[Channelle]

I actually had a question from my cousin, I told her I'd ask you guys.

She had her first child 6 years ago, medicated and laying down in bed. She ripped really bad, pretty much all the way down. She still has problems using the bathroom correctly. Now she is expecting her second in October, and she is desperate to not tear again. She is planning on trying naturally.

First she had wanted to do a water birth, but she was told she couldn't. Then she wanted to do it squatting as she heard that it helps in preventing tearing. Now the doctor told her that she can birth squatting without the doctor being able to watch her from tearing, or she can birth laying down where the doctor can watch her very closely.

She can't decide which one will work better. She thinks squatting will help with the tearing, but she also wants the doctor to be able to watch and help if needed. (But then again, she feels that the first time the doctors were watching really closely and it still happened, so maybe no doctor watching it closely will help...)

Any advice?

 

[alegna]

If the dr. is watching, how's he going to "help with tearing"?

-Angela

 

[PionusMidwife]

Hi there--I'm new at this forum. My name's Christi, I'm a student midwife.

There are other ways to help prevent tearing, but first I'm curious to know why she can't have a waterbirth--is it the location she's birthing at, or is it a personal reason? Birthing in water would really help the skin stretch.

Squatting is good, but I've seen babies born in all different positions with the midwives I work with, and tears are rare, and even rarer are ones so severe they need repair. Have your cousin practice perineal stretching exercises (get the perineum warm and wet and basically massage it both internally and externally; stretch the skin slowly but consistently to make it more elastic before the birth). Also, if the doctor (or midwife) is willing, there are herbs which can help as well. Ask if they know of any. We use some and make a big pot of tea with them (basically, though I'd never drink it) and throughout active labor, we hold really warm compresses made of old washcloths up against the perineum, changing them frequently. The herbs have healing properties, and the warmth helps the skin stretch as well.

Finally, the big thing is to go sloooooooowly. Suggest that she hires a doula to help her through that--if nothing else, maybe the doula can hold the herbs in place while the doc coaches.

Good luck!

 

[Bluegoat]

If she can avoid directed pushing that will make a huge difference. Which makes it really important to try to avoid an epidural or anything that will reduce the natural urge to push.

There are some good online resources about 2nd stage pushing around, she might want to do some research on that.

 

[Channelle]

Quote:

Originally Posted by alegna If the dr. is watching, how's he going to "help with tearing"? -Angela

The doctor said that she'd be able to press the sides together so it doesn't have a chance to stretch??

Christi and Bluegoat-thanks for your advice, I'll pass it on to my cousin!

 

[alegna]

Quote:

Originally Posted by Channelle The doctor said that she'd be able to press the sides together so it doesn't have a chance to stretch?? Christi and Bluegoat-thanks for your advice, I'll pass it on to my cousin!

hmmm... that's a new one... I would worry that the dr. will be eager to cut to "avoid tearing"

-Angela

 

[Mrs.Floyd]

To me it sounds like the dr. is pretty set on having her deliver lying down probably b/c it's easier for them as it's what they're used to and they feel more in control w/ the woman in that position. Doesn't really sound like they're that interested in your friend's concern if they're just giving an ultimatum ('do what you want and I can't/won't help or do as I say and maybe I'll help you'). I'd be inclined to tell her to look for someone who's actually concerned with your friend's fears who is actually willing to work with her as an individual. I know that sounds harsh but it's the impression that I get. I was fortunate to be with my dear friend when she gave birth to her second child - she'd had an episiotomy with her first and was adamant that she'd rather tear than have that happen again - when the OB first walked into the room she requested that she be allowed to tear if necessary and the dr. commented that he prefered to sew up a straight line - well wouldn't you know it, he cut her w/o even warning her during the delivery (baby was not in distress either). She was not aware and when the baby was out she asked if she had torn, and his response was "Nope, no tear, just a nice straight cut - now lay still so I can sew it up."

Your cousin's dr. made me think of that whole thing b/c it sounds similar - like they're set in their ways whether it's good for the mother or not b/c it's easier for THEM.

 

[SubliminalDarkness]

For starters, she needs to avoid coached pushing. None of this 1 to 10 come on come on junk. IMO, she needs to try really hard to resist the urge to push for a while, and then if possible not even push, but just relax. Let things happen on their own, slowly.

 

[babymonster]

I had a fourth degree tear last time. I have read it can be good to birth on hands and knees - slows the process down a bit and doesn't overstress the perineum. And +1 to what everyone else said - breathe the baby down, wait until the urge to push is irresistible, NO directed pushing, NO episiotomy!
If you find the thread 'Vaginal birth after fourth degree tear' there is tons of good info in there

 

[Channelle]

Thanks for the info, I'll go check out the other thread to show her too.

Alegna-Yeah I hadn't heard of it either, but I'm new to childbirth...my cousin did tell the doctor she'd rather be cut then tear bad again, and the doctor told her that she only cut in rare emergencies, that she really didn't like to cut...

 

[Bluegoat]

Quote:

Originally Posted by Channelle Thanks for the info, I'll go check out the other thread to show her too. Alegna-Yeah I hadn't heard of it either, but I'm new to childbirth...my cousin did tell the doctor she'd rather be cut then tear bad again, and the doctor told her that she only cut in rare emergencies, that she really didn't like to cut...

Cutting tends to lead to worse tears. Kind of like if you are trying to rip a piece of cloth in two, but you can't. Just a little snip in the edge of the cloth and it rips right through with no effort.

 

[MegBoz]

Sounds to me like she really, really, really needs a new health care provider. If she's that set on reducing her risk of bad tears, that is what it comes down to.

Pushing on your back increases the risk of tears. So... if the doc really cared, he wouldn't make her push on her back.

Right?

Second, as already said, birthing in water helps reduce the risk of tears - as well as being a scientifically-proven effective means of reducing pain. (And... of course, helping mama manage the pain of labor reduces her needing an epidural, and the epidural itself also increases the risk of bad tears.)

Very few hospitals, at least in my area, allow water births. If there is not a free-standing birth center in her area, I really suggest she looking into home-births. Most HB MWs are very comortable with water birth.

Sounds like she's going to have an uphill battle to have a good birth experience with this OB.

Why put yourself through that?

 

[mysticmomma]

She needs a midwife.

 

[Asiago]

The doctor or the hospital sounds as if they are practicing outdated medicine.
I attended a hospital sponsered birth class and even THAT program tried to steer moms away from giving birth on their backs! Instead it promoted using the squat bar on the hospital bed or getting down on hands and knees (all fours). Of course if mom has an epidural those may not be possible though. However, side lying would likely be possible and better than the stress of sitting on one's rear or lying on back and compressing the birth canal closed, and stressing the perineum.

My friend gave me this book. It has some of the suggestions posted and also so much more. It's really a great book.

Perhaps buy her this book as a gift, she'll thank you

http://www.amazon.com/Get-Through-Ch.../dp/0595188680

Also some hospitals do not permit water birth, yet others openly support it and do it regularly. Many hosptials though will allow labor in their tubs (if they have them) yet not permit birth in those tubs. However, if you bring your own pool, it is sometimes permissible then. It also depends upon the OB, your cousin's doctor likely doesn't allow it. She can search for another provider. Waterbirth aside, even one that is more current on suitable birth positions. The one she has just sounds really outdated.