Tearing during birth is a topic women bring up to us doulas quite frequently. A lot of women, nervous about tearing, look to an episiotomy as an easy solution. This is a problem, since an episiotomy doesn’t guarantee you will not experience a tear. In fact, tears generally heal much better than an episiotomy! Let’s look at some real ways you can save your perineum.
First let’s talk about squatting. This position can be great during labor as it can actually open the pelvis by 20-30%! That is HUGE when talking about having a baby! It only makes sense that the more room we create for baby, the easier birthing that baby would be. Unfortunately, this benefit doesn’t extend to the perineum. Surprisingly enough, squatting while crowning promotes tearing. Who would have thought? Even with the use of a birth stool or a squat bar it can still increase the chances of tearing as opposed to other positions.
Avoid being on your back
Being on your back while pushing is only good for one person, your care provider! Having your legs being pressed against your chest and holding your breath to the count of ten makes pushing extremely difficult. This position is used very widely at hospitals but women have better options! While pushing on your back, you and your baby are working against gravity. Your baby has to go underneath your pubic bone and through your compressed pelvis. If you must lie down during pushing, try a side-lying position. Like we said before, the only person benefiting from this position is the person catching your baby!
Hands and Knees
Instinctively, women will move to their hands and knees at some point in their labor. If they are free to move around, chances are they will be able to find comfort in this position. If a woman has been attempting to squat, hands and knees will offer a moment to relax those hips. Assisted hands and knees positioning (Leaning on the side of a birth tub or hospital bed, for example) counts as well.
Midwife Thinking tells women, “I have noticed that when women are left to birth instinctively they will often move from the squatting position - if they got into one - into a hands-knees position just before the head crowns.”
Your care provider can easily catch your baby if you are pushing in the hands and knees position.
During pushing, warm compresses can be applied while your care provider supports your perineum. The warmth promotes blood flow which helps your vagina grow to accommodate your baby. Not only are the compresses soothing, they are easy to make! Simply use warm water - not too hot now as you don’t want to burn yourself - and washcloths. If you are out of hospital, setting up a crockpot with warm water and washcloths is the easiest way. When it is time to push, the crockpot can be moved to wherever the laboring woman is. Just wring out the excess water and apply to the perineum. Easy as that!
To Massage or Not Massage
Recent studies have shown that perineal massage is not as helpful as once thought. It is even less helpful during the actual pushing stage of labor. These studies actually say that the more hands on a care provider is, the greater the risk of tearing! So tell everyone to keep their hands to themselves and let you get down to work!
Overall, if you are able to move about freely, trust your instincts and your body. We hope this list gives you some comfort. Birth is often unpredictable, but planning for success makes all the difference!
Love, Maura + Kasaundra