How can avoid tearing again in 3rd birth?

[staranise]

Hi, am pregnant for third time and am terrified of all the stitches etc that I experienced the first two times. 1st birth I had an epidural and episiotomy, which entailed lots of stitches and pain for weeks after. Second birth was faster with no pain relief and, panicking somewhat, the pushing wasn't controlled (MW was useless in helping me here, I was in the wrong position etc) and I tore badly, needed lots of stiches etc that really spolied my first hour with baby.
Desperate to avoid tearing and stitches, more scar tissue etc again but how? Am contemplating c-section though am sure they won't give me one as my births are straightforward otherwise and ther babies are quite small, around 7lb.
PS. first time i did all that pelvic floor stretching, olive oil on perineum etc, tons of yoga throughout both pregnancies but it didnot seem to help.

Thanks
S

Waterbirth. I have said this so many times on MN but you probably haven't seen it Staranise. I have had 2 waterbirths with very little perineal damage despite huge babies.

Waterbirth, and dont push at all (I didnt) and give birth on all fours, use your hand to feel the baby's head emerge, I read this often helps prevent tearing.
Had a bad second degree tear with DS1,was v worried about stitches with second birth, so I did lots of reasearch and asked on here and it all worked out well, not even a graze even though DS2 was 9lb.

You might not have a choice about pushing, but if you go for a waterbirth you will get a midwife with a special interest in it, probably, and she will be good at managing the 2nd stage.

Even if you don't have a water birth, doing it on all fours or up on your knees will really help. I was flat on my back the first time and had an episiotomy. The next two times I was upright on my knees, kneeling over the sofa ( or if in hospital anywhere you feel comfortable ) and didn't tear either of those times.

staranise, this was the thread I started a year ago which is similar to this one, loads of good advice on there
www.mumsnet.com/Talk/1365/290902?pg=2
HTH

thank you v much for suggestions, will raise them with my mw. Are waterbirths available as standard? Previous antenatal care was abroad and not sure what happens in the UK. My nearest hospital is Kingston in SW London, which has a good maternity reputation, though I could press for Queen Charlotte's, but it's further away. Will check link. Thanks again S

In most birthing centres there are more rooms than pools, so it depends how busy it is and whether the women who came in before you wanted a waterbirth. The only way to be certain is to have a homebirth and hire a pool.

Don't think my house is big enough to accommodate a birthing pool (am assuming they're larger than a bath?!). The bedrooms certainly aren't and I don't fancy giving birth in the sitting-room; my bathroom is tiny. TBH I've never wanted a home birth, I actually like the idea of a break from my older children with the new baby for a day or so (though realise that hospitals aren't exactly relaxing places!). Bit worried that I can't guarantee a water birth at a hospital.

Am I being really wimpish in wishing for a c-section? I know that it's obviously not an easy option but I keep thinking that at least the stitches are in your stomach and not your bottom!

I had my second waterbirth at a birthing unit. There was one birthing pool, 2 delivery rooms and they delivered about 180 babies a year. These are the qs you need to ask: how many pools, how many births per year? Then you can work out your chances of getting one.

You can never guarantee being able to use the pool even if you do have a homebirth because you have to be low risk for it to be allowed. EG if your blood pressure rises above a certain level, waterbirth is out.

Some people labour in the pool and then get out for the birth.

Try perineal massage, it really does reduce tearing. Its not so much massage, more stretching! Use an oil such as wheatgerm and put your thumbs inside your vagina and gently stretch and massage the skin between your vagina and anus with your fingers. You can also get your hubby/partner to do this if they're willing! Stretch it so that you can feel the stretch IYKWIM, but don't hurt yourself!

There's LOTS of research on this and I recommend it to all ladies. They give me lots of funny looks but I have low perineal injury rates!

