Super short perineum Yikes!!! C-section?? - Mothering Forums

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#1 of 34 Old 01-22-2012, 05:54 PM - Thread Starter
 
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HI guys,

    I am freaking out just a bit. My husband and I are going to start trying to get pregnant soon and I am deathly afraid of having a 3rd or 4th degree tear. I just really dont want any permanent dysfunction. I have a very very short perineum <1.5 cm yes cm not inches and I am wondering if anybody has had any experience with this and can offer any insite or advise??? HELP !

Thanks guys!

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#2 of 34 Old 01-22-2012, 08:01 PM
 
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I've never heard of anyone even knowing their perineal measurement (I sure have no idea how long or short mine is!), but I'm pretty sure that length has nothing to do with whether or not you tear. There are things you can do to protect your perineum during birth: pushing carefully once baby is crowning; birthing upright, not on your back; having a waterbirth (the warmth and support of the water supposedly help the tissues stretch); having good perineal support from your birth attendant (I'd recommend a MW for this, as for everything, rather than an OB)... And then I think a lot of it, if you've got an ideal birthing environment (see above), is just luck. Perineal massage is something people do ahead of labor, but I don't know whether there's evidence that it actually helps.

 

In short: I wouldn't worry about your perineal length! Welcome to MDC and enjoy trying to conceive!


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#3 of 34 Old 01-22-2012, 08:29 PM
 
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I've never heard of anyone knowing the length of their perineum... I know mine is short only because my OB commented on it.  Less than 5% of women will experience a third or fourth degree tear so I wouldn't get worried about it.  I've had two third degree tears.  They sucked but I'm 8 weeks post partum with my second baby and doing fine.  Most people are.   It is true that a short perineum can make it more likely to have a third or fourth degree tear but there are lots of things to do to prevent it.  Had I known that with my first I doubt I'd have torn as badly... There will be a million things to worry about in pregnancy.  I wouldn't get too focused on this.  Good luck

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#4 of 34 Old 01-23-2012, 02:36 PM - Thread Starter
 
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Thanks for the feedback guys. I am well aware  that people do not measure their perineum and it is something most people do not even think about. Thing is if yours was really really short you would definately be aware of it , because for instance the distance btw my 2 openings is about a finger nail width wide.... noooo room for any tear or it will be a sphincter tear! I'm assuming this is pretty uncommon. But I apprectiate the replies!

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#5 of 34 Old 01-23-2012, 03:02 PM
 
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I have a shorter peri than you do and didn't tear with any of my 10lbers.


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#6 of 34 Old 01-23-2012, 03:05 PM
 
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If I had to choose between a 1mm tear on my perinuem and a foot long gash on my stomach, I know what I'd choose.  But then again, I'm just a wee bit bitter.  :)

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#7 of 34 Old 01-23-2012, 03:19 PM - Thread Starter
 
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Thats fantistic mystic! Thanks so much! Its not the actual perineum tear that I care about.. I dont want to have problems with moving my bowels for the rest of my life.  Im not worried about pain or scaring I just dont want any permanent dysfunction.

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#8 of 34 Old 01-24-2012, 12:28 PM
 
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Hey! I don't have any personal experience with short perineum, but I definitely understand that it might worry you.  I would not want to go through a whole pregnancy and birth carrying that kind of fear- that would be miserable. I would find a midwife or doctor who would be VERY VERY UNLIKELY to cut an episiotomy. I am not aware of any support for the idea that birthing in a squatting position makes you less likely to tear. The research I have seen has the lowest rate of perineal trauma among women pushing in a side-lying position, and birthing the head slowly, between contractions. 

 

Your care provider will actually be able to SEE your anatomy, and will be the one making suggestions at the birth, so I would really look carefully for the right person, who will hear your fears and talk to you about them. I have never heard of someone having a planned c-section due to a short perineum, but if, say, it came down to using forceps or a vacuum (not that that is likely, just speaking hypothetically), you might go with a c/s versus those options, since they are strongly associated with 3rd and 4th degree tears.

 

Hope this helped  :)

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#9 of 34 Old 01-24-2012, 12:35 PM - Thread Starter
 
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That actually helps a lot! Thanks.so.much.Katie smile.gif
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Originally Posted by blessedwithboys View Post

If I had to choose between a 1mm tear on my perinuem and a foot long gash on my stomach, I know what I'd choose.  But then again, I'm just a wee bit bitter.  :)

You know that is sort of rude to those who have experienced third and fourth degree tears. My second tear was fine...first not so much but I don't want to scare op because all turned out fine.  However my recovery was much much longer than it would have been with a cesarean.  It isn't about the length of the tear itself...when the muscle tears you can end up with incontinence.  I'd rather have a c than poop on myself for the rest of my life. Just sayin... Also very rude to minimize saying a 1mm tear.  I required a full hour of stitching with my first.  I know someone who tore so badly it took 3 hours in an OR to repair... Fear not, OP... That's probably as likely as being struck by lightening. 
 

