Three Tips to Prevent Tearing During Birth
I can’t even begin to explain the amount of women post-birth who have mentioned that it would’ve been nice to know and be a little more prepared for the things that could potentially happen during the birth experience. They felt that it would’ve reduced the amount of shock and just general feeling of being left in the dark about these things that they had never even known were potential, or even worse, likely to happen during the birth experience! I feel that it is part of my responsibility as a healthcare provider to educate and empower women, so this blog post is dedicated to do just that. Tearing is a very real possibility during the birth experience; however, in this blog post I’m going to share three tips that are research backed ways to help prevent tearing during birth.
Tip #1: Talk to your doctor about “the hands off approach”
The hands off approach has actually been shown to be the MOST effective for protecting the perineum during childbirth (*). So, what exactly is the hands off approach? Well, it’s exactly as it sounds! This approach is the idea that the more the birthing professionals DO, the more likely it is to experience tearing. These things they may be doing to try to help during the delivery, can actually cause more harm; such as:
Perineal massage - massaging the perineal tissues to try to stretch and relax the tissue in preparation for baby’s exit
Episiotomy - cutting the tissue to widen the vagina
Modified Ritgen maneuver - attempting to maneuver the baby’s head into a chin tucked position by pushing on the outside of the rectal tissue
So, with the understanding that DOING more can actually cause further damage, come prepared to your next appointment with your doctor. Ask questions about their typical standard of practice during the birth experience and fill your doctor in on how you would like to take the more “hands off” approach.
Tip #2: Consider a more upright birthing position
If you choose an unmedicated birth, you will definitely have more options for your birth position and the ability to choose an upright position. In a previous blog, I covered this topic IN DEPTH, so click here for a refresher on Understanding Your Birthing Position Options! If you choose or require a medicated birth, no worries! Evidence leans towards a side-lying position for the best option to prevent severe perineal tearing. But overall, the research (*) determined that an upright birthing position led to decreased severe perineal tearing (and side-lying position being the best alternative for those with an epidural).
Again, this is a conversation you can have with your doctor ahead of time. You may want to ask if there are any hospital policies on birthing positions with or without an epidural - sometimes there are safety regulations on what the hospital will allow with a medicated birth. You can also discuss with your doctor a few positions you may want to try, and ensure that you are both on the same page! The key here is the ability to openly communicate with your birthing team - whoever that is - and be able to express your thoughts and ideas for how you want your birth experience to go!
Tip # 3: Breathe through the pushing phase
When you picture a woman going through the pushing phase, you may have an image of a woman bearing down. Bearing down goes hand in hand with also holding your breath in order to use that built up pressure to add force to your push. The problem with that; however, is that sometimes pushing as hard as you absolutely can may actually cause the baby to come through the canal too quickly, exiting abruptly and not allowing enough time for the tissue to adjust to the pressure and with a gradual stretch over time.
An alternative to the “holding breath and bearing down” approach is to instead, breathe in through the nose and focus on feeling your pelvic floor open up. As you prepare for another big push, purse your lips and breathe out while pushing. It is often said a low moan or groan can help the pelvic floor to relax and open up as well during that pushing phase! This approach may slow down the pushing phase, but it allows baby’s head to massage the perineum, which will help to slowly stretch and prepare the tissue for birth!
And lastly, in the spirit of not allowing you to feel left in the dark from all the things that could happen during child birth, I’m going to be blunt. Tearing may happen. You may feel like you did everything RIGHT. You listened to all the tips and tricks and you implemented everything you possibly could, and you still MIGHT tear. That’s the reality of birth! And it doesn’t mean that you did anything wrong - quite the opposite - these things just happen sometimes no matter how much we work to prevent them! But, knowing that might happen, preparing yourself as much as you can both mentally and physically, is going to set you up so much better in the after math than not knowing the potential for tearing to even occur in the first place!
None of this is to make you fearful of the birthing experience, but instead, to give you the education and awareness needed in order to feel prepared and empowered! These three tips are things that you CAN do to take back some control - to give you research backed tips to weave into your birthing plan and implement to the best of your ability when the time comes. And when the time comes, you will be AMAZING!
If tearing during birth is a real concern for you and you are looking for support during your pregnancy to prepare for labor and birth, my NEW Prenatal Program is an amazing option! If you’re currently pregnant and looking for an all encompassing program, Mind Body Core Prenatal Program is it! Click the button below to check it out.
Doc Lizzie
*(Zang et al., 2020); (Dekker, 2022)