7 Ways to Reduce Your Chances of Tearing During Labour

Let’s talk about perineal tearing. Your perineum is the area between your vagina and back passage (anus). I speak to so many women who are really scared of tearing, and I can completely understand why! The good news is that most tears are what you’d call a graze…which heal on their own and without stitches. But we are here to talk about my top tips for trying to avoid tearing during labour, so here we go.

First of all, tearing only happens when your baby's head is being born.

Secondly, your body is designed to give birth, and this part of labour is cleverly built into the physiology of birth. When your baby’s head presses against your pelvic floor it triggers a huge shot of oxytocin, and this fans open your perineal muscles which allow for your baby’s head to be born smoothly. Your body is very clever and knows how to protect you. Below are the extra steps you can take to avoid or reduce tearing.

woman laying on her back and giving birth

Different Degrees of perineum tear

There are 4 types of tear:

  1. A first-degree vaginal tear is the least severe, including only the skin around the vaginal opening. This type of tear will heal on its own and without stitches.
  2. A second-degree vaginal tear involves the vaginal skin and the perineal muscles. These do require stitches.
  3. A third-degree vaginal tear involves the vaginal skin, perineal muscles and the muscles around the anus. For these, you would need to go to theatre to be treated.
  4. A fourth degree vaginal tear is the most severe - involving vaginal tissues, perineal muscles, muscles around the anus and the tissue lining of the rectum. Again - these need to be repaired in theatre.

Your midwife or doctor should advise on post-birth care if you have experienced a perineal tear.

Why do tears occur?

Tears happen as the baby stretches the vagina and perineum during birth. Tears are spontaneous and not every birth involves a perennial tear.

The difference between an episiotomy and a tear

Women are understandably scared of tearing however did you know that a tear actually heals quicker than an episiotomy? This is because a tear means the edges of the skin are jagged and can bind together whereas an episiotomy is a straight cut and this means the edges of the skin have nothing to bind to and require stitches.

Here are 7 ways to reduce your chances of experiencing a perennial tear:

  1. More oxytocin

You can increase your levels of oxytocin by ensuring your birth environment is dark, cosy and private, and by practising hypnobirthing to stay relaxed. The more oxytocin you have, the less chance there is of tearing!

  1. Perineal Massage

Other ways of avoiding tearing include perineal massage throughout the 3rd trimester! I know women who swear by this. Get some perineal massage oil and massage this area from 35 weeks inside and out on a daily basis in the weeks leading up to labour. The idea is that it makes your skin more supple and stretchy which helps your baby’s head to be born easily.

The Royal College of Midwives has the following advice about doing this massage:

  • Warm bath
    Sit in a warm bath before you start. This may help you to relax before the massage and loosen the muscles around your perineum.
  • Short nails
    The tissues in your vagina and perineum are very delicate. Make sure your nails are short to prevent scratching the skin, or any discomfort to the area.
  • Comfortable position
    You need to be relaxed during the massage, so it's important you find a comfortable position. The best place to perform this massage is in bed. Prop yourself up with pillows to support your back and bend your knees.
  • Thumbs
    Hold your thumbs in the position shown for about 1 minute (diagram below). Press down towards the anus and to the sides of the vagina walls. Hold your thumbs in this position for about 1 minute. You will begin to feel a stretching sensation. Breathe deeply.
  • Gentle massage
    Gently massage the lower half of your vagina using a U shaped movement for 2-3 minutes. Repeat this 2-3 times.
  • Repeat daily or when possible
    It may take a couple of weeks of daily massage before you notice more elasticity in your perineal area.
  1. The birthing pool

Another preventative measure is getting in the birthing pool. Being in water makes you more buoyant and softens your skin. This takes some of the pressure off because everything moves more easily in water.

  1. Ask your midwife

Your midwife can help you avoid a tear when the baby’s head becomes visible so remember to discuss this with them in advance.

  1. UFO

Remember the acronym UFO! Keeping upright, forward and open during labour will significantly reduce your chances of tearing. Being upright means you will have gravity on your side and you will also create more space in your pelvis for your baby to descend and enter the world.

  1. Keep Your Legs Together

Many women birth on their backs, legs wide apart. This stretches the skin and means there is no flexibility in the perineum and this can cause a tear. To avoid this, keep your knees together!

  1. Your Birth Environment

Ensuring your birth environment is dark, safe and calm will bring out more oxytocin and this will help your labour to progress smoothly – including your baby’s head being born and your perennial muscles fanning out to reduce your chances of tearing.

Biomechanics of birth

A woman’s pelvis moves and flexes during birth. Knowing how to position your legs can help to reduce your chances of a tear.

During the first stage of labour keep your legs apart to help your baby move into your pelvis.

During the second stage of labour keep your knees together and feet apart to help your baby move down the birth canal. Doing this with your legs opens the pelvic outlet which makes more space at the base of your pelvis.

a plastic model of the female pevis

How to care for your perennial tear

If you do experience a tear then your midwife should support you with after care. If you’re at all confused about what to do then the NHS is a wonderful resource.

Here are top tips for caring for your perennial tear:

  • Rest when you feel tired and get as much sleep as you can
  • Get moving. Walk everyday and try to increase the amount of time you walk for each day
  • Avoid lifting anything heavier than your baby until you’re given the OK by your doctor
  • Don’t rush back into having sex and when you do want to try, stop if it doesn’t feel OK.
  • Keep the wound clean and if you’re worried about your wound be sure to seek medical help

And I’ll leave you with this - if you do tear, your body is incredible and totally capable of healing. If you end up needing stitches - that’s okay! You can take it easy for a while and recover while enjoying your new baby.

If you’d like more handy tips then be sure to check out the butterbean blog and our Instagram page!

