Episiotomies, Tearing and Perineal Massage

If you're planning a vaginal birth, you'll want to minimize the amount of injury caused by the birth of your baby. Episiotomies, tearing and perineal massage are all options that can create more room for your baby to pass through the birth canal. When is each option typically used and how effective are they? What is the recovery process like for episiotomies versus tearing? And why are episiotomies considered taboo these days?

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Episode Transcript

Preggie Pals
Episiotomies, Tearing and Perineal Massage


Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

[Theme music]

Sara Schaeffer: When you are in labor you want to minimize the amount of injury to both you and your baby. Episiotomies, tearing and perineal massage are all options to consider during the delivery process, when your baby is about to be born. But which of these is a best option is best for you? I am Sara Schaffer, a Labor and Delivery Nurse at Sharp Grossmont Hospital and this is Preggie Pals’ episode 73.

[Theme Music/Intro]

Sunny Gault: Welcome to Preggie Pals’ Broadcasting from the Birth Education Center of San Diego. Preggie Pals is your weekly online on-the-go support group for expecting parents and those hoping to become pregnant. I am your host Sunny Gault. Would you like bonus content after each show, great giveaways and some great discounts? Then join our Preggie Pals club. You also get a free subscription of pregnancy magazine and you can visit our website, www.preggiepals.com for more information. Another way for you to stay connected is by downloading our free Preggie Pals’ Apps. They are available in the Android, iTunes market place. We are available on windows phones, as well as Google play. You can also subscribe to our monthly news letter. And if you do not live in San Diego but you would like to be a panelist on our show, you can participate through our virtual panelist programme. And Preggie Pals producer Stephanie is here to tell us more about that.

Stephanie Saalfeld: Okay, so all you have to do is ‘like’ our Preggie Pals’ facebook page or follow us on twitter and when we record our shows, or actually prior to recording our shows, we will be posting some sneak preview questions on our facebook and twitter and so you can comment on whatever questions. You can ask your own questions and we will relay those to the expert.

Sunny Gault: And if you guys are on twitter, you can follow the #preggiepalsVP which stands for virtual panelists. Alright, let’s meet our panelists here in the studio. You guys know me. I will be chiming in our conversation today. I am the host of the show. My name is Sunny. I am 35 years-old. My due date, I am actually pregnant with identical twin girls, who are due on December 16th but we are having the babies via C-section. I did have some complications with the prior delivery and so now all my babies are C-section. That date has been set for December 2nd. So fingers crossed that I am going to make it that far because that puts me at 38 weeks and that’s a great goal to have to be pregnant with twins, but doesn’t always happen. And I do have two little boys at home. Sayer is 3 years-old and Urban is about 15 months. Stephanie tell us about yourself.

Stephanie Saalfeld: My name is Stephanie. I am 30. I am a producer for Preggie Pals’. I have one little girl at home. Savanna is 8 months-old.

Sunny Gault: Okay, Destiny?

Destiny Bochinski: My name is Destiny. I am 34. I am a physical therapist and I specialize in pelvic floor dysfunction. My due date is November 2nd and we are having a little girl. I have a son at home, Talon. He will be 3 in October. And we are planning our second homebirth with a midwife.

Sunny Gault: Do you have a name picked out for your little girl yet that you are sharing now?

Destiny Bochinski: No, we have a secret list.

Sunny Gault: And I love the name Talon and Ryan and I am my husband earlier think about that if these were boys but yeah, it’s a great name. Okay, Jessica?

Destiny Bochinski: Thanks!

Jessica Blagg: My name is Jessica and I am 29 years-old. A medical biller and my due date is March 8th and I have one previous child. She is 8 years-old and we are hoping for a VBAC.

Sunny Gault: Okay and Brigid?

Brigid Santiago: Hi, I am Brigid. I am 28. I am a non-profit fundraiser. My due date is December 19th and I am having my first baby and it’s a little boy. And we are planning natural childbirth with a midwife but in a hospital.

Sunny Gault: Okay, good for you. And Sara any kids yet?

Sara Schaffer: Yes, my name is Sara. I am 27 years old and a Registered Nurse at Sharp Grossmont Hospital. I have two children. My little boy is 4 and my little girl is 2 and I had home births with both of them.

