Ouch! How to reduce the risk of tearing
When I chat to mums about birth one of the biggest worries, or fears they have, is the risk of tearing, or needing an episiotomy.
About 90% of women tear in varying degrees during labour. Many of these are small and will heal on their own; others may require stitches and careful aftercare. The most common place to experience a tear is the skin of the vagina or the labia. Sometimes tears can also happen on the perineum (the bit between your vagina and anus)
Sometimes, a midwife will suggest an episiotomy, which is a surgical incision of the perineum to prevent a larger tear and make a little more room for babies arrival. An episiotomy will be done by your midwife or obstetrician and is usually performed during the second stage of labour. After your baby arrives, your midwife or obstetrician will give you a general anesthetic so that they can do stiches and your health visitor will check these when they visit you and your baby at home.
You’ll be happy to know though that there are lots of things you can do to help reduce the risk of a tear, or the need for an episiotomy. Some can be done in pregnancy and some during labour and birth.
Perineal massage. It doesn’t sound a lot of fun to most of you and I bet your wrinkling your face up as we speak, but STAY WITH ME! Research suggests that perineal massage a couple of times a week from 34 weeks can reduce tearing and episiotomy rate for first time mums (it’s lower in second or subsequent births!) A good place to do it is in the bath. It feels a bit more private and safe! It’s also really beneficial for getting to know your body. Knowing how those muscles will stretch to let your baby out, what that might feel like and how you can manage the sensations (Doing your UP breathing during the massage is a good idea! You’ll find that (just like working out a muscle at the gym) the more you do it the easier and more comfortable it becomes, which is good for birth! But take my word and do it, I’ve never has a mum say they’ve regretted it after birth!
A great ‘how to’ can be found here, on V is for Vulva
Keeping active in labour. Allowing baby to work with gravity to slow move down the birth canal. The birth positions with the lowest rates for tearing are all fours, lying on your side or kneeling (either in the birth pool, on the floor, or over the back of the bed!) A more risky position (Shock horror!) is laying on your back (as you know from your classes, this makes it harder for baby as they have to work against gravity and go ‘up hill’)
Here’s some great birthing positions from The Hypnobirthing Midwife, to help your body birth your baby more comfortably. They also do a great video on reducing the risk of tearing, with lots of tips, so look that one up too!
Where possible in labour try and maintain a good position – but ultimately, go with your instincts – you may find your body instinctively wants to get in to some weird and wonderful positions you could never have guessed – go with it.
Birthing in water. Evidence Based Birth do a great article on the benefits of water birth and reducing the risk of tears. Warm water softens the tissue and the pressure of the water can slow the final expulsion of babies head, making the arrival more gentle.
Use your breathing. Remember, in class we talk about why we don’t need to physically bear-down and push. Using your up breathing can support baby to move down without the force of coached and forceful pushing. Baby moves up and down as they make their way down the birth canal and pushing can rush that process and cause unnecessary perineum trauma.
Understanding the effect of medical pain relief. Some comfort measures, such as epidurals can increase the risk of a tear. There is some research to say that epidurals increase the risk of tearing, or the need to have an instrumental birth. We’ll talk all about medical and holistic comfort measures in class and way up the benefits and risks for you – that way, on the day you already have a good idea of the impact of any decisions you may make, so you can properly way up what to have!
Again, Evidence Based Birth have a fantastic pain management series that looks at the effects, benefits and risks of all different comfort measures.
In our Hypnobirth classes we cover all of this and lots more to help you feel physically prepared, confident and informed for the birth of your baby. Helping you to make the right choices for you and your baby’s birth.
Don’t forget, we offer online coaching sessions too, as well as group workshops and private 1:1 classes. Take a look at the full course outline.