Tearing – Prevention and Cure
One of the things that most concerns women when thinking about labour – apart from the contractions of course – is ‘tearing’. This refers to the tearing of the perineum and is unfortunately often part of giving birth. But there are a number of things you can do to avoid, or at least reduce tearing.
What is the perineum?
The perineum is the muscular area between the vagina and the anus. It supports the posterior (rear) wall of the vagina. During childbirth this area needs to soften and stretch to allow the head and shoulders of the baby to emerge safely.
For many years it was common practice to perform an episiotomy, a cut in the perineum either directly towards the anus, or angled down and away to the side, to help make room for the baby and avoid ‘tearing’. This is no longer standard practice unless there are real medical reasons as research has proved a natural tear carries less risks and heals better. These days episiotomies are only done if the baby is in distress and needs a quick delivery with forceps or vacuum, the cord is being crushed, or the labour has been very quick and the perineum has not had time to stretch at all.
How to Avoid Both
So how can you prepare your perineum for all the stretching it will have to do and hopefully avoid both tearing and an episiotomy?
Preparation is the key
In the later weeks of your pregnancy – from about 34 weeks on – you can start getting your perineum ready for birth.
Massage – daily massage will help relax and stretch the muscle. Your doula can show you how this is done. You can use vitamin E oil, coconut oil, or Perineal Massage Oil from Blissful Herbs, which contains calendula, rosehip and lavender.
Balloon – some women find massage difficult, and there are now a couple of devices a bit like a balloon on the market that you can insert and inflate to gently stretch the muscles. Your doula can let you know where to get these and how to use them.
Exercises – since your perineum is attached to the pelvic floor, the pelvic floor exercises you are probably already doing will help stretch this muscle. Your doula can recommend additional exercises that will not only relax the tissues of the perineum, but also prepare your body to give birth in an upright position and fully stretch your pelvis.
Protecting your Perineum during Labour
OK – so you’ve done all your exercises and your massage and now you’re in labour. What can you do to continue to protect your perineum?
Upright Birth – an upright position such as kneeling, squatting, standing or even on hands and knees will help the perineum begin to stretch early in labour by putting the pressure of the weight of the baby on the muscle.
Water Birth – a water birth has been shown to reduce the likelihood of tearing as it not only relaxes the perineal muscle, but relaxes the whole body and reduces anxiety.
Perineal Compress – holding warm damp towels against the area, especially during pushing and when the baby is crowning, not only relaxes the muscle but provides it a little extra support.
Baby’s Position – the optimum birth position for your baby is Occiput Anterior. This means head down, facing mum’s spine. In this position the head is at the best angle to come through the birth canal and vagina. If your baby is not in this position it is sometimes possible to ‘spin’ your baby. Your doula or midwife can give you advice on this.
Time – As long as neither you nor your baby are in distress, take your time. Listen to your body. It will tell you when you need to push. When the baby is crowning – the head is coming out – you will probably feel what we call ‘the ring of fire’. If you can, don’t rush this stage, as this is when you are most likely to tear. Allow the tissues time to stretch slowly.
If – despite all your best efforts – you ended up with a perineal tear or an episiotomy, there are a few things you need to know that will help reduce discomfort, and speed up healing.
Inflatable ring – as much as possible, try to sit on an inflatable ring to reduce pressure on the area.
Hygiene – keeping the area clean and dry is really important. It may sting when you you go the toilet. If it does, pour warm water over the area to dilute the urine. After a bath or shower use a hair dryer on the area, not a towel.
Cold packs – can help to reduce swelling.
Wound care – Blissful Herbs have a Soothing Salve and Post Natal Bliss Healing Bath Herbs that can help support the healing of the perineum and reduce pain.
Your doula can help you with ensuring your perineum is in top shape for delivery and help protect it during birth. If you would like to talk about anything related to your pregnancy and birth plans or concerns, I would love to chat with you.
What is a Birthing Doula?
I am asked this question so often! Very few people know what a doula is, yet anyone who is having a baby, or thinking about having a baby, should know about the incredible benefits a doula can bring to the birthing experience, for mum, baby and partner.
