Avoid a perineal tear

Updated: Oct 16

Its amazing how many women think a c-section is better because vaginas rip apart gruesomely during a vaginal birth. It is amazing to think that I was one of them just a little more than 5 years ago. I just was not educated enough. Biology lessons at school definitely did not prepare me for a strong belief in my feminine body and the amazing work of nature.


One thing you need to know is that Vaginas are incredibly elastic if left to do their thing during labour and birth. 1st degree tears can heal on their own and 2nd degree tears are stitched and heal easily. In other words, small tears are not a big deal. There are some comforts that will hasten healing and you'll be surprised at how good as new you'd feel. (Also dependent on your doctor's stitching skills.)


3rd/4th degree tears - these are the ones we worry about. They are rare however and usually unlikely in a hypnobirthing setting. Why? Because we learn why we need to let our bodies do their thing. Babies don't shoot out. They are meant to take their time to massage your perineum into softening and thinning so baby can enter the world without fuss.





I'm sure women out there who work with animals and have seen birth in its natural state know that....birth should not be meddled with unnecessarily. A smooth birth with a slippery easy delivery require a mother be allowed to take her time. Birth coaching for a quick delivery so you're pushing against your body's cues; this is likely to cause a severe tear. There are some things a well meaning doctor or nurse will say to make you push harder....to your perineum's detriment. As you can imagine, fear will not help with the relaxation of those vaginal walls. You can learn more about that during my hypnobirthing course.


Severe tears are also more likely with forceps or vacuum assisted births. (Wilson and Homer, 2020) Was there assistance because your baby was stuck or because he was taking 'too long'? Read paragraph above: a mother be allowed to take her time. An hour is not too long. Give your perineum the gift of time and relaxation. Give your baby a relaxed entry into the world.


Some might worry that their baby is too big. It is true that there is a relationship between babies that are too big and the risk of a perineal tear. (Pergialiotis et al, 2014) The number is 4000g. Anything below that number is doable. Your chance of having a too-big baby is 3.15%. Very low. Interesting how we hear so much of that warning only to find babies born closer to 3.5kg.


Easier said than done? For most Singaporeans, we have grown up with this fear and it really does take much more effort to reprogram ourselves to trust in our body and not go with everything we are told. It is achievable! I can show you how.


Other than what to avoid, here are some thing that help.


A warm water bath during labour can do wonders for your perineum, not just allowing you to relax emotionally but relax the perineum tissue. There are also other ways you can learn to relax your perineum and prep it for the day. There is a massage for your perineum (DIY or partner assisted!) using lots of moisturising vitamin E oil or coconut oil. I think Rebecca from Ladybird PT does an excellent explanation of how to do it...


Another commonly used method for preparation is the Epi-no…. Which is a little balloon apparatus you insert into your vagina, pump it to whatever you’re comfortable with… and gradually stretching the area to 10cm..


Hypnobirthing classes also teach a totally different way to birth. Do you know certain vocal sounds can open while others can tighten your perineum? Some positions are better than others when it comes to opening up your pelvis. Hint: Its not with your legs apart on stir ups. You decide whether it makes sense when you hear the explanation.


A guide can help you with this. Birth Doulas can help make your experience a more positive and relaxing one - which in my opinion is....pro perineum!





References:

Pergialiotis V, Vlachos D, Protopapas A, Pappa K, Vlachos G. Risk factors for severe perineal lacerations during childbirth. Int J Gynaecol Obstet. 2014 Apr;125(1):6-14. doi: 10.1016/j.ijgo.2013.09.034. Epub 2014 Jan 9. PMID: 24529800.


Wilson AN, Homer CSE. Third- and fourth-degree tears: A review of the current evidence for prevention and management. Aust N Z J Obstet Gynaecol. 2020 Apr;60(2):175-182. doi: 10.1111/ajo.13127. Epub 2020 Feb 17. PMID: 32065386.



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