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?

For DD1 I had a lateral episiotomy but also tore vertically, I did not do any perineal massage at all.

For DD2 despite being 100% focussed on what I was doing, I was relaxed and following instructions so I would not tear...I still tore again down the vertical previous tear scar.

My advice is not too worry to much about tearing/grazes, I know that is easy to say having gone through it.

The best advice I had was to REST REST REST following delivery, I stayed indoors for 10 days and avoided the stairs as much as possible. Did pelvic floors straight away to increase blood flow to the injured area, took arnica and VIT C. I was prepared to endure cabin fever to ensure my fanjo was going to heal as best it could. Started gentle exercise eg walk around the block after 10 days.

I have had no ill effects, and healed completely. I guess I have scars but I can't see them!!

my anecdotal evidence:

• took RLT
• walked/biked/swam/yoga'd gently throughout (had to keep active to keep SPD at bay)
• didn't do PM

Didn't tear - I do think it's probably massively down to being expertly guided by my midwife though. However, DS had his hand by his face and long jagged fingernails and they grazed me. Scar tissue overhealed and I had to have it burnt off with silver nitrate a month after he was born. Hurt more than labour and took days to recover

All fine now thought of course

Thanks all. It's really, really reassuring to hear that when people do need stitching, it recovers normally in the majority of cases (you hear scary stories about healing too... never the majority who recover normally). As I've mentioned- under no illusions there's a 'solution', what will be will be (fingers crossed this time the 'be' is for baby! That's my main battle with my sticky blood).

With my medical history and resulting medical anxiety, it's been suggested (and I wholeheartedly agree) that being prepared as much as I can, knowing what's what ("prepare for the worst, hope for the best") is a much better route than burying my head in the sand and just reading 'if you breathe the baby will dance out' stories.

Chicamomma - it helped with the second stage as you can feel what it is like to gently try to push something out that is near head sized . It made me realise why going slowly is important and learn how to try to relax the right muscles whilst pushing with others. It is also a lot easier if you are not lying on your back which was worth knowing for the real thing. All in all it gave me a lot more confidence.

As for the epidural - I think the theory is that the epidural relaxes your skeletal muscle in your perineum artificially (whilst not affecting smooth muscle in the uterus) and means you aren't completely overcome by the urge to push so you are less likely to push too soon or against contracted muscles. That means you are less likely to tear. However, in general it is quoted in this country that you are more likely to have an instrumental delivery so that increases the risk of tears. Overall for any level of intervention you are less likely to tear or have a bad tear if you have an epidural.
Personally I wonder about some of those studies showing increased intervention rates, for example some use older types of epidural rather than modern ones with mixed local anaesthetic and opiates. Also if you look at the stats in some countries where 80-90% of women have epidurals they don't necessarily have higher rates of instrumental delivery.