If you don't want to tear....
NicoleJoy totally agree about the episiotomy- I had one with my first birth as it was a forceps delivery with epidural and it took quite a while to heal. Second with 2nd degree tear I didn't even feel when it happened (no drugs) and it healed really quickly. Also agree with your comments about c sections, especially as you say you can have an epidural if the pain gets too much.
Thanka2 was waiting for your post on this as I know you have posted some great links on this recently, especially the Business of Being Born; I really hope RileyC watches it as it is so spot on.
Yes, the
Business of Being Born is a fantastic documentary. I watched it once by myself and once with my husband. I also have ordered
all of Ina May Gaskin's books (from
ShopinHK.com) and can't wait to read what she's written. So inspiring.
Regarding episiotomies. In the 12-week birth course my husband I took the instructor gave a simple demonstration: She folded a piece of paper in half and then asked one of us to rip it along the folded line. The paper ripped quite easily. Then she gave us an unfolded piece of paper and asked us to tear it from top to bottom--of course it was possible to tear it but ti definitely didn't tear as fast as the folded piece of paper. So it is with episiotomies. If your perinium is going to tear, it's going to tear but the likelihood that it will tear further and deeper increases with the help of a scalpel to start the process. If you want to avoid perinial tears (most midwives working in home settings NEVER see perinial l tears or perform episiotomies) there are some things you can do including:
1. Don't wear underwear. I know, I know, sounds all risque and stuff but it's not. We all have to wear panties at some point but don't wear them when you don't have to (to sleep in, around the house when you don't have guests etc.) Wearing underwear traps unnecessary moisture and can cause your skin to become brittle and somewhat chapped. There is a great example from the book
"Husband-Coached Childbirth" where the doctor is the OBGYN for a woman who lives in a nudist colony and he said she had one of the healthiest perinial areas because it was constantly exposed to "the elements."
2. Do your Kiegel exercises faithfully--it strengthens the pelvic floor and makes the perineum stronger and more flexible.
3. Perform perineal massage with a natural oil (olive oil) from at least week 36 onward for at least 5 minutes every day.
4. Use warm compresses on the perinium throughout labor as well as oil massage to prepare the area for the "big stretch" (thanks,
Baby Mama).
5. Don't lay back during labor. In other words,
do not let your practitioner or anyone else force you into the Lithotomy Position and
this is why. Your chance of both tearing or having an episiotomy goes up substantially in this position. Alternatively, get into
the most vertical position possible (squat, kneel, stand, sit)--it opens up everything "down there" and helps to prevent tearing.
Just a bit of a quote of why this position (which is what the hospitals in HK favor) is such a BAD idea all around (however, it is convenient for your doctor because he/she can sit there comfortably and not have to be inconvenienced much)
Roberto Caldeyro-Barcia, past president of the International Federation of Obstetricians and Gynecologists, states unequivocally, "Except for being hanged by the feet, the supine position is the worst conceivable position for labor and delivery" (1975:11). There are a number of problems generated by this position: (1) it focuses most of the woman's body weight squarely on her tailbone, forcing it forward and thereby narrowing the pelvic outlet, which both increases the length of labor and makes delivery more difficult (Balaskas and Balaskas 1983:8); (2) it compresses major blood vessels, interfering with circulation and decreasing blood pressure, which in turn lowers oxygen supply to the fetus (for example, several studies have reported that in the majority of women delivering in the lithotomy position, there was a 91% decrease in fetal transcutaneous oxygen saturation (Humphrey et al. 1973, 1974; Johnstone et al. 1987; Kurz et al. 1982); (3) contractions tend to be weaker, less frequent, and more irregular in this position, and pushing is harder to do because increased force is needed to work against gravity (Hugo 1977), making forceps extraction more likely and increasing the potential for physical injury to the baby; (4) placing the legs wide apart in stirrups can result in venous thrombosis or nerve compression from the pressure of the leg supports, while increasing both the need for episiotomy and the likelihood of tears because of excessive stretching of the perineal tissue and tension on the pelvic floor (McKay and Mahan 1984).
