Tearing and needing stitches, can this be prevented?

[dejags]

When DS was born I was attended by four midwives the last of whom made me take things very slowly. She was a strong personality and didn't "allow" me to push when I should have been panting. She did have to yell at me a few times though to stop pushing.

I didn't tear or need stitches and I was wondering if this was the result of having an experienced midwife manage my 2nd stage or if tearing is more physiological (I think that's the correct phrase)?

Incidentally I had a failed epidural and no other pain relief. My labour was induced with syntocin due to my waters breaking and labour not starting spontaneously - it was 12 hours from start to finish.

[WideWebWitch]

Dejags I didn't need stitches either and only had very mild tearing. Can't remember what the midwife was saying but my mum was there telling me not to push but to pant and she must have been right I assume or she would have been contradicted. Don't know at all if there's any connection though or if I was just lucky.

[pupuce]

Well Leese and Mears are the best to answer this but tearing is often due to women pushing (not necessarily voluntarily) the body of the baby too quickly after the head was out. So listening to the MW is really important.
I know that some people do massage their perineum before birth, I have read a Canadian clinical study which showed that this WAS helpful in first labours.
Also water does help avoid tears as it softens the area...but you may be very lucky too.

[leander]

I didn't need stitches either i had a very slight tear.I think the trick is to do excactley as you are told by the midwife, my labour was 12 hrs from mild contractions to giving birth i had 1 shot of diamorphine + gas n air.It wasnt as bad as everyone told me and will definately be doing it again!

[leese]

dejags - well done you - certainly not easy not to push when the overwhelming urge is just to go for it!
I think the answer to your question is this - you undoubtedly did yourself a big favour by managing to control that crowning stage (as the baby's head is born) - if you pant rather than push, it allows the head to be born more slowly - usually it just eases itself out - and in turn this gives the perineum a bit more time to stretch, hence less trauma to that area.
However, it also has a good deal to do with other factors - size of the baby, speed of labour/delivery, your perineum etc. Some women, however controlled they are whilst the head delivers, still end up with some tearing to a greater or lesser degree. Other women shoot thru labour and deliver really quickly with one massive push, and still end up with an intact perineum!
The length of the first stage of labour (as your cervix dilates to 10cm) doesn't really have that much to do with the stretching of the perinuem - that occurs more in the second stage as the baby's head descends and starts to stretch it, so it is this time which can make a difference. Listening to the midwife helped I am sure - but you should take the credit!

[Enid]

If you've already had an episiotomy, is it possible not to tear/need another one? Does the scar tissue stretch?

[Loobie]

i had a second degree tear with ds.1 which was not too bad at athe time but when it came to having the stitches they were excruciating,ds.2 was born extremely fast ,noe push and his head crowned another and he was born from head to foot,but even though he was born faster i had no tearing or stitches so maybe you just stretch better second time round LOL,i am due no.3 in Nov so hope i stretch as well third time round. I heard that massaging almond oil or such like into your perinium is supposed to help make it more supple,personally i couldn't reach but there you are.

[Bozza]

Loobie I also tried the perineal massage and failed due to my huge bump. Although my labour was fairly short I had a good two hours on the second stage (to the point where baby stopped in the canal, contractions weakened and I had to be hooked up to a syntocin drip)but still ended up needing a largish epiosotomy.

I assumed this was because of the size of DS (9lb 10 oz). Is this likely to be right? Is the tissue likely to be more stretched next time? Does the size of me (ie not that big) make any difference at such a late stage in labour?

[lou33]

I had a 3rd degree tear with my first child,along with an episiotomy, which I think was caused by having to push her out very quickly because they couldn't find her heart beat (and we were at home). I suffered terribly until the birth of my second child almost 5 years later, when I only tore slightly. The last two I didn't need stitches at all, and I think it was due to the fact that I had midwives who made themselves a bit more vocal when I wasn't supposed to push.

[ames]

My midwife told me not to push because she thought dd was facing the wrong way. Eventually when I said it couldn't not push anymore dd was born after a couple of pushes. Apparantly I only had a 'slight nick' which even after 36hours of the most hellish pain i've ever known, made me smile.

[pupuce]

Enid - I had an episio for the first and a tiny tear for the second (born in water). I know other mums like me... so not a problem.
BTW I helped deliver (another - youppee) baby last night...born in water and the mum did not tear at all (1st labour)! You should have seen the look on her face when we told her ! Pleased doesn't even begin to describe it !

