How to Prevent a Tear in Birth
As a pelvic floor therapist I work with many women who tore during birth.
Their primary concern is vaginal pain or issues with bladder control.
These however, are not the only side effects of a tear.
For you to completely understand why, you may want to prevent a tear, let’s first look at the different sizes of tears and what they can cause.
There are 4 sizes or degrees of tearing.
1st Degree - small, skin-deep tear, which usually heals naturally
2nd Degree - tear in the skin that also impacts the muscle of the perineum, may need stitches
3nd Degree - tear that involves the skin and perineum muscle extending away from the vagina toward the anus, requires stitches
4th Degree - a tear that extends through the anus sphincter and may reach into the rectum, requires surgical repair
The severity of the tear usually corresponds to the severity of symptoms to some degree, but not fully. For example, a fourth degree tear is more likely to result in bowel symptoms like leakage where as a first or second degree tear may not have any pelvic floor symptoms.
Here are typical symptoms that may occur after tearing:
vagina, vulva, perineum, or rectal pain upon touch, voiding, pooping or intimacy
bladder control issues - frequency, urgency, incontinence
bowel control issues - urgency, incontinence (of either gas or stool)
pelvic pressure or heaviness
There is evidence that tells us that 9 in 10 women will experience some degree of tearing during birth, with 1 in 100 women experiencing a more severe tear.
However, there is also emerging evidence that helps us better understand how to prevent tearing, so that you don’t have to deal with the possible long term side effects.
There are factors that increase your risk of to tearing by no more than 2-7% such as (listed in increasing risk):
Baby size - > 8 pounds 13 ounces
Induced labor
Epidural
Baby facing up
First baby
Second (pushing) stage of labor is more than 1 hour
Baby shoulder(s) stuck
Assisted delivery (forceps or vacuum)
Some of these factors you have no control over, but others you can make a decision to use or not. But either way there are strategies you can put into practice during your pregnancy and during birth that can reduce your risk of tearing.
You may have heard of perinuem massage, but it goes well beyond this. Massaging your perineum, the way most instructions tell you to do focuses on just stretching the tissue. But, that’s not the point. Your pelvic floor (the muscles and tissues your baby needs to pass through) stretches 3 times it normal length to allow baby out. So what’s the point?
I’ll tell you and what to practice.
Even though your pelvic floor has the ability to tremendously stretch, it may do the opposite when you are experiencing birth pains. Especially, if your pelvic floor is habitually tighter or contracts under stress.
But you may not know this until you explore your pelvic floor and it’s response to stress, pain and distraction.
The two main goals for practicing prior to birth is to improve your mind-body connection & physical ability.
To achieve this there are 4 strategies that I teach my patients:
Pelvic floor breathing - focusing on opening and lengthening the pelvic floor on inhale
Pelvic floor release - letting go of tension in your pelvic floor while sitting on a ball
Perineum massage - stretching the perineum and focusing on your response both physically & mentally
Pelvic floor massage - massage the internal pelvic floor muscles to release tension & calm any contractile response
These need to be practiced starting at least 4 weeks prior to your due date, however it doesn’t hurt to begin exploration of the pelvic floor earlier in your third trimester.
There are however other factors to consider that can influence your pelvic floor, such as labor and birth position, baby position, how you push and how safe you feel.
Practicing your pelvic floor breathing in positions that promote lengthening of the pelvic floor, such as supported squats. As well as practicing positions that assist in optimal baby position and gravity assist of baby’s decent, such as supported standing, all fours, or sidelying.
Understanding the mechanics of pushing is also important to avoid contracting instead of relaxing the pelvic floor. You may be asked to “push like you are doing a Kegel,” this is the opposite of what you want to do. So practicing opening and lengthening the pelvic floor in a controlled bear down will create motor pathways and mind-body connection to how your body should respond in birth, supporting the natural process.
Working with your provider and anyone who may be at your birth to make sure you are heard, listened to and working together prior to your birth. So you feel safe in your birth space. When you don’t feel safe, this can cause you to unconsciously contract slowing labor.
Another factor to consider during birth is using a warm compress on your perineum.
If you want to learn more about your pelvic floor to connect to these strategies on your own check out my self assessment.