In my childbirth classes, on the night we talk about pushing, a very important topic ALWAYS comes up. “How to Prevent Tearing During Birth” – An important topic!
Want to know how to prevent tearing during birth? Of course you do. #savetheladybits
Here are 5 surprising ways to prevent tearing that will change the way you give birth.
How to Prevent Tearing During Birth
1. Rethink Birthing Positions
Squatting to Push Increases Tearing
The first thing we need to talk about is squatting. When in the squatting position, compared to being flat on the back, a woman’s pelvis will open 20-30% larger than it would otherwise. Isn’t that amazing?! A greater outlet = an easier birth.
So of course, us Americans should squat and push our babies out just like in this video below, right?
Eh, maybe not.
Nobody talks about this! And many sources on the internet will even say to squat during pushing to avoid tearing.
In a nut shell, if you are a typical sedentary civilized woman, you probably should re-think squatting during pushing. Unless you’re like the 1970s Southern Brazilian Indian women in the above video who SQUAT TO REST, your body likely can’t handle squatting during birth.
However, if you’re up to the challenge, go visit Katy Bowman and teach your body to squat. Because I promise you, you don’t know squat. 😉
Side-Lying, Kneeling or Hands and Knees Decreases Tearing
Positions associated with a reduced risk of perineal damage are lateral positions like a kneeling or hands and knees position.
Midwife Thinking says,”I have noticed that when women are left to birth instinctively they will often move from a squatting position – if they got into one – into a hands-knees position just before the head crowns.”
(That’s exactly what I did for my births. At some point in all my labors I squatted but Gabriel was born in the side-lying position, Eden was born in the kneeling position and Mercy was hands and knees.)
So if you really want to squat in labor, go for it, maybe just move to hands and knees before crowning.
2. Rethink Waterbirth
I have some sad news, ladies. It seems that waterbirth, although safe for mom and baby, has an association with tearing (aka genital tract trauma).
I talked with my midwife, and she didn’t disagree with this. She definitely sees tearing happen with waterbirths.
When I gave birth in water I did tear, but it didn’t require stitches, so a waterbirth isn’t necessarily a death sentence to your vulva, but it’s definitely something to take into consideration if you would like to decrease your risk factors of tearing during birth.
This picture is way cool, right?
3. Rethink Perineal Massage
Perineal Massage: For First Time Moms During Pregnancy
So, what about perineal massage? You know, “massaging” the vulva/vagina/perineum during pregnancy to pre-stretch mom’s perineum before birth?
The evidence says that perineal massage during pregnancy will help a first time mom decrease the chance of her receiving an episiotomy. So, if you think you’re at risk of receiving an episiotomy (from my experience this is based mainly on who your care provider is) perineal massage might help you there.
To be honest, I’m not sure how the one helps the other. Maybe the moms who educated them on protecting the perineum were more active in their pregnancies and the birth process leading to less episiotomies? I don’t know…
How to do Perineal Massage
Curious about how to do perineal massage? Here’s a great tutorial. And remember, it’s not really a massage. 😉
Hands Off!
So, what about perineal massage during pushing?
The evidence says that perineal massage during pushing has little effect.
And that being “hands on” (aka actively slowing, holding, stretching, pushing… basically being VERY involved in the crowning process) shows an increase in tearing, episiotomy and postpartum perineal pain. (See image below.)
Instead of being “hands on” it’s suggested that “hands poised” is a safer alternative.
VENT:
Alright ladies, I need to vent about this. Over the years, I have seen this approach used in hospitals by doctors, nurses and midwives. Honestly, at the time I didn’t really know about the research saying that it wasn’t helpful.. but EVERY TIME I saw this happening these internal alarm bells would start to go off. It really bothered me to watch this technique.
Here’s what happens… The doctor (or whomever) sits at the bottom of the hospital bed on their stool, all gowned up with gloves on, then they put their outstretched and open hand towards the nurse, the nurse then squirts lubricating jelly on their fingers and then they would go to town with a lot of “perineal massage”. They take two lubricated fingers, place them in the vagina and push down and to the sides. Over and over again.
It looked so uncomfortable, almost painful. If not painful, then by golly it’s gotta be totally distracting! Sometimes these moms would have 30-60 minutes of this! Their vulva looked swollen. It made me sad. I just wanted to scream, “Leave them alone! You’re not helping!”
If questioned about this technique, I bet the doctors would say that they were helping to prevent tearing… but ironically they’re always suturing immediate postpartum! One doctor told me once that a second degree tear is normal for a first time mom. ???!!!
And what really makes me sad is that nurses will do this technique as well, when it’s just the nurse and mom (before they call the doctor because the baby is beginning to crown). The nurses are learning this from doctors, assuming it’s an evidence based practice.
The hands on approach to supporting a perineum is one of the biggest pet peeves I have about hospital births.
4. Warm Compresses to Prevent Tearing
So far what we’ve learned is that squatting and lying on our backs increases tearing, but a side-lying, kneeling or hands and knees position decreases tearing. We’ve also learned that perineal massage is mostly worthless. So what else can we do to prevent tearing during birth?
Warm compresses have been shown to help decrease the incidence of tearing, which is wonderful news because using warm compresses is SO SIMPLE.
How to use Warm Compresses at Birth
Supplies Needed: All you need is very warm water and washcloths. Here’s a 24 pack of washcloths for only $13. A crockpot can help keep the water warm. Here’s an inexpensive 3 quart one that’s only $16.
Instructions: Take the washcloth, submerse it in the very warm water, wring it out and then place it on the perineum to support mom while her baby is crowning.
Warm Compresses at a Hospital Birth
I’ve seen this done in the hospital once and it was the OB’s idea (awesome!). He asked the nurse to grab a basin, fill it with warm water and get a stack of washcloths. It took about 2 minutes to setup and mom was so grateful for the extra support.
Ginger Compresses for Pushing
Using warm compresses to support the perineum is standard protocol at out of hospital births. At homebirths you will often find a crock-pot filled with warm water (with a few pieces ginger in it) simmering, in preparation for the pushing stage. Ginger helps reduce inflammation and smells great too!
Once pushing and crowning begins, the crockpot is brought to wherever the mom is (bathroom, bedroom… wherever) to be used to prevent tearing. Obviously this doesn’t work with waterbirths. A midwife can’t support a perineum very well while mom is in the water.
