Seeking reassurance

[misshollygolightly]

I'm due in about three weeks and finally realized that the part of giving birth that scares me the most is the idea of tearing/episiotomy/damage/pain in the perineal area. For some reason, this just really, really freaks me out! So, I'm wondering if any of you have some words of comfort for me. I'd love to hear from women who managed to give birth without tears/episiotomies, or who had one but it wasn't a big deal. I'd also appreciate advice on helping me cope with my fear and/or avoid tearing. (I recently heard you can do some kind of massage to help out, but I'm not clear on the details and I'm not sure it would do any good this late in the pregnancy.) PLEASE no horror stories! Thanks!

[Emmas Mom]

I didn't have an episiotomy with either of the girls, though I had a small tear with each....really wasn't a big deal. With our older DD the doctor who delivered her did perineal massage during labor, when we got to the "time to push" stage. She basically used oil (can't remember which type though) to try to stretch me out to help avoid tearing. She also said in her experience it was "better" to tear then get an episiotomy. I think for me the epidural definitely helped manage the pain....I wouldn't have had such a great experience with delivery without the epidural, but that's me. As it was, it was no big deal but I definitely remember being in your shoes! I was terrified of tearing & the possibility of getting an episiotomy. When you go into labor I'd tell your doctor your concern & ask if he/she can do a perineal massage to help out. Hang in there! Keep thinking about what you'll be getting in return for all the "stuff" you have to go through. ;)

[fortato]

I was TERRIFIED of tearing and episotomies... and I even skipped the childbirth class that showed the videos...

Something that I had to realize was that the baby was going to come whether I was ready or not.. if I tore, I tore... there was nothing I could really do about it.

I know that there are fewer and fewer episiotomies now, and you can ask for perenial (sp?) massage, that should help things... and not pushing too hard..although that's easier said than done.

Big Hugs, I totally understand how you are feeling. Remember- the pain is temporary, and the outcome is truly amazing.

[jhrabosk]

Oh! I totally understand your fear and think it's completely normal! It's very scary to think about pushing a big baby through a small (and sensitive) opening. Keep reminding yourself that your body is built to birth your baby and if your practitioner works to slowly stretch the area, it is meant to do just that.

I did have a small tear. However, I had an epidural, so I can't can't comment on how that might have felt without the pain medication. I didn't feel it during the birth and was still numb for the stitches. The recovery is uncomfortable (and, frankly, I was scared about the first time I pooped...which ended up being fine BTW), but it's going to be uncomfortable no matter what. Just be gentle with yourself. The hospital will likely provide you with a peri bottle to rinse with warm water, which feels very nice. You can get some witch hazel pads, which feel good too.

We did the peri massage during the last few weeks before my DD's birth. Don't know whether it helped, but it certainly can't hurt. I can't remember where we read a description of how to do it...do they have something in What to Expect? Basically, you (or your partner) uses a little oil/KY and gently massages/stretches the area.

You're going to be great! Best of luck to you!

[cvanbrunt]

No horror story to share. Doesn't it make you crazy when people feel like they have to share those with you? How could those possibley be helpful? But I digress....
Anyway,I had small tears with both of my girls. I had an epidural so I never felt it. I have no idea if you feel it with natural childbirth. To tell you the truth, I never really gave it any though post-partum. Everything is tender and you keep yourself clean, regardless.

[brittone2]

Most women do not *need* episiotomies, and there is a pretty good amount of research out there showing that tears actually heal better than episiotomies. Once they cut, there is a bigger risk of things ripping and a woman ending up with more perineal damage than if things had been allowed to tear more naturally in the first place. I would make it clear to my care provider that I do NOT want an episiotomy and would prefer to tear (you could specify this in a birth plan).

I'm relatively small-framed (5'2" and 115-120 when not pg). DS was 8lbs 4 oz and I only had a teensy little tear with him (2 stitches, no big deal at all, I swear). With DD, I had an even more rockin' midwife and DD was also 8lbs 4 oz. No tearing at all. I was packing up my room to leave the birth center about 2 hours after the birth LOL. I was ready to go home! ;)

Oil, perineal massage, positive visualization, and a good, patient caregiver are all great things. You might even consider a doula if you can swing it. I'm also a fan of avoiding pushing on your back. Sidelying w/ someone supporting your leg can really help (my midwife did this for DD's birth and I swear it was a huge, huge help in my not tearing).

