[heldt123]

Just curious...what do you do if you tear during unassisted childbirth? Is that a "must got to the hospital thing?" Also, are their any local anethesics that can be purchased for childbirth? I had a local for an epesiotomy and it was a relief during pushing. Are their any alternatives for at home?

 

[Jane]

Locals usually involve an injection, it's not really something I'd consider a home procedure. Maybe someone has some more information.
If you need help depends on a few things. If you tear really badly, it would be best to go to the hospital for a repair. If you tear only slightly, home care should be fine.
It's the middle range that's difficult, because you don't have a really good way to tell what the extent of the tear is.
The standard is that any tear that involves muscle should probably be sutured. I'm not sure how you would tell that yourself unless it was really obviously ok or not ok.

 

[cottonwood]

Apricot covered it. I just want to add that tearing is not commonly seen in spontaneous non-managed birth, and deep tearing (into the muscle) is pretty much unheard of.

 

[Jane]

Thank you blueviolet. I was trying to think of a way to make my post more encouraging, but you got it in one try: it's rare.

 

[mwherbs]

a recent thread about an article pamamidwife wrote on preventing tears, probably would be a good idea to read.

http://www.mothering.com/discussions...d.php?t=221943

 

[heldt123]

Thanks guys for you help. After having an epesiotomy at the hospital I had these images of tearing at home, bleeding everywhere, and having to go to the hospital to be "fixed up." It does set my mind at ease thinking that it is rare or minimal at the least.

That post mwhearbs linked to was very interesting. It makes a lot of sense as I had wanted to squat soooo bad with my first baby. Of course the doctors and nurses act like they know best and put you in the position that makes it easier for THEM. They watch that contraction screen and tell you when to push even when it doesn't feel right. I started falling asleep and they hooked me up to pitocin. A few more pushes and ooop, not comming out, lets cut her. Oh happy day!!

: Recovering from that cut was the worst part of the whole pregnancy! The delivery wasn't too bad, but that lingering pain lasted for months. Intercourse has never been the same since.

This time I hope to spend at least some time in a birthing pool to help prevent tearing and hopefully use whatever position that feels comfortable. I had wanted to labor in thier whirlpool tub at the hospital with my first birth, but by the time they had it filled with water it was too late and they had me pushing already.

 

[Electra375]

I tore inside when my dd shoulder dropped. I felt the pop of the vaginal wall. The birth was not "managed" no one was there tugging, pulling, moving the baby around nothing, dd was on her own coming out. One mw was hold compresses and I firmly believe had she not been doing that I would have torn externally.

I did not want stitches, so my mw was trying to determine if the tear was 2nd or 3rd degree (3rd meaning the muscle wall). The final determining factor was my peeing and stopping my flow mid-pee. She marked my tear 2nd degree, but it was a deep 2nd degree.

I was told to ly on my sides only with legs together for 2 weeks. This wasn't modified bed rest, I literally was in bed for 2 wks except to pee and shower (and 1 trip to the chiropractor to push my lower back back in and get me out of pain). I ended up in bed for 3 wks, the last week was modified meaning I could sit up to comfort and then back to bed. I was really swollen so I didn't mind not sitting for 2 wks.

Don't kid yourself in thinking that a tear is a minor thing or only happens when their is intervention. I love my mw and they were by no means responsible for my tear.

I'd have a back up plan, do you know a mw who might come over to check you out and stitch you up if necessary. My mw does gyn exams for like $80, she comes to you. I wouldn't want a hospital to be my back up plan here in VA, they would admit me and the baby run all the newborn test, scrutinize me up and down. Not what I would want.

 

[Defenestrator]

Some of the apprentices in my midwife study group work with midwives who don't suture at all. I work for midwives who suture a couple of times a year. The common wisdom here seems to be that two things are important -- total bed rest for several days to weeks depending on the severity of the tear and absolutely no ice. The swelling that comes as part of recovery from tearing is thought to be important -- it helps to bring the tissues back together again.

We see 3rd and 4th degree tears extremely, extremely rarely. Like once every few years or so.

I also believe in postpartum herbal baths. We use one that is a combo of comfrey leaf, shepherds purse, ura ursi, lavender, sea salt, garlic, and calendula.

 

[the_lissa]

Quote:

Originally Posted by Defenestrator I also believe in postpartum herbal baths. We use one that is a combo of comfrey leaf, shepherds purse, ura ursi, lavender, sea salt, garlic, and calendula.

My midwives gave me a pp bath recipe that is very similar to this, only without comfrey and calendula. Maybe I should add those things next time. I brought the baby in the bath with me, and was told that it is also good for umbilical stump healing.