TIP: Make sure the water isn’t hot. Once it reaches the desired temperature keep the crockpot on the warm setting. If it’s burning your hands when wringing out the washcloths, it’s too hot for mom’s perineum.
BONUS TIP: Keep a stack of washcloths handy. If a washcloth becomes soiled, you’ll have a fresh one right there. 5-10 washcloths will be plenty.
5. What Would Ina May Do?
Finally, we’ve come to the fifth and last way on how to prevent tearing during birth. As usual, Ina May Gaskin is going to expand our thinking.
In the video below, she explains how a chimpanzee, obviously without inhibitions, was using its hand/fingers to arouse itself while it was pushing its baby out without tearing. Ina May believes that if we get the blood from our head, and move it to our vulva we won’t tear because we’ll get REALLY BIG.
In one of her books she says, “I’ve never seen a woman tear that was kissing her way through pushing.”
Basically if you were to become sexually aroused, your likelihood of tearing would drastically decrease.
I’ve never seen this attempted. I’m not sure I could masturbate or passionately kiss my husband while I pushed a baby out. If someone mentioned this idea to me during pushing I would have either ignored or yelled at them. Probably yelled. In fact, I typically am yelling at that very end pushing part anyways – it’s so intense!
Nevertheless, I feel that I wouldn’t be telling you the whole story on how to prevent tearing during birth if I didn’t mention Ina May. I totally believe her. I just don’t believe her advice is very practical for the modern woman.
For the sake of tearing, would you allow yourself to become sexually aroused during pushing? A lot would have to change to make this happen.
I gave birth to my son on my back but elevated. I had monitors on me due to induced labor because of low fluid. I did not move around as much once the monitors were on I didn’t get off my back much and I had a small tear. Next time I would like to try on my hands and knees.
Sounds like you did your best! Good job! 🙂 Birth is unpredictable and all we can do is “the next best thing”.
To be completely honest If necessary Best advice is to let the nurse cut you. Because it is less painful if the nurse makes a small snip( – )than for you to tear naturally( / )which is way more painful and can cause a lot more damage trust me when your in labor you’ll see what I mean.
The evidence just doesn’t back up episiotomies over natural tearing. Sorry!
I actually heard the opposite as to tearing is better because the jagged tear line will heal much quicker together than the straight cut.
Also, we have many layers to our skin and a natural tear might only tear the top layer, whereas an episiotomy instantly tears through all layers making it much deeper. Think about a piece of cloth. If you try to tear it naturally, it will be hard to tear. Now, using scissors cut a small cut in the material and put the same pressure against it. Which tears more easily? That being said in regards to the comment, I tore terribly with my first baby and have had three others since without one stitch! Keep your mouth relaxed and open, imagine opening with the contractions, not fighting them, and if possible, feel your baby emerging with your own hand. Those steps will all help to prevent a tear. It’s amazing what our minds and bodies are capable of!
So true! I was just thinking about this the other day. My first I was 16 hrs in labor as the baby was crowning the Dr cut me so the baby would come out. My second i was in there 1 1/2 hrs. And i was so mentally prepared. My doula was so great the baby just came no problem no tears. My third i was induced due to low fluid. I had a doula but she wasnt coaching me and I felt like I was fighting the contactions and was so tense…finally i said to myself I accept this pain and the baby needs to come out. After that contractions came and i felt them fully vouple contractions later baby started coming out! Your so right about your mind playing a big part!
I just had my first baby and had a bad tear tons and tons of stitches. I am worried about having another baby and tearing again Also I feel that from scar tissue the area is even tighter, anyone else experience this, and have an ok second birth?
I agree the evidence does not support episiotomies anymore, I am greatful I never had one, but healing from a large tear has taken three months and is still tender so I can’t say which I think is better for healing speed. This is a great article and I will definitely be trying some of the options listed to help prevent tearing with my second. After having a deep 2nd degree tear almost 3rd I am retried to have another!
I disagree; the episiotomy will actually just cause a larger tear because it’s already been cut. The cut doesn’t just “stop” at the end of the episiotomy, it tears more and more usually as the baby comes out.
Let me tell you that my ” small snip” did not feel very small and now I have scar tissue there! It was extremely painful for days after and the healing was so painful! Sits baths only helped while using them. I didn’t want to be cut. They obgyn did so without my permission. I will avoid that next time at all costs.
I agree. I’ve been a delivery room nurse for 20 years and an episiotomy when necessary is the way to go. Also, the idea that a woman wants to kiss/get in the mood, during labor is laughable.
It may be laughable, but I am a firm believer in informed consent and to know ALL the options. Who are we to censor information from women when they’re making plans for their births?
You can say that episiotomy is better than tearing only if you have experienced them both yourself and can compare. Which I’m sure you haven’t – and this is a thing that can’t be evaluated from the outside. With my first child, this ” small snip” was not small al all, and more of a hell than labor itself – for months afterwards it hurt terribly 24 hours a day! There is an awful scar in its place that is very ugly and visible, but the strangest thing that shocks me is that it sometimes still hurts 12 years later, it’s like phantom pain! The second time labouring I had a tear that was stitched, but to my great surprise it almost didn’t hurt postpartum, it didn’t give me sleepless nights and there’s no scar left in its place. And it didn’t affect my sex life afterwards whatsoever. After the episiotomy, attempting to resume sex was also such hell that my first husband and I eventually divorced. Only in a year and a half after giving birth to my first child sex started to feel comfortable. I believe episiotomy may only be needed in life-threatening cases for the baby or mother.
Yes, in my experience this has been true – episiotomies are helpful in life threatening situations, but when given for other reasons the work of recovery is much worse than the perceived benefit of an episiotomy.
I also was induced and was on my back for most. Baby was stuck so they flipped me to hands and knees, I ripped bow to stern. And she was only 6 pounds 2 Oz so not a big baby.
