Hi mamas! This is a HOT topic…how to prevent tearing during delivery? I get this question asked on my Instagram at least once or twice a week!
I get it, the thought of tearing your VAGINA is terrifying, to say the least.
I mean, your vagina is not like your elbow. If you skim your elbow, it hurts, and it heals. Who really cares about an elbow? Not me.
What I do care about (and probably millions of other women care about) is my freaking VAGINA. We don’t have sex with our elbows (well, not that I’ve seen), your vagina is kind of important.
Not only do you use it for sex, but geez, it’s part of what makes you biologically a WOMAN! And the thought of damaging that in any way can really screw with your head!
I think that’s one of the main reasons why women are so terrified of it!
Okay, so before we get to talking about the HOW’S, let’s talk about the WHAT’S, so you can get a clearer picture on vaginal tearing, and what EXACTLY happens.
***Don’t worry, no graphic images***
Vaginal tears are scored on a scale from 1st-4th. A first being the least invasive, and a fourth being the most invasive.
Here’s a little image I recently shared on my Instagram page, you can see how each degree goes a little deeper into the perineum and anal sphincter:
1st Degree Tear: The least severe, involving only the perineal skin- the skin between the vaginal opening and the rectum and the tissue directly beneath the skin. You may experience some mild pain or stinging during urination (FUN FACT: When I was writing this blog post out, I wrote “singing” instead of “stinging”, and had a great visual image in my head for about 3 seconds…). These tears may or may not require stitches and typically heal on their own within a few weeks.
2nd Degree Tear: These tears go a little deeper, into the perineal muscles underneath. These tears need to be stitched closed, layer by layer. They’ll cause you some discomfort and usually take a few weeks to heal as well.
3rd Degree Tear: This is a tear that extends through the perineal muscles, and into your anal sphincter (but not completely through). Your anal sphincter is the muscle that surrounds your butthole. This tear can USUALLY be done in your same delivery room, and just like the others, needs to be stitched layer by layer.
4th Degree Tear: This type of tear extends completely through to the anal canal or rectum, and will most likely have to be repaired by your provider in a procedural room or the OR. (Sometimes, some providers still do them in the same room though) It will be done right after delivery.
If you experience a 3rd or 4th-degree tear, you will also probably be given a dose of antibiotics after delivery to help prevent any sort of infection developing since these tears are a little deeper and have a higher likelihood of becoming infected. Your provider will also want to see you back in the office a few weeks after delivery to make sure things are healing smoothly. It’s also REALLY important to be taking stool softeners if you have either a 3rd or 4th-degree tear (it’s important for any type of tear, but especially these!).
OKAY STATS: HOW COMMON ARE THESE TEARS?
Don’t sweat too much. The likelihood of having a 3rd or 4th-degree tear during your delivery is only about 2-6% (if you even tear in the first place). So that means, you have about a 94% chance of NOT TEARING YOUR BUTT HOLE! (Source)
They DO happen, and it’s important to bring them up though! (I just saw a 3rd degree on a gal last week).
OKAY LET’S TALK ABOUT SOME MORE VAGINAL TEAR STATISTICS…
Let’s talk about risks, and WHICH girls tear more frequently.
Your biggest risk for tearing is being a first-time mom (I’m sorry, I know that is an unavoidable risk).
First-time moms have about three times the risk of tearing than moms who have birthed vaginally before. In fact, if you are a first-time mom, you have about an 85% chance you’ll have SOME sort of tear (remember, it’s likely going to be a 1 or a 2 though).
A few other risks include:
–Having an instrument delivery (forceps delivery or vacuum delivery)
–Baby weighing more than 4kg at birth
–Prolonged second stage of labor (the time that you push)
–Asian ethnicity (I’m not exactly sure why this is true, but it is, and I’ve noticed it first-hand)
–Episiotomy (Once your provider cuts an episiotomy, the likelihood that you’ll continue to tear further into a 3rd or 4th increases)
–Large Infant Head Circumference (well, duh)
–Having a Shoulder Dystocia
So, how do you prevent tearing during delivery? Unfortunately, you may not be able to COMPLETELY 100% prevent tearing if you are a giving birth for the first time. What you can do is somewhat PREVENT a worse tear from happening. (Read about a few other scary questions mamas have during birth here)
There are THREE things that I’ve researched and found that CAN help somewhat prevent a tear down there…even in a first-time mom.
(The third one is a little crazy so bear with me!)