[leander]

Pupuce
What a lovely job you have it must give you great satisfaction to see all these babies and happy parents

[leese]

Enid - if you've had a previous episiotomy then, like a previous tear, you may deliver without the need for performing another episiotomy and/or tearing. You are not predisposed to either because of your previous delivery - and the perineum can remain a little stretched if you like post first baby (best term I could think of!), so trauma may not be as bad. Saying that, subsequent babies can be larger, and for SOME women this can be a problem - I guess Bozza's little (?) one had a helping hand in her need for a stitch or two - big babies have bigger heads!
Bozza, I don't think your petite size would have made much difference to your perineal size or it's ability to stretch - we all look pretty similar down there, hwever big/tall we are! The issue with very petite women/large babies is the size of the pelvis, and how the baby descends through. Sometimes a baby just won't descend at all, at other times will descend so far then refuse to go any further. Sometimes large babies are born, and we can have difficulty delivering the shoulders once the head is born (if the baby doesn't have the room to rotate its shoulders once the head is out, as it should) - these babies require a bit more of a tug, and this can result in a bit more perineal trauma - suffice to say large babies can be born to small or large women, and are sometimes problematic, often not - sometimes small babies act in the same way.
Also to mention that some babies are born with hands alongside their ears/face etc, which can also result in some grazing.

[oxocube]

Small tear and 1 stitch with #1, nothing with #2 or #3. Second two were lighter than d.s 1 though, funnily enough. (8lbs 4; 5,11 and 7.4 respectively)

[mears]

Hi Leese - we haven't been around at the same time for a while
Totally agree with what Leese has said. Another factor that can make a difference is the position you deliver in. You are less likely to tear if you are on your side or out of bed because there is more flexibility in the coccyx at allow the head to glide out rather than be forced upwards on exit which can cause labial tears. Breathing the head out instead of actively pushing helps. Entonox is very helpful when getting through that stage. Sometimes though, no matter what you do, some women are not very elasic down there. I had episiotomies first and second time - done at the last minute because I had started to tear. Mind you that was a few years ago when nearly everyone delivered propped up on their backs. I didn't know as much then as I do now. Nos 3 and 4 slippedout - hardly surprising though

[SueDonim]

I had episiotomies with babies 1,2 and 3 but delivered number 4 without, hurrah!!!

I was so pleased as I'd thought my 'underneaths' must have resembled the Bayeux Tapestry after three cuts and stood no chance of not being snipped again.

[leese]

Hi Mears! Just posted you some good luck on another thread with your Masters degree. Wanted to do a smiley face, but am not yet that competent......!!

[pupuce]

Leese - sorry I am chasing you but all the smileys are under GETTING STARTED at the top of the page !

[Willow2]

Leese - it's not true to say that you're not predisposed to tearing again if you've already torn - it depends on how bad the original was. Some people have to have c/s second time around for just this reason.

[mears]

Willow2 - that is debatable I am afraid. I have seen women having C/S because of previous third degree tears. I have also seen women who hve had no stitches after previous third degree tears. Although some women have this type of tear with a normal delivery it is more common with a forceps delivery. Second time round a normal delivery is more likely.

[Willow2]

Mears - I'm talking 4th degree when the risk of severe damage is so great that it is not worth taking.

[mears]

I should have been more specific - so am I - 4th degree is a fairly recent description really.

[Willow2]

Am curious now - so would you let someone who had had a bad 4th degree and suffered problems as a result attempt vaginal birth?

[Willow2]

Sorry - meant advise rather than let. I'd have thought all medical opinion would have been against it.

[mears]

Not necessarily. Depends what type of delivery there was. As I mentioned before an instrumental delivery - ventouse/forceps increases risk of 3rd/4th degree tear.
When someone has had such a tear before then often it is advised that an elective episiotomy is performed. The only thing is these types of tears can be associated with an episiotomy being performed in the first place.
Depends on the wishes of the woman really. I have seen women have elective C/S at their request. I have also seen women have uncomplicated delivery second time aroung.
What I have noticed is that instrumetal deliveries can be associated with induction of labout which often involves an epidural. Not always.
Have you had experience of this Willow2?

[mears]

Sorry about the spelling mistakes - I am happily supping wine and periodically ironing ( what kind of risk is that?). dp is on the night shift