Ouch. Not a nice thought, is it? I was really terrified of tearing when I was pregnant with my first child, but luckily I was introduced to the techniques below, and I started to feel a lot better about it and worry less. In the end I had a small graze, but had no idea about it until the midwife told me when she checked me over after the birth.
If you are wondering what I’m talking about, I mean tearing to the skin of the perineum (the bit of skin between the vagina and anus), which stretches loads during childbirth – don’t worry, it’s designed to do that! It’s pretty common for women to experience some trauma to the perineum during birth, but the good news is there are things you can do to reduce your chances of experiencing a tear.
1. Avoid directed pushing
You know when you see women giving birth on TV and films and the midwives and doctors are shouting, “Come on, push!”? It turns out that’s not such a great idea. Several studies have found that directing women to push, especially whilst they are lying down, is actually dangerous for mothers and babies and can increase the risk of trauma to the perineum. So what to do instead? Let your body do the work. The natural expulsive reflex that kicks in during the second stage of labour will ensure your baby is born. It doesn’t mean you won’t push, but that you follow your body’s lead and push when you feel the urge, rather than when you are told to do so.
2. Stay off your back
When lying down on your back, your pelvis cannot open fully to allow the baby to descend and be born as easily as when you adopt upright or forward leaning positions during labour and birth. The practice of lying women on their backs with their legs up to give birth (called the lithotomy position) was invented by doctors to allow easier access to the ‘business end’ of things, so that they could see what was happening and feel involved. Of course, if assisted delivery is necessary then the lithotomy position is used, but during a normal birth then staying upright and forward makes your labour faster, more comfortable and reduces your risk of perineal tearing.
3. Stay calm
I know, easier said than done, but staying calm and relaxed allows your perineum to stretch gently and slowly to allow your baby’s head to pass through. If you tense up, then your baby’s head will be pushing against hard, tense muscle, which is much more likely to cause discomfort and trauma to both you and your baby. To stay calm, practice slow, deep breathing and notice and release tension in your body. This is much easier to do in labour if you’ve practiced during pregnancy, so look for a childbirth preparation class that teaches relaxation and calm breathing techniques.
4. Perineal massage
Regularly massaging the skin between the vagina and anus with oil from 34 weeks has been shown to reduce the likelihood of tearing in first time mothers. If you feel grossed out by this then I hear you, but it is SO worth it. I think getting used to sensations in that area of your body is key, so that when you feel them in childbirth it’s not such a surprise and you are able to remain relaxed (see above). Here’s how to do it.
5. Give birth in water
Or at least spend some time in water during your labour. Whilst there is little evidence to suggest that this reduces tearing, there is no shortage of midwives who swear by it, probably because the water softens the tissue of the perineum thereby allowing it to stretch more easily.
OK, I know I said 5 things, but here’s a bonus one for you. I think there’s a lot to be said for releasing any fear about tearing before the birth, as fear creates tension in your body, and tension means that there is resistance and your body isn’t able to relax, open and stretch as it is designed to. Try writing out an affirmation and repeating it to yourself a couple of times a day. Something like, ‘My perineum is perfectly designed to relax and allow my baby to pass gently through.’ It might sound a bit weird if you’ve never used affirmations before, but elite athletes and sportspeople use them all the time to improve their performance and get over their fears. If it’s good enough for Jessica Ennis-Hill and the Williams sisters then it’s good enough for me.
Photo by Frank de Kleine CC BY
I'm Liz Dew, founder of SheffieldHypnobirthing.com and I love a good chat about birth. This blog is where I explore some of the things that I find amazing, frustrating, or fascinating about birth and birth culture. Grab a cuppa and dive in.