Vaginal Tearing Workshop - Transcript

Here we go. Alright, so this is the save the cookie workshops, all about vaginal tearing during birth. I'm Nicole Joy. So who am I? What do I do? I'm a pregnancy coach, I'm a birth Doula, I'm a childbirth educator and I'm just super passionate about, education and knowledge about birth and I like to talk about vaginal tearing because this was something that really came up for me a lot and my first pregnancy and my second pregnancy. And so it's really close to my heart and what I've learned over the last few years I just can't help but share and talk about because I feel like it's a fear that a lot of moms have and we share that fear. So learning about it and kind of understanding it a little bit better I think is really helpful.

So can you prevent vaginal tearing during birth? The short answer is going to be no, I can't hands down promise you that you won't tear during birth. Right? Especially if you're a first time mom, you do have not a huge chance, but chances are higher for first time moms because birth is unpredictable. Um, but there are things that you can do during pregnancy and during labor and during the pushing stage, there are things you can do that are, that will minimize your chances of vaginal tearing. So there's definitely things you can do and most of them are pretty risk free. They're actually almost, I mean, I'm not really huge on pushing things that are risky. So the things that I'm suggesting are pretty low risk suggestions and ideas and things that, um, you know, just have, have been proven for the most part.

So you minimize your chances. Some of them are not evidence based and I'll make sure to point those out to you, but there are things that, in my opinion, they can't hurt. And if you understand the physiological process, you know, it's like, it, it doesn't hurt to try. Um, and then, you know, I'm going. So I'm going to go through those things kind of by where you're at in your pregnancy, so kind of a chronological order, um, and where you are in labor and during the pushing stage and then just little things that I want you to keep in mind during the process. And I've added a lot of content to the workshop. Um, so that you'll understand more about the physiological process of birth because I think that it really helps to understand why we tear, when we know what's really going on in our bodies.

Um, so I'm big on that. I'm a birth Doula and childbirth educator, pregnancy coach, but I'm not a doctor so I don't give medical advice and of course anything you know that we talk about and things like that, you can certainly run by your provider. And if you have a specific situation going on, um, I'd actually suggest you talk to your provider, you know, because you can always run it by them too. But again, a lot of my things are pretty, pretty simple. So, um, and not risky things. So having said that, let's get going.

All right, so the first one, so the beautiful picture to get us started. So the first one is something that you can do during pregnancy and you may have heard of perineal massage, um, and I want to explain to you that that's kind of, in my opinion, a pretty bad title for what it really is because massage sounds very relaxing and like something soothing that you can do.

Um, but perineal massage is not really a relaxing thing and it's not designed to soothe you. Right? So the, the point of it, and if you can see my screen here, so what the premium is this area at the base of your vagina. So it's the skin that starts at the bottom of your vaginal opening and leads down to your rectum. That's your perineum. And that's when people talk about tearing their perineum. That's where they're really talking about. That's the area that's most commonly, um, the area that most women do. Tear is down there at the bottom part. So when you're doing a perineal massage, and I'm going to show you really quick on my, on my little model because I think it's helpful. So let's see if you can see this is a pelvis right? And so if this is the, you're looking straight at my pelvis.

So this is the back into the pelvis and this is the front end. So if I tilt it up, now you're kind of looking at the vaginal opening right here. So at the bottom down here is kind of where we're talking about doing the perineal massage. And so this bottom part is where you're going to be stretching during that massage. And so, um, I have a video that I can send you that's really simple. It's on youtube and it can give you an idea of what it really looks like. But really what you're doing is using your thumbs in getting down in that bottom skin and just kind of gently stretching it and holding it. So the suggestion is about four to six weeks leading up to birth. You can start doing this daily. You can do it a couple times a week whenever you're really comfortable with, um, there's varying evidence on how much it can help.

And I will tell you one thing it won't do is it won't hurt. It won't hurt you, like there's no risks. They might not physically feel beautiful, um, but it makes you much more aware of that area in that skin and your body so you have more consciousness of what, you know, what it feels like to apply pressure, where the baby's head will be applying pressure during birth. So, um, you can use, there's several different oils like vitamin E oil and there's a few different ones that they could recommend. And you can do that. It's kind of physically, it can be a little bit difficult to get down there and do it because you know, you've got this belly and it's not very easy, but you can get your partner to help if that's something you want to do. Of course you don't have to do it, but a lot of women do report that they found it pretty helpful.

So that's one. And then also during your pregnancy, and this is something you can probably do right now depending on where you're at in your pregnancy, but I almost feel like it's never too late, um, is to go see a women's health physical therapist if possible. And so I have an interview video in the group with one locally here. To me that was fantastic. It really just kind of explaining what they do. Um, this is something that is relatively new in terms of coming to the birth world and really shining a light on what these people do. So they're doctors of physical therapy and they work on your pelvic floor muscles. So in this model, it's not the best picture, but this is the pelvis right here, right? So this is the half that's sticking out and so you can't really see, but the pelvic floor muscles wrap all the way around your pelvis.

