Tearing of the perineum during birth is a very common fear. I often get asked how to avoid this, both in my childbirth classes and at prenatal visits prior to attending a birth. Read on to get the PDF of all the tips I share with clients!
The perineum is the skin between the vaginal opening and the anus. This skin is meant to stretch as baby's head emerges. If the skin is unhealthy, or the baby's head is birthed too quickly, the tissue can tear.
There are many factors at play here, including some that are out of our control, such as genetics. However, there are some things you can do to minimize your risk of trauma to the area.
Here are five ways that you can reduce your chances of tearing during birth:
1. Start from the inside
Good, balanced nutrition promotes healthier skin that is more likely to stretch with the process of birth. Remember proper hydration and healthy fats will not only benefit the delicate skin of the perineum, but also your stretching belly! Check out our Prenatal Wellness class that focuses on prenatal nutrition and exercises that are beneficial for pregnancy, as well as birth.
2. Skincare regimen (it's not just for your face!)
Avoid harsh ingredients in your washing and moisturizing products. These may cause drying or irritation to the skin, especially the sensitive, thin skin of the perineum. Gentle perineal massage in your daily routine is appropriate and beneficial, but exaggerated perineal massage may not be necessary. Gently apply lotion/oil in a similar fashion that you would apply and massage your belly.
3. Patience while pushing
Some babies come out quickly in second stage, while others take their time and ease out. If there's no emergency, there's no rush - let baby do their thing! A slower second stage allows your tissue time to stretch and give way for the baby. Push to the point of comfort, or not at all. That's right, your baby will come out even if you don't actively bear down! It's important to tune into your body and do what feels most comfortable. There are scenarios where you may need to actively push, like if you have an epidural, so your provider, nurses, and your doula can give you additional guidance and support.
4. Rethink birth positions
It is beneficial to have the freedom to position yourself as your body directs. Squatting usually makes second stage faster since it shortens the vaginal canal and opens the outlet of the pelvis. For these reasons, this is a popular position for birth, but remember that faster is not always better. Side-lying, and a hands and knees position will slow things down. Consider these to allow the perineum more time to stretch, if needed. If you are laying back with your legs up (either being held or in stir-ups), be sure your knees are not too wide apart and your perineum is not being over-stretched, as this would make it more likely that tearing will occur.
5. Helping hands or hands-off?
Applying a warmed oil, can decrease friction and help the baby slide out. Olive oil is a great option. Also, a warm compress against the perineum during crowning increases the blood flow and softens the muscles. Some people find the warm compress very comforting and others prefer their care providers adopt a hands-off approach. There is some research that suggests that any hands, aside from the birthing person's, either doesn’t help or actually can cause harm, but more studies need to be done.
I hope you've found these tips useful! This topic has come up so much in my practice that I created a handout to give my clients. Click here to download the PDF which includes all of the above, plus additional tips!