A question about tearing... - Mothering Forums

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#1 of 12 Old 09-28-2006, 10:55 PM - Thread Starter
 
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I had a question for the experts on tearing... specifically why I might have torn in my recent home waterbirth, and how I might prevent it next time around. I had a fast and furious labor (a little less than 4 hours start to finish) and spent the last hour or so in the water. When the "pushing urge" came on, it was so intense, and I just went with it. I never pushed when the urge wasn't there, but when it was it was like a truck trying to push its way out. I didn't even feel like I was pushing, it was like the baby was pushing. I probably was only in pushing phase for 15 minutes or less. On the last pushing contraction, I may have forced the issue a bit (it's hard to remember that part) because his head was half in and half out and I was really uncomfortable sitting there waiting like that. The only other factor involved was my midwife's apprentice. We didn't discuss this before the birth, but as his head was coming out, she told me she was going to put pressure across the top of my perineum. I agreed, and really wanted it at that moment. So, wouldn't you know it, the big tear was at the bottom of my perineum. It was just big enough to be a pain to heal, but not big enough to cause any serious damage. There was also a tiny tear on the side that was pretty insignificant.

Anyway, I'm wondering what might have preventing the big bottom tear (for future reference). Pressure down there, too? No pressure anywhere? Trying to relax more with the pushing? Not forcing the issue on the final push? Something else?
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#2 of 12 Old 09-28-2006, 11:29 PM
 
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well, I happen to think that tearing in a spontaneous second stage is usually benign and there for good reason - to allow our vaginas to stretch so not to cause deeper, more difficult wounds.

I think it's also a good thing because it keeps us aware and down a bit after the birth...which is always good for our babies.

here's a thread on it that we had here recently: http://mothering.com/discussions/sho...d.php?t=525120
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#3 of 12 Old 09-29-2006, 04:06 PM
 
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My recent birth was very fast too. With both of my births the urge to push has been overwhelming. This time I went with it at first, but when she reached was really starting to come, I reminded myself to slow down. I let my body push b/c of course I couldn't have stopped it. But I didn't add any force to it. I breathed and relaxed as much as possible. with my first I pushed, and tore. This time I didn't tear at all. I also did my own perineal support this time. I think those two things made all the difference. Both births were waterbirths, though my first was in a hospital and my 2nd was a UC at home. With my first I pushed 45 minutes or so; with my second, maybe 15.

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#4 of 12 Old 09-29-2006, 06:11 PM
 
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i tore badly with a similar kind of short labor and overpowering pushing urge. it was a 2nd degree tear, but extensive enough that i was put under GA to repair... ack... this was in the hospital.

i'm actually happy to hear you say the same thing happened in a home waterbirth, because i was not pleased with the way my OB managed the pushing stage, and i am never sure how things would have gone differently if she'd been more hands off.

i hope you are healing well... it was painful for me for about a month.. especially sitting up and breastfeeding until we got good at sidelying. warm baths always felt nice... and not using too thick pads for the pp flow. i don't know how far you are pp, but hopefully the tearing will be a distant memory soon!

Rosemary & Gary :
James 12/04 & Cecelia 4/07
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#5 of 12 Old 10-01-2006, 07:09 PM - Thread Starter
 
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Thanks for the replies...

Pam, thanks for saying it's okay to tear -- it's been kind of freaky since I declined stitches and didn't really know if that was the right thing to do. It does make sense, though. I mean, cave women had to be tearing sometimes, didn't they? And I'm sure most of them managed.

I'm about 5 weeks pp and I think it's almost healed. I just keep forgetting to keep my legs together and then I feel the wound a little again, but I do think it's healing itself fine.
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#6 of 12 Old 10-01-2006, 08:53 PM
 
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there's an old obstetrical saying about tears - that if you put two sides to a vagina in a forest, they'll eventually find each other!

seriously, it means that our bodies are made to heal perfectly (or without serious reproductive, sexual or hygeinic implications) without sutures. it is true that most tears do not need suturing and suturing does increase the risk of postpartum pain, infection and swelling.

There needs to be a revolution in our thinking re: tears. We need to trust that our bodies have to tear sometimes in small places, in small degrees, to help prevent more serious issues.

