Its conclusion was that those with epidural anesthesia had a 1.95 times greater risk of perineal tearing than those who did not.
Background: Studies have shown increased incidence of severe vaginal lacerations (third and fourth degree) in women under the influence of epidural analgesia. This increase has been attributed to the increased the use of operative vaginal delivery (OVD), with attendant increased risk of laceration.
Deliver in an upright, nonflat position.
There are a number of delivery positions that might reduce the risk of a vaginal tear during childbirth. Rather than lying down flat during delivery, deliver in an upright position. Your health care provider will help you find a comfortable and safe delivery position.
The fact that mothers can't feel all of the elements of delivery with an epidural can also lead to a host of other problems, such as increased risk of tearing during vaginal delivery.
Due to the amount of pressure caused by your baby's head on your perineum, it is unlikely that you will feel any tearing. But everyone's birth is different and some women may find that they feel a lot of stinging, especially as the head is crowning (when your baby's head can be seen coming out of the birth canal).
Up to 9 in every 10 first time mothers who have a vaginal birth will experience some sort of tear, graze or episiotomy. It is slightly less common for mothers who have had a vaginal birth before. For most women, these tears are minor and heal quickly. What are the types of perineal tear?
The most significant downside of an epidural is that it may prolong the labor and delivery process. The epidural is very effective at numbing the nerves and muscles in a mother's lower body. The problem is that this makes the mother less able to use her muscles to effectively and rapidly push the baby out.
For women with epidural anesthesia who do not feel the urge to push when they are completely dilated, delay pushing until the urge to push is felt (up to 2 hours for nulliparous women and up to 1 hour for multiparous women).
Complications from epidurals are extremely rare, and pushing with an epidural is generally not a problem because you will still be able to feel pressure (rectal pressure, that is!) despite not feeling any pain or contractions.
The Odds of Vaginal Tearing
The position of the baby can be another factor—for example, babies facing up put extra pressure on the bottom of the vagina. Having a vacuum- or forceps-assisted delivery or an especially long labor that results in severe vaginal swelling increases your chance of tearing as well.
Up to 9 in 10 first-time mothers who have a vaginal birth will have some sort of tear, graze or episiotomy.
Birthing in the side-lying position has been shown to reduce perineal tearing by allowing the presenting part to descend more slowly (Shorten, Donsante, & Shorten, 2002).
Background. Perineal tears affect about 80% of women during childbirth, with primiparous women being affected more frequently than multiparous women [1, 2].
Some people describe the feeling as being like intense period cramps, others say it feels like a tightening or pounding feeling in your uterus or across your belly, others describe the feeling as being like very intense muscle cramps, while still other people describe contractions as being like the sort of wrenching ...
You can get an epidural any time you want. However, you shouldn't wait too close to delivery because you need to make sure the anesthesiologist is available and have at least 30 minutes for it to be administered and take effect.
While slightly more than half said having contractions was the most painful aspect of delivery, about one in five noted pushing or post-delivery was most painful. Moms 18 to 39 were more likely to say post-delivery pain was the most painful aspect than those 40 and older.
The American College of Obstetricians and Gynecologists considers 3 hours or more (especially with a first time mom and/or those with epidurals) to be perfectly normal.
The episiotomy tradition
Experts believed an incision would heal better than a natural tear. The procedure was also thought to help preserve the muscles and connective tissue that support the pelvic floor. Today, however, research suggests that routine episiotomies don't prevent these problems after all.
Your vagina may be looser after giving birth.
The muscles may improve over time, but often do not. Kegel exercises and pelvic floor therapy can help strengthen these muscles. If it continues to be a problem, Vaginoplasty can dramatically improve a loose vagina. See if Vaginoplasty is right for you.
Consider Kegels
One recent study found that pairing Kegels (also known as pelvic floor muscle contractions) with perineal massage aided in protecting the pelvic floor. People who did perineal massage and Kegels: Increased the chance of having no tearing at all from 6% to 17%.
It's most painful at the beginning, but you should feel better each day. Pain typically affects sitting, walking, urinating, and bowel movements for at least a week. Your first bowel movement may be painful. A tear is usually healed in about 4 to 6 weeks.
Most vaginal tears heal in about one or two weeks, whereas deeper tears can take longer, especially tears that require stitches (sutures), which typically dissolve within four to six weeks. Vaginal tears should be evaluated by a doctor and be treated appropriately.