One of the biggest fears that majority of women express about birth (apart from the pain) is the prospect of tearing, and although it’s a valid concern, it can also be easily prevented.
Where Can You Tear?
Tearing during birth can occur anywhere; the perineum or labia minora (most common tears) and even the clitoris, anus and rectum.
Degrees of Tearing
• 1ST DEGREE TEAR: Normally a superficial laceration; the surface of the skin splits slightly which may cause some bleeding. No muscle or deep tissue is damaged with a 1st degree tear and is often too small to stitch (sometimes requires minimal stitching). These normally heal in a week with minimal discomfort.
• 2ND DEGREE TEARS: A deeper tear that proceeds into the vaginal lining and submucosal tissues. Always requires stitching. Takes 1-2 weeks to heal with mild discomfort for about a month.
• 3RD DEGREE TEARS: These tears proceed past submucosal tissues and into muscle tissues that support the anal sphincter. Each layer needs to be stitched individually. These tears take 2-4 weeks to heal and discomfort can proceed for a few months.
• 4TH DEGREE TEARS: This tear proceeds past muscle, directly into the rectal lining/rectum. This is the least common tear and is most common with vacuum/forceps assisted deliveries and infant shoulder dystocia. Multiple layers will need to be stitched individually. These tears take the longest to heal, are the most traumatic to endure and can even lead to prolapse or pelvic floor dysfunction.
Tearing vs Episiotomy
Studies have shown that natural tearing is preferred over episiotomies for many factors:
• Lowered risk of 3rd and 4th degree tears
• Lowered risk of infection
• Faster/more effective healing
• Less invasive
• Lowered risk of excess blood loss
• Less risk of long term perineal pain, trauma and incontinence
How To Prevent Tearing During Birth
• BREATHING: This is imperative to the birth process for so many reasons, including the prevention of tearing. This relaxation technique has a direct effect on the perineal area; less force and tension is exerted on the perineum during crowning and the skin around the vagina gets a rush of oxygen-rich blood which causes the perineal area to relax, allowing it to stretch with ease, at a more relaxed pace to accommodate your baby better with less trauma.
• PERINEAL MOISTURE: As labour progresses, the vagina naturally produces more mucous to prepare the birth canal and perineum for a smooth birth; a moist perineum stretches more effectively than a perineum that is dry. Options include a water birth or applying water based lubricant or a warmed wet compress (like a facecloth) to the perineum during crowning to help support the delicate skin.
• UPRIGHT POSITIONS: Birthing in a more upright position (especially forward leaning positions) helps to minimize tension from hard pushing as gravity helps to draw the baby down, which allows you to relax more during the pushing stage of labour. It also takes the weight of the baby’s head and body off the perineum during crowning and birth, reducing stress on the perineal tissues during this stage.
• RELAX FOR THE RING OF FIRE: As the baby crowns and the perineal skin stretches it creates a stinging sensation around the vaginal opening; this sensation is a reminder for you to slow down. Your care provider may be able to see the ring of fire and remind you to slow down, although some women find it difficult to slow down and relax, especially if the urge to push is apparent, but quick, short breaths (like blowing out candles) helps to control that urge and relax the birth canal. This pause allows the perineal skin to slowly adjust to it’s new stretched state before the next push. Simply waiting for a few short seconds for the ring of fire to slowly ease up before the next push can dramatically reduce tearing instead of pushing through the ring of fire, which forces the perineum to stretch too quickly and tear.
• BODY-LED PUSHING: Body led pushing allows you to listen to your body, so you can push with contractions and with the foetal ejection reflex and also to slow down through the ring of fire. All of these factors help to reduce tearing.
These points can often become difficult to remember during the hormonal/mental “rush” and loss of focus you may experience during the transition and pushing stage. Hiring a doula who can help guide you through this process can be a huge help.
Effectively Caring For Your Tear
• Lean forward during urination (also known as “hugging your knees”) to prevent the urine coming into contact with the wound which can cause it to sting.
• Salt water: Spraying the area often with a water/spray bottle, dabbing gently with soaked cotton wool and/or shallow salt baths are ideal methods for cleaning the area.
• A high fibre diet and plenty of water to prevent constipation can ease the pressure exerted on the injury during bowel movements.
• Change your maternity pad often to keep the area as clean and dry as possible.
• A small, soft cushion to sit on can help ease pressure and discomfort on the injury.
• Sitting down, standing up, crouching, and walking up/down stairs slowly can help ease pressure.
• A good, safe painkiller can help with the discomfort and pain.
• Initiating sex slowly and with a generous amount of lubrication can help prevent irritation and further injury to the site. Remember to try and avoid intercourse during the first six weeks after the birth to avoid possible infection or injury. Exploring other forms of foreplay and intimacy is highly encouraged instead.
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