This is a TMI question

[daisymommy]

Fwiw, our recent American culture is one of the very few in the world that encourages women to lie on their back when pushing a baby out. In most other countries and cultures, as well as our own pre-hospital days, women labored and pushed more upright, squatting/on all fours/standing while holding someone for support, sitting in a birthing chair...because that is how the body works best, working with gravity, and to open up the pelvis.

I read a whole book on the history of labor and birth in our country, and one thing I took away from it is many things (like on your back, feet in stirrups pushing) evolved out of convenience sake, not because they were backed by science or necessity. A recent study showed this once again.
http://www.ncbi.nlm.nih.gov/pubmed/21826038
"One third of the recommendations put forth by the [American College of Obstetricians and Gynecologists] in its practice bulletins are based on good and consistent scientific evidence."

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[Green22]

Thank you so much for all the helpful information.

I have a medical condition so I knew that I would always need to be with doctors and in a hospital setting. It seems silly but it wasn't until after DD that I realized you can have midwives with you in the hospital too. When I was learning about birth I kind of figured - oh, well you're going to get tearing, who really cares. I guess I still feel that way for the most part - I just want a healthy baby! - but now that I know there are some options to make it less bad, I want to look into it. I have an appointment on monday, so I'm going to look into some of this - esp. the different birthing positions - before then so I can ask about it.

My doctors don't have midwives associated with them; do you know if there is a way to get access to a midwife? I admire you women who have done unmedicated birth - I am much too scared and know it is not something I could do. ALthough I'm sure that was part of the issue for me - I felt nothing with my epi, not even the urge to push. It was the nurse who was like - okay, it's time. I tried to breathe out during the pushing but it maybe wasn't enough. ; )

Thanks again!!

[SnuggleBuggles]

I was too scared of an I.V. so there you go! I didn't choose no meds cause I was tough or had a high pain tolerance (wimp, in fact before that!) but terrified of I.V.s! I had to learn how to do it unmedicated and, for the most part, it was all state of mind. I knew I could do anything for a day. I hired a doula, had a midwife, a knowledgeable and supportive dh, no interventions...basically I did all I could to stack the deck for myself when in the hospital. I think that if you want to stick with your OB and they don't have midwives on staff, you would be better off hiring a doula. She will come with lots of good tricks up her sleeve and will support whatever birth choices you want to make.

Yes, a healthy baby is the top goal but, there is nothing wrong with putting your desires and needs right up there too.

You don't have to tear- it is possible to avoid it. Don't be discouraged.

[american_mama]

I gave birth three times in a hospital with no tearing, so it is definitely possible. Your doctor shouldn't give up and neither should you!

I just read abstracts from 13 studies on pubmed.gov about how to protect the perineum during childbirth. The most conclusive statement is to avoid routine episiotomy. Ask your doctor how often he or she does them, what criteria he uses to decide if one is necessary, tell him you don't want one and tell your DH to tell him during labor that you don't want one. Of the 13 abstracts I read, the three that mentioned routine episiotomy all said there was clear evidence that they did more harm than good. All three of them were metastudies, meaning they were summarizing the results of many other studies. This may have been different than what your OB was taught, but he or she should be aware of the changing evidence about episiotomy and adjust his practice.

In terms of other things you can do, these were the results of the studies. Protective means protecting the perineum.

Prenatal perineal massage: three said it was protective for first-time moms, two said it was unclear or had insufficient data

Perineal massage in labor: two said protective, one said no effect

Perineal massage, unspecified: two said protective, two said insufficient evidence

Warm compresses during labor: one said protective, no others mentioned it

Mom in upright position: one said protective, three said no effect or insufficient evidence

Support perineum with hand during labor: one said protective, two said no effect or insufficient evidence

I'm a big believer in perineal massage during the final weeks of pregnancy because it can't hurt and might help, especially for a first-time mom or a mom who has had previous episiotomy or tears. Heres a how to: http://www.babycenter.com/404_how-ca...iotomy_1955.bc
Your DH can do it or you can do it alone, although it takes a little effort to do it around a big tummy. I've done it both ways.

In terms of finding a midwife, the best way would probably be word of mouth. You might try calling the labor and delivery of the hospitals you'd be willing to deliver at. Since you want to deliver in a hospital, you'll be looking for a certified nurse midwife (CNM) or, in a few states, a certified midwife (CM) is the same thing. They are like nurse practitioners - able to diagnose and treat routine pregnancy issues and manage a routine labor. They can prescribe medication and a patient can still have an epidural with them, although patients using midwives tend to use epidurals less often. Like nurse practitioners, they work under the supervision of an MD. You might also find one by looking in the ob/gyn listings of your phone book and seeing if any ad or listing mentions a CNM or midwife in the group.

