3rd Trimester

Wondering about a possible correlation between epidural and tearing?

My first was born via c-section (so obviously no perineum tear) and I didn't tear with my second (VBAC). I had an epidural and even though I could feel the contractions to push, I wasn't in real pain, and wonder if maybe that is why I was able to have slower/more controlled pushes (since not driver by intense pain).

My sister who had all her 3 children drug free, tore each time, and she claims that when you get to the pushing, you are so ready to be done that you tend to push harder and not really have to will/desire/energy to take it slowly.

I'm sure there is no rule to it and that women tear/not tear with and without epidurals, depending mostly on baby's size/head circumference....etc. But as I am considering going drug-free this time, I wanted to hear what you guys thought.



Re: Wondering about a possible correlation between epidural and tearing?

  • hmmm....I've had an epidural and needed a few stitches due to being too tired to push efficiently...(super-long labor, many complications)...i personally think it's either that you're equipped to pass the baby without stitches or not.
  • I have had 2nd degree tears with both of mine.  I had an epi with both.

    The first baby was a preemie but required a vacuum extraction that caused it to be super fast and furious.  She was only 5 pounds 1 ounce but I still had tearing.

    My second baby was full term and 9 pounds 11 ounces.  It was controlled and I was pushing effectively but he was HUGE.

    I would think that baby's size, your body, and whether you need any intervention have more to do with tearing than anything else.  If you google search journal articles you might be able to find a study on the correlation.


  • this says there is more than 3 times the percentage of tears with an epidural

    ETA. Also, IMO I don't think you're going to get a very good idea of what the general consensus is. Generally what I've found, is that people only take the time to answer if they really agree or disagree. You should post a poll for second time moms, you might get a better idea of actual answers because more people will respond.

    That's just what I think though. 


  • I had a 2nd degree tear. I did have an epidural, but it didn't work. It still took me 2 hours to push her out though.
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  • This is my first, so I don't know from my own experience, but one of my girlfriends swears that the epi is the reason why she tore so badly and needed so many stitches.  I think it has more to do with your own anatomy and the size of the baby.  But that is just my opinion.
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  • I had an epidural with my DS and I was given an episiotomy and I ripped on top of it. Not fun. They were in a rush to get him out though, his heart rate dropped from 150 to 73, so this is why they gave me an episiotomy.

  • I had an epi but it wasn't "active" when I was pushing. I also had to help via vacuum which slipped off and that's when I tore.
      Either way you decide, you need a skilled person at the other end to guide your baby out to help prevent tearing.  My doctor explained it like this.  When you have the epi, your pushes are not as urgent because you are not feeling the full force of the labor pains.  So many women do not push as hard.  This can enable your doctor to slide the baby out a little more gently.  And this in turn can lead to less tearing.  However, with natural birth even though you are probably pushing harder, your doctor should be able to work with you and help prevent much tearing.  My second came fast - under two hours from first contraction to holding him in my arms.  My doctor said that for most of my pushing (I only pushed three times) he was actually providing a little counter pressure to keep him in.  If he had let me push him out as hard as I was pushing, I would have torn open.  
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  • I had an epidural with DD1, who was 8lbs 7oz.  I only had to push for 12 minutes and ended up with a tiny first degree tear.  The cord was around her neck and I got the tear, while the doc was unwrapping it.
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  • I had an epi and had some tearing.  It wasn't too bad, but I did have tearing that needed stiches.
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  • We actually just talked about this in our childbirth class today (hypnobirthing). She said tearing is generally a 50/50 chance, but that she thinks more tearing happens with epi's because you can't feel how hard you are pushing vs natural when you can back off a bit if it feels like too much - with the hypnobirthing, they also don't have you hold your breath, so that helps decrease the tearing i would think..lets your baby come down more gently so you're not pushing as hard against the pelvic floor.

    More importantly, the teacher said kegels and doing squats to stretch our your hips is helpful to prevent tears. Like have your DH hold your hands while you squat down to the floor and rock back and forth a bit, and eventually your hips will stretch out a bit and give more room for the baby.

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  • I had an epi with my first and I had no tearing. She was not a big baby, but definately not tiny either at 6lbs 10 oz.
  • I am pregnant with #3. I had an epidural with my first near the end of my 44 hour labor and I tore both outside and inside(huge tear in vaginal wall) and required 2 blood transfusions. With my 2nd I tore again, actually in the same spots just not as severely. I was induced and had an epidural that time too. I dont know if an epidural is in the cards this time but my dr beleives I will tear again. She said if it happens once it is likely to happen again. I dont really see where the correlation between epidural(pain medication) and tearing comes in.
  • Yes there is a correlation. Epi = tearing like at least 95% of the time.
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  • I am a first time mom so I don't have any personal experience.  However, I was talking with a friend about this.  She didn't have an epi and she tore, not a great deal but a little.  She said her pushes were very controlled and we have the same doc who told me something similar to a pp.  My ob tries to apply counter-pressure so things don't progress too quickly and cause tearing-although if you are going to tear and I think you will tear (but that's just my opinion I don't really know).
  • I had an epidural and tore with DD. I think it was just because she was big because I really only pushed a few times and she was out.