Sunny Gault: Oh, good for you! You don’t always see that but that’s awesome, I love it. Okay, well ladies, welcome to the show.

[Theme music]

Sunny Gault: Alright, before we kick of today’s show, we have a special interview for all that Preggie Pals’ listeners. Xza Higgins is joining us and Xza is the founder of MommyCon. MommyCon is a fairly new conference that are man, people are just going into this thing from all over the place. They have different locations that they hold this conference and the focus is on natural and organic parenting methods. So Xza is here to tell us a little bit more about it.

Xza Higgins: Yeah, so MommyCon is a day of education, inspiration and community building that we bring to cities across the United States. One of our upcoming events is going to be in Los Angeles, California on October 6th. We are actually looking to set the babywearing world record at the event with over 1500 parents on this center, all wearing their babies.

Sunny Gault: Okay, so you mentioned the LA event and this is a pretty big event for you guys, because it is one of the largest venues you guys have been out in the past?

Xza Higgins: It is! Yes! We are really hoping to set this record with 1500 + people on this center. Our last event Philadelphia had over 500 people out there and they just keep kind of getting bigger and better. We love sharing all the knowledge that we have learned as parents and bringing our experts to the event to then speak on everything from birth, breastfeeding, to babywearing, cloth diapering, car seat safety and everything in the stream. So it’s definitely going to be big in LA.

Sunny Gault: Yeah, well, we are excited for because I know that we are going to go out to that event as well and if our listeners want to participate, want to get involved with the LA event how can they do that?

Xza Higgins: Yes, they can find us on facebook. We are “mommyconusa” you need to type it in our browser and then our website is www.mommy-con.com.

Sunny Gault: The tickets are really reasonable, this isn’t something, as far as the place is concerned. It’s not that is something, it’s going to, you know, you got to choose the between diapers or going to the conference!

Xza Higgins: Oh, yeah and we even have a free option, so if parents just want to come out and attend the event on such a world record, it’s absolutely free. Otherwise we have general admission starting at $25.

Sunny Gault: That’s great! I know that all of our listeners are from Southern California so you do have these conferences in other cities, so how can people learn about those other opportunities?

Xza Higgins: Yeah, visit our website, type “mommycon” in the Google, visit our website at www.mommy-con.com, go on find out our community of facebook, its over 18000 moms all coming together across the country and we are going to Fort Lauderdale in a couple of weeks, Philadelphia, LA, Kansas City, Chicago often, and everywhere between.

Sunny Gault: Love it! Love it! But if you are located in the Southern California area and you want to win two free tickets to the LA event you can do that. We are actually doing a raffle cup to give away with MommyCon. All you need to do is go to our show website, go under the episode section, go down to giveaways, and you can enter right there. So Xza thank you so much for being part of our show today.
Xza Higgins: Thank you!

[Theme Music]

Sunny Gault: If you are planning a vaginal birth, you have probably heard a lot about episiotomies and tearing and how perineal massage can help stretch the area and minimize damage. Here to breakdown these options for you is Sara Schaeffer. She is a Labor and Delivery Nurse at Sharp Grossmont Hospital. Welcome to Preggie Pals’ Sara, it’s great to have you.

Sara Schaeffer: Thank you, it’s nice to be here.

Sunny Gault: So let’s talk first about perineal massage. Before the show got started we were chatting a little bit about this. And you can do perineal massage on yourself throughout your pregnancy? But for the purposes of this conversation we are focusing on it more for labor and delivery purposes. So Sara, tell us a little bit more about what’s involved with that?

Sara Schaeffer: Well, when you are pushing, the baby’s head usually starts at a higher position and as it comes down we can usually kind of see what’s going on down below because we are right there pushing with you. And perineal massage is when we can use our fingers to just help the baby, guide the baby’s head and push against certain areas to create more space and allow the baby to come down a little bit further because as it comes down a little further, it’s not much closer to coming out. And there is sometimes we use mineral oil, some doctors use just regular lubricant, but we use lots of it to make it nice and slippery. We just kind of push down on certain areas however; you really need to be careful about not overdoing it as well. Because when you are in labor for a long time or pushing for a long time, everything can get really swollen and moist and sometimes that can actually cause more tears. So …

Sunny Gault: Interesting!

