Pushing stage

[dreamygirl25]

I don't know if anyone can offer me some advice? I'm expecting my 3rd baby in 2022. Seems ages away! But I'd like to be prepared.
First baby I had quite a traumatic experience. It was the not really knowing what to expect. 2nd degree tear kept getting infected. Labour was maybe about 18 hours?

Second baby, wonderful experience. I think twinges about 5pm, baby born at 9pm. Midwife notes said baby came in 8 minutes. 3rd degree tear, healed really well. Actually felt better than my 2nd degree. I seem to remember them saying it was just into the margins of 3rd degree.

Water birth for both. First birth they said, 'push when you feel the need'
So second birth I just remembered that advice and pushed like crazy and he came out soooo quickly.

My question is, if I hadn't had a water birth and the midwifes told me when to push do you think I wouldn't have torn?

I love my water birth experience but I'm afraid of causing damage. If with my third I don't have water and I specifically ask the midwifes to guide me, do you think I am less likely to tear?

I know no one can really know for sure, but based on my experiences would that help?

I don't think so. It is harder for them to coach your pushing in the water anyway.

But if you felt you were putting effort into the pushing that might have been the issue. When they say push when you feel the urge, what they actually mean is so absolutely nothing and let your body take over. It's a really weird feeling when this happens, almost like vomiting where you're not in control of it yourself but the baby is just coming out! You wouldn't want to prevent or stop yourself from pushing but just wait for the reflex to happen. Have you looked into hypnobirthing at all? They have a similar thing where they talk about breathing the baby down.

What I have read about waterbirth is that overall the number of tears is lower, but when you do tear the proportion of third or fourth degree is slightly higher.

I've heard that too about water births.
I did hypnobirthing and it was so great. But my headphones were taken off me when I got into the water and I think that impacted my breathing. I suddenly wanted to get out over with.

Maybe you could take a speaker or something this time so that you don't have to give up the headphones, or ask the midwives to help with the breathing rather than coaching you how to push.

Perineal tears are not really connected to anything except the size of the baby's head and the stretching of the skin .

The midwives can tell you "It's OK to push now", because they know that you are fully dilated, but the desire / need to push comes from your body, not from anything they say.

If you've had two tears with two babies, it's likely that you will tear again because the perineal skin has been damaged and so you'll have scar tissue there which is very unlikely to stretch much .

I was told in NCT that sometimes being coached results in more tears because you're not following the guide of your body and that the most helpful thing you can do is take your time and not push the baby out in one push if that makes sense. I doubt midwives can really help with this as they can't feel what your body is doing.

I have a friend who is an obs/gynae registrar and she always told me water is great for helping with pain but it softens the skin if you soak for a while and will increase the likelihood of a tear if you don’t get out before delivery:

I got my stats the wrong way around, sorry.

There is a slightly higher incidence of 1st and 2nd degree tears compared to land births, but fewer tears overall and fewer 3rd and 4th degree. Also no episiotomies because you have to get out of the pool for one of those, so overall intact perineum is more likely if you're in a pool (but that's sort of self selecting).

It may be that the higher incidence of 1st and 2nd degree tears is because somebody who would have torn worse or been cut on land is experiencing a less-serious tear than they would have, because of the effects of the water.

I have heard the water softening the skin theory before, but I think it actually works the opposite way to how people seem to think - it's a protective effect. The stats seem to support that anyway. Although you do have to account for the fact that someone with problems delivering would be asked to get out of the water. There does seem to be some protective effect simply from labouring in the water, which does support that water softening the skin is protective against tearing.

evidencebasedbirth.com/waterbirth/

Thank you, ah I'm at a loss at what to do. I've got plenty of time to think about it. I'm worried about the potential damage. I was told at my second birth that I'd be able to have a csection if I wanted one for my next birth but the recovery and risks of that are a bit scary. Think this will definitely be my last baby!! Thanks for that link.
I went for a check up a year on (with a probe) and they said there was minimal to no scar tissue.
I haven't had my booking in appointment yet. I just hope I get a nice midwife who can understand my concerns. I had quite a stern one last time!

I asked for no coaching with my water birth. Tbh the urge to push was so strong she asked me to not push so hard and just breath (your body just sort of does it anyway when things are progressing normally).

I tore both tones when in water, both times a second degree needing stitches and the second time i defo didn't push unless my body did it for me so I feel if your going to tear you will irregardless of if you push or not x

I had my 3rd a year ago, 1st dry land birth (tried for water birth but no luck) pushed for HOURS, 2nd degree tear. 2nd, water birth, really quick 2nd stage, second degree tear uncontrollable urge to push, my body just took over. 3rd, it all got very intense very quickly, and I was only in the pool for about 15 mins before needing to push. The midwife DID manage to coach me a little, told me not to push a couple of times (I shouted at her that I couldn't help it ha ha, but tried really hard not to) and no tear at all. I was flipping delighted.

So, yes you can avoid a tear on a 3rd birth after tearing on 1 and 2, and yes they can coach you in water!

Hope that helps a little

And to add the second time round I tore in exactly the same place as the first time so it was the scar tissue that tore x

I had a similar experience with DS1. I was in the pool for hours but got out for the last ten mins to deliver him and ended up with a 3B tear. I’m currently pregnant & have seen a couple of consultants over how to birth this time and one told me that they see more 3rd-4th degree tears among women who’ve been in the water & that if I had a vaginal birth this time I should not use the pool. My midwife agreed & said it’s easier for midwives to give perineal support if you’re not in the water. Wish I’d known all this sooner!

Good luck with it OP!

Just as a counter, I had an EMCS and was walking a couple of miles within a week. After than a bit of pain the first couple of days, it was way easier than I anticipated