Three Tips to Avoid Perineal Tearing in Birth

Worried about perineal tearing in birth? Consider these ideas…

One of the most common fears my clients express has to do with perineal tearing in birth. So many women are afraid to “tear” during childbirth, and rightfully so! If you’re anxious about it, you’re not alone.

What are perineal tears?

Perineal tearing happens when the tissues surrounding the perineum tear during birth as the baby passes through. Some tears are very minor and require simple comforting care, while others are larger and deeper and require sutures from your provider. Perineal tears are graded from 1st degree (skin abrasion) to 4th degree (passing through the anal sphincter and tissues). The vast majority of tears are minor and can heal simply on their own.

Perineal tearing is very common. It happens in approximately 44% – 79% of all births. However, less than 3% of these tears are third or fourth degree tears. You are more likely to experience tearing if you are having your first baby or have a vacuum or forceps delivery.

Tears can range from mildly uncomfortable to extremely painful. Also, the tissues in the vulva/perineal area don’t always numb well for sutures, which can make repairs painful as well. The healing process can be very rough and most mothers report it as very uncomfortable. It’s important to understand how to avoid tearing in order to have the best birth and postpartum experience possible!

Perineal tears suck! (There, I said it!) Who wants to deal with that?

There are many factors to consider when examining the topic of perineal tears. Firstly, there is a genetic component that gives some tissues greater ability to stretch, flex, and heal than others. Secondly, birthing choices and practices can offer you a better chance (but no guarantee) of avoiding this discomfort. Also, your baby’s size and position can also make you more likely to experience a tear. Babies who are born with hands/arms up or are in an alternative position at birth can make you more likely to tear as well. There’s no BIG SECRET to avoid tearing, and sometimes it just happens no matter what you to. Awareness of a few simple ideas can give you insight to prevention.

3 Ways to Avoid Perineal Tearing

Nutrition, Movement, and Body Love

As you are well aware, nutrition is critical to support a healthy pregnancy, birth, and postpartum experience. Nutrition is one of the most important things you can do to support your journey. If we think of labor like a marathon, then we can easily see how it is important to prepare your body.

Consumption of adequate protein, collagen, and omega-3 fats can help support healthy tissue and muscles. Also, good hydration will help keep your skin and tissue healthy and support circulation. These same elements can support healing after birth as well.

Movement is a critical component to the health of our bodies every day, and especially during pregnancy. Pelvic floor exercises that practice strengthening and relaxing your muscles can help prepare your body for birth. Natural daily movements, proper alignment, and incorporating squatting into your movement routine can help improve circulation, strength, and flexibility.

Although controversial, perineal massage can help prevent tears during birth. There are many resources available to learn how to do this. In this massage, you are essentially stretching and preparing your perineal tissues for birth. In one study, mothers who were randomly assigned to do perineal massage experienced a 10% decreased risk of tears that required stitches. This benefit applied to first time mothers only. Research shows that this practice is not hugely beneficial, but something to consider if it resonates with you.

Supportive Birth Positions

Birthing position matters. Imagine how it feels while you are squatting. You can feel the tissues across your perineal area tighten and stretch. This is great for preparing your body, but might not always be the best at preventing tearing. Some research shows that upright positions could potentially slightly increase the risk of second degree tears. However, it lowers your risk of episiotomy.

If you have an epidural, lying flat on your back can increase your risk of tearing. Using a side-lying position while pushing can help prevent tears. One study reported that the use of a side-lying position increased the rate of having an intact perineum (no tears) from 12% to 40%. Getting off your back is beneficial for most birthing people, as it also allows your sacrum to move and make more room for your baby to move through the pelvis.

Listen to Your Body

One of the most effective ways to prevent tearing is to listen to your body. Following principles of physiological birth allows us to listen to our body’s cues about when and how to push. Wait to push until you feel the urge to do so and avoid coached pushing. Coached pushing means that someone is telling you when and how to push rather than listening to your body’s cues. If you wait for the urge to push (fetal ejection reflex), then your body will give you important feedback. As your baby is crowning, you can slow down and use your breath to move your baby through slowly.

As your doula, I can help you plan some strategies to prevent tearing. Let’s get this into your birth plan and ease your mind. We can work together to manifest the best birth experience possible. Even if you do experience tearing (which sometimes happens no matter what you do), we can create some healing and nourishing strategies to get you feeling your best.

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