It's everything down there that's controlling. If you imagine what it feels like to do a kegel or what it feels like when you're holding your urine or any of those things, those functions down there are using your pelvic muscles, your pelvic floor. And so those are the same muscles that you use in birth. So if you see a doctor of physical therapy that specializes in this, they can actually do an assessment of those muscles to determine how balanced you are. Um, I recommend watching the video if you haven't already because it's just so helpful and they will actually. Why does this tie into tearing? So the reason that I've tied it in and brought it into this, this presentation is workshop, is because one of the things that they'll do is hook you up to this machine with these little electrodes and I don't know the exact medical terminology, but they have these little electrodes that like stick to your perineal muscle areas down there, like near your vagina and near your bottom.

And it assesses the strength when they asked you to like, do a kegel or hold down there. And pretend you're holding in your urine or something like that. They're assessing how strong those muscles are. And so, um, if it's not great to be too strong because then it can be harder for the muscles to relax and let the baby out, right? And you don't also want to be at the same time, you don't want to be to say loose, but you know, on your muscles to be too relaxed or not strong enough so they can work with you to find that ideal balance. And where this also affects your tearing is because they will put you in different physical positions that you can birth in. So like pushing positions to test which positions your body naturally relaxes your pelvic floor muscles the best. So it's really helpful if you're like, ah, I don't know how I'm going to be pushing.

I don't know what position I want to be in, what do I do? This just might give you a feel. And it's a practice, you know, it's a nice way to practice in a professional setting with a doctor and practice being in positions just to see how you know, where you're the most relaxed with those muscles because that's what you want, right? You want to be super relaxed in the pelvic floor because that will be the easiest and best way for the baby to come out. So threw that in there. And again, I have a link to that. I'm happy to share if you want to find these doctors in your area. And so, you know, you can find out sorts of insurance and things like that. What's covered. They're just amazing. So I brought it in here too so that it was helpful.

Alright, so the next thing I want to talk about our medical inductions and how that would affect vaginal tearing. So again, I brought in some physiological birth processes to this discussion on inductions, uh, because I thought it really would help to kind of lay the framework and I want to mention the time factor of the issues with inductions. And I need to also mention that, um, medical inductions are absolutely necessary for some women because there are situations where it is much safer for the baby and for the mom, for the baby to be outside rather than inside the womb. So the point of this section is not to bash inductions because they are certainly, um, you know, helpful and save lives, right? So I'm not bashing them. I just want you to understand how they, how they can interfere with the, with the birth process. And if it's an elective induction, something that's not medically necessary. Why this, you know, these are things that you can keep in mind if you're considering that. Again, not that you shouldn't consider that because you totally can, but now you'll kind of have a little bit more info.

Okay. So I talked about the time factor a little bit because I think that a lot of women, and there's doctors even who will mention, um, you know, once you reach a certain point, we can go ahead and talk about induction. But I wanted you to know what really, what term is. So what's considered term and so acog is the American College of obstetricians and gynecologists, they've released these um, these dates to kind of identify what's considered early, so early term is starting at 37 weeks and before 39 and then full term is considered 39 weeks to just under 41 and in late term is 41, two just under 42 and post term is anything beyond 42 weeks. So why am I mentioning that? Because I think it's important to note that only four percent of babies are born on their estimated due date because it's really just an estimate and the 38 to 42 week window is when most babies are born. So about 80 percent.

And then for first time moms, most of them go about a week past your due date that the doctor tells you. So it's just kind of, I know it's hard at the end because you're so tired and physically, you know, grown so much and there's a lot of reasons why that last month is just, it can be really challenging physically, mentally, emotionally. I mean all of those things. So for a lot of women an early elective induction is so appealing and I get it. Um, I just want to have the facts laid out because um, what's happening at that time too with baby is there's a lot of development, so going on with the baby in terms of their brain development, um, their, their brain grows significantly from like 37 to 39, 40 weeks. So there's a lot going on there. Um, and I wanted to make sure we mentioned that.

Okay. So then I also want to touch on the physiological process of what's going on with your cervix during Labor. So the cervix does three main things during labor and they're all kind of happening at the same time, but not necessarily one before the other. They're kind of all just happening together and at the same time and at varying speeds for different women. So the main three things are dilation, effacement, and then the service is actually moving forward for birth. And so this picture I think is nice because it illustrates where your cervix is not dilated at all. Right here, see how narrow it is. This is the cervix and so there's like no dilation, there's no opening. It's also really thick. So this whole area, see how thick and tough it is. So in terms of effacement, we're talking softening.

So if you kind of take your finger and touch your nose, like the way that the skin feels there, it's not very like soft and pliable and squishy. Whereas like if you're touching just like your lip right there, that's a little bit softer, right? So like see how much thinner that feels. So when you start to talk about moving from this point, which there's nothing happening yet over here to this point, see how much center it got right here. So that's the effacement is it's really sending out and then right here the dilation is how much it's opened. So it's starting to dilate. This is only one centimeter right here. And then this picture down here, it's completely opened and effaced. So now it's reached 10 centimeters. So understanding that you know, and the induction process can certainly impact how these things are happening and the different induction methods, they don't recreate this entire process, you know, so different.

