Waterbirth and tearing

JNoelleE · March 2012

I have always heard that water birth can help prevent tearing because the water softens the skin making it easier to stretch. However, when my mother was asking me lots of questions about it today out of curiosity, she brought up a good point. If you are underwater they may not be able to see everything as well to tell you to stop pushing to prevent tearing, and do the perineal massage. That when you are out of the water they can see when you are about to tear because the skin becomes thin and turns whitish, and they will say to stop pushing and massage the area. I know my hospital does this routinely but how can they do that if you are in the tub? Anyone know or have first hand experience about this?

I will ask my MW about it but wanted to get some of your opinions if you have personally gone through it!

Also, my mother was very concerned with the cleanliness of the tubs- how they are cleaned after each use and if the MW got into the tub with you it could contaminate... haha. I said I'm sure they clean it like everything else and I don't think the MW gets in the tubs with their feet all bare or anything, (If they even get in ever) ... She doesn't understand how they can help you get the baby out if they aren't in the tub with you, either.

I need to show her some videos on waterbirth, but any help in explaining all this would do me some good!! Thanks!!

annabelle.27 · March 2012

My tub came with a one-time-use vinyl liner that we put in before filling it up.

I had a waterbirth and didn't tear. The midwife didn't have any problem seeing my perineal area, or reaching to do any checks, although she didn't do a perineal massage.

My midwife never got in the tub. When the baby was coming out she reached in and pulled him out of the water.

I think your mom is overthinking this, lol. None of these things seemed like issues during my labour or birth.

barnwife · March 2012

A. was a waterbirth. I didn't tear, just bruised. My midwife hasn't told me to stop pushing with either birth. That being said, with J. we needed to get him out for various reasons. It was a "birth the head with this contraction or interventions" situation.

This time I just started pusing with a contraction and it ended up being the one. No one really expected that.

As for massage, I hate it. I hate being touched in that area during labor. It just bothers me. So no clue there.

A. was born at home in the fish kiddie pool that everyone (rightly) says is great. So cleanliness isn't a problem, as I am the only one using it. My MW didn't get in. I guess she would have in an emergency. I am not sure why that would be necessary in an uncomplicated birth.

My midwife had no issues reaching into the tub to guide/catch baby.

Sawyerplus1 · March 2012

I agree with above poster that your mom is overthinking it. Is she supportive? Or possibly looking for ways to change your mind?

I had a water birth with DS. I pushed for an hour and had only a tiny tear. My MW was helping to coach me as I found it difficult to properly direct my pushing, but I don't remember her ever stopping me to slow things down, etc. I also remember them using a flashlight to see into the water, but I think they (the nurse and MW) could tell what they needed to by feeling. On the push where I pushed DS out, they told me to grab him and lift him up, so they didn't catch him.

And I'm quite sure the tubs were clean enough. And NO my MW did not get in. I think that only happens in very, very rare situations. On my birth center orientation the MWs even discouraged husbands from getting in. They said they could if they wanted to, but why would they want to?! (alluding the often yucky quality of the water)

I think that tearing, or not tearing, isn't a guarantee either way. Sometimes baby comes too fast no matter how you try to slow it, and sometimes the pushing urge is too strong to ignore despite the risk of tearing.

LesleyT · March 2012

I'm going to be a FTM so I can't say about the tearing- but my tub comes with a new liner- and no one intends in getting in the tub with me; and I don't plan on any perineal massage going on either. No thank you. It'll be a "hands off me" kinda deal- just the way I like it and want it ....well, DH can massage my back and neck

I agree with the others- I think your mother needs to just be supportive of your decision and not get so involved and over think this - I'm sure she means well

JNoelleE · March 2012

Sawyerplus1:
I agree with above poster that your mom is overthinking it. Is she supportive? Or possibly looking for ways to change your mind?
I had a water birth with DS. I pushed for an hour and had only a tiny tear. My MW was helping to coach me as I found it difficult to properly direct my pushing, but I don't remember her ever stopping me to slow things down, etc. I also remember them using a flashlight to see into the water, but I think they (the nurse and MW) could tell what they needed to by feeling. On the push where I pushed DS out, they told me to grab him and lift him up, so they didn't catch him.
And I'm quite sure the tubs were clean enough. And NO my MW did not get in. I think that only happens in very, very rare situations. On my birth center orientation the MWs even discouraged husbands from getting in. They said they could if they wanted to, but why would they want to?! (alluding the often yucky quality of the water)
I think that tearing, or not tearing, isn't a guarantee either way. Sometimes baby comes too fast no matter how you try to slow it, and sometimes the pushing urge is too strong to ignore despite the risk of tearing.

No, she's super supportive. She was just confused on how the MW could see properly if you were about to tear and how she would be able to do a massage to help prevent it. She hasn't had a baby in 25 years and isn't familiar with water births. She just had some questions!

