If you had serious 4th degree tearing during labor...

[Elaine]

I'm not here, I'm not reading the other posts.

 

But why, oh why, are doctors letting women tear and/or cutting them? It makes my blood boil :glare:

 

We were blessed (blessed) to have the best obstetrician when my wife delivered. She naturally was nervous, and asked about the chances she'd need an episiotomy.

 

Our physician looked at us somewhat gravely and said, "I've never cut a woman during my practice, and your wife will not be the first".

 

I was impressed!

 

I was more impressed when I witnessed why he could make the claim.

 

During the delivery he stopped things from time to time, and ever so gently pulled back and eased tissues manually. It was so incredibly gentle. It look a little longer, a few extra minutes, but my wife did not tear. And I am still grateful for that.

 

We had family members with us in the large birthing room in the hospital. And the women were astounded at the gentle techniques of our OB. They'd never seen anything like it. Perhaps it's not usual, but why?

 

No woman should tear needlessly. Or be cut needlessly. And it's a shame too many doctors seem to want to pull a baby out a fast as possible, and that new mothers pay the price. I am "no expert" here but I've seen a better way. And I know it made all the difference in the world.

 

Bill (who is going back into "hiding")

 

My OB did the same thing and I never tore or had an episiotomy. We did the Bradley Method and I think that helped, too. My doctor also fully embraced the natural birthing methods, and I don't think that's the norm anymore unfortunately.

[Spy Car]

My OB did the same thing and I never tore or had an episiotomy.

 

Is there a "name" for this technique?

 

I feel kind of silly saying "gently helping part the ways". But it's the best I could come up with :tongue_smilie:

 

Bill

[Brindee]

Is there a "name" for this technique?

 

I feel kind of silly saying "gently helping part the ways". But it's the best I could come up with :tongue_smilie:

 

Bill

I think it's perineal massage.

[stripe]

Is that what that's supposed to be? Hmm.

[Rhonda in TX]

She was in labor and the baby was close to being born. The doctor was not in the room yet. The nurse was in the process of massaging the vaginal opening when the baby crowned. As soon as he crowned, she tore, all the way to her rectum. No episiotomy and all the baby did was crown! From that, it's always seemed to me that sometimes tearing happens no matter what you try to do to prevent it. Am I missing something?

 

(No tearing with me - 2 c-sections. All this talk of episiotomies and tearing just makes me say, "owwwww".)

[dirty ethel rackham]

I think it's perineal massage.

 

Okay, just to clear up a few misconceptions ... here is my childbirth educator lecture on perineal massage and tearing...

 

There are two types of perineal massage.

 

There is prenatal perineal massage, which is done before going into labor. Some believe that stretching ahead of time prevents tearing. Some believe that exposure to the sensation prevents mom from freaking out. There isn't any good data that supports doing this. Midwives have been helping women deliver babies for ages with no or minimal tearing without doing any of these things.

 

Then there is manipulation during labor. Some midwives will use hot compresses to help mom relax and help the tissues stretch. Some will use olive oil as a lubricant and do some gentle perineal stretching. Some docs will use a "fanning out" technique to try to help ease the stretching. Olive oil and hot compresses can be somewhat effective. Too much "fanny fiddling" as Ina Mae Gaskin calls it, can abrade the tissues, making tearing actually more likely.

 

There are many factors that go into whether a mom will suffer a laceration and how serious that laceration may be.

 

First is patience. If mom is not rushed and is allowed to birth the head slowly and is allowed time for the head to restitute (turn to line up with the shoulders) and the shoulders to come out slowly, tissues have plenty of time to stretch and there is less risk of tearing. Very fast births are often associated with more lacerations.

 

Second, is positioning - both of mom and of baby. If the baby is coming out with the hand by the head - well that increases not only the head circumference, but the shoulder width as well. Brow presentations and posterior presentations are associated with more tearing as well because the smallest part of the head is not presenting first and acting as a wedge. Mom's birthing position has a lot to do with it as well. Full squat (like a child having a bm - not the leaning in bed position) had a higher association with tearing because it has the most downward pressure - a good thing for getting the baby down, but not necessarily a good thing for crowning. The classic position leaning back in bed is the second worst position for tearing. I think it has to do with where the pressure is going as well as requiring more effort for mom. Side-lying position for delivery of head and shoulders is associated with the least amount of lacerations, partially because it is gravity neutral. Many midwives will insist that their premips (first time moms) use this position once the baby is crowning. Hands and knees and using a birth stool are good as well for preventing tearing.

 

Other factors that enter into the equation ... mom's nutritional state, her natural skin elasticity, and her overall health, episiotomy use (well, duh - it is by definition, a second degree laceration) and instrument use (vacuum, forceps). In the hands of a skilled practioner (that is, one who is skilled at helping women birth without tearing), the size of the baby is almost irrelevant. Big babies are not more likely to cause tearing than small babies. Macrosomic (very large babies) may be associated with more tearing, but that is associated more with shoulder width than head circumference.

 

Okay, here ends the long-winded birthing lesson. Here is a great website for factual information on childbirth - supported by scientific evidence. Childbirth Connection

[Amber in AUS]

I have not read the entire thread but -

 

Wee in the shower it will help not to sting the stitches.

 

Use a hair dryer on cool to dry down there thoroughly instead of a towel, if you do use a towel pat don't rub.

 

Agree on not getting constipated, hold stitches while doing and it will feel better.

 

Icepacks, oral anti inflamiatries.

 

Salt baths.

 

Obviously obstaining from intercourse until after 6 week check up and all clear from Dr. Some of the internal stitches can take longer than the outer ones to heal.

[Amber in AUS]

Bill, loving your post above, but ...

 

I had this kind of OB. I had witnessed previous births in which he did this no prob but ... my bub was 9lb 3oz i am under 50kg and VERY petite, i did have a tear bc of vac extraction. My bub was ALMOST to big to get out that way! Sometimes even with the VERY BEST sh*t happens. For my second and third bubs who were average size with same OB, no stitches, no worries.

[Amber in AUS]

Great post Ellen!!

 

I can relate to a lot of what you said - fast birth, prosterior position, large shoulders, vac etc