# tearing upwards??? is this common?



## LoveChild421 (Sep 10, 2004)

I have been reading and have discovered that women can tear UPWARDS! during birth??? I was wondering how common this is and exactly what is meant by this- I mean they make it sound like your clit is going to get torn off! as I am very attached to it I would like to get more info on this and how to prevent it.


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## AllyRae (Dec 10, 2003)

OWWWWWWWWWWWWWWIE. Ok, I don't know the answer to your question, but I just had a mental picture of that and my whole lower region started hurting. That sounds...um....really painful. Especially if you have to pee....


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## LoveChild421 (Sep 10, 2004)

that's what I read- someone posted on mothering a while back that her friend tore upward and she was practically screaming when she peed! I had never heard of it before then- now I am worrying- I thought you could only tear downward


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## pamamidwife (May 7, 2003)

There is a higher risk of tearing upwards if you're on hands and knees, but the biggest risk is when the provider places his/her hands on your perineum - thereby creating some resistance that forces the baby's head to go up more and creating more strain on the upper urethral/clitoral area.

The best way to prevent this is to birth in water, push only when you need to, listen to your body when you feel the ring of fire, support your own tissues - nobody else's hands down there, and stay well hydrated in labor.


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## LoveChild421 (Sep 10, 2004)

thank you so much pamamidwife!!! you are so knowledgeable! I think you responded to another one of my questions recently! you give the best advice! I wish you were here in GA so that you could be my midwife!

I am actually planning a waterbirth with slow instinctual pushing so hopefully everything will go well!


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## 2+twins (Apr 20, 2004)

I felt like I was tearing upwards during my last birth. It was a waterbirth but it happened extremely fast (90 min start to finish). I think that had something to do with it. I was in the water when I felt the usual burning sensation, but this time I distinctly felt as though I was going to rip straight upwards and it was a really frightening sensation. I didn't force the pushing or anything like that. I just let it happened as it happened, with gentle support by my own hands. I did end up with 2 tears on my labia which did not require stitches but did hurt quit a bit when I peed. I also tore - very slightly but enough for 1 stitch - in the usual spot.


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## Breathless Wonder (Jan 25, 2004)

Pam- that is really interesting to know. I tore upwards during one of my births, and it explains why.


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## laurata (Feb 6, 2002)

I felt like my clit was going to tear at my last birth. I did have a tiny labial tear, and it did burn a bit for a few days, but it wasn't bad at all. I just made sure to always fill up a peri bottle with warm water before peeing. I think within 3 or 4 days it felt pretty normal. MUCH easier recovery than my episiotomy/tear combo when I birthed my first baby.


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## Stacymom (Jul 7, 2002)

Okay, not to scare you or anything, but...

I tore terribly with my second dd. My labor was extremely fast, and it ended up being an unplanned, unassisted birth. Not only did I have a 3rd degree tear down, but I also tore straight up, through both my urethra and clit.







It was a complete mess- the Dr told me later that the paramedics said it looked like I had sat on a hand grenade.







I spent two days in the hospital afterwards (we were planning a hospital birth) hooked up to a catheter because they weren't sure I was going to be able to pee on my own. They almost sent me home with one, but I proved to them I could pee. Interestingly enough, though, I had an episiotomy with my first birth, and healing from that and healing from that moster tear took about the same amount of time with the same amount of pain. Being stitched up was a horrible experience though.














: Oh but the important thing is, my clit still works.







(I was worried too!)

Next time, I will be doing absolutely everything in my power to give birth over an intact perineum!


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## chow46 (Aug 21, 2004)

Pam, maybe you could answer this for me. How is it some women never tear? I have never torn, I didn't even feel the ring of fire the last time (and he was a good 8 lbs-my biggest). I didn't knowledgeably do anything special to help it out. I'm not a kegal meister or anything. what are some good ways to prevent tears?

ETA: Okay, thinking about it, I did a lot of squatting with last pregnancy a la Bradley Method. But I thought that just stretched out your inner thighs.