 

[Jane]

Quote:

Originally Posted by Electra375 I wouldn't want a hospital to be my back up plan here in VA, they would admit me and the baby run all the newborn test, scrutinize me up and down. Not what I would want.

If you end up thinking about going to the hospital, you can always chose to NOT take the baby with you. I would feel out the situation for your area, but not having the baby admitted would be my first choice.

 

[cottonwood]

Electra375 wrote: "I tore inside when my dd shoulder dropped. I felt the pop of the vaginal wall. The birth was not "managed" no one was there tugging, pulling, moving the baby around nothing, dd was on her own coming out. One mw was hold compresses and I firmly believe had she not been doing that I would have torn externally."

Disclaimer: I am not saying tearing in a spontaneous birth can't happen.

I just want to clarify

that when I referred to managed birth, I wasn't talking about just physical intervention. I should have also included the word "undisturbed", meaning no inhibition (touching or watching which can make the vaginal muscles tense up), no distraction (e.g., lights, talking, etc., which interfere with the release of the hormones that ready the skin for stretching), no coaching or direction or suggestions (as to position or time or ways to push), no leading (by announcing dilation), etc.

 

[amyjeans]

I can't remember where I read this, but for minor tears, (which are a judgement call,btw) use crazy glue. Obiously externally...put a drop on the tear to keep the skin together until it heals.
Anyone else heard this?

 

[pamamidwife]

yeah, i've heard of super glue and used it once. the thing is, IMHO, if it's small enough for glue, it's small enough to leave alone.

I think the vagina is an extraordinary healer!

 

[amyjeans]

Quote:

Originally Posted by pamamidwife yeah, i've heard of super glue and used it once. the thing is, IMHO, if it's small enough for glue, it's small enough to leave alone. I think the vagina is an extraordinary healer!

lol good point

 

[pamamidwife]

Quote:

Originally Posted by amyjeans lol good point

not to mention the fact that it's tricky! takes alot of patience and a good steady hand.

it would be horrible to end up in the ER with your hand stuck to someone's vulva.

 

[Jane]

Quote:

Originally Posted by pamamidwife it would be horrible to end up in the ER with your hand stuck to someone's vulva.

I actually have a philosophy that I live by: How would I feel explaining this in the ER. It eliminates stories that start, "Well, we had some left over estee rocket motors, and me and my buddies decided..."

 

[Electra375]

Not to mention the stinging from the super glue -- ouch!!! Small enough to glue, small enough to leave alone. I have a little piece of skin toward my clit that didn't adhere back together, no biggy, doesn't bother me one bit, besides if it tore once, it might tear again and I don't want the pain again!

 

[TEAK's Mom]

I'm living proof that it can happen. Sigh. i just have the least elastic skin in the world. I pretty much had a midwife at my second birth (she's also a friend) just to sew me up afterward. The birth was just me, dh and the baby with no one telling me anything and I still had 3rd degree tearing. So mw sewed me up and was on her way.

Now, I don't tell you this to scare you away from UC. If you're worried about it, see if you can find someone who would come over and suture if you need it. Most people just don't.

 

[TEAK's Mom]

I'm living proof that it can happen. Sigh. i just have the least elastic skin in the world. I pretty much had a midwife at my second birth (she's also a friend) just to sew me up afterward. The birth was just me, dh and the baby with no one telling me anything and I still had 3rd degree tearing. So mw sewed me up and was on her way.

Now, I don't tell you this to scare you away from UC. If you're worried about it, see if you can find someone who would come over and suture if you need it. Most people just don't need it.

 

[mamabain]

i didn't have unnassisted birth but i want to weigh in on the suturing issue. with my first (hospital, managed, pushing without desire, in semi-reclining position, on a bed) i had a 3rd degree tear. the suturing hurt worse than the delivery (i should say the injection to numb the site hurt worse). took about 7 weeks to heal. hurt at the site for several months.

this last baby, i had at home, in water. it was managed but only in the respects of me adding force to what my body was doing naturally. and only because baby's heartrate wasn't recovering after contractions. i had a first degree tear over the scar tissue of my previous tear. my midwives said they wouldn't recommend suturing but that i could if i wanted to. remembering what happened in the hospital with the pain, i decided not to. i took it very easy and rested, kept my legs together, took sitz baths with herbs the first 4 days. at two weeks it still looked very open and unhealed. i was freaking out. but by 3 weeks, i was completely healed and the skin was very together. i probably could have had intercourse but was too chicken. had intercourse at 4 weeks and it was absolutely fine.

long story short... for 1st degree tear, NO NEED TO STITCH!