I have recently been told stories by a good friend, my sister and my mother. They all involved slightly varying stories of tearing so badly in childbirth they required an hour +/- of stitching after.
This makes me really angry. At the OB's/doctors. There are ways to prevent much of the serious tearing that happens in childbirth. It takes a little effort and care by the birth attendant.
Don't OB's care??? Why don't they do anything to prevent this awful tearing (and no - prevention does not = episiotomy either!) Is it money? They can charge more for the careful stitching they do afterwards?
My heart breaks for these poor mama's. And it's just SO common (no surprise since 99% of births take place in hospitals and apparently very few doctor's care to do anything to prevent the tearing).
It's NOT a part of normal birth. Minor tearing, sure. It happens. Major tearing requiring an hour of repair? No. Not normal. At least it shouldn't be.
Tearing has nothing to do with (or very little to do with) the size of the baby. I have heard of mama's tearing from birthing their small 5lb. babies and I have heard of women birthing 12 lb. babies with NO tearing. (No joke!).
Midwives have (comparatively) VERY low rates of tearing. Many mama's don't tear at all, others require only a stitch or two. While I'm not a midwife and don't know all of the tricks of the trade, I will list some things I do know that help prevent tearing, in case any mama's want to try to help themselves if their doctor's refuse (or don't know how) to help them.
1 - If possible, labor in water for some time. This softens all of the tissues. This is probably mostly helpful during the end of labor. (Besides the fact that it provides much pain relief from contractions as well!)
2 - If at all possible, do not push lying flat on your back. This is the worst position for labor and delivery. (Yet the status quo in hospitals. Why? Easier access for your doc. Not for your good. Your doctor's). This position does not utilize gravity as well as puts additional unnecessary pressure on the perineum.
(Side note - I did end up delivering my daughter semi reclined on my back - after trying many positions, this is where I my pushing was most effective. I did have a small tear requiring 2 stitches. I will be trying other positions again this time, however, things don't always go as planned and I know that :)
3 - Probably one of the best things you can do: When you are about to deliver baby, you, your spouse, doctor, midwife, birth attendant, whoever can use an oil (arnica is a great choice, although any nutritive oil would do) to further soften your tissues, as well as gently supporting the tissues as the head emerges by applying pressure and gently easing the skin around baby's head.
Also, perineal massage/stretching during the last few weeks of pregnancy may also help prevent tearing. One of the greatest things about this practice, besides perhaps making the tissue more 'stretchy', is practicing how to relax when feeling an uncomfortable sensation (the massage/stretching does not feel good!). The more you are able to relax down there as the baby is being born, the easier, faster and less tearing there will be. If you are able to have your partner help it works best. Breathe deeply and close your eyes. Relax your jaw. Think of happy images or places and relax. Really good practice for birth.
4 - As your baby is being born, try to really control and slow your pushing. The slower baby comes, the less amount of tearing as the tissues have a chance to stretch and accommodate. Some women will pant during this stage to keep themselves from pushing too hard. Some will give a series of short pushes instead of one big push. *Hopefully* you have a birth attendant that can coach you through this part. If the tissues are looking white - slow down (if you can!). Your birth attendant can also put gentle pressure on the babies head to prevent baby from coming out to quickly.
Ok - as I said... not a trained midwife here... so this is all I can think of at the moment. I will add more to the comments if I think of more - or if anyone else has ideas or techniques - please add them to the comments as well!
Talk to whoever is attending your birth about techniques to avoid tearing. Ask about the possibility of pushing NOT on your back. Fight for what you feel you need and want. Be your own birth advocate! (or find a good midwife! no really!) ;)
blessings in birth,
S
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