question on water births and perineal support

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Joined: 09/29/09
Posts: 1346
question on water births and perineal support

I'm very much considering a water birth for my second baby. With my first (a land birth lol), my midwife was great and did lots of lube and stretching for me and perineal support. I had a few small tears and one that needed some stitching. I don't want to know what would have happened if she had not done been there to help ease the baby out.

When you have a water birth, is it not possible to offer perineal support? I'm not sure how a midwife would be able to get herself into a position where she could assist like that. I'm wondering if the water takes away the need for perineal support?

and one other question. Does a water birth do anything for the ring of fire pain from crowning?

please feel free to sing any water birth praises you have, I'd love to hear them!

Joined: 01/18/06
Posts: 1626

Both my girls are waterbabies. Smile DD1 was born with me in a squat and DD2 was born with me on all fours. Both times my midwife and I did the perineal support. I had a few skid marks with the first birth and nothing at all for my second. A good midwife will still be with you and will get herself as wet as she has to to help you along.

There are no real studies on whether or not water helps prevent tearing. There are theories that go both ways. Water may help to soften the skin to prevent tearing. Too much water may waterlog the skin and make it more susceptible to tearing. I'm more inclined to believe the first. I have never heard of stories of bad tearing in waterbirth. I think a lot of that has to do with the fact that in the water a mom wont be pushing in lithotomy position and she will be directing herself for the most part. I believe this has more to do with protecting the perineum than anything else.

I loved my waterbirths. Not necessarily for the actual birth in the water, but for the labour in the water. It did make such a difference being weightless. I coped much better. Plus, I felt it gave me a bit of extra privacy. Also, I liked that the 'mess' was contained better, lol.

Both babies were born with 8/9 APGAR's (though waterbirth international has their own set of APGAR's that they are trying to popularize specifically for waterbirth babies, which I love!).

You should definitely look into the option Carolyn! Also, remember that you are a second time mum now. The likelihood of you tearing as bad or even at all is lower now that you have 'paved the way' so to speak.

Joined: 01/18/06
Posts: 1626

Ah, forgot to answer your ring of fire question. I felt it anyway. But I don't have any 'dry' births to compare it to.

Here's a few pics of the support I got from my births.

This was Fiona's birth. I have my hand on my perineum here and so does my midwife:

Here's Violet's birth. My midwife had her hand on my perineum here. My hubby was able to catch both babies (a side note, I love the look on my sister's face here, lol):

Joined: 11/29/06
Posts: 1316


I love these pics! They always get me all teary!

mommys's picture
Joined: 05/08/06
Posts: 6264

I've spoken to both of my midwives about this. I labored in water last time, but birthed dry. I had no perineal support at all last time and tore a decent amount, so it is a "concern" of mine.

One of the midwives did say that they can definately do a lot more perineal support if I choose to birth outside of the water. She said the benefits for that may outweigh having a water birth if I want to avoid lots of tearing. My midwives use a warm ginger compress to help relax the area, but this can't be done in the water. They just have better access outside of the water.

My other midwife did say that she believes the warm water of a water birth does help, but again they just can't support quite as well.

It might help to note that I'll be at a birth center and it is a jucuzzi type tub with relatively high walls. I've seen that they have built a stool/ladder to help the midwives have better access, but it is still not quite the same as the softer, lower home birthing pools.

cactuswren's picture
Joined: 10/19/09
Posts: 4658

I think water birth is awesome, and a godsend for a lot of people...that said, I planned a water birth, but ended up moving to the bed DURING crowning, mainly because I wasn't progressing in the water. I had been pushing hard for over two hours and she was just not moving. My midwife said "You know, if you move to the bed I bet we'll have her out in the next five or six pushes" and she was right. I was also REALLY REALLY HOT. Of course, I was giving birth on a July afternoon in the desert SW, so with a winter due date, you may not have that problem. (But know that they have to keep the water at or above body temp to prevent the baby from breathing until they're out of it) I ended up with a first degree tear "with a little plus" that involved a bit of stitching. To be honest I have absolutely no idea what my midwife did or didn't do down there while I was pushing...all of my focus was on the actual contractions and I barely even noticed the ring of fire thing...just enough to think "Oh! That's what they mean!" but it wasn't a big deal for me.

My best advice as regards water is to be flexible. Give yourself the option, because if it works for you it can be truly wonderful, but make sure your birth plan (and mindset!) allows you do what you need in the moment, and if that is to get out of the water, then don't feel bad about it. Water is a tool, and there is no right way to give birth. GL!!

TiggersMommy's picture
Joined: 02/14/10
Posts: 6043

I think whether or not your MW can provide perineal depends on the tub you use and your position. For instance, the tub I birthed DD in was a corner jacuzzi tub. It's fairly big but sort of kidney bean shaped. If I'd been facing toward the center of the room my MW would have had to have been on top of me to provide support. However, I was aimed right at her with my back against the back wall of the tub so she was able to get all up in there. If you're in a big round tub in the middle of the room like Jordan was, the MW should be able to help out from pretty much any angle. I spent most of my labor on my hands and knees with my butt facing the corner. My MW probably could have figured something out to provide support (I'm sure she has in the past) but I wound up flipping over because she said I'd have to do some acrobatics with the baby before bringing her up out of the water if I gave birth in the position I was in. She ensured me that it would be perfectly fine to do so but in the moment I decided I didn't want to have to mess with doing that.

Like Leigh, I honestly have no idea what my MW was doing down there. For all I know she was on the other side of the room. (She wasn't. She's awesome. I was just that focused) I do remember the "ring of fire" but I was in birthy la-la land so it wasn't a big thing.

I tore and required a few stitches, nothing too bad. I can't really say if the water or my MW helped to reduce how much I tore. I had been laboring in the water for about 4 hours (I think, gosh it's all a blurr). So, perhaps the warm water helped. Whether it did or not I'm still a HUGE advocate of water birth. It wasn't the birth really but the laboring in the tub. The warm water was heavenly and helped me SOOOOO much to relax. I did get too hot at one point but my MW kept a steady stream of icy towels coming and DH fanned my face.

I loved my water birth and I plan to do it again. Flexibility is absolutely important. Even though I had a great experience with water the first time I might hate it next time. You'll figure it out when the time comes. It's best to have access to as many tools as possible so you can pick and choose what you want at the time.

boilermaker's picture
Joined: 08/21/02
Posts: 1984

I had two waterbirths-- yes you feel the ring of fire still, but my water births were really quick pushing phase (like pushed once or twice and babe was out....) but those were also my 3rd and 4th babes.

MW's can provide good support if you want it-- and position of delivery affects the possibility of tearing, too.

GL with your decision.

Starryblue702's picture
Joined: 04/06/11
Posts: 5454

I've never done a water birth, but I can comment on the tearing/perineal area. I needed an episiotomy with DS#1 and tore twice on the inside. But with DS#2 and DD everything was beautiful... no tears or cuts needed! I think that's usually just a first baby thing, as your body has never gone through that before. Once you've BTDT, your body knows what to do... so you should be fine!

Winky_the_HouseElf's picture
Joined: 02/10/02
Posts: 292

I have had four waterbirths, but my only "land" birth was with an epidural. My last three waterbirths happened with me kneeling in the tub. My mw gave perineal support with two of them. I did it myself with my last one. That was easier because I didn't have to communicate where needed more support. Smile No tearing with those three.

I think the warm water did help me relax those tissues and adopt more birth-friendly positions. I think that helped prevent tearing.