How to Prevent Tearing during Birth: A Guide

There are a number of things you can do to prevent tearing during birth. These include things that you can do during pregnancy, labor, and delivery. While preventing pelvic floor tearing entirely may not be possible, this guide can help you find ways to minimize tearing and prevent more serious complications.

What is pelvic floor tearing during childbirth?

Tearing during childbirth is essentially trauma to the area called the perineum during childbirth. According to RCOG, 9 in 10 first time moms will experience some degree of pelvic floor tearing. While tearing during childbirth is relatively common and even normal, there are things you can do to limit the severity of tearing.

Pelvic Floor Tears are Graded 1-4

• Grade 1 includes superficial tearing up to Grade 4 which has more significant implications postpartum and includes tearing of the pelvic floor muscles and superficial layers of the pelvic floor

How do I know if I have Pelvic Floor Tearing during birth?

After delivery of your baby, your midwife or doctor will examine your vagina, rectum, and perineum to determine if stitches are required. Then they will advise you on the degree of tearing and stitching required. Personally, I was asking my OB after birth what degree of tearing I had! So I knew right away what I was dealing with.

How to Prevent Pelvic Floor Tearing during Birth

Pregnancy

During pregnancy, one of the best things you can do is to learn to relax your pelvic floor muscles and coordinate them appropriately. It is not all about Kegels! It can also be helpful to know if your pelvic floor is either too tight or weak (or a combination) while you're pregnant to better know what to work on.

Some things that can be helpful during pregnancy include the following:

• Learn to coordinate the pelvic floor
  • Practice coordination with breathing by performing a Kegel as you exhale and releasing the muscles as you inhale
  • Repeat 5-10 times and really bring awareness to feeling the difference between tight and relaxed muscles
• Learn to bulge the pelvic floor muscles
  • Gentle bulging includes a gentle bearing down or "opening" of the pelvic floor muscles
• Perineal massage 35 weeks +

Labor

During labor, the best thing you can do to help prevent more significant pelvic floor tearing is moving. Generally, upright positions are best during labor. However, remember to balance that with rest positions. You may not want to spend the entire time up and moving and have limited energy left for pushing baby out!

• Upright, movement
• Relaxing the pelvic floor muscles
• Learning to bulge the pelvic floor muscles
• Warm compress on perineum during second stage

Delivery/ Birth

During the last and final part, birth, there are some positions that tend to be better than others in preventing tearing. However, the thing to consider is that everyone is different and there may be medical reasons some of these positions are not optimal. It's best to communicate beforehand your preference but also know circumstances can change.

• Positions that decrease risk
  • Side-lying
  • All 4s/ Quadruped
• Avoid Valsalva. Avoid holding your breath as you push, this will put more pressure on the perineum.

It's most important to be educated beforehand on all of your options. It may be that some of these are possible for you while others are not. Having a flexible birth plan is key and communicating with your support person and provider ahead of time will serve you best.

If you are having a hard time figuring this out on your own, seek out the care of a pelvic floor specialist who can help guide you through these things during pregnancy. You'll feel more prepared and ready for the experience!

Feel free to reach out with questions or schedule an appointment with Simpli Whole (if you live in Ohio!).