Exercises to avoid tearing/issues?

[squizita]

Hi all- I am coming up to the big 12 weeks. I have had 3 losses before this, thankfully am now on medication which has massively improved my prognosis (thanks NHS!). According to the calendars on these things, it's time to start thinking ahead (gulp!).

Due to my previous losses, I'm quite anxious about my body 'working' like a normal lady's when the day comes (my MWs have been fab and referred me to a nurse for support, again thanks NHS - I feel very lucky as I know it varies wildly town-to-town).
One thing I'm worried about is, if you read birth stories, 1st baby always seems to involve damage to mum (and yes, I know no one puts their bog-standard-average stories on websites, it's horrors or amazingly easy only). I understand that about 50% of first-time-mums tear/graze (or are offered an episiotomy) to some extent and you cannot guarantee anything at all ... but obviously would like to do what I can, if anything I find it reassuring to know whatever happens I've done "my bit" properly if that makes sense?

I am starting to do pelvic floor exercises every day.
Someone I know who has 'big babies' also mentioned an exercise where you use your thumb to 'stretch' your fanjo (tmi) to minimise tearing. Could anyone give me more information on this - when to start doing it, any links etc'?

Also, are there any other things I can do to get myself ready?

I did pelvic floor exercises and perineal massages religiously from quite early on, as I was terrified of tearing.

I ended up with an episiotomy and a 3c tear.

But as you say, I know I did everything in my power (ie not much!!) to prevent it, so at least I have no "if only..." regrets.

I do believe that listening to midwives and having a waterbirth can help, but just remember, that's not always up to you. If you need forceps, you need forceps, and then it's out of your hands.

I have to second lockie's view that it's luck of the draw. I'm the kind of person who prepares for the worst and hopes for the best, so even though I had a "traumatic" birth with DC1 (obstetric cholestasis going undiagnosed until I was in quite severe liver failure, necessitating an emergency induction with CS as a backup plan) I didn't feel like I'd been cheated out of a good birth experience. As I knew there was a probability it would all happen again with DC2 (though as I was being monitored there wouldn't be the same level of urgency) I was able to prepare myself for things going a bit tits up - with the result that my experience with DC2 was positively good.

I guess what I'm not saying very clearly is that you can prepare to the Nth degree and still tear or have other things go wrong

I also want to put in a good word for epidurals. After trying to birth DC1 without one, and becoming slightly deranged with pain (syntocinon induction) I finally caved and had one. I'd been dead against having an epidural as I'd feared the "cascade of interventions" so villified by the NCT et al, but when it came to it, in what remained of my brain I figured that I was already being intervened in due to the medical issues so I may as well go the whole hog. With DC2 I opted for an epidural from the start - so glad I did - it meant they could ping the specialist anaesthetist and get me a "mobile epidural". So I could move about a bit, and could feel the contractions, DC2 crowning etc, but all without pain. Utterly amazing. I would go through DC2's birth again like a shot (just not the 8 months of pregnancy beforehand and the having another child afterwards!)

Thank You Fish, that is so helpful. I'm sick of everyone around me (incl MWs) using epidural as a dirty word. I think it's because a) It slows their job down and B) they are expensive to administer. But then i'm very mistrusting of all medics in general!! Can you remember how many CMs dilated you were when you got it? My sister had it at 2cm on DC1, and 6cm on DC2, apparently 6cm is much better (or 8 if you can manage it) as getting it as early as 2cm really slows things down far too much?

Chica if it makes you feel better no one batted an eyelid when I requested an epidural and it came quite quickly. I was at 3 cm. And it was amazing.

the downside is that I'll never know how much it contributed to the "cascade of interventions" that did follow. Maybe it wouldn't have made a lick of difference. Maybe it would have. Who knows.

Don't be afraid to make an informed decision on the type of pain relief you want Chica. And keep an open mind. I was like, I'll have want I want when I want it and told DH to back me up. Don't be afraid to assert you wants and needs during your labour.

And trust in the medical professionals too. Not sure if that is a contradiction, but I had amazing midwives.

