How to Prevent Tearing During Childbirth
As a pregnant person, you're probably wondering how you can prevent tearing during childbirth.
Most of our patients at Vivid wonder this as well, and we help them learn exactly what they can do to decrease their risk for tearing and have the best birth experience possible.
In this blog, I share what I tell my patients with you!
What Causes Tearing During Childbirth
What exactly causes you to "tear" during birth? And why is it so common?
Here are some reasons and risk factors:
Poor tissue stretch and quality of the tissues in the pelvic region, specifically the perineum, and especially in those with thin tissue and those who are dehydrated.
Sometimes, it's just genetics. Some women’s tissue doesn’t have great stretch, which can greatly contribute to tearing. Unfortunately, this one is not one we have control over.
Sustained pressure in the vaginal canal can also cause tearing because the external tissue gives out, as it can no longer stretch. This usually happens with sustained pushing.
Rapid labor progression, or when the baby descends too quickly. This can lead to the tissues tearing because they did not have enough time to stretch out.
Inability to relax the pelvic floor muscles. In lots of cases, the pelvic floor muscles are unable to relax as needed for baby to pass through the birth canal and the force of the baby tears the perineal tissue.
Types of Perineal Tears
Perineal tears are quantified into 4 types:
Grade 1- Mild tear: This affects mostly the skin only
Grade 2- Moderate tear: Extends into the superficial pelvic floor musculature
Grade 3- Severe tear: Extends through the pelvic floor musculature and to the external anal sphincter. This usually requires surgical repair in an operating room.
Grade 4- Most severe tear: Extends through the pelvic floor musculature, external anal sphincter, and internal anal sphincter. This requires surgical repair in an operating room as well.
Why Perineal Health Matters Before Birth
Research suggests that proper labor/push positions, breathing mechanics, pushing mechanics, and perineal massage leading up to labor help to reduce perineal tears.
What this means for you: investing time into these things can help you have better birth outcomes! And ensuring that you're doing everything you can to prepare for birth is something you can look to control as much as possible.
How Pelvic Floor Physical Therapy Can Help
Pelvic floor therapy can help by educating patients on the things they can control.
While labor is a pretty involuntary process, there is a lot of preparation that you can do to your body in order to prepare it for birth.
When we work with patients in clinic, the promise is not to fully "prevent" birth trauma and tearing, but rather to do everything we can so that the chance of it happening is as small as possible. We never have 100% control over what happens during vaginal birth, unfortunately.
Here's a list of some common types of concerns that pregnancy PT and pelvic therapy can help you with:
Pelvic floor PT can teach you how to properly relax your pelvic floor in multiple positions to improve the mobility of your perineal body and pelvic floor.
Pelvic floor can also help you select which labor positions are best for you and your body’s needs based on your current ability to relax the pelvic floor muscles.
Pelvic floor PT can also help teach you open glottis pushing which has been shown to reduce the risk of severe perineal body tears. We know that open glottis pushing is pushing on an exhale with your mouth and throat relaxed, vs. closed glottis pushing (hold your breath and bear down). Closed glottis pushing actually creates more tension in your pelvic floor, which can contribute to severe perineal lacerations. Learning how to push with open glottis is extremely important.
Perineal Massage and How to Do It
We have a guide on how to do perineal massage.
Here's the brief summary:
We usually recommend perineal massage starts at 33 weeks pregnant.
You can perform lying or while standing.
We typically like standing better, as ergonomically it is easier to do on yourself. If you were standing, you’d put one foot on a foot stool, and if you were sitting, you’d prop yourself up with a few pillows
In either position, you can insert one thumb into the vaginal opening (to the first knuckle).
You push down towards the anus with moderate pressure while making a "smiley face” sweeping motion.
If we envision your vaginal opening like a clock- 6 o’clock is towards the anus, you would sweep from 4 o’clock to 8 o’clock.
Perform for about 5 minutes per day
Pushing Positions That Reduce Tearing Risk
Positions that reduce the risk of tears include positions where gravity can help you (squatting, hands and knees, kneeling).
Positions we typically like to limit are those where you are on your back because being on your back doesn’t allow your sacrum to flex and extend. When your sacrum can’t move, your baby will have a hard time transitioning down, which can result in increased pushing time.
If you have an epidural and are more bed-bound, you can do pushing in sidelying, which allows the sacrum (and thus baby) to move.
We also like to encourage patients to push while breathing and feel their pelvic floor and anus open.
We usually encourage huffing (or even mooing!) to help keep the pelvic floor skin and muscles relaxed, versus holding your breath to push. Holding your breath can lead to tensing of the pelvic muscles and surrounding structures.
Preparing Your Pelvic Floor in the Third Trimester
This one may surprise you, but preparing your pelvic floor in the third trimester does NOT involve Kegels!
In fact, you need just the opposite.
Your pelvic floor needs to learn how to relax and lengthen to allow the baby to pass through the birth canal without excessive stretching (and then tearing) of the muscles.
Baby is the boss, and the body will do what it needs to do in order for baby to move through the birth canal, as long as it can.
Partnering with a pregnancy specialist physical therapist is paramount in learning how to safely relax your pelvic floor to reduce your risk of tearing.
What to Expect During Recovery
Expect your pelvic floor and perineal area to be sore for a few days to weeks after delivery.
In the weeks after delivery, limit your time upright in the first few days to weeks postpartum in order to help encourage healing.
Make sure you manage your pain with the appropriate pain medication (breastfeeding will affect what you can take, of course).
You can also choose to use ice for pain relief, but long-term use can restrict blood flow and affect healing, so use sparingly.
And lastly, talk to your provider about using a perineal spray to help manage pain (dermaplast or for something more natural, like Earth Mama).
Where to Find Pregnancy PT and Birth Preparation in Doylestown and Newtown
We at Vivid believe that every woman should come to pelvic floor PT before childbirth to prepare for labor as well as after childbirth, regardless of whether she tore or not.
9 months of pregnancy cause changes in our ligaments, joints, and posture, which can affect how we move forever.
And for those who have experienced a perineal tear of any grade, pelvic PT can help you return to optimal sexual health, menstrual hygiene, and bladder and bowel function.
If you’re local to Doylestown or Newtown, PA, we’d love to help you with perineal massage and prepping for birth. We offer pregnancy pelvic therapy and birth prep sessions for those who are pregnant and want to prep for an optimal birth and decrease the risk of birth-related injury, trauma, and tearing as well as postpartum rehab after birth.
We proudly put our patients first by offering one-on-one appointments for a full hour. You will have time to be heard and we will take time to listen to your whole story.
You won’t be passed between different professionals and we will work to get you a holistic solution to your pelvic health concerns.
We choose to participate in a private pay model so that we can focus on putting patients first.
We’d love to work with you. Feel free to schedule online or reach out to us if you have questions before getting started.