I had an in hospital birth with a midwife for my recent birth and they did also say that water birth can increase tears, but having had no tearing with my first, I still wanted a water birth. After I got stuck at 8 cm for nearly 3 hours, I opted to have them break my water, there was questionable meconium (water was tinged yellow, enough that they called it meconium but admitted they weren’t sure), so water birth out due to hospital policy. Ok fine. So I continued my squatting through labor, laid down to be checked because I was feeling like pushing, and there was no freakin’ way I was getting up. It felt so good to lay down. Indeed, nearly 10cm, slight cervical lip, midwife moved it with the next contraction and I started pushing. I tried laying on my side and just felt like there was no way baby was coming out like that, like I couldn’t push him hard enough. I got comfortable on my back and that was how I felt I was most productively moving baby out. My midwife did use warm compresses but it was a lost cause, baby was 10.9 and sunny side up – 3rd degree tear. Afterwards I was all “dang it I should not have pushed on my back!” Midwife assured me I likely would have torn regardless of my position due to baby’s size and OP presentation. I was thinking I would squat for future births but I think I’ll go hands and knees next time, which I tried laboring in after they broke my water and just was not feeling it..ill have to try harder for that next time. Potentially dumb question, what’s the difference between squatting and kneeling?
I bet the best way to answer that question is for you to squat and then kneel. Feel which muscles are straining and which aren’t. When you’re squatting it’s much more strenuous and there’s a lot of potential pressure on your perinium.
This is a great article Lindsey! You just don’t see very many sources discussing the different ways you can push. I think people just assume there is only one way or that it doesn’t matter. Thank you for this very informative article!
You’re welcome,
Denise! Thank you for your sweet comment.
I had all 5 of my babies at home. Squatted all 5 times (that was my instinct, I physically could not be in another position), the last 2 I squatted with a birthing stool. The first 4 babies, I tore, the fifth I didn’t. Difference? I studied Ina May while pregnant with 5, I really learned how to breathe properly and make those “low sounds”. Which were a bit more embarrassing, I felt like a cow lowing, but for the first time – CROWNING DIDNT BURN!!! I was amazed because that is the part I worry most about, and there was absolutely no ring of fire! And no tear! Thank you Ina May! Also did the warm compress to support perineum, but I had done that in previous births too. The low sounds are where it’s at, and totally understanding the mind body connection and how to breathe, keep your face relaxed, and make low noises.
Forgot to add, that for me personally, being on the birthing stool with the last 2 made pushing more difficult and even a bit longer. If there is a number six, I will re read all my Ina May, ditch the birthing stool, and keep my warm compress. And kissing the hubby in the early stages was very nice, it was relaxing and made it a much more connected special experience. Once family and midwives showed up, so did inhibition and we stopped that, though it would have been nice to continue through. Maybe if you are kissing all the way through it isn’t awkward during pushing? Good luck!
Which books of hers did you read
Hi I have 4 babies my first baby I had to be cut omg it was so horrible to recover from it after my 2nd baby I didn’t need to b cut or I disn’t tore myself my 3 and 4 th were my big beautiful boys and I tore myself on them which don’t gt me wrong it was sore but not at all as sore as being cut and on my first I has an epidural didn’t work my other babies were just with gas and air they were better and faster
What book if her’s did you study?
this post is so informative, thanks very much for sharing
I never realized what they were doing as I was pushing until I read it here! I am definitely asking them to not do that this time!! I had a slight tear that required but was very painful.
Happy to help! Thanks for stopping by.
This is a great post wish I had read it before I had my first.. I pushed in squatting position and they did hands on perineal massage etc. And I ended up needing an episiotomy to avoid a tear. My second I pushed on hands and knees and the doctors didn’t interfere with the perineum they only dud warm compresses and i had no damage to my pereneum. Thanks for informing new mothers of this to help them make the best decisions for there bodies and babies.
Your vent is RIGHT ON! The stretching was by far the most painful part of my experience, so much so that I eventually yelled at the midwife to stop. Not my proudest moment. I can’t say if it was or wasn’t the reason for my 2nd degree tear, the cord was wrapped around her neck preventing her from turning into position. I will definitely ask for a warm compress next time.
I disagree. It was a proud moment. You made your voice be heard!! Good job.
I wish I knew the stretching wasn’t going to help with my first. Hours of it and it caused so much trauma and swelling that after the episiotomy they sewed me up and days later when the swelling went down the stitches were loose! Fast-forward 6 months later and I was back in the hospital getting a repair. My next will not be different.
I meant I will be different and I will not allow this “procedure”.
That’s right, my friend! It WILL be different! I’m so happy you read this article. ♥ Much love! ~Lindsey
Indeed!! It’s your body, you can yell if you want to!! Thank you so much for this article. I am 39 and have no children yet but my love and I want atleast 2. I’m not as young as I used to be. So any tips on keeping things in order down there are welcomed. I am so very much in tune with my body and I feel very confident now. Thanks ladies!! Now to get my man home from war. He’s been gone over a year now so I feel it won’t be long after he gets home that we conceive. I appreciate you all so much!! Bless you and all of these beautiful babies!!
So I am having my second baby in November. I am wondering if a second time mom is out of luck with tearing? I had a 2nd degree, I was induced last time due to cholestasis, which is 85% chance of getting it back. Any advice?
Take heart! I have found that many second time moms tear less than first time moms, even if the pushing time is faster the second go around. See if this time your care provider will try warm compresses! I’m betting it will make a world of a difference.
Would you say that second vaginal births tear less than first? I hate to nit pick, but my second birth was actually my first vaginal, and I’m looking forward to never tearing again! lol!
Typically yes. Although there’s no guarantee.
Oh your in luck! My 1st and 2nd I got 2nd and 3rd degree tears…. my 3rd? Stayed sexually active and no tearing at all!
Thank you for the much needed advice. I will do my best to recognize too many attempts to stretch. I will also mention the warm compresses during labor.
You’re welcome!
This was very helpful, thanks. I’m pregnant with my first baby and found this very informative. For all the pregnancy magazines I’ve read, I had no idea about the hands on approach and to me it makes logical sense that stretching the vulva and perineum during labour instead of allowing the stretching to happen naturally and from the inside out, is not good.
I had an easy birth with my first, albeit I teared (on the wall, 3 stitches but apparently delicate one) I was in the water, the midwife said I should come out to go on my hands and knees but I didn’t want to at the time. I due in December now and all I can think about is that burning pain, I am hoping I can try hands and knees this time (I can’t remember which position I was in but it must have been squatting as the water would have been to deep for anything else?!) I would love a home birth but my husband is absolutely panicking about what ifs… The Warm cloths and hands & knees or side pushing was really interesting! Thank you
You’re welcome! Let us know how it goes and what you learn. ♥
I’m due in December also- having a home birth. My husband was terrified and adamantly opposed to it at first, until we talked to friends of ours who have had 3 home births and started reading articles comparing the safety of hospitals vs. home. We are having a CNM (Certified Nurse Midwife) which is basically the same as what you’d have in the hospital, only she doesn’t have the facilities for c-section or epidural. Also, we live within 10 minutes of the hospital. i would never advocate defying your husbands wishes about something as serious as your baby’s birth, but if you can get him to do the safety research, it really is very convincing.
