When it comes to planning your home birth or natural birth, there are so many unknowns. Birth in itself, whether it’s your first or fifth is impossible to predict because each labor unfolds in its own way.
All of these unknowns often work together to create some fear and anxiety surrounding birth and wanting some control. Just one ‘fear factor’ that is on the mind of many mommas is tearing during birth.
Tearing during natural childbirth is one of those things that sounds pretty scary (am I right?), and something you’d want to prevent at all costs. The thing is, some amount of minor tearing is pretty normal and your body is able to cope with it. But this doesn’t mean you want it to happen.
The good news? There are some things you can do during your pregnancy and labor to help minimize your risk and hopefully prevent tearing during birth altogether.
Perineal massage, pelvic floor strengthening prior to birth, certain pushing positions, and even the type of birth you plan are just a few strategies proven to reduce instances (or severity) of tearing.
Ready for our best tips? Read on, momma!
What is perineal tearing and is it considered the ‘norm’?
During birth, vaginal tears (also known as perineal tearing), happen during crowning and pushing as baby’s head makes its way through your vaginal opening. The perineum is the area between your vagina and anus and is often the victim of tearing during birth.
The ACOG reported in 2016 that between 53% and 79% of vaginal births result in some degree of laceration. Other sources say that number is upwards of 90%
While that does show a high likelihood of tearing happening, don’t fret just yet! Not all perineal tearing is created equal. Tearing during childbirth is classified by various degrees as follows:
- 1st degree tearing: This involves slight or minor tearing of the perineum that results in minor stinging or pain when urinating while it’s healing. 1st degree tearing may not even require a stitch and typically heals within a few weeks.
- 2nd degree tearing: Slightly more severe than 1st degree tearing, a 2nd degree tear involves the same area (the perineum) but goes slightly deeper and usually requires a stitch or two right after delivery. Healing occurs within a few weeks.
- 3rd degree tearing: 3rd degree tears extend beyond the perineum to the muscles surrounding the anus. Repairs for this type of tearing may involve an operating room and can take longer than a few weeks to heal. You may experience complications such as leaking stool.
- 4th degree tearing: 4th degree tears are a more severe version of a 3rd degree tear, extending beyond the anus muscles into the membrane that lines the rectum. Repair almost always requires a visit to the operating room and can involve specialized approaches to repair and complications.
(source)
Fortunately, it is estimated that less than 2% of all perineal tears fall under the most severe category. The overwhelming majority of tears are 1st or 2nd degree. For all of your home birth mommas out there, this is good news. Your home birth midwife is well-equipped to provide sutures in the event of minor tearing at your home birth.
And remember, a 1st degree tear may not require any stitching at all, your midwife will simply apply pressure to stop the bleeding and your body can heal the tear on its own.
While those 3rd and 4th degree tears are rare, should they happen at your home birth it will likely be the reason for a hospital transfer after baby is born to have the tears properly repaired in an operating room.
What increases your risk of tearing during childbirth?
Looking at the research and prevalence of tearing during childbirth, there are some factors that may put you at a higher risk for tearing:
- Epidural use may double your risk for severe perineal tearing
- Vacuum or forceps delivery
- Heavier birthweight
- Posterior positioning of baby (sunny-side up)
- Being of Asian ethnicity
- Having your first baby
- Longer duration of the second stage of labor (the pushing stage!)
- Having an episiotomy
- Giving birth on your back
On the flip side, your risk of tearing decreases when it is not your first birth, when you deliver with a midwife, in certain birth positions, when you avoid an epidural, and even by planning a home birth.
Let’s dive into these and a few other strategies to reduce your risk (or severity of tearing) below.
How to prevent tearing during natural childbirth?
We’ve discussed risk factors for tearing and the prevalence of tearing during birth, but it’s not all grim. As you read above, a 1st degree tear often heals on its own and doesn’t require any stitching.
Here we’re going to talk about things you can do during pregnancy, labor, and in your birth plan to help prevent tearing altogether or lessen the severity to a more minor tear.
Remember that none of this guarantees you won’t tear, but when practiced with intention will help the situation and reduce the odds.
1. Do your Kegels now to prevent tearing during birth
Kegels are a pelvic floor exercise that helps strengthen, lengthen and stretch the muscles associated with pushing out a baby. Doing Kegels, and other pelvic floor strengthening exercises, during pregnancy will help reduce your risk of tearing. Toning and stretching these muscles will prepare them to push a baby out effectively and stretch in the process.
What’s important to note is the way you do your Kegels. It isn’t just about contracting the muscles and holding them tight. It’s equally important to let the muscles fully relax after contracting. The process of contracting and relaxing completely together is what best prepares your pelvic floor muscles for their big job of pushing out a baby.
2. Invest in an Epi-No
An Epi-No is a “childbirth and pelvic floor trainer” that women can use during pregnancy to prepare their perineum and strengthen their pelvic floors. Research shows that this device has a positive effect on natural birth, and in these clinical trials 70% of first-time mothers who did Epi-No training had zero tearing during their births. That is pretty outstanding!