Seriously, try to do a lot of visualization, positive imagery, etc. I know it sounds hokey but I think it can really help. Fear and pain are closely connected. I took Hypnobirthing and used Hypnobabies w/ DD's birth. Part of what they teach in Hypnobirthing is a fear release...picture your greatest fears, and then in your mind crumble them up and burn them/set them free. Yes, it sounds crazy, but I do think it helps many women.

[justlearning]

I haven't read any other responses but just wanted to encourage you not to worry too much. Before having my first, I was completely freaked out about giving birth and was a complete wimp when it came to pain. As it turned out, I was too dilated when I got to the hospital so I wasn't even able to get an epidural (which I had definitely planned on getting). I did get a spinal tap with some pain relief, but that wore off before my son came out.

Now, here's the good news...I got through the delivery just fine, even with my son being huge (10lbs 13oz) and needing an episotomy. But I didn't even feel any of the procedure (I was so happy to be holding my son then and glad that the labor pains were over) and I had absolutely no problems with the area afterwards. Right when I got home from hospital a couple of days later, I was going up and down our stairs and doing everything I normally would without pain. I did follow their suggestion to sray the area with water and then a certain type of spray (numbing, I think) whenever I used the restroom, and that seemed to work great. By the way, I never did any type of massaging before delivery in that area.

Best wishes on your delivery--I hope everything goes very well for you!

[brittone2]

I I did follow their suggestion to sray the area with water and then a certain type of spray (numbing, I think) whenever I used the restroom, and that seemed to work great. By the way, I never did any type of massaging before delivery in that area.

Best wishes on your delivery--I hope everything goes very well for you!

I loved, loved, loved my peri bottle. I only had one after DS's birth and wished I had more, so this time with DD I ordered one for each bathroom LOL. THey are inexpensive and for me, really cool water in there just felt so much better.

I also bought Dermaplast before my birth with DS because I had read it was helpful (it is a numbing spray). I never needed it, but I know a lot of moms have recommended it highly.

As the PPs said, I was able to do my normal daily living without any problems immediately afterward for the most part.

[ha98ed14]

I don't have any BTDT for you, but I wanted to say 2 things:

1) I know LOTS of ladies who have given birth (without drugs!, a la Bradley) and not torn. All of them had home births with midwives who massaged, massaged, massaged and stretched the cervix while they were in labor to help avoid tearing. So maybe hiring a doula (if you plan to birth in a hospital) would be a good thing. They will stay with you and massage you in ways an RN probably won't. Or if you are comfortable, you could teach DH this massage. Look at Spinning Babies dot com. They have lots of good info for having a natural and intervention-free birth. Or google Perinea Massage

2) Despite most of my friends/ tribe being natural birthers and home birthers, I opted to go for a C-section. It did not start out that way tho. I was induced because I was over my EDD and honestly, I just needed to get it over with. My anxiety level was in the rafters. After 12 hours on pitocin, breaking my water the baby was not really coming. This is not a horror story, I was not in pain for a long time. Epidural. They were happy to let be keep going, but *I* was done. I needed it to be over. I was SO anxious about pushing the baby out and after 12 hours I was not really any closer to that than I was when I came in the door. So I *asked* for a C-section.

The reason I am telling you all this is because I want you to know, believe and really give yourself permission to do whatever you need to do to get through this experience. It *IS* incredibly scary. You have never done anything even remotely similar to this. When I came face to face with the prognosis of yet more hours on pitocin after the 12 I already had, and then having to push the baby out, I was MORE afraid of that than I was of a C-section. I was afraid of the unknown and of it going on for hours. So I did what I needed to do for myself to be able to cope. It would not have been the choice of my more natural birthing friends. But it was my choice.