    DD was 8lbs 10oz.

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  • I had the epi w/no. 1 and didn't tear at all. At one point the doctor said he might have to cut me (ugh) but it ended up not being necessary. I think it was all due to how much peri massage he was doing the whole time...not pleasant to think about but w/the epi it wasn't something that was painful - just kind of weird feeling. Baby no. 1 was 7 lbs 6 oz...I was so thankful to not have stitches! FWIW, I've never heard the epis being connected to tearing...I know woman who have had drugs and haven't and who have torn both ways.
  • image JCragg:
    Yes there is a correlation. Epi = tearing like at least 95% of the time.
  • image JCragg:
    Yes there is a correlation. Epi = tearing like at least 95% of the time.

    Really? I am not a dr. but in all the things I have read about pros and cons of epidurals and the paper you sign at the hospital telling you risks of getting an epidural nowhere does it say 95% chance of tearing. This actually seems made up to me. Like I said I am no dr. I know why i tore and it has to do with the way my body is built. Not the fact I chose to have my pelvic area and legs numbed. I am pretty positive on this.

  • I had an epi but it was turned off pretty much right after I started pushing. Regardless I was still pretty numbed but had no trouble backing off and slowing down when told to. I did not tear but I did need an episiotomy to get the head out. My doctor did it because he thought it was that or a vacuum. Lucky the episiotomy was enough.
  • I've had one birth with an epi and one naturally - no tearing with either.  It had nothing to do with the medication or lack thereof, but had everything to do with a wonderful MW who coached me through pushing and helped me breathe through it so I wouldn't tear.  She also did a lot massaging down there to help stretch me out.

    My babies were 7 lb. 10 oz. and 8 lb. 11 oz. -  so size doesn't really have anything to do with whether or not you will tear IMO.

  • I had an epi with DS and 2nd degree tear that required lots of stitches. I didn't actually push him out- he shot out on his own (you can google my birth story). So I think if I had pushed him out when I felt the urge to push vs "laboring down" with an epi, I might not have torn so badly.
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  • image makclair:
    I had an epi with DS and 2nd degree tear that required lots of stitches. I didn't actually push him out- he shot out on his own (you can google my birth story). So I think if I had pushed him out when I felt the urge to push vs "laboring down" with an epi, I might not have torn so badly.

    I think this is the general theory about epidurals and tearing. Without one (usually) your body will tell you what to do. Push more, push less, this position, that, etc. 

    I wish I could find some studies on it. 

  • Here's a study for ya:

    DS1: 8lb 4oz, I tore

    DS2: 7lb 5oz, no tear

    Epi's for both.  The fact of the matter is, DS1 was almost an entire pound larger than DS2, my body is not that big and just didn't stretch that big. 

    Bigger baby = bigger tear.  Go figure. 


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  • I had an epidural with DD and tore. My mom had my sister and I med-free and she didn't tear with either of us.
  • I had an epi and tore.  DS had shoulder dystocia, so they did do an episiotomy, and I had a 3rd degree tear on top of that.  Not sure what it would have been like had he not had the dystocia.

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  • I can see a correlation between epidurals and pushing less effectively. Pushing less effectively may mean a woman is tightening up instead of letting her tissues relax, which is going to mean a higher likelihood of tearing too.

    One thing that really helped me to learn when pregnant with my DS was that the majority of the force that a baby is pushed out with is actually from the muscles of your uterus, not your pushing. You can't "push" with your uterine muscles - your body does it on its own. The pushing you do, or try to do, is only about 30% of the force acting against your baby, and your uterus is doing about 70%.

    If you're pushing ineffectively, or can't feel what you're doing, you may just be tensing up against the work your uterus is doing.


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  • image JCragg:
    Yes there is a correlation. Epi = tearing like at least 95% of the time.

    Yeah, I'm going to need some support to this asinine statement. 

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  • image lanie30:

    image JCragg:
    Yes there is a correlation. Epi = tearing like at least 95% of the time.

    Yeah, I'm going to need some support to this asinine statement. 

    Thank you. This was my point earlier. Foolishness really.

  • My sister has had 3 babies, all without an epidural. 

    Baby #1 - 6 lbs 8 oz and a tear (I have no idea how big, but required stiches)

    Baby #2 - 6 lbs 11 oz and a tear (again, I don't know how big, but again, needed stiches)

    Baby #3 - 8 lbz 10 oz and no tears, but a different doctor who coached her through her pushing.

    I have had one baby, with an epidural

    Baby #1 - 6 lbs 10 oz and a small 2nd degree tear that needed like 4 stiches I think.  I could feel the urge to push though and knew when to push and when not to.

    I don't think you can say that epidurals cause tearing.  I think it's more the doctor and your pushing method.

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