How Do I Avoid Tearing During Birth?
We've all heard (or read) the horror stories. That cousin, or friend of ours. Or that random loud mouthed mom on a mom's group. All of whom are wayyyy too happy to scare the living crap out of us just before birth by meticulously recounting their gruesome experience not being able to walk for weeks and weeks after birth because of how badly they tore. Or maybe it was their story about how an episiotomy was suddenly performed, and now thanks to 'Dr. Trigger Happy', they have permanent damage to their vaginas, and sex with their partners are forever ruined because of it. But of course, they always end with the staple "but all that matters is that baby is here and healthy". (cough, cough....while that is one of the things that matters the most, that absolutely is NOT all that matters....)
And so there we are now, having unintentionally become someone's emotional garbage dump, and we're suddenly left with an unwelcome panic attack as the only company we have, and no ability to even indulge in wine to calm our nerves. Yay!! (NOT!) Of course at this point, we're wanting to frantically scramble to call up our OB's office and demand an elective cesarean section because there is NO WAY IN HELL we're letting a child, or anyone else for that matter, do that kind of damage to an area of our body we rather enjoy for the most part.
But before you go all gung ho on the bandwagon of a major abdominal surgery.....WAIT! There are actually a lot of things you can do to help prevent this from happening to you, and there are also some important facts you should know about tearing versus an episiotomy that may in fact change your mind and calm down those cray cray anxiety attacks. We thought we would take some time to lay all that out for you here, in one handy place, so that you can take this blog with you to your doctor or midwife's office, and discuss this with them well ahead of your birth! That way, you can get even more peace of mind when heading into the unknown world of labour and delivery. And who doesn't love that?!
First up on the list......
HAVE LOTS OF SEX....And Make Sure You Orgasm!
*gasp!* Yes, we've totally gone there. And there's a good reason we've gone there. Because the muscles that get exercised *down there* when you experience the Big 'O' are super important when it comes to preserving the natural elasticity of your cervix and your perineum when it comes time for your little one to make their grand entrance into this world. It also helps to continue to improve and maintain good blood flow to that region, all of which is needed to help those tissues stretch slowly to make way for baby's body to pass through them. So keep that love life alive!!!
If you're interested in tips and tricks to do that during pregnancy without worrying about the well being of you or baby, watch for an upcoming guest blog post and podcast we will be hosting soon with Sex Education Expert Extraordinaire, Tynan Rhea on how to keep that flame alive and well during and especially after pregnancy.
Choose Your Healthcare Provider & Birth Place Carefully
Why would we include this? Because not all providers are going to approach birth the same way, and this actually makes a HUGE difference in how your birth plays out, especially when that fateful time comes to push your precious baby out. Having attended hundreds and hundreds of births between all of us doulas in the past, we have firsthand experience witnessing how various doctors and midwives approach the pushing phase of labour and delivery. Some providers are aggressive and do what's called "coached pushing" with all of their clients, and others are very patient and gentle in their approach, relying on the birthing person's 'fetal ejection reflex' (future blog post on Fetal Ejection Reflex to come...) to help guide that baby through the birth canal in just the right way. To find out more about which side your current provider sits on, ask them questions such as what their personal opinion is on natural tearing as opposed to performing an episiotomy. Also ask what their personal episiotomy rate is (any provider who cannot provide this is either not being truthful, or is likely to not be a provider who puts much thought into it, and therefore won't likely put much thought into what is important to you during delivery when it comes to tearing or avoiding it). The other question to ask is what types of techniques does your provider use in order to support your perineum during the pushing phase.
Someone who is skilled at helping their clients birth as gently and easily as possible will likely be familiar with physically supporting the perineum with either a hot compress during the pushing phase, or massaging it with fresh virgin olive oil/coconut oil, or even helping you get into a more optimal position to push in so that it naturally helps your body stretch and open for baby without damage to the surrounding tissues. They will also likely avoid the "coached pushing" and opt to allow you to openly communicate with them during the pushing phase as to what your body is telling you to do. (And trust us when we say, your body will tell you exactly when and how hard to push!)
In general, evidence shows that the risk of tearing or episiotomies being needed are greatly reduced under the care of midwives versus either an ObGyn or family physician. Again, though, this is a general statement, and regardless of who you have as your care provider, remember to ask the above questions of them to know for sure!
Practice Perineal Massage
If this is your first baby, your body will definitely not be used to the amount of stretching that your perineum will have to endure during delivery of that babe, so it's a really good idea to prepare your perineum well ahead of time by doing what's called perineal massage. This massage and stretching technique has been proven to greatly reduce the risk of tearing during childbirth. Here is a diagram to show the technique itself, and can either be performed by you as the pregnant person, or by your partner, or even your care provider during the pushing phase with the help of some freshly opened extra virgin olive oil.
Rules for performing perineal massage either on yourself or with the help of someone else:
1. Always make sure you or the person performing it either washes their hands for at least 5 minutes with warm, soapy water, or they put on sterile gloves
2. Make sure you or the person performing it trims their nails well down before doing this, so as to avoid injury during this process
3. Have a fresh amount of extra virgin olive or coconut oil, or a lubricant that you do not have any allergy or sensitivity to, in order to help lubricate the massage technique and the tissues so that they naturally stretch more effectively
4. If you are doing the massage yourself, make sure you have a mirror that you can place in such a way that you can see what you're doing
Click here for a step by step instruction on how to perform an effective perineal massage, before attempting to do so yourself.