When you get there, in the moment, and you are face to face with your fear, do what you need to do to get through it. Do not hold yourself to some standard of "the perfect birth experience" or your birth plan or whatever ideas you have of how it *should* be. There are no SHOULDS in birth, because in reality, YOU HAVE NO CONTROL. You cannot "make it happen" any other way than the way it is happening. So give up trying to plan it out and just love yourself enough to let yourself be able to do what you need to do to get through. Good luck. Prayer and PT go with you :)

P.S. I intended this little personal narrative to be helpful. If you don't find it to be, please disregard. EVERY woman's birth experience is different. The key is finding what will work for YOU. This is what worked for me.

[misshollygolightly]

Thanks so much for all the encouragement and suggestions! I'm going to start working on that positive thinking thing right now :-) And keep the good stories coming--it's SOOO helpful to hear about lots of positive/easy real-life experiences, especially because so many of the books/magazines try to prepare you for the worst by focusing on all the things that *may* go wrong (which is not always reassuring!).

[SnuggleBuggles]

I had a 2.5 degree tear with ds1 and I healed quickly and easily. I did not have anepisiotomy- the thought of that really made me cringe. During that birth my CNM did ask if I wanted one when ds was crowning (no idea why she asked) but I declined. I kicked myself in hindsight b/c I know I could have minimized the tearing better by my actions. I did not stop pushing when he was crowning. I didn't go all out but I still gave baby pushes and I know that was part of my problem. Advice? *Listen to them! A good care provider will want to help protect your perineum so if they suggest no pushing do it. Also, I pushed 2/3 of the time on my side but wound up w/ my feet in stirrups for the final pushes despite having told my CNM ahead of time that I didn't want that. I was very disappointed later at how that went down. I feel like I was too distracted to make any decisions at that point and just did what they suggested. I don't know why she had me push that way when I was making great progress on my side. (I only pushed 35 minutes with my 8lb 5 oz ds and I could have been even faster had I wanted to be.)

So, for my 2nd birth I wanted things to be different. I read and knew even more about birth since ds1. I had dif't CNMs and they knew that I really, really didn't want to tear. This is from my birth story:
I t was time to push now. We knew the baby was going to be big (was 9lb 9oz) so I got on my hands and knees to push. Like I suspected the position didn’t feel right. I did it for a few pushes but I didn’t like it. We decided to try side lying and progress was made quickly. I didn’t want to push though because I was afraid of the actual birth and the intensity of the feelings. However, I did it. I just wanted to be done. As the baby was coming out my CNM made me stop so the skin could slowly stretch. Whoa! That was amazingly hard because I just wanted to push. I was allowed to give a baby push with each contraction for 3 contractions in a row. The rest of the time he was crowning. I didn’t feel any burning, just pressure. I knew that if I didn’t want to tear I had to listen to them. I only had one chance to get this right, I felt. They talked later about how much control I had at this point.

I wound up with a 1 degree, 3 stitch worthy tear as well as a tiny tear upwards that didn't need stitches. Quick, easy recovery. The hemmroids were far more uncomfortable than the tear.

*******************
Kegels help before and after birth. Before birth they teach you how to use the muscles so you can effectively relax them when the baby is crowning. Afterwards they send blood down there to speed recovery.

Insist on warm compresses during pushes. They feel great and the counterpressure is helpful.

Labor down. Don't wear yourself pushing as soon as you hit 10cm, especially if you have an epidural. Let the baby descend and save your energy for those final pushes. Your uterus is strong and can really move that baby.

Don't let anyone rush you. For a mom with an epidural 2+ hours is normal! Without an epidural it is less. There should be no pressure to get that baby out if all is well. You can always take a break, get a drink and just take a few contractions off. Talk about your care provider's thoughts on
2nd stage management at your next appointment. Why and when do they do episiotomies? Don't let them give you a cop out, "when necessary" line b/c who knows what that means! If they give you that line press for more details- length of pushing? baby's condition? mom's condition? looks like you are going to tear (bad reason 99% of the time1)? Get specifics on when they use things like vacuum or forceps. What do they like to try instead?


GL! You will be ok!