Very simply, a birthing doula is a trained professional whose only role is to support pregnant women and their partners through late pregnancy, birth and beyond. A doula will do all she can to give you the confidence and comfort you need for a wonderful birthing experience.
The word doula comes from the Greek for ‘women’s servant or caregiver’. The term began to be used in the 1960’s meaning a friend providing comfort during labour. In recent times, it has begun to be used for a group of professionals who provide much needed support for parents and babies.
Why Doulas are important
All of us feel some trepidation as the time for the birth of our baby comes near, but for some women giving birth can be a very scary prospect. We have all heard stories from friends and relatives that make us wonder how things will go for us, or have had previous birthing experiences that fill us with dread or outright fear.
When we arrive at the hospital, we are generally greeted by midwives and nurses we don’t know. We sometimes know our doctor, but birthing can be a long process, and the doctor that you know and trust will generally only be there for the final act – delivery.
Until then you are taken care of by the midwives, who are highly trained professionals. They have responsibility for your medical welfare, But they also have responsibility for other birthing mothers, hospital protocols, and paperwork.
So, while the nurses, midwives and doctors are – very rightly – taking care of your medical needs, sometimes your emotional needs can be neglected. This is where your doula steps in.
Your doula has only one responsibility. And that is to you and your baby. She will be by your side the whole time, providing you with emotional and physical support, comfort and encouragement throughout the whole wonderful, scary, miraculous experience.
Pregnancy and Doulas
A doula will work with you before your labour to understand what type of birth you would ideally like to have. She will help you understand what your options are, and what some of the unfamiliar terms the medical team might use mean. She will not tell you how to approach your birth, or try to influence your decision on things like pain management or interventions, but she will certainly try to help avoid the need for them.
Your doula can give you advice on how to make the final weeks of your pregnancy as comfortable as possible, so you can relax and enjoy the anticipation. She will provide advice on relieving back pain, managing Braxton Hicks contractions, what to take to the hospital and any other concerns you may have.
Childbirth can be difficult. It’s true. But it is also a wonderful, joyous experience. It should – and can be – the best experience of your life.
Once you are in labour your doula will be there to help with whatever you need. Advice on labouring positions that might provide relief, help with showering, heat packs, massage, or just calming your fears. She will be there to inform, support and empower you. And should things not go as you had planned, she will be there to provide comfort and help you understand your options. Her only aim is to ensure you have a positive birth experience and ultimately deliver a healthy happy baby and mum!
Whilst your doula will be on hand to decode some of the medial terminology that might be used, they will not give medical advice, or interfere in your decision making process. They will simply support you and your partner in making informed choices.
A word about Dads or partners
During birth dads or partners are often cast in the role of advocate for the birthing woman, and this can be confronting. They often feel unprepared, especially if things are not going as you expected them to. Yet some people are concerned a doula will replace the father or partner in the birthing process. Nothing could be further from the truth. Your doula will help your partner understand what is happening, and provide them with the moral support, techniques and confidence they need to best help the labouring mum. And if your partner needs a breather or bathroom break, your doula will be there.
And after the Birth
Once your baby is safely delivered your doula will continue to provide you with support and information.
The early days as parents can be overwhelming. Sleep – even showering and eating – can sometimes seem like something you will never do again. Your doula will come to your home and take care of baby while you have a much needed rest, an uninterrupted shower, and even serve you a hot meal you haven’t had to cook yourself. Whatever support you need, your doula will provide including managing all those well meaning visitors!
New parents often wonder if the way their baby is behaving is ‘normal’. A doula can put your mind to rest and help you understand what falls into the enormous range of ‘normal’. She will let you know if she thinks there is something you should speak to a medical professional about.
Your doula can also help you with how you are feeling as new parents – both physically and emotionally – and give you confidence that you are not alone in the wildly fluctuating feelings you might be experiencing.
And if this is not your first baby, your doula can help your new arrival settle smoothly into your family.
If you have any questions about the role of a Doula, or would like more information, I would love to hear from you.