One of the most common concerns for women is the thought of tearing during childbirth. In fact, a quick google search using the keywords “how to reduce the risk of tearing during birth” shows about 380,000 results in 0.47 seconds!
It was probably the only thing that I was anxious about before my labour. Because of this, I prepared myself myself by following my 5 top tips below and I had a good chat with my independent midwife about my fear. By communicating this with her during our antenatal appointments, she knew how best to guide me on the day.
I do distinctly remember that crowning took what felt like a long time (in reality 20 min). My midwife had to remind me to let go and just let the birth happen (I think subconsciously I was holding back a bit). I also wanted the head to descend slowly so I wasn’t pushing hard.
How does perineal damage occur?
Occasionally, during the crowning of the head or birth of the shoulders the skin and muscles between the vaginal opening and anus (the perineum) can suffer damage.
Sometimes you can have a graze on the superficial skin. It is red and raw, like a scrape. However, no tearing has happened and there is no need to suture. The primary aim of suturing is to stop any bleeding from the affected area. And sometimes you tear.
There are 4 degrees of tears:
- 1st degree – perineal skin or the labia are lacerated. This requires no sutures. Sometimes stitches can help for cosmetic purposes, rather than to stop any bleeding.
- 2nd degree – skin and muscle are torn. Usually requires suturing by a midwife to stem bleeding. But if there is no active bleeding and will heal nicely on its own, then it is your choice whether to suture or not.
- 3rd degree – skin, muscle and some part of the anal sphincter is affected. A doctor will suture this in theatre.
- 4th degree – the tear has reached the rectal mucosa. If not repaired there will be leakage from rectum into the vagina leading to infection.
The damage described above happens naturally with the birth. At other times, the damage is caused by a doctor/midwife who will make an episiotomy using sterile scissors. The doctor/midwife should ALWAYS ask for your consent before they perform this procedure. National guidelines only suggest this when your baby’s heart rate is compromised, the baby’s head is at the perineum, and baby needs to be born quickly.
5 ways to minimise tearing during childbirth:
- Perineal massage – to be started from 34 weeks. Weleda do a fantastic perineal massage oil that I recommend and use myself. However, any plant-based oil is fine to use. The best time to do this is after a relaxing bath or warm shower. The heat will help the blood vessels in the area to dilate. This makes the perineum softer and more comfortable to touch. Studies have shown it eases the pain during crowning, reduces likelihood of needing an episiotomy, minimises tearing, and reduces the pain felt 3 months after birth.
- Hypnobirthing/Breathing techniques – to control the crowning of the head and birth of the shoulders. If you breath slow and controlled, the more your tissues and skin can stretch. You can either pant, use visualisations (white feather breath or bowl of hot soup image), both of which I have used in our yoga classes and yoga birth workshops. These techniques helps to take your mind away from fear. It will give you the confidence to keep calm and relaxed.
- Warm water – either immersed in a birth pool or use warm compresses pressed to your perineum during crowning. This allows the tissues to stretch and provides pain relief. The warm water will help your body to relax and release any tension, thereby giving your tissues more elasticity.
- Listen to your midwife’s directions during the crowning stage – sometimes when you’re in the moment feeling the intense sensations you may forget all your techniques from step 2. However, your midwife will be there and will be able to encourage you to pant or slow down your pushing. This can be invaluable to control the crowning of the head so it is nice and slow.
- Birth positions to try – all fours, or lying on your left side if you have an epidural. If you are lying on your back, your baby has to fight against gravity and a smaller diameter pelvic outlet so it is more likely you will tear.
My view on other devices
There are devices on the market (Epi-No and Ani-ball) – essentially, you insert a balloon-like device into your vagina which you inflate to gently stretch the perineum. Some women say it helps. But personally, I’d rather use my own hands as in the massage which doesn’t come at a crazy high price. There have been some cases where the balloon has over inflated and caused damage to the tissue.
So, did I tear?
In short, yes I did. I had a 2nd degree tear, which is the most common of tears. However, it didn’t hurt. I did not remember a distinct pain from the tear when it occurred. I believe my preparation helped my tissues to stretch as much as they could. Also, it was a small 2nd degree tear and my independent midwife offered to suture it but as it wasn’t actively bleeding, we both agreed it would be able to heal nicely without stitches. (And it did heal really well!)
I hope you found these 5 tips useful and feel confident in knowing how to minimise tearing during childbirth. Click below to download my free Perineal Massage step by step instructions: