Perineal tears during vaginal birth are common and might sound scary, but don't let that fear stop you from learning about them. Remember, we are designed to give birth and so this skin is meant to stretch, tear and heal. Knowing what to expect and understanding the different types of perineal tears can help you better prepare for the recovery process and reduce the risk of severe tears.
In my personal experience giving birth, I had a 2nd degree tear but I had so much adrenaline that I didn’t feel it. My tear was very quickly stitched up while doing skin to skin with my baby, it felt stingy but not painful. It healed very quickly, only about 3 days. I used an angled peribottle when I pee'd to keep it clean and avoid wiping.
So, what exactly are perineal tears? How big can they get? And can we avoid them?
Perineal tears are graded on a scale from 1 to 4 based on their severity:
Grade 1: These tears involve only the skin around the vagina and usually heal naturally without stitches.
Grade 2: The most common type, extending through the skin and into the pelvic floor muscles. These tears may require stitches, but typically heal well.
Grade 3: These tears go through the pelvic floor muscles and reach the external anal sphincter, the muscle around the anus. This is repaired with stitches typically and can lead to more pain/ difficulty with bowel movements or even some bowel or flatulence leakage for the beginning month of healing.
Grade 4: Rare but extensive, these tears extend from the vagina through the anal sphincter and anal mucosa. These are typically stitched up by a seasoned OBGYN or may require surgical repair immediately after giving birth. It is important to have a medical management approach with these tears as medical complications can be extensive if the repair is not completed well.
While Grade 3 and 4 tears are rare, good preparation can help minimize the possibility of them occurring.
Top 4 Ways to Reduce Tearing During Birth
1. Perineal Stretching (Start at 32-34 weeks)
Begin manual stretching of the perineum around 32-34 weeks. This can be done by yourself, your partner, or a pelvic floor therapist. The goal is to increase your pelvic floor muscles' stretch capacity and help your body become accustomed to stretching, reducing the chance of muscle guarding. This preparation can help you relax and open up during birth, easing the baby's passage through the vaginal canal.
2. Pelvic Floor Elongation and Awareness
Learn how to perform a reverse Kegel, the opposite of a regular Kegel exercise. By mastering this technique, you can actively elongate your pelvic floor muscles. Essentially it's learning to release/lengthen these muscles rather than contracting/shortening. This practice helps your body allow the baby to descend without resistance, reducing the risk of tears.
3. Practicing Birthing Positions
Whether you plan to have an epidural or not, practicing different birthing positions can be beneficial. Focus on positions where your tailbone can move freely, and your hips are slightly rotated inward. These positions help prevent perineal tears by allowing more space for the baby to pass through.
4. Learning How to Labor and Push
Many women desire a fast labor, but slowing down can help prepare your body for birth, especially your pelvis and pelvic floor muscles. Standing labor positions can expedite labor, while lying down can slow things down when progression is too rapid, allowing your body to better prepare for the birthing process. As you transition into the pushing phase, learning optimal pushing techniques can help prevent perineal tears too.
One key technique is avoiding closed glottis (throat) pushing, where you bear down forcefully. Instead, focus on open glottis vocalizations while pushing. This method allows the pelvic floor muscles to open and elongate without tension. Open glottis vocalizations include vowel sounds such as “aaahhh,” “oooohhh,” and “uuuuhhhh.” Practicing these sounds during pushing can prevent bearing down and tensing of the pelvic floor muscles, reducing the risk of perineal tears.
By incorporating these steps into your prenatal routine, you can significantly reduce the risk of perineal tears and have a smoother birthing experience.
Do you have any questions or concerns in regard to birth prep to prevent tears? Find a pelvic floor physical or occupational therapist to set up an evaluation with. They can give your further education on how to complete perineal stretching on your own, learning how to elongate through your pelvic floor muscles, and finding positions that your body responds the best with and helping teach you and your birth partner how to get into these positions.