Have an epidural. Then make sure your OB has another patient in labor next door. The nurse had me hold off on pushing to wait for her and I honestly believe the slowed movement of my baby on the way out saved me from the damage!
If someone has a. Epidural simply to decrease tearing it does not pass the risk/ benefit test.
I had a 2nd degree tear with my first and no tear with my second even though he was a pound and a half bigger. The differences were vast. With my first I did not have very good coaching while pushing so I just blasted the kid out and did not have much perennial support. With the second – I talked with my midwife in depth about my desire NOT to tear and she was AWESOME, she coached me through every step. I think one HUGE key to not tearing is controlled pushing while crowning. I crowned for probably 5 minutes just gradually letting his head stretch all of my tissues. It was intense – but totally worth it. Also – I had read Ina May’s book and my husband and I did kiss throughout the labor and birthing process. No kissing during pushing but definitely in between contractions and I could physically feel my body relax even though I wasn’t “aroused.” It was wonderful and I felt so connected to my husband through the whole process.
That is beautiful!! Thanks so much for sharing.
Kudos for the reminder that sexuality plays a role in giving birth! Knowing how much being aroused can help reduce tearing and make the experience more natural for your body, it’s sad that any woman should have to feel ashamed about it!
Screw what everyone thinks, no one should be ashamed for touching themselves while they squeeze new life into the world through their own vagina!!
This is a very interesting blog , I learned a lot reading it. My experiences with giving birth to my two children I experienced little to no tearing I was relieved once I seen them putting away those tools. Both births, I gave birth naturally with no pain medication and really really fast. Your absolutely right I layed on my sides before I gave birth because it was the most comfortable way to position myself;I never layed on my back at all until the head was already pushing out I could feel it on my thighs. I will try on my hands and knees with my third child. Mahalo to no tearing !
HI. Im a second time mom (23 weeks now) who has had my heart set on a natural waterbirth. After a not-so-awesome medicated hospital birth experience with my first, I began to research natural birth to try to prevent the same experience twice. I decided after research that a waterbirth is the way to go because not only does it supposedly reduce labor pain, it also supposedly prevents tearing and has all the other awesome benefits that I cant think of to type at the moment. I was pretty scared of natural birth at first so these great reviews of waterbirths really gave me comfort- particularly about the supposed reduced risk of tearing. I had an episiotomy (not bad, only 1st or second degree) with my first and had read that women who had an epi with a first pregnancy have like a 50% chance of tearing second time around and Im really really scared of feeling that pain. So I say all of that because this is the very first article I’ve come across that says contrary about water births and I’m wondering if you can give more info/advice on that? Thanks!
Hi! First let me just say that if you tear naturally your recovery will be way better than your episiotomy recovery. So take hope in that. Frankly you just have your baby where you feel most comfortable. If that’s in water, great! If that’s on land, great! Maybe you could spend time laboring in the tub and come out to push? Just an idea.
Much too late for Liz, I am afraid, but I had three children and the last two of them born in water without any tearing. My first was born in hospital and assisted by a gyney who said we are land animals, not water animals. He got me an episiothomy while kneeling and leaning forward. I suffered from it for half a year: sex was awfull in those first months after the birth. The second one was born at home in a birth pool. I waited two contractions when the head was crowning, which probably also helped in the process. It resultee in no tear at all and the best experience of my life. Third one was in hospital due to breaking of water early, but still managed a water birth (with a lot of arguing) and again I waited a bit before the final push and no tear. So for me water birth is what I want in case of a no 4.
Just wanted to add a suggestion from my experience. Have the woman support her own tissues on crowning. She has immediate feedback on an intense 360′ stretch, and her hand knows just where to go to minimize pain and damage. Also, allow your body to do the pushing, breathing through contractions to slow crowning. Slow = stretch, fast = tear.
Hello, I’ve been a traditional midwife now for over 30 years. I’ve assisted with almost 2000 mommas at this point. I have found that not demanding that our mommas push at 10cm, but allow the body to labor down, and let her grunt her baby out when she has the urge ( usually right before the baby comes under the public bone and begins to crown), no one yelling at her to PUSH, PUSH is the best way to prevent a tear no matter the position. Although I believe through experience that giving birth on your back is as counterproductive as doing it standing on your head. A momma in labor will listen to her body and get in the position her baby needs her to be in if she feels safe and heard, is educated in what is happening in their body and trust and knows her care provider. A relationship, a real relationship is key for the whole experience. I have also found that if the momma puts her own hands on her vagina as her baby starts to crown will contribute to a slow delivery of the baby, no one will protect your vulva better than the owner of that vulva. Thank you. Lisa .Coomer CPM-TN
Thanks Lisa!! This is great advice.
You might like to see this recent ACOG piece: http://www.medpagetoday.com/OBGYN/Pregnancy/58745
In my experience, the best way to prevent tearing during pushing was to NOT PUSH. I had a home water birth after 2 csections. I worked so hard during labor to relax everything mentally and to physically keep all my muscles relaxed. It helped greatly with contractions. When it came time to push it felt so wrong to suddenly tense all those muscles. So I didn’t push. My uterus did all of the pushing it needed to do. I remained completely relaxed. My body pushed my baby out in about an hour. Not a tear in sight. In fact, I felt like I hadn’t even just given birth.
As much as I would love to say this method will work for all women (because who really wants to push, right?) some women will actively have to use their muscles, their whole body, to push their babies out. I’ve been at a bunch of births and it’s always frustrating for a mama versed in “not pushing” to suddenly realize they’re going to have to push with all they’ve got to get their baby out. Hope that helps!
I’ve had four babies, all born naturally. The first one was tough, but I really think it was my midwife who made it so as everyone I knew tore badly under her care. I don’t know the degree to which I tore but I know it was to my bottom and I hemorrhaged. I feel a great deal of it was because the midwife had me start pushing before I had any urge to push, and I never really felt that urge during the process. She had two labors in the same phase and hoped to speed mine up. I think I pushed before ready and had swelling due to the trauma. She also held a count (“One Two Three Four…”) I was sidelying and she used warn compresses, but my body wanted to switch positions. It turns out our son was sunny side up, which also made the birth more challenging.
