Women that take my childbirth classes want to know how to prevent tearing during birth, just as much as they want to know how to have a natural childbirth. It’s a very important topic that’s unfortunately riddled with misinformation.
A doctor once told me that the average first time mom will get a second degree tear during childbirth. Basically, he believes most women tear significantly from childbirth. The underlying assumption is that a woman’s perineum is not made to withstand the stress of childbirth.
I call bullshit.
If that were true, then all women, no matter where, when, or how they give birth, would have second degree tears as well. However, this is simply not the case. Many women that give birth in and out of the hospital are able to prevent or reduce tearing by following simple guidelines, many of which are discussed in this post.
The thing is, obstetricians are surgeons and are therefore very comfortable suturing a woman’s perineum after birth. Suturing is their jam! Because of this, I think they are less inclined to learn how to prevent tearing during birth, because at the end of the day, they can just sew a woman back together.
However, a postpartum recovery with minimal tearing and suturing is much more pleasant for a woman than if she’s stitched to high heavens. It is a worthwhile endeavor to learn how to prevent tearing during birth.
How to Prevent Tearing During Birth
Whether you’re planning for a natural birth or a medicated birth, in or out of the hospital, the following are 5 surprising ways to prevent tearing that will change the way you give birth.
1. Choose Birthing Positions Wisely
Squatting 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 opens 20-30% larger than it would otherwise. A greater outlet equals an easier birth. Isn’t that amazing?!
In conclusion, us Americans should squat and push our babies out just like the women in below video, right? Eh, maybe not.
In a nut shell, if you are a typical sedentary woman, you probably should re-think squatting during pushing. However, if you’re like the 1970s Southern Brazilian Indian women in the above video who squats to rest, your body may be able to handle squatting during pushing.
If you’re up to the challenge, visit Katy Bowman and teach your body to squat.
Side-Lying, Kneeling, Hands and Knees Decreases Tearing
The semi-reclined lithotomy position is what most women use when pushing at hospital births. Despite the convenience this position offers care providers, it’s one of the more common mistakes that don’t actually prevent tearing.
On the other hand, positions associated with a reduced risk of perineal damage are lateral positions like kneeling or a 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.)
If you really want to squat in labor, go for it, maybe just move to hands and knees just before crowning.
2. During Waterbirth, Continue to Support the Perineum
Unfortunately, it seems that waterbirth, although safe for mom and baby, has an association with tearing. I talked with my midwife, and she agreed with this. She definitely sees tearing with waterbirths.
Maybe this phenomenon happens because care providers are more hands off when a woman is in the water. Or maybe it’s because care providers aren’t pursuing gentle birth in any venue – land or water. Either way, I have some solutions.
Even when in the water, women should continue to use the information discussed in this article. The same techniques to prevent tearing on land can be used use in water.
- Choose lateral positions like kneeling or hands and knees.
- Provide firm support to the perineum with warm compresses.
- As much as possible, relax.
- After the head is born, wait.
When I gave birth in water I did tear, but it didn’t require stitches. A waterbirth isn’t necessarily a death sentence to your perineum, but it’s definitely something to take into consideration to prevent tearing during birth.
3. Rethink Perineal Massage
Perineal Massage During Pregnancy
Many women wonder if perineal massage during pregnancy can reduce tearing at birth. Perineal massage is when two lubricated fingers are placed in the vagina, and pushed down and to the sides to “pre-stretch” the skin prior to birth.
The evidence says that perineal massage during pregnancy will help a first time mom decrease the chance of an episiotomy. However, in my experience a woman is more or less likely to receive an episiotomy depending on who her care provider is.
If you are a first time mom and are at risk of an episiotomy, perineal massage during pregnancy may help. Hope on over to this post for more information and instructions on how to do perineal massage at home. And remember, it’s not really a massage. 😉
Perineal Massage During Pushing
When parents hear the term perineal massage they typically imagine something that’s done during pregnancy. However, many care providers provide perineal massage during the pushing stage of labor to help reduce tearing.
- While mom is pushing, her care provider will sit at the bottom of the hospital bed or stool, gowned up with gloves on.
- Next, they place their outstretched hand towards the nurse, who squirts lubricating jelly on their two fingers.
