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Okay, so I'm not pregnant now and am not planning to be any time soon, but this has been bugging me. I had terrible hemmorhoids after my daughters birth 9 months ago...they were only protruding for a few days as my perineum healed but then for weeks after were EXTREMELY painful every time I had a bowel movement. I was eating really well and was not constipated, getting plenty of rest, but they were just awful and I am terrified of revisiting that experience, and I know I want more children.
I had a great second stage of birth, I pushed my daughter out in about 20 minutes with no tears. I pushed some while standing, on hands and knees and very briefly squatting, but did all of my real pushing lying sort of on my side with one leg on my midwife's shoulder.
What can I do to prevent (not just treat) hemmorhoids with future births?
 

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Next time, breathe the baby down farther before pushing--mmm, assuming that your pushing was somewhat directed, assuming that you added extra oomph to the naturally occurring fetal ejection contractions. A woman does not have to push just because her cervix is fully dilated, for one thing, you can wait until the fetal ejection/pushing contractions get going on their own. For many women, this does not occur until baby is pretty well descended into the vagina. And you don't have to add any conscious effort to pushing, don't have to hold your breath. I tell mamas--breathe when you can, push when you have to, follow the contraction and what your body wants.

So, even for women for whom the ejection contractions are strong and well established, you can breathe deep as the contraction begins, breathe again as you are able to, only bearing down as your body does so naturally--you don't have to resist that feeling, nor do you try to help it along, make it stronger with conscious effort, etc. THis may mean that you do hold your breath for a few seconds at a time--though many women will leave their throat open and push with a grunting or growling or screaming sound (whatever comes naturally, you don't have to plan this!).

If you don't push just because you're fully dilated, and if you only push when and as your own body directs, focussing more on breathing and staying relaxed, then you are less likely to have hemorroids in the end. And if you do get them, they will be less pronounced and will tend to resolve more easily following the birth.

Meantime, doing pelvic floor exercises should help resolve the ones you've got now. Also, do you use a stool to put your feet on while pooping? Raising the knees higher than the hips, an imitation of humans' natural pooping position of squatting, can help in the long run. This can make poop's passage that much gentler/easier, reduce or eliminate any need to bear down while pooping and thus reducing repeated flare-ups of the hemorroids.
 
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