Worried about tearing during birth?

June 09, 2022

Pregnant woman resting with a coffee with a doughnut on her baby bump

This is one of the biggies isn’t it… I hear so many people say they’re terrified of tearing. And I totally get that, because it sounds awful. But there are lots of things that you can do to minimise your risk of tearing. And knowledge is power, right?!

If you picture the classic birth scene that you might’ve seen on TV – woman lying on her back, unable to move, legs in the air, looking stressed, holding her breath and then pushing as hard as she can whenever they shout “PUSHHHHHH’ at her…. That’s basically what we want to try and avoid! Because everything I’ve described there is going to increase your risk of tearing.

Positioning

Being able to move around during labour and choose the position in which you give birth in is really important. When you choose the position you birth in, you instinctively choose positions that are most helpful for your body and your baby. This means positions that make your baby’s journey through your pelvis as easy as possible, and also positions that feel most comfortable for you. Lying on your back will rarely be a position which you choose instinctively – it happens most frequently in a hospital setting, sometimes with the encouragement of a midwife or consultant.

When it comes to the pushing stage, being on your back means that your baby’s head is directed into your perineum. The perineum is the area between your vagina and your anus and it’s the area which most commonly tears. You are also at increased risk of having an episiotomy (a cut to your perineum) when you give birth on your back. Think in advance about which positions might be most appealing to you - perhaps standing, perhaps on your hands and knees, perhaps laying on your side - so that when it comes to birthing your baby, you can choose the positions that feels best for you.

Vaginal examinations

Vaginal examinations will be offered to you during labour and birth (and maybe even before). They are used as a tool to assess progress in labour however they are not the only tool and, as with everything, they come with both benefits and risks. The study of Gluck et al, 2020, found that having 5 or more vaginal examinations is associated with a higher risk of severe perineal tear.

So before you go into labour consider whether you would be wiling to have vaginal examinations, and in what circumstances. You may choose to have none, you may choose to have one only (perhaps when you arrive at triage or if you choose to be induced, for example). As with everything, it's entirely your choice.

Perineal massage

“Perineal what?!” I hear you shout! I know, it's not for everyone. There are studies that show that, for first time mums, massaging your perineum in the third trimester of pregnancy can reduce your likelihood of tearing during birth. However! There are criticisms of the evidence that supports perineal massage and there are certainly other (less daunting…!) ways of reducing that risk if its not your cup of tea.

Get bouncing!

Something that I cannot rave about enough is the trusty birth ball! Any old exercise ball or gym ball will do (just check that its the right size for your height - you need your hips above your knees!) - but using that ball for sitting, bouncing, swaying etc in pregnancy and labour comes with many benefits. One of those benefits its reducing the risk of tearing! Use it for watching TV in the evening, use it for working at your laptop. You'll find it helps with other things like back ache too!

And....relaxxxx....

Being as relaxed as possible as you give birth is great for the whole labour and birth process – and when it comes to the actual pushing-a-baby-out bit there are a number of ways of doing that.

Firstly, learning how to really relax! That means with your breathing, with being really aware of your body and where you’re holding tension, maybe using visualisations – and extending that relaxation all the way through from your jaw to your shoulders to your pelvic floor! Because it's all connected. Hold tension in your jaw and it will also be in pelvis. If you’re thinking “I find it SO difficult to let go of tension and relax” – come and join me at my evening pregnancy relaxation class. You’ll be nodding off in no time! 

Plan to give birth at home 

That’s right. You heard me!

In April 2020 there was a massive analysis published of half a million births. It compared the safety of giving birth at home with the safety of birth in a hospital. Among many other really amazing findings, it found that simply by planning a home birth, you were 40% less likely to experience a 3rd or 4th degree tear (the most severe), and 55% less likely to have an episiotomy.

Why? I could go on for hours about the conditions that we need for birth and the impact of fear and medicalization on the birth process… but in part its simply that you are most relaxed at home. So birth unfolds more easily. And note that these findings applied simply when home birth was planned – so the benefits were still there even if a transfer to hospital took place at some point.

Give birth in a birth pool

You know when you get into a warm bath after a day on your feet? Ahhhhhh…. That’s the sensation of getting into a birth pool when you’re in labour. So imagine what that does to your muscles! It helps everything relax so much more! You’re also more likely to be able to be in those upright, active birth positions when you’re supported by the buoyancy of the water.

Consider a warm perineal compress

There is evidence that holding a warm compress against the perineum during the pushing phase can help to prevent tearing. (Think about the warmth of the water in the birth pool – this is doing a similar job.)

If this is something that appeals to you then pop it on your birth plan and chat it through with your midwife. This one also comes with another “However!” though. The evidence that we have around warm compresses come from studies where women are giving birth in hospitals and, you guessed it, are on their backs! So we already have an unnatural, less instinctive and more medicalised approach to birth. This is “an intervention to address an intervention” if you like.

If you’re planning a birth pool, or if you’re planning to give birth in upright positions, the warm compress will be unlikely to be of much benefit to you. However when you’re considering all the “what if?” scenarios and you think about a more medicalised birth scenario, the warm compress may be something that appeals. 

And finally…. avoid coached pushing!

What do I mean by “coached pushing”?

You know when they say: “Chin to chest, hold your breath and PUUSSHHHH!” – That. That’s what I’m talking about. Directed pushing from someone else.

If you’re given the right environment, time and support, you will experience overwhelming urges to push your baby out. You won’t miss them! And by following those urges – their timing, their intensity – rather than pushing when your midwife tells you to, you will reduce your likelihood of tearing. That might mean you go slowly in some parts, and that’s ok. There’s no time limit on birthing a baby! Most importantly, it means continuing to breathe, and this is where all that breathing practice during your pregnancy comes in.

Having said all of the above...

I want you to know that minor tearing is a really normal part of childbirth. We are designed to tear and heal really easily. When I say this, I am of course distinguishing between minor tears (that heal all by themselves or just with a few stitches) and severe tears requiring surgery. Of course, sometimes there will be circumstances or a reason beyond our control. But in many cases tearing can be minimised – so note down the above and think about how you can apply it to your birth plans! Your plan A and your plan B!

And if you’d like my support in working all of that out, come and join me on Bump to Birth to Breast. We talk about all of this and lots, lots more.

Rachel xxx





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