Preparing for birth

Women do not want to tear in the process of birthing and it is known that in the pushing stage of labor as the baby’s head is pushed forward against the opening of the vagina the passageway does open to allow for a trauma free birth. What we want to talk to our patients about is how to best avoid those tears. In Rates of episiotomy has varied over the past years and now only about 1/3 of women will get an episiotomy (cut in the vaginal opening to make more room for the birth), and most of those are done to specifically speed up the birth in cases where the medical situation warrants a more rapid delivery. Interestingly in the not too distant pass we used to have episiotomy rates of about 90%, and it really was being performed electively. Now we don’t do the episiotomy and in some hospitals this means that almost 3 of 4 women will have a tear, but actually in some hospitals the percent of women who actually tear is less than 10%. In this post we will discuss some of the ways. Some of the information and “common beliefs” should be considered “myths” as there is not research to substantiate some of what others may tell you.  
               The more babies you have had, the more your tissues are stretched and you are less likely to have a tear than if this is your first baby. Bigger babies are more likely to cause tears. Babies who are being born with face up instead of face down are more likely to cause tears. Complicated births that require vacuum or forceps may be more likely to tear, and vacuums cause less tears.  Finally there may be a genetic predisposition to tearing.
               Should you stand or sit to actually give birth? That’s a good question and many studies have been in conflict. Generally there really is no difference…that’s one of those common beliefs…in one study women who are upright (standing or squatting) they actually had more tears, but they were less severe. Should you get an epidural to help you not tear? If you can push the baby out effectively, and your gyno doesn’t use forceps to deliver the baby, then there is no difference.
               Should you do pelvic floor stretching exercises before or during birth? Yes you should! You can begin about 4-6 weeks before the delivery. If your obstetrician or your midwife actually does stretching maneuvers during your labor or pushing, sometimes called “ironing” there’s no medical evidence that that would really work to help you not tear. Actually controlling the delivery of the head so that it doesn’t emerge too quickly, and keeping the neck flexed down so the smallest diameter of the head comes out first, do help a patient not tear. So your birth attendant does have a role in protecting you from a tear!
               Does an episiotomy protect against a tear during birth? Not usually, it may protect against tears near the urethra, but it may increase the rate of severe tears such as those that go through to the rectum. So protecting against tears: bottom line: gain a healthy amount of weight, doing some stretching exercises, deliver in a comfortable position (one that is effective for your pushing), and have a birth attendant help you as much as possible!


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