A lot of women are fearful when it comes to labor and childbirth. It’s the unknown and the unexpected that gets them. This is normal, which is sad to say, but I totally 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 number for us. I’ve had a lot of clients express this same fear to me during their pregnancies, so I thought sharing some tips on how to help prevent tearing might help. I will say that it can be very difficult 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. This is normal, and it happens to the majority of women during childbirth. However, if this is something that you are hoping to minimize and (hopefully) eliminate from your birthing experience, here are 12 tips that can help.
1. Eat Right & Exercise
You may be wondering how your diet and exercise can help with minimizing vaginal tearing during childbirth. But good nutrition, hydration, and exercise can indeed help improve your skin and muscle health as well as your circulation and skin elasticity. A lot of us don’t do regular exercise, and sometimes this comes to a complete halt when we are pregnant. But labor is a marathon, and pushing requires endurance, flexibility, and strength. It’s important to get your body moving to help improve your blood flow, which in turn improves 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 as well as improve your tissue health. So keep that passion and love alive!
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 him/her questions about how they assist their patients when they are pushing. Ask what their opinion is on natural tearing versus episiotomies. Also, what their episiotomy rate is as well as the support techniques they use. (For example, warm compresses, perineal massage, positioning, etc.) Generally, midwives have a significantly lower rate of clients tearing and cutting episiotomies.
3. Do Your Kegel Exercises
You may think that Kegels are counter-productive when it comes to 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, together, they will improve the lengthening and coordination of your pelvic floor muscles. If you do not practice relaxing your pelvic floor, lengthening those muscles while working on your strength, then that 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 perineal massage. Perineal massage during pregnancy has been shown to reduce the risk of tearing in mothers having their first vaginal birth. By stretching and opening your pelvic floor and vagina before birth, this can prepare your body for what’s to come and reduce pelvic trauma. Perineal massage can also be done by your care provider during the pushing stage to help stretch your perineum as your baby’s head is descending.
5. Get an Epi-No
I’m a BIG fan of Epi-Nos. Too bad that it is not sold in the US because they are not FDA approved. Which I find to be ridiculous. It has been proven in studies to be beneficial in decreasing damage to the perineum during vaginal childbirth. What woman wouldn’t want one? I have had several clients purchase them while they were overseas or have had friends ship it 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. Get 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 she 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 more likely to have their perineum intact after giving birth. 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, the vast majority of women who receive epidurals are unable to 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, partner telling them when to push and how to push even though their body may not be ready. These two reasons are major risk factors for tearing.
8. Labor in Water
For most people, taking a nice warm bath or shower is the perfect place to help your body and mind fully relax. The same is true when you are pregnant and in labor. There are so many benefits to laboring in the water, and one of them is that it can help soften the perineal tissues. Not only that, laboring in the water while in transition and during pushing can also ease the sensation of the baby’s descent and the crowning stage.
9. Get into Good Pushing Positions
The position you are in while you are 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, it’s encouraged that you breathe more during the pushing phase. 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 of your might while holding your breath to birth your baby. Actually, the faster your baby comes out, the less time your body has to stretch, which then causes it to tear. Breathing with your contractions allows your baby to descend slowly, and it will help you have less pelvic floor trauma
11. Use Warm Compresses
When your baby is crowning, a warm compress held to the perineum can reduce tearing. The warmth of the compress increases 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 the 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 a lot better than having an episiotomy for many reasons:
- 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 of the points above to reduce your chances of tearing and having an episiotomy.
Are there any other points that you would include to this list that helped you?