Any Labour Advice?

[TMI2000]

TLDR: Previous birth Nov 23, spontaneous labour at 39+5, ventouse delivery with 3rd/4th degree tear & episiotomoy - had a PPH 4.5 litres lost, in an induced coma for 38 hours.

Now 24 weeks pregnant and after speaking to my midwife who is amazing and also speaking to a registrar at the hospital (who only seemed to discuss csection with me once I brought it up as an option), midwife has said she doesn't think they would push either way as both carry the same risk that neither delivery would mitigate the other however seems to be many more benefits in my opinion to a spontaneous vaginal delivery. Last labour I was in labour for 24 hours and hardly ate or drank as I felt nauseous, didn't fuel my body probably.

This time my plan is to remain open to a csection (especially if I go overdue) but wait for my body to go into labour and try for a vaginal delivery but have a low threshold for a csection if anything starts looking a bit worrying at all.
I want to make sure I eat and drink plenty throughout the process so I am fuelling my body and I want to do everything I can between now and April to prevent tearing if possible (looking into perineal pressure and slow controlled delivery of baby's head, panting etc) and PPH.

Does anybody have any advice or experience of things they did to have a very smooth labour, preventing tearing as much as possible?

Sorry to hear your first birth was so rough! That sounds very traumatic.

I didn’t have either a severe tear and PPH so feel free to ignore my comment if it’s not helpful! I’ve just tried to list a few considerations.

For the severe tear, things to consider/ try to mitigate against might be: Why did you have a ventose delivery? Was it the baby’s position (hand up/ back to back)? Were there any warning signs that your first baby would need ventose? Often, once the doctors are recommending ventose, it is too late for a basic c-section as they would have to push the baby back up the birth canal first making it a more complicated procedure.

Do you still have an issues with the 3rd/ 4th degree tear? If so, C-section is normally recommended I think? If not, you are still at increased risk of it happening again - C-section removes this risk entirely.

Do they know what risk factors you had for the PPH and whether they are likely to re-occur? Ventose and long labour increase risk of PPH, but so does a C-section. Assuming all other things are equal, the only advantage of having a C-section would mean you are already in theatre in a very controlled environment.

I’d probably opt for the C/section. It removes the risk of severe tearing and you are already in theatre if you have a PPH so logically they should be able to get the bleeding under control quicker. But if the medics aren’t pushing one way or the other then it’s probably impossible to predict which way is best and you should go with what you want.

@Notthebeard thank you for your response!
the ventouse delivery was becuase I had been in the pushing stage for 2 and a half hours and baby’s head was right there but due to factors (the 24 hour labour, no food and drink) I almost think I was just too exhausted to be able to get his head out though I tried my best! So he just needed a bit of help the last bit of the way. The tear and episiotomy was mainly due to the ventouse.

no issues at all with my previous tear, healed pretty well though took about 7-8 odd weeks to completely remove the discomfort.

risk factors for pph are the same for c section and vaginal delivery. I think I’ve decided for a vagjnal if I go into spontaneous labour and if not a C-section, I’ve made this decision due to outside factors (having a 17 month old to care for and my wedding just shy of a month later) that makes the recovery time of a C-section less than ideal. Obviously if it was recommended I would absolutely do it regardless for the safety of me and baby but as you say the midwife has said that they something recommend either and are happy to be totally led by what I want.

Sorry that sounds like you had a horrific time last time. On a positive note I think second births are usually easier as your body knows a bit more about what it's doing.

I'm currently 20 weeks pregnant with my second and finding ways to reduce the risk of tearing is something I'm very keen on! I actually spent a bit of time yesterday looking into it. I think the evidence for perineal massage is hit or miss, but it won't do any harm. There seems to be a good amount of evidence for a warm compress during birth so I'm planning on speaking to my midwife about that.

I think the position can also help; labouring upright and birthing whilst squatting/hands and knees can reduce the length of each stage, and not lying on your back can reduce the need for interventions slightly.

I'll see if I can share some resources...

https://evidencebasedbirth.com/evidence-birthing-positions/ - this is quite lengthy but really informative.
https://www.rcog.org.uk/for-the-public/perineal-tears-and-episiotomies-in-childbirth/reducing-your-risk-of-perineal-tears/ - covers warm compress and perineal massages.
https://evidencebasedbirth.com/evidence-birthing-positions/ - in the podcast they discuss warm compress and hands-on/hands-off birth techniques.