sfcnmone t1_izu7hcl wrote
Reply to comment by Skyblacker in A question on the history of perineal stitches after giving birth by Endorion
Oh well yes I’ve done “some” stitching and yes it is absolutely an art. In fact, deciding whether to put any stitches at all into shallow tears is an art. Midwives tend not to sew shallow tears (1st degree) as long as they aren’t bleeding, because the stitches are often much more uncomfortable than unsutured “skid marks“. Not to say that vulval tears are particularly pleasant no matter what!
This doesn’t really work well for deeper tears, where the muscle or small sphincter are torn. That’s really the point of OP’s question.
My observation, from delivering a couple of thousand babies, is that first time teenagers almost never have deep tears, and first time 35 year olds almost always have tears, and so probably there were fewer tears hundreds of years ago.
Skyblacker t1_izubiqq wrote
I've also read that pushes during natural birth tend to be shorter (less than 10 seconds each) than when coached through an epidural, and it's long pushes that increase the odds of pelvic dysfunction afterwards.
I actually ran that experiment myself during my last birth. While coached, I watched the clock behind my doctor and deliberately did not go over 10 seconds per push. It made a difference!
After a previous birth, I fainted. But after this one, I still had enough energy to be hungry and demolish a cheeseburger from hospital room service. After another previous birth, I had hemmeroids that felt like continuous contractions. But this time when the epidural wore off, I was just sore like I'd overdone squats at the gym.
Were there other factors? Maybe. And I admit that this is anecdotal. But I do believe that shorter pushes made the difference between fainting from exhaustion and screaming in pain, to being merely worn out and sore.
And up until the advent of the epidural (which I love overall, don't get me wrong), shorter pushes were the norm.
sfcnmone t1_izupxtc wrote
Yes I absolutely agree. Sometimes women without epidurals even sleep right through a “pushing” contraction.
Sounds like you’ve got this thing figured out. I had a patient once who said “I think I’ve found my sport!”.
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