Worried About Tearing During Labour & Birth?
Many of my clients often say to me, that they are worried about tearing during labour and birth and what can they do to reduce tearing, when giving birth? During a vaginal birth, when the baby's head is pushing out of the vagina (crowning) the vagina stretches. The vagina is designed to stretch during birth. If you imagine an elastic band being stretched, it can grow significantly in size and this is just like the vagina. As the vagina stretches, it is then capable of allowing your baby's head to come out. However, as much as a woman's body has been perfectly designed to birth a baby, sometimes the vagina or the area between the vagina and anus (perineum) can tear. Many women do experience some degree of tearing, especially if it is their first vaginal birth. However, there are things that you can do to reduce tearing and I will tell you how...
What tears during birth?
The degree of tearing during childbirth can be categorised into 4 sections:
1st degree tears
These are small skin deep tears and usually heal on their own, naturally.
2nd degree tears
Deeper tears, that affect the muscle of the perineum and usually require stitches.
3rd degree tears
A tear that extends into the muscle that controls the anus (the anal sphincter). This will require stitches in theatre and you will be given anaesthetic, either as a spinal block or epidural.
4th degree tears
The tear extends further into the lining of the anus or rectum. This will require stitches in theatre and you will be given anaesthetic, either as a spinal block or epidural.
If you endure a 3rd or 4th degree tear, you will be given a catheter (a tube in your bladder to drain the urine) until you are able to go to the toilet by yourself. Once you are out of theatre and your anaesthetic has worn off, you will be given paracetamol and ibuprofen to manage any pain you might be in or you might be offered stronger pain relief, should you need it. You will be advised to take antibiotics to reduce any infection risk and laxatives, to help you to poo more easily and comfortably. Your midwife might make you an appointment with a physiotherapist, depending on how severe your tear is.
Why does tearing occur during birth?
Very often tearing occurs during birth when the baby is born very quickly.
How can I reduce tearing during birth?
There are a variety of things that you can try, to reduce the severity of tearing during a vaginal birth. Doing a Hypnobirthing course can be a great way to learn some of these techniques.
Allow your baby to be born slowly and gently. When your baby's head becomes visible, your midwife will ask you to do some quick short breaths or pant. Do not do strong, forced pushes or coached pushing. Your midwife will hold your baby's head and guide it out of your vagina. Listen to your body and allow your baby to emerge by themselves, slowly and gently, allowing the skin and muscles of the perineum to stretch slowly, reducing any tearing. If you feel the urge to push though, go with your instincts. Your midwife might also place a warm pad on your perineum to reduce any discomfort and tearing. Many women refer to the moment when the baby's head is crowning, as the ring of fire. As your vagina stretches, you might feel a burning sensation for a short period of time. It is really helpful to do some hypnobirthing techniques at this time. Being calm and relaxed will help the vagina to stretch more easily, so using your Hypnobirthing toolkit to help you to do this, can be really useful. Doing some visualisation, reciting some positive birth affirmations or saying a power word can be really helpful.
Certain positions can help reduce tearing. Such as kneeling, lying on your side or being on all fours. Being Upright, Forward and Open is an ideal position to be in.
Birth breathing. Do this by doing a quick, deep breath in through your nose and a longer breath out through your nose. Imagine following your baby down and out of the birth canal. Practice this breathing technique during pregnancy, when you are having a poo.
Using water. Some studies have shown that birthing your baby in water can be a really useful way to reduce tearing. The warm, lubricating water can help soften the vagina and allow it to stretch more easily and comfortably.
Perineal massage. Perineal massage during pregnancy can be a great way to stretch the perineum in preparation for birth, making it stretch more easily during the birth. The ideal time to start perineal massage is in the 3rd trimester. The National Childbirth Trust (NCT) have a useful information sheet on how to do perineal massage. There are also devices that you can buy, that help you to do perineal massage, if the idea of doing it yourself makes you feel a bit gross, uncomfortable or uneasy. Check out EPI-No. A recent client used this amazing device during pregnancy and swears by it. Read the birth story below, on how she believes EPI-NO saved her perineum.
What is an episiotomy?
Sometimes during birth, your midwife or medical professional might recommend that they do an episiotomy. An episiotomy is a small cut made to the perineum. A local anaesthetic will be used, to help numb any discomfort and stitches will be required after your baby has been born. An episiotomy will help to make the vagina a bit wider and help the baby to come out more easily. Sometimes an episiotomy is advised if severe tearing is likely, to speed up delivery if baby needs to be born quickly or if forceps or ventouse (instrumental assistance) are recommended. In England, episiotomies are not done routinely and you will need to give your permission for an episiotomy to be performed. You do not need to have an episiotomy or instrumental assistance if you do not want to. It is your decision and it is always best to approach any decision that you are unsure about, with an informed decision. Using the BRAINS acronym can be a helpful way for you to make an informed decision. BENEFITS, RISKS, ALTERNATIVES, INTUITION, NOTHING, SECOND OPINION. Using this acronym can help you to come to a decision that's right for you and your baby.
If you have had an episiotomy, you might find it a bit uncomfortable for a few weeks, until the area heals. You will initially be given paracetamol, ibuprofen or other stronger pain relief medication, shortly after your birth, to help with any discomfort. Placing a maternity pad in the freezer and then onto your vagina can help ease any pain. Pouring warm water onto your vagina/perineum when having a wee can also be helpful. When having a poo placing a clean pad onto the cut and pressing gently, can help reduce any pain. To make having a poo a bit easier, your medical professional might give you a laxative.
Make sure that you keep your perineum and vagina area clean when going to the toilet, to avoid the risk of any infection. Always wipe your bottom from front to back.
If you are at all worried about your recovery after experiencing vaginal tearing or after having an episiotomy, then contact your medical professional for advice.
Tearing during childbirth is common, but as mentioned above, there are things that you can do to reduce the severity of tearing.
Crowning During Birth - Birth Story
A recent client used EPI-NO during her pregnancy and experienced zero tears during birth! She had a few minor grazes to her vagina and didn't require any stitches. Her baby certainly wasn't small and he was born in the "Superman" position. This means that his hand was up by his head and so she had to get his head and his hand out of her vagina, at the same time. This required the vagina stretching slightly more than it would usually need to stretch, but the perineum still didn't tear. My client also stipulated in her birth plan, that she wanted her midwife to use a warm compress on the perineum, during the crowning stage of labour, which the midwife did. I believe that the combination of her baby being born slowly, the warm compress and the EPI-NO, saved the perineum from injury.
If you would like to prepare for your birth and learn more hypnobirthing techniques or learn about how to increase your likelihood of having a positive birth experience, please contact me to arrange a free 30 minute online consultation. I can offer you doula support or hypnobirthing courses, to help you to reduce any fears that you might have about birth and to feel calm, confident and in control. Visit my website to find out more or drop me an email.
I'd love to support you on your pregnancy and birth journey and hope to hear from you soon.
Julia xx