 

 

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#11 of 34 Old 01-24-2012, 02:04 PM - Thread Starter
 
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Well put toddlermama! I actually have a medical background and have prob seen too much which is y I'm worried. I ve done enough pelvic exams to realize that my anatomy is way off. And I also have dealt with enough pts who have had rectal surgery to know the risk that come along with a sphincter tear. I am well aware this is not the place to come for medical advice and I do plan on having a serious screening process for my ob ...I was just wondering if anyone out there had a similar issue :)

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#12 of 34 Old 01-24-2012, 02:06 PM - Thread Starter
 
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Well put toddlermama! I actually have a medical background and have prob seen too much which is y I'm worried. I ve done enough pelvic exams to realize that my anatomy is way off. And I also have dealt with enough pts who have had rectal surgery to know the risk that come along with a sphincter tear. I am well aware this is not the place to come for medical advice and I do plan on having a serious screening process for my ob ...I was just wondering if anyone out there had a similar issue :)

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#13 of 34 Old 01-25-2012, 10:09 AM
 
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A short perineum does not automatically equal tearing. Even if you did tear it would be a quicker recovery and less long-term effects than an elective c-section.

 

Once pregnant there are ways to soften the perineum to aid in stretching. You can do perineal massage, which husbands tend to like helping once you have a hard time reaching past the belly. Using evening primrose capsules in the vagina overnight helps soften the perineum and the cervix, but should only be used in the last 4-6 weeks of pregnancy. Contrary to the rumor, evening primrose does not induce labor!

 

Avoiding coached or "purple pushing" helps ease baby out gently, allowing the perineum to stretch. Do not let your caregiver tell you when to push, how hard to push, or how long to push. This can rush baby out and actually causes unnecessary tearing. Just push when you feel the urge. Avoiding an epidural helps you feel when to push and eliminates the need to be told when. I had a natural birth and pushing felt good. You do not need an epidural for pushing.

 

Having a warm compress held against your perineum while pushing aids in softening and relaxing tissues.

 

When the baby begins to crown, stop pushing for a contraction or two. This allows the perineum to stretch slowly.

 

My best friend is a size zero with a short perineum. She birthed a 12lb 14oz baby with no drugs and no tearing. So, if she can do it, you have no worries. ;-)
 

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Originally Posted by pineapplehorse View Post

HI guys,

    I am freaking out just a bit. My husband and I are going to start trying to get pregnant soon and I am deathly afraid of having a 3rd or 4th degree tear. I just really dont want any permanent dysfunction. I have a very very short perineum <1.5 cm yes cm not inches and I am wondering if anybody has had any experience with this and can offer any insite or advise??? HELP !

Thanks guys!



 

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#14 of 34 Old 01-25-2012, 01:21 PM
 
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Even if you did tear it would be a quicker recovery and less long-term effects than an elective c-section.

 

You have no way of knowing that.

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#15 of 34 Old 01-25-2012, 03:35 PM
 
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Serious tears are VERY rare in births where mom follows her body's signals and needs, and where she's not told when or how long to push, "purple pushing", etc., and is not laying on her back. An out-of-hospital birth would definitely be your best bet for avoiding a tear; or, worse, an episiotomy, which is far more likely to result in a severe tear.


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Originally Posted by APToddlerMama View Post


 

You know that is sort of rude to those who have experienced third and fourth degree tears. My second tear was fine...first not so much but I don't want to scare op because all turned out fine.  However my recovery was much much longer than it would have been with a cesarean.  It isn't about the length of the tear itself...when the muscle tears you can end up with incontinence.  I'd rather have a c than poop on myself for the rest of my life. Just sayin... Also very rude to minimize saying a 1mm tear.  I required a full hour of stitching with my first.  I know someone who tore so badly it took 3 hours in an OR to repair... Fear not, OP... That's probably as likely as being struck by lightening. 
 

 

 



No offense was intended.  I meant to type 1cm, not 1mm, and that only bc the OP gave her perineal measurement.  Let's not get into a game of "my c-sec recovery was worse than your 4th degree tear".  You poop on yourself and I can't feel anything between my belly button and pubic bone.  I can't imagine the horrors you experienced, and you can't imagine mine.  But I can express my personal opinion.  Which is what I did.  So, nope, not rude at all.  :)

 

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#17 of 34 Old 01-26-2012, 11:13 AM
 
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No offense was intended.  I meant to type 1cm, not 1mm..... Let's not get into a game of "my c-sec recovery was worse than your 4th degree tear".  