- After that they take their two fingers and place them in the vagina and push down and to the sides. On a clock, picture 3 o’clock to 6 o’clock, 6 o’clock to 9 o’clock, and then 9 o’clock to 6 o’clock.
- Rinse and repeat.
Watching this looks incredibly uncomfortable, almost painful. And if not painful, then by golly it’s gotta be totally distracting! Sometimes these moms get 30 to 60 minutes of this! The vulva becomes swollen, and leaves me feeling frustrated, mad, and sad.
And what really makes me frustrated is that nurses do this technique too when baby is crowning (before they call the doctor in). Nurses learn from doctors, assuming it’s an evidence based practice.
This hands on approach to supporting a perineum is one of the biggest pet peeves I have about hospital births.
Does Perineal Massage During Pushing Work?
My feelings and anecdotes aside, however, the research does not support the practice of perineal massage during pushing.
“Perineal massage in the second stage of labour did not have any effect on the likelihood of an intact perineum, perineal trauma, pain, or subsequent sexual, urinary or faecal outcomes, but was not harmful.” (SOURCE)
Use 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 an inexpensive 24 pack of washcloths. 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 with firm support while 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 and ginger 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 mom is.
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.
4. As Much As Possible, Relax
Tension plays a role with tearing during birth. Anything a woman can do to reduce tension and encourage relaxation will help the body to do what it instinctively knows to do. An easy way to think about this is to encourage a birthing environment that is conducive to oxytocin and eliminates adrenaline. The same environment that helps make a baby helps get the baby out. 🙂
The following are specific ideas ways to experience a more relaxing birth.
Eliminate Fear
When the body is fearful, it instinctively tenses to protect itself, which makes so much sense. What doesn’t make sense, however, is a tensed body during birth. One way to eliminate fear at birth is to to address fears prenatally, as much as possible, so as to avoid the fight or flight response during birth. It is possible to give birth without fear!
Relax the Jaw
During birth it may be difficult achieve total relaxation if all a woman hears is to “just relax”. Being more specific by pinpointing a specific body part is much more doable. Try saying the following to yourself, or a laboring mother, and you’ll likely be more helpful.
“A relaxed jaw is an open vagina.”
Try Kissing
A fun, and even more effective way to relax the jaw, is to kiss your partner. Not only will the jaw relax (hopefully!), but your body will release more feel-good, labor encouraging hormones like oxytocin and endorphins. According to Ina May Gaskin, she’s never seen a woman kissing her way through pushing that also tears during birth. If that’s not fabulous news, I’m not sure what is. 😉
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.
Don’t Forcefully Push
If a woman is pushing in a way that is forceful and unnatural, odds are she is experiencing coached pushing instead of spontaneous, undirected pushing. For a woman that is unmedicated, it’s best to be hands off physically, but also with directed pushing.
Coached or forced pushing may sound like a nurse instructing a woman to hold her breath while counting to ten, two to three times during each pushing contraction. It may also look like a doctor or midwife telling a woman to push after baby’s head is out, but between contractions, when she has no urge to push. (You can read more about this phenomenon below.)
Push with Great Strength, Slowly and Gently
Instead, it’s best to push instinctively with great strength, but slowly and gently. Before baby is crowning, it may be helpful to envision pushing with the strength of a gorilla. However, when baby is crowning, pushing slowly and gently is a great way to prevent tearing.
Listen to your care provider as they guide you through these intense moments of birth. You may want to push like a wild woman and “get the baby out”, but anything you can do to allow things to unfold slowly will help keep your lady bits intact.
5. After the Head is Born, Wait
Finally, I’d like to introduce an idea on preventing tearing that is generally not discussed or considered. Minimizing tearing during birth can be facilitated by care providers when they give the opportunity for baby to be born during two contractions – one for the head and the second for the body – and not just one.
After the head is born, by allowing the baby to instinctively rotate on its own and waiting for the mother to experience another involuntary push, the body will be given the space it needs to birth in a gentle way. (BACKED BY RESEARCH, Y’ALL —->>>>> SOURCE)
(Photo Credit: Indie Birth Association)
Having said that, I realize this is a tall ask of most care providers. You see, the standard procedure for most is to intervene if the baby’s isn’t completely born within 30 seconds after baby’s head.
