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Tears Tears Tears

A topic most pregnant women are afraid about Evidence-Based Birth had a public webinar on how to prevent tears. The most influential factor is the provider!

In short

:-Avoiding episiotomies prevents tears.

-Being in an upright position without an epidural is overall helpful (more 2nd-degree tears, but less severe tears, also shorter pushing stage).

-With an epidural, being in an upright position doesn’t seem to be helpful, but side-lying and delayed pushing is helpful to increase the intact perineum rate

.-Warm cloth compress decreases the risk of severe tears and has a higher rate of the intact perineum rate, it also might increase comfort.

-Having Hands-On (hands of the provider are pressing on the perineum) or Hands-Off (hands of the provider are not touching the perineum) makes no difference in the risk of the severe tear. Hands-Off has a lower episiotomy rate, might have more 1st degree tears, less pain, and a higher rate of intact perineum.

-Perineum massage during (not before) by the provider. Gentle massage seems to decrease severe tears rate, a lower episiotomy, and has no benefits of the provider already has a low severe tear rate.

-A slow birth of the head and shoulders is very efficient (breathing, no breath-holding pushing).

May be an image of text that says 'Your Provider! •Who you choose as a provider is one of the strongest predictors of whether you'll have an intact perineum" Cochrane review: assignment to midwife-led care less likely to have forceps, vacuum, and episiotomy Some providers are much better at helping you prevent tears, and some make it much more likely you'll tear! ENCERAS 16:32 Bisth"'
May be an image of text that says 'Your Birth Setting! Study on planned home births: 49% intact perineum, 40.9% 1st or 2nd degree tear, 1.4% episiotomy and 1.2% had a 3rd or 4th degree tear Kopas review found overall rates of tears to be lower at birth centers (38.7% 75%) and home births (50.8%) than in hospitals, but no difference in rates of 3rd 4th tears Hospitals in the U.S. do not publicly report tear rates 18:05'
May be an image of text that says 'RebeccaDekker Risk Factors for Severe Tears Care provider Giving birth for the first-time Higher birth weight of baby Forceps or vacuum use Episiotomy Shoulder dystocia Prolonged or very short pushing phase Occiput posterior fetal position .Family history EVIDENCE BASED Birth Protecting the Perineum'
May be an image of text that says 'RebeccaDekker Birthing People's Experiences 34 quantitative and/or qualitative studies People who have severe tears are given little info and feel abandoned and "let down" Repair procedures can be traumatic Post-repair symptoms can range from minor inconvenience" to having a severe impact on sexual and social functioning ENCERASED 23:36'
May be an image of text that says 'Klein's Randomized Trial: Follow-up Compared episiotomy with no episiotomy (rather than intent-to-treat) Episiotomy associated with 22x risk of severe tear Best outcomes in those with intact perineum Physicians with high vs. low episiotomy rates- clients had a severe tear rate of 21% vs. 2% Spontaneous tears were less painful than episiotomies EVIDENCE BASED Birth® Protecting the Perineum'
May be an image of text that says 'Birthing Positions without epidurals Several meta-analyses have found that people randomly assigned to upright positions in the 2nd stage were: risk of forceps/vacuum forceps risk of episiotomy Upright positions may also: Shorten the pushing phase (~8 min), especially squatting (~16 min) risk of 2nd degree tears (sig. increased with squatting and sitting) risk of severe perineal trauma ENCERASED 32:01 Diaaatindtha_Davinam'
May be an image of text that says 'Birthing Positions with epidurals ebeccaDekker In the Walker et al. Cochrane review of 8 trials (>4,000 participants), upright positions resulted in no difference in: Use of vacuum/forceps vau/ Length of pushing phase Perineal tears requiring stitches But in one of the trials, lying on your side with delayed pushing significantly increased intact perineum (40% vs. 12%) EVIDENCE BASED Birth Protecting the Perineum'
May be an image of text that says 'RebeccaDekker Warm Compresses Magoga meta-analysis (2,103 participants; 7 RCTs) Compared warm compresses to no warm compress With warm compresses: rate of intact perineum (22.4% vs. 15.4%) risk of 3rd and 4th degree tears (1.9% vs. 5.8%) risk of episiotomy (10.4% vs. 17.1%) ENCERASED 33:49'
May be an image of text that says 'Hands-On or Hands-Off? Rebeccabekker .Meta-analysis -analysis by Huang et al. (2020) of 9 RCTs (7,112 participants) and 8 non-RCTs (37,786 participants) Results from randomized difference found: •No No difference in rate of 2nd or 3rd/4th degree tears No difference in length of pushing phase •Hands off was linked to fewer episiotomies, higher rate of intact perineum and less perineal pain, but more 1st degree tears. •Non-RCTs were similar (except 2nd degree tears with hands off) Hands off is more protective and was safe to use ENCERASED 37:55'
May be an image of text that says 'Hands-On or Hands-Off? Rebeccabekker .Meta-analysis -analysis by Huang et al. (2020) of 9 RCTs (7,112 participants) and 8 non-RCTs (37,786 participants) Results from randomized difference found: •No No difference in rate of 2nd or 3rd/4th degree tears No difference in length of pushing phase •Hands off was linked to fewer episiotomies, higher rate of intact perineum and less perineal pain, but more 1st degree tears. •Non-RCTs were similar (except 2nd degree tears with hands off) Hands off is more protective and was safe to use ENCERASED 37:55'
May be an image of text that says 'Summary: Perineal Massage in Labor •Gentle perineal massage with a water-soluble lubricant during labor may reduce risk of severe tears Leads to a lower episiotomy rate and higher intact perineum rate among those giving birth for the first time BUT has little-to-no benefit if providers already have a very low severe tear rate (1.5% or less) Pain/satisfaction has not been well studied EVIDENCE BASED Birth Protecting the Perineum'
May be an image of text that says 'The Midwives' OTHER Methods... Episiotomies rarely cut (only 10 out of 1,211 people) .80% of clients were sitting upright when giving birth Culture of favoring a slow calm, and controlled delivery of the head, slow expulsion of the baby on-Valsalva pushing while pushing) Delivering the baby s head in between contractions No need for warm compresses or perineal massage! ENCERASED 47:26'
May be an image of ‎text that says '‎What do Expert Midwives say? Interview with 21 expert midwives from NZ and reland with a no suture" rate of 40% or greater Calm, controlled birth ("nice and slow") Birthing positions (preferred hands and knees) Spontaneous pushing; don't push during crowning Split 50/50 in terms of hands on vs. hands off Importance of patience with birth of head and gentleness with the birth of the shoulders ENCERASED Bisthi 48:39 ا.‎'‎
May be an image of text that says 'RebeccaDekker Best Practices for Pregnant People Educate yourself and others about protecting the perineum during birth; be ready to advocate! Find out your provider's episiotomy rate (should be <1%), severe tear rate (ideally <2%) no suture" rate (ideally 40% or greater) Plan for a slow, gentle crowning of the fetal head; talk with your provider; put it in your birth plan! EVIDENCE BASED Birth® Protecting the Perineum'

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