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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Feb 04
    2012

    Non-Standard Tear and Second Pregnancy

    Archived User

    I delivered my daughter last November. I was induced at 41 weeks and 3 days. After 36 hours in the hospital (cervitol followed by petocine) I started to push and the pushing lasted two hours. I had a tear that did not go from the vagina to the anus. The tear went the other way, upwards toward the labia and stopped right before the urethra. I am fine now over a year later but the healing process was long and I was having pain for 6 months postpartum. It also felt like genital mutilation almost... I am now planning a second child and I am worried that I will tear the same way....

    I can't find a lot of information on tearing of the labia during birth... I had absolutely no perennial tearing...Is there a reason why I tore this way? What can I do to avoid this type of tearing in the future?

    Thank you in advance.

     

     

    Henci Goer

    The systematic review (a kind of study of studies) of the trials of liberal vs. restricted use of episiotomy reports that anterior tears, the kind that you had, are more common when episiotomy is restricted, but because restricted use avoids anal sphincter tears and their consequences, avoiding episiotomy is the better bet. I also would think that few anterior tears are as severe as yours, or they would be of more concern when weighing the benefits vs. harms of episiotomy. I am neither a midwife nor a doctor, so please do not consider this as advice, but here is what I think I would do were I in your shoes and my reasoning behind it: Given the risk of anal sphincter injury with median episiotomy, I would not preplan an episiotomy, and I would do everything I could to reduce the chance of tearing (see below), but I would have an agreement with my care provider that  if I started to tear upwards, she or he would snip a small episiotomy to release the pressure. As to how to minimize the chance of tearing:

    • Avoid an epidural. Epidurals increase likelihood of instrumental vaginal delivery, which increases risk of tears.
    • If it isn't objectionable to you, practice perineal massage during pregnancy. There is evidence that it reduces tears possibly by gently stretching the perineum but possibly also by helping women learn to relax that area instead of tightening up in response to sensation.
    • Give birth side-lying.
    • When you feel the burning that normally accompanies the vagina stretching open, concentrate on releasing and opening. Because of your prior experience, you will probably need lots of encouragement and positive feedback from your birth team, so they should be prepared ahead of time for this. 
    • Once the head has crowned, ease it out rather than push it out, in between contractions, and have an agreement with your care provider that unless there is a reason to assist, you will birth the shoulders naturally. 

    ~ Henci 


    All Times America/New_York

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