Sara Schaeffer: Fine balance!

Stephanie Saalfeld: I have a question. At what point in the pushing process do you start doing that? Like I am just thinking like at the station, like, how far down the baby is? I mean, no, yeah, at what point…

Sara Schaffer: However the baby is lower.

Stephanie Saalfeld: As they are lower.

Sara Schaffer: Definitely! Because now a days, there are women who have epidurals and there are women who don’t. Obviously, when you don’t have an epidural you get that urge to push and you know, its hard to not push. You can’t really control that urge.

Stephanie Saalfeld: I had that urge with the epidural.

Sara Schaeffer: And that sometimes is a great thing with a good epidural you still get that urge. And I don’t mean good as in some are bad, some are good help. But because there is never any way for us to gauge how it’s going to affect each person. So a lot of this has to do with the person.

Stephanie Saalfeld: Does the mamma always know that you are doing it or not because, now I am thinking back because I pushed but I still ended up having an unplanned C-section. But I felt like she was although deep and really so was she possibly doing perineal massage?

Sara Schaeffer: Possibly yes.

Stephanie Saalfeld: Because my problem was this that my daughter was posterior but she had her head back too so that’s why we ended up not being able to get her up that way.

Sara Schaeffer: Sometimes, you can’t feel it with an epidural. Usually, if you don’t have an epidural you can pretty much still feel everything. But we don’t do it constantly. I would say that its more as like a tool when you feel like the baby just needs a little more room and you feel what side the baby needs more room on. So you can put your fingers there and use your fingers as a guide to create more space so that with the head, it can come past that area where it is stuck.

Stephanie Saalfeld: I think she must have been trying to do that. She had probably….she went, ‘I am girl, what’s going on?’ I felt like that, seriously! We only joke that we put gloves to our elbows, as like, ‘is she is going to come out by mouth! What’d happening!’….is that ever played where its patient-guided for the mom if whose pushing? If they do have false sensation and the epidural is not too overwhelming. Is there a point where you are guided by where she feels the pressure and where she feels the ring of fire or whatever? Or is that more involved with a counter pressure techniques?

Sara Schaeffer: Well, You know, Can I give a personal experience here?

Sunny Gault: Sure.

Sara Schaeffer: I know that with mine, unmedicated natural birth, I could feel where I was burning and my midwife told me don’t push against it because the burning is you trying to stretch and possibly going to tear in that area. And with my second one, just like an urge to put my finger there, I just moved things out of the way. I remember it very clearly. And they were amazed. They were like, “Oh, wow, you just pushed it out of the way” and I didn’t tear. However, it’s hard because with an epidural you don’t always feel everything and so sometimes you are pushing past that burning and you do not know it. And sometimes the epidural doesn’t take away that burning and so you are feeling the burning and its happening but you don’t necessarily know what to do with it. And so the pressure that we apply helps to keep everything intact.

So the goal is to do a very slow control at the end that if everything is very slow and controlled and we can support the area, support the perineum, support your labia, because a lot of women tear on their labia and not have a perineum tear. So just to support everything with your fingers and could it be patient guided? Possibly, you know, but usually, women don’t want to get their hands down there and touch anything or they don’t know that they are allowed to. It’s your body, you are allowed to do whatever you want. That all we always try to remind people. It’s your body whatever you want. But most people don’t do that.

Sunny Gault: Okay in perineal massage we use conjunction with having, I don’t know if it will be needed if you have an episiotomy because theoretically, that should provide enough space, but can it be used in conjunction with that or tearing? Like if you start to tear a little bit, to prevent more tearing, would you ever go back in and still try to do some of that massage?

Sara Schaeffer: It just depends, as one should not create any more damage, if you are already torn. You don’t want to just push on that area where the tear occurred. But definitely, say you tore on the upper right-hand side and then the doctor or the nurse can push down on the bottom left to create some more space and just use lubricant or just use mineral oil to rub, massage, I guess to create more space and stretch everything down.

