Are you a mom-to-be? If you’re a first-time mom who is on your last trimester, you are probably anxious right now of what labor will feel like. Aside from the labor pain, you might also be concerned about perineal tear that is pretty common during childbirth. It can’t be totally prevented, but luckily, there are many ways to reduce tearing during labor.
Before we proceed to the methods of preventing perineal tears, it is essential to understand what they really are and how tearing happens while you’re on labor.
What is a perineal tear?
The perineum is the area between the opening of the vagina and the anus. Tears or lacerations in the perineum, also called perineal tears, are common for women who are giving birth vaginally.
What causes perineal tears?
These wounds naturally occur as the baby’s head pushes down and stretches the vaginal and perineal wall during labor and delivery. Perineal tears are more likely to happen if your vagina and perineum can’t stretch enough or if your baby’s head is too large for the opening.
Degree of perineal tears
Perineal tears are categorized to four degrees based on the extent of lacerations.
- First degree perineal tear involves only the skin and can heal without treatment.
- 2nd degree perineal tear extends to the muscles of the perineum and may require stitches to assist in healing.
- 3rd and 4th degree perineal tears are a bit deeper and extend up to the opening and muscles of the anus. These types of lacerations need surgical repair in the operating room.
What is the difference between perineal tears and episiotomy?
A perineal tear is different from an episiotomy. While perineal tears spontaneously occur, an episiotomy is a cut made by the health care provider who is attending to the delivery.
An episiotomy is done to provide a wider space for the delivery of the baby’s head. This cut is usually made if the childbirth needs to be assisted with forceps, if your baby needs to be delivered immediately, or if you are at risk of getting serious perineal tears.
Just like second degree tearing during labor, an episiotomy needs to be repaired through stitching to assist in wound healing.
How to avoid perineal tears during childbirth
Perineal tears add up pain and time before you completely recover from childbirth. This is why many mothers seek alternative ways on how to prevent perineal tears by the time they give birth to their babies.
Some techniques can be started as early as the third trimester of pregnancy, like the following:
Perineal massage is an exercise taught by a health care provider to a mother starting on the 35th week of pregnancy. It involves a shallow insertion of both thumbs into the vaginal opening and applying pressure on the sides and lower walls of the vagina to facilitate stretching of the perineum. A perineal massage is often paired with water-based gels or essential oils to prevent tearing during labor.
So how does perineal massage prevent tearing? Tearing is usually caused by the perineum’s inability to stretch enough to accommodate the baby’s head. Thus, if your goal is to reduce tearing during labor, it is important to exercise its flexibility ahead of time.
Perineal massage can also be done by your health care provider during active labor to slowly apply pressure and stretch your perineal wall.
Birth training device
A device called EPI-NO birthing trainer is gaining popularity in some countries. Basically, it features a silicone balloon that can be inserted and inflated inside a pregnant mom’s vagina to mimic the “crowning” of the baby’s head while on actual labor. The size of the balloon can be adjusted to slowly provide pressure on the perineum and stretch it gradually.
With this device and the help of a health care provider, the mother can also be taught how to push slowly during active labor to reduce or prevent perineal tears and the need for an episiotomy.
Learn when and how to push
Pushing inadvertently while on labor will not only increase your risk of perineal trauma, it will also drain your energy which is supposed to be reserved for childbirth.
It is usually advised to learn deep breathing exercises that can help you deal with labor pain during the first stage of labor. During this time, active pushing is not required because your baby’s head is not yet positioned and your cervical dilatation is still small. Pushing during this time will more likely end up to cervical swelling, prolonged labor time, and lacerations in your perineum.
When your cervix is fully dilated and you enter the second stage of labor, it’s time to do some pushing. However, be reminded that no matter how intense the urge you feel, pushing slowly and together with your contractions can reduce your labor time and help lower down the chances of getting perineal tears.
The proper technique on how and when to push can be learned from childbirth classes or your health care provider while you are still pregnant.
So now that you’re done with the labor and childbirth exercises, it’s now time to talk about some ways to prevent tearing during actual labor and delivery. It is important to discuss these things with your doctor or midwife so that they can take the necessary preparations for your preferred childbirth setting and practices.
Here’s a couple of things that have helped reduce perineal tears among mothers while giving birth:
Application of warm compress
The practice of applying moist, warm towels or pads on the perineum while the mother is on labor has been used in several childbirth facilities. According to the World Health Organization (WHO), applying warm perineal compress during labor prevents the risk of third and fourth degree perineal tears. Warmth is believed to enhance the flexibility of the perineal area so that it can stretch better as the baby’s head is delivered.
Alternative birthing positions
Lying down is the traditional position in giving birth, but according to experts, it produces more pressure on the pelvic wall and is more likely to cause tearing. Explore alternative childbirth positions like all-fours, kneeling, standing, side-lying, and squatting.
Giving birth in water is also preferred by many mothers because it is claimed to reduce labor pain and perineal tearing. It uses warm water that promotes relaxation and softening of the perineum.
Hands-on or guarding approach
This technique is used by health care providers to reduce 1st degree perineal tears. On a hands-on approach, the health care provider will guard your perineum manually to facilitate gradual stretching and prevent the severity of tearing in the perineum.
Labor and childbirth aren’t easy, and perineal tears can be your lifetime testimony to that. But don’t despair, mom! Whenever you feel anxious, or need a bit more information about your upcoming labor, speak with your doctor or midwife. We’re pretty sure they’ll gladly extend help so that you can make informed choices and find your way to at least minimize perineal tears by the time you give birth.
This article is for informational purposes only and should not be considered medical advice. Always consult with a doctor or licensed medical professional before making any medical decisions.