How can i prevent tearing during childbirth




















Ask what techniques he or she uses to prevent vaginal tears and for any additional advice to help you prepare for delivery. There is a problem with information submitted for this request.

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Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. A single copy of these materials may be reprinted for noncommercial personal use only. Stitches after birth are necessary with these types of lacerations. Since severe tears into the vagina or rectum can cause pelvic floor dysfunction and prolapse, urinary problems, bowel movement difficulties, and discomfort during intercourse, it's important to share all of your symptoms with your doctor, no matter how embarrassing they may seem.

These professionals are trained to understand your vagina before and after birth. To decrease the severity of vaginal tearing, try to get into a labor position that puts less pressure on your perineum and vaginal floor, like upright squatting or side-lying, Page says.

Hands-and-knees and other more forward-leaning positions can reduce perineal tears, too. It also helps if you lead the pushing phase of labor. On the flip side, when you're directed to push as hard as you can while someone counts, there's a lot of additional pressure on your perineum, which can increase chances of tearing.

In addition, you may reduce your odds of vaginal tears by applying a warm compress to the perineum during the pushing phase of labor, says Dr. Finally, four to six weeks before your due date, practice a to minute perineal massage daily.

Always consult your doctor before beginning the practice, especially if you have a history of herpes, as practicing perineal massage with an active herpes outbreak increases the risk of the virus spreading throughout the genital tract. You might want to retain the look and feel of your vagina before and after birth, and are wondering if you should ask for an episiotomy. An episiotomy—an incision made in the perineum to widen the vaginal opening—is sometimes necessary, but is no longer routine during a vaginal delivery, says Dr.

By Holly Pevzner Updated July 31, Save Pin FB More. Broken red paper heart on wood background. Today, Katie McGee, PT, DPT, a physical therapist specializing in pelvic floor health for the childbearing year shares valuable information about tearing during childbirth. From time to time on Connecting the Dots, they will be sharing information and resources that will be valuable to educators and the families they work with.

This series is called The Body in Birth. I am grateful that the topic of pelvic floor health during pregnancy and postpartum is being discussed, as many people suffer in silence and without helpful resources. To find all The Body in Birth articles, click here. This article was written by Dr. Tearing during childbirth is one of the most common concerns of pregnant people. But what about those more significant tears? It is true that large tears do happen. Fortunately, research has shown us that there are ways to reduce the risk of tearing during a vaginal birth.

Some of these ways of preventing tears can be done before childbirth, while others are done during childbirth. Perineal massage is a type of stretching for the vagina to prepare for childbirth. Typically, a pregnant person does the stretching on themselves by using one or two thumbs to widen the opening of the vagina, although sometimes a partner helps.

A review of research on perineal massage done prior to birth found that it:. Reduced pushing time. Reduced the risk of perineal tears that reached the anus grade 3 and 4. Reduced pain in and around the vagina after birth. How much perineal stretching should I do? Perineal massage is often started eight to four weeks prior to the expected due date. It can be done daily, however, performing it just three times per week might be equally effective in preventing moderate and severe perineal tears Leon-Larios et al.

Daily stretching is associated with developing no tearing whatsoever Leon-Larios et al. Pregnant people should check with their medical provider before starting perineal massage. Frequently, people on pelvic rest or at risk of early delivery are instructed not to perform perineal stretching. One recent study found that pairing Kegels also known as pelvic floor muscle contractions with perineal massage aided in protecting the pelvic floor.

People who did perineal massage and Kegels:. Notably reduced the risk of perineal tears that reached the anus grade 3 and 4. Had less pelvic pain after delivery Leon-Larios et al. How many Kegels should I do? The study mentioned above prescribed 5-second Kegels repeated 10 to 15 times, twice per day, starting at 8 weeks prior to the expected due date.

It is worth noting that pelvic floor exercises by themselves do not prevent perineal tears Schantz, However, they can be helpful with preventing urinary incontinence during pregnancy and after birth Woodley et al.

As with perineal massage, pregnant people should check with their medical provider before starting Kegels. Certain positions are more likely to lead to larger perineal tears. In particular, these positions are ones where the sacrum part of the low back is pressed against another surface, such as a bed or chair Jansson et al. Often, it is easier to remember what TO DO when it comes to birthing, versus what not to do. For this reason, I encourage birthing people to practice positions that will be less likely to cause tears sacrum is freer to move.

Here are some to practice before going into labor:. Recent research suggests that upright positions in general are less likely to lead to tears Rocha et al. Use of an epidural has not been found to increase the risk of severe perineal tearing Loewenberg-Weisband et al.

Labor induction studies on the risk of perineal tearing show mixed results. Make a visit to the midwife or obstetrician to talk about ways they can help reduce the risk of perineal tearing during birth.

It is much easier to include perineal tear prevention strategies in the birth process if they have been agreed upon before labor starts.

Here are some of the common ways a midwife or obstetrician might try to reduce the risk of perineal tearing:. Good visualization of the perineum during pushing Sveinsdottir et al. Warm compress on the perineum during pushing Magoga et al. Occasionally, birthing people will decide that an episiotomy is a safe choice for their vaginal delivery. Similarly, if given the option to choose, some birthing people know that they would rather have a Cesarean delivery than risk developing a large perineal tear through the application of forceps or vacuum extraction.

Having five or more vaginal examinations is associated with a higher risk of a severe perineal tear, even when other factors are controlled for Gluck et al. A birthing person might consider requesting the medical team to only perform medically necessary examinations. Waterbirth has been associated with having fewer severe perineal tears Sidebottom, et al. If a birthing person is interested in a water birth, they should be sure to check a that they have a provider who will honor their wish to birth in the water and b that a tub will be available.

A tub may need to be rented or purchased depending on the birthing location. Some birthing people are instructed to push right when they reach 10 centimeters of dilation, while others wait until they feel the urge to push.



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