Sunny Gault: Right! Okay, that makes sense. So let’s focus now and shift in and talk about episiotomies. I know episiotomy is kind of get a bad rap. So first of all let’s talk about what is involved in an episiotomy? We can break down why that’s a little bit controversial.

Sara Schaeffer: An episiotomy is when the doctor, they are the only ones who are allowed to do it, would use scissors to actually cut, usually it’s a second degree, I would say, it’s the most common, in a straight line to create more space for the baby to come out. And it just, you know, sometimes the doctors can tell when that needs to happen and so they do it as usually very fast, sometimes the patient doesn’t even know what happened because they can’t feel it and I would say that sometimes it is needed in an urgent situation if the baby is not fitting or if there is a shoulder dystocia. And it’s usually straight down so where the baby is coming out and your perineum, it would go straight down. They try and stay away from the anus. It’s very rare that a doctor would do, what is called a mediolateral meaning going more off to this side, towards your thigh, your left or right thigh. But I have seen that done, but it’s very rare.

Sunny Gault: So ladies here in the studio, when I say episiotomy do you cringe or what thoughts do you have, of this? It seems like a lot people try to avoid this, I think, it’s got a bad rap and I am just wondering what your personal opinions are on it?

Destiny Bochinski: Well I know it used to be really common and I used to think, episiotomy and forceps were like that was the way to go for a while and to my understanding of it is that the literature now no longer supports that episiotomy is beneficial and protective of the pelvic floor. And in often times it can worsen the tearing and that can end to what happens. So that’s my reaction.

Sunny Gault: Sara, can it worse a tear, can episiotomy worsen a tear?

Sara Schaeffer: I haven’t personally seen that happen. But I think the thing about it is really asking your doctor because there are quite a few doctors who just routinely do episiotomies and there are doctors that are little more conservative and only do it when space is needed. And there is some doctors who would rather like you tear than do an episiotomy. That’s a big controversy between the three options.

Sunny Gault: Regardless of what their philosophy is can you go in and say, “Listen I don’t care what you want, this is my body and you are not doing an episiotomy. I don’t care!”?

Sara Schaffer: Yes and if a patient did that then we as a nurse, we are a patient advocates, so we are responsible for knowing what’s important to our patients and what is going to make their birthday a beautiful one. So when it comes time we usually pass on to the doctor if they haven’t already and remind the doctor because you know, they see multiple patients a day sometimes. And we just pass it on, if she really is opposed to an episiotomy. So keep that in mind, you know.

And so when it comes down to it I think an episiotomy would be a lot less likely to occur, if that’s what the patient is choosing except in an emergency. Because in labor and deliveries things do change quickly. We are watching heart tones on a monitor which in natural birth isn’t always the case, you know, at home birth and so when we can see heart tones on a monitor and it’s been certain amount of minutes and the heart tones are in a certain area when things tend to get a little more sticky and everyone is more in a rush to get out the baby.

Sunny Gault: Right!

Sara Schaffer: So sometimes things can change but obviously in that case the doctor would tell the patient and ask the patient and say, “Listen we really need to get this baby out, is that okay with you if I do an episiotomy?” and then it’s up to the patient.

Sunny Gault: Right!

Sara Schaeffer: There are times when patient say, “No its not”. So it’s still your body.

Stephanie Saalfeld: So what are the alternatives, I mean, in that instance. Is it different positions? More likely to not lead to an episiotomy and tearing, if you are seen, pressures in different places, is there alternatives to positioning the mom differently?

Sara Schaeffer: Well, positioning is an awesome thing in labor. Because really when you come in and you are stuck in bad, it makes it hard for a baby to come down and when we start to see patients getting stuck at dilation-wise, okay, there are 5, another 6, another 7 but they are making very slow progress and the baby is just not coming down, I think positioning is very important. Going from side to side, if they don’t have an epidural, letting them get up and go to the bathroom, letting them get up and walk around a little bit. It just helps the baby to use gravity on its side and to figure out, “Oh, hey this way has a lot more room so let me come down this way”. I mean, obviously the baby is not thinking that but I can imagine that that would help them with gravity and with what space is needed for their head to come down. So as far as positions preventing an episiotomy, I think what it comes down to is that the baby is very low and positions can help babies to get low. So that is the important thing.

