On birth tears or; The Many Ways to Use Comfrey
As some of you know, I had a second degree tear with Fiery's birth. It didn't hurt at all, and I didn't have the whole 'ring of fire' experience, so I wouldn't have even known that I tore if I hadn't looked. After I discovered it, I was pretty freaked out, because I didn't know what I know now about healing. So I share this in hopes of empowering the lot of you to heal with confidence. Here I will be talking about only tears that can happen at a home birth. Injury that occurs in hospital birth is too severe for me to address.
Sometimes birth tears are preventable, and sometimes you can only speculate on their preventability. There are some things which we *know* can effect tearing. Some of these things are:
* Diet Poor diet can affect skin elasticity as well as tissue healing. You HAVE to eat well during pregnancy! Vitamin E (200-400 IU) supplementation and daily intake prenatally of Vitamin C (1000-2000) may help with skin elacticity, and you need to drink lots of water!
* Labor and birth position Certain positions stress the perineum in ways it is not meant to be stressed, and can make you more prone to a tear or injury. Unless you regularly squat to pee, poop, cook, and socialize, birthing in a true full squat will likely result in a bad tear. Don't get me wrong, squatting in labor is super, but not usually for birth itself. Also, laying flat on your back can be bad as well. What positions are good will vary from woman to woman, but these two are common no-no's for tearing. Many women also tear badly on birth stools when used improperly. Being upright in a supported squat, standing, kneeling, hands and knees, and bending over standing are the best positions for avoiding tears and for birth in general!
* Slowed expulsion If the baby's head is allowed to crown and slip out slowly (breathing the baby out and allowing the fetal ejection reflex to do the work) rather than hard pushing, tearing may not happen, or it may be substantially less. Of course, sometimes a mother will have an intinctual feeling that the baby needs to be born quickly, and will find it impossible to slow the baby's entrance - which is for the best in those cases. Always follow your instinct, it exists for a reason!
* Catching your own baby Catching your own baby means that you are in contact with your perineum during the baby's birth, and will be more aware of your tissues and how they are stretching than if someone else catches.
* Waterbirth/well lubricated birth Waterbirth may provide women with less propensity to tearing. I have a theory that this may be because the water can act as a barrier to intervention: most midwives do not enter the water with you, and most waterbirth moms catch their own babies. Also the water makes tissues more pliable and relaxes the mother, as well as lubricating the birth passage. Lubrication can also be found in the form of a water based (does not need to be sterlie) lubricant such as you would use for sexual intercourse, or olive oil.
* Orgasms Speaking of lubricated birth...
* No fingers in the vagina No vaginal checks, unless you are doing them yourself!
No matter what you do, sometimes you will tear. Blondes and redheads are much more likely to tear than brunettes of any nationality. If you do tear, do not freak out! It can really color your first days with your baby with unnecessary feelings of fear or sadness. Women have been tearing and healing and going on to have sex and more babies for hundreds of years, and you can too!
On to healing:
First, hopefully you are familiar with what your perineum looks like before birth. If you have no comparison, you will be less able to know the true extent of the tear.
The most important parts of the healing process happen in the first 3 days. Before I go into treatment options, let me say that the best course of action may be the simplest: Keep your legs together and stay down! Do not sit! If you must sit, sit on the side of your ass, and only briefly. If you sit to nurse, do it slightly reclined and prop yourself up with pillows. Now is a great time to master nursing while laying down! Do this for at least 5-7 days, and you will have helped your body heal tremendously. I also recommend not looking until several days have passed (if ever!). Swelling can make things look worse than they really are. So no pants, underwear, pads, lots of stairs, riding in cars, etc. Stay in and enjoy the baby!
Ice should only be used in severe cases of swelling or hematoma. Ginger tea hot packs can be very soothing, and they help stimulate circulation and promote oxygenation of the area to help with healing.
If you have bad swelling, start with cold compresses for the first 24 hours. A condom (with lubricant washed off) filled with water and frozen makes a perfectly shaped, long lasting compress. Wrap them in paper towels before freezing so they don't stick to things in your freezer. You can also make great ice packs by taking sanitary pads, cutting them in half, and dribbling them with a comfrey leaf infusion before freezing. If you want plain pads, you can use cloth menstrual pads or disposable ones, get them wet (don't soak them, this makes them hard as a brick!) and freeze them in a bowl so they have contour. These are good things to prepare before labor. After 24 hours, switch to warm compresses, as warmth facilitates healing, and cold only reduces swelling.
Fresh comfrey leaves (check ebay!) make a great healing poultice. This can be made in advance and frozen in an ice cube tray then thawed one at a time as needed. If no fresh comfrey is available, steep (not boil!) dry comfrey for an hour or more.
Comfrey root (again, ebay!) can be simmered for 40 minutes, then soak cloths in the infusion, and apply warmed (strain for root debris). It's awesome. Or, put comfrey leaves in a blender with some water and whirl for a few seconds and apply to perineum, it's like a gel.
