse part of the whole thing.
 
#22 ·
Rachel, I think the epidural might have made it so your body had a more difficult time guiding the baby out due to lack of sensation. My best friend had 5 children with no tears or epidural. She had an epidural and tear with #6. The doc wasn't in the room so she tried not to push but the baby came right out as the doc arrived.
 
#24 ·
Quote:

Originally Posted by lizabird
I'm really not sure, but I think I pushed somewhere between 45 min and 1 hour, and I had a big tear. I was in the water, and apparently the midwives said that was more common in the water because they had less control over the baby coming out.
I always heard tears are less common in waterbirths because there is less interference by other people trying to manage the pushing and because the water gives a bit of gentle, firm, equal, perineal support. I don't have references or anyting, it's just something I remember hearing on more than a few occasions so it might be totally wrong.

To the midwives, is this true? Are tears more common in waterbirths?
 
#25 ·
To the OP, for me this was true. But I only know one side of it, since both my babies were born quickly. With my first, she was out in 3 pushes. I tore all the way down and required many stitches. With my second dd I only pushed twice, and I still tore all the way down requiring stitches.

I have no idea if I would tear during a slower birth or not, but I imagine I would. I even tear slightly during intercourse.
Makes it such a fun happy thing to do!!
:
 
#26 ·
With all 3 babies, I pushed for 10 min. or less. #1 was a hospital birth--I was semi-reclined, and had two tiny tears, one stitch each--and ds was only 3 lbs, 5 oz.

DD1--home waterbirth. Pushed around 10 minutes, I think. I had no tears, but a skid mark, which made for more painful healing/peeing than with my first. I think I pushed a little harder than I needed to. Once her head was out the rest of her just shot out, and I think that's what caused the skid. She weighed 5 lbs. 11 oz

DD2--home waterbith. The midwives never checked my dilation after they did so once when they arrived, when I was at 7 cm. THey just told me to trust my body. I didn't have a huge urge to push, and didn't actually know at what point I was fully dilated. My water broke with my first little experienmental push. I felt inside and her head was right there. I think I pushed a couple more times to get her head out, let myself stretch a bit, pushed her body halfway out, stretched a bit more, then pushed the rest of her out. I was squatting in the water. Total pushing time was 3-4 minutes.No tears, no skids, no healing needed, no pain with peeing. She weighed 6 lbs. even.
 
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