One of the biggest concerns women hold as they approach birth can be, what is going to happen to my vagina! Will I tear during birth? Will it ever be the same again down there? It’s not a subject readily spoken about, unless we hearing the horror stories, so here are 5 things to understand about tearing and suggestions that can help you positively prepare and help prevent tearing during birth.
1. Our Bodies Are Designed For Birth
During birth our babies pass through our cervix and our vaginal canal, or as I like to call this area, our Birth Path. We have been beautifully designed to allow for the stretching and opening that must happen during birth, by the many folds of tissue within our cervix & vagina, that will soften, thin, pull up and gradually open during labour. There are also tiny nerve receptors within the vaginal path, that, when stimulated by our baby’s head descending on them, secrete our natural lubrication, helping mum & baby to be comfortable.
The perineum is a group of muscles and elastic fibres that provide support to our pelvic functions and connect to our pelvic floor, they also circle around & in between our vaginal opening and our rectum. The tissues and muscles of the perineum will fold and stretch during birth to allow our baby to birth gently.
2. Get To Know Your Birthing Muscles
Practising pelvic floor exercises daily will help to tone the muscles within and around your perineum, as you prepare for your birth. Its also a great way to get to know the muscles that you will look to relax during your labour & birth. Build up to a daily practice, aiming for 3 times a day. Build it into your routine so perhaps when brushing your teeth & at lunchtime.
The idea of perineal massage can feel daunting, but it can be a simple way to connect with your birthing muscles & help to gently stretch them before birth. Experiencing the sensation of pressure within this area, whilst you practise relaxation, can also really help you let go & relax those muscles during birth. Be gentle and slow as you engage with this massage, from 32 weeks, build the pressure a little each time you do it, relax and try not to rush.
3. Position During Birth Matters
Movement & positions will happen naturally during labour, your body instinctively showing you what feels good. Taking a position that will help you work with your birthing muscles, not against them, however, can really help you to prevent tearing during birth. A side lying position encourages a slow, gentle birth and is shown to have the fewest instance of tears. Kneeling or on all fours positions can also help to relax the perineum, alleviating pressure on this area. Avoid lying on your back and pulling up your knees which will tighten the skin and tissues of the perineum, increasing the risk of tearing.
4. Birthing Muscles Need Oxygen
Forced pushing by default requires us to hold our breath and creates tension within our bodies, we are more likely to tear when our baby is descending on to hard, tense muscles.
Our muscles need oxygen to work, particularly our birthing muscles! Deep breathing during the birthing phase will help you to maximise your intake of oxygen, and directing your breath down through your body will send deep, oxygen rich blood to your pelvic area helping these muscles to work efficiently. Relaxed muscles which are soft and open are less likely to tear in birth and will help your baby descend gently.
5. Water & Warmth Support Our Birthing Muscles
A birthing pool filled with warm water is a feeling of total bliss during labour. Not only do we get a rush of oxytocin from the warmth and sensation on our skin, we also naturally relax in this environment, and that means our birthing muscles too!
If you do not have access to a birth pool, a warm bath can do the trick just as well, and this is great during the early phase of labour when you will be at your home, or if you are planning a home birth and don’t have the space for a birth pool.
A warm shower is also amazing, direct the water over your tummy and pelvis or fill a jug and pour over your back and your tummy for a deep feeling of relief.
A hot water bottle can also be your best friend, applying warmth to your back and pelvic muscles as you need.
There is some evidence to suggest that warm compress and massage to the perineum in the late stages of can reduce the risk and severity of tearing, however some may find the physical contact at this stage too obtrusive, so keep an open mind to this option and really discuss it with your midwife team on the day to know that you will feel comfortable and supported for this to be really beneficial.
What if I do tear?
So, there are lots of positive steps that you can take to reduce and prevent the risk of tearing during your birth. Sometimes however, tears do happen for no fault or reason of our bodies design, or the way in which we are birthing. Episiotomies are really not recommended, but they can at times be necessary for our birth journey.
If you do experience a tear or an episiotomy, there are some active steps you can do yourself at home to alleviate discomfort and aid physical healing. A cold water compress for the first 24 hours after birth will help to reduce swelling & pain in the area. Soak & freeze a cloth or flannel, then wrap again in a soft cloth before applying to the skin for 10-20 mins at a time.
Keeping the area clean is really important, boil a litre of water with 1 cup of Epsom salts to dissolve. Allow the water to cool and keep by the toilet, so that each time you go for a wee you can pour some of this water over to move the lochia blood away from the area. Refresh this water daily.
Within the first few days after birth a deep, warm bath can feel wonderfully restoring. A herbal sitz bath can support healing of tissue damage, episiotomies & help with haemorrhoids too. At Nama Mama I create herbal blends to use during the postpartum so you can enjoy the cleansing benefits of herbs including calendula, yarrow, lavender & comfrey in your bath. A simple bath of Epsom salts however can be really beneficial and help to heal and restore your whole body after the amazing efforts of your birth.
Thanks Emma for this wonderful blog post. You can find Emma over at Nama Mama, on facebook and instagram. She teaches The Little Birth Company courses in Dorking, Surrey and online.