Surely, also, biologically, we are NOT meant to have another person's hands on us, holding and stretching those tissues. To do so negates our body's natural wisdom, and often makes tears far worse.
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#7 of 12 Old 10-01-2006, 11:35 PM
 
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Quote:
Originally Posted by pamamidwife View Post
there's an old obstetrical saying about tears - that if you put two sides to a vagina in a forest, they'll eventually find each other!

seriously, it means that our bodies are made to heal perfectly (or without serious reproductive, sexual or hygeinic implications) without sutures. it is true that most tears do not need suturing and suturing does increase the risk of postpartum pain, infection and swelling.

.
Are you talking just 1st degree tears? Will a 2nd degree heal without sutures?
Have you ever used seaweed for tears?

Christa
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#8 of 12 Old 10-01-2006, 11:43 PM
 
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There are alot of second degrees that will heal without sutures, but I am referring to mostly first degrees. A truly spontaenous, hands-off (other than the mother's), good positioned second stage is less likely to result in second degree tears.

I feel like things like seaweed and glue are missing the point: that if the tear is small enough for those things, it's small enough to be left alone. Adding anything to the wound interferes with the natural healing process. Even urine has healing properties!

It is my belief that sutures should only be used when the sides do not come together well. If they do come together well, the body will heal from the inside out - perfectly.
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#9 of 12 Old 10-02-2006, 01:39 PM
 
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I just want to chime in and say that a tear doesn't mean failure. I had a 15 hour first stage and a 20 minute second stage. I was in the water, too. I pushed when I felt like it. I actually didn't push with many contractions so I could catch my breath and let things stretch, but I still felt my body pushing. During crowning, I didn't push at all until the largest part of her head was out and then in one big push her body followed. I had a 1st degree tear and 2 skidmarks. I got 2 stitches. My midwife gave me the option of not getting them, but said "no stitches, no stairs" and that wasn't feasable. I kind of felt like I shouldn't have torn but I have come to the realization that it wasn't that bad. My body didn't let me down and my labor was completely hands off. Whatever I felt I had to do, I did. I don't think I could have prevented it without throwing something else off balance.

Emily, cooking allergen free, knitting, reading, gardening Mom to 1 beautiful girl, born in the water on July 1, 2006 Wife to 1 handsome man since September 10, 2005
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#10 of 12 Old 10-02-2006, 03:48 PM
 
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Quote:
Originally Posted by pamamidwife View Post
there's an old obstetrical saying about tears - that if you put two sides to a vagina in a forest, they'll eventually find each other!

seriously, it means that our bodies are made to heal perfectly (or without serious reproductive, sexual or hygeinic implications) without sutures. it is true that most tears do not need suturing and suturing does increase the risk of postpartum pain, infection and swelling.

There needs to be a revolution in our thinking re: tears. We need to trust that our bodies have to tear sometimes in small places, in small degrees, to help prevent more serious issues.

Surely, also, biologically, we are NOT meant to have another person's hands on us, holding and stretching those tissues. To do so negates our body's natural wisdom, and often makes tears far worse.
ITA with all of this. I think stitches are way overused in hospitals. I even read where some UC moms have had 3rd+ degree tears that healed on their own w/out stitches.

And having attended births with lots of perineal massage by midwives, I must say that that cannot *possibly* be a good thing for anybody. I say hands off (except for mom's). Mom knows instinctively where to touch and what to do to keep the birth gentle. An outsider can't possibly know that.

Laura, CBE and mom to Maddiewaterbirth.jpg ( 06/03/04) & Graceuc.jpg (  09/10/06)
 
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#11 of 12 Old 10-02-2006, 03:58 PM
 
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Quote:
Originally Posted by pamamidwife View Post
there's an old obstetrical saying about tears - that if you put two sides to a vagina in a forest, they'll eventually find each other!

seriously, it means that our bodies are made to heal perfectly (or without serious reproductive, sexual or hygeinic implications) without sutures. it is true that most tears do not need suturing and suturing does increase the risk of postpartum pain, infection and swelling.
I sure wish that were true for me.

I had a 4th degree laceration which required surgery 6 months later. Even after the surgery (which did improve things greatly) I will never be the same sexually and there are hygenic implications which I guess I will have to deal with for the rest of my life.
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#12 of 12 Old 10-02-2006, 04:58 PM
 
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fourth degrees are totally different, mama.

I know from experience and my own reconstructive surgery.
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