Based on the results of my survey, I have decided to avoid an ELCS at all costs. There. I’ve said it. Just typing this thought makes me nervous. Will I be too scared to push? Will the hospital be short staff again? Am I even capable of delivering a baby without syntocinon? There are no answers to these questions. However, I’m confident that the risks can be minimised so have compiled a few lists of actions that I will take to avoid a severe tear in the future. The first source of information I’ve relied on is the lovely 50 women who completed my survey….
Based on my survey results, I’m certain that I will take the following actions to avoid severe tears in future labour:
(1) Say no to forceps
(2) Say no to induction with hormone drip
(3) I will not push strongly during delivery of the head
Obviously, there may be extreme cases where 1 and 2 can not be avoided but these decisions must certainly not be taken lightly. A well informed birth partner and comprehensive birth plan will be essential.
Based on scientific literature, I will take the following actions:
(1) I will not give consent for an episiotomy
(2) I will choose an ELCS if still experiencing severe symptoms from first tear at time of delivery
(3) Prior to labour, I will have a recto-anal scan to determine strength of muscles, extent of scaring and any weak areas that could cause problems
(4) Request the midwife be ‘hands on’ during delivery if circumstances seem right
(5) Listen to my body instead of push when instructed
Based on my gut instincts, I will do the following:
(1) Deliver baby with an experienced midwife I can trust who is up to date on the latest research regarding severe tears
(2) Not worry about the size of baby unless excessively large
(3) Ignore any advice given to me about my skin type
I’m still undecided on the following points:
(1) Should I have local anaesthetic in perineum again? (pro – would stop me worrying about tearing, con – would stop me worrying about tearing!)
(2) Is the length of my perineum important? (is it worth learning whether mine is normal?)
So there you have it. I may come back and add to this post in the future.