Tearing

[lucielooo]

Aside from the baby being ok, this is my big worry about childbirth. I'm on 20 weeks and fretting about it already. In fact I am far, far more worried about this than I am the pain/general gore of labour.. though that might be because I've no idea what I'm letting myself in for!

I'm planning a water birth, for various reasons but one of them being that it might help reduce chances of tearing and planning on a bit of perineal massage.

Did anyone do both these things and still tear and is there anything else I can do to try and help?

I don't mind if it fixes ok... Are my expectations totally unrealistic then?!

With DD1 I only had a minor graze and one stitch - no big deal at all, didn't notice during birth. With DD2 I had no tears/grazes stitches or any damage at all - so it's not certain you will tear

Thank you - that's really helpful. I do realise that what happens, happens but I would just like to be able to do everything I can to help my chances!

StarlightMcKenzie where would I find out more info about good birthing positions etc? Sorry if this is obvious question, I'm only just at the stage of thinking in more detail about the birth and really have no clue!
Thanks for your help

I tore both times. It didn't hurt either time (too much else going on), although I did hear an audible 'pop' as I tore the second time.

Have a look here if you want some info on positions.

Good luck and, really, try not to worry.

Tearing isn't inevitable but there's nothing you can do to guarantee it won't happen.

It sounds like you're already taking steps to minimise the risk (labouring in water, avoiding being on your back etc...)

I also used a pool for labour but wasn't in it when I got to transition (ended up giving birth kneeling on a rug in the living room...) My midwife did a really good job of talking me through the 10-15 minute pushing / crowning phase and I had no tears.

Good luck!

I'd recommend doing some decent antenatal classes too. At my NCT classes, we've been taught that we need to do the puffing breathing & no pushing for the length of a whole contraction and the gap before the next contraction when the baby is crowning to minimise the risk of tearing. Our teacher has said that you'll really want to push because it really stings, but if you hold, you give the skin a chance to stretch, not tear.

Thanks for all your replies :) It's not the pain of the tearing that I mind, but how it might heal. I'm signed up for antenatal classes already so hopefully with the added info I can do what I can to minimise chances. It's good to hear people's experiences where tearing isn't the end of the world. My sister tore badly and maintains things have never been the same since, which is what (if I can) I'd like to avoid.

Thanks for your help

Try this to avoid tearing: EPI-NO
It helped me and a friend of mine, who recommended it. In both cases, the doctors were really surprised that there was no/minimal tearing - one was a ventouse deliver and the other was a large breech baby

My top tip would be to have a small, deep tupperware type pot in the bathroom (the sort of plastic pot that your Christmas pudding might arrive in from the supermarket). After you've had your baby, fill it with warm water ever time before you go to the loo and then slosh it over your bits. Then spend as much time as possible with no knickers on, sitting around with your legs apart ( attractive?) to get plenty of airflow.
You'll heal in no time .

Its a scary thing worrying about tearing but in the midst of childbirth you really won't feel it! - everything is so stretched that you'll be concentrating on getting out the baby! The midwives will do what they can so you don't tear but from a healing point of view its better to tear than to be cut. With my first I tore quite badly going up to my bladder instead of the other way (he was a big baby and I was strapped to the bed on my back!) but I was stitched properly and I healed very well, with my second, I had a water birth and didn't tear at all - you are much less likely to tear if you give birth in the water I was told! xx

I had a bad tear due to a difficult forceps birth. Had to be stiched in theatre. The surgery went really well and I healed fairly quickly.

I now have a choice whether or not to have a c section this time. The hospital said if I didn't heal well, the would recommend a c section but as I did heal well (and I didn't do anything special) I can go for a natural birth if thats what I want.

Only about 9% of births end in bad tears, 3rd of 4th degree. 1st and 2nd aren't too much of a problem. Intervention is more likely to result in a tear as well.

I am hoping for a water birth this time too but as the hospital only has 1 pool, I'm not holding my breath!

Just a point about epidurals causing bad tears - it just isn't what the research evidence on modern (not the old) epdurals say. Just had a look in work - there is a 2002 and 2009 study looking at this:
Here's what the two studies say:

"No statistically significant association was found between epidural analgesia and the occurrence of perineal tears (p=0.83), vaginal (p=0.37) or labial trauma (p=0.11)."

?Primipara and occipitoposterior position (OP) during delivery are the only statistically significant risks for the occurrence of severe perineal damage. ?

So if it does get really painful, you can ask for an epidural and it won't affect tears BUT it is a good idea to try to sit bolt upright during the second stage with epidurals.
Hope that helps and good luck:)

Its not the epidurals that cause the tears but the fact that having an epidural increases your chances of having intervention which then increases the chances of a tear.

I'm not going to completely rule out an epidural next time but if I want to avoid intervention I am going to try and do without it.

lucieloo, I was terrified about tearing in this labour, as when I had DS I tore very badly (the tearing didn't hurt, and I had a drug-free labour

whether or not you will tear is down to luck, as well as how you handle the pushing stage. My DS came out like superman with his hand up to his face, and he was 9lb7oz.

The stitches hurt me a LOT. I don't think that they put the local anaesthetic in the right place . I was so desperate to have an early discharge, and they threatened me with an epidural if I didn't be quiet and let them do it.

I had to go back to have the (labial) tear repaired a few months after he was born. This was painless and I healed very quickly afterwards.

I discussed everything during this pregnancy, and I was in tears a few times over it. I was reassured by the consultant putting it in my notes that I had to be stitched by a doctor rather than a midwife, and I had my concerns highlighted when I went in to have DD (5 days ago )i felt very supported by the Mws and consultant after I had voiced my concerns, as they are certainly valid ones.

In the event I have had a second delivery with a correctly positioned baby, (still a big one though!) a 2 min pushing stage and no tears at all. So hopefully your worries will come to nothing! Good luck!