There's a lot of different induction methods and options and each one kind of does a different thing. And so I'm just keeping in mind that those medical induction options, they do interfere with this process. And so also what's going on, it's hard to see in this picture. So I wanted to show you on my little baby here, but um, the baby is also at this time. So your cervix is doing all these things but the babies also coming down. So during pregnancy, you know, so again, here's your pelvis. During pregnancy, babies kind of floating up higher. He might feel or she went, feels super low, like she's like knocking on your vagina, right? Um, I mean that's how mine always feel, but she's actually kind of floating up here. So when things start happening and there's a hormone shift and some chemical things that happen in your body that signal that your body and your baby are ready for birth, he starts to move or she starts to move down.

So what she's doing is descending down into your pelvis, right? And really getting down in there to get ready for birth. So they talk about station when you're, um, when they do the checks, the cervical checks, they'll tell you how fast you are, how dilated you are, but you're a provider. Will also mention where the baby's station is. And so what that is, I'm going to take this little vaginal opening off so you can see the pelvis better. Okay. So again, back of the pelvis, front of the pelvis, and I'm tilting it up so you can see. But when they talk about station, negative three is still the baby's still up here. So as the baby moves down to negative two, negative one to reach zero, they're kind of in line with the bottom of these pelvic bones right here. And then when you go one, two, three is when they're starting to, their head is actually coming out of the pelvis and moving through the vagina, right?

So the higher up they are there in the negatives and what you want ultimately for them to reach is to get down to three and beyond for birth. So during this process of all the cervical changes, the babies also continuing to descend. So if you hear you're 100 percent, 10 centimeters and three, that means you're 100 percent effaced. So you're completely soft, like the skin on your lip, you're 10 centimeters, so you're completely dilated so that the baby can pass through your cervix and the babies at a station three. So the babies pretty much, you know, coming out of your vagina at this point. Okay. So what are the issues with inductions like I just mentioned? Um, when you talk about any medical induction, it does interfere with the birth process, the natural process that's going on, right? The hormones, all of those other things happening there, they serve.

It certainly interferes and a lot of different ways. Um, another issue is that your body and your baby just might not be ready yet. So if it's not medically necessary, it's certainly something to consider, you know, am I kind of pushing my body to do something, it's not ready to do or am I pushing my baby to do something he's not ready to do yet. So if it's not a medically urgent situation, um, or a necessity, you know, it's something to consider. Right. Um, and then there's risks of course, and I didn't go into everything about inductions here. I have that in a separate workshop, um, but some of the risks of induction are Sicilian. Um, painful for mom. Uh, it can be stressful to the baby because you're introducing, you know, foreign substances and drugs and things like that and the babies might not be ready so it can stress them.

And how do you know, because they're monitoring their fetal heart rate. So you can, that's an indicator of, you know, can show you stress for the baby. And then other risks, the baby can be born prematurely. So even if you're at 37 weeks, it's still considered early and there are babies who are born early at 37 weeks of induction ended up going to the NICU because maybe they just weren't ready. Um, I met a woman, you know, in this industry that has five babies and every single one of them has gone to 42 weeks. Her babies and her body, they just, you know, everybody's different. So there's no medical emergency and she luckily didn't have any urgencies. Um, she just needed her babies needed 42 weeks to grow and you know, everybody's different. Every baby's different. So those are just some things I want you to consider about inductions.

Um, and then, so here we talked about kind of some of the risks of indust inductions and how they can ultimately lead to a Syrian, but there's a lot that can happen before that point. So I wanted to explain a little bit about the cascade of interventions. Um, which you may or may not have heard of. This is just one example. There's a lot of different examples and it doesn't always happen this way. So for some people, none of these things end up a cascade of interventions is kind of like, like domino effect, you know, you line up the dominoes and knock one and then domino's continue. It's kind of that concept and it doesn't always happen that way, but for a lot of women it does and it's just something and there's a lot of different ways it can move. So I just grabbed the most simple example of what that means.

So if you've heard of Pitocin, which is an induction drug, um, and pitocin is artificial oxytocin, oxytocin is a hormone that your body naturally releases and, or in early labor, it releases oxytocin. The job of it is to contract your uterus. So this is your uterus. The oxytocin is forcing. You're allowing your uterus or creating these contractions starting at the top of your uterus to push the baby down. So if you're being induced with pitocin, pitocin, as you can see, the picture is an IV drug and it comes, you know, through an ib, it's the artificial form of oxytocin. So it's creating those contractions in the top of your uterus that are artificial contractions.

So what that can mean is that it's more painful for mom sometimes because it's not a natural contraction. It's artificial. So why is that more painful for mom? Well, because when you're having a natural oxytocin induced contraction, your body's also releasing other hormones. Endorphins. I'm sorry, not endorphins. I'm now blanking on the term. Um, yeah, I'm pregnant. So I'm definitely, it isn't different. So there's other hormones that are coming into play. I've had like major brain farts with this pregnancy with terms. So if you're having these natural oxytocin based contractions, you're also getting the hormones from your body that are going to kind of provide like natural pain management. So it's offsetting with the other hormones that are kicking in. Now, if you introduce pitocin because it's not a natural thing and it blocks and messes with the natural flow of hormones. So now you're not getting those other hormones to help with the pain management.

