# tearing



## kosh

hi all, i'm very new to all this, so please bear with me! :flower:

i was reading a thread here (Q's to ask MW in an interview) where someone said they would ask: _ "how often do her women keep an intact perineum? (tearing/being cut is a major fear of mine)." _

this is a big fear of mine too, but had no idea it could be somehow avoided/prevented. i thought it was just a consequence of the baby's size and your body built. 

could someone shed some light please? 
thanks!


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## chuck

Positioning, coached/natural pushing, epidural etc all contribute to liklihood to tear.

As far as I know birthing in water and perineal massage reduce tearing -but only anecdotally. I think birthing in water it's more a matter of positioning and relaxation that reduces tearing.

Birthing in lithotomy (on your back legs raised) increases tearing - you push harder and at a crazy uphill angle. Birthing upright/all fours better. But you gotta do what feel right.

Coached pushing (do you have a pain? deep breath, chin to chest 1, 2, 3 ...) BAD all around, it works against what your body might be trying to do and you may force baby out faster than your poor perineum can stretch. Pushing when and for however long you get the urge - better.

Epidural can increase rates of perineal trauma as you cant feel what's going on properly and it increases the need for further interventions such as episiotomy/ventouse/forceps.

All that aside, you could massage, give birth on all fours in a pool breathe your baby out yourself and have a smallish baby and sill tear up dow in and out ...a lot of it is luck of the draw.

I birthed an average 6lb 11oz baby in stirrups and without a shred of perineal massage and had not even a graze to my perineum, 1 tiny tear to my labia so small it didnt need stitching...lucky.

Dont be afraid, you always remember the stories of tears but rarely the hundreds/thousands with none!


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## numum

Hey kosh I agree with chuck it seems the statistics say luck of the draw but for what its worth from my own experience the WORST thing you could feel at that moment is fear so i strongly advise you to work on any fears you have relating to labour and birth so they don't get in the way of the best day of your life. I hypnobirthed and one of the sessions with the practitioner is all about fear release and i found it really helpful, i got rid of fears i didnt know i had!
I know i just said luck of the draw but actually i firmly believe in my own case that perineal massage(every day for 6 weeks before the birth) and gentle pushing helped me birth my 9lb baby with no tearing. 
good luck! x


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## sophisticat

I gave birth in water, on all fours and pushed when it felt right - midwife never coached me to push and tried my best to "breathe him out" while he was crowning - and I still had a second degree tear. Maybe my baby's head is just massive heh. Sorry, this is probably not what you want to hear, but I agree that getting rid of any fears about birth beforehand is the best way to have a positive experience.


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## chuck

I was quite slow to get Stanley out, I have no idea how long I was pushing for (still waiting for my notes to give me an idea) MW reckons that was part of the reason I didnt tear.


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## numum

chuck said:


> I was quite slow to get Stanley out, I have no idea how long I was pushing for (still waiting for my notes to give me an idea) MW reckons that was part of the reason I didnt tear.

me too my midwife said the same

oh also lo's head was 36cms so big head no tear!


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## chuck

I wish i knew how long I was pushing for, it felt like forever at the time, but yet again as I was living contraction by contraction it may not have been.

HUbby has no idea he was in and out of the room or had his head between his knees the poor dear!


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## lynnikins

i got cut with ds1 caus of the ventouse and tore quite alot with ds2 but he did kinda fly out lol im hoping to "breathe" this baby out and let things stretch and avoid another tear but with my scars thats gonna be tough and my habit of having BIG babies lol


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## Kess

That quote's from my post :). I have done a fair bit of reading and talking to people about this and my plans are:

Perineal massage - have been doing this every night for weeks. The main study I can find on it showed a marked reduction in tearing in primiparae (but oddly enough not in multiparae) who did it regularly from 36 weeks. I use KY jelly to get my thumb in, but then also apply a small amount of vitamin e oil directly to my perineum. I think the biggest benefit is probably getting yourself used to the burning sensation so you don't panic and push too fast during crowning.