I experienced this first hand at my son’s birth. I pushed my son’s head out during one contraction, that contraction went away (as they always do), and I stopped pushing while the rest of his body remained inside of me. My midwife, however, impressed it upon me that I should continue to push and get him out NOW. I remember her saying, “PUSH, Lindsey!”.
Based on how my midwife was acting, it seemed like an emergency. However, years later I looked at my records and there was no huge lapse in time after his head was born. My body was just waiting for the next contraction. I wasn’t given the option to wait for the next contraction because my midwife pulled my son out after that. That’s when I felt myself tear.
30, 30, 30
A few years later, I became a birth assistant and was given the opportunity to witness women and babies having the time and space to deliver baby’s head and body in more than one contraction. It was affirming to see this happen with no adverse affects.
However, I will say that if you’re accustomed to GETTING THE BABY OUT NOW, waiting for the next contraction after the head comes out, will feel like one of the longest waits of your life.
While baby’s between two worlds, it may be best to wait. During this challenging time, grab a cup of tea or sit on your hands. 😉 According to Barbara Harper, if after 30 seconds of waiting nothing happens, move mom into a new position. Every 30 seconds after that, try a new position until baby is born. 30, 30, 30.
Tearing during birth is a common fear of expectant mothers, with good reason, as a local OB once told me that the average first time mother experiences a second degree tear. It would seem that the use of perineal massage during pushing, the preferred method to prevent tearing during birth at the hospital, is not working. So then, what does work? Perineal massage, when done during pregnancy, has been shown to reduce the risk of an episiotomy with first time moms. However, in my experience, this risk is drastically reduced by choosing the right care provider. Have a talk with your care provider and ask them about their episiotomy rates. As an Amazon Associate and member of other affiliate programs, I earn from qualifying purchases.Tips for How to Prevent Tearing During Birth
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Alix Kalfin says
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.
Lindsey Morrow says
Sounds like you did your best! Good job! 🙂 Birth is unpredictable and all we can do is “the next best thing”.
RosIe says
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.
Lindsey Morrow says
The evidence just doesn’t back up episiotomies over natural tearing. Sorry!
Maria says
I actually heard the opposite as to tearing is better because the jagged tear line will heal much quicker together than the straight cut.
Ysabella G. says
I’ve heard the exact opposite. a clean cut will heal better than a jagged tear will.
Shelley says
Actually, I have had no end of problems over the years from scarring after a natural tear, as the tear didn’t heal neatly and sometimes friction during sex can cause it to get sore (even 21 years later).
In an earlier birth I had an episiotomy and had no issues at all.
Christine says
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!
Betty says
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!
Jill says
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?
Jill says
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!
Bri says
I had horrible tearing with my first, and felt that tightening as well. Just had my third, and each time got significantly better, and I had less tearing. Also the tight feeling was way better after having baby #2, and is gone after having #3! Time will help, don’t worry! It took the full 6 weeks to heal with #1 (or longer) where the other 2 I felt better very quickly after. Good luck!
Melissa Mosey says
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.
Ashlie says
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.
tracy says
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.
Lindsey Morrow says
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?
AR says
I actually just saw a show where a DR was doing research on the affects of arousal helping mom to deliver her baby safely and easier with minimal tearing and reduced her pain b/c she was not allowed medicine due to her allergies to them. I truly believe that our bodies were meant to do all things natural and there has to be some link to what happens down there during a climax that would help to reduce damage and pain.
Natalie says
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.
Lindsey Morrow says
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.
Val says
The arousal thing makes a lot of sense to me. I’ve never been in a delivery room, so I can only igagine how invasive, forced, and uncomfortable it is. However, I do know my vagina.
I once had a sexual partner that had such a fat penis, that if our foreplay wasn’t enough that he couldn’t fit. Lube alone wasn’t enough. Higher levels of sexual arousal allowed my muscles to relax enough to stretch more than lower levels of arousal.
Leslie says
Sorry- that is insane. This is horrible advice. Please do some research. Episiotomies do. not. help.
C says
So so so wrong. So bad.