Sunny Gault: So if you do have to have an episiotomy, what is the recovery process? I get into this conversation with my mom all the time. We are talking about how older generations, is it just kind of how it was done? My mom is still insistent that episiotomies are better than tearing.

Jessica Blagg: My mom too!

Sunny Gault: Yeah, and she has some good points because if you take a piece of paper and rip it, its jagged, right? So if you think it about stitching something up it could be harder to heal. It makes more sense if it’s a straight line and it really does and in my mind it makes more sense. So I understand her point but at the same time I read the current literature and stuff too and I understand that, that isn’t the preferred way. if you don’t have to do it, don’t do it. It’s just like your body, do it what its going to do. But going back to the healing process what is that like for an episiotomy what should woman expect?

Sara Schaeffer: Well usually with an episiotomy our patients are pretty sore, which they are regardless at what that there is episiotomy because you just had a baby. But there are a little bit sorer and they have a lot more pain from that area but we do have medications that we can use and it doesn’t mean an oral medication. We have pads that we can place on your pad for it to touch your episiotomy to cool things down to numb the area a little bit. We have sprays that we use. I am sure every hospital has something different or a different brand. But we usually tell the patient to use it every time they go to the bathroom to replace their little pads and spray themselves which will numb the area, which will lessen the pain. We also offer oral pain meds if the pain is just not controlled with the pads and the spray. Also using a spray bottle every single time you go to the bathroom regardless of tearing, episiotomy or anything will just definitely help you to relax and allow yourself to urinate or to have a bowel movement. Because you can fill your little bottle up with warm water and then if that dilutes your urine, urine is acidic when it touches an area that is a fresh cut that is very painful.

Sunny Gault: Right!

Sara Schaeffer: So if you can dilute it, it makes it a lot less acidic and then you are more likely to fully empty your bladder and so holding it in… and you are more likely to just not have as much pain when you are going to the restroom.

Sunny Gault: Sure, okay, well when we come back we are going to talk all about tearing and the benefits, if that makes sense, the benefits of tearing as well as on the complications that may result. We will be right back.

[Theme Music]

Sunny Gault: Welcome back. Today we are discussing Episiotomies, Tearing and Perineal Massage. Sara Schaeffer is our expert. She is a labor and delivery nurse at Sharp Grossmont Hospital. So for the first half we talked about episiotomies, we talked about perineal massage, some of that may come back into our conversation. But let’s focus mainly on tearing. So walk us to this a little bit Sara, when a woman tears during labor delivery what is happening in the body?

Sara Schaeffer: Your body is stretching to fit a baby out and its usually stretching to the amount that it needs, not anymore than that. So we usually see it right up the very end. Every once in a while we see it while a woman is pushing we see a tear occur but usually it happens right at the very end as the head is coming out.

Sunny Gault: Ladies here in the studio, who have had babies before, tearing as, have you guys tore, did you tear and what was your experience, I guess?

Destiny Bochinski: I had my son at home and completely unmedicated and I did have a small first-degree tear and it was again right at the end. He came out with his hand right next to his chin to his cheeks so that obviously made his head a little bit bigger. And I was shocked because I did not feel it at all. I think I had a really long labor so everything was super stretchy and I didn’t have across a ring with fire, I didn’t get any of that. And my pushing was relatively short for the length of time that I was in labor and but I was shocked when she told me that I had a small tear because I didn’t feel any pain at all when he came out. So I think it was just a matter if he got his hand in the wrong place the wrong time.

Brigid Santiago: And posing for you …..(overlapped)

Destiny Bochinski: He was and he still does that…but yeah, then my recovery with it was really pretty easy. Very simple, very quick and I did the whole rinsing every time I went to the bathroom and did the icepacks and everything and it was relatively comfortable experience.

Sunny Gault: Okay, and Jessica, what about you?

Jessica Blagg: I had a C-section.

Sunny Gault: You had a C-section so it didn’t apply. Did you go into labor at all?

Jessica Blagg: I did but as soon as I got there on the way to the hospital she did a flip. So she was breach. So I didn’t then get a pushing.

Sunny Gault: You didn’t get a push. Alright!

Stephanie Saalfeld: I pushed for three hours but so it ended up with a C-section so she didn’t get down, she is ….