The second time I was nervous, but I read “Ina May’s Guide to Childbirth” and felt more confident. My midwives were more skilled in preventing tears. I didn’t bother with perineal massage as I hated doing that the first time. No one told me when to push out for how long. They were patient. I had our daughter on my hands and knees (the position my body chose) and this time I felt my body pushing her out without being told! The midwife was trying to slow me down actually and I couldn’t as she was just coming! Such a different feeling than being told what and when to do it! I had a tiny knick and no stitches! Such an easier healing!!!
The third time our baby was sunny side up again and I was concerned. For him, I stood up to birth! It was awesome! I had stalled and my midwives gave me space to see if things would start up again. My husband and I, given the privacy, did decide to try Ina May’s suggestion to kiss. It’s hard to describe. It was one of the most amazing, intense, experiences ever as I passed through transition. It can be done and it’s out of this world! The contractions intensified with the kissingand, he was born with three minutes of pushing with his hand beside his head (I’m sure trying to suck his thumb as he is a big thumb sucker!) I was able to pull him out myself at my midwives prompting and I’ll never forget that amazing feeling of victory after a traumatic first birth! I didn’t get a single knick, even with his hand emerging with his head. As he came out, I kept saying aloud, “I’m going to get SO BIG! I’m going to get SO BIG!” And I did.
With the last baby, he was tiny and born lightening fast. He was born 34 min from my water breaking and the start of my contractions. It was incredibly intense and I was a bit scared when he began crowning since it was just my husband and I and the midwife hadn’t arrived yet (they didn’t arrive until 20 min after his birth and it was a beautiful memory of peace as we waited). Because of my first birth, tearing was one of my biggest fears. I didn’t have anyone to support me or use lubrication or compresses and I felt so dry, but I remember Ina May saying to open your mouth and that she’s never seen a woman tear who touched herself as the baby crowned. I didn’t have any time to really prepare, but I got on my hands and knees on the bed at the last second so the baby wouldn’t fall to the floor. I balanced on one hand and held myself with the other hand. I could feel him coming and I naturally applied pressure to slow him down. When I felt the second shoulder pop, I moved my hands and my husband caught him. Despite the quick birth and lack of trained hands, I had no tear and we had a completely healthy baby boy. 🙂
Thank you so much for sharing!! What amazing stories. Rock on!
Interesting point about perineal massage, my doctor did this for probably 2-3 hours, no drugs so I felt it all. Honestly I would have rather felt a contraction.. I kept squirming. And I swelled up a lot.. I guess I thought it was from 3 hours of pushing rAther than the “massaging”. I thought what she did worked because I had only a minor tear that didn’t require stitches. Now that I think about it though, I think what was most helpful was when the baby is crowning and they have you hold it and not push, and let the baby’s head slowly stretch things out. this is easier said than done and also maybe easier when you can feel everything rather than if you have a epidural.
Hi! I have a 9 month old, and he’s my first baby. I fortunately was able to do a lot of these techniques- gave birth on hands & knees, and used warm compresses. However, I did still tear (second degree tear). I gave birth without an epidural. A woman’s hormones are so elevated at that point, so thankfully I didn’t feel myself tear at all! Sometimes you do all you can, and it still happens. But I can only imagine how bad the tear would have been if I’d been on my back!
Oh, but I will say, giving birth was the most amazing, empowering, and the most beautiful thing I’ve ever done! 🙂
Interesting article! I tore with my first. Fourth degree! Apparently my daughter moved her arm/elbow up and out. After what I would call an easy pregnancy, labor and delivery I ended up in the operating room for repair. Tore through my sphincter muscles and had a not so great recovery. We are contemplating having another and I’m terrified. The colorectal surgeon said I should only have a cesarien next time but my doctor didn’t think that would be necessary. The surgeon’s point was that I shouldn’t take the chance of getting any more damage due to the scar and repair leaving my ‘back end’ muscles not as strong as before. She said “you don’t want to be wearing diapers in your late 30’s or 40’s” to which I cried. I would prefer to have the next one just as the first. I didn’t think labor and delivery was so bad. Painful but not unbearable and I don’t know what recovery from a cesarien is like but i do know recovery from that tear caused a lot of other issues and concerns for a long time. It’s seems like hands and knees may be the best option with warm compress? I had a friend who had a third degree tear and her second with no issues.
Read this with the husband, and he was very willing to help me out with the pleasuring tip, haha. I think this would only be something I would do if hubby and I were alone in our bedroom, having a very private homebirth in our room or something like that. Other than that, I’d be too rigid and unresponsive to it in a place like a hospital, where a nurse or doc could walk in on the moment!
First timer here, 6 month pregnant. I almost wish I didn’t read this! Very informative, but too informative for me haha. Now I’m more freaked out about giving birth than excited. I guess I’m just the type of person that would rather find out when I get there, because it’s easy to get caught up in your own head if you know too much. Definitely looking into Ina May though!
My best suggestion is to read positive birth stories and keep them flooding over you until baby comes! I’ve had four babies but it’s always a neat moment each time when I pull out “Ina May’s Guide to Childbirth” and re-read it. Even after already having some AMAZING birth experiences, other people’s horror stories can get into my head. I really believe that our bodies do respond to how we feel about birth. If we are terrified, they act accordingly and tense up, sometimes creating problems that wouldn’t have occurred. However, if are positive and peaceful and trusting, they can function to their optimal potential. Read those positive stories and don’t be afraid! Your body is amazing! It’s already growing a human! 🙂
Wow, what a fantastic post! I see you linked to my blog on protecting the perineum written in 2013. I wanted to let you know that I’ve since updated my post. I strive for evidence based writing, and some of my older posts could use updating, clearly. And while nursing school and has made me a better critical thinker/researcher, the all-consuming demands of my program have me otherwise committed. Thanks to your fantastic post I can that I did not adequately state enough the importance of avoiding widely flexed knees when pushing. Nor did I clarify that pushing in a deep squat position is not recommended when baby is crowning and how this position might tax the dexterity of the skin. Thanks again for putting together such an informative post! I would value the professional courtesy of hearing from you should you link to any additional blog posts of mine. Thanks so much for supporting birth and families!
