It is common for birthing people to worry about tearing during their birth. Some tears are small and don’t require any intervention to repair, making for a faster and easier recovery in the days postpartum, but a deeper tear in or around the vagina can require suturing from your care provider and be uncomfortable in the healing process.
In addition to tearing, an episiotomy might be something your care provider suggests and it
brings its own concerns. Episiotomies are not as common in modern medical practice as they once were, but sometimes it is still used in an effort to speed up labor and make more space for a larger baby. An episiotomy is an incision that your care provider will make on the perineum of your pelvic floor to make the vaginal opening larger. The incision is then stitched up after delivery. This practice carries its own set of risks and most would agree that they would like to avoid one if possible.
I am going to share three things you can do to greatly reduce your risk of tearing: perineum
massage, mother-led pushing and utilizing specific birth positions. Evidence shows that each of these can decrease the severity of tears, or even prevent tears altogether.
1. Perineum Massage
If you aren’t massaging your perineum yet, what are you waiting for? According to the WHO’s website posted in February of 2018, “Evidence suggests that perineal massage may increase the chance of the keeping the perineum intact and reduces the risk of serious perineal tears.”
If you are unfamiliar with this massage technique, here are some basic instructions to get you started:
Start by getting familiar with the muscles of the pelvic floor and your own unique anatomy.
Use a safe lubricant or oil such as coconut oil (no scents or fragrances!)
Using the padding of your thumb, insert your thumb into the opening of your vagina and press down toward your anus until you feel a slight tension or even a light stinging sensation, letting you know that you are stretching the skin and muscles of the area.Gently hold the tension pressing downward and massage side to side (from hip to hip).You can do this in a seated position with support behind your back, laying down with the help of a partner or standing with one foot elevated on a chair or the bed.
It is recommended to begin the practice before labor, starting around your 36th week of pregnancy.
2. Mother-led Pushing
Allowing the birthing person to determine the timing and intensity of pushing has shown to
greatly reduce the risk of tearing. You can have conversations with your birth team and provider ahead of time to make your wishes known before labor so they can support you. Be aware that some providers might not be used to this model, so having a conversation ahead of time will ensure that you are more likely to be supported in the way that you want during labor. Pushing gently and slowly will allow time for your body to stretch naturally. Evidence shows that fast, hard pushing leads to more trauma on the perineum and a greater chance of tearing.
To learn more about effectively pushing on your own, you can take my Labor & Pushing Prep Course where I cover these topics in more detail.
3. Laboring and Pushing Positions
The position that you push in can have a big impact on whether or not you are likely to tear. You might try one of these positions that are proven to be effective in a gentler birth:
Squatting or using the squat bar in the hospital bed
Pushing on your side with support on the lifted leg
On your hands and knees
Each of these positions is proven to benefit the mother and baby physiologically in the birthing process.
Remember, that even if you are able to accomplish all three of these suggestions, there is still always a chance of tearing during a vaginal delivery. This is not always a bad thing, as natural tears are shown to heal more quickly and easily than intentional cuts like episiotomies, and it doesn’t mean you will have a difficult recovery. Being informed and proactive will, however, result in a better outcome for you and for your healing.