One of the most common issues that pregnant women fret about is how to avoid vaginal tearing during childbirth – and understandably so. Not only is this a very sensitive area of a woman’s body in which damage can cause great discomfort, but also this type of damage can cause long lasting pelvic floor dysfunction.
A vaginal tear, also known as a perineal tear, is a break in the vaginal tissue, typically between the vag!na and the anus, that occurs during childbirth. As the baby passes through the vaginal canal the tissue is slowly stretched.
However, the delivery of the baby’s head and shoulders through the vag!na can cause tissue to tear. Women can tear in any part of their vag!na, however the most common area is between the vag!na and the anus.
Vaginal tearing is very common, especially in first time mothers. In fact, as many as 9 out of 10 women tear. These tears, often referred to as either superficial, first or second degree lacerations, sometimes require stitches and generally heal after several weeks.
However, a third degree perineal lacerations (a tear that extend all the way to the muscles that surround the anus) or a fourth degree perineal laceration (extends through the anus) are much more serious and can cause disruption in the functioning of the anus and other pelvic floor dysfunction.
Unfortunately, tears are unpredictable. However, there are some things you can do to try and help minimize your chances of a tear or the extent of the tear if it happens. Here are 5 suggestions to prevent vaginal tearing and pelvic floor dysfunction.
Especially in first-time mothers the vaginal tissue is very tight and inflexible. So, when the baby’s head is being delivered rather than stretching, the tissue tears. One way that you can help increase the elasticity of this tissue is to massage the perineum regularly during the last 6 weeks during pregnacy.
You can do this using a natural oil, such as olive oil (do not use mineral oil). Don’t rub excessively or to cause discomfort. Just gently massage the area between your vag!na and anus to increase blood flow and elasticity. You can also ask your health care provider to place warm compresses (a warm wet washcloth) on your perineum during labor and pushing. This is not only soothing, but increases blood flow to the area
You want to avoid any situation in which your perineum becomes very swollen during labor or pushing. This excess fluid buildup in the perineum decreases flexibility and can promote more tearing and bleeding. One thing that causes excess swelling is prolonged pushing.
You can shorten the time that you push by a technique called “laboring down”. This is basically delaying the start of pushing after you are fully dilated until the baby is in a low position, typically 1 hour. This technique is also helpful in preventing against pelvic floor damage which can cause incontinence and other issues after childbirth.
However, this is usually only possible when a woman is epiduralized, as the urge to push may be too strong to overcome in women who are laboring without pain medication. Also, in some cases the baby may already be low enough to begin pushing when the woman becomes dilated. Talk with your health care provider about his or her preferences on laboring down.
Avoid an Assisted Birth
Vacuum and forceps deliveries are more likely to cause a vaginal tear because they are pulling the baby forcefully through the vag!na. Unless it’s an emergency, ask your provider to avoid an assisted delivery if possible.
If an assisted delivery becomes necessary, ask you provider to delivery the baby until crowning and then allow the head to stretch the perninum for some time before completing the delivery.
Avoid Pushing While Baby Is Crowning
As I mentioned before, the action of the baby’s head and shoulders coming through the vag!na is typically when tears occurs. The best technique to help minimize this damage is to allow the baby’s head to crown and then stop pushing.
The force of your contractions will still push the baby downward, however it will be less forceful, allowing the tissue to slowly stretch out. Ask you health care providers to help you achieve a very slow and controlled delivery, allowing for time for this stretching to occur.
You should also be mindful that closed-glottis (closed-mouth, blue face, bug-eyed pushing) is not recommended as it causes the vasalva maneuver which is damaging to your pelvic floor. When you push, make a grunting noise and do not hold your breath.
Practice your kegal exercises before birth to strengthen the muscles of your pelvic floor. These will not only prevent against incontinence, but can help protect against tears and improve healing time in the event that you do tear. One kegal exercise is to practice is repeatedly stopping and starting the flow while urinating.
However, in some women Kegals are not appropriate so you should always talk with your obstetrician or pelvic floor physical therapists before practicing these exercises.