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## Breathless Wonder (Jan 25, 2004)

I have heard that for some women, it is having an excellent diet, full of vitamins that encourage healthy skin, and for some women, it is just the luck of the draw, the same way stretch marks are. Some women have skin that stretches well, and some don't.

Don't know if that sentence makes any sense.


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## broodymama (May 3, 2004)

I had 3 tears with DS, one of them was upward almost into the urethra. Ouch! Things were quite painful for the first little bit, but by 3 weeks pp everything was healed and fully functional.


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## nikirj (Oct 1, 2002)

Quote:


Originally Posted by *Breathless Wonder*
...it is just the luck of the draw, the same way stretch marks are. Some women have skin that stretches well, and some don't.

ACK! So you're saying that by that theory, because my stretch marks are AWFUL, I'll tear too? (It's true so far, tore with both my births so far.)


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## pamamidwife (May 7, 2003)

BW is totally right. Women who have more stretch marks (or get them easily) are more prone to tearing during birth.

I think the important thing to remember is nearly all tears are slight and not a horrible thing. There is a great article from a midwife I love that talks about why we are so focused on trying to prevent tears (most of which, I believe, often interrupts the natural process of our bodies and could encourage more tears): http://www.withwoman.co.uk/contents/info/tears.html


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## pamamidwife (May 7, 2003)

Quote:


Originally Posted by *LoveChild421*
thank you so much pamamidwife!!! you are so knowledgeable! I think you responded to another one of my questions recently! you give the best advice! I wish you were here in GA so that you could be my midwife!

I am actually planning a waterbirth with slow instinctual pushing so hopefully everything will go well!









Thank you for the major love. I'm feeling like a grinch because I'm spending too much time in War & Politics.


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## AnnMarie (May 21, 2002)

I don't know how common it is, but it happened to me with my second child. OMG that hurt like hell. I can still feel the scar from it.


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## nikirj (Oct 1, 2002)

Thanks Pam, at least I know there's some reasoning behind it now. I had pretty gentle-for-hospital births both times (no 'cheering section' style pushing), but the first time the tearing was horrible, 3rd degree and it took months to feel normal. The second time my I had a couple smaller tears that healed so fast I hardly noticed them, and I think that this is how it is 'supposed' to be, for me anyway (my mom had tears of this nature with all four of her births, and has similarly severe stretch marks, so now I'm wondering, I'd always thought genetics had little to do with tearing...).

And, I was wondering...how common is it for tearing to occur not with the head, but with the shoulders?


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## Lula's Mom (Oct 29, 2003)

I've heard the stretch mark theory too, and I think it's probably true most of the time. Not in my case of course...







I'm fairly stretch-mark free, but I did tear upwards a little bit with Lula. Actually, it's hard for me to understand quite how one tears where I did, on one of my inner labia, like love_homebirthing. I mean, how does that happen?







: If anything you'd think you would tear at the actual vaginal orifice, not way up above it. I was sitting when she was born; this next time I'm going to try hard to be squatting or on hands and knees. Maybe that will help.

My midwife did not notice my tear, but I sure did when I peed later on!







She gave me a stitch the next day when she came out to check on us, but it didn't hold and I ended up with a permanent split. Oh well. Just a little souvenir, I guess.


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## LoveChild421 (Sep 10, 2004)

I've heard the theory about stretch marks and tearing- it seems logical enough- my mom has a few stretch marks and had an episiotomy with me and then tore some more (thank god i'm not giving birth in the 80's totally uninformed like my mom was). She had no tearing with my sister (and she came FAST like labor started they got in the car drove 5 min to the hospital and barely made it onto a bed before she "popped" out- literally.

I wonder though- can you take after your Dad more when it comes to your skin? My mom and I seem to have very different skin- even the pigmentation is different (you can definately see the Cherokee in her and not in me).

For those of you who do have stretch marks- I was just curious- when did they first start appearing? What is your skin like- oily, dry? thin, thick? I guess I am just hoping that since my skin is thick and oily I won't get stretch marks


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## 2+twins (Apr 20, 2004)

Quote:


Originally Posted by *Lula's Mom*
I've heard the stretch mark theory too, and I think it's probably true most of the time. Not in my case of course...