Sunny Gault: Pushing it down finer…

Stephanie Saalfeld: She was a +2, I guess whatever that really means but…

Sara Schaeffer: Its station, +2 station.

Stephanie Saalfeld: Yeah, so she wasn’t down enough.

Jessica Blagg: And that’s what you said she was posterior right?

Stephanie Saalfeld: Yes, posterior and like I said, over deep. They were trying to turn her and I guess the problem was is that her head was back and it wasn’t touching and so they just ….. and it just got to be too much eventually and ….

Sunny Gault: Sara with your home births did you tear at all?

Sara Schaeffer: I did with my first one it was a small first degree, more labial tear.

Sunny Gault: Okay!

Sara Schaeffer: But it was very small, very minimal.

Stephanie Saalfeld: And how long were you pushing?

Sara Schaeffer: And I didn’t feel it even.

Sunny Gault: You didn’t feel it?

Sara Schaeffer: I only pushed for about 25 minutes in the first and with my daughter, she came right out. Maybe three pushes.

Stephanie Saalfeld: And we had a lot of comments from our Preggie Pals’ VPs. So one, and this isn’t not just scaring but even….but our friend Chelsea said that she did do a perineal massage and she still ended up with a fourth-degree tear and she said that it took about 11 weeks to recover and two applications of silver nitrate and we had a couple of other various comments. A lot of them were like second-degree tears and now we will go question and they ask, what are the degrees of the tears? What do they mean?

Sara Schaeffer: So the first degree is when only the vaginal tissue is involved which just usually like what you can see and then a second degree, it goes more into the muscle. So when they cut an episiotomy, its usually a second degree because they need to create a little more space than just the first degree. So they are cutting from your vagina down a little bit, actually cutting into the muscle. And third-degree would be involving the anal sphincter and then the fourth degree actually involves your rectum which basically means there is no wall in between.

Stephanie Saalfeld: Oh, my gosh!! So now, but I have also heard of tearing up.

Sara Schaeffer: Yes, you can tear. That’s like a labial tear.

Stephanie Saalfeld: Okay.

Sara Schaeffer: Where you can tear up and I believe that would still be considered a first degree because I don’t think any muscles are involved there. It’s still just tissue.

Stephanie Saalfeld: Okay, but equally even more so ___(overlaps)

Sara Schaeffer: Right.

Stephanie Saalfeld: I feel like there is one nerve ending there in that area.

Sara Schaeffer: So in either way regardless of the degrees, stitches are involved except for maybe a first degree, that’s just what we call like a skip mark. It’s just like, some doctors do use the silver nitrate stick where it just cauterizes it, it stops bleeding and helps it heal. A lot of the times you don’t need anything for a first degree. But for a second degree would definitely end on would definitely involve sutures.

Stephanie Saalfeld: And one of our facebook friends, Heather, said that she had a first degree but she had once stitch or so.

Sara Schaeffer: It’s the doctors call what they see and if there is a lot of bleeding, if there is not a lot of bleeding from that area then usually if it’s not large they will let it heal it on its own. But if there is a lot of bleeding coming from that area or it’s a larger tear then they usually put in a stitch or two.

Sunny Gault: So you know, every situation is different. I don’t want to try to categorize things too much. But I am trying to get a visual, at least an understanding of what could prompt? It seems to be like first degree and second degrees are most common. And was it that fair to say those tears? Okay. But when you get into third degree and fourth-degree, what are some circumstances that could result in that like how much of it does it have to do with our own body and the way our own body is made up versus positioning of the baby or the force that the baby is coming out?

Sara Schaeffer: Well, every woman is so different. I mean, it does have to do with how stretchy things are down below. How big the baby is, that can have a huge difference between a woman who tore, a woman who needed an episiotomy, and the positioning, I don’t know that that really is a huge factor. I think it is more just having more of a slow ending to the birth and allowing the baby to come down and allowing not pushing to occur without forcing the baby out yet and just the end being very slow and controlled.

Sunny Gault: Have you personally seen a fourth degree tear?

Sara Schaeffer: I have!

Sunny Gault: You have and what prompted that?

Sara Schaeffer: I think in that case that was really fast. The baby was coming out pretty fast and it was a very large baby.