I liked adding garlic, sea salt and uva ursi to my poultices. Just throw it in a large pot of water with the leaves and steep it (overnight is best, but for at least 30 minutes). Amounts used are a whole cup of sea salt (don't be afraid, it won't burn at all), a whole bulb of of peeled garlic whizzed in a blender, and uva ursi (1/2 cup or as much as you want). To make the poultice, get some 4x4 inch gauze pads. Spoon the mixture onto the pads and make a burrito for your underpants! Leave on the area for 25 minutes, 3-4 times a day. Apply them warm for added benefits.
You can put any of these strained infusions in a squirt bottle to rinse your perineum after using the bathroom. Keep any unused mixture in the fridge for up to three days.
Other supplementation to help healing can be in the form of daily vitamin C with bioflavinoids (500mg), vitamin A (25,000 IU), vitamin E (1200 IU), and zinc (15-25 mg). Also you can take homeopathic Arnica (30C 2x a day) to help reduce bruising and swelling and relieve trauma.
Seaweed! Using food quality seaweed from a health food store, Cut a piece of seaweed that is twice the length and width of the tear, fold in half, and moisten with water. Place it down the center of the tear and bring the edges of the tissue together, carefully aligning them. Then cover the entire length of the tear with a patch of moistened seaweed. Replace it after using the bathroom, each time. It may sting a little for a minute, but it's just the salt water in the seaweed and it will not be uncomfortable for long.
After 10 days, vitamin E from the capsule can be applied directly into the area if there is still discomfort.
Times that you may want to seek a second opinion or medical help:
Excessive bleeding from the tear site
Prolapsed uterus (when the uterus is out of the body, VERY uncommon and not life threatening)
A tear that extends into the anus (extremely uncommon in a birth where no instruments are used)
I know someone will ask, so I have to give my opinion on perineal massage. Studies are inconclusive about the effectiveness, and it is not comfortable when done 'correctly'. So I don't advise it, but it's your vag, do what makes you confident!
So, so SO much more great information can be found in these two (affordable! easy to understand!) books: Saving the Whole Woman (which makes a great case for avoiding sutures), and the Tear Prevention & Treatment Handbook from Midwifery today, full of useful treatments, tips and opinions.
When you had sex for the first time, your vagina changed, you 'popped your cherry'. Birth is similar. Your first birth or tear will 'pop your birth cherry'. Your vagina may look and feel different even after healing, but most women agree that sex after a natural birth with a tear vs. an episiotomy is better than it was before the birth! Sara Wickham put it well when she said, "Birth is a rite of passage that takes women's bodies on a journey. We become marked with the symbols of our passage into motherhood and retain the cellular memories of the experience. Whether we judge these marks as good, bad, or neutral, we hold them as women whose bodies tell the stories of our lives. To what extent does the fact that we often judge all tears to be bad affect the way that women percieve their bodies, their tears and scars?"
Food for thought!
If you have any suggestions, please add them in the comments! I will add to this post over time as I have time.
Sometimes birth tears are preventable, and sometimes you can only speculate on their preventability. There are some things which we *know* can effect tearing. Some of these things are:
* Diet Poor diet can affect skin elasticity as well as tissue healing. You HAVE to eat well during pregnancy! Vitamin E (200-400 IU) supplementation and daily intake prenatally of Vitamin C (1000-2000) may help with skin elacticity, and you need to drink lots of water!
* Labor and birth position Certain positions stress the perineum in ways it is not meant to be stressed, and can make you more prone to a tear or injury. Unless you regularly squat to pee, poop, cook, and socialize, birthing in a true full squat will likely result in a bad tear. Don't get me wrong, squatting in labor is super, but not usually for birth itself. Also, laying flat on your back can be bad as well. What positions are good will vary from woman to woman, but these two are common no-no's for tearing. Many women also tear badly on birth stools when used improperly. Being upright in a supported squat, standing, kneeling, hands and knees, and bending over standing are the best positions for avoiding tears and for birth in general!
* Slowed expulsion If the baby's head is allowed to crown and slip out slowly (breathing the baby out and allowing the fetal ejection reflex to do the work) rather than hard pushing, tearing may not happen, or it may be substantially less. Of course, sometimes a mother will have an intinctual feeling that the baby needs to be born quickly, and will find it impossible to slow the baby's entrance - which is for the best in those cases. Always follow your instinct, it exists for a reason!
* Catching your own baby Catching your own baby means that you are in contact with your perineum during the baby's birth, and will be more aware of your tissues and how they are stretching than if someone else catches.
* Waterbirth/well lubricated birth Waterbirth may provide women with less propensity to tearing. I have a theory that this may be because the water can act as a barrier to intervention: most midwives do not enter the water with you, and most waterbirth moms catch their own babies. Also the water makes tissues more pliable and relaxes the mother, as well as lubricating the birth passage. Lubrication can also be found in the form of a water based (does not need to be sterlie) lubricant such as you would use for sexual intercourse, or olive oil.
* Orgasms Speaking of lubricated birth...
* No fingers in the vagina No vaginal checks, unless you are doing them yourself!
No matter what you do, sometimes you will tear. Blondes and redheads are much more likely to tear than brunettes of any nationality. If you do tear, do not freak out! It can really color your first days with your baby with unnecessary feelings of fear or sadness. Women have been tearing and healing and going on to have sex and more babies for hundreds of years, and you can too!
