CAN YOU PREVENT VAGINAL TEARING DURING BIRTH?
I get asked this question ALL. THE. TIME. “Can I prevent tearing during birth?”
As someone who has vaginally birthed two 9 pounders (with no perineal tearing) AND worked with thousands of women…
I can confidently say that there are a lot of things that you can do during pregnancy, labor and pushing that can impact the likelihood & extent of vaginal tearing. Having said that, we do have to remember that birth is unpredictable.
Here are a few tips:
1. Perineal Massage
Perine-what? The perineum is the area between your vagina and your rectum.
Perineal massage is manually stretching the perineum to get it ready for birth. During the (4-6) weeks leading up to birth, daily perineal massage can help the skin begin to loosen. Here are instructions and a video tutorial.
When you’re in labor, your vaginal tissue will stretch, thanks to our miraculous bodies. Don’t worry, it’s also designed to return to the normal size, absent any significant tearing or an episiotomy.
2. Allow Labor to Begin on Its Own
In the absence of complications, let your baby chose her birthday. If she is left alone to come when she’s ready, your body is ready, too. Your uterus, cervix and hormones are all working together, as they were designed to.
If your baby and body aren’t ready for birth, an elective induction can create challenges for a normal, healthy vaginal delivery.
Note that there are exceptions when pregnancy and/or birth complications indicate that a medical induction of labor is a safer option.
3. Consider your Epidural Plans
Epidurals are an (often amazing & I would know - I’ve had two) effective pain management option, with inherent risks and benefits.
The purpose of this section is not to persuade you to skip an epidural.
Rather, to inform you that getting an epidural may increase your chances of vaginal tearing… and to give suggestions about your epidural strategy.
Why might an epidural increase your chances of tearing? Once you get an epidural, you probably won’t feel anything, depending on the dose. This is excellent for alleviating contraction pain; however, you might not feel the urge to push. You may just feel pressure, or nothing at all. Without the urge to push, your provider will probably coach you through pushing. Coached pushing can lead to more incidents of vaginal tearing. Women tend to tear less often when they push as they have the urge.
Of course, this isn’t always the case.
If you’re planning on getting an epidural, you might consider delaying and/or starting with a lighter dose. Also, discuss with your Doula (or provider) what labor positions will be possible once the epidural is administered.
4. Laboring Down
Laboring down is described as the period of time after you reach 10cm dilated, when your baby makes her way down the birth canal on her own.
Some women also experience a “rest and be thankful” period during this time, when contractions appear to have stalled out. Your labor hasn’t necessarily stalled out. Your body is giving you a break to rest before transition (pushing). (Lamaze)
Laboring down and “rest and be thankful” period can last up to a couple of hours. During this time, your vaginal tissue is continuing to stretch. Stretchy vaginal tissue = less likely to tear. Winning!
Note that if you’ve had an epidural, ACOG recommends against laboring down.
5. Pushing Positions
To minimize potential tearing, optimal pushing positions are:
Side lying (bonus: use a peanut ball)
On all fours (hands & knees)
Leaning forward (either sitting, kneeling or supported standing)
Squatting is great for preparing for labor and for opening your pelvis; however, it can increase your chance of tearing during pushing.
Ideally, listen to your body and have your partner (or Doula) assist you in changing positions as needed.
6. What’s the rush?
Most of us think that once we reach 10cm dilation, it’s go time!
Usually, however, baby is not ready to come out just because you are fully dilated. She’s still making her way south, tucking, turning and squishing herself into the best position for birth (see Laboring Down section above). Give her time, she knows what to do.
In the absence of an emergency, what’s the rush to push baby out before she’s ready?
Consider pushing with the urge. As discussed earlier, your chances of an intact perineum are best if you push only when you feel the urge to do so.
Here’s a comparison for you - the urge to push is a lot like the urge to poop. If you have no urge to poop, what is sitting on the toilet forcefully pushing going to do? Hemorrhoids, that’s what it’ll do.
7. The Sphincter Law
Straight from Ina May Gaskin (the Queen of midwives), “The state of relaxation of the mouth and jaw is directly correlated to the ability of the cervix, the vagina, and the anus to open to full capacity.”
How do you apply this? Breathe. Relax. Allow your sphincters to open up and work together.
Don’t: hold your breath, clench your jaw, tense up.
8. Mindful Practices
Have you heard the saying that your thoughts become your reality? Let’s apply that to keeping your cookie intact!
Visualization may not an evidence based practice in birth; however, it can be a powerful tool. Spend some time each day of your pregnancy visualizing your ideal birth. Try closing your eyes and replaying the movie of your birth in your head as often as possible, paying special attention to an easy pushing phase.
Find positive birth affirmations that resonate with you. Even better, write your own! Try to focus on using positive statements to describe what you desire - an intact perineum or a smooth, easy birth. This is more effective than the negative statement of the same goal - avoid / prevent tearing. Your mind will hear “tearing,” not good.
If you’re comfortable, tell your baby your ideal birth story while she’s in the womb. Here are some cute ways to speak to her about carefully making her way through your vagina: “... feel free to take your time coming out… you’re coming into a safe space… I’ll be here… you can come out gently and carefully… thank you for leaving mommy’s goodies intact.” Of course, modify as you wish.
9. Hands Off
Perineal massage can be helpful during your pregnancy in preparation for birth. However, that’s only a few minutes each day.
Perineal massage during pushing can be particularly uncomfortable. To put it in perspective, the average first time mom pushes for 2-3 hours in an unmedicated birth. Your poor vagina is going to be unnecessarily sore if there are hands poking and prodding it while you’re pushing.
10. Gentle Options
There are a few more gentle manual options that your provider can do during crowning.
Applying counter pressure on your perineum.
Warm compresses on your perineum.
Pouring olive oil on your perineum.