Thanks, Joy. Good to hear from you! ♥
Thank you for this post. I’d love to be in a position to help me daughter not have the same kind of outcome that I did.
11 years ago I had a late joy baby at age 34. My labor stalled and my birth attendant did not seem to know how to help me. while he was sitting with me I heard the squeaking sound and felt the discomfort of his gloves as he kneaded my perineum. He left when I stalled. I sat myself up as much as I could thinking it would get things moving. It worked and I got moving again, but I also tore through my pelvic floor as well as partially through my anal sphincter. As quickly as the placenta delivered my birth attendant was called away on an emergency. He never returned to stitch me up and I did not realize I was in such a bad way until I was home with the baby. I healed up the best that I could without a repair. I was left with a rectocele and a cystocele and a low uterus. When I saw a doctor I was told I would need to have reconstructive surgery because I have muscle tearing and no perineum to repair. The consolation prize was I was also offered a hysterectomy. I’ve mourned over this, but have felt concern about the the possible outcome from repair surgery. I’ve worried the result would be less than desirable. Mesh has too many problems and I was so glad that I did not do that. That was the reapir of choice after my son was born. Now a simple purse string repair for the cystocele is the most likely option, but they don’t last forever. I was left in less than desirable condition, but I am aware that things could get worse.
I wish so much that I could turn back the clock and get better care.
My hope is to prevent my daughter from having to follow in my foot steps.
Hi!
Thank you for this post. We have 22 mo-old twin girls and are getting ready for baby #3.
The twins were born at 30 weeks by an emergency c-section and I hoping to have a vbac now.
Since I’ve never actually been in labor, all will be new to me!
But what scares me the most is the possibility of tearing.
My mom was seriously hurt when giving birth to me and she has scared me a lot with that story.
:/
My mom had 4th degree tears (from vagina to anus) with my brother and I. When I was planning my VBA2C, she reminded me of that. Scared the heck out of me. I’ve since learned that she was kept on her back, given an episiotomy, and yelled at to “PUSH!” while holding her breath, all of which increased her likelihood of damage. I popped out my 9 lb 11 oz baby with only a 1st degree tear (my OB says it’s from his very fast exit). Every birth is different, so don’t expect to have the same experiences as anybody else, even our own mothers. 🙂 Good luck with your upcoming birth!
Great article! I was lucky enough to have two births with no tearing. I truly believe that it is because of breathing techniques I learned through Hypnobirthing. I did perineal massage leading up to labour with Evening Primrose Oil as well. But I definitely recommend everyone check out Hypnobirthing. It is definitely worth reading the book or taking the classes.
I’m currently pregnant with baby #4 (well, technically #5 after a miscarriage)… so it’s not my first rodeo. But I still like to read articles and so forth. Each pregnancy and birth is different, why not learn as much as you can, maybe try something new? Each of my children have been on the small side (under 7lbs, one of under 6lbs), but I’v e torn with ALL of them. And i’m not a small woman! My first came out with her hand next to hear face, which might have had something to do with it – yikes!
Anyhoo, I brought this up with my midwife recently, asking her if there’s some way to prevent tearing all the time – a different position, NOT pushing so hard, etc. She laughed, and admitted it’s because I’m pale-skinned. (pause) Seriously?! I had NEVER heard that before, but she said it’s true… pale women tend to tear and black woman almost never. Something about the quality of the skin – thickness, elasticity, whatever. So, just like being prone to stretch marks or cellulite or whatever, I think some women may just tear because of their DNA.
I thought it was very interesting because I haven’t read this ANYWHERE and kept thinking I must be doing something “wrong.”
I’ve never heard that, but I’m very fair skinned also. Honestly, my first midwife told me it was because I ate sugar at my baby shower. Umm…I don’t think so. 🙁 Find a midwife that’s confident in her abilities to prevent a tear and doesn’t blame you instead! I found new midwives with my other three babies after tearing so badly with my first. They said they rarely have tears. I never needed another stitch with any of the other three, and mine were all about your baby’s sizes and one was born with his hand beside his head (not a knick). Read Ina May about tearing and don’t just resign yourself that your going to tear. Tell yourself your body was MADE for this and can stretch!
This study doesn’t really back that up. http://www.sciencedirect.com/science/article/pii/S0002937803000735 ….
I don’t have children myself, however, my younger sister is pregnant with her second! Her first was an extremely difficult and long labor and delivery but our momma (an RN) was there every step of the way. With our mom’s recent and unexpected passing, my sister has struggled the whole pregnancy with the thought of not having her there for the delivery. I’ve got some big shoes to fill so of course I’m trying to educate myself to be prepared and there for whatever she needs. I have to say, this has been the most interesting, informative and inspiring posts I’ve read yet and I can’t wait to share it with her, so thank you!!
I also thought this study was so interesting. I know you posted it in regards to the pale skin comment, which it negated. What I thought was awesome was the fact that it clearly supports what everyone has been sharing about episiotomies. With every single ethnicity the percentage of women with 3rd & 4th degree tearing was SIGNIFICANTLY higher when they had an episiotomy!! It was shocking to see how high the chance of tearing was w/ the episiotomy compared to the low chance of tearing without. Shocking to me that even with these statistics that’s it’s such a common thing too.
Interesting, about waterbirth. Everyone in the natural birth world is so overwhelmingly positive about it. Of my four homebirths, only the first was in the water, and while it did feel nice as long as it stayed warm, there were definite downsides – particularly that there was one position and one position only that I felt I had enough traction that I could relax (sort of a frog squat with my arms over the side), and I was scared to get out because I’d lose the effects of the warmth. Knowing what I know now, moving around would have helped baby rotate, shortened the labor and probably resulted in me not being so very exhausted by second stage. I was so tense by crowning that I’m fairly sure I would have torn no matter what, but feeling insecurely positioned in the tub surely didn’t help.
My subsequent labors have been quite short (~2hrs), and despite the incredulity of my midwives I’ve planned not to use the tub; there simply hasn’t been time, and the shower has sufficed nicely, with less trouble. Of those three, one (who had trouble rotating, I think) I delivered on hands and knees, and the other two quite surprised me by coming down when I was upright, standing and sitting on the toilet. They were both born in asymmetrical squatting-kneeling positions, with zero tearing or even burning, always with my hands down on their heads as they came out. All three were born without a midwife in the room, twice because she hadn’t arrived yet and once because she had stepped out to give me my privacy in the bathroom. No pushing beyond a grunt or two.
