One of the scariest-sounding things about birth is the perineal tear. Perineal tears are when the perineum, i.e. the skin between your vagina and rectum, naturally tears to make room for the baby’s head as it’s coming out.
The majority of first-time births will involve some form of tearing, the most common being first and second-degree tears, which are stitched up and healed by four to six weeks. Third and fourth degree tears are much less common, occurring in roughly 6% of first-time births and 2% in consecutive births.
While there’s no way to completely prevent tears during a vaginal birth, there are ways to try and minimize them.
1. Take a Birthing Class
Educating yourself is key. Take a birthing class to learn techniques for slow and controlled pushing, then practice breathing and connecting with those muscles.
If you’re planning an unmedicated birth, you’ll be able to physically feel how you’re progressing. If you’re going for an epidural, communicate your technique to your provider so they can support and guide you while you push. Some providers offer mirrors to help keep your eye on the prize.
2. Strengthen Your Pelvic Floor
A strong pelvic floor won’t necessarily prevent or minimize tearing, however it will likely help with recovery.
Be sure to do your kegels and choose workouts that engage your pelvic floor, like squats, bridges and bird dogs. Juna has a whole library of workouts designed to engage that specific area.
3. Perineal Massage
The jury is out on the effectiveness of perineal massage: the process of priming your vagina for stretching during delivery.
After 35 weeks, your provider might recommend starting perineal massage at home, which involves washing your hands, then placing two lubricated fingers at the opening of your vagina, and applying pressure as you sweep from side to side. Your partner can help with this as well, and your provider might perform perineal massage during labor.
4. Keep Your Perineum Warm
Placing a warm cloth on the perineum during the second stage of labor may also help soften the skin around the vagina.
5. Change Positions
Switching up your birthing position may aid in your pushing. The most common birthing positions include:
- Reclining
- Squatting
- Kneeling
- A birthing bar or stool
Contrary to popular belief, you can change birth positions with an epidural. Talk to your provider about your options.
Know How to Manage a Tear
If you do end up with a tear, knowing how to manage your recovery will go a long way. Here are our tried and true tips:
- Ice the area ASAP with ice diapers or padsicles.
- Spray the area with Dermoplast, a cooling and numbing agent.
- Use a peri bottle when you pee to dilute the acidity of your urine and minimize stinging.
- During bowel movements, wrap your hand in toilet paper and apply pressure to the perineum to support and ease pain.
- Take Motrin or a preferred prescription painkiller.
- Rest as much as possible for the first two weeks postpartum. The first two weeks are critical for proper tissue healing.
- Air out the area, wear breathable clothing and avoid tight underwear.
- Sit down while coughing and sneezing if those instances are painful.
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