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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
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.
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.
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.
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
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.
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)
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!
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'
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 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.
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!
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.
Quite possibly! Some have better skin elasticity than others so I imagine the same principle could apply to tearing.:
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!
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?
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.
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.
This is all very good to know - I now have to think about things and talk to my OB. thank you
I got about 400 billion stretchmarks and didn't tear at all ... everyone's different.:
But then I put on a LOT of weight when I get pregnant, and all 3 births I've been able to move to whatever position was least unpleasant.
My DD didn't read my birth plan lol
Tearing/epi was my biggest fear but I got lazy and didn't do anything I had planned like massage etc......I ended up being induced, having an epidural, birthing on the bed - though it had a bit that dropped down that made it like a squat position and a vontouse delivery - so basically everything working against me and I ended up with only a minor graze, but I did have a great Ob & midwife who really coached me through the pushing. She was 3.16kgs so average sized.
Interesting about the stretchmark/tearing thing - I got one stretchmark on my side, but my bb's are like road maps!
Doh, I was going to try and avoid tearing when I go for #3 after being 2 for 2 but if thats true i'm buggered.:
In saying that from my perspective, yes I tear, but I also heal quickly.
I do agree it's one of those things were you can prepare as much as you like but it may still happen, doesn't hurt to prevent, but don't be too hard on yourself if you still tear.
From my own experience though if you do tear, minimum of 2 showers a day, gentle drying - ultra thin pad while you dry the rest of yourself can help, and only drink water, even the slightest acidity comes out your wee and ouch!
Anyone tried the Epi-No? I've heard it helps, but haven't heard anything directly from anyone who's actually used one.
Yep im sure everyone is different that why she said its more likly but not a given, i questions how much this would be true, after all everyone is different as is every pg and every birth. x:
What is an Epi-No?:
I tore pretty badly in the birth canal with dd2, it was a fast labour and we think i wasn't fully dilated. No one was expecting me to push so we don't know for sure. She was very little at 2.75kgs.
This time my waters broke on their own and we knew it was going to be fast so the midwives were prepared and could see I was fully dilated. I was able to deliver a 4.4kg baby with no tear this time.
Making sure your body is ready and that you relax into the ctx rather than tensing up seems to make a big difference.
with my last bub I had a 2nd degree tear, but my second stage was only 2 minutes, so nothing had time to strech gradually, lol. I had stiches, but healed very quickly!
It's a little pump (almost like a blood pressure pump) that has a balloon on the end of it. You insert the balloon and pump to it just starts to sting and leave it there for ten minutes. Each day you try and expand it a little more until you get to 10cm and then you just practice pushing it out. I've heard it reduces tears, but haven't tried it myself.:
Is that safe...the Epi-No? I ask because I'd be awfully scared of sticking something up the business end of things at any stage - especially something that could theoretically POP and push air into you uterus.
That, is a very good point. Hadn't thought about it. I'm guessing though, the balloon would be fairly thick and it would be unlikely to pop - but that's still a risk.:
My OB recommended it. I've heard conflicting reports about its effectiveness however - on the whoel I think it's probably a marketing scam. I used it but then ended up with an episiotomy anyway :rolleyes:
The biggest risk with using it, as I understand, is you try to stretch too much and tear pre-birth. You will stretch better during labour due to the hormones.
Can you imagine - tearing a few days before birth - and then birthing - eeks... I'm getting the sense that as much as we wish we could do something to prevent this, it's mainly luck in terms of our individual elasticity! (putting aside interventions that can increase the risk)
check out this web link re high doses of vitamin C, but bear in mind your ob will probably just dismiss it as it wont fit with their medicalised view of things..
its an old article but i doubt much research has been done on it since then - why would the medical profession want to when it makes no money for them? sorry i have a pretty pessmistic view of doctors unfortunately.
food for thought anyway.
i wouldnt do what the article suggests without consulting a naturopath though, and plan to discuss it with my naturopath at appointment next week. with vit C as it has a laxative effect, you would need to build up gradually.
ive also read water birth is good for preventing tearing, and as others have mentioned already - perineal massage.
http://happybub.com/content/view/55/71/1/3/
Yeah, you're probably about right bulie