Its enough to make you go all Michael Jackson-esque, and grab your own crotch and wince, right? You know? The thought of ripping that delicate flesh of…down there. At least that used to be my reaction as a youth, whenever I heard these horror stories of women who had birthed and torn themselves to seemingly shreds. And I mean, just looking at the stats of all the stories, it seemed like it was inevitable that a woman was to tear more often than not. Even as excited and relaxed as my view on birth had always been, that little factor of tearing, or worse yet, being SLICED open by the doc always seemed to be looming in the back of mind. Like a tiny little birth bogey man, grinning in the back shadows of my thoughts.
And I don’t think I was the only one who thought like that. Right? I mean, you still hear of so many horror stories today. Maybe you were one of those unfortunate mamas? Or maybe its also currently a fear of yours? Consciously or subconsciously? If so, then how would you like it if I told you that you can actually AVOID tearing during birth? Like, tell you that it is NOT necessarily an inevitable matter? As in, one woman’s story doesn’t have to be YOUR story! Or just because you tore before, doesn’t mean you will tear again? That you can actually do something to reduce your chances of tearing?
Sound good? Sure it does!
‘Cause you know all those fears I had? Boy, were they so badly misplaced! So fear not mamas, I come bearing some promising news. And if you don’t believe me, know that I have had two births – both of which left me with no tearing. And my girls weren’t tiny babies. Even the second birth, where my daughter was born with a nuchal hand – something that is known as a quite a complication in the medical birth field. As in it is known to rip a mama to shreds. (Even my midwife, jokingly said to my baby as she came out, “oh you naughty little..”, but stopped dead in her tracks as she checked me in utter disbelief and realised I didn’t tear – not even a little bit. Even she was amazed that the nuchal hand birth had no effect on me.) And Im not the only mama that has reported this…and there is definitely a common thread that I’ve found amongst these women I’ve spoken to, women I’ve read about, and articles that support how this is possible.
So here’s what you need to know:
Based on all the movies you see depicting a woman birthing on her back, or on the fact that most doctors make a birthing woman adopt the lithotomy (on her back) position, you’d think this would be in the best interest of the mother right? But truth be told, its not. It’s so absolutely not – lest that’s the position a mother actually actively prefers. In fact, there is so much of not, that I think I will cover all the reasons WHY YOU WOULDN’T WANT TO BIRTH on your back in another post – it’s not just to avoid tearing. The only one it truly benefits is the doctor – it’s easier for them to “see what’s going on down there”.
In fact, historically women were previously allowed to birth in any position as they pleased, until Louis the XIV came along with his sick and twisted fetishes of enjoying watching women birth, and ordered that they adopt that position for his own viewing pleasure. (I warned you he was a bit of a sick puppy). And going forward, this convenience for the doctor’s perspective just stuck around and still plagues us to this day.
So what is the connection with the lithotomy position and tearing your perineum? Well, it’s the fact that lying on one’s back or even upright but reclining, puts ALL the pressure on the perineum. And doesn’t allow enough room for stretching – especially when a mother pushes down.
Upright, squatting, on all fours or kneeling, or on her side offers a birthing mother’s body ample room to move without constriction and as needed, thus not limiting the movement and ability of the perineum to stretch in the way that it needs to. Which in turn, removes the direct pressure onto the perineum.
2. Don’t push!
Why are you pushing? You really don’t need to at all! This is an age old (bad)habit of some birth workers that still for some reason persist. I think there is some history of it’s origin in that women who had an epidural or for some other medical reason, could not feel their body’s natural expulsive reflex kick in or as strongly, because the meds have deadened it all, so the birth care provider would often have to then coach the mom and signal her when to push and not to push in lieu of her not knowing. And then somehow the lines became blurred, and that coaching of telling the mom when to push or not to push became the norm, whether the mom could feel her body doing it’s thing or not.
But the reality of it all is that, given normal non-exceptional circumstances, your body doesn’t need you to do anything to help get baby out. Baby and your body’s got this. In fact, did you know that a woman in a coma can birth without any assistance whatsoever? Yup! Fact!
It’s called the Spontaneous Birth reflex, and works and can be felt best when there are no meds streaming through your body, disrupting the natural hormonal cocktail that makes it all happen.
