Teaaaaaaring. Probably one of the things women are most aware of when going into birth. Will it hurt? Will it heal? Will I be left looking deformed? Will my partner still like me?! The thought of someone stitching you up down there probably makes you wanna cross your legs? This is all emotional stuff. These perceptions may be from other people's stories or stuff you've read online - but it goes deeper than the tear itself.
Lets start from the beginning.
What is your Perineum?
Your perineum is the area of skin and muscle between your anus and vaginal opening. It is way more than just a bit of redundant tissue, it has a job. Weird, right? Aside from separating holes and reducing infection, the skin of the perineum is made to stretch. It is made to tear. It is made to heal. It supports the birth of your baby by streeeeeetching wide, so the head can get through. On the way though, it can overstretch and tear. This is okay.
You don't understand how hard it was to get a decent diagram of a perineum. So this is happening. Not anatomically correct, but you get the idea.
How many women will tear?
There are different degrees of tearing, from 1st degree (only the skin involved) to 4th (where the anus and rectum are torn too). Approximately 75% of all women will have some sort of tear. That is the majority! Most of them will be 1st and 2nd degree, with a small percentage sustaining more serious tears.
Around 3% will have a 3rd or 4th degree tear, more common in first time mums. Some preventable, others unpreventable.
What increases the chance of tearing?
It is your first baby
You have a long 2nd stage of labour, conversely a reaaaaally quick birth can cause tearing
Use of forceps or ventouse
If your baby's shoulders become stuck
If your baby is weighing over 4kg (8lbs 13)
You have had a tear before
The thing you've all been waiting for - what can you do to reduce the chance of tearing?
No one WANTS to tear. Obviously. Alot of the time there is nothing that could have been done to stop it. The important thing here, is to consider what psychological factors impact how we feel about birth. The tear itself may not be the traumatic part of your birth, it is everything going on around you that makes you feel this way. However, there are some things you can consider, that can help your experience to be more positive and be less likely to tear.
1. Aim to stay in an upright, gravity promoting position. What this does, is when the baby's head hits the pelvic floor ready for birth, it is already beginning to stretch the skin and muscles without you doing a lot. If you were laying down on the bed, this action wouldn't happen. You also have to put in more effort to birth your baby in a laying down position, so more trauma to the perineum.
2. PUSSSSSSSSSSSSSSSSHHHHHHHHHHHHHHHHHHH. Guided pushing, although sometimes totally necessary, can increase your chance of tearing. It is also not great for baby if you are holding your breath, chin on chest and pushing down. It restricts their oxygen supply. You want to aim to breathe deeply and control the 2nd stage of labour. Keep it slow and steady. That isn't to say you can't push, you'll probably have quite the urge. But do it when you want to and you are ready.
3. Labour or birth in water. The warm water softens all the tissues, making more room for your baby's head. Along with this, some midwives like to place a warm compress on your perineum (with your consent) during the 2nd stage of labour. The rational for this is to soften the tissues and it is meant to be soothing. This specifically has been found to reduce the amount of 3rd and 4th degree tears.
4. Perineal massage. You'll see I've left this one until last. That isn't because it isn't effective, but because it is something women don't often want to do and the above are more practical ways to support you. Perineal massage has been shown to reduce trauma in first time mums especially, if done regularly from 34 weeks of pregnancy. It works by preparing the tissues to stretch and relax in childbirth. It also gets you used to the sensation of something being THERE, so in labour, you won't be as nervous of that feeling. You'll be able to control your breath more effectively. It can also support an easier recovery after birth.
HOW?
Start between 34 and 36 weeks of pregnancy, several times a week, for around 5 minutes a time. It is best to give it a go after you've had a bath or shower as the perineum is softer. Use a small amount of unscented oil i.e. olive, sunflower or a specially designed massage oil such as this one from Motherly Love (you can get 10% off with the code 18HANNA10 - they were kind enough to offer this to my clients, I do not benefit if you buy!)
Get in a comfy position, this may be in the bath, on a sofa or on the toilet. Place your thumbs just inside the vagina, with your fingers resting on your buttocks. You should be applying some pressure. Move your thumbs upwards and outwards, then back again in a U shape. It may feel like an odd sensation. This is okay. Relax as much as you can. As time goes on, you'll be able to press harder and remain relaxed.
If you are too tense or feel pain, stop and try again another time.
The Bottom Line
If ya gonna tear, ya gonna tear. Sometimes, being at peace with that is better than any massage.
There is limited evidence on all this stuff, mostly anecdotal. I suppose anything is worth a try, but it shouldn't consume you in the final weeks of pregnancy.
The important thing in all of this, is that you are relaxed. You are informed. You feel educated and empowered to birth your baby. The way that you control those final stages of labour is key, if you are panicked and doing everything you can to push your baby out ASAP, it is likely you will tear. Breathe deeply, do not hurry and ease your baby into the world as much as you can. Consider the environment around you, if you are feeling out of control, this is what impacts a negative birth experience, not always the tear itself.
If you tear, thats okay. You will be professionally stitched, your recovery is likely to be smooth and there are many things you can do to make that more comfortable. Do not be in fear of tearing. Your body was made this way.
Thoughts on this? Did you do anything to reduce the likelihood of tearing? Did it work? Any tips for mums to be?
If you want to know more about pregnancy, birth and beyond, you might want to book a hypnobirthing course. I'm in East Sussex, or via Skype if you are elsewhere. There is no barrier! I have a range of courses which are bespoke to you, so there will be something to suit! The perfect time is after 20 weeks. Lets get you educated, in control, calm and confident for whatever happens in your journey to motherhood.
Hannah x x