I wonder how much my quite-atypical birth stories have to do with my and my babies’ particular anatomy (one midwife described my pelvis as “highly architecturally sound” ;)) and how much they have to do with my attitude (relaxed) and the undisturbed nature of my births.
You’re not alone! Many women find it hard to get their bearings in a big tub. It’s like they don’t have enough leverage or something.
Any insight into using a “peanut ball”? I just heard about it. I am pregnant with my 3rd and my 1st labor was failure to progress and resulted in a c section. My 2nd I successfully had a vbac but had a 2nd degree tear and had such trama( I did push for almost 4 hours, sunny side up that turned at the last minute) I thought when I got up to walk I had something stuck between my legs; nope, just swollen labia. Anyway it took me like 5 months to heal and not feel like my vagina was falling out ofmy body. And this #3rd time I am again trying for a. 2Vbac and looking for the least amount of trama; Thanks!
Peanut balls are AMAZING and are really helpful, especially for the labors with epidurals. Or even if you’re unmedicated, but are in bed because of exhaustion. It helps open up the pelvis which helps to encourage labor progress. A good thing! I think you can’t go wrong with a peanut ball.
I HATED the peanut ball to help me to try and give birth on my side !! I waved it away. and it helped my contractions not hurt as much.
i didn’t tear but I put it down to the fact that my husband had gone to the car to get my bag and phone my mum as I was told I was only 4cm dilated! He’d only been gone 5 mins when the baby crowned and I had to pant my way through about 6 contractions so he didn’t miss the birth!! I think the extra panting helped stretch everything and prevent tearing!!
I wanted to have a natural delivery and the baby was in the correct position but instead I ended up with instrumental delivery (vacuum and spatula) and a big episotomy that restricted my movements for months! It wasn´t painful because they adviced me to go for epidural even though I didn’t want it and it was the worst choice ever because I didn´t feel like pushing, I didn’t feel my legs for hours and of course they took advantage and cut me because I couldn´t say no. My baby was born with the cord around the neck, lack of oxygen and kept in ICU for hours alone. Fortunately he was and is now (16 months later) a beautiful healthy baby but I still cry when I remember his birth.
I’m so sorry that you weren’t listened to at your birth. That wasn’t right. You have every right to cry about it even while still feeling thankful for your son. ♥
I am a first time mom and when I had my son, I was on my side just before the pushing stage. They wanted to have me on my back to check how dilated I was but I couldn’t physically roll over so they had to check me on my side. I eventuallly got to my back with some help. While waiting for the OB to arrive, the nurses were using perineal massage and having me push him down the canal so that I was almost crowning when the OB arrived. I did tear unfortunately. Overall my hospital birthing experience was fine. But looking back, and planning for future, I would probably want to labor a bit differently.
thanks for commenting Cierra! What do you think you would want to do differently next time? 🙂
Was the grannie midwife energy for a birth of a woman I had helped birth since she was 18. She was having her 5th and 6th babies, cephalic twins. Blood pressure creeping up and in a different hospital than planned with substitute doc. She informed him he would deliver the second one breech if he turned once baby #1 was out. He scurried away. We did a manifestation of babies who remained cephalic and the turning off of pitocin if doc would break presenting water bag. He scurried in when we sent out the request and scurried out.I had taught this baby daddy father #3-#7 Lamaze for the first time (authentic Lamaze out of the 70’s/psychoprophlaxis not stuff they pas off as CB education). Mom refused to let the nurse turn up the Pit, in fact made her turn it off. 20 minutes later full blown active labor. The couple was in total communion and after each hard contraction she would close her eyes, he would cradle her face, and he would kiss her forehead. He would kiss her eyelids. He would kiss her eye-sockets, he would kiss her cheeks. He kissed her lips, her neck and her chest, And here would come another contraction with them in total communion, The room was dark. Everyone was silent. Her doula was on the side opposite the Gurdian of Courage (her husband). A German PT student who had attached herself to our birthing circle who had never see a birth was there and in the corner was the mom’s best friend from kindergarten*. There was so much oxytocin in the room I thought we might all have orgasms! She bore down slightly and said she had to push. Someone called the nurse who saw the head as we did. The nurse ran out muttering “I told him not to wander off!” My hands were somehow close enough that when she had a spontaneous fetal ejection reflex I simply created a barrier so Jill would not skid off the bed. Mom picked up the baby. I doubt if there were a tear.
THEN, in rushed the doctor, 4 nurses, someone turned on the lights and the staff started screaming at her to push. Contractions stopped. We asked for silence. Contractions began later. Staff members screamed. We asked for silence. Jack, not wanting to come out in to that hostile environment, took forever to emerge. When he finally did, she tore.
He WAS kissing her as she birthed baby Jill! copyright 11-13-16 Janis Bell Bush
It’s completely false that perineal support can’t be done during a waterbirth. I’m a midwifery student who’s done perineal support on every single mom (except one, who chose to catch her own baby and she did her own support) who chose to give birth in the water and we have a very low incidience of tearing.
Otherwise, good tips. Perineal massage is traumatic to watch and to have it done. Not okay. I love the idea of the ginger water for support! Sitz bath herbs would also be another good idea!
I am so glad you left a comment! If you have a moment would you mind giving us some tips or practical advice about how to support the perineum during a water birth? This way we can get that good information out there.
All three of my births were water births. And I never tore not even a little. And I am small framed 5’3″ 115lbs and had 8lbs 4oz, 9lbs4oz, 8lbs7oz babies. Its all about relaxing and supporting your perineum.
As I am now a doula this is great info, Thanks for ginger idea I usually just do warm water, but I will add ginger next time.
You’re welcome!
I had a 3rd degree tear with my first (and only) but I believe it was because her hand came out next to her head. It was all very quick and I wasn’t even offered the option for an episiotomy because it was a quick labor and I wanted to have as little intervention as possible. I’ll definitely try these techniques next time. In your opinion will I be less likely to tear with the next? Pending uninvited hands lol…
Yes! Many women tear less when they give birth. Especially when there are no hands… 🙂
Did the author read the one and only study that she used to support her conclusions? The study concluded that “Anal sphincter injury occurred in 3.5%” … of that 3.5%, only 1.8% were squatting!!! That is NOT a recommendation against squatting. Very disappointed in the lack of fact based evidence.
