tearing

[kosh]

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

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!

 

[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!

 

[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

 

[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.

 

[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.

 

[numum]

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!

 

[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!

 

[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

 

[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.

 

[kosh]

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

 

[kosh]

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....

 

[kosh]

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!
so far, i'm just trying to face them and see if they became less scary...

 

[kosh]

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
as i said, i have too many things to learn...

 

[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.

 

[Kess]

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
as i said, i have too many things to learn...

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... 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.

 

[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.

 

[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.

 

[VickieLP]

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

 

[lynnikins]

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

 

[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