Stephanie Saalfeld: Like how big? Around?

Sara Schaeffer: I think it was in the tens.

Sunny Gault: In the tens? So fat. Okay because you mentioned that your body being able to stretch so would you say its better or again may it’s just a case-by-case, but is it better like Destiny said she had a really long labor process. Does that naturally, if it takes longer to first step to stretch out is that usually better than something going boom right through? Because your body hasn’t had a chance to…or is it a bit fast like gripping of a band aid is usually better than slowly ….

Sara Schaeffer: Well what matters a lot is the station of the baby. So you said you had a long labor and the baby’s head was really high up, most of it. Then that really didn’t do any stretching down below. But it’s when the head gets lower and lower, if the baby is gradually and suddenly stretching you and so when we are pushing with you at the end, we are trying to allow the baby that is just kind of inch its way down and inch its way down and a lot of women are like, “why isn’t the baby moving?” Well it is. It’s coming down and then it’s going back up in between. And that’s okay because that stretches. And so it keeps doing that until it gets to this point where it’s right under the pubic bone and then eventually it comes out from under the pubic bone.

So us as nurses are trying to time the delivery of the baby if the doctor is not in the room, we are trying to get you to that point and then the doctor in the room to actually deliver the baby. Doesn’t always be like that way. But that’s our goal. And so when you are at that point where the baby is pushing down and stretching you and then going back up and pushing down and stretching you. That’s actually a really good thing because that is helping everything to be a little bit more slow and controlled and your body is not just blasting the baby outright.

Destiny Bochinski: That was something that was really that I could feel because I was undmedicated, I could feel the baby when it was too much and I could back off from the pushing and then I could push a little bit more and I control that a little bit so that nothing got to intense too quickly which was, it was really nice and then I could support myself like you said that you did with your delivery. I could support myself when I needed to if I felt like it was too much.

Stephanie Saalfeld: So is that along, you wanted to push the baby as early or is it the part, you know, before that the stage 1 labor where you are slightly dilating, is that the part that you want to be slower or is it the birth.

Sara Schaeffer: Well it’s the very end. It’s not that you want to push the baby out slower while you are pushing because someone will push for hours, someone will push for 5 minutes or less. Its more that at the very end when the baby is crowning or the baby is stretching you to your fullest, that part needs to be very slow and controlled because if there is a hand coming out with the head, the doctor can assist and just push things where they need to be and then the hand will fit perfectly without tearing. That is possible. Every woman is different. How much space there is its so different on everyone and how much they stretch. But I feel that the baby being really low definitely helps your body to stretch and further to be less tears and less episiotomies.

Sunny Gault: So I know, you ladies, some of you have already talked about this, not being able to feel the tear. You guys but had, Destiny and Sara, you guys had natural child births. So is that common which you are saying that, because its pressure, you got so much of pressure on down there.

Sara Schaeffer: You have so much going on.

Sunny Gault: Yeah, that you can feel it.

Sara Schaeffer: Adrenalin and …

Sunny Gault: Right.

Sara Schaeffer: You know, that urge to push is so strong that is probably the strongest thing you will ever feel in your life.

Sunny Gault: So what did you feel it afterwards though? Do you guys remember? Do you remember being like, ‘oh yeah, that ….

Sara Schaeffer: The tear?

Destiny Bochinski: Not until way after because you said that all these crazy hormones and endorphins going on and I don’t even remember being aware that I had any stitches or anything like that until much later, many hours later.

Sunny Gault: What about you Sara?

Sara Schaeffer: A little bit but not very much, just like a little cut.

Sunny Gault: Right. Okay. I had with my first son; I had an epidural, so I didn’t feel tearing. I had a second degree tear which is pretty common. And I really wasn’t sure what to expect after having a baby. I felt like that whole area was awful and now ‘it’s no matter what’ for a while, you know. So but that was uncomfortable for me. I remember doing, and this is question for you too Sara, that the stuff that they have you do for tearing as far as the witch hazel and then changing out of the pads and the warm water and everything. It’s the same pretty much for episiotomies and tearing right?

Sara Schaeffer: Yes!

