I’ve been seeing a lot of posts on Pinterest lately on preventing tearing during birth.  I always click greedily into the post to see what tips they have (this is what labor nurses do for fun).

And then I leave dejected.

The thing is, everyone is kind of a fan of their perineum (in case you didn’t know, your perineum is the skin between your vagina and your anus).

I mean, without it — you mostly just envision all your guts falling out.

I bet tearing might be one of your biggest fears about delivery — and that’s a normal one.
So, let’s talk about tearing, why it happens, what causes it, some possible ways to prevent it and what to do afterward.

**You might wonder why the heck I know so much about tearing, and that is because I've been an L&D nurse since 2001.  You can even sign up for my pregnancy series to get helpful information all through your pregnancy, just for the stage you're at!**

If you’re in the zone of wanting to learn more abouy your delivery, I totally recommend this.

Causes: Why Tearing Happens

Tearing happens when the head comes out of your vagina.  As you can imagine – your Vagina (hopefully) is not the size of a baby’s head, normally.  However, it is meant to stretch and adjust as the baby’s head comes down.

Depending on a number of factors, the vagina and/or your perineum can sometimes tear.

We grade the tear in degrees.  First degree is pretty small, and 4^th degree extends into the anal sphincter tissue.  You can also extend to the Anus, which happen to very special people like me.  **Spoiler alert – I’m still alive **

Information about episiotomies

An episiotomy is when your practitioner cuts your perineum.  It can happen for a variety of reasons

1. Your doctor always does it.  

It’s pretty rare anymore, but I know doctors who always do it.  You can ask your doctor their episiotomy rate.  They should know.  We do give the data to the doctors (computers are handy this way).  It should be low.  I don’t see them frequently.

Some doctors believe you heal better with an episiotomy than a jagged tear.  I’m not sure I agree with this.

1. Baby is not safe inside anymore

If your baby’s heart rate is dipping and delivery needs to be soon, your doctor might cut an episiotomy to get it out faster.  It can speed up delivery.

1. Your doctor is “so busy”

Yup, they might not want to wait anymore for delivery.  So, they cut.

Again, I see that super rarely anymore.

You always have the option to say “nope” to an episiotomy.  The doctor should ask you if it’s OK (unless it is truly an emergency) and you can always say – no, I’d like to try on my own, thank you very much.  You can learn more about informed consent here.

**I have been getting a LOT of emails lately with women who aren’t sure how to talk to their doctor — that post about informed consent is SUPER helpful to talk their talk and try to understand each other better, I totally recommend it (and I also have  webinar in getting the labor you want)**

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Related post:  If you have an epidural does childbirth still hurt?

What causes tearing at delivery?

Tearing happens for a few reasons:

**First off – none of these things are the “kiss of death” – just because one happens doesn’t mean you’re sure to have a tear**

1. Baby’s head size.

When I married my husband I did some thorough discussion with his mom about the size of his newborn head and shoulders.  He seemed like your basic run of the mill baby – so I married him.  This is a true story.

1. Baby’s head positioning

Babies are meant to come out looking down at your bum.  If they come out looking up (also called OP or “sunny-side up”) the head doesn’t have the same ability to flex and adjust to the vagina and the opening.  It can cause tearing.

1. Your tissue type

I don’t see this often in women of good nutrition, but often when I had poorly nourished patients the tissue would just sort of fall apart.  Their diet consisted of a lot of rice, and soups.  Very little meat.  They just weren’t fully nourished.

It also made for a hard time to sew them up.  Kind of think of fraying fabric.

Anyway, have a burger.   The nutrition you’ve had all your life helps make up your tissues — but it is important to stay well nourished during your pregnancy (which, frankly — most women don’t have a problem doing).

1. Speed of delivery

If you blow your baby out at home, you’re likely going to tear.  In fact, some of the worst tears I’ve ever seen have been at un-anticipated home births.

This is a nice stretching that happens as you give a controlled push.  It doesn’t feel great, but it can prevent you from tearing.

1. Skill of your practitioner

I’ve delivered a few babies in my time.  But, there are things we do as the baby comes out to support the tissues and allow the delivery at a good pace, but not too fast.  Slow it down too much, and you’ll tear at other spots, slow it too little and you don’t get the stretching I mentioned above.

Which is why you really want to be picky when finding a doctor.

Prevention of tearing at delivery

Ahh, the stuff dreams are made of….

Preventing tearing.

Well, if you read the above section you’ll see that there isn’t a whole lot you can do about a few of them.  But, there are some things you can do.

1. Marry someone with a small head.  Or, if you’re not the marrying kind — only have sex with people who have small heads, or examine their baby picture to see if they came out with a giant noggin.
2. Eat a well-rounded diet that allows your body to create tissues that are healthy and strong. The Bradley Method recommends having an egg every day during your pregnancy and I am actually a fan of this advice. Either way, eat a balanced, nutritious diet.
3. Listen to your doctor: When he says to not push too hard, listen to him.  You might feel greedy that you want the whole experience over, but those extra 30 seconds could really help your perineum.  It will thank you for it.
4. Pick a doctor you trust. Ask them their episiotomy rates, and mention that unless there is an emergency you’d prefer not to have one.  Mention you’d also like to be asked before he cuts one.  Also, trust him/her.  Make sure they aren’t the lazy ones mentioned above.

I do not recommend vaginal stretching.  I’ve seen articles that say it does more harm than good.

I always recommend Kegal exercises.  They might help you recover faster, but they won’t prevent you from tearing.

I do believe there could be something too hot/cold compresses, but that would be something to ask your nurse about.  It would certainly depend on if your tissues are swelling or if they’re noticing anything else.

There may be something to essential oils —  but each person’s body reacts so differently, I certainly wouldn’t recommend them across the board.

What to do afterward ~ Recovery from tearing at childbirth

Don’t miss my BEST tips for AFTER baby!

My best advice is that tearing is something you can come back from!  People LOVE this stuff.

You will still be able to use your vagina for a playground (waiting at least the 6 weeks of pelvic rest).

Life will go on… by doing a few things.

My post on postpartum comforts outlines some of my very best advice — since this post is already twelve miles long, I’ll just let you click on over to that.

I bet you CAME to this post because you’re nervous about tearing, and likely other things — like the epidural the IV.  This Online Prenatal Class covers everything from 3rd-trimester testing, up through your first months home with the baby.

It’s going to put fears like this one to rest.  I even have a beginning version, if you’re wondering if it’s for you.

And be sure to check out my other postpartum tips right here:

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