How to Prevent Tearing During Childbirth

A lot of women are fearful when it comes to labor and childbirth. It’s the unknown and the unexpected that get to them. This is normal, which is sad, but I understand this fear. For me, what I’m afraid of during childbirth is tearing. And I’m not alone when it comes to this. Around 90% of all women experience vaginal tearing during childbirth — which isn’t a great percentage for us.¹ I’ve had many clients express this fear to me during their pregnancies. So, I’m sharing some tips on how to help prevent or minimize tearing. I will say that it can be tough to avoid tearing, but there are some things that women can do to reduce their chances.

*Disclaimer: I’d like to mention that there is nothing wrong with tearing during birth. It is normal and happens to the majority of women during childbirth. However, if this is something you are hoping to minimize and (hopefully) eliminate from your birthing experience, here are some tips that can help.

12 Ways to Prevent or Reduce the Risk of Tearing During Childbirth

1. Eat Right & Exercise

You may wonder how your diet and exercise can help minimize vaginal tearing during childbirth. But good nutrition, hydration, and exercise can indeed help improve your skin and muscle health, circulation, and skin elasticity. Unfortunately, many of us don’t exercise regularly, and even if we do, sometimes this comes to a complete halt when pregnant. But labor is a marathon, and pushing requires endurance, flexibility, and strength. So it’s important to get your body moving to help improve your blood flow, which helps improve your skin’s elasticity.

Also, having sex and orgasms are helpful since they can help improve your blood flow from your perineum to your vagina and improve your tissue health. So keep that passion and love alive!

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2. Choose Your Care Provider & Birth Location Wisely

Having gone to hundreds of births myself, I have seen how many different doctors and midwives work during the pushing stage. I also notice how the place you choose to give birth can affect the outcome of your birth. Some care providers are more aggressive and instructive during pushing, and others are more patient and gentle. Get to know your care provider and ask how they assist their patients when pushing. For example, ask what their opinion is on natural tearing versus episiotomies. Also, what their episiotomy rate is and the support techniques they use. (For example, warm compresses, perineal massage, positioning, etc.) Generally, midwives have a significantly lower rate of clients tearing during childbirth and cutting episiotomies.

3. Do Your Kegel Exercises

You may think Kegels are counter-productive when preparing for birth, but that couldn’t be further from the truth. Yes, you need your pelvis and vagina to be relaxed and open during the second stage of labor. However, you also need pelvic floor strength to help baby descend and deliver. Kegels (pelvic floor exercises) help strengthen those muscles, which give you the strength to push your baby out. However, Kegels should be accompanied by squats since they will improve the lengthening and coordination of your pelvic floor muscles when paired together. So, if you do not practice relaxing your pelvic floor and lengthening those muscles while working on your strength, it won’t help.

4. Practice Perineal Massage

Your body has never pushed out a baby before, so it’s a good idea to prepare your perineum for this type of stretching. You can do that by doing a perineal massage. Perineal massage during pregnancy has been shown to reduce the risk of tearing in mothers having their first vaginal birth.² In addition, stretching and opening your pelvic floor and vagina before birth can prepare your body for what’s to come and reduce pelvic trauma. Your care provider can also do perineal massage during the pushing stage to help stretch your perineum as your baby’s head descends.

5. Get an Epi-No

I’m a BIG fan of Epi-Nos (view here). Too bad that it is not sold in the US because they are not FDA-approved. Which I find to be ridiculous. Studies have proven it beneficial in decreasing damage to the perineum during vaginal childbirth.³ What woman wouldn’t want one? I have had several clients purchase them overseas or have had friends ship one to them, and I will say they really do help. All of these women either had either very minimal tearing or no tearing at all. If you can get one, I recommend it.

6. Hire a Doula

Yes, hiring a doula is also a great way to reduce your chances of tearing. A doula helps relieve stress and tension during labor. The more tension you hold, the more likely you will tear. She helps you move into different positions during labor and pushing and uses various methods to help you stay relaxed and strong. For 30 interview questions to ask a doula, read here.

7. Avoid an Epidural

Studies have shown that women who don’t get pain meds during labor are likelier to have their perineum intact after giving birth.⁴ There are two main reasons for this. Firstly, an epidural prevents you from assuming the best positions for giving birth. You are limited to only pushing on your back or maybe your side. Secondly, most women who receive epidurals cannot feel what is happening in their bodies and do not have the urge to push. They then have to rely on their doctor, nurse, doula, and partner to tell them when and how to push, even though their body may not be ready. These two reasons are major risk factors for tearing.

However, it’s important to note that the evidence for pain medications during labor associated with increased tearing is not solidified. This is because of the increased rate first-time moms choose epidurals, and first-time vaginal deliveries are associated with a higher risk of tearing. Another study showed that epidural analgesia was not associated with severe perineal tears once confounding factors were controlled for.⁵

8. Labor in Water

For most people, taking a nice warm bath or shower is the perfect place to help your body and mind relax. The same is true when you are pregnant and in labor. There are so many benefits to laboring in the water; one of them is that it can help soften the perineal tissues. Not only that, laboring in the water while in transition labor and during pushing can also ease the sensation of the baby’s descent and the crowning stage.

9. Get into Good Pushing Positions

Your position while pushing could determine whether or not you will tear. To minimize the chances of tearing, the best positions are:

On all fours, on hands and knees.
Leaning forward in a supported standing, kneeling, or sitting position
Lying on your side.

Squatting and kneeling are also great pushing positions. However, if the woman’s knees are too far apart, the perineum will be stretched sideways and may increase the likelihood of tearing.

Ultimately, the best position while pushing is the position that your body chooses. Listen to your body and do what feels best and right for you.

10. Breathe More While You’re Pushing

As long as you and your baby are doing well, breathing more during the pushing phase is encouraged. Breathing helps stretch your pelvic floor and reduces tearing. When your baby is this low in your pelvis, you will feel the urge to push and bear down during each contraction. That is good and normal. But listen to your body. If it’s too much tension, breathe through it and allow your body to stretch as your baby descends lower. You don’t have to push with all your might while holding your breath to give birth to your baby. Actually, the faster your baby comes out, the less time your body has to stretch, which causes it to tear. Breathing with your contractions allows your baby to descend slowly and will help you have less pelvic floor trauma.

11. Use Warm Compresses

A warm compress held to the perineum when your baby is crowning can reduce tearing. In addition, the warmth of the compress will increase the blood flow to that area, and the counter-pressure also can feel very relieving.

12. Avoid An Episiotomy

If you don’t know what an episiotomy is, it is a surgical cut made to the skin and muscle of the perineal area to enlarge the vaginal opening. For some doctors, they are a routine procedure for almost all patients. For other doctors, it is done only when performing assisted births (for example, using forceps or a vacuum).

Tearing naturally is better than having an episiotomy for many reasons:⁶

The cut of the episiotomy increases the chances of the mother having a third or fourth-degree tear. This happens because the baby’s head presses against that cut and causes it to tear deeper into the muscle.
Tears heal better than episiotomies.
Scar tissue from an episiotomy restricts the perineum’s ability to stretch, which causes more tearing in future births.
Episiotomies can cause infections, perineal trauma, urinary and fecal incontinence, and painful sex.

Try all the points above to reduce your chances of tearing during childbirth and having an episiotomy.

Would you include any other points that helped you minimize or prevent tearing during childbirth in this list?