At one of my recent checkups, I was talking to one of the midwives at the hospital about delivery positions. Specifically that I don't want to deliver in the lithotomy position if at all possible. She said that it was a good idea to "push" in another position, but that it would be better if the actual delivery of the baby's head was done with me on my back (not legs up) so that support could be applied to my perineum. She also said that she's never seen anyone deliver upright (on birth stool etc) without tearing! Is this true that you're more likely to tear in an upright position??? I'd never heard anything like that before (everything to the opposite actually)...Any insight, concrete personal stories etc would be much appreciated.
P.S. I think that the position I'll be most comfortable delivering in will be on all fours, can't my perineum be supported in that position just as well as it would be with me on my back?
Thank you in advance for any info!
I should think it would be pretty easy to support the perineum of someone laboring on all fours. Just my two cents. Also, just to add some fuel to your anecdotal fire, I birthed my baby in the "proposal" position (semi-squat, on bended knee) while supporting my own perineum, and had just a superficial 1/8-1/4 inch nick. First baby. :)
I don't have any quotes offhand, but Henci Goer's book "The thinking Woman's Guide to a Better Birth" might have some good evidence for you.
I did probably 85% of the pushing stage in a semi-upright all-fours position - we had the back of the hospital bed upright (so acted like a headboard), and I was leaning against it and kneeling on the bed. I found this to be really effective with gravity and all because even between pushes when i would 'rest', i would lower my bum and the baby would move down even more. They said it was fine to go ahead and push him out that way, but at the last minute I felt like I wanted to turn around and sit upright (slightly leaning back) so that I could see him come out. The change in positions must have done something internally too because he crowned very soon after (I am convinced our bodies just know!) Anyway, long story short, since I had done so much of the 'work' already, I didn't feel like this last bit of pushing in that position put too much strain on the whole area. I didn't tear, and I didn't have much soreness at all after a day.
I only have this one experience to go on, but I think I will try to do something similar with my second baby since it seemed to work well. I can't speak to what your midwife said about people always tearing in an upright position (somehow I can't believe that's true) but I would definitely recommend a combination of positions like this so that no one part gets too much strain put on it. Bottom line - just listen to your body!!!
At a home birth I assisted a mom who gave birth to an eleven pound baby without tearing. She was most comfortable, walking and sitting on the birthing ball throughout labor. She felt best upright. When the baby's head was just beginning to crown she got into bed and pushed in a semi-sitting position.
The advantage of the semi-sitting or C-position, and also the all-fours position is that the birth attendant can assist mom to ease the baby's head out. When there is a great urge to push, pushing too hard, too fast can lead to perineal tears.