Beth

[brittone2]

If you feel you have educated yourself pretty well, at this point in your pgcy I personally would urge you to put down the books and focus on having a positive birth experience. Connect w/ baby and realize you will soon meet DC and be holding him/her in your arms. Women have been giving birth for a loooong time. Our bodies know what to do....trust yourself and your body. Take time to positively visualize your baby's birth and think about that moment when you are holding baby in your arms for the first time.

eta after reading Snugglebuggles post above--
I agree w/ having a good care provider. With DD, I think pushing in sidelying was a huge help, but the midwife I had that time also got me to stop pushing and breathe as she was crowning and I think that helped avoid a tear the 2nd time around.

[Tondi G]

I'm due in about three weeks and finally realized that the part of giving birth that scares me the most is the idea of tearing/episiotomy/damage/pain in the perineal area. For some reason, this just really, really freaks me out! So, I'm wondering if any of you have some words of comfort for me. I'd love to hear from women who managed to give birth without tears/episiotomies, or who had one but it wasn't a big deal. I'd also appreciate advice on helping me cope with my fear and/or avoid tearing. (I recently heard you can do some kind of massage to help out, but I'm not clear on the details and I'm not sure it would do any good this late in the pregnancy.) PLEASE no horror stories! Thanks!

I had an episiotomy both times and it was no biggie! I went natural and with #1 I felt her snip... can you say OUCH! With #2 he was crowning and she did it... I didn't feel a thing! She did give me a shot to numb the area while she sewed it up! I had no issues from it. I used my little squeeze bottle when I went to the bathroom and it was all good. I used nothing more than motrin for pain afterwards. My OB tried to massage with oils as I was pushing but I have a wierd band that was either going to tear or she could cut it... I opted to cut and lessen my pushing time! With #2 I told her if she thought I was going to need an episiotomy again not to hesitate... sure enough she told me that band just wouldn't stretch and I told her to go ahead! It's not as bad as you think and mine was healed up quickly. When we got to the 6 week point I had no issues with pain during intercourse etc.

HUGS and Good luck.... I can totally understand your worries! It's gonna be fine... just keep telling yourself that!

~Tondi

[HIU8]

With DS I had an episiotomy and it was no big deal. Of course I had an epidural. It took longer to sew up than the cut so DS could come out. With DD she came so fast there was no time. I ended up with a 2nd degree tear that my OB had to sew up. The recovery from the tear was actually better than with DS to be honest.

[1964pandora]

Hi! I just wanted to chime in to say that I recommend what someone else recommended-- that it might ease your mind to prepare for a tear. I had two vaginal births and I didn't end up with a scratch on me, but I was also terrified of tearing, so I put a container of products together that were supposed to help with the pain of perineal tears. I read over and over that Dermablast (spelling? It's a spray with anesthetic/numbing ingredient in it available in any drugstore) really helped, and there were some cold compresses or something that I also purchased from a midwifery type website. I also had some other items that I can't remember.

Having all of the items together to deal with the aftermath of tearing really helped ease my mind! I had a little shoebox sized plastic container full of items that I never even had to use! I guess my message is that if you can't stop worrying, it might help to get comfort items together. You'll be fine!!

Susan

[MommyAllison]

I had an episiotomy with DD because her heartrate kept dropping and they wanted to get her out - I watched the OB do it but couldn't feel it at all! I didn't have too much pain in recovery - was only on Ibuprofen for a few days (less than a week, don't remember now how many days), no problems with sitting, etc. I used the Tucks pads and the Dermaplast spray (on the pads, not on me), along with the peri bottle of water, and that was it.

With DS I had a midwife who was massaging my perineum as I was pushing and ended up with a small tear (which I didn't feel or know I had until a few minutes after birth when my midwife told me she would need to put a few stitches in!). I didn't need anything other than the peri bottle, which I mostly ditched after I came home from the hospital. Very little pain at all. Don't worry!

Oh, and I didn't have epidurals, still didn't feel the episiotomy/tear.

[maestramommy]

I suppose it depends on whether or not you have an epidural. I had an episiotomy with my first, and no episiotomy but a tiny tear with my second. Both times it didn't make much difference to me because I had an epidural so I didn't feel it. My impression was that my recovery with the tear was shorter because it had fewer stiches. I was equally sore afterwards though. Sitting on a donut pillow for SHORT periods helped.

