Are you afraid of tearing during childbirth? Tearing is very common, especially first and second-degree tears. Depending on the severity and circumstances surrounding the birth, it may even result in birth trauma. These are the four different types of tears:
First-degree tear: skin-deep tears that usually heal naturally
Second-degree tear: goes through to the muscle tissue
Third-degree tear: extends towards the anal sphincter
Fourth-degree tear: stretches into the anal canal and rectum
You may be at a higher risk of tearing if this is your first baby, have a large baby (over 8 lbs 13 oz), push for over an hour, or if you have difficulty birthing your baby’s shoulders. We really want to prevent third and fourth-degree tears as those are more severe and can cause long-term health problems.
Perineal massage can be performed starting around 35 weeks to prepare your body for labor. While there isn’t much evidence supporting the effectiveness of perineal massage, it may help you get acquainted with the feeling of your perineum stretching, helping you let go of any fears associated with it.
Steps for perineal massage (you can do this on your own, or ask your partner for assistance):
Wash your hands thoroughly.
Get into a comfortable sitting position with legs spread.
Using a body-safe lubricant or oil (like Vitamin E oil), insert both thumbs into the vagina about 1-2 inches and press down on the perineum, going towards the anus.
Apply pressure for 1-2 minutes, then make your way up each side of the vaginal walls for another minute.
Breathe for relaxation in the pelvic floor muscles to allow for a deeper stretch.
Do perineal massages once or twice a week until birth.
Try to wait until you feel an overwhelming urge to push. This is called laboring down. You may not feel the need to push as soon as you reach 10 cm dilated, it may come an hour or two later. By laboring down you are conserving energy and letting your body do the work.
As your baby’s head begins to crown, try focusing on your breathing to relax. This can allow you to “pause,” while your baby’s head applies pressure and slowly stretches the perineum. Imagine you are breathing your baby down rather than pushing them out. A fast ejection of the baby’s head could result in a severe tear. Patience is key here.
Find a Position That’s Right For you
Often when we think of a woman giving birth, we imagine her laying on her back in a hospital bed while doctors are between her legs waiting to catch the baby. This position may be preferred by doctors, however, it can go against the woman’s best interest. This position means she has to battle gravity to deliver her baby and it may compress the aortic valve, leading to the baby getting less oxygen through the placenta.
Giving birth in an upright position or side-lying can permit you to work with gravity rather than against it. A lot of women instinctively want to birth upright as it feels most comfortable. Squatting, kneeling, and being on your hands and knees can open the pelvis, giving way for the baby as they make their descent through the birth canal.
Applying a warm compress to the perineum during labor can provide comfort and increase blood flow to the area allowing for more elasticity.
Waterbirth can also help prevent tearing. Giving birth in the water is like applying a warm compress, except you are immersed in it. Laboring in the water may also lead to a shorter active labor stage and provide pain management. It has often been dubbed the “aqua-dural.”
If You Do Tear
While not all tears are preventable (you may still acquire a first or second-degree tear), trying these methods may significantly reduce your odds of tearing severely. After birth, the midwives will examine you for tears and determine the severity and whether or not they require sutures.
To aid in the healing you should:
Keep the area clean with daily baths or showers. It may be helpful to add a couple of drops of tea tree oil to your bath to reduce inflammation.
Drink plenty of water.
Take stool softeners.
Practice pelvic floor exercises.
After urination, spray with water using a peri bottle then blot with toilet paper.
Try to avoid sitting in a position that puts pressure on your perineum. A donut pillow may help ease the pain when sitting.
If you notice a foul smell coming from your genitals, contact the midwives immediately as it could be a sign of infection.
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