Tips to stop tearing during birth?

[MotherofPearl]

I'm 36 wks into my 2nd PG and starting to think ahead more to the birth. First time round I had epidural which arrested labour, baby went into foetal distress, was born with forceps which of course meant episiotomy. I had lots of problems with healing and a year after the birth had to have fenton's procedure to remove a painful ridge of scar tissue.
So, this time around I'm hoping for a natural delivery without all that intervention, but I am really worried about the ability of the scarred area to stretch properly to accommodate the baby's head as it comes out, and am frankly terrified of tearing/ripping open the old scar! Sorry, it's a mental picture I can't seem to get rid of no matter how much positive thinking I try.
I wondered what tips people have for reducing the likelihood of tears? I guess trying to relax might help, breathing, panting out the head etc, but any advice or tips gratefully received. Thanks!

I have 3 DCs. DS1 and DS2 both had big heads (37cm) and were both 9lb+. Both times I had to be cut as to be frank they just got stuck.

DD1 was only 8lb and had a much smaller head (35cm). Now that 2cm made a huge difference! She also came VERY fast and believe me, for love nor money I couldn't do anything to slow things down. I ended up tearing a teeny bit - no stitches needed, and it certainly didn't make the old scars split or anything. So although there may be things you can try, I think at the end of the day a lot of it boils down to head size and plain luck!

Thanks grubbalo, it's reassuring to hear that your old scars didn't split the 3rd time around. A little bit of tearing seems OK, it's a massive rip that scares me so!

Thanks ScaredBear, will do! My plan is to listen attentively to MW but my worry is that I'll panic and in the heat of the moment just sort of block her out and do something stupid like push the baby out in one go! Hope I manage to stay focused.

Afaik, scar tissue is actually stronger than normal tissue, so you are less likely to tear along the scar. However, if you do need another episiotomy, they will cut the same place as the previous one, so you won't be left with two scars.

Things that are linked to lower rates of serious perineal damage:

Good communication and positive relationship between mum and midwife

No epidural

Prior use of perineal dilator (epi-no - google it)

Perineal massage (maybe)

Homebirth

Unassisted birth (!)

I think delivery in water is supposed to reduce the risk of tearing as well

Well actually, epidurals have been found to PROTECT against tearing - see below - I guess because you are able to control and listen rather than panic in pain and push too hard.

My best ever birth was under a doctor who did not leave anything to chance. He 'got in there' and eased my perineum over the baby's head - according to my DH it was a 'work of art'. I could just about feel something going on (had mobile epidural) but because I wasn't in pain I just waited patiently, thinking WTF is going on?? Intact perineum at the end. :)

From Globe and Mail in Canada:

But a new study out of Australia has found that an epidural may play a positive role in women's health long after the baby is delivered by reducing damage to the pelvic floor muscles.

Australian researchers used two sets of ultrasonic imaging on a group of almost 500 women undergoing their first pregnancy and planning vaginal birth ? one taken during pregnancy and one three to four months after childbirth.

Because damage to a woman's pelvic floor muscles during childbirth is known to be a risk factor for future health problems including collapse of the pelvic organs (pelvic organ prolapse) and incontinence, the researchers wanted to see whether style of birth played a role.

Of the 488 women in the study, published last week in the British Journal of Obstetrics and Gynaecology, about 13 per cent experienced ?avulsion,? or tearing, of their ?levator,? or pelvic floor muscles. Women who had had an epidural had a lower incidence of tearing.

Interesting re the epidural vs not debate. And yorky, yes, I am hoping to try a water birth this time because I had heard the water helps to soften up the perineal tissues, so to speak!

Water birth!! Water soaks into your muscles and allows for easier stretching when you are pushing your baby out. That's my plan!

Epidurals may protect against pelvic floor damage but there is a strong association between epidurals and forceps deliveries, and consequently with OASIs.

I didn't tear with DS - the MW who delivered him said because I had mostly been on my left side, this was a good way to avoid tearing. I was only on my back for the last push, literally - he crowned while I was still on my LHS.
I had also been using olive oil and manual stretching prior to the birth (was induced, btw).

So I don't know if staying on your side (L or R, don't know if it makes a difference) helps or not but it certainly seemed to help me.

All good advice, thanks everyone. Am going to try for a water birth but if for whatever reason I end up delivering on dry land I will give lying on my left side a go, and listening to the midwife esp at the end! Off now to google epi-no!