8 Tips to Prevent Tearing During Labor & Birth
There are 3 main fears commonly associated with your bottom during pregnancy:
1. Pooping.
2. Tearing.
3. Hemorrhoids.
1. Pooping during labor. You can read about that here:
Bottom-Based Birth Fear #2- TEARING.
Deeeep breath in, release all the way out.
Okay, let's start. Tearing during birth is a pretty valid fear.
Before we look at ways to prevent a tear from happening, I want to encourage you to ask your care provider a few ever-important questions:
"Do you routinely perform episiotomies?"
"What is your policy regarding episiotomies?"
"Under what circumstance do you find that necessary?"
"How often do you find it necessary?"
"How do you work to avoid the need for an episiotomy?"
"How do you support women in preventing a tear?"
"How often do women in your care give birth without damage to their perineum?" (PEAR-UH-KNEE-UM)
You care provider's answers should be precise and without ridiculing you, using scare tactics or making you to feel bad for asking. If you want to prevent a tear, you definitely want to prevent a cut! Some doctors will still tell you that a cut to your goodies will lesson the damage of a tear- but that's simply not true. A common example is this: Take a piece of paper and try to tear it by pulling the ends straight out. Now, make a small cut in the middle of the paper on top and try again. Tears much easier and deeper, right? Episiotomies come with common, long lasting problems. A tear can heal much easier. Go over the circumstances with your care provider and decide ahead of time what you're okay with. It's so, so, so important that you do your research on your care providers and their backups as well! If you have the most fabulous care provider in the world...but then their backup is the one supporting you on the big day... it's important you're all on the same page! Do your research and don't be afraid to refuse the care of someone you're uncomfortable with.
"Okay, so how do I prevent tearing during childbirth?"
1- PREVENTATIVE PERINEUM CARE.
Your perineum is the stretch of tissue/muscle from your vagina to your anus. Perineum massage can help gently stretch your tender tissues as well as help you practice relaxing your pelvic floor when things start to feel uncomfortable. You want to think about creating a muscle/mind memory of sorts. A trigger that'll let you know that you're safe and everything is well. This can be done by yourself or with a partner.
Here's how you can set the stage:
Practice in a relaxing atmosphere. Dim your lights and get cozy.
If you're using essential oils during your birth, use them now. Diffuse them while you do your massage so that your memory will be triggered to relax while feeling the stretching sensations later on.
If you're using music, Childbirth in the Glory or Hypnobirthing tracts..go ahead and use them now. Same goes for mantras and affirmations. Remember, we're creating muscle/mind memories.
If you're using a rebozo, now is a good time to wrap up in it.
If you are doing this by yourself, you'll be using your thumbs.
If you're doing this with a partner, they'll be using their fingers.
Everyone should wash hands and trim nails before starting. This is important for infection prevention.
Always use an organic oil or momma/baby safe lube, NOT BABY OIL OR LOTION.
A quick search online and you’ll find dozens of perineal massage how to's. It's pretty simple. You'll start by slowly massaging down and outward (towards your anus) in a U shape motion. When it starts stinging, slow down and get comfortable with the sensation before continuing. Remember, that's one of the main reasons of doing this. To become accustomed to, and comfortable with, that stingy sensation and know how to relax in the midst of it. It'll get easier with time and you may even surprise yourself! You'll want to practice this for a few minutes each night starting a few weeks before birth. DO NOT do this once your water has broken. All things stay out of the vagina at that point! NO INFECTIONS HERE, right guys?
2-Say "No thank you" to local anesthesia.
A local anesthesia shot to help numb the sensation associated with "The Ring Of Fire"? Sounds heavenly, right? Maybe you're considering a medication free birth, but want to opt for this little helper, "just in case". If you're looking to avoid a tear, I'd encourage you to opt out. The shot can oftentimes swell your tissues, reducing their elasticity. Less elasticity= more likely to tear. Plus, your body may sting for a moment, but you usually numb out pretty quickly. Most women who have slight tears don't even notice in the moment.
3-Position yourself for pushing.
Legs spread eagle? Remember that paper experiment? If you absolutely have to be on your back, try pulling your knees a little closer together. Back birthing isn't the easiest and plays against gravity for you. You're much less likely to tear in an upright position! Squatting is great for laboring, but when it comes to pushing...it puts a whole ton of pressure on your perineum. If it's feeling good for you, stay with it! But you might be more comfortable in a hands and knees or side lying position. These are going to help slow it down a little bit and help prevent tearing. If you're confined to the bed for any reason, you can still do all of these positions! Hospital beds are pretty much adult transformer toys, and doulas are great at helping you reposition yourself.
