Epidural - more in control of labour? Question...

[thepandasayshello]

Hello! First time poster here.
I'm 28 weeks with my second baby. My first child's birth was a traumatic experience and resulted in 3rd degree tearing (was reconstructed in the birthing room). Lots of things happened that were scary, and it was all compounded by being in a country where I was fluent in, but not a native speaker of the language. In addition, the midwife was also not a native speaker in the native language, so I didn't really understand 100% of what was going on. I know that as the birth went on, the pain increased & I went into the zone & kind of forgot how to understand :(

Anyway, I digress. This time around, we've moved to another country (not home), but speaking the native language. Recently moved to another city & have been getting set up with all of the relevant services etc. As part of that, I've met 2 obstetricians, to find out what they recommend for birth #2.

Can anyone share stories on avoiding / managing tearing through a carefully "managed" pushing stage? Epidural has been mentioned by both as a way of managing the situation. I had no pain relief first time round, and I really was no where near understanding any instructions. How did you find an epidural?

Sorry for long post. I'm trying to get inputs that can replace the scenarios that are keeping me awake at night.

Not sure if this will help, but I had my daughter 5 months ago. I had an epidural as I was induced with the drip. It was a long labour - 25 hours - but the pushing stage was only an hour. The epidural was amazing, I could still tell when I was having a contraction, so knew when to push, but it wasn't painful at all. I did have a second degree tear, but she was 9lbs 5oz so I think it may have been inevitable. Healed fine in a couple of weeks with little to no discomfort.

Good luck 🙂

Thanks for that insight! Delighted to hear it was positive & healing was swift.

I had an epidural during my first which did result in an episiotomy ; induced, hormone drip, epidural to manage BP, and an eventual ventouse. The epidural gave me enough awareness to refuse forceps and still be conscious enough to know what was happening. Tbh I didn't even feel the stitches after and didn't even take paracetamol. I have never torn so I don't know the difference.

Labour 2, I had an epidural at 4cms and it was BLISS. Although that still resulted in an emg csection, although the plan was to turn it down towards the pushing stage. I would recommend one to anybody really, you can still feel the contractions very mildly and so you know what's going on. I was a mess before they gave it to me.

I had an epidural and it was bloody wonderful. Would definitely recommend, god knows why I ever thought I wanted to labour on just had and air. Like PP I had a very long labour and ended up on an oxytocin drip, so the epidural was a very welcome relief.

I could still feel my contractions (not painful) but there is the possibility that you can't and you just have to push when the midwife tells you you're having one. Pushing stage was almost 2.5 hours for me - no idea if that's due to the epidural or not, but an epidural can potentially make pushing less effective and means you're more likely to end up with an assisted delivery (I didn't though). I had a few tears, worst was a second degree, but none were painful afterwards.

Thanks for your replies, I really appreciate your taking the time to share your experiences.

You're less likely to tear with a second or subsequent baby than the first, though, because everything is... well, looser

I had a 2nd degree tear with DS1 that healed fine, no problems. Midwives weren't concerned about tearing risk for second baby when I asked, and DS2 popped out with no tearing at all even though it was a fast labour and delivery. I think what helped was that DS2 wasn't large or awkwardly positioned, I didn't have any bad scarring from the first tear, and I didn't have an oxytocin drip (which ramps up contraction strength) so the chances of tearing really were pretty low for DS2. I was ok on gas and air, able to follow instructions, etc.

OP, could you ask your midwives/obs if you have any extra risk factors for tearing? It might help you decide whether you book an epidural now or just play it by ear on the day when you know baby's size, position, etc.

Hi panda,

I'm inferring from the suggestion of an epidural by the obstetricians that speed (baby coming too fast) was the reason behind the tear (???).

Normally epidurals are more likely to lead to an instrumental delivery which themselves carry a higher risk of a severe tear (particularly with forceps).
www.nhs.uk/conditions/pregnancy-and-baby/pages/ventouse-forceps-delivery.aspx
I'm assuming they're taking into account the fact that it is a second birth and that baby came too fast first time and so they think an epidural would help slow things down? Personally I'd confirm with them this is what they think.

Because you have had a severe tear already, you now have an increased risk of another one.
www.rcm.org.uk/news-views-and-analysis/news/recurrence-of-severe-perineal-tears
Here the RCOG recommends discussing how to deliver subsequent babies (ie have you had incontinence issues or psychiatric injuries, pros and cons of a c-section etc).

There's a hospital in Kent using prenatal assessments and hands-on techniques to reduce the risk of severe tearing.
www.kentonline.co.uk/medway/news/safer-birthing-project-wins-award-121820/
Supporting the perineum and slowing down pushing seems important.

Hope this helps

My first baby was born very quickly and turned his head as he was being born. Ouch. I had a nasty tear the required an hour of stitching. It did however heal quickly.
My second baby was bigger and the labour longer. They had suggested an epidural but I refused as I agree with PPs about increasing assisted delivery and actual.y greater risk of tearing. I gave birth to her on all fours and didn't tear at all. She was 9lbs 8oz and head crowning and second push to deliver the rest of her almost ran into each other.

I'm expecting my third now and having had two excruciating labours I still know I would prefer this baby to come without the need for an epidural. That's no criticism of women who chose or have to have one, all the matters is baby is born safely and we make choices we ours,eves are most comfortable with.

Good luck whatever you decide and hope your second labour goes well!

my dd had a combined spinal epidural last year.
she was already in transition when she arrived at the hospital, it was inserted right away.
she really enjoyed how it took the edge off the contractions, how she was able to breath relax and stay in control.
she had no trouble not pushing when asked.

I had a positive epidural experience with both my children each in a different country. Both times I was in total panic and birth fearing mode having contractions but not quite ready to go and both times I was transformed into a relaxed state and actually enjoyed the birth - could feel the pressure but not pain. I wasn't induced but had reached such a stage that an epidural was offered which actually enabled me to relax and sped things up. The actual (v quick!) pushing stage for my second was magical with just us and the midwife and her trainee. No stitches and fast recovery :))

I had an epidural for both births. The first time, I was at 8cms but was clamouring to push. I was completely delirious and it calmed me and slowed things down enough for me to get my bearings and follow instructions.

The second time I had it at 4cm so they could break my waters. Labour then took all day but was a relaxed and chatty affair.

Neither birth required stitches, instruments or has any other issues. In fact the first working out so well made me completely relaxed about the second, during the second pregnancy.

I had an epidural with my first, I couldn't feel a thing, I couldn't feel a contraction, I couldn't control anything to push, basically I was helpless lump, docs ended up having to use forceps and the venthouse (vacuum) together, they both cut and tore me, it took me months to heal and get over it.

2nd baby I refused it .. I'm glad I did, the birth was so much easier, the pain soon forgotten and while I did end up needing a few stitches the recovery after was a breeze.

good luck with whatever you decide to do

Thanks everyone. First delivery was chaos, hoping for less chaotic round two

Pushing too early can exacerbate tearing, I would avoid the epidural in that case and hold off pushing as long as possible, this will mean it may take slightly longer but allows the body to adjust and stretch more effectively.

Thank you everybody for sharing. I've chosen an obstetrician who is very experienced & has a solid reputation for running a calm delivery room. We discussed these aspects further today, and my anxiety generally. I feel much better now, and I'm confident that over the next few weeks, I can reset my brain. I just needed the obstetrician to make me feel calm, and that's starting to happen. Thank you all.