 

Eye roll.  Really? Well thank you for being a fine upstanding member of mdc.  Pretty sure I was pointing out it is rude to minimize the experience of those with bad tears and was not saying a cesarean is a piece of cake. 

 

My tear was not 1 cm... Clearly you don't understand what a third or fourth degree tear entails. 
 

 

 

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Serious tears are VERY rare in births where mom follows her body's signals and needs, and where she's not told when or how long to push, "purple pushing", etc., and is not laying on her back. An out-of-hospital birth would definitely be your best bet for avoiding a tear; or, worse, an episiotomy, which is far more likely to result in a severe tear.



Well I think this could be a big consideration if mom chooses an epidural.  I think that's why she's asking ahead of time.  I don't think an out-of-hospital birth makes her less likely to tear in and of itself.  If she chooses vaginal birth, she may want to be in the hospital setting based on what she and her OB decide. 


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#19 of 34 Old 01-26-2012, 12:04 PM
 
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Originally Posted by blessedwithboys View Post

If I had to choose between a 1mm tear on my perinuem and a foot long gash on my stomach, I know what I'd choose.  But then again, I'm just a wee bit bitter.  :)


Wow, you must have had a seriously emergent c/s to have a one foot incision on your stomach because I know that mine is just a few inches long and is well hidden beneath my pubic hair.

Regardless, there is no way to know if recovery will be easier for a serious perineum tear than it would be for a c/s.
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Originally Posted by naturalbirthoff View Post

A short perineum does not automatically equal tearing. Even if you did tear it would be a quicker recovery and less long-term effects than an elective c-section.

 

Once pregnant there are ways to soften the perineum to aid in stretching. You can do perineal massage, which husbands tend to like helping once you have a hard time reaching past the belly. Using evening primrose capsules in the vagina overnight helps soften the perineum and the cervix, but should only be used in the last 4-6 weeks of pregnancy. Contrary to the rumor, evening primrose does not induce labor!

 

Avoiding coached or "purple pushing" helps ease baby out gently, allowing the perineum to stretch. Do not let your caregiver tell you when to push, how hard to push, or how long to push. This can rush baby out and actually causes unnecessary tearing. Just push when you feel the urge. Avoiding an epidural helps you feel when to push and eliminates the need to be told when. I had a natural birth and pushing felt good. You do not need an epidural for pushing.

 

Having a warm compress held against your perineum while pushing aids in softening and relaxing tissues.

 

When the baby begins to crown, stop pushing for a contraction or two. This allows the perineum to stretch slowly.

 

My best friend is a size zero with a short perineum. She birthed a 12lb 14oz baby with no drugs and no tearing. So, if she can do it, you have no worries. ;-)
 



 


I'm sorry but this is ridiculous.  So those of us who have torn have done something wrong since your size zero friend gave birth to a huge baby with no tears?  I had a posterior baby which was a huge reason I tore. And the vacuum which was necessary because after 2.5 hours baby's heart rate was decelerating.  Yes there are things to do to minimize risk of tearing, but you can do all those things and still tear or end up in a situation where you are choosing between greater risk of tearing and your baby's safety. 

 

And it is definitely not true that all tear recoveries are easier than c recoveries. 

 

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#21 of 34 Old 01-26-2012, 06:38 PM
 
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Originally Posted by APToddlerMama View Post



 


I'm sorry but this is ridiculous.  So those of us who have torn have done something wrong since your size zero friend gave birth to a huge baby with no tears?  I had a posterior baby which was a huge reason I tore. And the vacuum which was necessary because after 2.5 hours baby's heart rate was decelerating.  Yes there are things to do to minimize risk of tearing, but you can do all those things and still tear or end up in a situation where you are choosing between greater risk of tearing and your baby's safety. 

And it is definitely not true that all tear recoveries are easier than c recoveries. 

I agree! Absolutely ridiculous.
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#22 of 34 Old 01-26-2012, 07:33 PM
 
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OP, you might want to look into the Pink Kit. It is a birth preparation program which focuses on understanding your personal anatomy ( not just anatomy in general) and ways to maximize your pelvic space and tissue stretching.


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#23 of 34 Old 01-27-2012, 12:24 PM
 
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Wow, you must have had a seriously emergent c/s to have a one foot incision on your stomach because I know that mine is just a few inches long and is well hidden beneath my pubic hair.
Regardless, there is no way to know if recovery will be easier for a serious perineum tear than it would be for a c/s.