I'm fairly stretch-mark free, but I did tear upwards a little bit with Lula. Actually, it's hard for me to understand quite how one tears where I did, on one of my inner labia, like love_homebirthing. I mean, how does that happen?







: If anything you'd think you would tear at the actual vaginal orifice, not way up above it. I was sitting when she was born; this next time I'm going to try hard to be squatting or on hands and knees. Maybe that will help.

My midwife did not notice my tear, but I sure did when I peed later on!







She gave me a stitch the next day when she came out to check on us, but it didn't hold and I ended up with a permanent split. Oh well. Just a little souvenir, I guess.


My midwife didn't notice mine either! I thought it was odd that the burning sensation I felt when peeing was on the side rather than at the bottom where I knew I had torn. I eventually got out a mirror and checked and there were 2 red lines on the labia. Not being all that familiar with that part of my body, I asked dh if that was normal for me. He had no clue.







When I went for my 6 week pp check I mentioned it. I was scared to death to though cuz I was afraid they'd want to stitch it. She said it would heal fine on it's own though and it seems to have, but I think there may still be 2 visible lines from it.


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## homebirthing (Nov 10, 2002)

I think that the upper tearing could be from shoulders.


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## chow46 (Aug 21, 2004)

Quote:


Originally Posted by *love_homebirthing*
Not being all that familiar with that part of my body, I asked dh if that was normal for me. He had no clue.







.

This boggles me. I asked my dh something after my first and he had no idea if it was normal or not. I mean, seems to me like he should be the one that knows that part of your body better than others! :LOL


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## wasabi (Oct 12, 2004)

Quote:


Originally Posted by *pamamidwife*
There is a higher risk of tearing upwards if you're on hands and knees, but the biggest risk is when the provider places his/her hands on your perineum - thereby creating some resistance that forces the baby's head to go up more and creating more strain on the upper urethral/clitoral area.

That certainly explains why when the oncall midwife kept putting pressure on my perineum I kept feeling like I was tearing upwards. She kept saying I wasn't and that she was pushing underneath but all the pressure was upwards.







:

RE Stretchmarks and tearing I know there was an actual study on that recently that found a high correlation. I have to say though I wonder about the perception that a woman with stretchmarks is more likely to tear/"need an epis" affecting the treatment we receive and becoming a self-fulfilling prophesy.


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## doctorjen (May 29, 2003)

I also see more upward tearing in a rapid birth. The posterior part of the vaginal opening has a lot of give and stretches very nicely, but the labia don't stretch as well. If baby has a nice round head the labia can be stretched quite widely and tears are common then. I also think I see more upwards tearing when mom is sitting or semi-squatting since pressure from below encourages the baby's head to extend as it delivers.
Most of these tears are really small, though. I tell moms that the bad news is that these tears hurt like crazy in the first few days, but because they are usually just skin, they heal quickly and rarely cause any kind of permanent problem, unlike episiotomies or large tears through the muscles of the vagina and perineum.


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## broodymama (May 3, 2004)

Quote:


Originally Posted by *LoveChild421*
For those of you who do have stretch marks- I was just curious- when did they first start appearing? What is your skin like- oily, dry? thin, thick? I guess I am just hoping that since my skin is thick and oily I won't get stretch marks 

I have oily skin too. My stretchmarks didn't appear until 38 weeks (just long enough for me to think I escaped them), then I delivered at 39 weeks.


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## broodymama (May 3, 2004)

Quote:


Originally Posted by *doctorjen*
Most of these tears are really small, though. I tell moms that the bad news is that these tears hurt like crazy in the first few days, but because they are usually just skin, they heal quickly and rarely cause any kind of permanent problem, unlike episiotomies or large tears through the muscles of the vagina and perineum.

That was the case with me. My stepmom and aunt were asking why thet didn't do an epis, they didn't understand why I didn't get one.