Jaimie says
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.
Sab says
The doctor I had used warm cloths for the perineum. It was most welcome. I am pregnant with baby 6 and never needed stitches, only had what they called micro tearing. I gave birth on my back with all of them, even though I tried hands and knees and side laying, baby didn’t want to come out. I think my diastasis might be partially to blame for that. Hoping for no tears this time, too.
Marissa says
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?
Lindsey Morrow says
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.
Denise says
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!
Lindsey Morrow says
You’re welcome,
Denise! Thank you for your sweet comment.
amber says
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.
amber says
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!
Saraj says
Which books of hers did you read
Lani says
If only kissing turned me on ):
Melissa says
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
Priscilla says
What book if her’s did you study?
Fredie Ian says
this post is so informative, thanks very much for sharing
Courtney says
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.
Lindsey Morrow says
Happy to help! Thanks for stopping by.
Jessica says
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.
Abby says
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.
Lindsey Morrow says
I disagree. It was a proud moment. You made your voice be heard!! Good job.
kristy says
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.
kristy says
I meant I will be different and I will not allow this “procedure”.
Lindsey Morrow says
That’s right, my friend! It WILL be different! I’m so happy you read this article. ♥ Much love! ~Lindsey
Rheanna says
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!!
Rachel says
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?
Lindsey Morrow says
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.
Alexandria says
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!
Lindsey Morrow says
Typically yes. Although there’s no guarantee.
Mama of 3 says
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!
Irene says
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.
Lindsey Morrow says
You’re welcome!
Simone says
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.
Marion says
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
Lindsey Morrow says
You’re welcome! Let us know how it goes and what you learn. ♥
Andrea says
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.
Danielle says
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!
Patty says
If someone has a. Epidural simply to decrease tearing it does not pass the risk/ benefit test.
Debbie says
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.
Rheanna says
That is beautiful!! Thanks so much for sharing.
Jenna says
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!!
AUDREONI.COBLE@GMAIL.COM says
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 !
Liz says
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!
Lindsey Morrow says
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.
Loes from Holland says
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.
Mindy says
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.
Lisa Coomer says
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
Lindsey Morrow says
Thanks Lisa!! This is great advice.
Linda Bennett says
You might like to see this recent ACOG piece: http://www.medpagetoday.com/OBGYN/Pregnancy/58745
Audre says
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.
Lindsey Morrow says
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!
Christine says
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. 🙂
Lindsey Morrow says
Thank you so much for sharing!! What amazing stories. Rock on!
Whit says
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.
Mandy says
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!
Mandy says
Oh, but I will say, giving birth was the most amazing, empowering, and the most beautiful thing I’ve ever done! 🙂
Sarah says
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.
Ginnie says
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!
SAmantha says
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!
Christine says
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! 🙂
Joy Kusek, LCCE says
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!
Lindsey Morrow says
Thanks, Joy. Good to hear from you! ♥
Marianne says
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.
Mariana faria says
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.
:/
Elizabeth says
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!
Lindsay says
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.
Karla says
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.”
Christine says
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!
Lindsey Morrow says
This study doesn’t really back that up. http://www.sciencedirect.com/science/article/pii/S0002937803000735 ….
Megan says
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.
Ally says
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.
Lindsey Morrow says
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.
Noelle says
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!
Lindsey Morrow says
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.
Amanda H says
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.
Kris says
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!!
Estela says
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.
Lindsey Morrow says
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. ♥
Cierra says
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.
Lindsey Morrow says
thanks for commenting Cierra! What do you think you would want to do differently next time? 🙂
janis says
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
Erinn says
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!
Lindsey Morrow says
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.
Kylee says
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.
Lindsey Morrow says
You’re welcome!
Michelle Hought says
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…
Lindsey Morrow says
Yes! Many women tear less when they give birth. Especially when there are no hands… 🙂
Laurie says
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.
Aimee says
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!
Lindsey Morrow says
You’re welcome!
cervixwithasmile says
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.
Lindsey Morrow says
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. 🙂
cervixwithasmile says
Thanks and right back atcha! 🙂
Amanda H says
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.
Hailey says
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.
Erika says
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!!