MW will put a warm compress on the area during crowning.

Not pushing during crowning.

Positions like all fours or, more likely, leaning over the birth ball or couch, that help protect the perineum.

Keeping as relaxed as possible.


I know nothing is certain, and I might well tear anyway depending on how big his head is etc, but this way I can go in confident that I've done all I can to avoid it, and that allows me to relax more.


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## kosh

thank you so much ladies for all your replies! :flower:
i've got lots to learn!


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## kosh

chuck said:


> *Coached pushing *(do you have a pain? deep breath, chin to chest 1, 2, 3 ...) *BAD all around*, it works against what your body might be trying to do and you may force baby out faster than your poor perineum can stretch. Pushing when and for however long you get the urge - better.

you see, i had no idea about this....


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## kosh

numum said:


> Hey kosh I agree with chuck it seems the statistics say luck of the draw but for what its worth from my own experience the WORST thing you could feel at that moment is fear so i *strongly advise you to work on any fears you have relating to labour *and birth so they don't get in the way of the best day of your life. I hypnobirthed and one of the sessions with the practitioner is all about fear release and i found it really helpful, i got rid of fears i didnt know i had!
> I know i just said luck of the draw but actually i firmly believe in my own case that perineal massage(every day for 6 weeks before the birth) and gentle pushing helped me birth my 9lb baby with no tearing.
> good luck! x


totally agree, and i know that's my worst problem! 
any suggestion how to get rid of your fears? i know i have 100's! :dohh:
so far, i'm just trying to face them and see if they became less scary...


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## kosh

Kess said:


> Perineal massage - have been doing this every night for weeks. The main study I can find on it showed a marked reduction in tearing in primiparae (but oddly enough not in multiparae) who did it regularly from 36 weeks. I use KY jelly to get my thumb in, but then also apply a small amount of vitamin e oil directly to my perineum. I think the *biggest benefit is probably getting yourself used to the burning sensation* so you don't panic and push too fast during crowning.

just googled 'perineal massage'...glad i did, otherwise, my 'massage' would have been totally useless :haha:
as i said, i have too many things to learn...


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## NaturalMomma

You can do perineal massage prior to birth. During pushing you can have someone massage or hold a warm cloth on your perineum. Being in an upright position helps a lot. And push with the urge, not directed pushing.


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## Kess

kosh said:


> Kess said:
> 
> 
> Perineal massage - have been doing this every night for weeks. The main study I can find on it showed a marked reduction in tearing in primiparae (but oddly enough not in multiparae) who did it regularly from 36 weeks. I use KY jelly to get my thumb in, but then also apply a small amount of vitamin e oil directly to my perineum. I think the *biggest benefit is probably getting yourself used to the burning sensation* so you don't panic and push too fast during crowning.
> 
> just googled 'perineal massage'...glad i did, otherwise, my 'massage' would have been totally useless :haha:
> as i said, i have too many things to learn...Click to expand...

It is a bit of a weird word for basically sticking your thumb tips inside your ladybits and stretching! I think if they called it anything more accurate they might put people off... :haha: One thing if you're going to do it, though, is not to get discouraged if it's hard at first. I found it difficult to even get a thumb in without pain the first couple of times (and freaked out about how am I going to get a baby out if I can't get a thumb in!), but it got easier quite quickly.


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## moodle

You could get this nifty gadget https://www.epi-no.co.uk/ I'm not really a fan of gadgets and gizmos for childbirth but all the women I know that have used this have had very gentle births with no tearing, sometimes a little graze but nothing more. It seems to have been more helpful than perineal massage as I think it takes the fear of what it will feel like away.


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## Mum2b_Claire

I didn't birth in water and kept an intact perineum. I don't really know why, as I definitely had coached pushing, I did give birth upright on a birthing stool though.


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## VickieLP

Wow I have soooo much to learn - All these different words are another language.... 
perineal massage??!! Best google that one!!