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## chow46 (Aug 21, 2004)

I guess I'll chalk mine up to luck. I have so many stretch marks, I look like a watermelon. With my first ds, I didn't use an OB, I used a family dr who was training as a midwife before she decided to become an md. She took a step-back approach and reassured me my body knew what it was doing. She did have to step in, my son had his left arm wrapped up behind his neck with his fist resting next to his right ear! I had been pushing and he was acting like he might be "hung up" or something, then she saw a little fist!!! Through all of that, all I had were a few skid marks, and his cone head was hard to see, was pretty much gone in 24 hrs. Second son the birth was so wonderful and easy, people asked me if I had a c-section. My mother thinks some women just birth easier?


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## Ms. Frizzle (Jan 9, 2004)

Quote:


Originally Posted by *nikirj*
ACK! So you're saying that by that theory, because my stretch marks are AWFUL, I'll tear too? (It's true so far, tore with both my births so far.)

Just want you to know that I have no streach marks, and I tore with both my kids.


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## USAmma (Nov 29, 2001)

Quote:


Originally Posted by *nikirj*
ACK! So you're saying that by that theory, because my stretch marks are AWFUL, I'll tear too? (It's true so far, tore with both my births so far.)

I have terrible, awful stretch marks. Looks like a spider web across my whole belly. However I didn't tear significantly with either birth. My first birth I would not have torn but Abi's hb almost stopped so they cut me at the very last minute after her head was already crowned, so they could pull her out. Turned out she was fine.









Second birth I said no cutting at all. Nitara was born in just 3 pushes and just a tiny tear to one side because her head was off-center coming out. It didn't need stitches and was healed within 2 weeks.

So while there may be some connection to stretch marks and tearing, it isn't 100%.

BTW I did do the massaging down there with the EPO. I used to massage and stretch gently just to the point where I could start to feel burning, hold it there, then release. I did that daily for about 3 weeks until the birth. Maybe it helped, maybe it didn't.

Darshani


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## watermamma (Dec 29, 2003)

I have major stretchmarks, the worst that I have seen in real life (just comparing to friends, etc.). My mom has not one, but had a major episiotomy with my birth.

I tore badly 1st birth (3rd degree), however, I was also on my back w/epidural and coached pushing, big baby w/a big head.

2nd Birth was all natural waterbirth. I really expected to have a 1st or lesser tear, but ended up w/a pretty bad 2nd degree that required transport to surgeon for suturing. However, baby came FAST, with a hand at her head and sticky shoulders that came out together. Oh, and big head, no head molding, baby was 10lb3oz.

That said, it is really uncommon to tear as I did outside of a hospital. My midwives have a 6% suture rate (6%!!!!). And I healed nicely from both births, no long term issues, back to normal within 6 months, pain gone by 2 months pp. I think this is because I tore and was not "cut". Funny thing, the 2nd degree hurt more than the 3rd, probably becuase of the stress of transport to hospital (which is where I did NOT want to be).

I really hate to even tell people about my tearing, it seems to scare them. I don't want people thinking it is "common" for that to happen, it just happended to happen to me. And it always sounds so much worse than it is, at least to me. I think a "cut" would be alot different, and I would not be able to feel ok about it, I consider it such an enormous violation. But tearing naturally _I_ _can_ deal with.


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## Oregonicmama (Aug 13, 2002)

I tore up with DD. It almost reached my clit, but fortunately went off to the side a bit and missed the important stuff! It hurt like hell when I peed for a few days, but the peri bottle diffinitely helped with that. It healed up fine (with no stitches) and my midwife says it shouldn't be a problem for this birth.

I have very little stretch marks though. But I did have pressure on my perinium, which probably pushed the baby up and caused the upward tear. She was also posterior, and I have been told that may have contributed to it.


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## mandib50 (Oct 26, 2004)

my girlfriend tore upwards on her labia close to her clit with her last baby, i have to say it looked quite painful! she was in the water and her midwife didn't have her hands on her perineum at all. i know with her second baby she tore too, but not upwards.

with mine, i had no stretch marks (thank you lord!) with my 2nd baby, i had a second degree tear, but i pushed for 4 hrs so i was pretty darned numb on my whole perineal area. my 3rd and 4th babies were almost a pound heavier but like my midwife said, i could have sex that same night if i wanted







i chose to skip that option







interestingly, i had the same midwife for all 3 births, she didn't do anything different, and i think that i ate probably the best with my second baby, and i was side lying. 3rd baby i was hands and knees because of sticky shoulders, 4th baby i was squatting. interesting topic anyway.

