Tearing During Delivery

Tearing During Delivery There is one question that undoubtedly gets asked while I'm teaching childbirth education. "Can I avoid tearing during delivery?" Having sex and the physical and emotional satisfaction a couple gets from having sex is of importance. Hearing the words vaginal and tearing in the same sentence sounds worrisome.

Let's talk about the power of the va-jay-jay and the possibility of tearing during delivery! First, your vagina is amazing! It's super elastic-like and was made to stretch, tighten, and do great things. Secondly, I want you to know that vaginal tearing during birth is common. According to ACOG, 53-79 percent of vaginal deliveries will include some type of tear or laceration. In studies where the use of episiotomies were restricted the range was lower at 44-79% (Soong and Barnes 2005; Dahlen, Homer et al. 2007). The good news is that most vaginal tearing doesn't result in adverse functional outcomes. Many are only first degree tears involving the skin, not muscle. While it might be impossible to avoid some vaginal tearing, it's possible to lower the chances of severe trauma to the perineum. Even better still, many women don't feel the tearing during delivery. Many, not all. That's because of the immense amount of pressure and intensity happening during this stage of labor. Some do, some don't, you might.

Why does tearing occur? Like other muscles in your body your perineum muscles need to time to warm up before they are stretched to capacity. When forceful pushing happens and your baby descends in the birth canal too quickly we tend to see more tearing. Your baby's position and your position can also play a role. Examples of fetal positioning that can cause more tearing during delivery are: a posterior baby, breech baby, or baby born with a nuchal hand. The use of an episiotomy can result in tearing. The tearing can sometimes be worse with an episiotomy versus a natural tear. A skillful provider and clear communication can prove to be beneficial to your crown jewels. Wait, did you think an episiotomy would keep a vagina from tearing? Well, you are not alone. In our Confident Birth & Baby class we cover this topic and even have an exercise with visual to specifically bust this myth! In addition, a first vaginal birth also increases the chances of tearing during delivery, but there's not a single things that can be done about that now is there? Lastly, the use of forceps or vacuum assisted deliveries also increases the chances you will tear with or without an episiotomy being performed.

What can I do to lower my risk for tearing during delivery? Being proactive in your approach can help lower your risk for vaginal and labial tears. Positions where you are reclined/lying back close the pelvic outlet, put pressure on your tailbone, and increase the risk for injury to your tailbone. Those same positions increase your risk for tearing during delivery.

Position Matters! Get up and use positions that are most comfortable for you whenever possible! Being on all fours, also known as the hands and knees position will relieve some of the pressure from your back and your tailbone. Biologically it makes sense. Side-lying with open pelvis is another great position, especially for women who are exhausted from a lengthy labor. Squatting does require more energy and can be intense, but it increases the pelvic outlet by up to 28%. Squatting can be done while standing.It can also be done while sitting on the edge of the hospital bed using a squat bar. Ask your hospital if they have one!

Get warm water and or oil on the perineum! Warm water is relaxing and helps to reduce pain, pressure, and the intensity of the stretch. Additionally, warm water and or oil can help the birthing woman keep her perineum more relaxed. A more relaxed perineum can help lower the risk of tearing as her baby's head exits the birth canal. In my professional opinion I also think it helps woman visualize more easily. There is some controversy over whether or not birthing in water is safe. Notice I didn't say you should give birth in the water. I simply stated to utilize warm water. How you decide to do that is up to what you and your provider feel is best. We support your choice 100%. If you are giving birth at home or in a birth center water birth is usually always an option. If you are birthing in any hospital in Jacksonville, FL a water birth is not an option. So, how then do you accomplish warm water and or oil while in a hospital? Warm wet wash cloths applied to the perineum as your baby descends is one option. Having warm oil applied to the perineum and massaged into the vagina is another option. This can be done by the birthing woman, her partner, or her provider if he/she is comfortable with this.

Avoid routine episiotomy! Declining a routine episiotomy decreases your chances of tearing. Episiotomies have been associated with increased risk of postpartum anal incontinence in addition to other things. Talk with your provider about your wishes to avoid routine episiotomy ahead of time. Also ask them to consider an evidence-based approach when caring for you in labor.

Last, but not least, breathe your baby out! That's right, breathe your baby out. As the widest part of the head emerges, or crowns you may experience an intense burning sensation known to many as "the ring of fire". Remember earlier I said, "Some do, some don't, you might"? As crowning happens and when the situation allows for it you'll want to stop actively pushing. Instead pant through this part. Doing so allows the perineum and labia more time to stretch around your baby’s head. I'm not going to lie to you; this can present a challenge for many. This sensation may scream at you to, "Get 'em out now", but if you can pant and breathe through this it can be helpful.

I've spent numerous hours teaching about this subject, but I want to close with a few final thoughts. These things can help to lower your risk of tearing and the severity of the tearing if it occurs. Sometimes though you do all the things and you still tear. With some skillful suturing by your doctor or midwife and intentional mindfulness of your part during the healing process you can bring sexy back to your lady bits! Many first degree tears don't need any suturing at all!

I like to help women and their partners celebrate labial uniqueness, especially when we're talking about changes that occur in childbirth. Labia from one woman to the next and even one side to the other are so unique and different. Most vaginas heal damn near perfectly after labial tearing and are another variation of normal, healthy, and beautiful!

Happy Birth and parenting!

~Elizabeth Luke