Preventing Tearing

[Crystalwings]

Hi,
I am 33+3 wks pg and am starting to get lots of pre labour pains as I did with DD1. I had these for about 4wks last time too but anyways i'm getting nervously excited about my impeding labour.
The thing is that I am really worried about tearing as I had a 3rd degree episiotomy and tearing after a rotational forceps delivery the first time.
I've read about perianial massage and will start this after Christmas as they say from 34wks is optimal. I have also vaguely read about asking a midwife to support the perianium during the pushing stage. So I am wondering who has had this. Did it work in preventing tears? Did it restrict you with positions? I have thought about asking dh but fear he will be a bit clumsy and annoy me and it's not something i really want to ask mum to do.
Any other preventive measures would be much appreciated.
TIA

[Artechim]

The midwife should help if you ask her. Have you considered/does your hospital support water birth? The warm water softens and relaxes the area and you are less likely to tear.

Good luck.

[Arimeh]

We did the perineal massage from about 36 weeks, and I had minor tears that didn't need stitching. My midwife didn't support the area whilst birthing but I was on my knees, which is apparently a pretty good position to birth in to be kind to your perinium!

I probably wouldn't have torn at all, but I was in a rush to get her out and I pushed her out with all my might, instead of just breathing her out as instructed. She also had a biggish head too

[Crystalwings]

Thanks The hospital i'm hoping to deliver in doesn't have a bath however if i do have to travel to a larger hospital nearby then they do. If i get transferred i'm assuming it will be for a medical reason that will might mean the bath is out anyway and while i did think about going there initally TBH i think i would feel claustrophobic in the bath.

I will try and do the breathe out method (so much to remember) as well. I ended up having to have an epidural right at the end last time after a 50hr drug free labour and 2hrs of pushing so i'm a bit scared about the actual delivery bit. Maybe thats part of my problem, i need to get in the zone.

[luna moth]

I did perineal massage from 37 weeks. Midwife supported the area with some kind of cloth (I was a bit busy at the time so don't recall exact details) I used the bath for 3 of my 9 hours of active labour.

I had first degree tears, but internal, and got three stitches. Perineum stayed intact.

[*Ali*]

I had 2nd degree tearing with dd1 and ds both requiring a fair amount of stiches. With dd2 i birthed on all 4 fours, and really listened to the midwife when she told me to pant and do little pushes and managed to only get a tiny 1cm tear that didn't need stiching. The midwife may have supported the perenium, can't really remember.

[meow]

- Position. Not being on your back, or in a position that requires an assisted delivery can help.
- Water. Being in warm water can help. If you birth on land, having the midwife hold a warm, wet facecloth on your perenium can help.
- Slow birthing. Don't push, but breathe between contractions. Allow baby's head to crown slowly.

Ive heard mixed reviews on whether massage and epi-nos actually help. The stretching you'll do in late pregnancy is very different to the stretching that happens in labour with other hormones in play.

I tore in both my labours. First appeared to be caused by sitting on a birth stool, pushing with ALL my might for about an hour. All the blood would have been pooled down there and it would have been fit to burst once babys head came out. The MW supported the perenium with her hand but I still tore.

Second labour was in a birth pool, breathing baby out. The tear was second degree again but only fairly shallow intothe muscle. Best decision I made then was not to get stitched. Tearing didnt bother me a whole lot. Stitching did.

[Tegam]

had great head support birthing DD1 and didnt tear, but was a 6hr labour. The next two i had no support and have had 2nd degree both times but they were fast labours... So was it the support or the length of labour?? Not sure sorry. All their heads have been about the same size... I wouldnt get DH to do it, it would just be too much for him!

Heres to a happy, positive birth for you!

[Babyluv]

I used epino for 1 week, bub came a week early. I got a 1st degree tear needing only 2 stitches. I had a fantastic ob telling me when to push and when to breathe. I focused on doing short, quick breaths when he told me to, you can't push when doing little quick breaths. I was in a sitting position which is not good as it can limit the pelvic space, maybe if I were on all fours or something I wouldn't have teared at all.
Good luck Hun, I recommend asking the MW or Ob to talk you through it.