One of the biggest fears of pregnant women is tearing during birth, so it’s helpful to know that there are thing we can do in both pregnancy and labour to reduce the chances and severity of tearing.
We know that around 90% of women will tear a little during labour, however the majority of tears are small and will heal on their own or with a few stitches. Tears usually occur to the skin of the vagina or labia, and sometimes include the tissue of the perineum (the area between the vagina and the anus).
The good news is that our vagina’s have been birthing babies for millenia, they were designed for exactly this purpose! In the later stages of pregnancy we have a huge surge in the hormone relaxin, which allows the tissues of the perineum to soften and stretch, and the bones of the pelvis to become more ‘wobbly’ and create space for our baby! If you do have a tear that need suturing after birth, this will be done by a midwife or doctor and you will receive local anaesthetic.
So, how can we reduce the chance or severity of tearing during labour?
Follow your instinct- move into whatever position your body needs you to be in and listen to your own urges during the ‘pushing phase’
Birth position- the positions associated with the lowest rates of tearing include all fours, lying on your side, or kneeling. Squatting and laying on your back with your legs in stirrups (a la ALL MOVIES) are associated with the highest rates of tearing. However, if you BODY is asking you to squat, it’s probably because it needs you to squat! So follow your instinct, birth position isn’t usually something you can pre plan!
Avoid ‘coached pushing’ if possible, where a midwife or doctor tells you how and when to push. If you are using hypnobirthing techniques, this is when you would utilise your ‘down breathing’ tool.
Warm compress- research has shown that applying a warm compress to the perineum as baby is being born can reduce tearing.
Perineal Massage- research has shown that perineal massage approximately twice a week from around 34 weeks of pregnancy can reduce tearing and episiotmy rates amongst first time mums. A fantastic article on ‘how to’ from Midwife Issy (V is for Vulva Blog) here.
Water Birth- research suggests giving birth in water can reduce perineal trauma.
Avoid an epidural where possible. Some research suggests that epidurals may be associated with an increased chance of tearing. This may be down to the fact that you can’t follow your body’s own urges during the second stage, that often you may end up lying on your back and that epidurals come with an increased chance of instrumental birth.
Give birth at HOME or on a birth centre. Research suggests that for low risk women, giving birth at home or on a birth centre can significantly reduce the rate of tearing when compared to giving birth on an Obstetric Led Unit.
Avoid instrumental birth unless completely necessary. If accepting instrumental assistance during labour, forceps are associated with a higher rate of tearing than a ventouse, so you may like to discuss this choice with your care provider.
Hands on vs Hands off. Many of our local hospitals are currently involved in a new trial known as the OASI Care Bundle, which involves a midwife supporting your perineum at the point of baby being born, in the hope that this may reduce the most severe types of tearing. The trial is not yet complete and taking part is entirely at your consent. Your community midwife should give you information about this during your antenatal appointments if your hospital is taking part in the trial. The best available current research suggest that a ‘hands off’ approach reduces the rate of episiotomies in labour.
So there you have it! 10 ways to help reduce tearing in labour. If you would like more helpful hints and tips for birth, why not join one of our in person courses in Surrey or SW London?