Ouch! is it possible to avoid tearing in labour?

Posted on 12/10/2016 by Antenatal Online | Leave a Comment

When I was 12 I silently vowed that I would NEVER have children following a particularly shocking childbirth video shown to us in Religious Education. My concern was that having a baby would in fact split my difference and I couldn’t be having that.  I fainted in the middle of the class. Humiliation ensued. As an adult this fear of tearing and what it would feel like stayed with me until one day I found I was pregnant - eek.  I quickly realised that I only had a vague notion of what it was that was actually at risk of tearing and needed information fast!

Should any of you find yourself similarly traumatised by nuns, here our midwife, Nina, tells you some useful stuff about tearing and how you might avoid it:

Let’s start with the basics – what is tearing? There are different types of tears or trauma that might be experienced during a vaginal birth. You may spontaneously tear during the delivery of your baby’s head or the midwife or doctor attending your delivery may recommend an episiotomy – a left lateral cut to your perineum. Your perineum is the area between your vagina and your anus and is made up of tissue and muscle. This is the most common place to experience trauma during a vaginal birth. It is also possible, but less likely, to have an anterior tear, which impacts on the tissue around your urethra and/or your clitoris. You may also experience lacerations to your labia – the folds of tissue (vulva) either side of your vagina.

The extent of tear can vary and you may experience more than one tear at the point of delivery. Tears are more common in women having their first vaginal birth and range from small abrasions to deep lacerations affecting several pelvic floor muscles.

Will I feel it? Whilst you won’t necessarily experience a tearing sensation, as the baby’s head crowns (the largest diameter of the baby’s head is being delivered) you will feel a burning/smarting sensation as your vagina stretches to accommodate your baby. A warm compress (flannel) can help soothe the burning and reduce the urgency to give an almighty push at this stage and your midwife will encourage you breathe or pant your baby’s head out gently to allow the perineum to stretch. This stage will take a matter of seconds but can feel longer due to the intensity of it all.

How can I avoid tearing? The truth is that there may be no way to avoid tearing - according to research most of the risk factors for a perineal tear are out of your control and the control of the midwife. These are:

  • A big baby
  • High weight gain in pregnancy
  • Older and younger maternal age
  • Ethnicity (Caucasian and Asian)
  • First vaginal birth

That said there are some things that might help and are certainly worth trying if tearing is something that you worry about:

  • You're less likely to tear if you have a slow, controlled delivery that allows plenty of time for your perineum to stretch to allow room for your baby. This can mean breathing or panting through the urge to push for a while when the baby's head is crowning, for example.
  • In a recent study, the use of warm compresses on the perineum during the second (pushing) stage of labour was linked to a reduction in more severe tears.
  • Perineal massage in pregnancy can be started from 34 weeks and has been linked with reducing the incidence of tearing. Try having a warm, bath which will help relax your muscles of any tension. Use a natural oil such as almond, olive or coconut oil. Lie down propped up by pillows and place your thumbs about 3 cm inside your vagina. Press your thumbs downwards and sideways until it tingles, then hold for approximately 2 minutes. Gently massage the lower part of the entrance to you vagina for about 3 minutes. If you continue this on a daily basis until baby arrives, you will notice a difference in the tissue stretchiness after the first 2 weeks.
  • There is a device on the market designed to use during pregnancy to stretch the perineum. There is limited research regarding the effectiveness of the device and its safety is inconclusive.
  • Adopting a left lateral or kneeling position during the pushing stage can help reduce the chance of tearing, and any tears that do happen are usually labial as oppose to perineal.

If you had a tear in your previous delivery it does not necessarily mean you are more likely to tear the second time round, research has shown that one of the risk factors for tearing is first vaginal birth. However, if you have had a previous 3rd/4th degree tear you are at an increased risk of this happening again.

It is worth noting that perineal tears are normal in vaginal birth and about 50% of women will experience a tear but getting to know your anatomy in the form of perineal massage or using a compress will not cause you any harm.



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