[SnuggleBuggles]

The Bradley method book I have talks about pressure episiotomies...if they cut the episiotomy while the skin is in a certain position the nerves are less sensitive and makes it so it doesn't hurt.

Hopefully your cp doesn't do routine episiotomies. They don't prevent tears and usually cause tears that are deeper and bigger than the tear would have been.

Beth

[s7714]

I had an episiotomy and still tore some. I didn't have any drugs, so I felt the episiotomy. It was an ouch, but it wasn't horrifyingly painful or anything! You know that whole pain scale of 1 to 10 thing. Lets put episiotomy and tearing at about 3-4 and a contraction at about 8-10 (8 for me that is--I know contractions rank right up there at 10+ for a lot of people).

I didn't want an episiotomy, and my OBs knew that, but my second DD arrived so quickly the ER doctor delivered her and opted to do a episiotomy without asking. Either way my episiotomy/tear recovery was quick and no big deal. And between recovering from the episiotomy the second time around vs. from the c-section I had the first time, recovering from the episiotomy was a walk in the park.

[wellyes]

I was terrified of tearing too. I ended up having two very minor tears that were *so* not a big deal.

My midwife told me that the most important thing to help avoid tearing is to listen to them during coached pushing, particularly *not* pushing at certain points (as directed by the OB/midwife).

Giving birth is weird - the sensation of the child in the birth canal is something you just have to experience to understand. It's intense. After the afterbirth came out , they had to tell me that I'd torn and needed a few stitches. I had a lot of different sensations going on but I wasn't specifically aware of tearing..... but I did have an epidural. I can't say what tearing would feel like without painkillers.

For recovery, I used that ice-pack thing they put in your underwear, Tucks (hemorrhoids pads) and this numbing paste they gave me in the hospital. I didn't experience pain, but I did feel some stinging when I peed. Not enough stinging to make me dread going to the bathroom - just an annoyance. The muscles in my legs were kind of a mess after all that pushing, so with or without tears I wouldn't be doing much walking / moving around in the days after giving birth.

It was all healed up about two weeks later.

[barbarhow]

[QUOTE=SnuggleBuggles]The Bradley method book I have talks about pressure episiotomies...if they cut the episiotomy while the skin is in a certain position the nerves are less sensitive and makes it so it doesn't hurt.


I tore with both of my deliveries. My first delivery was med free. I could feel myself tear but it did not hurt. It was a very strange sensation. I guess this goes along with the above. I think everything else was so intense that the tearing was just a drop in the bucket so to speak. I received lidocaine to suture it back up and it was no big deal. I had an epidural for #2 and wasn't even aware of my small tear. I was not a good listener with either delivery. I wanted them out and out they were gong to come-despite my MW telling me to ease up on the pushing. Oh well-they are here-they are healthy.
Good luck with your delivery. Listen to the other wise ladies. Trust that all will go well.

[mytwosons]

For DS1, I was terrified of tearing (but not enough to do the massage) and definitely didn't want to be cut. When it came down to it, at the very end of two hours of pushing, I just wanted him out (right then!), so kept pushing even though I knew that would make me tear. While I knew I was tearing, it didn't hurt. I had (I think) a second degree tear and 2 or 3 stitches. Not sore at all and never had to even take a tylenol. It was more the slight itching as it healed that somewhat bothered me. I don't even remember feeling the numbing shot prior to the stitches.

For some reason, I had always thought tearing meant tearing in a line (straight or jagged) between the outer edge of the vagina and the anus. TMI: I tore slightly higher up...farther inside along the vaginal wall. And, more at 4 o'clock. Very different from what I expected.

I'd spend my time stressing about whether the baby will sleep instead. :D

[bethie_73]

I haven't read the other posts, so I'm not sure what you have heard. but..

I had an episiotomy. I didn't even know the DR did it. When I was PG I did not want to think about it, and I made DH do the massage etc, but when it came time it was no biggie.

