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.