Also, lest there are medical reasons for this, you really don’t WANT to be doing this Valsalva pushing aka purple pushing, because:
a) This out-dated technique may actually starve baby of valuable oxygen, as well as starve your uterus of the necessary oxygen it needs to do its work. IN fact, with a reduced oxygen feed, it could slow matters down further.
b) This tensing of your body as you purple push your baby down, actually promotes tightening of the birthing muscles, where really you want these muscles of yours to relax. You actually work against your body when doing this.
And really there is no need to rush. (Note this is the important part!) You want to give your body ample time to stretch and accommodate baby’s head. Your body knows what it needs to do this. So don’t rush your body along. Rushing it, is often what leads to tearing. So work with your body’s pace. Whether that’s 2 minutes, or 2 hours, just go with your body’s pace. (ps. The birthing phase of both my girls were pretty quick. Morgan was a super fast two to five minutes before I held her warm pink body in my arms. Whereas Parker was a little longer like 5 to 10 minutes, but then as I learnt that was because my body was taking it’s time accommodating her nuchal hand. (I used breathing techniques I learnt in HypnoBIrthing that clearly helped) And others have half an hour to an hour and so on.
Ever heard of that ring of fire? That apparently exquisite pain as baby brings with its crowning? Well that’s your body warning you to slow down!
I remember distinctly having a fat chirpy chat with hubby while Parker-Grace was crowning. A fat chat with a fat smile plastered on face to match, all while crowning – no ring of fire, whatsoever.
And it’s not like I’m special or anything. There’s nothing special about me. I relaxed into the surges, let my body do the work, and just breathed. No pushing. And worked with my body’s timing, and my care provider knew not to rush me either.
But what if I feel like pushing?
And many women do get that sensation or sudden urge to want to push that you simply can’t resist. That’s a normal and natural sensation that you need to go with. What you really want to be doing here is work with your body – work with that need. So when a woman does feel the need to bear down, go ahead and work with your body’s rhythms, and breathe that baby out. Just do NOT push! Holding your breath and pushing (aka Valsalva pushing) is so different to bearing down WITH your breath. (By the way, if you’re interested, HypnoBirthing has such amazing yet simple breathing techniques for just this. Go check it out!)
In fact, they’ve (RCOG in the UK and the American College of Obstetricians and Gynaecologists) only recently amended their recommendations regarding pushing during labour. I have no IDEA why it took them SO long to make this adjustment, it’s been known for some time already. But already they saw that this slight change in protocol had drastic improvements in their stats for reducing traumatic tearing. It went from seven percent to one percent, and successfully cut unintentional damage caused to the body during delivery by 85%. (as reported by Sarah Young of the UK’s Independent.)
3. Perineal Massage
This one gets a lot of mommies giggling. (And a lot daddies excited!) It invvolves exactly what the name suggests,massaging your perineum – that little bit of skin between your vagina and anus, using specific oils. (Olive oil is good. Vitamin E, however, has too many question marks over it, so perhaps just avoid it.)
Also, I don’t think I need to mention, but just toss the left over oil after each massage. Let’s not even joke about using it for dinner later – fried chips anyone?!;)
If your interested in the technique, just google it, and you’ll be sure to find plenty of how-to’s on this.
But the gist of it is that it’s not meant to stretch you out as such, but I believe it’s more about conditioning your body and mind to relax into that sensation of your skin being stretched once baby starts crowning, and not for you to wince and go into panic mode and thereby totally tense up. Which would totally defeat the point of it all. (remember, we want to relax into this, not tense up)
However, I’ve got to be honest – I didn’t really do it. So if this is not your speed and you don’t do this one, please don’t think it’s all your efforts for no tear plans have gone to the dogs now. I think I did once. And I still didn’t tear.
But so many women swear by it, and I think if this is also one of your big birth bogey men that lurks in the shadows of your thoughts, then maybe it’s worth a shot or two. But totally up to you, mama. So many other mamas out there can’t be wrong!
And there you have it, my personal recommendations, based on my personal birth experiences, my own research of how to avoid tearing, as well as my professional opinion as a qualified HBCE (child birth educator) on how to reduce your chances of tearing or needing an episiotomy during birth.
There are of course other recommendations that come along with this that is more holistic, like a proper diet, so as to ensure healthy skin with appropriate elasticity, etc. But these three are the three major players in the game, in my opinion.
Now just be sure you have the right birth team on your side who will totally support you in these efforts. It’s worth asking and clarifying these with your care providers well before hand.
Here’s to better informed and empowered births! X