Sure, the first incision is low down, but then you build up scar tissue and the next one goes up two inches higher.  Which is why I stopped at 2 babies. 

 

I am not intentionally minimizing anyone else's experience by saying that I would prefer a 1cm tear to what I have endured for the last 17 yrs post-csec.  I am simply stating my feelings.  One could argue that griping about that is minimizing, couldn't one?

 


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I am not intentionally minimizing anyone else's experience by saying that I would prefer a 1cm tear to what I have endured for the last 17 yrs post-csec.  I am simply stating my feelings.  One could argue that griping about that is minimizing, couldn't one?

 


This thread is really not about you and your feelings. Your experience is not universal. How about you try to meet OP where she is?

 

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#25 of 34 Old 01-27-2012, 04:09 PM
 
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Well I think this could be a big consideration if mom chooses an epidural.  I think that's why she's asking ahead of time.  I don't think an out-of-hospital birth makes her less likely to tear in and of itself.  If she chooses vaginal birth, she may want to be in the hospital setting based on what she and her OB decide. 



Statistically speaking it is less likely that she would tear if birthing out of hospital because of the significant difference of care in MOST cases. 

That said, she can implement which things she does want (no purple pushing and epidural, or squatting and freestanding birth center - she can even do an epidural in hospital with assisted squatting! or turning it off at the very end) and decide what she IS okay with. And figure out HOW to get those things she wants. If she wants to go with a hospital and OB, great for her! And she could look for an OB who would support a natural birth if that's what she wants, or one who will help her get a minimally interventive birth even if she does want an epidural, etc. 


I think some people in here are getting a little butthurt here (not to you, Youngfrankenstein - I'm speaking in general). For some people a cesarean is far worse. For some a tear is far worse. It's up to the OP to take all the info on how to minimize the likelihood of tearing, look at the risks and negatives of a cesarean vs. the risks and negatives of tearing if that happens, decide the birth she wants and figure out how best to achieve that birth. So I imagine that giving personal experiences with cesarean vs. tearing IS relevant and important since those are the two primary issues at hand in her original post. 

Obviously I'm not the OP - that's just my opinion on that.


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To the OP - whatever you decide, I hope you make the best decision for YOU and happy birthing!!!!!


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#27 of 34 Old 01-27-2012, 05:14 PM
 
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What I haven't seen so far in this thread is someone's experience with both - it seems to be one or the other. So I'll chime in with my experiences and a suggestion. These were my experiences and do not apply to every person but are definitely things you can consider in your research.

 

I had a primary cesarean. Due to the position of my organs and baby, I had to be cut a little deeper on the right side. My incision is about six inches long (my outside, don't know about my insides). I had to have two units of blood after the surgery. I had a bad reaction to the staples used to hold my abdomen together - each one was infected and had to be pulled out earlier than usual but I don't seem to have any long term effects from that. I couldn't get out of bed for over 20 hours. I had a catheter and the first poop was excruciating because I had to use the same muscles that had just been cut. I couldn't drive for three weeks because, again, using the same muscles that were cut. I ended up with lots of scar tissue inside that very painfully ripped apart during my next pregnancy. I am still unable to feel completely on my right side where the incision is - it is better than it was but still not back to 'normal.'

 

My next pregnancy was fine - no repercussions from the surgery. I had a VBAC with a 3rd degree tear. The stitching was a bit painful because they wouldn't wait for the anesthetic to fully take effect. I was able to get up and go the bathroom with assistance within an hour. I could walk around, get out of bed and take a shower within three hours of birth. I used ice packs and epi-foam on my vulva for about four days during the healing process and then didn't feel the need to anymore. I couldn't sit cross-legged for about two weeks without some burning sensation (so I didn't!). I was able to drive easily within five days of birth. The first poop was painful and burned but was not excruciating. I did have some urinary incontinence after this birth for about one week.

 

My latest birth (Jan. 20th) was also a VBAC. I have a 2nd degree tear with this one. It's been so easy for me this time and not at all painful - BUT I think that is a relative opinion given my painful experiences with the other two. This just doesn't register as hurting because it isn't to the same degree as the others. I can drive, move around, used the bathroom within 30 minutes by myself, first poop was no big deal AT ALL and I can sit cross-legged with no issues. I used about three ice packs and epi-foam for one day with this one and haven't felt the need since.