LeAnn says
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.
Jana says
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. 🙂
Michelle says
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.
Hannah says
My mom a L&D NURSE SAID IS WAS COMMON FOR 2ND DEGREE TEAR FOR 1ST TIME MOMS, AND WAS HORRIFIED.
Ruth says
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!
Lindsey says
I’m excited for you! I’m so glad you found a care provider that you trust. Makes all the difference.
SAra says
I thought hands and knees would be best, so after pushing lying on my back for awhile, I switched to the hands and knees position. However, the problem was that the hospital bed which felt very firm when I was lying on my back, shockingly gave zero support to me when I tried pushing on my hands and knees. My hands and knees were sinking into the mattress like a marshmallow or like a water bed, it gave zero support and I couldn’t hold myself up. After a more than ten hour day, it quickly zapped all the energy that I had left wwith a just few more times pushing. I tried so hard to muster all my strength, and mentally think of all the strong women in my life, pray, and imagine that I was pulling in all the energy from the universe and I couldn’t push the baby out. They said the baby was having distress and they called a csection.
Aubrey says
I don’t agree with the perineum massage view. With all three children, it has worked for me. I’ve never had tears. I’ve had two natural labor/deliveries in hispitals (one with a doctor one a midwife). My doctor or nurse did not massage. I was advised by a midwife in my second trimester to begin perineal massages at 20 weeks. She advised me to have my husband help, and to continue building my pelvic floor muscles. I labored with my first for 11 hours and pushed for 5 minutes. It was back labor…no tears. My second was with a midwife in a birthing center inside a hospital. She massaged when it was time to push. No tears. Again, my husband had helped me massage at 20 weeks. My third was a very quick labor and birth, my biggest baby, althouh all were big, again no tears. He was born at a birthing center. She swears by massage and was glad to hear of my methods. She was shocked at the fact the my big, back labor, quick to arrive baby, left me without tears. You can’t write a method off because you don’t like it, and it’s not a “hospital” thing; which that statement in fact was a huge turn off to your blog. When done correctly, coupled with working on your pelvic floor, and knowing how to properly push (and when to), you can have a non to a very little tearing delivery. I have studied Ina May, an I do agree that a close, physical, although I’ve never tried arousing contact with your partner creates a calming, intimate labor and delivery. I’ve implemented that in all of my l&ds.
Kim says
Interesting info!
I have had 5 vaginal births and I am expecting my 6th any day.
With my first I delivere side lying and tore slightly (doctor called it a “skid mark”) on the side wall and it was only a few stitches. Unfortunately I reacted to the stitches and developed a keloid scar that was painful for years at times and I can still feel the scar 13 years later.
With my second (a home birth) baby came unexpectedly fast and without a single voluntary push while I was seated on a commode (think adult potty). I tore but was told it was borderline for needing stitches. After my first unpleasant experience I opted not to have them. It healed without painful scarring but not approximated so my perineum was not really the same.
I did not tear with my 3rd even though she was the biggest (hands and knees) or my 4th (kneeling) or my 5th (hands and knees waterbirth). Planning on hands and knees again whenever this babe arrives!
Marinda Griffin says
Can you use Ginger Essential oil instead of shaved ginger?
Lindsey says
Honestly, I’m not sure! Ginger cut is way less potent than ginger EO! However, I see the draw. Ginger EO is much more portable.
MIRANDA says
Makes no damn difference if they have to cut you. Ouch 🙁
Imani Abdul-Zahir says
“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.”
How is being sedentary in any way civilized?
A typical sedentary CIVILIZED woman as opposed to the Southern Brazilian Indian women? This an interesting comparison.
Gabby Young says
With my second baby, I gave birth in the upright position and it took about 30 minutes. I slightly tore but I think it was because of baby’s position (the doctor told me baby “came out swinging” meaning one arm flew out so that may have caused the tear). Just FYI I did not tear with my first and my recovery with my second was just as easy as my first. All I took was ibuprofen and I didn’t even need padsickles or numbing spray or anything extra.
Ashley Jones says
Ever masturbate to lessen menstrual cramps? Totally works. It makes sense to me that it would help during labor. I just couldn’t do that in front of people…no way.