Perineums can be functional after childbirth

[mears]

Just thought I would start a thread to reassure the women out there who are planning vaginal birth that perineums are designed to allow babies an exit. It is more often than not that perineums recover without any problem after delivery.
I have had 4 children and needed an episiotomy with the first two. I had sex 2 weeks after DS2. The last 2 children I had without a stitch. I am now 43 years old, my youngest is 10 years old and not a drop of urine escapes when I sneeze

Aaah, but is that because you are a midwife and did your pelvic floor exercises religiously?

Possibly - but you don't need to be a midwife to do them Pelvic floor exercises are the easiest yet most forgotten exercise.

Mears - glad to hear that! I had episiotomy with DD1 after very quick labour, and got 3rd degree tear. Then had section with DD2 because of "damage" - sure I could have had a natural one though - and I'm afraid despite fairly religious pelvic floor excercises still have quite a severe (and embarassing) problem with leakages! Too embarassed to go to doc! Seems to be worse after 2nd preg - so not linked with the tear I don't think. Sorry to dash your optimistic thread though!

Mears, have to agree with you. Youngest 1 yr old, both vb no tears or episiotmies, and yes agree, had sex quite soon after with both. No drops here.

tatcity - don't be embarrassed to see the doctor. There are a number of things that can be done to help - physiotherapy for a start. Best to try and get it sorted, don't just put up with it. I know there are many women who have had problems but I think that it needs to be known that it is not the vast majority.

I had no tears with either of mine depsite quick and intense deliveries, only very slight grazing which healed well in a couple of weeks first time and within a week the second.

Mears, I agree it is not the vast majority. Felt a bit guilty posting on such a positive thread. Think its to do with intervention. If I'd been left alone during first labour, this probably wouldn't have happened. I will go and see doc next week - still a bit embarassing though! Doc is good looking too!

Don't feel guilty - glad to have your post. Will be checking up to hear how you get on at the docs.

First birth, small tear, healed by itself. Think my pelvic floor is better than before or certainly no worse. Hope another positive message does help reassure some of the pg mumsnetters.

I had a great episiotomy with DD1 that healed easily and had little damage. The scar was a bit bumpy and on my follow up check up with my GP he noticed it and prescribed some local anaesthetic cream to sue and rub and stretch the area to flatten the bumpy bits...was sceptical but did work.
The episiotomy was painless - I think - was so busy "doing other things" like giving birth at the time that I didn?t notice them doing it. After all that worrying and deliberation about whether or not to allow them to do it, when the moment came, it just wasn?t an issue.
Second time round I didn?t have one but tore badly instead. Took much longer to heal despite careful stitching by a lovely and experienced MW.

If you get the choice, I would advise any woman in labour to go with what your MW suggests at the time and view episiotomies as not ideal but can be a lot better than tearing. Tearing can be ragged and unpredictable concerning how deep and long it is going to be so harder and more painful to stitch and heal (IME).

mears, great idea to start this thread. there was one post in particular on the other thread that i really wanted to respond to but didn't want to get into a fight! my bits are perfectly fine, despite long labour, ventouse delivery and episio!

But stripymouse, isn't a tear supposed to be better than an episiotomy? Mears, what's the official view on this? I'm also fine (2 x homebirths, no episio, second a 9lb 8oz baby) so that's positive stuff to your thread!

I've had one episiotomy, one tear. Pretty damn good bladder control although I think when I sneeze very very VERY hard, ditto coughing there is the odd drop.

I do lots of pelvic floor exercises, because I combine them with stomach ones.

Aha, bet Mears is now going to tell us about her glorious tum (if you do, sweetie, you deserve one)

Tears are better if the are no bigger than an episiotomy. Often they are much smaller and follow the natural fibre lines of the muscle or just involve the skin. They heal much better. Large tears are more difficult to repair and can cause more pain than an episiotomy. It means that the midwife needs to use her judgement. If it looks as though the perineum is going to tear when there is still a good bit of the head to come, she will advise an episiotomy. Not always easy to judge though.

Motherinferior - my stomach is resting on the top of my thighs as I sit and type here. Joined the Bigmamas club but only lasted 2 weeks - pathetic will power. Am supposed to be writing reports and doind an assignment just now, not posting on MN

One baby, big head - 98th centile, small tear, told by midwife to keep my legs together that night and should be ok - I was, no stitches. Don't wet myself at all. In fact the only person I know who does leak - am sure there are more but... - had 2 CSs.

