5 Ways to Avoid Vaginal Tearing In Childbirth

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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 vagina 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 vagina can cause tissue to tear. Women can tear in any part of their vagina, however the most common area is between the vagina 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.

Perineal Massage

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 vagina 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.

Labor Down

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 vagina. 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 vagina 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.

Kegals

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.

Read more: 5 ways to prevent pelvic floor dysfunction after pregnancy.

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This article has 13 comments

  1. Kerstin Lopata 06/15/2011, 4:38 am:

    Very nice post. I just stumbled upon your blog and wanted to say that I have truly enjoyed surfing around your blog posts. After all I will be subscribing to your feed and I hope you write again very soon!

  2. symptoms of diabetes 10/13/2011, 8:45 am:

    Great web site. A lot of useful information here. I am sending it to a few buddies ans also sharing in delicious. And obviously, thank you on your sweat!

  3. allison 07/31/2012, 11:47 am:

    i am 17 and am having a baby i am very very scared and when my class i go to for pregnancy started talking about this i freaked out and i am just scaredto give birth this helped me consider some options while giving birth

    • Health News Watch 10/29/2012, 9:50 pm:

      Allison, thank you for your comment. I hope you were able to discuss your concerns with your physician. If you ever have concerns about your pregnancy or with childbirth, please do not hesitate to contact your doctor.

    • Amanda 10/11/2013, 3:31 pm:

      Allison,

      Don’t just take what you hear from TV or hospital birth class personnel as gospel truth. Do some research on how birth is SUPPOSED to be, not on all the scary things they may want to do to you once you get into the hospital. Read ‘Ina May’s Guide To Natural Childbirth’. Trust me, as someone who has done the hospital birth with an epidural AND a completely natural delivery, the chances of you tearing are much worse if you can’t feel your body. My first was 7lbs. 2oz. and I had Pitocin and an epidural. I also had a 3rd degree tear with 19 stitches that took 7 months to heal fully. My second baby was 8lbs, 4oz. (Yes, over a pound bigger!) and with him I had no medication and a very slight tear that was better in 3 weeks, which was really my own fault because I got impatient to get it over with right at the end and pushed too hard. There are a lot of ways to prevent tearing. Look it up, check it out, and take control. Your body was made to have children. If it wasn’t, you wouldn’t be pregnant! Best of luck!

  4. MarthaR 12/15/2012, 11:15 pm:

    Im having a baby as well and this is my first time I was wondering about the pains that come along with childbirthing so I found this site. I just wanted to say thank you because it helped alot.

  5. Melissa 12/19/2012, 6:12 pm:

    I pushed very hard when baby was crowning because I just wanted it all to be over sooo bad. I had a home water birth. Although my midwife encouraged me to breathe to try and slow me down, I didn’t listen and pushed with all I could. I had a lot of tearing and it was very painful healing for at least a week. Heed my advice, sloooow down.

  6. amber 01/26/2013, 7:45 pm:

    fantastic post – all things i wanted to understand but couldn’t find anywhere. ii look forward to perusing your website!

  7. Jillian 06/15/2013, 12:15 am:

    I disagree with your comment about having an epidural be the only way to “labor down”. A good birth coach is the best way to labor down: encouraging grunting through contractions, deep breathing/blowing/visualizing during the contractions of transition.

    It is important to also encourage women to encourage women to birth in positions other than on their back to encourage the baby’s head away from the perineum during crowning. On our backs, the baby’s head is pushed forward by the sacrum tilted up/forward; squatting, hands and knees allows for equal distribution of the head pressure as well as less resistance against the head allowing for more effective, and therefore, shorter pushing.

    Thank you for opening up the door for discussion!

  8. beena 07/06/2013, 12:05 pm:

    i had a very bad case of post delivery vaginal synachie.i treated it with blunt and sharp dissection,taking care as not to injure bladder & rectum
    i would like to know any other treatment if it is there.pt. still has severe burning in vagina.

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