And so these are artificial contractions and they can be. A lot of women feel like they're much more painful than the natural contraction. So you'll hear a lot of women say once I got the pitocin and that was it, I needed the epidural. It was just really common that women feel that way. So I put a picture here of a woman with an epidural because that's kind of the next intervention. Um, and then what can happen commonly after this is an epidural will typically slow or stall your contractions out because it's a pain management drug and it slows things down. So what happens when your body slows things down? A lot of doctors in a lot of hospitals say, okay, give her more protests in. So now you get more pitocin to speed things back up. And then it might hurt more because you just got more pitocin. So now you're like, oh, I need more epidural because it hurts again. See you got more epidural and kind of this pattern, right? So that's kind of just a really basic example of the beginning of cascade of interventions. It's really just when a minor thing like, chosen can lead to bigger interventions. And I'm not against Pitocin, I'm not against epidural, but it's just something I wanted you to know that this is what people are talking about. Um, and that's kind of how you can get on that track.

Okay. So then there's other interventions that those two could lead to. And these are also examples and these can affect vaginal tearing. That's why I brought up the Pitocin, the epidural, the cascade of interventions because I wanted to lead into forceps vacuum extractor and a PCI autonomy. So forceps are those prom looking things that if baby's in distress and he or she is like right there, um, you may or these might all happen concurrently or together. Your doctor might say, okay, baby's in distress, but we think he needs to come out pretty quickly. So to avoid a c section, let's do an episiotomy, which is a cut where they actually surgically cut your vagina. And then maybe we need to use forceps. So this prong thing to kind of help them come out. Or we want to use the vacuum extractor to kind of pull them out.

And all of those things can increase your level of tearing a PCI dummies definitely increase your risk of tearing. I mean you have an episiotomy, you're automatically cut, but think about a piece of fabric, and I didn't bring it in here, but think about like a goddess or a piece of fabric. If you're just kind of pulling out a piece of fabric and stretching out it usually, unless it's got spandex in it, they're hard to stretch, right? Or cut like they're hard to tear. But if you put a little snip in it and mimic and a [inaudible] and then do that same motion, it'll tear a lot easier and possibly a lot more. So again, not knocking a Pez academies or forceps or vacuums because in certain instances they can avoid a bigger problem like a Sicilian. Right. But if you can do things to try to avoid those or be aware of them and say, you know, I only want to use them.

If it's absolutely necessary, then that's something to consider. And then I just want you to know too that they certainly can affect vaginal tearing. I'm forceps and vacuum, obviously because they're sticking stuff inside your vagina. So anytime you're doing that, you're, you know, stretching it unnaturally. Okay. So back to the epidural. I did want to mention a couple things because I think, um, because I'm an educational person and I can't help if we're doing a workshop on this, I have to, I feel like I have to tell you more about them. So the epidural, it's great pain relief, right? And it's easy to get in most hospitals in the United States and it's very effective for most women. So those are the pros, the cons, which we already talked about. It disrupts natural labor hormones. So kind of like the Pitocin, once you get an epidural, your body's not going to be releasing those oxytocin, endorphins, things like that to, to, you know, kind of continue with a physiological process.

So you're really messing with the process. Um, and then, you know, you're restricted with movement because now you're hooked up to an ivy, you're numb from a certain point down, waist down, so you can't move. You're stuck in bed. Um, and then, so I've started here to kind of highlight the last two cons because those most applied to our discussion today is that an epidural can lead to a longer labor and a longer labor is shown to result in greater instances of vaginal tearing. And then the last one is that mom won't feel the urge to push. So if you've had an epidural and you don't feel the urge to push, it certainly can affect your chance of vaginal tearing. And I'm going to go more into that in the pushing stage, but I wanted to mention it here too. Um, and there are risks and not just mentioned a few of them here.

So the epidural can affect the baby's heart rate, of course, because it's a drug and it does, this drug does, um, effect. Maybe it does crossover and cross the placenta and go to baby. So can certainly affect baby's heart rate. And then it can make it more likely that you'll need. I started this one too, because it applies directly to today's workshop, is that it will make it more likely that you would need, um, delivery interventions like backends and forceps, which we already addressed that they can even increase your chance of tearing and we already talked about this, but then you'd be more likely to need more pitocin because it can slow down your labor. So those are a couple of little extra things on epidural. Um, a few other risks just because these, I mean, these don't specifically apply to vaginal tearing, but I have to put them in here because I can't help myself.

I'm so kind of nerdy like that, but you know, one in 100 went too fast. Sorry, one in 100 people have severe headaches. It can cause a fever and mom, which can be an infection and the baby can make breastfeeding more difficult. It can increase your chance of needing a cesarean. Um, there's times the epidurals don't work. You may have heard that there, you know, of women telling me that, oh, you know, I got, I got the epidural, it didn't work or half my side worked. And I, they had to replace it again, and so those things can happen and there are complications that are pretty severe and also very rare that I need to note them. A nerve damage, seizures, severe breathing, difficulty and death. And the more common side effects that aren't serious, not, aren't always a serious is decreased blood pressure, itching, nausea and fever.

Now, having said all of that, again, I'm not against epidural. I've had an epidural twice, so I'm not against them. But I do think that there's some things to keep in mind. Um, if you're considering getting an epidural, how can you, I don't want to say strategize, but what's, what can you do if you're considering getting an epidural to kind of help your chances overall it's tearing because that was kind of a big deal for me. It was like, okay, I'm, I know I'm okay with getting an epidural, but what's my best chance at keeping my one of attacked? Right? Because now I've got all these facts and it looks like, you know, no matter what happens, if I'm looking at this, it makes it seem like, oh gosh, if I get an epidural, I'm going to tear. That's not true either because I didn't tell her.

