Are you more likely to tear with an epidural and/or assisted delivery?

[PixieCake]

I had a 2nd degree tear after a vacuum (kiwi) extraction.
Also had an epidural.

Does anyone know if epidurals increase the risk of tearing, maybe as you can't feel what is happening so much?

And does assisted delivery make you tear more, maybe because of all the tugging and shoving?

Wondering if I could avoid tearing next time by trying to go more 'natural'

I tore with both of mine (both 2nd degree) and had no epidural or assistance with forceps/vacuum so sometimes it just happens anyway.

Same as Seona1973, only I've just had one DC. Epidural/intervention does increase the likelihood of tearing I think, but there's no guarantee that doing it all 'naturally' will mean no tear. If I had to do it again, I'd go for the epidural!

I think if you have an assisted delivery they give you an episotomy which is a cur rather than a tear. This was what,they did to me tho I think they gave me a local anasthetic first.
From what I have read epidurals increase the likelyhood of a tear or cut but only because they increase the need for assisted delivery.

I've had 2 epidural+ventouse deliveries. One had a cut to help ds out ASAP, second I had a second degree tear plus small cut to stop tearing worse.

In both cases I was stitched up very carefully and recovered very quickly - that seems to be more important than how bad any tears were. I didn't even know I tore until 3 days later when I read my notes.

Don't know if the research evidence helps but here it is

Epidurals actually protect against tears because you are less likely to push uncontrollably but slightly more women who ask for epidurals have instrumental deliveries. However, with modern epis it is uncertain whether this is because women with more difficult obstetric problems ask for them more often or whether there is a real association to epidurals.

So, overall not a lot of difference in whether you are likely to tear or not BUT at least you shouldn't feel it if you have an epidural

fn.bmj.com/content/96/Suppl_1/Fa75.2.abstract

Just giving my tuppence here, I had an epidural and my midwife guided my pushing for a nice controlled crown which meant no tears. Obviously this was in a calm situation where there was no rush to get my DS into the world and midwife had the time to do this.

my tuppence - exactly the same experience as Debeez except no epidural

No tear with DS1 when I had an epidural but I was cut for forceps .

I had a small tear with DS2 when I had no epidural or indeed any pain relief and no midwife - it was along the scar of the episitomy and didn't need stitches.

Perhaps a risk factor for tearing in second and subsequent children is having torn or been cut before?

BigBoobiedBertha You're no more likely to tear for a second or subsequent child if you tore with your first, than someone who didn't tear with their first. It's pot luck essentially.

Subsequent tears are likely to be as bad or worse than the first though, probably due to lack of flexibility in the scar tissue.

Can you not have a waterbirth.i had my second one yesterday and it was the best pain relief going with no tears and i have no pain at all down there

molly congratulations

Thank you

Its my second waterbirth and i honestly dont think i could cope without once you have experienced it there is no going back!

I'd have to disagree with that - water did nothing for me pain relief-wise, but it did slow my contractions right down so I had to get out again.

midwifethinking.com/2010/08/07/perineal-protectors/ brilliant online article about protecting the perineum that you may find interesting op. God, hope link works!

I was the same metalhead, lying down (or sitting) to get into the water ramped up the pain...

I think a skilled practitioner who can protect the perineum makes the difference. I recently had a ventouse (for rotation) with epidural. Had no tear or episiotomy but fantastically controlled delivery.

The risk of instrumental / operative delivery increases with an epidural therefore risk of perineal trauma is higher.

Empty crisp packets That is not what the peer reviewed evidence indicates although it is what lots of antenatal teachers and midwives say.

There have been several studies on this. You are right, there is a statistical link between instrumental deliveries and epidurals but we are not certain whether this is caused by the epidural or just associated with it because women in more pain and therefore with more problems ask for epidurals more often.

Perineal trauma has several causes - instrumental deliveries and, more commonly, injuries caused by the uncontrollable urge to push being two of them. Epidurals damp down the latter so there is a non-significant trend to be LESS likely to suffer severe perineal trauma with an epidural.

Here is one of the studies on the net - you can google and read it yourself.

J Obstet Gynaecol. 2009 Feb;29(2):119-22. Links

I've read that one, albeit a few years ago when I trained.

I wish I had my laptop close by as I have a fair few articles on perineal trauma. Some interesting ones too.

Can't remember who mentioned it above, but definitely try the water it can help immensely.

My first DC was born with epidural and by ventouse (had a 4 day induction and 8 hours of syntocinon).

The registrar wanted to do a episotomy but I refused (my mum was cut up to her urethra and down to her anus without anaesthetic and I have always had a fear of epi. for some funny reason!) - guess what - I had no stitches and just grazing so if I had let her do an epi. I would have had been guaranteed stitches and a wound

I had an epidural for DS and a 100% natural birth for DD (not even gas and air!), and I had a small tear both times.