I did all taht massage with my first birth - i did all the J Balakas stuff as well and it didn't work that's why I'm so scared third time round!

staranise - I can sympathise, as I did everything "right" last time and ended up with a very large episiotomy (that I did not consent to ) and Ventouse.
I also don't want a homebirth, or more damage to my perineum, and I'm hoping for a good midwife who will do everything possible (birth positioning, supporting the perineum when I'm crowning etc.). To be honest, I think that my main tactics are -

talking to the people at the birthing unit and making sure that they know exactly what I do and don't want so that we are all on the same side (my midwife is organising this for me when I'm 16 weeks)

making sure that DH knows exactly what I do and don't want so that he can keep an eye on the midwife and be my advocate (he feels very guilty from last time as he knew that I did NOT want an instrumental birth, but he sided with the OB - in his defence he was really scared that something bad would happen if he didn't - but we checked the hospital notes and DD was in NO distress at all - anyway, he is completely behind me whatever I want this time).

I'm 32 weeks pregnant with my 4th and I am also very scared of tearing. I tore with all the others although managaed to avoid stitches with no. 2. I've found stitches incredibly traumatic and distressing.

This is what I have planned:

I have booked a doula and have been practising hypnosis techniques. In all my previous labours I have panicked as the 2nd stage approached and, according to DH, I think I'm pushing but am not so everyone gives each other nervous looks and then starts yelling at me to push.

This time I'm planning on asking for no VEs unless clinically indicated - to avoid the whole rigmarole of "ok, she's 10cm now, come on puuuuush". I'm hoping to push when my body is ready to, rather than in time with people yelling at me.

I'm also hoping to deliver in water. And I have the doula to back me up as DH and I have in the past been quite passive with the medics. And hopefully the hypnosis will help to stop me panicking. I would love it if I could breathe the baby out, rather than push, but I'll have to see how that goes.

Thanks for useful replies.

Yes, afraid that I panicked at the push stage but the pain really took me by surprise as I had an epidural with DD1 (bliss!). What does VE stand for Rolf?

It seems that i will need to do a lot of preparatory work with the MWs etc. Thing is, I will be giving birth in a busy London hospital and I don't really trust the MWs after my last experience, thoguh I appreciate they are doing their best under v difficult circumstances. I really felt that last time they thought "She's fine, she's not wailing too much, it's a quick, straightforward birth" and left me alone. I had to fight to even get G&A, thgouh I was begging for an epidural from the beginning. Also agree that DH needs to fight my corner more as well Mrs Tittlemouse, though not sure how great he would be at getting involved with the mechanics of not tearing .

Think I am even more scared now than when i first posted! Did asnybody consider a c-section to avoid tearing again?

VE = vaginal examination.

One of the reasons I wanted a doula was to take the pressure off DH. Would you consider a doula?

Ernest (on the June 08 ante natal thread) is having an elective c-section becuase of previous v severe tearing.

How bad was your tearing? Are your concerns psychological or medical, IYSWIM? In my case, my tears were never worse than 2nd degree so not severe by any reckoning but I still found them (and the stitching) terribly distressing.

I had lots of stitches (20+ first time, more second - is that a lot? I assumed it was)which was v distressing at the time and afterwards (particularly in the second birth with no epidural, it really ruined my post-birth euphoria). However, they were both 2nd degree and have healed fine though I'm definitely a different shape now! They said I could refuse stitches last time but I would be left with flaps (!).

I think I feel that my poor old body can't go through that a third time, plus I felt that I wasn't in control last time and the MWs weren't interested. And thsi time I might not heal so well because of previous scar tissue. I'm jsut wondering what the other options are given that I did all that perineum massage etc and it didn't seem to work. it doesn't seem possible to guarantee a waterbirth. My babies aren't big but have big heads! Am beginning to really panic now

No, haven't considered a doula - are they expensive? Are they allowed in as well as DHs?

staranise, i feel for you. i am currently 35 and a bit weeks with second baby and with my first i had a similar experience to yours- she shot out really fast, 2nd degree tear, it took HOURS before they could find someone who could be bovvered to do the repair (although, in all fairness, i do feel that perhaps the mw did a good job in standing out for me and insisting a senior regisrtar do it rather than some clueless house officer). i had probs afterwards which are now completely solved but as a result i am left with a complete phobia and terror of tearing again. clearly haven't had the baby yet, but ehre's what i am doing:

