Let’s get real. We know that one of the biggest worries people have when it comes to childbirth is vaginal tearing. You hear stories from friends, family, and TV, all scarier than the last. We also hear all of the old-wives tales on how to prevent it, but how do we know what actually works? Roughly 90% of people experience tearing during childbirth. This does not mean it’s a guarantee, it just means that most people might not know how it can be prevented and that pelvic floor therapy is not just for postpartum people, but for those who are prepping for labor and delivery as well.
You first might be wondering, why do vaginal tears happen during birth? Well, there are a number of different factors. During the second stage of labor, the baby’s head descends into the vagina and moves down onto the perineum. The perineal skin (the area between your vagina and anus) thins and stretches over your baby’s head. As the baby’s head begins to crown, the labia and vaginal opening begin to bulge and stretch around the head. If the skin and perineum have not stretched sufficiently then a tear can happen.
Factors that increase the likelihood of tearing are:
- Size of baby
- Birthing position
- Use of forceps or vacuum
- The elasticity of the perineal skin
- If it’s your first delivery
It is very uncommon for women to actually feel themselves tearing, due to the intensity and pressure that occurs during this stage of labor. Often women will be told they have a small graze or tear and express surprise as they didn’t feel it happening. It’s not something to be fearful of, however, doing what you can to prevent it is the best course of action.
What types of tears are there?
Tears or lacerations of the perineum are classified into four types. The most common are first and second-degree tears. A first-degree laceration occurs when the skin has torn but is considered small and doesn’t require any or only a few stitches. A second-degree tear involves skin and muscle underneath and usually needs a few stitches. More severe tears are less common and occur in around 1% of births, usually as a result of an episiotomy. Third-degree lacerations are a tear in the vaginal skin, perineal skin, and the muscle that extends to the anal sphincter (muscle around your anus). A fourth-degree tear is the same as a third-degree one except it extends into the anal sphincter and the tissue around it. Both can impact the pelvic floor function and anal muscles. It’s hard to predict which woman will have a tear but there are things you can do to minimize your risk of a tear, or the extent of a tear if it does happen.
There are different ways that you can try to prevent or minimize vaginal tearing at birth, and some of these steps can be taken even during pregnancy as you begin to prepare your pelvic floor for birth. These methods can include the following:
During pregnancy:
- Perineal self-massage after 34 weeks of pregnancy can help protect your perineum and reduce the risk of third- and fourth-degree perineal tears
- Pelvic floor physical therapy will help prepare you for labor and childbirth and reduce the possibility of a third- or fourth-degree perineal tear. Common advice to pregnant women is to do pelvic floor exercises (known as Kegels) to strengthen the muscles in the pelvic floor. This is NOT something we recommend for everyone. If your muscles are too tight, you are actually more likely to tear. While pelvic floor strength is important, knowing how to stretch and relax these muscles is even more helpful.
During a vaginal birth:
- Applying warm compresses to the perineum during the second stage of labor (when pushing and giving birth) can significantly reduce the risk of a third or fourth-degree perineal tear
- Slowing the rate at which the baby’s head and shoulders emerge, with the help of your birth attendants, may help prevent perineal injuries
- The position you are in when pushing has a big influence on whether you are more likely to tear. Lying down, lithotomy position (lying down with legs held up) or semi-reclining positions put pressure onto your tailbone and perineum, reducing the size of the pelvic floor and increasing the likelihood you will tear. The best position for birthing your baby is the one you choose instinctively for yourself and you feel most comfortable in. Women who are free to move about during labor will find the position that helps them cope with contractions at each particular stage. Some women like to float free of gravity in water, others like to have their feet firmly planted on the ground.
If you are preparing to give birth, or if you have already and are experiencing residual pelvic floor pain, you have come to the right place. We would love to help you work through your pain to help you get back to feeling like yourself again! Feel free to reach out to us at Arancia Physical Therapy online here or give us a call at 401.602.7006 if you are interested in learning if we are the right fit for you or for a free consultation with an expert. We look forward to hearing from you!
Works Cited
Hannah Dahlen Professor of Midwifery, and Holly Priddis Lecturer in Midwifery. “What We Know about Perineal Tearing, and How to Reduce It during Childbirth.” The Conversation, 17 July 2022, https://theconversation.com/what-we-know-about-perineal-tearing-and-how-to-reduce-it-during-childbirth-63212.
Papa, Jessica. Postpartum Is Forever: A Pelvic Health Specialist’s Guide to Heal and Optimize Your Body Before, During and After Pregnancy. 2022.
Pevzner, Holly. “Vaginal Tearing during Childbirth: What You Need to Know.” Parents, Parents, 31 July 2020, https://www.parents.com/pregnancy/giving-birth/vaginal/vaginal-tearing-during-childbirth-what-you-need-to-know/.
“Vaginal Tears (Perineal Lacerations).” Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/21212-vaginal-tears-during-childbirth.
Tags: childbirth, pelvicfloorphysicaltherapy, pelvicfloorpt, birth, postpartum, vaginaltearing
