This is a TMI question

[Katigre]

There are a few things you can do (though some things are outside your control like the position and size of the baby - a baby trying to be born with a hand by it's face will tend to cause more tearing than a baby who is only head-first).

1. Perineal support by youur OB/midwife during pushing - including teling you when to pause to let the tissues stretch. I had this with both births (with DS the midwife massaged the area as I pushed with oil)?) and with DD the midwife used warm compresses (washclothes soaked in warm water) on the area as I pushed - this is also called "supporting the perineum'

2. A longer pushing stage - if your baby flies out in 2 pushes then it doesn't matter if it is a preemie who only weighs 4 lbs - you're at a higher liklihood of tearing than if you push for 30 minutes which gives everything time to stretch instead of tear (think of this like silly putty or taffy - if you warm it up and then gently stretch it you can get it MUCH longer than if you grab it cold and yank where it breaks. Similar analogy to ours skin - having your skin warm, lubricated, and slowly expanded will reduce your risk fo tearing)

3. Research different pushing positions - I have read that side lying has a much lower rate of tearing than other positions. Also, only push when you feel the urge (unless there is some fetal distress complicating the process). working with your body's process instead of outside coaching will hep things to go more smoothly too.

[misshollygolightly]

I had a 4th degree tear with DS. It was awful, but fortunately healed pretty well. (It is standard of care to offer women w/ 4th degree tears elective c-sections for subsequent births--I'm glad I didn't take advantage of that option.) I was terrified about tearing again with DD, but honestly shouldn't have worried. Had only very minimal tearing with DD (I wasn't even aware of it!), and had a much better labor/delivery experience overall. I had an epidural both times (actually, the only reason I got one with DD was because I was so worried about tearing badly at the end again and just couldn't face that without meds). Honestly, there wasn't much I did differently the second time, but I don't think it's unusual for subsequent births to be much easier and less painful. Your body is often just more "ready" for childbirth, and things are a little stretched out already. One thing that I do think helped was that my labor/delivery nurse with DD was much more involved and "hands on" in helping me into different positions to ease the labor and make sure DD was ideally positioned. If you don't have confidence in the labor/delivery nurses at your hospital, it might be worth getting a doula who can help you with that (or at least do some advance research on your own). Feel free to PM me if you want commiseration/advice/encouragement about birth after 4th degree tearing!

[mjs64]

I had a 4th degree tear with DS. It was awful, but fortunately healed pretty well. (It is standard of care to offer women w/ 4th degree tears elective c-sections for subsequent births--I'm glad I didn't take advantage of that option.) I was terrified about tearing again with DD, but honestly shouldn't have worried. Had only very minimal tearing with DD (I wasn't even aware of it!), and had a much better labor/delivery experience overall. I had an epidural both times (actually, the only reason I got one with DD was because I was so worried about tearing badly at the end again and just couldn't face that without meds). Honestly, there wasn't much I did differently the second time, but I don't think it's unusual for subsequent births to be much easier and less painful. Your body is often just more "ready" for childbirth, and things are a little stretched out already. One thing that I do think helped was that my labor/delivery nurse with DD was much more involved and "hands on" in helping me into different positions to ease the labor and make sure DD was ideally positioned. If you don't have confidence in the labor/delivery nurses at your hospital, it might be worth getting a doula who can help you with that (or at least do some advance research on your own). Feel free to PM me if you want commiseration/advice/encouragement about birth after 4th degree tearing!

I'll commiserate! I had 4th degree tearing and it was awful. I still have pain. I don't know what I could have done to prevent it. OP, I think communication with your OB is your best bet. I would not wish that on anyone!

[daisymommy]

Fwiw, my last birth, that I didn't tear with...DS had his fist up over top of his head. Proof that these measures really do work to help prevent tearing!


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[brittone2]

With my first, a CNM attended hospital birth, I asked for no coached pushing but got it anyway. I only had a minor tear (2 or 3 stitches) but I had a lot more swelling and sore legs, etc. afterward from my legs being held back by the nurse and DH. It is pretty much my only regret with that birth, only because I feel it was unnecessary. I felt like I ran a marathon the next day (and I had a relatively short pushing phase and labor for a first timer-6 hour labor, 20 mins of pushing). I remember *loving* an ice filled diaper they brought me afterward. I was definitely swollen and sore even though I didn't tear badly at all. I think a good bit of that could have been avoided.

With my 2nd, I was seeing a different practice of midwives and had DD at a FSBC. I expressed my feelings about not being heard about coached pushing with my first birth. They were much more respectful of the whole "breathing the baby down" (a concept from Hypnobirthing and Hypnobabies). I didn't purple face push, no counting, no pulling my legs back. I did ask for perineal support and did say they could coach a little to reduce tearing (like slow down, blow, etc. type stuff). I pushed in sidelying with her and it was 2 pushes, no tearing, muuuuuuch more comfy, and none of that marathon leg, lots of perineal swelling feeling that I had after my first birth.

My third was a HB with a CNM. I had him in the water in a semi squat position. He was 9 lbs. I didn't push until I couldn't *not* push. I was grunty for a bit (mw only checked once for dilation when she arrived). I think I was probably fully dilated at that point and in a typical setting would have been told to start pushing. Instead my urge was to just be a little grunty for lack of a better description. I basically gave two pushes once I couldn't not push, and he was out. No tearing, and after that birth for the first time I didn't even want or need a peri bottle. Much, much easier recovery.