Sunny Gault: So I remember doing all that and cleaning the area but I really just felt like everything was so weird down there anyways and honestly I have had the same thing after having a caesarean. This is one thing that people don’t really tell you, is that you are going to bleed like after having a caesarean even, you know. Even though the baby didn’t come out that way, your body is still expelling a lot of stuff from your body and it’s still a sore area and stuff. So I felt I ended, obviously didn’t tear with the caesarean but that form of caring for your body down there and everything. I think you have no matter what.

Sara Schaeffer: Yes.

Stephanie Saalfeld: And I feel like I gave birth both ways (overlapping)

Sunny Gault: Yes you did.

Stephanie Saalfeld: Because of how much I pushed and the whole area was just …yeah, I mean, it’s like a ran a marathon and then I got hit by a truck. It was just terrible.

Sara Schaeffer: I think it’s awesome for the way no matter which way. No matter how it ends up.

Stephanie saalfeld: Yeah, but there is definitely swelling still.

Brigid Santiago: If you just have a C-section is there a swelling?

Sunny Gault: Well, there is just a lot of stuff going on down there and like….

Stephanie Saalfeld: Well, you still bleed, you still ….(overlapping)

Destiny Bochinski: Yeah.

Jessica Blagg: I think there is still swelling.

Sara Schaeffer: And there is still cramping, because your uterus is trying to go back to its normal size.

Sunny Gault: That’s what I mean, I felt light. I mean I didn’t have the tear again, but it felt like I had a vaginal birth and the other thing that’s really weird too is the way like around your scar. You know, it’s obviously very fresh after you have a caesarean. Your whole vaginal area bulges out. It’s really weird. I asked the nurses. I was like, “Is this normal like, this is a deformity here? What’s that towards my you know…just didn’t look …

Destiny Bochinski: Are you talking about your vaginal area or like above your pubic bone?

Sunny Gault: Well, no, it’s the vaginal area. It’s like yeah, it bulges out.

Brigid Santiago: Is it because of swelling and fluids and things like that?

Sara Schaeffer: I think so in hormones and your uterus cramping. A lot of women get really swollen to a point where they are like, well, this is not normal for me! Why are the labias so huge? That is very common

Stephanie saalfeld: Oh my god, that was so weird.

Sunny Gault: I just wasn’t expecting. I know, so weird. You kind of expect that kind of stuff I think if you have a vaginal birth but when you don’t…..

Stephanie saalfeld: But I didn’t know if it was because I had pushed and yeah, I don’t know.

Sunny Gault: Well, rest assured. I did not push at all with my second. I didn’t go into labor. He wasn’t even anywhere near coming out when they did the C-section. Must have had all that so yeah, but anyways. Alright! Well, thank you so much Sara for joining us today that this is a great conversation. Very informative! So now we all know that episiotomies, tearing and perineal massage. And for more information about our experts as well as panelists, you can visit the episode page on our website. This conversation continues for members of the Preggie Pals’ club. After the show we will discuss how episiotomies and tearing can impact future pregnancies and even births. To join our club visit our website www.preggiepals.com.

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Sunny Gault: We have a comment from one of our listeners. It comes from Carra Johnson and Carra writes, “Sunny I have been listening to Preggie Pals’ since before I was pregnant. I am now 28 weeks with our first child and I just wanted to say a huge belated congrats on your pregnancy with twin girls. So exciting! My hubby and I don’t know what we are having and are excited for the surprise. Upon becoming pregnant I downloaded all the pregnancy podcasts I could find and yours is the only one I still listen to. It’s by far the most interesting and helpful. Thanks for a great podcast and I hope you are having a good pregnancy so far.” Carra that is so sweet! I love getting e-mails from listeners. So you guys, thank you so much. Carra, congrats on your pregnancy and I hope you and husband get everything you want and yeah, it’s a really exciting time for everyone right? Thank you so much for writing in.

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Sunny Gault: That wraps up our show for today. We appreciate you listening to Preggie Pals’. Don’t forget to check out our sister shows, Parent Savers for Parents with Newborns, Infants and Toddlers and our show The Boob Group for Moms Who Breastfeed their Babies.
This is Preggie Pals: Your Pregnancy, Your Way.

This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

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