Does waterbirth help prevent tears?

[Ceci]

Quick question, met a lady (a neighbor not a client) who was telling me she is choosing a waterbirth for baby #2 b/c "studies have shown" that it can prevent tears almost 100% of the time.

The weird thing is that she is actualy grossed out by the thought of a waterbirth (the water being bloody etc.) but is so motivated by preventing a tear that she is overlooking her other reservations.

Anyone have any information on this? I am curious what studies she was talking about but all she said was that this is what the m.w. assistant told her.

[truelife]

Yes, while I was doing my midwifery training I was told that a waterbirth does help prevent tearing for a few different reasons. One is that the warmth helps the tissues soften and make them more stretchable. The second reason follows along the same lines of counterpressure being a source of pain relief - the water puts even pressure on the perineam and helps "support" the head as it crowns. The third reason a woman is less likely to tear is b/c the water is known to calm and be more gentle which leads to a more gentle birth and slower, gentle pushes. There was a study done in the late 80's/early 90's that showed that women who labored in water were less likely to tear.

Out of the 3 waterbirths I have been to none have been a "blood bath." When I saw my tub the next morning it looked like murky water, but I got out before I delivered the placenta.

[RosyDoula]

Another reason women in waterbirths don't tear is because midwives don't have their hands on the mother's perineums, most likely mom is holding herself. Its a myth counterpressure or massage by an attendant prevents tearing.

[nocomparta]

I've had five vaginal births. My babies were from 7lb 7oz all the way to 10lb. My ten pounder was my first waterbirth, and I didn't even have a skid mark, but with the other births that weren't water births, I tore. In my opinion, the water does help prevent tearing, but Moms should be encouraged to crown VERY slowly if they can control it at all. That's my 2 cents.

[Jilian]

I wondered the same thing so I did a poll over at mothering a while back about waterbirth and tearing. I think it does lessen the chances of tearing but it certainly does not always prevent tearing. There were a few moms who still tore during their waterbirths. But there were also moms who gave birth to 10+ lb babies without any tearing.

[truelife]

RosyDoula- If counterpressure or the mom holding herself works - why wouldn't a midwife applying counterpressure help?

The one repeat birth I have been to the first time the Mom didn't want any counterpressure and she had a pretty ugly tear through the perineum. Second birth she asked the MW to do counterpressure with warm washcloth and olive oil. MW suggested that she support her labia minora and she got distracted (can you believe it? LOL) and didn't. That time she tore labia minora. I don't know if it was b/c the MW was supporting the perneum that she didn't tear down but it seemed that way.

Val- I had a similiar situation but only with my two DS's. My first was not a water birth and I pushed VERY slowly and gently but had a pretty good tear. My second son was a water baby and a full pound bigger, born in 3 hours (versus 45), and in two pushes he was out - no tear at all.

I do believe that waterbirths help with not tearing, but there are so many variables with childbirth that it's hard to say what *really* worked and what didn't to avoid that tear. Am I off in this thinking?

[Jeanette]

I had a first degree tear with my waterbirth. I swear that I had the reference for a study that said less tearing happened during waterbirth, but I can't seem to find it right away.

[loveslabor]

I have heard the same thing that neighbor notes in my midwifery classes. I will have to see if I can find a link or something for you later.

[RosyDoula]

Quote:

Originally Posted by truelife RosyDoula- If counterpressure or the mom holding herself works -why wouldn't a midwife applying counterpressure help?

Good question. Be prepared for a long answer.

Over and over, the hands-off technique has shown to have lower incidences of tears and abrasions. I've heard many midwives report: “The longer I practice midwifery, the less I do to (or for) the perineum, and the lower my laceration rates get.”

Think about it: if nature had intended hands to routinely guide the baby out, women would be born with an extra pair attached to their inner thighs, right?

Every woman has different tissue and skin integrity. This is evidenced by the color of our skin, the amount of stretch marks we find on our bodies, and our nutrition. Supplements like Vitamin C and omega fatty acids will help assist this integrity, but it's unknown if it can make a huge difference.

I've been following discussions of many UC friendly and hands-off midwives and most agree that there is literally very, very little midwives can do to prevent tears. However, they CAN create more trauma to the area by applying pressure to the head and tissues as the baby crowns. By exerting pressure in one area, surely another area is going to be stressed? I, and they, think it's best to keep their hands off and allow the body to do what is natural. All the warm olive oil, perineal stretching and pulling and hand positions cannot really prevent tears.

There is the fact that any support is basically uneven. There are always pressure points at finger tips, the fat pads where your fingers meet your palm and at the base of the thumb. The perineum slowly streches and is taunt so the presence of the "support" actually creates a weak point and a subsequent tear either starts at the pressure point or a tear occurs between two points of contact.

I know that it makes me tense up when someone's hands (and eyes) are down there that are not mine or my lover's, and I believe most women feel the same way. It's just common sense that cervical checks, perineal massage, and tissue support would prevent us from relaxing fully, and would distract us from paying attention to our body's cues.

One other thing to consider is that of tissue readiness. The hormones that get the tissues ready for sexual intercourse are the same ones that get them ready to birth. When the release of those hormones is interfered with (by anything in the environment that is inhibiting or distracting,) tissue trauma is more likely to occur.

Your vagina has a built-in protective mechanism. We experience it when we are getting a pelvic exam - fingers placed right outside the vagina or right inside the vagina will result in a contraction of your vaginal muscles. Women are often told, "just relax" at this point. This response to such touch is NORMAL and POSITIVE.