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## lynnikins

moodle said:


> You could get this nifty gadget https://www.epi-no.co.uk/ I'm not really a fan of gadgets and gizmos for childbirth but all the women I know that have used this have had very gentle births with no tearing, sometimes a little graze but nothing more. It seems to have been more helpful than perineal massage as I think it takes the fear of what it will feel like away.

this has intrigued me lol i know already im likely to be having a big baby so gonna look into this


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## chuck

Kosh..read this article it's from the Royal College of Midwives (so people who know what theyre on about) about coached pushing otherwise known as the valsalva technique

its a link to a word doc

https://www.rcmnormalbirth.org.uk/E...ssetID=88450&type=Full&servicetype=Attachment


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## lynnikins

if i thought my mw was likely to use directed pushing id print this off and watch her read it lol, good for giving to OB's who like to push for quick delieverys


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## chuck

I didnt get the coached pushing but I did get a lot of encouragement which is a good thing, it was hard! Really hard as they put me in stirrups but being told how I was doing was good and being told calmly was important, no yelling and shouting like I was at some boot camp.


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## Kess

moodle said:


> You could get this nifty gadget https://www.epi-no.co.uk/ I'm not really a fan of gadgets and gizmos for childbirth but all the women I know that have used this have had very gentle births with no tearing, sometimes a little graze but nothing more. It seems to have been more helpful than perineal massage as I think it takes the fear of what it will feel like away.

I'm slightly gutted; I heard of this around a month ago, but decided it was too expensive. Now I think it's probably too late to make a difference. :cry:


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## numum

Hey kosh i think you're on the right track face the fears and do whatever practical things you can to address them. If you can talk them through with someone supportive and just keep telling yourself all the things you've heard are other peoples stories and your birth will be as unique as you are. Just make sure you havent shoved anything to the back of your mind undealt with and also realise its normal to wonder and be unsure-you'll feel that way all the time as a mom!


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## kosh

moodle said:


> You could get this nifty gadget https://www.epi-no.co.uk/ I'm not really a fan of gadgets and gizmos for childbirth but all the women I know that have used this have had very gentle births with no tearing, sometimes a little graze but nothing more. It seems to have been more helpful than perineal massage as I think it takes the fear of what it will feel like away.

wow, that's interesting, i'm not fan of gadgets either but i think i might get this one. thanks! :flower:



edit: pricey though...


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## kosh

numum said:


> Hey kosh i think you're on the right track face the fears and do whatever practical things you can to address them. If you can talk them through with someone supportive and just keep telling yourself all the things you've heard are other peoples stories and your birth will be as unique as you are. Just make sure you havent shoved anything to the back of your mind undealt with and also realise its normal to wonder and be unsure-you'll feel that way all the time as a mom!


you know, i think i've already started to feel less scared! i think the most difficult/scary thing for me is the unknown, so, as you said, reading people's stories and advise, and also knowing that i *can *do things to feel more in control really helps.
thanks!


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## numum

:thumbup: good woman! x


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## madasa

kosh said:


> hi all, i'm very new to all this, so please bear with me! :flower:
> 
> i was reading a thread here (Q's to ask MW in an interview) where someone said they would ask: _ "how often do her women keep an intact perineum? (tearing/being cut is a major fear of mine)." _
> 
> this is a big fear of mine too, but had no idea it could be somehow avoided/prevented. i thought it was just a consequence of the baby's size and your body built.
> 
> could someone shed some light please?
> thanks!

There are lots of factors :) Just "the way you are built" is one, maybe.... the size of the baby's head is another, to a degree, but the head DOES mould to "fit" your body. 

I am fairly sure it's more about perineum support, whether you are in water, whether you have had a baby before, whether you have done any perineal massage, whether you are coached during pushing, whether you have an epi, what position you are in, whether you are relaxed and what your environemnt is like.

"Envirment" - last but NOT least! It CANNOT be understated, how important environment is! 

