Tearing during birth, tearing prevention; Of all the pregnant ladies I have talked to, tearing is one of the most common fears. Some providers just shrug it off and say everyone tears...Not True!

As a mom who recovered from one birth with tearing and one without....trust me, you want to follow as many of these tips as possible. Recovery was SO much easier postpartum without dealing with tearing and stitches.

So here we go...

10 Ways to Reduce the Risk of Tearing during Birth

1. Just say NO to an Episiotomy

An episiotomy is a cut performed by your doctor to enlarge the vaginal opening by cutting into the skin and muscle of the perineum (the skin between the vagina and anus). They were used during forceps deliveries and at some point became standard practice for many doctors. Thankfully routine episiotomies are now not the standard of care (though there are always a few doctors stuck in their ways). We now know that episiotomies increase the chance of a third or fourth degree tear. Ouch! Once the cut is made, baby’s head will often cause the skin to rip further into the muscle causing more damage than if you just tore naturally in the first place. Natural tears usually heal together more easily with less scarring.

2. Perineal Massage

Perineal massage is a technique you can practice while pregnant. It involves gently stretching the skin at the vaginal opening. Check out this article explaining the evidence on perineal massage and how to do it. According to the study in the article, women who were randomly assigned to do perineal massage had a 10% decrease in the risk of tears that required stitches (aka “perineal trauma”), and a 16% decrease in the risk of episiotomy.

3. Water Birth

Laboring and/or delivering in water can soften your skin to allow for more stretching as the baby’s head is crowning. The more your skin is able to stretch, the less likely it will tear. Water also doubles as pain relief so win win! This is more likely to be an option if you are planning to deliver at home or in a birth center, but some hospitals are now offering water birth too. For more information on the benefits of water birth, check out Evidence Based Birth. I’m even one of the featured births in their article on water birth!

4. Birth in an upright position

When you push while laying on your back, you are essentially pushing up hill. When you birth in an upright position (standing, squatting, using a birth stool, on your knees, etc.), you take pressure off the perineum and allow gravity to help things along.

5. Have your doctor, midwife, or nurse support the perineum during pushing

If your provider holds a warm, wet compress over the perineum during crowning, it can prevent the skin from tearing. Similar to birthing in water, a wet compress will help soften the skin.

6. Don’t Push

Say what!? Hypnobirthing teaches a technique called J Breathing. You “breathe baby down” instead of pushing. It involves quick inhales with long slow exhales as you relax your pelvic floor and think of opening. It seems odd but works! There is no holding your breath with purple face pushing, just breathe, relax, open. Sometimes this method can be a bit slower for the “pushing” stage, but that brings us to our next point.

7. Slow down

I know you want to meet your baby and are SO ready for labor to be over but try to slow down. Pushing as hard as you can is not the best plan here. Take your time and slow down. Baby’s head will go two steps forward, one step back. This is a good thing! It will again help to slowly stretch the skin and give you a better chance of no tears.

8. Hire a Birth Doula

How can a birth doula prevent you from tearing you ask? Doulas are great for lowering stress and making your labor a more calm, peaceful, and relaxing experience. This will make it easier for you to slow down and stay focused during the pushing stage instead of trying to get it over with as quick as possible and power push that baby out (yes it will be over but you will regret the big fatty tear that usually comes with that option). A doula can help remind you to take things slow and make sure your provider knows you want a supported perineum during crowning. A doula can also help advocate for you if your provider is not as excited about upright birth positions and prefers you on your back.

9. Don’t get an Epidural unless you REALLY need it

A doula can help a lot with avoiding the epidural. Once you have an epidural, you will be limited in the types of positions you can get into for delivery. It is much harder to birth upright with an epidural (though I’ve heard of some awesome nurses that help make it happen). When you have an epidural, you also can’t feel much so you’ll have to push when your provider tells you instead of going off sensation and what feels right in the moment. This can all increase your chance of a tear. When you’ve crossed over from the hard work of labor into suffering through it, the benefits of an epidural may outweigh the risks. It’s much easier to make that decision during labor if you know all the risks and benefits ahead of time so do your research now!

10. Drink Water!

This one is easy! Drink lots of water and take care of yourself during pregnancy. Hydrated, healthy skin has better elasticity which means less tearing. You’ll want to get in the habit of drinking lots of water anyways if you plan to breastfeed so start now.

There you have it! 10 ways to avoid tearing during birth

I know the idea of tearing can be scary, but even if you do tear it’s not the end of the world. Most tears are pretty minor and heal up very well. I didn’t even feel my 2nd degree tear with my first baby. If you need stitches after delivering, you can have your new baby in your arms as a nice distraction too. If you do tear, make sure you go home with a peri bottle and I highly recommend Young Living’s Claraderm Spray.

Happy Birthing!