That said, I was pretty drugged up at the time even though I didn't plan that either. DS was pretty big 10# 22.5 inches. SO after laboring and then pushing for over 2.5 hours I had an assisted delivery. He just didn't want to come out. Honestly, I walked to the bathroom myself to get cleaned up and then walked to my recovery room. All I had after delivery was some Motrin and that was from my shoulders and hips hurt from pushing. No issues at all with the cut or healing.

I had Dermaplast (SP) which I didn't really use, but warm water in the plastic bottle thingy... that was great!! PSA.. If you do tear etc and need the plastic bottle to help, tell DH (or whoever) warm water please... not cold :ROTFLMAO: I filed it with cold, not thinking. brrrr

[karstmama]

very good points here, and i hope it's helping you. i have a few things to add. (i'm a certified nurse midwife. ;) )

unless you have a midwife or a doula, the nurse will be the one helping you push. when you're checking in, talk to her about your thoughts so she'll know to do the massage, compresses, stretching, etc. if she's not comfy with these things, you can ask for another nurse or ask for her to get someone to help her learn - it's very very likely that there will be a more natural-minded 'crunchy' nurse there, you just might not be her assignment. it's unlikely she'll mind.

thing two is to be aware that if you elect to tear, expect to have several small tears. not that an episiotomy is huge or something, but the more usual tear pattern is a small one on the bottom and one or two small ones on the sides or toward the top - it's pretty much a 'six of one, half dozen of the other' thing, but nice to know there might be two or three spots that need a couple of stitches instead of one bigger one. in fact, if they're not bleeding, your care provider might not stitch them. (in that case, if you have matching ones on the sides, keep your pad up between so the sides don't touch.)

if you're burning when you pee, pee in the sitz bath. they are usually prescribed but not often used - take advantage of them! most folks who take the time *love* them!

this is a very small part of the whole experience. don't get too hung up on any one thing - try for as much of what you want overall. best of good luck to you!

[ShanaMama]

I didn't read thru all the posts but wanted to suggest discussing this with your doctor asap. Believe it or not some docs still do episiotomies as routine. You can ask your doc what methods s/he uses to prevent/ minimize tearing. Some suggestions that I've been given (I also *really* want to avoid tearing during this birth) are pushing in any position out of bed; slow, controlled pushing; perineal massage; kegels & eating lots of protein. Best of luck.

[urquie]

i had a natural birth with a pretty big tear/s. i didn't feel it at all - the cnm had to tell me about it afterward.

i've heard, from some doulas, that dry heat can be nice for healing the perineum. after bathing just use a hairdryer to dry off the area.

[randomkid]

Haven't read the other replies, but I know many feel that episiotomies are not necessary. Thought I'd share my experience. I tried the massage while pg, but I just really couldn't tolerate it - too uncomfortable somehow. My OB knew I didn't want an episiotomy, so she and the RN were massaging like crazy while I was in labor. All of a sudden the OB said, "I have to get her out" and I saw the scissors. She made a tiny little snip and DD came right out - no more pushing. I was shocked.

Turns out DD was becoming distressed and the cord was over her shoulder. If they had worked a little longer, I may have gotten her out without the episiotomy, but that little snip was totally worth it to get her out safely and quickly. I only had a couple of stitches with no further tearing at the incision site. Healed quickly and really wasn't a big deal. I did have an epidural, so that made it easier. In the recovery stage, I really did not notice any additional discomfort from the episiotomy.

[american_mama]

I see no one has given you directions on how to do the perineal massage. Here;s a link plus a blip about research showing it is effective, especially with first time moms and especially with moms who do it more consistently.
http://parenting.ivillage.com/pregnancy/plabor/0,,midwife_46dl,00.html

It is not too late to do it at all, but start doing it now. The blip says start at 34 weeks, but I think 36 weeks is when my midwives recommended I do it.

I did it with all three births using Vitamin E oil and didn't have episiotomies or tears for any. Others use sweet almond oil, olive oil, etc. If you do it yourself and your thumbs don't fit (which they probably won't), use yourn fingers. Yes, it's weird, yes it's clinical, but yes, it may work and can't hurt. Totally worth it to me.

I believe in the masage in the weeks before labor, but not so much in a one-time thing during labor. Don't pin all your hopes on that.