Natural Birth

how to prevent tearing during childbirth

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If you’ve thought about birthing a baby, chances are you have also thought about perineal tearing. Tearing during childbirth is a common concern during pregnancy, especially for first time mamas. While perineal tears are not uncommon, there are effective ways you can minimize the risk. In this blog post, we’ll explore practical tips and medical insights that can help you protect your perineum during childbirth.

What is a perineal tear?

This is a tearing of the skin between the vagina and the rectum.

What are the risk factors for perineal tearing?

  1. Your Provider- Some providers are trained to perform an episiotomy, even without consent from the patient. Episiotomies have been proven to contribute to more severe perineal tearing. Discuss this with your provider at an office visit and feel ok switching providers if they typically perform episiotomies during birth.
  2. Natural vs medicated birth- with a natural birth, mama is able to feel when it is appropriate to push during the pushing phase. With use of an epidural, mama has to rely on the nursing staff to know when to push. This can lead to pushing too forcefully or too much too soon.
  3. Your Birth Setting- Having a peaceful, darker, and quiet environment can allow labor to progress and mama to be in “the zone.” This can also help mama to relax and know when it is the best time to push baby out.
  4. How Many Babies You Have Delivered- If this is the first vaginal birth, sometimes it is harder for the perineal tissue to stretch slowly to accommodate baby.
  5. Higher Birth Weight Of Baby- there is an increased risk of tearing if baby is bigger. Still, severe tears are much less common than smaller tears.
  6. Epistiomy- episiotomies have been proven to increase the severity of tearing and associated pain.
  7. Use Of Forceps Or Vacuum
  8. Shoulder Dystocia
  9. Prolonged Pushing Phase
  10. Quick Pushing Phase
  11. Baby Being Face Up
  12. Family History

How common are perineal tears?

Perineal tears are very common, especially for first time mamas. The current statistic is 90% of births will result in some degree of perineal tearing (1). The rate of severe tearing is 3-7%.

Perineal tear vs episiotomy

Episiotomies were discovered in the 1920’s with the idea of creating a surgical tear to allow more room for the baby. A surgical tear is a straight line that tends to be easier to stitch up than a more unpredictable perineal tear. However, this method has been proven to be more detrimental than helpful. Studies have proven that episiotomies increase the risk of severe tearing compared with mamas who did not receive an episiotomy.

Complications from perineal tear

  1. Pain with sex
  2. Incontinence of bowel or bladder
  3. Postpartum depression
  4. PTSD
  5. Traumatic event

The severities of perineal tears:

  1. 1st degree: a small tear of just the skin below the vagina. This usually heals on its own.
  2. 2nd degree: a tear extending deeper into the perineal muscles. This usually requires stitches
  3. 3rd degree: A larger tear that extends into the anal sphincter
  4. 4th degree: The most severe, extending through the anal sphincter muscle and to the anus

9 ways to prevent tearing during childbirth

  1. Avoid episiotomy: research has found that episiotomies lead to severe tears
    • Ask your provider ahead of time what their episiotomy rate is. It should be less than 1%. Make sure to communicate that you DO NOT want to have an episiotomy in your birth.
  2. Birthing positions: without an epidural, birthing upright (sitting, hands and knees, squatting) is best; with an epidural, pushing in the sidelying position with delayed pushing was best
  3. Warm compress between pushes
  4. Perineal Massage during labor (usually done by the provider between pushes)- gentle massage with water-soluble lubriant
  5. Breathing while pushing (breathing the baby out)- not holding breath while pushing.
  6. Don’t scream. Instead of screaming, do a low moaning sound like a low “moooooo” or “ahhhhh” while you are pushing.
  7. Plan for slow and gentle crowning of the fetal head.
    • There are ways you can prepare for this, such as not pushing too hard too soon, trying to allow baby to descend slowly and being in those upright birthing positions can help. It is also important to stay relaxed during this time and allow your tissues to slow stretch to accommodate baby.
  8. Have someone, like a family member or doula advocate for a calm, quiet birthing space. This can allow the limbic system of the brain to be the dominant communicator, which helps the mind and body to work together to progress in labor.
  9. Have partner or doula advocate to allow mama to know when to push and not have the hospital staff input on when to push (unless of course and epidural has been used. In that case, mama may need help knowing when to push).
  10. “Hands-off” approach from the provider. This means that the provider doesn’t touch the baby or the perineum at all during the pushing phase. This has been proven to reduce the episiotomy rate, which could help in preventing perineal tearing (2).

Check out this video on ways to prevent tearing during childbirth:

5 ways to prevent tearing during childbirth

What is the ring of fire?

This term refers to the burning sensation felt when baby’s head is crowning. This can be a cue to slow down and allow the baby’s head to crown slowly.

My Favorite Labor prep resources:

  1. The Bradley Method Book– Husband-Coached Childbirth
  2. Built To Birth Course– Bridget Teyler
  3. The Mighty Mama Movement Course

Helpful labor tools:

  1. Peanut ball
  2. Birthing Ball

If you are preparing for natural birth, check out this post:


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References

  1. Perineal tears during childbirth | RCOG. RCOG. Published 2019. Accessed December 23, 2024. https://www.rcog.org.uk/for-the-public/perineal-tears-and-episiotomies-in-childbirth/perineal-tears-during-childbirth/
  2. ‌Replay of The Evidence on the Top 5 Ways to Prevent Tearing during Childbirth – Evidence Based Birth®. Evidence Based Birth®. Published October 24, 2021. Accessed December 23, 2024. https://evidencebasedbirth.com/replay-of-the-evidence-on-the-top-5-ways-to-prevent-tearing-during-childbirth/

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This newsletter will provide notification of resources available regarding health and wellness for women of all ages. You won't want to miss it!