We may love our midwife or doctor that is performing the exam. They may be a classmate, friend, or trusted provider. It doesn't matter - their fingers are not your fingers. They are not the fingers of your lover. Your body is so wise that it will offer some resistance for touch that is not sensual and/or our own.

What happens when midwives put their fingers inside the vagina as the baby is trying to emerge? Isn't it hard for women to concentrate on pushing something OUT of their bodies when we're putting things IN? Are they helping women by dragging down on the perineum? By "pushing" tissue away as the head descends? Is the woman's vagina instinctively trying to protect her during all this? How does it feel to the mother?

When women place their own hands on their vagina, they explore. They touch all the folds, gently inserting a finger inside to see if they can feel that hard little head that they're working on bringing down. With every push, they can experience the "one step forward, two steps back" motion as the baby comes down. Many women are physically unable to feel the baby's head inside until it really comes down. Still, when it's getting ready to emerge under the pubic bone, women will instinctively put their hands down there, feeling as if the head is "right there".

(Fathers hands on the baby as it is emerging is far less invasive to women...they do not need to know anything except not to push or pull on the baby - just wait for the baby to slip into their hands. The same could be said for midwives, as well! The pulling up on the head, the pushing down as the body emerges - all not necessary in normal birth.)

With the crowning, keeping the mother's hands on herself is important. She will gently push around her perineal tissues, knowing how much is too much pressure, feeling how each of her pushes brings her baby closer to her arms. She may apply counterpressure up by her clitoris - usually with counterpressure at the occiput.

If the mother is standing, she will be leaning more forward, typically. If she is on hands and knees, she will want to rise to being upright on her knees. This alignment of her body with the baby's body is amazing to watch and oftentimes will occur with the birth of the head.

Quote:

Originally Posted by truelife I do believe that waterbirths help with not tearing, but there are so many variables with childbirth that it's hard to say what *really* worked and what didn't to avoid that tear. Am I off in this thinking?

Not at all. I totally agree.

[truelife]

That is a lot to really think about! I had never thought about it that way and will have to talk to my MW/mentor about this. It does make total sense and seems that it is the way that it should be. THANK YOU!

[NewMoonDoula]

Good question, great answers!
The philosophy makes sense to me, but I don't know about preventing almost 100% of tears, not sure where that figure comes from?
I attended my first waterbirth last weekend, babe was 9.5lbs and mama tore a little bit. Also, the mess was far less than I had expected even though this babe was really covered in vernix. She also got out to birth the placenta. It was a great experience, and I will definately be considering a waterbirth for my next time around....

[Jeanette]

I found it. It actually says that perineal tears are no different between water and land births.

Bodner, et al. 2002. Effects of water birth on maternal and neonatal outcomes. The middle european journal of medicine. 114: 391–395.

This abstract says that 3rd and 4th degree tears are less likely with waterbirth, but first and second degree tears are more likely with it. Unfortunately I can't find the full article for free.
Geissbuehler V., Stein S., and Eberhard J. 2004. Waterbirths compared with landbirths: an observational study of nine years. Journal of Perinatal Medicine. 32: 308-314.

I found another one too but the abstract doesn't specify how the tearing is different between waterbirth and land birth, it just says that they are different.

[b'earth angel]

Quote:

Originally Posted by truelife Yes, while I was doing my midwifery training I was told that a waterbirth does help prevent tearing for a few different reasons. One is that the warmth helps the tissues soften and make them more stretchable. The second reason follows along the same lines of counterpressure being a source of pain relief - the water puts even pressure on the perineam and helps "support" the head as it crowns. The third reason a woman is less likely to tear is b/c the water is known to calm and be more gentle which leads to a more gentle birth and slower, gentle pushes. There was a study done in the late 80's/early 90's that showed that women who labored in water were less likely to tear. Out of the 3 waterbirths I have been to none have been a "blood bath." When I saw my tub the next morning it looked like murky water, but I got out before I delivered the placenta.

I just have anecdotal evidence from my own experience. My first birth, hospital, leaning back, forced purple face pushing resulted in a severe 2* tear, nearly a 3*. Lidocaine, 12 stitches and the hives afterward. Very bad!
My 2nd birth was @home in the water. With a anterior lip the midwife held back, no directed pushing, relaxed atmosphere, and bigger baby, I only had a 'skid mark'. No problems healing. I was in the pool, on hands and knees leaning on the side of the pool for delivering.
I know that the water helped to relax me, emotionaly and physically. I also know that being at home was a big help.
I wouldn't want this woman to think that just because she is in water she will not tear, however, I believe her chances of tearing are reduced by being home, relaxed, in the water, etc.
Also, my water wasn't yucky. It was barely tinted and I did stay in to deliver the placenta. That's when the water changed color for me. During the birth it stayed clear. Didn't bother my dd, she jumped right in to be near momma! One of those precious moments for me!

[MindOverLaborDoulas]

Great answers and I'm glad that there is some research out there, but as with most things I feel that experience means just as much.

Quote:

Originally Posted by RosyDoula Think about it: if nature had intended hands to routinely guide the baby out, women would be born with an extra pair attached to their inner thighs, right?

This made me pee a little!!!

[RosyDoula]

Quote:

Originally Posted by b'earth angel I wouldn't want this woman to think that just because she is in water she will not tear, however, I believe her chances of tearing are reduced by being home, relaxed, in the water, etc.

I think we all agree.