And, speaking more generally, I don't think tearing or other problems are inevitable during labor, or that it's something to suffer through. A healthy baby is the most important thing and without it, nothing else much matters. But with all our medical knowledge and resources, my standard for childbirth is a healthy baby AND a healthy AND happy mom. I shoot for more than oh, I couldn't walk well or lift my toddler for weeks or enjoy sex for a year because of this tearing, but that's ok, I had a healthy baby. Or I felt terrified and traumatized during birth and felt treated horribly by my doctor or nurse, but that's ok... I had a healthy baby. We can't always avoid those negative outcomes, but TRYING to - with actions and words - should be the goal. You seem to feel like there is nothing you can do to improve labor and maybe nothing your ob can do, and that just isn't true.

I hope this delivery is easier than your first. Good luck.

[daisymommy]

And, speaking more generally, I don't think tearing or other problems are inevitable during labor, or that it's something to suffer through. A healthy baby is the most important thing and without it, nothing else much matters. But with all our medical knowledge and resources, my standard for childbirth is a healthy baby AND a healthy AND happy mom. I shoot for more than oh, I couldn't walk well or lift my toddler for weeks or enjoy sex for a year because of this tearing, but that's ok, I had a healthy baby. Or I felt terrified and traumatized during birth and felt treated horribly by my doctor or nurse, but that's ok... I had a healthy baby. We can't always avoid those negative outcomes, but TRYING to - with actions and words - should be the goal. You seem to feel like there is nothing you can do to improve labor and maybe nothing your ob can do, and that just isn't true.

to every bit of it.

I'm not sure how we got to this place in society, where we as women think it's an either/or situation, and we have to chose between a great, happy, empowering, beautiful birth that leaves our body intact and healthy, which leads to less pain and a quick recovery...OR a healthy baby. This isn't a third world country for crying out loud!

We deserve better than that. I think it's cheating ourselves out of what can be the most incredible experience of our lives to say "all I want is a healthy baby...". Well so do I, and so does everyone else, but I want MORE than *just* that. I want it all!

By reading and educating myself on all the possibilities, on what was the best for my body and my baby both in the short and the long term (and not just taking an OB's word for it), by seeking out a care provider that was on the same page as I was and was willing to help me achieve my goals, by doing everything in my power to stack the deck on my own behalf and that of my baby--made all the difference in the world.

I didn't just settle for the idea that birth was a means to an end, and that it was only about "getting the baby out" no matter what that did to my body and my emotional, mental state in the end. Birth can be so, so much more than that. I don't mean this condescendingly, but I feel for many moms, who don't have a clue as to what I'm saying, because they have yet to experience a satisfying peaceful happy birth.

Empower yourself with the knowledge and the tools to get what you want. Your body, your baby, your birth.

I agree it would be an excellent idea to hire a doula to be a go-between/mediator on your behalf to help you try to achieve the birth you desire.

[brittone2]

Here are a few studies related to pushing:

http://www.ncbi.nlm.nih.gov/pubmed/20215948

http://www.ncbi.nlm.nih.gov/pubmed/18307484

http://www.ncbi.nlm.nih.gov/pubmed/21392242

http://www.ncbi.nlm.nih.gov/pubmed/18226152

http://www.ncbi.nlm.nih.gov/pubmed/20952110

http://www.ncbi.nlm.nih.gov/pubmed/19352230

[daisymommy]

http://www.lamaze.org/ChildbirthEduc...5/Default.aspx

[sntm]

American mama, awesome summary!

[Mopey]

Thank you SO much everyone! I am so grateful for all your willingness to help. I will definitely be doing some reading and research before I see the doc again Friday

[cookiemonster80]

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!

I agree- I had a 4th degree tear and was in absolute misery for days after the birth- couldn't walk, sit, or POOP- I thought I would die because it hurt so badly!

I'm terrified of repeating that this time- and my doc did "gently" try to push a c section this time to avoid all of that.

I really think the reason it happened so badly is because (I was induced) the nurses weren't staying on top of me- I was induced at 8am, they checked me every hour, no progress, then at 11 turned up the pitocin, and didn't check me for 2 hours (they had like 10 births immediately and were short staffed so I understand, but and still suffering bc of it). When they checked me at 1-I was a 10 and ready to push- pushed twice and she was out.

I really think if the pushing stage had been longer it wouldn't have been so bad- I 'm planning this time to make them take their time with the pit (if needed) and DH is making sure someone checks me on the hour every hour.