So I think that, you know, knowing what, what you can do. So here's some tips. If you're considering getting one an options, one would be get a light epidural. So what do I mean by that? Once you get the epidural placed and the drugs are coming in, you have a pump so you have this little hand pump thing and you can control how much you're getting. So if you only want to get and maybe start with a little bit, maybe you don't have to, but if you want to start with a little and just kind of see how you feel, that's an option because then you might actually feel the urge to Bush. Um, and also you can lay off of it a little bit. As you get closer to the pushing stage, it's another option because then you might feel the urge to push.

You also might consider delaying it, so you might say, okay, I'm pretty sure I want an epidural, but let's see if I can try to delay it as long as possible, and then you kind of mostly strategize, but you kind of strategize a bit and lay out all of these things that you want to try first to kind of get you to that point where you're like, okay, I'm ready for it now. Um, so maybe I'm delaying it. Right? And so there's a lot of things you can do during Labor to, to help you, you know, physical comfort measures, breathing techniques, and I have a whole separate workshop on all of that on kind of things you can do up until that point if you want an epidural. And if you don't, then those are things you can do for your whole labor, right? Um, peanut ball.

So this looks like a yoga. It's a yoga ball, but it looks like a peanut shaped. And I have a picture a little further in the slides. Um, we talked about once you've had epidural, you're, you're kind of stuck in bed. And the problem with being stuck in bed is it's not really helping your pelvis continue opening during birth if you can't get up and move around and squat or stretch or walk or dance or all these great things that are really good for opening your pelvis. So using the peanut ball is one thing you can do once you've had an epidural to help your pelvis open so you lay on your side and kind of record legs around it and I'll show you a picture. And then the last one is laboring down and waiting for crowning. So I'll show you. I'm going to go more into detail on that because I think it's pretty important and not as much attention is drawn to it. Um, let me just get a sip of water.

Okay. So laboring down. And this image is actually my Doula that I'm using this coming birth. So she shared this image with me with the mom's approval, who's in the picture. So this mom, she just got her epidural and she's in this like rest and be thankful they call it or laboring down, um, time period. So she got her epidural and you can't see it very well from this picture, but she has her legs wrapped around the peanut ball, so she's kind of sideline and you can see or like laying side when she's a little bit at an angle, you know, not a whole lot, but she's sideline so she's angled up a bit which is helping the gravity and her legs are wrapped around the peanut ball. And so what she'll do is flip sides every half an hour or so. And the Doula, this is the dual learner names email.

Uh, she's with one lug doula services and then grind and process the photographer, the birth photographer that took this picture that she would help her flip. So every, you know, as often as you can, but at least every half an hour you want to be flipping because it'll help your pelvis open and it can help with baby positioning to just side note. Um, so this laboring down is this time period. What this time period really is not every woman experiences this and you might not even know that it's going on if you've had an epidural. So what is it really? It's after you've reached 10 centimeters dilation, it's, it seems as though your Labor has stalled out in your contractions may have completely stopped at this point, right? Um, and it could be like an hour or two, but what's happening in the process, the physiological process is your body is giving you a break and a chance to rest.

A lot of women will fall asleep during this time period. It could be up to two hours, it could be 15 minutes. And so some providers will say, oh, things have stalled out. Let's do something to get it going. Let's get you some pitocin. But that might not be the case. So I've talked about the time factor before, and I'm going to mention it here too, because if there's no, um, emergency situation or medical complication, excuse me, then why rush it? And if your body's giving you a break, take one, you know, take a nap rest a little bit. Because a lot of women have said that during that period, even if they only slept for 10 minutes or five minutes, it took a little micro naps. When they picked back up and their contractions started back up again, they felt rejuvenated, they felt energized, they have mental clarity, and they were like, okay, now I feel good.

I'm ready to continue. I'm ready to punish. So what's also happening during that time is your vaginal tissue is continuing to stretch. That's why I brought it up in this particular workshop, because the more your vaginal tissue has a chance to stretch, the less of a chance that'll tear, right? Um, and again, if there's no medical reason not to, it's like another one of those things. What's the problem? What's the risk? Why not do it? Right? And if your contractions have slowed down, installed, and it's not like you're uncomfortable, you're taking a break and you take a rest. Um, and it's helpful to know too, that even if you've had an epidural, you can still do this. So again, as long as there's no problem, um, and I did this so I reached 10 centimeters and if, you know, if you have this conversation with your provider in advance and say, hey listen, you know, if I end up with the epidural once I reached 10, as long as there's no issue with time, I want to allow more time for baby to descend.

And you can talk about where babies at in station. So we talked about negative three, two, one zero, you know, you can say I want to give her time to be crowning is ideal. So your best chance at minimizing your tearing during birth is if you've had an epidural during pushing is to wait until the baby's actually crowning. Um, and so I know when people talk about the ring of fire, right? So this is again your pelvis. So what happens, he doesn't just like come out, right? So he's like out back in and I'll turn it sideways. You can see a little better, but they're like, they pop their head out, they come back in, they pop their head out, they come back in, they pop their head out of it, and they come back in. So what they're doing is they're stretching your vaginal tissue gently, right?