I know people can tear either way, but when you are out of the water sometimes they will say to stop pushing, so they can massage the area to help you not tear, then they will guide you when to push again. I know it can be hard to not push and sometimes the baby is coming fast, but they still try to help. She was just confused on how they can see to do that if you are in the tub under the water, and it made me wonder too!

pixieprincss · March 2012

It sounds like your mom (though she is supportive) is coming at this with an OB/medical mentality rather than a MW/nature-knows-best mentality. I'll generalize and say that the CPM mentality is that a woman's body knows what to do without coaching.

For example (albiet I am saying this as someone who has not yet lived through a MW delivery but is under MW care for this PG), barring a crisis situation, if mom wants to stop pushing, she stops. If the MW sees mom is straining beyond what she probably can handle, she'll call you on it. My MW will only provide any sort of coaching if I ask for it. Otherwise, it is up to me to call the shots on what I want advice on or not.

Not everyone advocates perineal massage. It is not universally seen as beneficial. A low-intervention mindset on this is that (optimally) our bodies are designed to stretch and deliver babies without being messed with, and if the body needs to tear to get baby out, that is not necessarily a bad thing. Small tears tend to be no big deal, and most extreme tears are a result of coached, extreme pushing, not a mom pushing to the degree her body indicates. Also, I suppose there is nothing from stopping the mom from doing the massage on herself if desired.

I plan to catch my own baby in the water. Again, this is something that a mother doesn't necessarily need help with. Nature tells babies how to get out all on their own. This something that is very different from the image we have of doctors "delivering" babies, and I wonder if those images and the role of the doctor doing the work vs. the mom doing the work are the things that are on your mom's mind.

JNoelleE · March 2012

pixieprincss:
It sounds like your mom (though she is supportive) is coming at this with an OB/medical mentality rather than a MW/nature-knows-best mentality. I'll generalize and say that the CPM mentality is that a woman's body knows what to do without coaching.

For example (albiet I am saying this as someone who has not yet lived through a MW delivery but is under MW care for this PG), barring a crisis situation, if mom wants to stop pushing, she stops. If the MW sees mom is straining beyond what she probably can handle, she'll call you on it. My MW will only provide any sort of coaching if I ask for it. Otherwise, it is up to me to call the shots on what I want advice on or not.

Not everyone advocates perineal massage. It is not universally seen as beneficial. A low-intervention mindset on this is that (optimally) our bodies are designed to stretch and deliver babies without being messed with, and if the body needs to tear to get baby out, that is not necessarily a bad thing. Small tears tend to be no big deal, and most extreme tears are a result of coached, extreme pushing, not a mom pushing to the degree her body indicates. Also, I suppose there is nothing from stopping the mom from doing the massage on herself if desired.

I plan to catch my own baby in the water. Again, this is something that a mother doesn't necessarily need help with. Nature tells babies how to get out all on their own. This something that is very different from the image we have of doctors "delivering" babies, and I wonder if those images and the role of the doctor doing the work vs. the mom doing the work are the things that are on your mom's mind.

No, they are not on her mind. She had all 4 of her babies with a midwife, naturally. She was just wondering how they can help prevent you from tearing if it looks like you are going to, if you are under water.

lostaspen · March 2012

I had a water birth with my second (c/s with first), and had a minor 3-stitches tear.

flyer23 · March 2012

I pushed in bed with perineal massage with DD, and tore. No one ever told me to stop pushing to prevent tearing, and obviously the perineal massage didn't help, either. It's definitely not universally accepted as a way to minimize/prevent tearing.

Then I had a waterbirth with DS, and tore. I actually can't remember if my midwife did perineal massage or not. She might've. She might not be able to see quite as well in the tub, but there's no reason why she can't do perineal massage anyway.

For cleanliness, DS was born in our bathtub at home. I daresay there are fewer germs in there vs. in the average hospital room Wink My midwife only reached in with her (gloved) hands to pull him out.

Cassaundra.M · March 2012

I had a water birth with my daughter. I was so happy to be able to get in the tub at 7cm! The water was relaxing and my husband was able to rub my shoulders and wring water on me. It was pretty much the only time while in labor I sat down (total 30 hours) and felt comfortable. No one got in the tub with me at any time.

To answer your mother's question about how they get the baby out - the tub we used is oval in shape. It was very easy for the midwife to sit/squat at the side. I sat facing the short width of the tub and put my feet against the side (when pushing). Once it was time, she was there to "catch" the baby. As far as being clean...right after the birth, they drained the water and washed me off immediatley. A lot less messy than a "bed birth."

I would HIGHLY recommend water birth...however, I don't know that it helps you with tearing. I tore, but that was because after being in the tub for only 15 minutes, I was getting the urge to push (remember 7cm). Wanting to do what my body was telling me, I didn't wait...and pushed her out within three tries! Needless to say, I won't do that again and will wait to allow the area to stretch, then push.

Now we are pregnant with twins (cannot do water birth) and I'm really bummed that I can't go back to the birthing center and the tub! Good luck!

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