 

So - there you have three different experiences from one mama. My feelings don't matter much in the end - it is your choice. I hope you make it based largely on factual information though I understand seeking personal stories too (it is what most women do especially about pregnancy/childbirth related topics). I would definitely research facts about cesarean risks, repeat cesarean risks and vaginal birth after cesarean risks. These should factor heavily in your decision making process because a cesarean does determine how you are treated in your next pregnancy/birth and your choices for that next pregnancy/birth, i.e. some states do not allow a midwife to attend a homebirth for a VBAC. Sometimes VBACs are not successful and very, very few providers will 'allow' you to attempt a VBAC after multiple cesareans. If you even think you want more than one child, in my opinion, you should very much consider these future situations in deciding which path you want to pursue.

 

ICAN (International Cesarean Awareness Network) has a lot of information. www.ican-online.org

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#28 of 34 Old 01-28-2012, 08:24 PM
 
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This thread is really not about you and your feelings. Your experience is not universal. How about you try to meet OP where she is?

 



 

Seriously?  What is your problem?  The OP asked for insight and advice!  I did not offer advice, but I did share my own personal insight.  Which is what I was invited to do.  By the OP.

 

 

 

 

FWIW, I just measured my 1st scar and it's a solid NINE inches across.  The 2nd one, which is 2-3 inches higher up, I didn't measure because it goes across from left to right and then the doctor's hand apparently slipped on the massive amounts of internal scarring and the line goes straight up all jaggedy-like.  It's at least 9 inches across but the part that goes up adds another 2-3 inches I would imagine.

 

OP, I am well aware that that women sustain all sorts of damage from vaginal tearing.  But there is a trend in this country to downplay the seriousness of c-birth.  It is major surgery.  You don't just end up with a scar on your stomach.  Your abdominal muscles are cut apart (though I have read of a method that "pushes them aside" or something rather than cutting them) and some women also end up with damage to the bladder.  My recoveries from my 2 csec were pieces of cake in the grand scheme of things.  I was young and otherwise healthy.  My desire to EBF led me to decline use of post-op morphine, and while I certainly wasn't comfortable, I wasn't in excruciating pain.  With ds2, I found myself with no choice but to drive myself to the grocery store 4 days pp.  I was lucky in that I handled it well.  But I did have pain and soreness and now I have numbness.  In addition to all of that, my surgical births put me at 4 times greater risk of dying than would have vaginal births.  I am not sure that bleeding from a vaginal tear can cause death by exsanguination.  That's not sarcasm, I truly don't know.  So you must weight the risk to your life vs. the rik to your perineum.  That's for you to decide, but again, my personal opinion is that I would rather have faced a tear than surgical birth.  So, FWIW, there is my insight.  Best wishes to you!  :)


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#29 of 34 Old 01-30-2012, 03:54 PM
 
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For me, I'd pick a cesarean over a severe tear. I had a great cesarean with DS. Limited separation of he and I, great healing, was up and walking (carefully!) around 3 hours after surgery. My scar is about 4 inches long when I'm not pregnant. The lingering numbness was gone by the time I was about 4-6 months postpartum. It's a fine white line. Now, on the other hand, I know a few women who have had 3rd-4th degree tearing. Two required later surgery. They seemed to have a much harder time postpartum than I did. Their healing harmed nursing and getting back into the swing of things. 

If you do go for a vaginal birth I would look into lots of different positions for pushing and make sure your doc is cool with catching a baby in a position you'd be best in. I imagine the typical reclined on the bed with your legs up would be harmful. 

I don't think you can make a bad choice. Just stay informed and in control. 


Cindy, joyful SAH mama to rainbow1284.gif William & Katherinefly-by-nursing2.gif Forever missing Amelia 7-12-09 angel3.gif  signcirc1.gifsaynovax.giflactivist.gif Ask me about my natural cesarean! 

 

 

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#30 of 34 Old 01-31-2012, 04:55 PM
 
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Quote:
Originally Posted by WaitingForKiddos View Post

For me, I'd pick a cesarean over a severe tear. I had a great cesarean with DS. Limited separation of he and I, great healing, was up and walking (carefully!) around 3 hours after surgery. My scar is about 4 inches long when I'm not pregnant. The lingering numbness was gone by the time I was about 4-6 months postpartum. It's a fine white line. Now, on the other hand, I know a few women who have had 3rd-4th degree tearing. Two required later surgery. They seemed to have a much harder time postpartum than I did. Their healing harmed nursing and getting back into the swing of things. 

If you do go for a vaginal birth I would look into lots of different positions for pushing and make sure your doc is cool with catching a baby in a position you'd be best in. I imagine the typical reclined on the bed with your legs up would be harmful. 

I don't think you can make a bad choice. Just stay informed and in control. 


From my own personal experience, I agree with this completely.
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