Just know the implications of what you choose, that certain pain relief has been linked with intervention etc but likewise these things also do happen for no rhyme nor reason and nothing you can do to change them.

No guilt for whatever happens, when it happens.

I suppose there are 2 ways of looking at it:

1: too much pain with pain relief = hell and a body that seizes up.

1. Not a lot of pain, lots of pain relief = a relaxed Chica and an easy labour.

1. Of course, there's always a 3rd option: Not a lot of pain, lots of pain relief = all sorts of interventions, a fanjo cut open or an emergency section due to lack of progress.

here's hoping for Option 2!!!!

Oh just one thing you should probably check in advance: I assumed my hospital would offer mobile epidurals (which sound amazing) because it's a big teaching hospital, but I found out once in labour that they didn't. Worth checking what your options are, so you know what to expect.

... and yes, basically all you can do is hope you're not one of the unlucky ones, and stay as calm and comfortable as you can in the meantime!!

I've actually just added that to my notes for my 28 week appointment, as a quick google suggests that my hospital does not yet do Mobile epis but that's a VERY old thread that i read that on (2006..nearly 10 yrs ago so here's hoping they've moved on!)

The mobile epi certainly sounds like a great happy medium for definite. But you're right Chacha, v important to find out if it's an option rather than having a lovely birth plan that includes it and then your hospital doesnt offer it!

Well, you might be like me, give birth and look up to midwives going "that was amazing, you didn't have any pain relief" and me being like "oh, didn't i? What's painrelief?" (I was feeling pretty loopy).

That's not a stealth boast (though I realise it sounds like it) I think I was shocked to be in labour and super lucky and just focusing on getting to the pushing with my breathing techniques that it literally didn't cross my mind to ask for anything.

God, reading that back sounds so bloody smug.

Spose the point is just be informed and take it as it comes,

Fish thanks for your story. You sound the kind of strong mama I'd love to be one day - so glad the urgency and medical needs of your DC1's birth didn't ruin the experience, and you had a better time with DC2.

That's the crux of where I want to get to really - knowing things can will probs go differently and it can get very medical/scary but that I've prepared the best I can and know the facilities at my hospital. Basically I don't want to be one of those 1st time mums who reads a 'woo' book or has a very selective NCT session then has a horrific reality check if intervention is needed (I have a RL friend who actually had this happen and feels incredible resentment as she felt 'lied to' but also guilt as she 'failed' and 'allowed' intervention: intervention which was required but had been treated as a dirty word :( ).

you can prepare to the Nth degree and still tear

Without going into too much detail, I agree with the above from experience.

squizita it sounds like you have a very balanced view

Good luck and I hope all goes well for you.

-- I have a RL friend who actually had this happen and feels incredible resentment as she felt 'lied to' but also guilt as she 'failed' and 'allowed' intervention: intervention which was required but had been treated as a dirty word

I can relate to that somewhat... in hindsight my NCT classes were laughably unrealistic. And the "natural birthing" trend is great if it works out for you, but it's really guilt-inducing if for some reason it doesn't.

I'd actually read a lot of horror stories too, but somehow I was still convinced deep down it wouldn't be me. I've been super healthy all my life and subconsciously I thought that bad stuff only happens to other people. Well I got a reality check, lol!

So I guess my point is... do your research, don't have any expectations, and be prepared for anything!!

I got my poor OH to do perineal massage for me both times.

First birth, I had a small 1st degree tear and 'labial grazing'.

2nd time was a waterbirth, quite a big baby. 2nd degree tear.

Neither time did I feel the tearing, and I didn't need any stitches either.

I'd like to think the perineal massage helped, but I have no control group of myself to compare with!

Chacha I was just the same - didn't expect labour to be easy, but certainly never thought I'd end up where I did. As much as I'm glad I did nct for the friends I made, it does make far too much of choice and control over what happens to you - I was so out of my mind with pain that the decisions needed to be taken by others - the professionals with my dh, and I am so grateful to them - a very timely decision to intervene by the consultant saved me an dd with an emcs. Nothing like I thought labour would be and I felt so sad and surprised about comments other mums made afterwards, e.g. 'at least you didn't have to push' - well I did actually and had the stitches to show for it - and someone even said they would 'never have had a section' - to which I said we'll we'd both be dead then, would you prefer that?!