mandi


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## mwherbs (Oct 24, 2004)

things that can help prevent tearing -- making sure you don't have an infection, yeast, BV, mycoplasma, if you treat infection try to re-colonize with lactobacillus.
dietary support for connective tissue which would be foods high in bioflavinoids like dark colored berries, food with live culture lactobacillus.
Birth in water, if it is comfortable.
Try to be really be conscious while pushing, slow down, try not to push to a 10 count or be cheered on, feel what you are feeling if it burns let the baby rock back and forth like it does, don't be impatient. you can feel slack in areas and tightness in others move the slack around, do not be inhibited in where your hands have to go to protect yourself.
i have 4 kids- 10lbs 5 oz, 10lbs 11 oz, 9 lbs, 12 lbs
with the first 2 I had episiotomies with extended tears and bad sewing jobs with the 9# baby she was born at home and I had small amount of tearing, none upward although she was born semi-hands and knees I was a bit inpatient and wanted to just get it over with , with the 12# baby I decided not to tear no matter what and i didn't, born in a full squat not a bit of a tear.


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## suearoo22 (May 4, 2004)

I tore upwards with my last 2 births, the first they inserted a catheter after just in case I could not urinate. The 2nd time no catheter, it was not too painful a little sore I think the stitches were more annoying then anything. It took a while after the first time to be able to reach the big O after but thankfully everything is back in working order.


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## nonnymoose (Mar 12, 2004)

I tore upwards, too, except mine tore in a "V" (up both sides) and missed all the important stuff







As far as I can tell, it was solely a labial tear - there was no vaginal/urethral involvement whatsoever. I was busy at the time, but I'm told the doctor framed the exit with his hands, so that may have contributed. I was telling him that it was getting awfully tight up top and he told me to push anyway. The stitching was the worst part of the whole experience...there's nothing quite like getting poked in the clitoris with a needle







I threatened to kick him in the head if he kept doing it, so I guess we're even.
I got one teeny stretch mark (son born @ 38wks, 8lb 1oz) and I was semireclined knees-to-chest during the birth. They put a catheter in, which was fine with me because I wasn't real clear on where I'd torn and didn't want to swell up and not be able to pee. They pulled it the next morning. My peri bottle was my best friend for a week or so, then everything was fine. I actually think the tears made everything more sensitive for a long time, though it's starting to get back to normal now.


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## loraxc (Aug 14, 2003)

I pushed semireclined and on all fours and I tore upwards, badly enough that I received 4 stitches there (and 7 below). The midwife told me I had torn there and it freaked the heck outta me. It was, as someone said, excruciatingly painful for about a week, but I don't have any long-term pain at all and the parts still work!

My midwife was extremely assertive with the "cheerleading" while I was pushing--it was not at all a "push to the point of comfort" birth, but I suspect she was worried about the hospital timing us out (I pushed for 2 hours after a 32-hour labor; she was a posterior baby who turned in the last half hour.)


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## Maprilynne (Oct 22, 2004)

Quote:


Originally Posted by *nikirj*
ACK! So you're saying that by that theory, because my stretch marks are AWFUL, I'll tear too? (It's true so far, tore with both my births so far.)

Actually, I think she meant that they two are similar in that they are based on luck of the draw, not that they are necessarily connected. Just to make you feel better, I had some of the worse stretchmarks my *very* experienced midwife had ever seen and when my DD was born I had a very small internal tear and that was only because her hands were by her face and her fingers tore me a bit. So those two do not necessarily go together.
Aprilynne


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## applejuice (Oct 8, 2002)

Interesting theory, pamamidwife.

I have no stretch marks from pregnancy, and I did not tear with #1 and #2, only alittle teeny bit with #3 and #4.

I have been told that stretch marks and tearing have something to do with hormone production.


