[Mer]

I haven't ever posted here but do lurk fairly frequently on the pregnancy board. I was going to post there but this board seems more fitting. I'm about 36 weeks now and am realizing this birth is going to happen soon. Anyway I was doing some reading tonight on tearing and am getting scared. All of a sudden I am feeling really unprepared. To sum my first birth did not go well and I ended up with an episiotomy and 4th or 5th degree tear to my rectum. Ugh.

Anyway, my midwives keep telling me it's not likely to happen again, but I'm scared. I had started doing perineal massage with this pregnancy thinking it would help prevent a repeat tear but now I've read that it could contribute to tearing. I had also been thinking that I would try squatting for this birth but I think I read that this may put too much pressure on the perineum. I saw something about fingers in the vagina to try and help during pushing which was actually counter productive. Should I put something about this in my birth plan? What about internal exams? I guess I'm feeling confused.

: Any help, thoughts, experiences would be greatly appreciated. TIA.

 

[Angierae]

FWIW, I had an AWFUL episiotomy/tear with my 1st, and a really insignificant tear the 2nd time. I did decide to lay on my side while I was pushing b/c squatting was bringing back bad episiotomy memories. All the pressure. I don't think I would have torn at all the 2nd time if I hadn't decided to push like gangbusters on the 2nd push. I probably could have used a few more pushes. I just remember thinking, "I don't care if I tear the whole freaking thing off! I am ending this NOW!" Live and Learn. ALso the 2nd tear was no where near the episiotmony site--I thought for sure I'd blow the whole thing open.

 

[girlndocs]

Have you read Ina May's Guide to Childbirth?

You have a great deal of control in your hands over whether or not you're likely to tear. If you insist on pushing only when you feel like it (not before, not for a count of 10, not bulging your eyes out), in a position that intuitively feels right to you (*not* flat on your back just because someone says so), and if you give birth in a place where you feel truly safe and only have people you trust present, you will be far less likely to tear.

Water birth reduces tears dramatically too! My midwives did mostly water births and they said that in the 300 births they'd done so far they had never had to stitch anyone.

Have a wonderful birth!

 

[ladybugchild77]

Hello!
First of all, congrats to you and your little one on the way! I just gave birth in March to a 9lb 4oz girl and I tore quite a bit but to be honest - she was sideways and her head was HUGE so I was glad she could come out in the first place! (Ha ha!) My midwife put warm compresses on me as well as massaged me so I didn't tear as badly and I healed up just fine even though I had a zillion stiches! I feel great and I'm sure you will too! Good luck!

 

[pamamidwife]

here's an article that I wrote that might be helpful (want to add that I had a third degree episiotomy and you ALWAYS tear worse with a cut than if you weren't cut...it probably won't happen again as long as your body is the one in control during pushing!!):

http://www.midwifemama.com/honoring.html

 

[danav]

I just wanted to second the suggestion of using water - at least to labor in up to the point of pushing if you don't want a full water birth. I labored in a warm jacuzzi for 1 1/2 hours before starting to push with Noah. He turned out to be frank breech and came fast (15 min total pushing). I had started out pushing in hands/knees, but turned over to squatting midway, then we discovered he was breech and they had me lay down on my side thinking there was time for a transfer to the hospital (I was at a freestanding birth center and they aren't technically supposed to catch a breech baby there). At that point, he was coming too fast to do anything but continue pushing him out, and I literally could not move - so my doulas/husband/midwife rolled me to my back and I ended up pushing him out nearly lying flat on my back.

So, essentially I pushed out a breech baby with a huge head while lying in the worst possible position and he came really fast. My midwife was shocked when she examined me after and I had NO tearing whatsoever! I give the credit for that to laboring in the water for so long immediately prior to the birth.

 

[ZeldasMom]

Quote:

Originally Posted by pamamidwife here's an article that I wrote that might be helpful (want to add that I had a third degree episiotomy and you ALWAYS tear worse with a cut than if you weren't cut...it probably won't happen again as long as your body is the one in control during pushing!!): http://www.midwifemama.com/honoring.html

Just bookmarked this!

 

[dynamohumm6]

I was worried about tearing along my huge episiotomy scar. I labored two hours in a jacuzzi before pushing, which i think helped. I had a small labial tear, with just two small stitches, but nothing along my perineum/scar. My midwife was amazing at stretching the tissue over his head as his head came out. The most important thing, I think, is to push when you feel the urge, not as pushing orders are being barked at you.
For what it's worth, I pushed in squat, hands & knees, and finally on my left side (posterior babe).
nak

 

[Mer]

Thanks for your replies. I feel a little better after reading them and after sleeping on it a little. I think I'll put something in my birth plan that I would like everyone to be as hands off as possible during the pushing stage, and definitely no episiotomy. I do plan on a water birth so hopefully that will help. I did see your article, Pamela, and I have saved a copy. I just hope I can be patient with my body this time. Wish me luck!

 

[liseux]

Another super helpful thing to try is to sit twice a day in a warm bath, (just needs to be enough water to sit in, not necessarly a full bath) starting at 36 weeks. It heals tremendously pp if there`s been tearing and it also does a lot to prepare the skin to stretch. I know this has worked better than perineal massage for a lot of moms.

 

[asianmama]

I am also at 36 weeks, but this is my first pregnancy. Last week I asked one of my midwives about perineal tearing, and she told me that the literature on perineal massage indicates that it does help to reduce the likelihood of tearing. She also said that tearing can also depend on how quickly the baby comes out. Apparently, if you ease the baby out, using your hands (or your helper's hands) to keep the baby from popping out really fast, it can help prevent or minimize tearing. She also said that when mom lies on her side during delivery, the baby tends to come out slower...so that may be one of the positions that may be helpful for you.

All the best!

 

[sleet76]

My fear of tearing for my 2nd birth was what directed me to a much more natural birth than i had the first time around. I didn't tear that badly the 1st time, it was only 2nd degree, but I got granulation tissue as it was healing and that was cut off 3x over the course of 5 months before I was finally healed. I really was afraid of going through that again. My recovery was also pretty difficult--maybe because of the granulation tissue? I don't know why (maybe just because of some of the factors--induction at nearly 42w, epidural, etc...). This baby was 7lbs 6oz.

The 2nd time I used a midwife in a very crunchy hospital birth center, and did it totally natural. Not an IV or even a hep lock. My labor was easy--showed up at the hospital at 8cm thinking I was going to be sent home because I didn't think it was "really" labor. I had planned on laboring in a tub, but things were going so easy that I was afraid to change anything! I pushed in many positions, but near the end, when the head was in the birth canal, I used a side-lying position and then crowned and birthed in a hands and knees position. I did have a tiny little 1st-degree tear that felt totally healed in about a week. I even considered having sex at about 4 weeks, but waited until 6 (didn't want any chances of that granulation tissue coming back!). Very easy recovery, felt pretty much normal by 2 weeks pp. I was very happy with the results. This baby was 8lbs 9oz.

Good luck! I know my experience is different from yours, but tearing was my big fear, too.

 

[homebirthing]

About 95% of ALL 4th degree tears are from episiotomies that rip too far. In avoiding that, you have done half of the work!!

Also waiting panting or grunting the baby out when s/he is crowning, no active pushing (healthy baby of course) will really help. Perineal support is important, which you don't often get in a waterbirth, so either you can put your hand down there, or have someone do it. NO BIG PUSHES when that baby is crowning. Pant!

And don't be surprised to have some small tearing along the previous cut. It is very common and OK. Just take very good care of yourself afterwards. No moving about...get three to four baths a day minimal. Good luck and happy birthing!