Background: Studies have shown increased incidence of severe vaginal lacerations (third and fourth degree) in women under the influence of epidural analgesia. This increase has been attributed to the increased the use of operative vaginal delivery (OVD), with attendant increased risk of laceration.
It may increase your risk for a perineal tear
Research shows that perineal tears are more common in women who have epidurals. Other factors that increase your risk for perineal tear include: baby with heavier birth weight.
Answer From Yvonne Butler Tobah, M.D. Vaginal tears during childbirth, also called perineal lacerations or tears, occur when the baby's head is coming through the vaginal opening and it is either too large for the vagina to stretch around or it is a normal size but the vagina doesn't stretch easily.
Births with epidural analgesia had a higher rate of primiparity, augmentation of labour, instrumental delivery and episiotomy. They concluded that epidural analgesia was not related with severe perineal tears once confounding variables were controlled.
4) How can I prevent tearing? (
A great way to allow your vaginal tissues and perineum to stretch when possible is to “labor down”. Laboring down is resting once your cervix dilates to ten centimeters.
The most recent analysis (Pergialiotis 2014) combined the data from 22 studies with a total of 651,934 subjects. Its conclusion was that those with epidural anesthesia had a 1.95 times greater risk of perineal tearing than those who did not.
Due to the amount of pressure caused by your baby's head on your perineum, it is unlikely that you will feel any tearing. But everyone's birth is different and some women may find that they feel a lot of stinging, especially as the head is crowning (when your baby's head can be seen coming out of the birth canal).
Bogod suggests another reason for women being denied epidurals. “There's reasonable, anecdotal evidence that some midwives will use the excuse that an anaesthetist isn't available if they themselves feel an epidural isn't appropriate for the woman based on their own beliefs around intervention-free births,” he says.
The episiotomy tradition
Experts believed an incision would heal better than a natural tear. The procedure was also thought to help preserve the muscles and connective tissue that support the pelvic floor. Today, however, research suggests that routine episiotomies don't prevent these problems after all.
The No. 1 reason the procedure has fallen out of favor is that it actually contributes to worse tearing than might occur naturally during childbirth. As many as 79 percent of women who deliver vaginally will experience some vaginal tearing during childbirth.
Birthing in the side-lying position has been shown to reduce perineal tearing by allowing the presenting part to descend more slowly (Shorten, Donsante, & Shorten, 2002).
Choose Your Position
You can still push in all sorts of positions even with an epidural! At a minimum, you can push on your side or with support under your back to still make space for the sacrum. If you can move, you can even try all fours or kneeling, using the back of the bed as support!
Yes. About 9 out of every 10 women tear during their first vaginal birth. It's less common for women to tear in subsequent deliveries, but it still happens. Some tears are almost like scratches that heal on their own.
Background. Perineal tears affect about 80% of women during childbirth, with primiparous women being affected more frequently than multiparous women [1, 2].
It is common for the perineum to tear to some extent during childbirth. Tears can also occur inside the vagina or other parts of the vulva, including the labia. Up to 9 in every 10 first time mothers who have a vaginal birth will experience some sort of tear, graze or episiotomy.
Second-degree tear: This second level of this injury is actually the most commonly seen tear during childbirth. The tear is slightly bigger here, extending deeper through the skin into the muscular tissue of the vagina and perineum.
Permanent nerve damage
In rare cases, an epidural can lead to permanent loss of feeling or movement in, for example, 1 or both legs. The causes are: direct damage to the spinal cord from the epidural needle or catheter. infection deep in the epidural area or near the spinal cord.
While it's very rare, having an epidural procedure can lead to some long-term complications, including: Permanent neurologic deficit due to spinal cord or nerve root damage from the epidural injection. Chronic pain due to due to spinal cord or nerve root damage from the epidural injection.
Epidurals Can Slow Labor Down…
The reason is that once you receive the numbing medication, you are confined to bed until after the baby is born and the anesthesia has worn off so you can walk again. The disadvantage to this confinement is the lack of movement and gravity to aid in labor.
Hospitals and doctors have their own individual policies for epidurals. In most cases, however, an epidural will not be given until the mother is at least 3-4 centimeters dilated. Once the mother is fully dilated most doctors and hospitals will consider it too late for an epidural to be given.
The biggest benefit of an epidural is undoubtedly pain relief during labor and through delivery. After the 10 to 20 minutes needed for an epidural to take effect, many individuals find that an epidural provides them with an easier, less stressful birth experience.
Occasionally there are circumstances where women can't get an epidural. Occasionally we see this in women who have a low platelet count. Additionally, women who are taking blood thinners (such as heparin) to prevent a blood clot during pregnancy should not receive an epidural within 12 hours of taking that medication.
Your healthcare professional can gently place a warm compress (pad, swab or gauze) on the perineum as the baby's head stretches the perineal tissues. This can help to reduce the severity of tearing.
The “husband stitch” refers to an extra stitch that some women may have received after vaginal delivery led to their perineum becoming cut or torn. This stitch extends beyond what is necessary to repair a natural tear during childbirth or a cut from an episiotomy.