I personally like to avoid coached pushing, someone holding back my legs, etc. I like sidelying or alternative positions. I found the water helpful but that's not an option for most women. A provider willing to do compresses, perineal support, etc. was also helpful to me. With my 2nd I was fully dilated for a loooong time before I had any urge to push and they were a-ok with that. (I was a 10 for at least an hour and not pushy during that entire hour). With my third I had one check when I was 5-6 cm (when midwife arrived) and no other checks. I think pushing was efficient because I could follow my urges. In my 2nd and 3rd labors in other settings I might have been encouraged to start pushing way before I had a real urge to do so. That can be tiring and inefficient for some women.

[daisymommy]

Oh yes, as with Beth, with my 3rd I was fully dilated for an hour but felt no urge to push. I waited until my body said push!


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[Mopey]

Is there ANY way to feel your body's urges WITH an epidural? I've heard about backing it off but am not sure it would do the trick. I am worried about being exhausted by the pain and then not having enough energy to push efficiently. Also, I didn't search but are there reputable sites for checking on alternative pushing positions? I've not thought lying on your back was okay this whole time....

[SnuggleBuggles]

Is there ANY way to feel your body's urges WITH an epidural? I've heard about backing it off but am not sure it would do the trick. I am worried about being exhausted by the pain and then not having enough energy to push efficiently. Also, I didn't search but are there reputable sites for checking on alternative pushing positions? I've not thought lying on your back was okay this whole time....

Define reputable. Don't discount places that are "crunchy" or encourage unmedicated labor. When I was pregnant with my first, I devoured every book whether it was mainstream (What to Expect...), written by OBs (American College of OB Gyns) or more "crunchy" like Dr. Sears or Penny Simkin. I learned something from all. My b.s. meter got raised on either more extreme end of the spectrum and I learned to take some things with a grain of salt. When pg with my second, I found the Baby Center Essential Guide to Pregnancy and Birth...it rocked!! It presented the mainstream and crunchy options almost side by side so you could get fully informed- risks, benefits and options were laid out. If you can get a copy or sit at the bookstore for an hour, I'd highly recommend it. The book is a collaborative effort with Dr.s, midwives and other care providers and by far the most neutral book I found (no one knocks epidurals or unmedicated, which I really appreciate).

Alternative birth positions really just aren't wacky. They aren't common since the majority of women use epidurals and lose some options for positions. Like you said, it can be turned down so you can feel though. I always had a surge of energy (or maybe it was just a desire to be done!!) that made it so I wasn't exhausted with pushing (no pain meds). Also, like pp's said, there isn't usually a reason to begin pushing the second you get to 10cm. Often, if left alone, there is a break in the pain. Some wise women take a bit of a break before pushing. That isn't common with many care providers- they just want to get to the end- but you may be able to get your care provider on board.

A good collection of articles from a variety of sources (again, read them all and take what you want from them ):
http://pregnancy.about.com/od/second...r_Baby_Out.htm

Ask Dr. Sears (a site worthy of book marking, or books worthy of buying)
http://askdrsears.com/topics/pregnan...hing-positions

Baby Center and birth positions:
http://www.babycenter.com/0_position...th_10309507.bc


If you have an epidural, you'll have monitoring. If you are on your back, the monitor will keep check of the baby. But, really you should talk to your Dr. because most are now saying that laying on your back is ok.

[brittone2]

Is there ANY way to feel your body's urges WITH an epidural? I've heard about backing it off but am not sure it would do the trick. I am worried about being exhausted by the pain and then not having enough energy to push efficiently. Also, I didn't search but are there reputable sites for checking on alternative pushing positions? I've not thought lying on your back was okay this whole time....

Check out Penny Simkin's info. She's a physical therapist, childbirth educator, etc. I am a PT and knew anatomically, pushing flat on my back was not something I wanted to do. You have to push up and over your sacrum that way, like pushing baby over a speed bump. I wasn't sure if I wanted to do an unmedicated birth, but knew I wanted to look at positions for labor, etc. because that's an interest due to being a physical therapist. Certain positions are known to greatly increase the pelvic outlet for example. For me, that was something I really was interested in because I was familiar with the anatomy and physiology of the pelvis. That eventually lead me to an interest in trying to go unmedicated. I eventually opted to look into Hypnobirthing for my first birth, and then Hypnobabies with baby #2 and #3.

eta: this was compiled from one of Penny's books:
http://transitiontoparenthood.com/tt.../positions.htm

I used a lot of position changes in labor and found it very, very helpful to have some in mind in advance. I labored sitting on a birth ball, leaning over a birth ball, on hands and knees, tailor sitting, lots of walking while upright, etc. I was only really uncomfortable while *in* bed and kind of semi reclined and not moving.

[AnnieW625]

Is there ANY way to feel your body's urges WITH an epidural? I've heard about backing it off but am not sure it would do the trick. I am worried about being exhausted by the pain and then not having enough energy to push efficiently. Also, I didn't search but are there reputable sites for checking on alternative pushing positions? I've not thought lying on your back was okay this whole time....

I had an epidural with DD1, but I got it around 8 cm so that is pretty late, but I was still able to feel the sensation of pushing, however when I did push with DD2 who I had unmedicated I noticed that the pushing hurt more than it had with an epidural. I was laying on an incline semi upright position both times. I had a tear both times that required a few stitches but honestly after giving birth I never looked down there to see how it looked. I was sore for a couple of days, but Tucks pads and Mediplast spray were helpful.