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

"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 that most midwives feel that lying on your back is worse as it puts more pressure on the perineum. What your aunt is saying is dubious and not backed by any research. The best position for a woman to be in is the position that she feels most comfortable in. Some babies come quickly whatever the position.

I don't know! I seriously considered asking for an EC but I don't really know which would be worse! In the end I think I thought there was at least a chance that I wouldn't tear with a natural birth and am more likely to be back to normal more quickly. Plenty of things can still go wrong with a CS and your stitches can still get infected etc.

I have never had worse than a 2nd degree tear either and I heal pretty quickly and the births were bearable and quick apart from that so I felt I should just give it another go. I just hate tearing/being stitched and DON'T want it to happen again!!!

My two were 8lb6 and 8lb so not that big (I am 5'8'' and have big hips) but interestingly both were born with their hands on either side of their heads so don't think that helped!

Agree re the doula. I had a doula for the second birth and I talked to her before the birth about avoiding tearing. She advised me to avoid pushing if I could and try to relax and breathe the baby out, which I managed, but only after she reminded me.
She realised (more than the MW) that the baby was crowning (no view as I was kneeling in the pool) and she coudl tell from the noise (screaming!) that I was pushing.
As soon as I stopped pushing I felt much calmer straight away, things eased off and DS2 emerged much slower than DS1 (who shot out).
Really worth the fee IMO.

Maxbear- I agree that you should be in whatever position you feel most comfortable in. She was just saying that being on your back is generally thought to be the hardest way due to not using gravity therefore slower and, if the MW is good, more controlled.

Yes, dd came very quickly even though I was lying on my back. I couldn't change position because I was being induced so they were monitoring the heartrate. MW broke my waters and dd was born within 30 minutes. However, the MW made no attempt to control the head crowning- just kind of left me to it, gave me morphine and got all snappy with me and DH- we think because I tore and she wasn't expecting it!

Acually a really good point of Panacotta's, to avoid active pushing. Only push if you have a strong urge to, you are more likely to tear if you push early on in the second stage before you have the urge to push yourself. For people having second or subsequent babies you could probably deliver fairly easily without pushing. I personally was unable to do anything but push at that stage though.

Gosh, and I thought I knew what to do in second stage! Didn't even realise that you could choose to not actively push! Must admit, my transition from first to second stage last time was very obvious and the urge to push was overwhelming though I was in a complete panic becasue of the pain and because it had finally dawned on me (doh!) that i wouldn't get my precious epidural.

First birth, with an epidural, was much slower and more controlled but I had an epi as baby's head got stuck.

Afraid I have a very rosy view of c-sections, never having had one myself! Quite fancy a month in bed with new baby int he weeks leading up to Xmas (could do all my shopping online ). Though I know I won't get one so am not seriously considering it, plus they're worse for the baby (aren't they?) and guess I should give the wee thing some consideration...

staranise, have a read of Active Birth by Janet Balaskas, as well as anything by Sheila Kitzinger, Michel Odent etc etc. You can prob get some of their books at your library.
Some info here too
www.activebirthcentre.com/

Thanks, I did a lot of J Balakas stuff in my first pg, have got her tapes etc. I like it but it didn't stop me tearing, hence my paranoia! Don't agree with all of Odent but appreciate his views on the negatives of elective c-sections.

It's just that my friends with c-sections all seemed to be up and about after their births immediately whereas I was hobbling about, bleeding, too scared to sneeze/have sex for weeks after. And I'd rather have pain in my stomach than bottom.

Guess I just want a cast-iron guarantee that it's going to be okay and that's just not possible!

I know, I was also v worried - but not keen on CS either, my Mother had 3 and had an awful time of it (she woke up under GA when having me but was unable to move or even
communicate!).
I do think that for me it was the water that made the most difference. I'd really try for a waterbirth if you can, it really eases the pain of contractions and am sure it helped me not to tear, DS1 and 2 both had huge heads and had 2dh degree tear with DS1 but nothing, not even a graze with DS2.

Thanks pannacotta, i need reminding that c-sectiosn are not always a walk in the park. Your poor mum!

Will definitely press for a water birth - I don't think Kingston offer them but am sure QC do, which is reasonalby close.

Thanks again, good to know that tearing is not always inevitable.