How to decrease your risk for perineal tear during birth

If you are having a vaginal delivery, reducing your chance of tearing is most likely high your list of things you would like. There are some things you can do to help REDUCE the risk of tearing.

It is important to note that it can help but tearing can still occur and it has nothing to do with what you did or did not during your pregnancy.

What is tearing?

• 1st degree tear: injury to the perineal skin and/or vagina mucosa

• 2nd degree tear: injury to the perineal skin, vagina mucosa and perineal muscles (1st 2 layers)

• 3rd degree tear: injury to the perineal skin, vagina mucosa, perineal body and external anal sphincter

• 4th degrees tear: injury to perineal skin, vagina mucosa, perineal body, external anal sphincter plus anterior rectal wall, internal anal sphincter and rectal mucosa

what can influence tearing

• Who your provider is

  • it is important you are discussing with your provider what their episiotomy rate is, their severe tear rate is, and their rate of requiring surtures

• If it is your first vaginal delivery

• If your baby is >9 lbs

• You have a long or short second stage of labor

• The baby’s shoulder gets stuck behind the pubic bone (shoulder dystocia)

• Instrumentation is used during delivery (ex: forceps or vacuum assisted)

What you can do to help reduce your risk of tearing

These are some options that help improve elasticity of the tissue to help decrease it from tearing. While these are things commonly used to help reduce your risk of tearing, there is not a significant amount of research to support them.

1. Open Glottis Pushing

   • This is when you do not hold your breath while pushing

   • The more relaxed you pelvic floor, the easier it will be for tissue to stretch when the uterus is pushing the baby out

   • Breath holding can contribute to more pelvic floor tension which is why trying to avoid it may be helpful

2. Optimal Birth Position For You

   • The position that allows you to connect best to your pelvic floor to allow it to lengthen

   • If you have an epidural laying on your side with delayed pushing has been shown to improve intact perineum (Walter et al)

   • Upright positions (such as hands and knees or squatting) has decreased risk of severe tears, use of episiotomy and forcep or vacuum assistance. It did however show with squatting and sitting an increase risk of 2nd degree tears

3. Hip Position

   1. Hips that are spread wide (think knees and hips apart toward your chest) will put more tension through your perineum

      • If this tissue is already pulled tight, it will make it harder for it to stretch further without damage

4. Self Perineal Massage

   • This can help improve the elasticity in the skin allowing it to stretch with the baby

   • See this blog post for detailed instructions on how to perform

   • Provider perineal massage during the second stage of labor has been shown through the literature to decrease severe tears (Aquino et al 2018, Asahien et al 2017). There are however studies that also do not support a decrease in tears with perineal massage during labor. More research is required to determine its affects

5. Warm Compress during 2nd stage of labor

   1. Having your provider provide a warm compress over the perineum during the second stage of labor has been shown in some studies to decrease risk of severe tearing (Aashien et al)

6. Perineal Moisturizing

   • Dry skin has higher incidence of tearing than moisturized skin therefore using a vulvar moisturizer leading up to birth may help

If you are pregnant and are worried about tearing, please discuss all of your concerns with your provider and advocate for yourself! If tearing does occur, know you are not alone and there are many pelvic health physical therapists that can help guide you to achieving all of your goals as well as help with other resources to optimize your birth experience.

If you are currently experiencing any pelvic floor related issues or are unsure if you are please reach out to us either through social media @empowerptandwellness, email: Hello@WeEmpowerPT.com or give us a call or a text at 678-413-5587. You are not alone in what you are experiencing and we would love to help guide you to achieve everything you want!