Understandably, natural birth tearing is an issue on the minds of many women as they approach labor. Let’s discuss what tearing is, and ways you can try to prevent tearing during birth.
What is Natural Birth Tearing?
Tearing is when the skin of the perineum (area between the anus and vagina) receives a laceration during birth. Tears typically occur when the baby’s head starts to crown. As the skin of the perineum stretches, sometimes the pressure of the head causes the skin to tear. 
Fortunately, most tears are not severe and heal on their own (1). The only symptom you may notice is mild burning with urination. More severe tears, on the other hand, usually need stitches and may require months to heal. Tears are graded according to severity (1st – 4th degree).
Can You Prevent Natural Birth Tearing?
Perineal tears are not entirely preventable. They occur in up to 85% of women after a vaginal birth, yet most will be mild. Your chance of experiencing a tear is influenced by a wide range of factors. Severe perineal tears are more likely if (2):
- This is your first vaginal birth
- Forceps or a vacuum extraction were used to deliver the baby
- Baby was born in a posterior position
- Shoulder dystocia (baby’s shoulders have difficulty moving through the pelvis)
- Higher birthweight
How To Try and Avoid Natural Birth Tearing:
While tears are common, don’t loose hope! There are a few evidence-based techniques you can implement to try and avoid a tear. At the very least, these techniques might help prevent more severe perineal tears.
1. Perineal Massage During Pregnancy
Perineal massage has been shown to moderately decrease the risk (10% reduction in relative risk) of tears that require stitches in first-time moms (3). While the process can be a bit time-consuming and off-putting to some women, it may help increase muscle and tissue elasticity and avoid a serious tear.
Perineal massage is performed for 10 minutes daily, starting from the 34th or 35th week of pregnancy until delivery (4).
How to Do Perineal Massage: Get into a semi-sitting position. Apply K-Y Jelly to your thumb or partner’s index fingers. Place thumb or fingers into the vagina up to the second knuckle. Curl fingers and gently pull outward and downward toward your anus. Then, rhythmically move it within your vagina in a U motion. As much as possible, concentrate on relaxing your pelvic floor muscles during the exercise (5).
2. Low-Gravity Pushing Positions
To avoid tearing during the birth, use pushing positions that put minimal strain on the perineum. These are positions that decrease gravity and increase mom’s ability to control the speed at which baby’s head is born. These include positions like side-lying, kneeling, and hands-and-knees.
3. Warm Compress at Birth
Studies have shown that applying a warm compress to the perineum as the head is crowning leads to less 3rd and 4th degree tears (7). It may also decrease perineal pain postpartum and reduce the risk of urinary incontinence after birth (8).
A warm compress is nothing more than a facecloth soaked in warm water and wrung out. Have your doctor or midwife apply the compress to the perineum starting from the time it starts to distend from the pressure of baby’s head until birth.
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References:
(1) Feigenberg, T., Maor-Sagie, E., & Zivi, E. (2014). Using Adhesive Glue to Repair First Degree Perineal Tears: A Prospective Randomized Controlled Trial. BioMed Research International, Article ID 526590, 5 pages, 2014. doi:10.1155/2014/526590
(2) , , , , , , , . Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG 2013;120:1516–1525.
(3) Beckmann, M. M. and A. J. Garrett (2006). “Antenatal perineal massage for reducing perineal trauma.” Cochrane Database Syst Rev(1): CD005123.
(4) Labrecque, M., E. Eason, et al. (1999). “Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy.” Am J Obstet Gynecol 180(3 Pt 1): 593-600.
(5) Simkin, P., Whalley, J., Keppler, A., Durham, J., & Bolding, A. (2010). Pregnancy, childbirth, and hte newborn: The complete guide. Minnetonka, MN: Meadowbrook Press, 235.
(7) Aasheim V, Nilsen A, Reinar L, Lukasse M. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD006672. DOI: 10.1002/14651858.CD006672.pub3
(8) Dahlen, H. G., Homer, C. S. E., Cooke, M., Upton, A. M., Nunn, R., & Brodrick, B. (2007). Perineal outcomes and maternal comfort related to the application of perineal warm packs in the second stage of labor: A randomized controlled trial. Birth, 34(4), 282–290.
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