I’ve only given birth once so far, but I had a fourth degree tear! I said I didn’t want an episiotomy but the doctor did a lot of massage (which hurt real bad) and I am very stubborn and wanted labor to be over so I pushed more and longer than my body was ready for… I appreciate the info about the washcloths and massage. I had already decided that I will listen to my body in the future, but now I have a couple other ideas in my bag 🙂 Thanks!
You’re welcome!
FINALLY! Someone who posted the truth about perineal massage. I’m an L&D nurse and I have seen so many women so swollen from perineal massage that at times, it results in C-section because mom swells to the point where she can’t physically move the baby past her vulva.. And yes, GREAT observation about how uncomfortable–and instinctively ugly–perineal massage just looks! I don’t think it’s fair to call this technique “massage” as it sounds like it’s a gentle, comfortable process. But in reality, it is not! It’s a provider’s excuse to physically widen and stretch the vagina to shorten the pushing phase when the vagina does not need their help and likely will not benefit at all from their interference. It is notable that most women who are unmedicated do NOT tolerate perineal massage at all! I’ve seen several midwives attempt perineal massage in unmedicated gals only to get snapped at: “Get your fingers out of there!” That says a lot on its own.
Great advice overall, especially regarding avoiding the lithotomy/traditional squatting positions (unless you’re a gymnast, ballerina or accustomed to sitting in a cross-legged style). Some of the most traumatic births I’ve seen are births where the provider routinely has the staff push mom’s knees up toward her ears and pull her feet back and up while in lithotomy, thus combining the squatting/lithotomy positions. If you want to tear, that’s a fabulous way to make it almost a guarantee.
Soooo… I love your comment and I love your blog. I think if we were to meet in RL we would get along just fine. 🙂
Thanks and right back atcha! 🙂
I gave birth in the semi squatting position/ reclined position with my knees held near my shoulders ! from my first contraction to delivery was 27 hrs. 10 hrs of active labor. I was tired and never wanted to birth in that position but I had no energy to say no.. >:( I had a 2nd degree tear and swollen bits for a month ! never again am i birthing in that position. even though I have strong legs.
I just had my first baby six months ago and I had a third degree tear. I could not walk or even sit for six weeks after. The recovery was very difficult and I have so much scar tissue now that intercourse is painful. I’m looking into physical therapy for complete healing, but I can say that naturally tearing that much has definitely done life-long damage.
Great article! One expecting Baby #3 and of course labor is right on the top of my mind! With my first, I delivered with a midwife in a hospital. I had the intense urge to push when I was only 8cm. My midwife had my husband (tmi) stimulate my nipples in between contractions to dilate me quicker and my son was born 30 minutes later and only suffered a very minor tear. Obviously, I was fine with it. At that point, you’ll do anything to get the baby out lol. With my daughter, I used a conventional OBGYN because we suffered many minscarriages in between our first and second and so we went to a specialist. I was very frustrated when it came Tim to push. I wanted to be hands and knees but they forced me to lie on the bed. They put my legs in the stirrups (while I begged them to stop because it was excruciating) and then I pushed my daughter out in one quick push. I tore so badly he said it was one of the worst he’d seen. I am looking forward to #3 and will be much more assertive about what I want in the hospital room!!
I am a hospital birthing midwife and many times I beg women to listen to their bodies and move accordingly unfortunately in todays society many moms absolutley cant or wont listen to their primal selves.
I frequently try to reposition my moms to protect their perineum as well. My very best friend begged to deliver squatting and I almost had to force her on her back to prevent what would have likely been a 3rd degree due to the position of the baby. She had 3 tiny stitches after it was over and was actually super grateful for the direction.
Also to speak to tear vs snip. Think of the perineum like a hemmed t shirt hard to tear completely through but snip it and it will rip all the way through. “Preventing a tear with an episiotomy” is antiquated medicine. Episiotomy should only be done in an emergency situations. I have only cut 5 episiotomies in my entire career and I have the highest “intact delivery rate” of any provider at my facility mostly because i work with each mom and baby. Some need perineal massage, some need squatting pr on their back or side lying or standing; problems arise when everyone shows up to the delivery with preconcieved ideas of what should/shouldnt be done. EVERY single mom and baby are different as is every labor. Respecting the process is the most sacred thing to do to ensure a good outcome.
Ps love hot compresses.
Also simply birthing out of hospital is a good way to prevent tearing! The statistcs on tearing are crazy lower for out of hospital birth, especially for first time moms! Probably for the reasons you explained in different practice of the care providers during pushing. 🙂
Out of my 3 births, the only time I tore was during the hospital birth. The doctor cut me and then I ripped all the way. 🙁 My last two births were home births. My first home birth I was leaning against my husband and we sorta squatted together, that’s the best way I can describe it. lol Then my second home birth was a water birth and I didn’t tear than either. I didn’t really do anything to prevent tearing, I didn’t even think about that part of it. I just stayed focused on pushing and getting past that ring of fire. My second midwife did tell me to push slowly when I feel the ring of fire. That was a hard thing to do! I wonder if she had me go slow to help prevent tearing.
My mom a L&D NURSE SAID IS WAS COMMON FOR 2ND DEGREE TEAR FOR 1ST TIME MOMS, AND WAS HORRIFIED.
Thank you for this article! I am pregnant with my second and terrified of tearing again. I wanted to deliver my first with a midwife, but there were none in my area. I delivered with a “natural friendly” OB/GYN, and had a great labor until the Dr walked in the room when I was starting to push. I ended up in lithotomy position and he did extensive “massage”, which was excruciating (and hard to watch according to my husband). My baby was delivered in the bag of water (cool!) with head and shoulders coming out in one pushing with no pause to rotate or perineal support (not cool!). I had 2nd degree perineal, periurethral, and deep vaginal tears. The recovery was brutal, and I hemorraged from the vaginal tears. I think the “massage” and failure to rotate the shoulders prior to delivery were probably the culprits of my severe tearing. This time I am using a midwife, who I love. She is planning to be entirely hands off until crowning and then to support my perineum and help me to slow down as I deliver the head and shoulders. I am also hoping to deliver on hands and knees or side lying. I am hopeful that this will be a much better experience, and it helps to be reminded of what I can do to make it better!
I’m excited for you! I’m so glad you found a care provider that you trust. Makes all the difference.