Tips to Prevent Tearing

Giving birth is a beautiful process and one question I get asked a lot is, “What if I tear?”

The percentage of first time moms that tear is pretty high since the tissue can be less flexible, but there is hope my friends! I am going to give you some tips to help prevent tearing and some scenarios where you may have more options than you think.

1. The Position of the baby

The position of the baby and the position in which you deliver your baby can have a huge impact on tearing.

When baby is in the right position for birth, it helps everything fall into place during labor. The optimal position for baby is head down facing your back and baby’s back towards your stomach (occipito-anterior position). Exercise is very important to help you and baby get ready for the big day. Here are a few other exercises that can help when practiced daily:

  • pelvic tilts, hip circles, rock forward and back, and hands and knees all on an exercise ball daily (while watching tv, doing computer work, etc.)

  • leg stretches (butterfly and hip openers)

  • squats

  • kegels

  • starting the Miles circuit at 37 weeks (click here for instructions)

2. The positions you labor and deliver in

During Labor, being able to move around freely and try several positions helps your body move along during labor and prepares you for the pushing stage. Even if you are in bed, switching sides you are laying on while using a peanut ball can be very beneficial.

Being able to get into a position for pushing that puts less pressure on the perineum aids in the prevention of tearing. Optimal birthing positions (however, you may feel your body telling you another one):

  • upright positions

  • side-lying ( can put leg in stirrup, have partner hold leg or use a peanut ball)

  • upright squatting with support of squat bar or partner

  • hands and knees

  • forward leaning positions (supported standing or kneeling on bed, ball or chair)

These all work with gravity to help you and your baby out during the pushing stage. In case of an epidural, positions are limited. Talk to your healthcare provider about possible birthing positions.

3. Pushing

When you feel the uncontrollable urge to push, it helps if you take the lead in listening to your body. This allows your tissue time to stretch slowly as you feel your baby coming down and out during pushing. Sometimes being instructed to push can feel as if trying to force the baby out which puts more pressure on the perineum increasing the risk of tearing.

A clinical practice guideline from the the Society of Obstetricians and Gynecologists of Canada showed that not instructing women to push and allowing them to deliver the head on their own decreased tearing by 50 - 70%.

The fetal ejection reflex are strong pushing contractions that happen involuntarily that moves your baby down and out. Your baby actually kicks off of the uterus to make its entrance into this world. Women have given birth in a coma before because their body and baby knew what to do and the fetal ejection reflex took over. You don’t have to push, but again, listen to your body and move with it.

If you are getting an epidural, it is harder to feel the urges but talk to your provider about how you prepare to push during delivery. Pushing on your own is in the case of nonemergency births only.

4. Preparing perineum

There are a couple things you can do to help prepare your perineum for birth. Perineum massage can be beneficial in helping to relax the tissues and get you comfortable with your body. There are some oil blends that have added benefits if added to this massage to help prevent tearing such as the Lotus Elixir.

Using a warm compress during pushing is also a great help. Add this to your birth plan and ask your care provider to hold a warm compress on your perineum for pushing.

Eating healthy fats and staying hydrated may also help the elasticity of your perineum.

5. Care providers

Finding the right care provider is essential. Although episiotomies are less common today, they can cause you to tear further and make recovery harder. Find a provider that doesn’t make this a part of their daily practice. Go over your birth plan with your provider and make sure you will feel supported in your labor.