Ina May Gaskin talks about the fact that we women, we are convinced from a young age to believe we have shoddy crotches. It's true, we are! But for the most part, it's a lie! *We are well designed for birth.*

Think about a man's penis. Can I say that? Does it get star-red out?? Anywho. Think of it when it's soft and floppy. Now, imagine you get the end of it and YANK IT to be as long as it would be when he has an erection. That's going to hurt, right? Probably going to cause damage, right?! never going to be the same again?? Legit concern. 

So how come men are not scared of getting an erection? How come they don't worry that their skin will tear? How come they don't think "after it's got that big, it'll never be the same again. It'll be ruined. Everyone will be able to tell, unless I have surgery to fix it."

They are DESIGNED to get that big, that's why!

Pssst! Guess what? Want to know a secret? SO ARE WE!!

When a man gets an erection, he gets a rush of blood to his penis. That's what makes it get full and long and hard. It doesn't hurt a bit! In fact, it happens as easy as falling off a log. He LIKES it. Feels all tingly :D

WE get a rush of blood too. Our engorgement happens on the inside! Usually, under normal circumstances, if we are relaxed, comfortable, if we feel SEXY and "tingly" and goddess-y.... We will get engorged and we will get huge and accommodate the baby with minimal to no damage. hey, it can even feel GOOODDD!!!

Now, you put a man in hospital. Make sure there are bright lights and people come in and out all the time. Give him a time limit to achieve an erection and then have sex, and achieve an orgasm. Have someone come in unanounced at regular intervals to measure his penis, check how lubricated it is and make a note about this in a chart. Threaten him with all kinds of procedures to augment the process if he "fails to progress". (Yeah. I am hearing you. They'd never treat a MAN like that, would they ;) )

So, like I said. Environment canNOT be understated. It plays a MAJOR role, IMO, on whether or not birth is comfortable and whether or not you tear.

There endeth my novel, AMEN! :)


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## calliebaby

Honestly, the pushing part of it felt AMAZING to me. It was such a relief after the contractions. I tore and even that didn't hurt that bad. It felt a little warm. 
I would have loved to push longer, but he was out after 14 minutes.:haha: (I know, I'm crazy for saying that).
I did it without any pain relief and it was all manageable. Just find something to focus all your attention on and meditate on it. You will do fabulous!!!:thumbup::hugs:


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## kosh

madasa - i loooove your post, thanks!!! :thumbup:


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## kosh

chuck said:


> Kosh..read this article it's from the Royal College of Midwives (so people who know what theyre on about) about coached pushing otherwise known as the valsalva technique
> 
> its a link to a word doc
> 
> https://www.rcmnormalbirth.org.uk/E...ssetID=88450&type=Full&servicetype=Attachment

very interesting chuck, thanks for this.
now, i'm hoping for a waterbirth at a midwife led unit, what can you (or I!) actually do if they try to coached you?


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## madasa

Your dh should VE briefed beforehand to ask them not to, IMO. Arguing with MWs yourself is nOt going to be easy or effective at that point.


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## violetsky

My lo came out with her hand over her face, and it was her hand/arm that tore me as she came out. (2nd degree tear, but natural vaginal labour, and delivery, all pain relief free) I dont think you can really do anything to prevent situations like that :)


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## madasa

True, sometimes it's just going to happen! But you can influence it, and I think this is encouraging and empowering to know.... I know it was for me :)


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## chuck

kosh said:


> very interesting chuck, thanks for this.
> now, i'm hoping for a waterbirth at a midwife led unit, what can you (or I!) actually do if they try to coached you?

Tell them to shut up!

If they are saying something you dont like or asking you to do something you dont like tell them.

Put it in your birth plan that you do not want coached pushing, I think it's less common now anyway many more MW's will let you push when you feel the need and give more encouragement than anything else.

Make sure your birth partner knows what you want/don't want, by the time you get to pushing you may not be in a place to challenge what is happening because you'll be concentrating so had on the task at hand it's easy to get swept along in what's being done.

I ended up in stirrups because I was not able to move myself or even ask to be in another position (I really struggled to move/talk come the end I was very within myself)and hubby wasn't my advocate so didn't challenge the decision either.


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