And not all babies do it exactly that way or with a certain amount of pushes and, but generally that's most common that they kind of bought that, a little turtle style and they're helping you stretch. So if you've had an epidural, maybe request waiting until your crowning, waiting until the baby's right there to start pushing. So if you start pushing too soon and we're talking about coach pushing, which I didn't include here, but if you're talking about coach pushing and it's in the baby's still higher up, you're exerting a lot of energy to push him all the way down and Fyi, he will come down anyways. You know, babies come out, they come out, women in comas give birth. Women that are paraplegic, they birth babies and they don't have control over some of the muscles and stuff down there. And so those things should tell you like the baby will come out, so if there is not a huge problem, what am come down on his own a little bit before you start pushing will exhaust yourself and if you push on vaginal tissue that has an adequately stretched, you could make it worse on tearing.

So all of those things kind of play in and can help you make the decision on what's best for you in the moment.

Okay. So I included this picture because my daughter was so cute and I just had to, I was like, okay, wait for crowning to push. And so this is my daughter with her little crown when she was born. But this is, you know, kind of a funny play on the crowning because I, I didn't, I didn't grab a picture of the actual crowning but you know, that crowning is actually when the baby is like right there at the vagina. Okay. So this is another thing I wanted to mention. Um, the sphincter law is something that I may gaskin talks about in the guide to childbirth. So if you haven't read the book, pick it up, if you don't want to pick it up, go to the bookstore and just flip to this section and take a look. But the way she talks about it or look it up online is her theory is that your cervix, your vagina, and your anus.

So those, all those things down there, that whole area that's responsible for pushing the baby out are connected to your mouth and your jaw. So if you're somebody that holds a lot of tension in your face, like think about whenever you're in pain. Like this mom here, I included this picture because she's, she's got a very tense face during pushing and that's not really good for her pelvic floor muscles. Right? Um, it's hard not to do that for a lot of women because it's kind of, you know, I hate the dentist so when I go to the dentist I'm like so tons and I'm so nervous and I'm just, even if it doesn't hurt right away, I just like this anxiety feeling and I sit there like 10 stuff and it just makes it worse. So I have to constantly remind myself to relax, relax my face, relaxed my jaw breathe, and the breathing techniques are huge.

And I had a whole other section and another workshop on practicing breathing techniques. Um, because they're huge, right? So think like, one example I can think of is like raspberries. So my kids blow raspberries on each other and I do it to them. But if you try to like blow a raspberry, just. And this might look silly, but right, if you do that, that thing with your mouth and the breathing, there's no way you can tighten your pelvic floor muscles. There's no way you can tense them up while you're doing that. And so like horse let's is another one if you kind of, it's silly, but you'll remember it because you'll remember I did these stupid horse lips like, right? And it's, if you do something like that, even again, try tightening your pelvic muscles, try doing the KCL while you're doing horse lips. It's really hard because I've tried it. Um, but it's, it helps you to get in that mindset of like relaxing and thinking of whatever you can do to relax and whoever's there with you, your birth partner or your Doula, your husband, your wife can keep you in that breathing and reminding you of your breath and reminding you of your breathing techniques that you've practiced. Um, so according to this theory, they're all related. And how does it relate to pooping?

Again, try this. I never thought I would be talking about pooping like this and so openly, but try it next time you're pooping. Like if you think about people who like pushed to poop and try to like make that grim a space and push it out, it doesn't feel good. It's not, not going to say it doesn't work, but it's not the best technique. But if you try breathing, I know this sounds really silly, but if you try this like belly breathing for pooping, it's a similar process and if you practice it while you're pooping, it will probably be a lot easier for you to focus on breathing while you're pushing the baby out during birth because you'll have practiced it during pregnancy. When you're hoping. And so d deep belly breathing. I'll have to send you a video link. But basically what that's talking about is when you take a deep breath in, allow your stomach to fill up and let your belly just come all the way out. So like in let's say a count of three, like you really let your stomach fills up and then when you exhale, try to use your abdominal area muscles to pull back in. As you push your air out. So in when you breathe in, let your area in your stomach fill up and then push it out and pull your stomach in.

And if you do that technique and practice that, try it while you're pooping and you might realize that it's kind of a similar process and you might be able to stop pushing down when you're pooping and maybe prevent hemorrhoids a little bit. Um, you know, because pregnancy. So that's just kind of a little side note on breathing. All right? And a little more here on mindset breathing type stuff. So this is not evidence based, but I brought it into this workshop because, um, when I was pregnant and when I was during my birth with my second, I had done a lot of mindset work during my pregnancy. I talk about meditation, but it doesn't have to be like sitting, you know, Criss Cross applesauce with your hands up and you know, your eyes. It doesn't have to be like that. Meditation can be laying in bed, meditation can be in the shower.