Mears - you say that pelvic floor are the easiest form of exercise. Not sure if I would agree with you there. I find them really really hard to do and after a nasty wake up call after DD1 was born I am fairly religious about daily PF exercise - have been now for 3 years. Despite this, I still feel like I am going cross eyed trying to "visualise", not pull in my tummy, carry on breathing while tucking in. Mind you, I have never been the most physically co-ordinated person and was rubbish at PE in school!

However, I do agree with you - blimey, are they important and what an incentive to do them...I worked on mine like mad after giving birth and getting a nasty wake up call when trying out that mid urine flow thing...The fear of catching a cold and embarrassing myself in public was the driving force behind keeping me going on those awful, illusive internal muscles. No probs now. Typical - the only unflabby, toned muscles I have in my whole body and they are the ones not to show!

Stripeymouse, maybe that's what I'm doing wrong! Find it impossible not to hold breath/suck tummy in. God. How do you manage it?

Great thread -- I got quite fed up with reading all the pro-caesarean newspaper articles implying that every vaginal birth results in agony, forceps and incontinence.

I've had 3 vbs, dd1 episiotomy, ds largish tear (v. quick labour, 10lb baby, no time to get upright), dd2 (9lb 5oz), induction, small tear, no stitches.

The repair to the episiotomy was def. more painful than the tear.

I had largish tears and episiotomies (because the tears were getting out of hand) with both my sons. The second was ventouse turned and the first was just really big headed. (Still is.) None of it (tears, cuts or repairs) hurt, although I was grumpy at the end and wanted the doctor to go away. (LEAVE ME ALONE ALREADY!) Both times they healed quickly and without problems. No problems with incontinence either and I'm a bit (ok, a lot) lazy with the pelvic floor exercises.

But sex after two weeks? No way -- not due to the damage, but the lack of sleep and drive.

I'm confused... if incontinence is just as common among women who have only had CSections (that's what MN told me recently)... then what difference does your perineum make? I got the impresion it was pregnancy that did the damage, not childbirth.

I thought it was the general wear and tear of pregnancy as much as vaginal delivery.

Not good for you, IMO, pregnancy. Bah.

Oh, and this is the exercise we did lots of in my antenatal pilates class which involved the old pelvic floor - plus lower abdomen (I posted it on CD's flabby tummy thread as well).

?Breathe in, and then breathe out ? you do this exercise on the out-breath. The first thing you?re thinking of is drawing your navel back towards the spine, to pull your abdominals in. Then think of pulling your sitting-bones together by squeezing your lower gluteus muscles ? this will automatically lift the pelvic floor. This will strengthen two of your core stability muscle groups.?

You can do this while you?re waiting for the bus, sitting at your office chair, doing the washing-up and so on.

Now, young mears - just to show I do balanced research :0

I'm sure my sister won't mind me using her story as a good vag birth........

her first birth, in a large teaching hospital, was probably 'good' by NHS standards but she had a bit of really unecessary intervention, instead of being left to it (she arrived at the hospital at 10cm!) As soon as she got there, lots of vag examinations, an oxytocin drip, multiple midwifes - she was terrified after doing sooooooo well on her own at home. Anyway, lovely baby, minor graze, no gas & air or epi etc. But she felt let down.

2nd birth - midwife-led unit in a small hospital. Delivery room looking out to sea, midwifes asking her -'what do you want us to do?', bringing her cups of tea etc. She said she never felt so relaxed and baby popped out no probs with no intervention at all. No damage.

I asked her why she didn't have the 2nd at home if it was so easy and she replied that it was nice to leave someone else to tidy up the gore! (and she was worried the dog might pull the placenta out of the bin ).

After such good births she then felt she had the energy to concentrate on BF, which she did with both for 6 months each.

She's been such a good role model for me - cheers sis

Do any of you really, truly, honestly do these pelvic exercises in places like the bus and at work?!! I am seriously impressed if you do manage it and are doing them properly. I am sure I go slightly red, a bit cross eyed and grimace with a "I?m really concentrating hard" look on my face. I wouldn?t dream of doing it in public, esp. not driving - could cause an accident or worry passers by thinking I was having a seisure or something

I do PFE when I'm standing in queues... helps to absorb the frustration I feel at slow staff on shop tills!