Tearing During Childbirth - Empowering Women And Reducing Fear
First up, the entire point of this article is to REDUCE the fear and anxiety around tearing in childbirth and encourage you to feel empowered. Ultimately, perineal tearing during childbirth will be a normal part of a vaginal delivery for many women. And I want you to know that your body is incredible at healing and repairing and the majority of the time the outcomes are amazing. I truly believe the more you understand about it the more power you have over your own outcomes during birth and healing afterwards.
(I don’t know where you are at with your anatomy, but “perineum” is the skin and muscles between your vagina and anus. FYI)
SO, LETS START WITH THE STATS
In Australia, about 70-85% of women will have some degree of perineal trauma after a vaginal delivery. I realise this seems like a lot, I do get that, but stay with me as we break this down.
Majority of the tears will be either a first degree (skin graze) or second-degree tear (involving the muscles). These injuries heal really well and are rarely associated with ongoing problems. And the good news is that ONLY 2.9% of perineal injuries are the more significant third or fourth-degree tears (a third-degree tear extends back to the anal sphincter and a fourth-degree tear extends into the anus)
.This is really important information to hear ladies! And to put that 2.9% into perspective, 60-80% of that 2.9%, will have NO adverse symptoms at 12 months after the birth. I have been involved in the postpartum care of incredible women that heal perfectly after third and fourth-degree tears. The vagina and perineum have a brilliant blood supply which is why these tears can heal really quickly. A very small percentage do have ongoing problems but there is always help available!
HOW TO REDUCE YOUR RISK
Well this is the red-hot question isn’t it. I am going to focus on the best evidence we have at the moment:
1. Warm compress: Applying a warm compress like a face washer or small towel to the perineal area during the second stage of labour (pushing stage) can help to reduce third or fourth-degree tears.
2. Perineal massage: Can help to reduce the risk of significant injury as well. If you haven’t heard of this or haven’t been taught how to do it have a chat with your healthcare professional or send me a message and I’ll talk you through it.
3. Birthing position: Giving birth in kneeling or on all fours has been more closely associated with an intact perineum when compared to sitting or squatting.
4. Active first stage: Staying upright and active in the early stages of labour may help reduce the chances of prolonged pushing or assisted delivery.
5. Medical assisted interventions: Such as guarding of the perineum during crowning, appropriate use of episiotomy or coached pushing. I would encourage you to discuss these factors with your healthcare provider for more information.
So that’s the scientific evidence and for those who don’t like science I will give you some anecdotal evidence too, my experience…
I have had two vaginal deliveries and both times I have used a warm compress through the second stage of labour. In Georgia’s birth I instinctively held the face-washer to my perineum while I was in the bath and then just kept it there until the end. And I will tell you if someone tried to take that washer away, I roared like a bear! I had a graze (1st degree tear) from Georgia’s birth and healed very well. I obviously did the same in Adele’s labour which resulted in no tearing so that was good. I also did practice perineal massage from 36 weeks during my pregnancy with Adele which may have helped too. So, my personal experience does match the science but that is not always the case, of course.
UNCONTROLLABLE FACTORS
There are factors that have been linked to higher rates of perineal tearing which are often uncontrollable, and these are:
-It’s the first baby
-The baby is over 4kg
-The use of instruments during delivery (forceps or vacuum assisted)
-The baby’s shoulder gets stuck behind the pubic bone (shoulder dystocia)
-An extended second stage of labour (the pushing stage)
Some of these factors are out of our control but what we can control is how we heal after birth. So, let’s get into postpartum recovery.
WHAT TO DO IF YOU DO TEAR
Start with the general principles of wound healing. For more details on this check out my article on Healing After Childbirth – The First 6 Weeks
If you are having trouble or just need some extra guidance, then start with your GP or your Pelvic Floor Physiotherapist. We have specific training in assessing, treating and managing problems related to the pelvic floor and will work closely with your GP or Obstetrician.
Treatment for childbirth injuries include pelvic floor education, muscle strengthening or relaxation, perineal scar massage or desensitisation. We will focus on teaching you about healthy bladder and bowel habits, advice and guidance on safe exercise and returning to sport.
WHEN YOU MIGHT NEED A LITTLE EXTRA HELP
Although most tears heal really well with no adverse effects, sometimes symptoms can persist that need to be discussed with your doctor or Pelvic Floor Physiotherapist. These include:
-excessive pain, swelling or bruising in the perineal area
-pain when going to the toilet
-urinary or faecal urgency
-leaking (incontinence) from your bladder or bowel
-pain when returning to sex
A FEW LAST TIPS
I read an article the other day that said the mental and social wellbeing of a woman is now viewed as equally important as her physical health. Umm YEAH obviously! I could have told you that! Whether you believe knowledge is power or ignorance is bliss, information shapes the beliefs that we have and our expectations. And we know that fear during pregnancy can lead to a negative birth experience. So, I hope you feel empowered and confident in your body and its ability to birth and heal. And if you want to talk more about this topic I am always up for a chat.
Birth Trauma: I acknowledge that some childbirth injuries can be associated with a traumatic birth so please reach out to the Australian Birth Trauma Association if you would like to talk.
Birth Classes: I highly recommend Calmbirth or Hypnobirthing courses as part of your birth preparation. You can search for a Calmbirth Educator click here or for Hypnobirthing Courses in your area click here.
DISCLAIMER: This information is intended to be used as a guide of general nature, having regard to general circumstances. The information presented should not be relied on as a substitute for medical advice, independent judgement or proper assessment by a doctor, with consideration of the particular circumstances of each case and individual needs. This information reflects information available at the time of its preparation, but its currency should be determined having regard to other available information. Megan Mullane disclaims all liability to users of the information provided. Please email megan@meganmullane.com.au for a reference list