It's really just a mindset thing. And if you're into prayer, prayer or affirmations are huge. I've talked about affirmations a lot in the group, um, but how does it relate to vaginal tearing? So I did a lot of affirmations and visualization last pregnancy and talking to my baby and I would kind of use really carefully planned out statements and thoughts were I didn't so much say please don't hear me on the way out baby or um, I don't want to tear or I didn't use those terms because I didn't want my subconscious to hear the word tear because I don't think that my subconscious could differentiate between not tear and I don't want to tear. I think all your subconscious will hear is tear. So I found other ways of saying it. So like intact, perennial or smooth, you know, gentle way out or something like that. Something that you can say and visualize and I just think, um, you know, putting it, what you put out is oftentimes what you get back. So these are things again, that they're not evidence based but they can't hurt. There's really no risk involved. So having that mindset and while you're in birth in labor, continuing to go back to replaying that ideal situation and more specifically for this workshop as it applies to keeping an attack, perennial can't hurt.

Okay, so let's talk about the urge to push and how it compares to a bowel movement first. So how I compare it to a bowel movement is if you don't have the urge to Poop, you're not going to go sit on the toilet and just try to go and try to push it out because realistically it probably won't work, right? If you don't have the urge to go, you're just gonna sit there pushing and kind of hurting yourself and giving yourself hemorrhoids. It's not going to be very helpful. So when you start to feel the urge to Poop, you go and it kind of relates to pushing and labor. So if you don't feel the urge to push yet, um, which again can be impacted by epidural, but if you haven't had epidural and you don't necessarily feel the urge to push, you may or may not want to.

It's a choice that you can make, right? Um, but again, it can be impacted by what position your answer. Sometimes just moving positions can help baby, just enough to spin and rotate is a baby, doesn't just come down. He's also rotating. So sometimes moving your position can help them to get just where he needed, just the position he needed to kind of get a centimeter or inch even, not even to just twist a little bit and now he's in a good position and you have an urge to push pain management med. So epidural can certainly affect a kid. You don't really feel much of anything when you have, usually when you have the epidural and then again where your body and baby are in the process. So if things aren't quite ready yet, then you might not fill in our jet. Um, ideally you'd push when you have the urge and kind of listened to that, that instinct.

And so, um, this is actually something that came up recently as I was talking to a mom and we were talking about what if I feel the urge to push before on 10 centimeters dilated. And so this is a question, I mean, it's, it's an important thing to consider, right? Because there are a lot of women who feel this undeniable urge to push and they're not yet at 10. And so this is a conversation that I would have with your provider to see where they stand on because different providers handle it differently. So some will tell you if there's no urgency or if there's nothing going on, this is how I handle it. Or sometimes they'll say that they typically will like hold the cervical lip back. So it just means that maybe your cervix isn't completely dilated yet, um, and they might want to hold it back while you push, which a lot of women say can be very painful.

So it's, it's such a personal choice really, and a discussion that you can have an advanced with your provider if it's important to you. Um, because again, you have that right to make that decision and talk to them to see rather than wait for the moment to see what their kind of protocol is. That way they know and you know, where you stand on what you would prefer in the moment if there's nothing urgent going on and no complication. Right? Um, and there are, by the way, a lot of women who pushed before 10 with no problem and didn't have severe tear, you know, so it doesn't necessarily indicate that you're going to tear if you have the urge and you haven't had any pain management meds, you can gently breathe into that urge and push gently and you don't have to grin and bear it and kind of bare down and push hard and fight it to, to push them out, but you can kind of give into that urge and brief him out or her out kind of pushing softly if that makes any sense. Um, so again, I'm going to talk about the time factor because I always do, um, what's the rush? So a lot of time for your body to open up if there's no emergency.

Okay. So this is another thing that I want and where are we at? Okay. We're at seven. Six. So we, we are, we've got about 10 minutes and I think that's good timing. So I'm pushing positions there are pushing positions that you have a better chance at keeping your perennial intact. Some of these will not work if you had an epidural. So this first one here is leaning forward. Um, so this woman is supported standing, so she's supporting herself. It's just a stick figure, but she is supporting herself on a wall. Sometimes you'll lean into your partner, um, leaned onto the bed, but basically that leaning forward position so you might not be completely vertical, um, but you're leaning forward. Another good pushing position for minimizing your chance at tearing, leaning forward, but kneeling. So she's just here leaning on the Yoga Ball. So, and it's also kind of, you could kind of look at this as being on hands and knees, all fours because that's almost a similar like all forced type position, just that her hands are resting on the ball instead of on the floor.

But it's that same leaning forward, all fours position, both of which are good positions for pushing, um, that are, you have a better chance at keeping your cranium attacked, sitting. So not to be confused with squatting. So this lady is sitting on the toilet, which a lot of women really enjoy sitting on the toilet again because it's a lot like pooping. You're using all those same muscles. So for a lot of women it feels so natural to sit on the toilet to push the baby out. So if where you're birthing allows it and you know, it's something that you feel like doing in the moment. And again it's one of those things if it's feeling good, do it right and ask them to support you while you do it. Maybe somebody holds you up a little bit or you know, something like that. But if it feels good, listen to your body's urge.

Okay. So here's a modified hands and knees. Hands and knees is another good pushing position to minimize tearing. So she's kind of modified it a bit because she's in the bed. I'm not sure if she's had an epidural. I don't think she's had epidural because she's, you know, she's putting weight on her legs. She may have had the walking. I'm not really sure about this lady's story, but it is kind of a hands and knees type position. She just hasn't modified that she's wrapped around the ball. Um, but again, that's a good position for tearing. It's also a good position because it works well with gravity without putting as much pressure as squatting. And I want to show you why one thing, because. Okay, so this is the pelvis, right? So this is the back of the pelvis back here. So I'm going to flip it around so you can see the back and see this bone at the back of the pelvis, how it kind of hooks in.

