Birth Doula Blog
Let's talk perineal prep and care! Many women wonder if they will tear during a vaginal birth and if they can do anything to prevent it.
WHY DO TEARS HAPPEN?
Contrary to popular belief, a baby with a larger head isn't always the cause of tears. They typically happen when the perineum doesn't have enough time to gradually stretch due to a baby who's emerging very quickly or if the skin doesn't easily stretch even with a slowly emerging head. During the pushing stage, you might have a provider tell you to slow down your urge to push if they believe the skin hasn't fully stretched. This is easier said than done, but some controlled breathing, small grunts, or laying on your side can help slow down the process.
Tears may also occur if baby is malpositioned. Getting in certain positions can encourage baby to turn into an ideal position to prevent a tear. Laboring upright for too long can also apply too much pressure on your perineum. I suggest you switch positions every 30 minutes. Pushing with an Epidural means you may end up with directed pushing, where the nurse tells you when and how long to push. Directed pushing could sometimes be ineffective and exhausting because you can't properly feel the urge to push or recognize the muscles required to push. I recommend you turn down/off the Epidural at 8-9 cm. so that you can feel your pushing urges and listen to your body. It'll know how and when to push.
Lastly, you're more likely to tear for your first vaginal delivery than subsequent ones.
CAN TEARS BE PREVENTED?
While no one can predict if you'll tear, you can definitely help yourself during labor by forgoing numbing meds such as an epidural or getting a low dose of them. If you are unable to feel your urge to push, the staff will likely direct you to push before your body is ready, before your perineum is ready. This unnecessary pressure against your perineum can increase your chances of tearing.
During labor, a warm compress to the area can help relax the muscles, provide counterpressure, and help you focus on where your pushing muscles are.
Studies have also shown that laboring with a midwife or at a birth center/home setting reduces your chances of tearing. Midwives are known to do fewer interventions, which can lead to tearing. Laboring in a comfortable environment such as your home leads to better outcomes due to your relaxed nature.
IS PERINEAL MASSAGE HELPFUL?
Your perineal area is designed to stretch and accommodate your baby during birth but you could try and increase its flexibility by doing perineal massages in the last month of pregnancy. There are studies that state it helps first-time moms prevent tearing and that it helps experienced moms recover more quickly. From my own personal experience, I never massaged and I never tore. Studies have been limited and with mixed results. So the jury is still out on who could benefit from the massage. Still, a massage won't hurt or make things worse.
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WHAT ABOUT EPISIOTOMIES?
A while ago, episiotomies (surgical cuts) were routinely made on moms during the pushing phase in the hopes of preventing a severe spontaneous tear. After many studies, it was found that episiotomies were not beneficial and that they weren't any easier to heal from compared to a spontaneous tear.
Keep in mind, episiotomies are occasionally needed if baby's head is emerging and his heart rate is dropping. At that point, getting him out quickly is vital even if your perineum hasn't fully stretched.
If an episiotomy is deemed necessary by your provider, they will have to ask for consent and you will have the choice of a local injectable anesthetic or a pressure episiotomy. If there is enough pressure on the perineum, sensitivity is decreased and you likely won't feel the surgical cut.
WHAT IF I TEAR?
If you tear, the repair will be immediately after delivery while you hold baby. You will likely be given a local injectable anesthetic. With all the excitement of birth, you might not even be aware that you tore or that you're being repaired. Stitches will be made and they will dissolve within 6 weeks. You can relieve the discomfort by using a peri bottle to keep yourself clean, using vaginal sprays with numbing or cooling sensations, and wearing cold pads. Drinking plenty of water and doing Kegels are also ways to ensure a speedy and successful recovery.
WHAT ARE THE TYPES OF TEARS?
Tears range from first to fourth degree, with the fourth being the most severe. A first degree tear is a small injury around the vaginal opening. And a fourth degree tear is the least common but it involves an injury from the vagina to the rectum.
Remember, tearing once doesn't mean you'll tear again. The risk is very low, even if you've had a fourth degree tear.