This is a TMI question

[Green22]

Re: Pushing. Is there anything that can be done to minimize tearing with childbirth?

With DD I had a lot of tearing and "too many stitches to count" (but a really fantastic, fast birth). Almost 2 years later, that area still looks bad. Not scar tissue necessarily, but it definitely does not look like it did pre-kids. At all.

Part of it might just be my delicate skin (I"m a bad healer, have lots of bruising/vein issues) but I'm wondering if there was something I did wrong when pushing. I'd like to try and avoid some of that with DC2.

Obviously I'm going to talk to my doc about this, but I'm anticipating they will say that it-is-what-it-is or something along those lines.

TY!

[veronica]

The things I remember reading about is to do as many kegels as possible and you can put oil in the perineum and massage it frequently in the months leading up to labor. I never did feel right asking DH to help with that.

[mctlaw]

That's not TMI at all....I had 3rd degree tearing with my first and I'd like to avoid that too, LOL. From what I understand, positioning of the baby is what makes for the least amount of tearing. There are tons of tips regarding getting your baby well positioned on the website Spinningbabies.com. My DS had a compound presentation of the hand, which is what I understand from the OBs likely caused the degree of tearing I had; it was very hard to push him out. My first OB, when she saw I was starting to tear, did an episiotomy, but then I tore elsewhere anyway.

You can do "perineal massage" in preparation for birth, but I think the jury is out as to whether that is actually helpful. Also, I have read that coached ("purple") pushing also leads to excessive tears. I don't have any data on this perhaps a doula or mom that has done natural birthing previously, might. Also, your doc/midwife can direct you when to slow down on pushing to give you time to stretch out as opposed to tear. I am going to use Hypnobabies this time around which emphasizes mother-directed pushing. First though, I need to get this little stubborn boy out of the transverse lie that he loves so far.

Good luck! Hopefully you can get some more specific info from other posters!

[daisymommy]

There's a ton of information out there and ways to avoid tearing.
For starters, don't do the whole "count to 10, push hard" typical purple-faced style of pushing. That does not allow your body to stretch and open up naturally the way it was designed. It also raises your blood pressure and reduces oxygen flow to your baby.

When you feel a contraction, push for as long as your body tells you to, when your body tells you to. None of this acting like you are underwater holding your breath for a long time while people yell and count to 10 then quick do it again.

When your baby's head starts to crown, go very, very, slowly. At my last birth, at home (the only birth I did not tear with) my son's head was 1/4 of the way out, and I just lay there for a minute of two. Then it was half the way out, and he was looking at people (I kid you not!) and I lay there for another minute, then I pushed it the rest of the way out. Then with another gentle push birthed his body. I didn't have even a tiny tear, no swelling no bruising, and minimal soreness afterwards.

Warm compresses on your vaginal area and perineum (my midwives put warm water in a crockpot, and have washcloths in there soaking the pushing phase), warm oil drizzled and rubbed on your perineum before and during pushing really helps as well.

Also, laying flat on your back is not optimal for so many reasons (like pushing a mac-truck uphill over a speed bump which is your pelvic bones). Side laying at the very least, but sitting upright or squatting will open you up by another 30% more, so it is much easier to push baby gently out, and you are less likely to tear.

I know all these things are not typical in a hospital setting (and frankly, that's why I avoid the hospital)--it's practices are there for Dr's convenience, not what is ultimately best for your body. But you can still do any of these things in a hospital setting, you just need to be vocal about how you want things done.

I hope that helps!

[swissair81]

I think the biggest help is an understanding and knowledgeable care provider. My first doctor gave me an episiotomy because he felt like it. But the next three births were with doctors who slowly allowed my perineum to stretch out and gave me clear instructions with pushing (not coaching. I hate coached pushing)- it was like okay now slow down, stop pushing for a second, give another little push. It works better if you don't have an epidural and can actually feel the pushing. I couldn't feel my pushing at all with my oldest. I have a nice amount of scar tissue from my oldest, but didn't have a single stitch from the next three.

[daisymommy]

It works better if you don't have an epidural and can actually feel the pushing. I couldn't feel my pushing at all with my oldest.

Yes, I hate to go there, but this is so true. If you can't feel what is going on with your body, you have to rely on others to tell you when to push, when to stop, how hard to push, etc.. I prefer to have the control myself and listen to my body.

Fwiw, I did have an epidural with my first, and I tore the worst.

[SnuggleBuggles]

Sure! Like pp said, getting a good care provider is one of the very best things you can do! My first midwife was crap with this issue. She stood back and let me tear and indicated it was my fault that I didn't want an episiotomy She had done warm compresses during pushing but didn't provide enough support during crowning. I will take some ownership though-- the nurse told me to stop pushing and allow the skin to stretch slowly but I couldn't do it. I plowed through and shouldn't have.

With ds2 my midwife was fantastic! He was born at a birth center and they actually had a crockpot full of warm, moist cloths. They provided support during all of pushing. Then, at crowning I summonded great inner strength and patience and didn't push. I waited through a contraction or 2 to let things really go slow. I was very successful and it came to me and a great midwife! Tiniest of tears and he was 9lb9oz.

[MSWR0319]

Like others have said, my midwife has me stop while DS was crowing and I think maybe one other time. She had me breath through the contractions so the skin would strech, when all I really wanted to do was push!! I remember asking her if she was serious. I did tear a tiny bit, but not enough to need stitches.

Thanks for bringing this topic up. I'm delivering with a different doctor this time and I want to make sure I'm not forced just to push.

[SnuggleBuggles]

Also, position matters! Legs in stirrups pulls the skin more tightly so it just isn't the best. There are many, many better positions.

[LBW]

Yes, I hate to go there, but this is so true. If you can't feel what is going on with your body, you have to rely on others to tell you when to push, when to stop, how hard to push, etc.. I prefer to have the control myself and listen to my body.

Fwiw, I did have an epidural with my first, and I tore the worst.

I have pretty much the same story. I tore really badly with my first and it made the first month or so post-delivery really awful for me. I was in a lot of pain for at least three weeks. I used a midwife with my second but still wound up with an epidural b/c I was induced. Tearing was minimal b/c she didn't force me to push and she massaged my perineum w/olive oil during labor. But, I was still in pain for a while after birth. By my third, I went the homebirth/no epidural route. Labor was painful (duh) but I didn't tear at all. My recovery was amazing. I felt great the next day, like I hadn't even had a baby the day before. Honestly, the few hours of painful labor was well worth the pain free days days with my newborn.