The Epi-No is basically a soft, silicone balloon that you insert into your vagina. In the early stages of pregnancy, you use the device to exercise the pelvic floor muscles by inflating it slightly. Once you reach week 36, you switch to Epi-No stretching exercises, in which you gradually increase the size of the balloon to train your muscles to open up to 10 cm.
The catch of the well-researched and clinically proven Epi-No? It’s not yet FDA approved which means you won’t be able to purchase it in the US. But don’t fret. Many US mommas are still benefitting from the Epi-No by purchasing it on Ebay, on trips overseas, or from friends and relatives overseas. The Epi-No is wildly used, available and popular in Australia and Europe.
3. Practice perineal massage to prevent tearing
Another way to prepare your perineum for the intense stretching it will undergo during birth is with perineal massage. Perineal massage should only be practiced after week 34 of pregnancy and is something you can do on yourself, or have your partner do.
To perform a perineal massage, you will:
- Insert clean, lubricated fingers into your vaginal opening 3-4 inches and firmly apply pressure towards your anus until you feel stretching of your perineum
- You can then alternate between pulling down and then opening your fingers in a V to stretch the sides.
- According to the American Pregnancy Association, “The main goal is to stretch and massage the back portion of the birth canal, down towards the anus, and then apart from side to side, using more pressure over time.” (source)
- Lastly, you can stretch your perineum from the outside by stretching the skin towards your thighs. (source)
Research is conflicting on the effectiveness of perineal massage but seems to show it is most effective for first-time mothers.
4. Which oil is best for perineal massage?
When you practice perineal massage, it is important to have well-lubricated fingers. Oils can be a wonderful and natural way to achieve this as opposed to a synthetic lubricant.
There are a number of massage oils blended specifically for perineal massage available such as Motherlove Birth and Baby Oil, which can be used for perineal massage and after birth for massaging baby. You can also use Sweet Almond Oil, Coconut Oil, or Vitamin E oil for your perineal massage.
5. Certain pushing positions help prevent tearing
One thing we know for sure is that pushing and birthing baby on your back (as is the norm in most hospital settings) puts you at the highest risk for vaginal tearing. So what are the best alternative labor and pushing positions to prevent tearing?
Research has shown that pushing on your hands and knees, in a supported keeling or sitting position, or in a side-lying position will minimize tearing most effectively. For some, squatting can also decrease tearing, but if you don’t routinely practice squatting or squat with your legs too far apart tearing likelihood can actually increase.
6. Warm compresses during pushing/crowning
The use of warm compresses on the perineum during pushing and crowning is a practice often seen at home births and in midwifery care. Many women find it to be comforting and help with pain management during this second labor stage, and research shows that it significantly reduces your risk for severe tearing.
The idea is that the warm compress promotes blood flow to the area which increases the flexibility and stretching going on. The counter pressure the warm compress provides can also help with the pain of pushing and crowning.
If you are interested in trying this technique during your birth, definitely include it in your birth plan! Then prepare by setting up a crockpot with warm water and a stack of clean washcloths. This is easy to achieve at your home birth, but you shouldn’t be shy about bringing a crockpot and including it in your birth plan at a birth center or hospital birth either.
Sometimes people add ginger to the hot water because it is a known anti-inflammatory.
7. Orgasmic birth to prevent tearing
Orgasmic birth is a pain-coping strategy for birth in which stimulation of the clitoris and vagina and thinking about things that arouse you are used to block pain messages to the brain. While not for everyone, this can be an effective way to manage pain during birth and reduce tearing.
Wait, what? Well, when you are aroused, there is a serious increase in blood flow to your vaginal area which promotes stretching and flexibility as baby moves down and out. In fact, Ina May talks about the way that Chimpanzees instinctively use their hands and fingers to arouse themselves while pushing out their babies. (source)
8. Planning a home birth prevents tearing during birth
Lastly, the type of birth that you plan can greatly influence your risk for tearing during childbirth. Planning to give birth under the care of a midwife will result in fewer instances of tearing. Furthermore, choosing a planned home birth has been shown in studies worldwide to be associated with less perineal injuries.
How to heal your perineum after your home birth?
If you do experience a perineal tear at your birth, don’t worry too much. While there will be some discomfort, remember that over 95% of tears are 1st or 2nd degree and will heal within a few weeks of birth.
Some things you can do to feel more comfortable during the postpartum healing process are:
- Use a peri-bottle to clean yourself after using the bathroom when wiping can be painful. The Mom Fridet has an especially effective and easy to use design
- Witch Hazel cooling pads and perineal ice packs will help with inflammation and pain
- Perineal sprays and herbal sitz baths will provide a lot of relief
Feeling more prepared to prevent tearing during your birth?
Now we know that while tearing is common, and most are pretty insignificant, there are some concrete things you can do to drastically decrease your risk of tearing.
Things like perineal massage, using an Epi-No, planning a home birth, and birthing without an epidural will all help. Don’t forget to do your Kegels and strengthen your pelvic floor, too.
Have another tip or experience with perineal tearing from birth? Share your story below!
Additional Sources:
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-13-59