1. A WARM COMPRESS AS YOU ARE PUSHING
While you are pushing, ask your nurse or doula if they may assist you in applying heat to your perineum. This can simply be a washcloth that is soaked in warm water. It’s super easy, and this is one the most effective ways you can decrease tearing.
I really like doing this with my patients (especially if they are pushing for an extended amount of time). Heat helps to dilate the blood vessels in the area, relaxing them, and making you LESS susceptible to a tear!
You really don’t need anything fancy, a basin of warm water and some washcloths will do!
2. PERINEAL MASSAGE DURING YOUR PREGNANCY
Next up, perineal massage! This can be done starting at week 34 of your pregnancy, and you really only have to do it for about 5 minutes per day! There are some conflicting studies about whether perineal massage DURING labor is beneficial in preventing tearing (actually, many of them concluded not). BUT, pre-labor it certainly makes sense! As long as you are comfortable getting up close and personal with your lady-parts, it’s a pretty simple exercise! Mama Natural has an awesome guide of how to do this properly!
3. GET SEXUALLY AROUSED DURING LABOR
Okay…whaaaat? Yes it’s true, and Ina May Gaskin has confirmed this herself! When you are sexually aroused, you naturally produce more lubrication, and the walls of your vagina become a bit thicker, elongated, and more elastic…because…well…it thinks a penis is about to enter it.
Kiiiind of the same thought process here.
I know that’s super hard to do because let’s be honest, not many women are down with getting sexually aroused during birth…but have you heard of orgasmic birth? It’s a thing, and those ladies never, ever tear.
***Additionally, I have no experience with the EPI-NO, but THIS might decrease your chance of tearing as well?!***
OKAY LET’S TALK ABOUT DECREASING YOUR RISKS OF TEARING A LITTLE MORE…
Why do women tear? As I’ve said previously, your biggest risk factor is going to be a first-time mom. But let’s talk about some less-obvious reasons why women tear.
THE POSITION YOU GIVE BIRTH IN
Yep, it’s actually been shown that squatting while giving bith, can make your chances of tearing a bit worse. Now, squatting isn’t the same as hands-and-knees. Hands and knees increases your tearing risk by zero, and its a great way to give birth!
But just think about it, squatting and bearing down puts a whole lot more pressure on your perineum. Gravity is your friend when giving birth (aka, many women don’t like to give birth on their backs), but gravity may not be your friend when it comes to tears.
DECREASE YOUR LIKELIHOOD OF GETTING AN EPISIOTOMY
Sometimes this is unavoidable. Episiotomies are done in an emergency setting if deemed necessary by your provider. This is really the ONLY time they should be done, but unfortunately, many providers are still old-school are perform episiotomies routinely.
So, what’s the easiest way to avoid this?
Simply ask them. And, if your provider has a higher than average epis-rate, it may be worth looking into switching providers.
Yes! No one talks about this, but I heard this reason from a doctor that I work with, and it totally makes sense! Making sure you are adequate in your protein intake will promote tissue health and elasticity, which may allow for an easier delivery. Along with adequate protein consumption, make sure you are of course staying hydrated and consuming a well-balanced, healthy diet!
OKAY SO HOW DO I TAKE CARE OF THIS TEAR AFTERWARDS?
Great question! I’ve already mentioned previously, but the MAIN thing you need to be focused on is taking your stool softeners and/or really upping your fiber intake! That first postpartum poop is no joke, and you do NOT want to bear down at all when having a bowel movement.
Secondly, you’ll probably receive a fancy little squirt bottle after you give birth. This thing is glorious, and you should try to use it every time you use the bathroom. Urine isn’t going to infect your tear at all, but it can make it sting quite a bit. By using a little squirt bottle while you’re peeing, it helps to dilute your urine and really cut down on the soreness.
Also, DERMOPLAST! It’s like an epidural-in-a can.
No, just kidding, it’s not like an epidural at all, but it DOES numb your vagina right up! It’s going to be cold coming out of that can, but I encourage you to spray an ample amount and follow with a padsicle (Check out that link of how to make some!)
Hopefully, that’s cleared up some of info out there on perineal tears! I hope I’ve made them a little less frightening too. I personally had a second-degree tear after I had my son, and while it wasn’t a walk in the park, I really can’t complain. My doctor was able to stitch me up within minutes, and my recovery was very easy. (If you want to read my whole birth story, check it out here!)
Do you have any tips to share about perineal tears? Leave me a comment below! 🙂