4-Avoid getting in the tub too soon.
Personally, waterbirths are some of my favorite! They can help prevent episiotomies and severe tearing. It's important not to get in the tub right away, though. You want your baby in a good, engaged position first! Your doula and/or nurses can help you determine the right time to get in. (Usually around 7 cm.) One of the midwives I studied under told a story of a group of women in another country where the humidity was severely high. Higher than Atlanta! Where they were from, they couldn't give birth in water because these poor women would have their skin just deteriorate from being so water logged. You know when you get a good sunburn and start to peel, and your skin just rolls off in the shower? That's what was happening to them! So while water can soften your tissues, you don't want to be a plumped up raisin.
{I've linked the Evidence Based Birth study report on waterbirths so you can have a little more in depth info here.}
5-Avoid purple pushing.
Purple pushing: exactly what it sounds like. Strained face, breath held. PUUUUUSH. Way too much unnecessary pressure on your perineum.
A lot of times, what happens during birth is the mother will reach 10 centimeters and then all of a sudden, it's on! "PUSH, PUSH, PUSH!!!" But sometimes this isn’t necessarily best. Sometimes, if you give your body time, you may feel this irresistible urge to push. Your body knows what she’s doing, and doesn’t need anyone yelling at her to push. This is another very important thing to talk to your care provider about. How much time will they allow you to rest between reaching 10 centimeters and giving birth? If you're dilated at 10cm, but your baby is still high up in the birth canal, you're going to wear yourself out while possibly causing swelling and too much pressure on baby. Occasionally, birth happens quickly and once you're dilated, the game is on. But it's not uncommon to experience a rest period (up to a few hours even!) of what seems like a "stalled labor". This rest period can cause confusion and frustration if you aren't expecting it. It's a very important time for baby though, to move down and rotate into the best possible position for joining you earthside. It also allows your body time to recoup and your vagina time to prepare (stretch) for the baby coming!
If you wait until your body and baby are ready, an incredible mechanism called the "Fetus Ejection Reflex" kicks in. And a reflex it is! Unstoppable and strong- much like a sneeze. You can't help it. Your womb is moving that baby out! If you wait for this reflex, your baby will be out most likely in a few pushes instead of a few hours of pushing.
6-SLOW IT DOWN, DOWN, DOWN and OUT.
Now that you're in the position that feels best, your womb is ready to push that beautiful baby of yours out and you're comfy with that little bit of sting, here's something you should know:
The STING is KING!
Okay, not really. Actually, not at all. But it is important! It's a signal that your magnificent body sends to your mind to send back to your body to say "SLOW. IT. DOWN."
Here comes baby, let's do this gently. When the stinging comes, you'll want to breath through it instead of pushing through it- best you can. It helps to breathe like you’re pretending to blow candles out. By slowing down, you allow your tissues the chance to slowly stretch open. The slower and more controlled the stretch, the better your tissues can fan out. Remember, your body is completely capable of doing this without tearing. God didn't make you with this one single flaw. Like, "Opps, oh well. She'll just heal." No! He put this amazing design in to help you slow down and ease baby out. You can do this!
7-Remember that you are sexual.
I had the absolute honor of studying under Ina May, and in her book "Ina May's Guide to Childbirth", she states: "I like to ask female audiences what happens during a good kiss. What sensations do we feel? Eyes begin to roll, and women get interesting looks on their faces when I ask this. Finally, someone gets the courage to point to her crotch and say, "It gets all tingly." Then we agree: Engorgement happens. Birth is one of the acts that enlarge the vagina. (Sexual foreplay is another.) Probably the greatest difference between the engorgement experienced by a man and that of a woman is that he can see his, and she can't see hers. But hers is just as real and important as his- especially when she is giving birth. If her tissues aren't well-engorged when the baby's head starts to emerge, her uterus is going to keep pushing the baby's head against them anyway, forcing its way through vaginal tissues that aren't all the way softened and open. Tears happen this way. Ideally, all women would be engorged at the time of birth, because this would mean less stitching." She also states, " I've never seen a tear in a woman who was kissing her way through the pushing phase of labor or touching herself as her baby emerged."
Interesting stuff, y'all! This is a biggie, so we'll save it for a rainy day. But do yourselves a favor and go ahead and get her book!
8- Soothe it, Baby.
One last, final tip. Soothing, hot perineal compresses. You'll love 'em. You can request this at home, your birth center or any hospital. Warm, wet compresses will feel nice and cozy on your couchie. It can help you to relax these tissues as well as help you to feel physically supported while taking a little pressure off. These can be especially helpful and soothing if you're struggling with hemorrhoids, which is next in the line-up. Until then, my dear.