Tearing?? — The Bump
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Tearing??

Anyone have ideas on how to prevent this?  I'm electing not to have an episotomy. 

Re: Tearing??

  • My doctor tried to massage me through it all but long story short - my little guy was just too big/broad and I had a 4th degree tear.
  • I would research having your husband (or yourself) do perineal massages during your pregnancy. It's supposed to help stretch out that skin before labor.

    I've also read to ask your nurse/dr/coach to put warm/hot washclothes in that area during labor and pushing as the warmth will help relax that skin.
    Also to ask them to apply baby oil as it will help the area stretch.

    Good luck!
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  • Perineal massage during pg.

    Hot washcloths, lots of lube (my doc used gel but many use oil) and perineal massage while pushing.

    My baby was 8lb 1oz and I had only 2 stitches (1 each in 2 different spots).
  • another reason for tears, aside from large babies (my guy was 9 lbs w/ a 17 in. head - still only ended up w/ a 2nd degree - healed in 2 wks just fine) is the position you are in when crowning.  water birth is an excellent option and REALLY helps soften the area - naturally.  oils, and perineal massage as well - my midwife helped put pressure on the area- but, really, tearing is totally normal. 

    in addition, think of going natural as this will help you 'feel' what is happening down there, as to not put too much strain on the area.  lastly, position is KEY and also how you push.  laying down is perhaps the WORST way to push the baby out - gravitational pull is key.  if you go w/ a midwife or a more 'open' hospital/practice, they will be more willing to let you move about freely and perhaps use a birth stool or allow your body to take over and be in the best position for the baby - your body decides that for you.  unfort., if going w/ a mainstream OB, they may not be willing to let you 'choose your birthing position' - if your hosp. allows water birth - DO IT!!! 

    here is a great resource for more on this:

    But My Vagina.

    Maybe you?ve heard that vaginal birth is bad for vaginas. The whole melon being squeezed through an opening the size of a lemon thing. The stretching. The virgin pelvis.

    There?s no data showing that vaginal birth in and of itself is bad for your body. But there is data showing that certain maternity care practices will do your bottom harm.

    • episiotomy ? This practice of cutting the perineum as the baby?s head crowns to widen the vaginal opening came into vogue in the 1930s, decades before any research determined if it was helpful. By the ?60s, most women were cut. Research began in the 1980s and has continued since, and now we know: routine episiotomy causes deeper tearing, longer and more painful recoveries, sexual pain, and incontinence. This surgical procedure is rarely, if at all, necessary, yet one-third of U.S. women who give birth vaginally are still cut.
    • bad vaginal tears ? It?s not uncommon to tear a little when giving birth vaginally for the first time. Ideally you don?t tear at all or you tear superficially and don?t need many stitches, if any. But it is possible to tear badly, the most severe tear extending into the anus. Not good. This is why it?s so important to have a provider who not only swears off episiotomy, but one who will help protect your perineum.
    • directed pushing ? Also called ?purple pushing,? this practice of asking women to hold their breath, count to ten, and PUSH! has been shown to increase the chance of a severe tear, along with incontinence and other undesirable consequences. The best way to avoid relying on the direction of others is to avoid or turn off immobilizing anesthesia, feel the urge to push, and give birth in an upright position with gravity on your side.
    • forceps and vacuum ? These instruments are used to hasten or achieve a delivery when pushing isn?t enough, and they are almost always accompanied by an episiotomy. Both are associated with more severe vaginal tears and incontinence. And either instrument can damage the baby?s head.
    • laboring supine ? When you?re on your back, the weight of the baby puts tremendous pressure on your pelvic floor, the muscle that?s essential for normal bladder function. You?re also compressing your vena cava, the major vein that keeps you and the baby oxygenated. Keeping upright and active is best for both of you.
    • pushing supine ? A.k.a. lithotomy position, or ?pushing uphill.? A Uruguayan obstetrician once said there is no worse position in which to give birth, save being hung upside down by the feet. Lying or leaning back while you push lengthens labor, delivers less oxygen to the baby, and increases the chance of pelvic injury.
    • fundal pressure ? This is when your birth attendant presses down on your abdomen (technically the top of your uterus, called the ?fundus?) while you are pushing. Like all of the above, this can be damaging, and it can also cause the placenta to detach prematurely. If your provider?s hands are anywhere, they should be supporting your perineum, not putting more pressure on it.

    A note about incontinence: Some studies have shown that women who give birth vaginally have more short-term urinary problems than women who give birth by cesarean. But these studies do not control for the damaging labor practices common in standard American maternity wards. To really examine the physical impact of vaginal birth itself, we?d need to compare women having cesareans to women having spontaneous, physiological, supported births. So far we have no such study.

    A note about size: it generally doesn?t matter. For the past century, physicians have tried various means to predict whether a woman?s pelvis was ?adequate.? They tried using a tool called a pelvimeter; they took X-rays (to the developing fetus?s detriment); they examined with their hands. But unless a woman has a physical deformity or a truly enormous baby (we?re talking more than 12 lb), nobody can really predict whether the pelvis is too small or the baby too big, because the pelvis stretches during childbirth.


  • chiming in -

    I just found this link to a study about laboring positions and tearing :

    https://www.jaoa.org/cgi/reprint/106/4/199.pdf

    It echoes sme of what momofivan wrote.
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  • My doctor was amazing and did a lot of massaging in between pushes.  I was lucky and only ended up with 1 1/2 stitches.  I think the only way to prevent it is to have a doctor that knows when to have you stop pushing and massage...but then again I think everyone's bodies are different and some people will just be prone to tearing.
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