Opting to have a vaginal delivery for the birth of your child is going to require your vagina to stretch enough to allow the baby’s head to push through the vaginal opening. Sometimes it doesn’t live up to expectations and unfortunately, the joyous event of giving birth can be somewhat tarnished by a perineal tear (many times referred to as a vaginal tear that requires stitches).
The size of the baby’s head as it pushes through the vaginal opening is more than likely to leave you with tears in your perineum. The perineum takes a lot of pressure as the baby’s head descends, becoming stretched and potentially torn. These tears are known as perineal lacerations.
Tears, where only the skin is torn, are known as 1st or 2nd degree tears. More severe tears are referred to as 3rd and 4th degree tears.
Even the very best doctor can’t give you guarantees that you aren’t going to experience some degree of tearing during childbirth. Providing options can potentially prevent tearing during childbirth can make a huge impact on your recovery after the birth.
There are a number of things you can do to minimize the risk of perineal tears and their severity.
1. Strengthen the Pelvic-Floor Muscles
You want to be sure your body is prepared for labor. The main muscle of the pelvic floor, the pubococcygeus, lies around the openings of the urethra, vagina and rectum. With perineal exercises such as Kegel exercises, you’ll be strengthening the pelvic floor muscles.
Simply squeeze the muscles around the vagina. You’ll have done this squeezing or ‘holding in’ before when you were out and about and needed the toilet and there wasn’t one available. Hold for 10 seconds and release. Repeat this throughout the day. To keep these muscles working well, these pelvic floor exercises can be practiced for the rest of your life.
2. Specialized Physiotherapy
The perineal muscles can be weakened because of excess weight, pregnancy, childbirth and hormonal changes. Physiotherapy trains the perineal muscles to improve their strength and flexibility and to also strengthen the pelvic floor.
Different techniques are used, such as a personalized exercise program and electrical stimulation.
Also, after the birth, if you did experience a tear, perineal trauma affects a women’s physical and psychological wellbeing, even disrupting breastfeeding. Specialized physiotherapy is important in the early postnatal period so as to minimize the effects caused by perineal trauma.
3. Eat Well
To build up good skin and tissue integrity, pregnant women need a variety of vitamins and minerals. Following a healthy diet can help to ensure that your tissues are healthy and that they retain their elasticity and also protect the perineum from tearing.
Unfortunately, in the 21st century, a ‘normal’ diet isn’t a healthy one. It is often devoid of vital nutrients, particularly if we’re eating refined, over-processed foods. Since organic fruit and vegetables aren’t always possible, it becomes necessary to take a supplement, delivering a dependable dose of proteins, vitamins, minerals and carbohydrates to the body.
Vitamin dosing shouldn’t be done during pregnancy without your doctor’s knowledge. The reason for this is that some supplements contain active ingredients with strong biological effects, and their safety isn’t always assured as they may interact with prescription medicines.
4. Perform Perineal Massage
Perineal massage (also known as perineum massage) is shown in many clinical studies to reduce your chance of tearing during birth. It involves massaging the area between your vagina and bottom to prepare for childbirth.
From the 35th week, start massaging your perineum using perineal massage oils to make the vaginal tissue more elastic and flexible. There are a number of excellent plant oils including almond oil-, olive- and coconut oil among others which you can use for the massage.
5. Have Confidence in your Midwife or Doula
The outcome of childbirth is dependent on the mother-to-be’s experience. Modern women have birth plans. They articulate precisely what birthing ideas they have in mind. They stipulate who will attend the birth, the birthing process they wish to follow and what medical intervention they will allow.
Having confidence in your ‘support team’ set’s the correct stage and mindset for birthing. A mom-to-be has confidence that her medical team will have advised her on the best ways to prepare for childbirth and how to avoid tearing.
A doula, for instance, provides emotional and physical support during pregnancy and childbirth. The doula will show you relaxation and breathing skills and provide advice on the birthing process and how to deal with possible complications such as a tear.