There are an awful lot of smug people around sadly who can't wait to tell you what you should do or have done. Basically be ready to go with the flow and understand that most healthcare professionals are just that - professionals who want to help you.

This is my experience

DD1 did a but of perineal massage couldn't exercise due to SPD, DD1 was a compound presentation came out like superman she was only 6lbs 3lbs as well, third degree tear including a large labial tear I had 4 MWs standing around owner ding how to stitch me up ended up a doctor did it, all healed well no problems.

DD2 was 9lbs 3ozs not even a graze

DD3 the same

DS I think I had a second degree tear but into my bum this time. All healed though.

I definitely feel different down below and you can feel the scars but DH says it all feels the same to him

I tried Perineal Massage (DH was too weirded out by it to want to help, and was mostly away with work anyway).. but I think after the 2nd attempt I gave up (I was surprisingly squeamish which is abnormal for me!)

I ended up having a waterbirth, using hypnobirthing techniques. No tearing which surprised the midwife.

Best piece of advice I read was that when 'pushing' the baby out, if it feels too painful/too much, etc then stop, give yourself a minute and try again.. it was compared to.. (and this is TMI so please do not read if easily grossed out) when having a poo.. If you are having a poo and it becomes quite painful to push out you don't just carry on through the pain do you.. you stop, then gently try again..

I do agree though that anything can happen, but I felt it helped me to plan/prepare for my ideal birth, and do everything I could to support that, with the knowledge that things could go wrong and that all my wishes in those cases were in my birth plan. As we all know, at the end of the day as long as you and baby are safe thats all that matters..

Cake I can't believe other mums actually said those things to you.

Thanks all. :) Weird I know but stories of "It didn't go to plan, but it was OK in the end" and that it's OK to have interventions/pain relief are immensely reassuring to my funny brain.

Cakebaker what an awful, awful comment to make to you. :( I'd probably have said something far ruder than you under the circumstances!

I did perennial massage but ended up with forceps and tore front to back, all healed up soon enough though.

I know, hard to believe it now, thankfully they weren't friends just random nosey types at a few baby groups! I was so upset I didn't say much at the time but if I saw them again now I might have to give them a slap

There's been some very wise words on this thread from OP and others (not necessarily me!) I initially felt utterly shocked by DC1's birth - I went to the MDAU for some checks, and after the liver thing was discovered was induced the same day with a multitude of blokes in white coats hovering round (not Maternity either - Gastrointestinal, Renal, Communicable Disease, you name it ). I had done NCT and in the hours after the birth felt (a) like I'd been hit by a juggernaut and (b) that I'd "failed" because I'd wussed out and had an epi, which had led to needing forceps, which meant DS's head was all bruised and he couldn't feed properly....The lovely senior midwife slapped me round the chops (metaphorically) and told me that despite the vaginal delivery, I should be under no illusion that I'd had a natural birth. In reality, it was as medical and artificial as a CS, and so any thoughts of breathing the baby out, or managing the pain on lavender oil and a bit of G&A were unrealistic. That made me feel a lot better!

I have had a few Alpha Birthers try to tell me I was a wimp for needing pain relief, but all I can say is, if they had been me at that time and in that place, they would have been sobbing for an epi too.

Argh, sorry for the essay (again!)

PS thank you squizita for your lovely compliment - trust me, I often feel very far from strong. But I will chin anyone who criticizes epidurals

i always wondered how do you reach round there after 34 weeks? ive had a couple of stitches with each of mine its no big issue to be fair the most painful one was the internal graze my middle son gave me he scratched me with his hand on his way out it was worse than skinned knees xx

preparation can help but in the end its just how it goes fingers crossed you have an easy one (my second was short painful no complications i really wish all three had been the same!)