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## Doodlebugsmom (Aug 1, 2002)

Interesting thread. I tore both times on my right, inner labia. Nothing major, just two stitches each time. I had very fast labors and delivered on my hands and knees and nobody was touching my perineum at all. I have to say, it really wasn't very painful and I had no burning during urination. Also, my first was a smaller baby-6lbs. 11oz. Ds was larger-8lbs. 13oz. I had to work a little more to get him out and his shoulders were a tad sticky, but I didn't tear any more with him than I did my dd. I don't think size is always a big factor in tearing. Oh, and I have no stretch marks!


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## fiddledebi (Nov 20, 2003)

I have to thank my lucky stars that my midwife hated labels and refused to tell me what "degree" my tears were or how many stitches she put in. She said, "yes, you tore a little, but not too bad. I'll put some stitches in and it might sting a little." I think she squirted on some topical anesthetic and I didn't feel much, except really super exposed just lying there with someone's face in my vulva for half an hour.









Anyway, it was very uncomfortable, but I was OBSESSIVE about the peri bottle. I used at least a full bottle and a half of warm water every single time I peed for at least three weeks. I know I should have been more in touch with my genitals, but I just really did not care to look after my daughter's birth, so as it turned out, I found out at my 6 week checkup that one of my tears had been ABOVE my clitoris. I hadn't even known. I definitely didn't feel it. It didn't tear from my vaginal opening all the way to there -- my perineum tore (and THAT I could feel) and then there was a small tear (maybe the width of my pinky fingernail) just above my clitoris. I can see a scar there now. I will tell you again, honestly, that it absolutely did not hurt, and there have been no repurcussions.

The one on the bottom, though -- oy! I went with my gut and pushed when my midwife was yelling for me to stop pushing...that was a mistake. THAT was how I tore -- 29 hours of labor and only 40 minutes of non-stop, heavy-duty, howling-at-the-moon pushing, and even a 5lb 7oz baby like mine can split you!


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## TheMoMo (Feb 1, 2002)

I tore upwards with my first child. Labor, even back labor, had nothing on that tear. I remember screaming "my clitoris is tearing!!!" thinking that surely they'd just shove him back in there and do something about it. Alas, there was nothing to do but wait for the next cx and push, knowing I was going to tear worse. It was a pain the likes of which I hope never to feel again.

My mw tried silver nitrate to stop the bleeding (the tear itself was tiny, but pumped out a lot of blood), which stings like acid. Then she tried to stitch it, but the blood didn't stop. This was without anesthesia btw, cuz she explained that I'd either get a stitch or a shot...either way it's a needle. I should've argued the point, but I was very trusting. Friggin A, just remembering this gives me the willies. Then an OB came to the birthing center and gave me three shots of local anesthetic and stitched the tear.

The only positive was that all the trauma cause my clitoris to be numb for almost a month, so the worst of the recovery was over before feeling returned. I remember going back for my 6 week check and crying at the thought of her touching me...it was more traumatic than I'd thought.

That baby was delivered on my back...my next baby (11lb 3oz compared to the first one's 9lb 13oz) was delivered on hands and knees with no tearing whatsoever. I had told my (new) mw that I was going to be afraid to push when the time come and that she had my permission to lie to me...tell me everything's going to be okay and no way was I going to tear. In a rare moment of total insensitivity, she said instead "well if you're going to tear there's nothing we can do about it now". If I could've reached her, I would've hurt her.

Now I'm heading into my third delivery (due date is tomorrow) and the tear is very much on my mind. They're very rare, but clitoral tears definitely do happen and I wouldn't wish it on anyone. Not even that insensitive midwife.









Maureen


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## Lizzo (Jul 26, 2005)

I tore upward. It was very small, requiring only a stitch or two. I delivered on my side, the baby was 9lb 1oz and I pushed 11 minutes.
I did a lot of perineal massage prior to birth- like starting at 35 weeks and I delivered at 41.7 weeks


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## wannabe (Jul 4, 2005)

THAT is the one thing I was REALLY scared of giving birth.

(well, after something happening to the baby, of course)

I had a huge discussion with my midwife about would she be able to tell if it was going to happen, if it was could she please get the episiotomy scissors out, etc.

I'd prefer a c-section to my clitoris tearing.


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