Avoiding tears - is it possible?

[buliej]

I've been reading some of the labour stories to educate myself in advance of my own January (fingers crossed) labour. I am wondering if anyone has learned anything about avoiding tears? I've also just started reading about perineum massage - does this work? are there other things that one should do - or discuss with their OB - to lessen the chances of a bad tear? thank you

[Visitor7]

Positioning during birth will help. Try avoid delivering bub on your back, try on all 4's, standing, or on your knees. A lot more natural for bub to move down the birth canal then you being on your back.

[onthefly]

There are ways of managing the birth that can reduce the likelihood of tears, but there are no guarantees.
Avoid lying on your back to birth, instrument deliveries and episiotomies if you can.

[ShootingStar]

I had an episiotomy with my first pegnancy and just tore with my second.. however.. i have read that you can try and make it not so bad by massaging the area a few weeks before the birth.

[Hayden_Sam_Adam]

agreed with Jodi about the postioning all though i also agree with trying extremly hard NOT to push to hard and just letting your body do the work i pushed like hell with my DS and even though i did the massages and i was standing i still suffered a 4th degree tear. sometimes its just inevitable but good luck with your birth i hope everything goes to plan for you Xo

[LionsandBears]

I hadn't started perineal massage in time for when Leo was born. He was breech and I birthed him on my back. He was prem but also a good size (3.3kg) I pushed with the contractions and I pushed hard. I ended up with a "nick" that didn't need stitches, but that seems to be more luck than anything. The OB also had her fingers in holding things open wider as he slipped out, so that may have helped.

[meow]

A few things I have found as I am hoping to avoid tearing this time:

Kneel in warm water
Have a 'hands off' labour
Don't push- you may feel urges to push so going with these as gently as possible, not overdoing it, stopping between contractions and trying to breath through (not push through) crowning should help
Taking vitamin e beforehand (I think? I need to look into this more)

[allycat06]

Tearing is sort of like stretchmarks, there are lots of things you can try but unfortunately no fail safe method for prevention.

Perineal massage, pelvic floor exercises, active birth positions are very important, avoid any kind of position that goes against gravity such as lying on your back but even some positions like squatting can make you more susceptible to a labial tear. Coached pushing is also not recommended, try breathing your baby out. Your body knows what to do In a few birth videos I've seen midwives apply pressure to the perineal area (with a folded towel or similar) when the baby is crowning to help reduce tearing. Labouring immersed in water is also supposed to be good to soften up the skin. Do your reading, the power or knowledge can minimise lots of interventions in childbirth!

[YoYo]

I tore and had stitches with DS but didn't tear with DD...

I birthed her on my side, DIDN'T push hard (just let my body do the work) and I can also thank Pre-natal Yoga a bit I think. Doing squats and stretching the 'nether regions'

[Loula]

Tearing is sort of like stretchmarks, there are lots of things you can try but unfortunately no fail safe method for prevention.

My MW said that women who get a lot of stretchmarks are at more risk of tearing, do not how much of the truth is in that but she would see more than I

[black_rose]

I had internal tearing because I dilated so fast and dd was determined to come up so my body wasn't ready. Not sure I can avoid it this time, but the labour I'd progressing slower so I might be lucky.

[OceanPrincess]

Talk to your MW and/or obs about it. I let mine know I was worried about tearing with DS and they helped with positions to try and also applied a warm face washer to the perineum as I pushed, which really helped with the burning but I still tore.

I tore along my old episiotomy scar but also the other side tore as well. Possibly because DS was a bit of a big bubba! Having said that, my tears felt more natural than my epi (logical I guess) and they have healed better.
When I tore it felt like a big release of pressure, didn't really hurt much at all!

[Arimeh]

My MW said that women who get a lot of stretchmarks are at more risk of tearing, do not how much of the truth is in that but she would see more than I

I've heard that, and I have to say it was one of my biggest fears going into labour because my belly looks like rail road tracks - sooo many stretchmarks!!!!

But, i did the perineal massage from 36 weeks - every night most of the time - and had Eden kneeling on the floor. Only got 2 minor tears, didn't even need stitching - and she had a biggish head too - 36.5cm.

[allycat06]

My MW said that women who get a lot of stretchmarks are at more risk of tearing, do not how much of the truth is in that but she would see more than I

Quite possibly! Some have better skin elasticity than others so I imagine the same principle could apply to tearing.

[Traveller]

I tore every time, although less after labouring in water than I did labouring on the bed. However a friend of mine has 4 kids, and with one she had an epis, with the next she tore really badly (so much so she needed repair surgery) and with her 3rd had a bad tear too. With her 4th she did perineum massage religiously and also had a waterbirth, and despite all the scar tissue she has she did not tear at all. It's certainly worth a try!

[buliej]

Wow - thanks everyone... happy to read more if anyone else wants to add...I'm definitely going to talk to my OB about this as well....I hate to ask this (please don't judge - this is more about gathering info to make decisions), but I suspect if one opts for an epidural, all the suggestions re: position are moot...is this correct? (I still have a lot to learn about the labor/birth process). Does this mean that those who have an epidural are more likely to tear?

[onthefly]

That is something to consider bulie. Inductions, for instance, are associated with more frequent monitorin (often on the bed, where they like to keep you if they can), high epidural rates (where, again, you're on your back and not able to feel the pushing urge so not able to 'go with it" so well) and higher instrument-delivery rates (more likely to tear, or tear badly with an episiotomy), and so on.
If you have an epidural, you're more likely to end up with an instrument delivery *i think*, and certainly you won't be able to make use of positioning to redue the likelihood of bad tearing. That said, I don't know whether there is increased risk of bad tearing statistically speaking.

[Traveller]

You can now get a "walking epidural" which numbs the pain, but allows movement and some sensation so you can move position and feel when to push. It might be worth asking your OB if this is an option where you plan to give birth.

If you have a totally numb epidural, then you will be at a higher risk of an instrumental delivery (such as forceps) which usually require an episiotomy. You would also have to be on your back or side, and would have less control over the speed of pushing, so you may find a tear more likely.