Labour (And Inquire About Delivering) In Water
There truly are soooooo many amazing benefits to labouring and delivering in water. One of those benefits is that the constant submersion of your perineum in the warm water helps naturally lubricate and soften those tissues, perfectly preparing them to stretch more easily during the pushing phase of delivery. It can also greatly ease the sensation as baby's head descends down and through those tissues, often times avoiding the extreme "ring of fire" type feelings as well, when coupled with allowing your body to push according to your fetal ejection reflex.
We rent out easy to set up birthing pools JUST for such occasions, if you're interested in having this as part of your labour or delivery plans we would be happy to get that set up for you. Click here to get to our Rentals page!
Get Into A Good Position While Pushing
Depending on how you are positioned while pushing, this could greatly determine whether or not you tear or don't tear during delivery. Laying flat on your back is ergonomically the worst position for your body to adjust to, and so this is one of the reasons you might want to reconsider the use of an epidural, or ask if it's possible to have a light epidural dose so that you can still feel and understand the communication those sensations during the pushing phase are sending to your body. Too heavy of an epidural results not only a very large increase of risk of tearing, but it also can fool the body into thinking you are pushing baby out, when in fact your pushing reflex has been interrupted completely and you are not pushing baby out. That can automatically increase risks like shoulder dystocia (when the shoulders get stuck behind the pelvic bones), the need for forceps or vacuum assisted delivery, as well as the risk for needing an emergency cesarean section.
There are typically three types of positions that generally work the best in terms of pushing with minimal to no amount of perineum damage.
1. On all fours, on your hands and knees
2. Lying on your side, with your top leg held up
3. Leaning forward in a well supported standing, kneeling or sitting position (sitting on a birthing stool for instance)
However, the most ideal position for you to be in is the one that your body screams for you to be in during that phase of delivery. It will always dictate to you what will feel and be best. Listen to it, follow it, and that will always be the path of least resistance!
HIRE A DOULA!
We know, we know. Most of your reading this are either rolling your eyes or shaking your head right about now. But wait! There's a good reason we are stressing this, and it's not just because we feel so passionate about providing you with amazing, personalized support during your labour and delivery. (okay, and snuggle a newborn baby for half a second....but we digress)
Studies have actually shown that having a well trained, professional birth support worker (a doula, not just a crazy aunt or that one super fun best friend of yours) present with you during labour and delivery, can vastly improve a NUMBER of risk factors associated with birth, including the risk of tearing or needing an episiotomy. The improvement was as much as 50-60% in some areas, 50% specifically in the areas of complications during birth!
So head over to get to know some of our amazing Birth Doulas, to schedule your no-obligation, FREE interview today!
Avoid Having An Episiotomy
Now, we have to just outline, there are a minority of cases where agreeing to have an episiotomy is medically needed, and is life saving for both baby and birthing person. But the vast majority of episiotomies are being performed as a way to speed up the birthing process for the sake of the care provider's schedule, or personal preferences, rather than for a medically important reason. There is a lot of question as well as to whether the constant and unnatural insistence of care providers to have birthing individuals be placed on their backs in order to push their baby out, may also be contributing to the increased "need" for an episiotomy to be performed, when all that may have helped avoid it would have been to allow the birthing person to change to a more ergonomically driven position (such as what was outlined above). Be that as it may, there are some important things to understand about an episiotomy versus tearing naturally, that it's so worth considering before agreeing to allow your provider to snip you from here to next Sunday.
When skin or tissues tear by being pulled apart, versus being sliced apart with a precision instrument like a scalpel or surgical scissors, the tissue tears with lots of uneven, jagged edges on either side of that tear. This is actually VERY important to the healing process and how the body heals itself. Think of those jagged edges as a whole bunch of tiny little arms. When the body goes to heal that wound, those arms start stretching and reaching out for each other until they find what they need on the other side to grab onto and merge seamlessly to heal the wound. Regardless of stitches being needed or not, this is the process that occurs to help that wound heal the most quickly and efficiently, and safely.
When tissues are cut or sliced with a surgical instrument, however, it creates perfectly straight edges instead of jagged ones. The problem with that is all those little tiny "arms" have been cut off, and no longer know how to effectively grasp each other. And so the healing takes much, much longer, often with permanent nerve and bladder damage, pelvic floor damage, painful sex and much, much higher risks of infections occurring because of how long it takes to heal properly. The other risk to be aware of is that the scar tissue created by that cut will prevent the perineum from being able to stretch properly during any future births, putting you now at a much higher risk of having 3rd or 4th degree tears during any future vaginal birth.
As you can see, there are LOTS of ways to help reduce your risk of tearing during birth, but to be quite honest, if you employ all these tips above, and you still end up tearing a bit, chances are it will be very minimal, you won't feel it, and recovery will be SUPER fast and easy on you. So, just know, YOU'VE TOTALLY GOT THIS BIRTH WARRIOR!! Don't forget to keep your eyes peeled for our announcement of our updated podcast on this and many other birth-related topics.
Did you like this list of handy tips? Are there any other tips that you found were especially helpful that we forgot to include on this list? Hit us up in the comments below and let us know!!