6. Use a Warm Compress
During the crowning stage, a doula can apply a warm compress to the perineum to help prevent tearing during childbirth. This is achieved by placing a clean towel in hot water, wringing it out, allowing it to cool to a comfortable temperature and then applying it on the perineum, soothing the area and bringing relief. These warm compresses help to increase blood flow to the area. Also, should a tear occur, the pressure can help with reducing the severity of the damage to the perineum.
The World Health Organization recommends to use warm perineal compress which is shown to reduce 3rd- and 4th-degree perineal tears. Heat stimulates the thermal skin receptors as well as deep tissues so as to reduce pain.
7. Perennial Support with Controlled Delivery
During the birthing process, your midwife or doula will support the perineum with one hand while holding the baby’s head with the other. The head is in the optimal position to be delivered which ultimately means less pressure on the perineum.
During the crowning stage, the midwife or doula will deliberately slow the birthing of the baby’s head. This slow, controlled birth may be important for avoiding perineal trauma. The mom will have been advised not to push during this stage, reducing the chance of tears.
8. Have a Water Birth
There are some labor wards which boast with birthing tubs. Apart from providing pain relief, it is believed that these water births can prevent tearing during childbirth. The reason for this is that warm water softens the perineum.
There is much debate about whether water births do in fact prevent perineum tears. Some studies show that a water birth is decreases the rate of 3rd and 4th degree tears. These tears could lead to problems for the mother, one of which is having difficulty with sitting as well as having to contend with fecal- and urinary incontinence.
9. Practice Breathing Techniques
Knowing how to breathe correctly during labor can help to reduce your risk of tearing. There will be times throughout labor when you will want to push but it’s not the right time. With labor and birth, you breathe differently, but with practicing breathing techniques, you’ll learn about using breathing to make your contractions more productive.
10. Choose the Right Birthing Position
Your birthing position can play a part in you tearing. Squatting for instance, can increase your chances of tearing. There are a number of delivery positions that give you a better chance of reducing the risk of a vaginal tear during childbirth.
In the past, women have always been encouraged to deliver lying on their backs. But these days it is believed that this position increases the risk of tearing because of the pressure it places on the perineum.
Lying on your side or getting down onto all fours puts less pressure on your bottom, minimizes tearing of the perineum and decreases contraction pain.
Giving birth is a joyous experience. Pain and tearing during the birth are forgotten momentarily when you look at your new infant.
These tips on how to prevent tearing during childbirth will ensure that you can look back on your baby’s birth as a stress- and tear-free event, and one worth repeating
- WebMd. How to Create a Birth Plan. Available at https://www.webmd.com/baby/guide/how-to-create-a-birth-plan#1
- WHO recommendation on techniques for preventing perineal trauma during labour. Available at https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/care-during-childbirth/care-during-labour-2nd-stage/who-recommendation-techniques-preventing-perineal-trauma-during-labour
- NCBI. Midwives’ Management during the Second Stage of Labor in Relation to Second‐Degree Tears—An Experimental Study. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324579/
- NCBI.The impact of third- or fourth-degree perineal tears on the second pregnancy: A cohort study of 182,445 Scottish women.Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459505/
- IndieBirth. Nutritional Protection for your Perineum. Available at https://indiebirth.org/nutritional-protection-for-your-perineum/
- NCBI. Birth, Bath, and Beyond: The Science and Safety of Water Immersion During Labor and Birth. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210671/
- NCBI. Effect of Breathing Technique of Blowing on the Extent of Damage to the Perineum at the Moment of Delivery: A Randomized Clinical Trial. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364755/
- Journal of the Association of Chartered Physiotherapists in Women’s Health. Perineal trauma following vaginal delivery. Available at https://pdfs.semanticscholar.org/ac51/364bf1719570603e046ae26da04da160b5d8.pdf
- Evidence Based Birth. The Evidence on: Birthing Positions.Available at https://evidencebasedbirth.com/evidence-birthing-positions/