I would be willing to bet a great deal of money that your friend's doctor gave her an episiotomy before she tore. That is a potential complication of episiotomies.
In case you don't know: An episiotomy is a small cut made with a knife or (more common) scissors. The cut is made at the bottom of the vagina, on the perineum. The (flawed) theory is that it prevents tearing and speeds labor and heals better. What it acually does is speeds about by just a few minutes (which sometimes *do* count, rarely), causes unnecessary pain to the mother during birth and afterwards during stiching, makes tears more likely, damages muscle and nerve, and opens another way for infection.
Have you ever tried to rip a sheet, or a towel, or some denim? It's hard, right? Until you make a small snip with some scissors... Then the fabric rips easily. Same with episiotomies. That little snip the doctor gives makes it dramatically easier for the perineum to rip dramatically, sometimes requiring reconstructive surgery.
Lots of doctors like to give episiotomies because a straight smooth cut is easier to stitch than a more ragged tear. (Many people, including me, believe that doctors also have another, subconscious, motivation. Uncomplicated birth isn't really a medical thing. It'll progress just fine without a doctor. There really isn't anything for him to do besides moniter for problems and catch the baby. Doctors are trained to doctor, so he creates a situation that needs his particular skills, medicalizing the birth. I don't think this is a deliberate thing, rather a subconscious drive inherent in medical training.)
A natural tear will just tear the skin. Yeah, it hurts like a bitch, but I'd equate the pain level with stubbing my toe or banging my shin on the table. Not a really big deal. Felt like a bruise. An episiotomy cuts through muscle, in a straight line, and torn/cut muscles hurt more and take much longer to heal than skin. The scar tissue is usually greater, and scarred muscle doesn't function as well.
In your friend's case, strong PC muscles *might* have helped. The stronger the muscles, the less likely it would tear. However, if she had an episiotomy, there might not been a whole lot she could have done to prevent the severe tear.
I'd also be willing to bet she was induced, or was given pitocin during labor to "speed things up". Pitocin makes contractions tremendously stronger, out of control strong, and it could have forced her to birth the baby before her perineum had time to stretch properly. Pitocin + episiotomy = a bad tear. And if you add something like an epidural, your body can't feel when you should chill on the pushing for a moment, which also increases your risk for a tear. Interventions during labor almost always multiply, and that can be a very bad thing. (Not always. I know women who've had very medicalized births and loved them, but those women are rare.)
To help prevent tearing during labor: Stay very well hydrated throughout your pregnancy. Hydrated tissue is stronger and stretchier. Give yourself (or have your partner do it) perineal massages, to help make your perineum stretchy. Use a midwife for your delivery. She'll do everything in her power to keep you from tearing, including supporting and massaging (with olive oil, usually) your perineum during labor. Avoid pitocin and numbing drugs if at all possible. Don't let anyone cut you, unless those few minutes could make the difference between a very bad outcome and a good one. (Situations like that are actually very very rare.) Walk around and relax your pelvic floor during labor. Gravity helps the baby to come down and stretch your perineum. Stretching is good. Tearing is bad. Getting cut is the worst.
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Sorry this is so long...
Date: 2004-07-15 08:07 am (UTC)In case you don't know: An episiotomy is a small cut made with a knife or (more common) scissors. The cut is made at the bottom of the vagina, on the perineum. The (flawed) theory is that it prevents tearing and speeds labor and heals better. What it acually does is speeds about by just a few minutes (which sometimes *do* count, rarely), causes unnecessary pain to the mother during birth and afterwards during stiching, makes tears more likely, damages muscle and nerve, and opens another way for infection.
Have you ever tried to rip a sheet, or a towel, or some denim? It's hard, right? Until you make a small snip with some scissors... Then the fabric rips easily. Same with episiotomies. That little snip the doctor gives makes it dramatically easier for the perineum to rip dramatically, sometimes requiring reconstructive surgery.
Lots of doctors like to give episiotomies because a straight smooth cut is easier to stitch than a more ragged tear. (Many people, including me, believe that doctors also have another, subconscious, motivation. Uncomplicated birth isn't really a medical thing. It'll progress just fine without a doctor. There really isn't anything for him to do besides moniter for problems and catch the baby. Doctors are trained to doctor, so he creates a situation that needs his particular skills, medicalizing the birth. I don't think this is a deliberate thing, rather a subconscious drive inherent in medical training.)
A natural tear will just tear the skin. Yeah, it hurts like a bitch, but I'd equate the pain level with stubbing my toe or banging my shin on the table. Not a really big deal. Felt like a bruise.
An episiotomy cuts through muscle, in a straight line, and torn/cut muscles hurt more and take much longer to heal than skin. The scar tissue is usually greater, and scarred muscle doesn't function as well.
In your friend's case, strong PC muscles *might* have helped. The stronger the muscles, the less likely it would tear. However, if she had an episiotomy, there might not been a whole lot she could have done to prevent the severe tear.
I'd also be willing to bet she was induced, or was given pitocin during labor to "speed things up". Pitocin makes contractions tremendously stronger, out of control strong, and it could have forced her to birth the baby before her perineum had time to stretch properly. Pitocin + episiotomy = a bad tear. And if you add something like an epidural, your body can't feel when you should chill on the pushing for a moment, which also increases your risk for a tear. Interventions during labor almost always multiply, and that can be a very bad thing. (Not always. I know women who've had very medicalized births and loved them, but those women are rare.)
To help prevent tearing during labor: Stay very well hydrated throughout your pregnancy. Hydrated tissue is stronger and stretchier. Give yourself (or have your partner do it) perineal massages, to help make your perineum stretchy. Use a midwife for your delivery. She'll do everything in her power to keep you from tearing, including supporting and massaging (with olive oil, usually) your perineum during labor. Avoid pitocin and numbing drugs if at all possible. Don't let anyone cut you, unless those few minutes could make the difference between a very bad outcome and a good one. (Situations like that are actually very very rare.) Walk around and relax your pelvic floor during labor. Gravity helps the baby to come down and stretch your perineum. Stretching is good. Tearing is bad. Getting cut is the worst.