i considered a c-section, but dismissed it quickly because the last thing i want is having stitches in my uterus whcih surely is more unpleasant?
i have mentioned it to every single mw i have seen- they have all been relatively simpathetic and it's there in big letters on my notes- as a result i feel quite confident that when in labour they will do all they can to help me, by controlled pushing, supporting the perinaeum etc.
i am doing perinaeum massage and lots of pfe- despite hating them and not too sure they actually work- but you never know
i am lisening to a self hypnosis/visualisation tape every day to try and reduce my fear

i thinkt he most important thing, though, is to try and see things a little differently... last time i was terrified of tearing and when i did i was devastated and the whole stitching up was really traumatic. i am trying to tell myself that, even if i do tear, i won't take it as a failure of my body and i will accept that it's one of those things and will trust that with a decent repair (whcih i will fight for!) all will be well. i am already different down there so it wont' be the end of the world even if the geography somehow shifts further lol.

i saw a consultant after last time and he told me very clearly that, as long as the repair is done quickly and neatly, the overwhelming majority of tears can be sutured with no complicaitons.

so i am trying hard to focus on the "so what" attitude.

of course my real terror is to end up with an even worse tear- but i am just trying to ignore this fear and listen to all the positive messages instead. i am convinced that that has got to help a bit.

good luck to you (and to me!)

The doula I'm using charges £400, and yes, you can usually have a doula as well as your DH with you.

I don't know how many stitches I had but I know that all my tears have been 2nd degree. You sound as though you're in a similar state to me about the whole panic/control/stitches thing.

Obivously I don't know how I'll be this time but I'm feeling much more confident about it now that I have booked the doula and am learning the hypnosis. The lady teaching us hypnosis techniques is an independant midwife who works at a birthing centre up here. I would actually love to have her deliver my baby but for various reasons I am chosing to go to hospital.

beforesunrise - I did have the clueless junior house officer and I'm still suffering the consequences.

It's interesting what has been said about a doula - I was sort of considering one, but I can see how it would take the pressure off DH a bit. Something to think about a lot more seriously...

staranise - 20 stitches is a lot. I didn't even bother asking how many I had, I just know that the scar goes a long way up my vagina. I'm probably the only person who is ^hoping& to tear, as I really don't want an episiotomy.

Good luck to us all.

Thanks for all your replies - it's great to hear your various experiences though can't say I'm pleased to hear that I'm not the only one who's gone through this

beforesunrise I think you're right that the most realistic option is to maybe think about it differently and I am lucky I guess in that I've never suffered any lasting damage (excpet a phobia about childbirth now!).

It's good to know there are some sympathetic MWs out there as wll, thoguh will also look into doulas so some sympathy and interest could be guaranteed!

Am going to start shouting about my fear sloud and clear from my first GP appointment, plus I am giving birth at a different hospital to last time, which will help psychologically as well I hope.

Thanks again for your help

Hello, there have been lots of threads like this recently! I am in the exact same position.

Torn twice before, couldn't have water birth due to being induced etc, had to get consultants in to stitch me up, MW was crap last time and didn't control the birth at all and DH was really scared cos he didn't have a clue what was happening.

My aunt who was a MW and Health Visitor said lying flat on back is the best way to avoid tearing as it allows for the most controlled birthing- if you are upright the baby will crown more quickly and it is harder to control.

I think having to be stitched up for 2 hours after the birth is awful cos you really miss out on those first precious hours with your NB. You have to sit and watch your DH holding them while you are either wracked in pain from being stitched or delerious on gas and air. Not to mention being overemotional, exhausted, legs up in stirrups and about 2 men and 1 woman all standing peering up into your fanjo. Just delightful- can't wait! (am due on Friday)

Thanks soph28! Must admit, i was on my back last time, can't believe it could be faster!

Do you think a c-section would be that much worse?

Forgot to say Soph28, good luck for Friday!

Sadly some women will just tear, however good the midwife is is not usually an issue. It is the way that you are made and the position that the baby is coming out and how fast it is coming.

A friend of mine had a 4th degree tear first time around (pretty much the worst type of tear), and a cs second time round. She said she knew having a cs is not an easy option but was totally unprepared for the pain. Of course she might be better off in the long run having had a cs, but in someone who will probably heal well after a few months it is not a good option in most cases. As you say they would almost certainly not do one anyway as your births were otherwise normal.