So when the baby has to come out, if you're laying flat on your back, okay. And he's coming out this way. He has to come out and go up and fight gravity to go around this back of your pelvic bone. He has to go out and up, right? So if you are the way this woman is in the picture, if you're like this, it's a lot easier for him to slide out down this way than it is for him to fight gravity. And be birthed upward and I'll send you a video in the, in the, um, I'll email you a video that's really helpful to see that process, but I wanted to mention that, um, you know, that's another reason why this position is really good and a lot of women really like being on their hands and knees during pushing. So same picture that I had earlier because I thought it was a really great image of sideline because you can certainly push in this position that this woman's in and this is a good option for epidural.

So if you've had the full epidural, this is probably one of your best chances, you know, rather than being flat back and having baby fight gravity, you can be sidelined and have him come out. Um, you know, to minimize the chance of tearing. Oh, before I move on, I wanted to say one other thing about pushing physicians. So squatting, I did not include here because I want to differentiate. So squatting during labor, during pregnancy and during labor is amazing for what it can do for your pelvis and opening your pelvis up because everything you're doing is you want to focus on keeping your pelvis open. It'll all go back so don't worry about that, but you want to focus on opening it. The issue with squatting while you're pushing is that you've got gravity and pressure being applied to the vaginal tissue, so pushing your baby out while you're squatting can actually increase vaginal tearing, so not that you shouldn't do it, wasn't to your urges.

Listen to your instincts, listen to your body of course, but just keep in mind that the statistics are there that squatting during pushing, so maybe you squat all during labor and then when it's time to push, you're like, okay, switch positions, I want to move to sideline, or I want to move to all force, or I want to move to standing leaning something that puts less pressure on it. It makes perfect sense, right? Because at the baby's right there and gravities in your favor, putting a lot of pressure on your vaginal tissue so he could come out, you know, and do a little bit more damage. So just something I wanted to mention. Okay. So hands off. So what do I mean by this? Um, while you're pushing. There are some providers that, I don't know why, but there are some providers that feel the need to get really hands on and really get their fingers and their hands inside your vagina and help it stretch.

And the thing is that they really don't need to do that. Right? So generally speaking, unless there's an issue and they're really trying to get them out quickly, but generally speaking, the ideal situation for preventing, tearing his hands off and not completely because I put a compress in this picture because the warm damp compress, like pushing his counter pressure onto your perennials to the bottom of your vagina. If they're just kind of applying some pressure down there without getting in there and digging things. But just applying some pressure with a warm compress. Think about what a warm wet compress does to your body naturally, not just your vagina, but when you're trying to kind of relax parts of your muscles and stretch things out. It's helpful, right? So that pressure can be helpful but not hands on, fingers in type of thing. And that's a conversation I would have with them too at your prenatal visits, um, to see what their protocol is because every provider's different.

So I would ask them and see if it lines up with what you want, right. Um, and then they can certainly use olive oil. It's not going to hurt anything if they poured some olive oil down there while you're pushing 'em and put the warm compress. And then of course avoiding an episiotomy of possible. Again, I would have that conversation and they're not commonly performed anymore unless it's an emergency, but it's still a conversation that I would have, um, because I did actually work with a mom who had a really. I just didn't realize that there were still doctors doing things like her situation with the autumn and she just had no idea until the moment. So having that conversation I think is pretty important if it's important to you. Okay. So my last point on this whole thing is, and the absence of any real medical complications just don't make someone else's urgency.

Your urgency and take your time, take your birth. Takes time. So this is a picture of my daughter, my second birth, um, but it takes time. It can take time. Everybody's different, every baby's different and it's perfectly normal to take, um, you know, a lot of hours. So if your is putting a time limit on certain things, be okay with asking why or can I have more time or is there a medical emergency, you know, asking those things or asking your, making sure your partner knows that you're not going to hurry and as long as there's no urgency, you want to have a chance to talk to your partner privately or talk with your Doula or whoever's there as your support person. Right? Um, so yeah, that's my big thing on time. It's just kind of not rushing in and not letting their urgency be yours.

Like their dinner plans are not your problem. Um, you know, whatever they have planned and whatever else like that, that's not your issue. And unfortunately I have heard people say that, I've heard doctors say that, um, and I kind of feel like you're in the wrong business, you know, if you feel that way, like you really probably shouldn't be doing this. Um, so take your time and let your baby do its thing and whatever you decide, you know, just getting an epidural and not getting epidural, being induced or not. Um, you have options, right? And, um, and it's just important to know that those things aren't always. There are risks, there are things that can happen, yes, they interfere with the birth process, but sometimes they're super helpful. So epidurals can be super helpful. Moms who've had several hours of labor and they are exhausted sometimes just getting that little bit of epidural can give them a chance to rest. And then it's like after they get a little bit of rest, Bam, things start happening. They progressed really quickly, baby comes right out. Um, I had the epidural, you know, and I didn't care. I didn't lead to any other intervention. So it's not an always thing, but it's something to just know, you know the facts. Right. So having said that, I think that's it for us. That's it.

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