Tearing is a very common experience during vaginal births. A crowning head puts strong pressure on the skin and muscles between the vulva and anus, which often results in a tear. These tears can occur on the outer skin or can even go as deep as muscle tissue or tear as far as the anus. Ouch! Nonetheless, the vulva may tear under pressure despite its best efforts of widening.
Preventing an injury is ideal! Especially since natural tearing can lead to long-term effects such as scarring, difficulty controlling bladder functions, and discomfort with sex. Taking steps to prevent tearing before a vaginal delivery is a great way to manage your pelvic floor health.
There are a few ways mothers can try to prevent tearing:
1. Exercise and pelvic floor stretches (1)
2. Choosing a birthing position that allows the mother to be upright and leaning forward (1,2)
3. Perineal massage (3)
4. Devices to stretch the vagina leading up to the birth (3)
5. Hydration and eating foods with omega-3, vitamins E, C, and zinc to promote skin elasticity (1)
6. Preparations to help keep calm during labor (2)
7. Submersion in warm water during birth (1)
8. Breathing continuously during birth (1)
1. Exercise and pelvic floor stretches
If you’re clear to exercise while pregnant, exercise is great for blood circulation and keeps your skin healthy and elastic. Elastic vaginal tissues with ample blood circulation are well-equipped to prevent tearing. Regular exercise and pelvic floor exercises are a great way to prepare for birth. Kegels, squats, and yoga poses like downward-facing dog and child’s pose are recommended to keep your pelvic floor muscles and tissues in shape and healthy for birth! (1)
2. Choosing a birthing position that allows the mother to be upright and leaning forward
To prevent tearing, midwives recommend that the mother choose a position that involves her sitting, standing, or kneeling upright and leaning forward, not back. This way, pelvic floor muscles can work freely and are not pinned down under the rest of the body. (1,2)
One downside to the upright and forward-leaning positions is that they might involve more blood loss than reclined positions. If blood loss is an important concern of yours, there are many other alternative birthing positions that do not impose that risk, such as giving birth on your side. (1,2)
3. Perineal massage
During birth, the perineum is under a lot of pressure. Massaging the skin and muscles between the vulva and anus in the weeks leading up to the birth is one way to try to prevent tearing. There is no guarantee that this will completely prevent tears, but it has shown to lower the risk of larger tears, and also to reduce pain during recovery! It has also been shown to minimize the need for assistance during birth, such as the use of instruments or an episiotomy. Not a bad way to take the pressure off! (3,1)
4. Devices to stretch the vagina leading up to the birth
Some women stretch the vagina with a device in preparation for birth, such as an EPI-NO—an inflatable balloon device that allows gradual stretching before birth. It requires 2-3 weeks of persistent work from the mother-to-be just before the birth. The stretching should not be painful, but instead slightly uncomfortable in order to take effect. What a way to “gear up” for childbirth! (3)
5. Hydration and eating foods with omega-3, vitamins E, C, and zinc to promote skin elasticity
Hydration is another great method to prepare your skin and muscles for birth. Healthy, hydrated skin is more elastic and will be equipped to stretch and limit tearing as you work the baby out of the birth canal. Hydrated muscles function better, promote circulation and flexibility. Healthy muscles are more resilient to the pressure from pushing during vaginal deliveries. (1)
Eating a nutritious diet is another way to avoid perineal tears. Omega-3, zinc, vitamins E and C all promote healthy skin and muscles—which are instrumental in preventing tearing! Eating a variety of vegetables will supply you with vitamins E and C, as well as zinc. Omega-3 can be found in the fats of fish, seafood, flax seeds, chia seeds, pumpkin seeds, nuts, peanuts, soy, brussel sprouts, and cauliflower. (1)
6. Preparations to help keep calm during labor
A mother in labor is more comfortable and calm when she feels at home in her environment and is familiar with the people around her. Meeting and talking with your medical professional ahead of time will allow you to feel comfortable with them and share your preferences and fears. This way they will recognize your anxieties and be fully informed when they facilitate the birth. It is important to choose a medical professional that you feel comfortable with because a mother in labor is releasing lots of hormones, and “stress” hormones have shown to increase pain and muscle tension. (2,1)
A midwife’s job is to facilitate the birth and help the mother and baby feel as comfortable as possible. A midwife should also review various birthing positions ahead of time to allow the mother to choose based on her individual needs and preferences. Interviews with midwives have confirmed that the best way to keep a mother calm during the birth is to be responsive to changes and listen to her concerns. To promote skin elasticity and blood circulation in the perineum, a midwife may apply warm moist towels. Midwives should give mothers as much time as they need to allow skin and muscles to stretch and avoid tearing. (2,1)
7. Submersion in warm water during birth
An alternative birthing style with evidence of preventing tears is giving birth with your lower body submerged in warm water. Just like any other soothing bath, warm water has a relaxing effect and simultaneously keeps skin hydrated and healthy! Moisturized skin between the anus and birth canal can increase the skin’s ability to stretch and prevent tears. Another way to simulate this is having your midwife place warm moist towels on the perineum during labor. (1)
8. Breathing continuously during birth
Unlike births in movies, mothers should avoid holding their breath while pushing. Continuous, smooth breathing supplies the muscles with oxygen and makes them more effective while pushing. Don’t feel pressured to rush and tense your whole body unless instructed to during the birth. Taking things slowly and focusing on full slow breaths is relaxing and will keep the muscles from becoming too tense and vulnerable to tears. This will also provide you and the baby with valuable oxygen and allow the baby to slowly and safely make their way out. Straining and rushing may create tears as the vagina has little time to stretch. If possible, be mindful to breath throughout contractions and take your time! (1)
Conclusion
Hopefully you’ve learned something new about how to avoid natural tears! Stay healthy with exercise, deep stretches, perineal massage and by eating nutritious foods to prepare your perineal skin and muscles for delivery. Take steps to create peaceful surroundings for the birth by communicating with your medical professional ahead of time. Consider upright, forward leaning, or on-the-side birthing positions, and be sure to breathe during contractions!
References
1. Sam McCulloch Dip, 2018
Tearing During Birth – 9 Ways To Help Prevent Tearing
BellyBelly Birth & Early Parenting Immersion
2. Helena E Lindgren, Åsa Brink, and Marie Klinberg-Allvin, 2011
Fear causes tears - Perineal injuries in home birth settings. A Swedish interview study
BMC Pregnancy Childbirth; 11: 6, doi: 10.1186/1471-2393-11-6
3. Síssi Sisconeto de Freitas, Alana Leandro Cabral, Rogério de Melo Costa Pinto, Ana Paula Magalhães Resende, and Vanessa Santos Pereira Baldon, 2018
Effects of perineal preparation techniques on tissue extensibility and muscle strength: a pilot study
International Urogynecology Journal, pp- 1 to 7