 

pregnant woman looking out of the window

7 Ways to Reduce Your Chances of Tearing During Labour

pregnant woman looking out of the window

Let’s talk about perineal tearing. Your perineum is the area between your vagina and back passage (anus). I speak to so many women who are really scared of tearing, and I can completely understand why! The good news is that most tears are what you’d call a graze…which heal on their own and without stitches. But we are here to talk about my top tips for trying to avoid tearing during labour, so here we go.

First of all, tearing only happens when your baby's head is being born.

Secondly, your body is designed to give birth, and this part of labour is cleverly built into the physiology of birth. When your baby’s head presses against your pelvic floor it triggers a huge shot of oxytocin, and this fans open your perineal muscles which allow for your baby’s head to be born smoothly. Your body is very clever and knows how to protect you. Below are the extra steps you can take to avoid or reduce tearing.

woman laying on her back and giving birth

Different Degrees of perineum tear

There are 4 types of tear:

  1. A first-degree vaginal tear is the least severe, including only the skin around the vaginal opening. This type of tear will heal on its own and without stitches.
  2. A second-degree vaginal tear involves the vaginal skin and the perineal muscles. These do require stitches.
  3. A third-degree vaginal tear involves the vaginal skin, perineal muscles and the muscles around the anus. For these, you would need to go to theatre to be treated.
  4. A fourth degree vaginal tear is the most severe - involving vaginal tissues, perineal muscles, muscles around the anus and the tissue lining of the rectum. Again - these need to be repaired in theatre.

Your midwife or doctor should advise on post-birth care if you have experienced a perineal tear.

Why do tears occur?

Tears happen as the baby stretches the vagina and perineum during birth. Tears are spontaneous and not every birth involves a perennial tear.

The difference between an episiotomy and a tear

Women are understandably scared of tearing however did you know that a tear actually heals quicker than an episiotomy? This is because a tear means the edges of the skin are jagged and can bind together whereas an episiotomy is a straight cut and this means the edges of the skin have nothing to bind to and require stitches.

Here are 7 ways to reduce your chances of experiencing a perennial tear:

  1. More oxytocin

You can increase your levels of oxytocin by ensuring your birth environment is dark, cosy and private, and by practising hypnobirthing to stay relaxed. The more oxytocin you have, the less chance there is of tearing!

  1. Perineal Massage

Other ways of avoiding tearing include perineal massage throughout the 3rd trimester! I know women who swear by this. Get some perineal massage oil and massage this area from 35 weeks inside and out on a daily basis in the weeks leading up to labour. The idea is that it makes your skin more supple and stretchy which helps your baby’s head to be born easily.

The Royal College of Midwives has the following advice about doing this massage:

  • Warm bath
    Sit in a warm bath before you start. This may help you to relax before the massage and loosen the muscles around your perineum.
  • Short nails
    The tissues in your vagina and perineum are very delicate. Make sure your nails are short to prevent scratching the skin, or any discomfort to the area.
  • Comfortable position
    You need to be relaxed during the massage, so it's important you find a comfortable position. The best place to perform this massage is in bed. Prop yourself up with pillows to support your back and bend your knees.
  • Thumbs
    Hold your thumbs in the position shown for about 1 minute (diagram below). Press down towards the anus and to the sides of the vagina walls. Hold your thumbs in this position for about 1 minute. You will begin to feel a stretching sensation. Breathe deeply.
  • Gentle massage
    Gently massage the lower half of your vagina using a U shaped movement for 2-3 minutes. Repeat this 2-3 times.
  • Repeat daily or when possible
    It may take a couple of weeks of daily massage before you notice more elasticity in your perineal area.
  1. The birthing pool

Another preventative measure is getting in the birthing pool. Being in water makes you more buoyant and softens your skin. This takes some of the pressure off because everything moves more easily in water.

  1. Ask your midwife

Your midwife can help you avoid a tear when the baby’s head becomes visible so remember to discuss this with them in advance.

  1. UFO

Remember the acronym UFO! Keeping upright, forward and open during labour will significantly reduce your chances of tearing. Being upright means you will have gravity on your side and you will also create more space in your pelvis for your baby to descend and enter the world.

  1. Keep Your Legs Together

Many women birth on their backs, legs wide apart. This stretches the skin and means there is no flexibility in the perineum and this can cause a tear. To avoid this, keep your knees together!

  1. Your Birth Environment

Ensuring your birth environment is dark, safe and calm will bring out more oxytocin and this will help your labour to progress smoothly – including your baby’s head being born and your perennial muscles fanning out to reduce your chances of tearing.

Biomechanics of birth

A woman’s pelvis moves and flexes during birth. Knowing how to position your legs can help to reduce your chances of a tear.

During the first stage of labour keep your legs apart to help your baby move into your pelvis.

During the second stage of labour keep your knees together and feet apart to help your baby move down the birth canal. Doing this with your legs opens the pelvic outlet which makes more space at the base of your pelvis.

a plastic model of the female pevis

How to care for your perennial tear

If you do experience a tear then your midwife should support you with after care. If you’re at all confused about what to do then the NHS is a wonderful resource.

Here are top tips for caring for your perennial tear:

  • Rest when you feel tired and get as much sleep as you can
  • Get moving. Walk everyday and try to increase the amount of time you walk for each day
  • Avoid lifting anything heavier than your baby until you’re given the OK by your doctor
  • Don’t rush back into having sex and when you do want to try, stop if it doesn’t feel OK.
  • Keep the wound clean and if you’re worried about your wound be sure to seek medical help

And I’ll leave you with this - if you do tear, your body is incredible and totally capable of healing. If you end up needing stitches - that’s okay! You can take it easy for a while and recover while enjoying your new baby.

If you’d like more handy tips then be sure to check out the butterbean blog and our Instagram page!