On to healing:
First, hopefully you are familiar with what your perineum looks like before birth. If you have no comparison, you will be less able to know the true extent of the tear.
The most important parts of the healing process happen in the first 3 days. Before I go into treatment options, let me say that the best course of action may be the simplest: Keep your legs together and stay down! Do not sit! If you must sit, sit on the side of your ass, and only briefly. If you sit to nurse, do it slightly reclined and prop yourself up with pillows. Now is a great time to master nursing while laying down! Do this for at least 5-7 days, and you will have helped your body heal tremendously. I also recommend not looking until several days have passed (if ever!). Swelling can make things look worse than they really are. So no pants, underwear, pads, lots of stairs, riding in cars, etc. Stay in and enjoy the baby!
Ice should only be used in severe cases of swelling or hematoma. Ginger tea hot packs can be very soothing, and they help stimulate circulation and promote oxygenation of the area to help with healing.
If you have bad swelling, start with cold compresses for the first 24 hours. A condom (with lubricant washed off) filled with water and frozen makes a perfectly shaped, long lasting compress. Wrap them in paper towels before freezing so they don't stick to things in your freezer. You can also make great ice packs by taking sanitary pads, cutting them in half, and dribbling them with a comfrey leaf infusion before freezing. If you want plain pads, you can use cloth menstrual pads or disposable ones, get them wet (don't soak them, this makes them hard as a brick!) and freeze them in a bowl so they have contour. These are good things to prepare before labor. After 24 hours, switch to warm compresses, as warmth facilitates healing, and cold only reduces swelling.
Fresh comfrey leaves (check ebay!) make a great healing poultice. This can be made in advance and frozen in an ice cube tray then thawed one at a time as needed. If no fresh comfrey is available, steep (not boil!) dry comfrey for an hour or more.
Comfrey root (again, ebay!) can be simmered for 40 minutes, then soak cloths in the infusion, and apply warmed (strain for root debris). It's awesome. Or, put comfrey leaves in a blender with some water and whirl for a few seconds and apply to perineum, it's like a gel.
I liked adding garlic, sea salt and uva ursi to my poultices. Just throw it in a large pot of water with the leaves and steep it (overnight is best, but for at least 30 minutes). Amounts used are a whole cup of sea salt (don't be afraid, it won't burn at all), a whole bulb of of peeled garlic whizzed in a blender, and uva ursi (1/2 cup or as much as you want). To make the poultice, get some 4x4 inch gauze pads. Spoon the mixture onto the pads and make a burrito for your underpants! Leave on the area for 25 minutes, 3-4 times a day. Apply them warm for added benefits.
You can put any of these strained infusions in a squirt bottle to rinse your perineum after using the bathroom. Keep any unused mixture in the fridge for up to three days.
Other supplementation to help healing can be in the form of daily vitamin C with bioflavinoids (500mg), vitamin A (25,000 IU), vitamin E (1200 IU), and zinc (15-25 mg). Also you can take homeopathic Arnica (30C 2x a day) to help reduce bruising and swelling and relieve trauma.
Seaweed! Using food quality seaweed from a health food store, Cut a piece of seaweed that is twice the length and width of the tear, fold in half, and moisten with water. Place it down the center of the tear and bring the edges of the tissue together, carefully aligning them. Then cover the entire length of the tear with a patch of moistened seaweed. Replace it after using the bathroom, each time. It may sting a little for a minute, but it's just the salt water in the seaweed and it will not be uncomfortable for long.
After 10 days, vitamin E from the capsule can be applied directly into the area if there is still discomfort.
Times that you may want to seek a second opinion or medical help:
Excessive bleeding from the tear site
Prolapsed uterus (when the uterus is out of the body, VERY uncommon and not life threatening)
A tear that extends into the anus (extremely uncommon in a birth where no instruments are used)
I know someone will ask, so I have to give my opinion on perineal massage. Studies are inconclusive about the effectiveness, and it is not comfortable when done 'correctly'. So I don't advise it, but it's your vag, do what makes you confident!
So, so SO much more great information can be found in these two (affordable! easy to understand!) books: Saving the Whole Woman (which makes a great case for avoiding sutures), and the Tear Prevention & Treatment Handbook from Midwifery today, full of useful treatments, tips and opinions.
When you had sex for the first time, your vagina changed, you 'popped your cherry'. Birth is similar. Your first birth or tear will 'pop your birth cherry'. Your vagina may look and feel different even after healing, but most women agree that sex after a natural birth with a tear vs. an episiotomy is better than it was before the birth! Sara Wickham put it well when she said, "Birth is a rite of passage that takes women's bodies on a journey. We become marked with the symbols of our passage into motherhood and retain the cellular memories of the experience. Whether we judge these marks as good, bad, or neutral, we hold them as women whose bodies tell the stories of our lives. To what extent does the fact that we often judge all tears to be bad affect the way that women percieve their bodies, their tears and scars?"
Food for thought!
If you have any suggestions, please add them in the comments! I will add to this post over time as I have time.