Terrified of Tearing? How to Protect the Perineum During Childbirth

Photo Credit: Sabrena Rexing Photography

You may have heard the word perineum before but more commonly this area is known as your pelvic floor. It is made up of two layers of interwoven muscles. The perineum is the area between the vagina and anus and these muscles work as a support to your bladder, rectum and uterus. 

If you are planning a vaginal birth, whether unmedicated or medicated, you could be at risk for tearing this area. 

Here are some simple steps you can take to decrease your risk of tearing during childbirth and to support your body in making a speedy postpartum recovery.

Let’s start with the basics. We all are familiar with the law of gravity, and this rule applies to birth as well! Birthing in an upright position such as hands and knees or kneeling allows gravity to help bring baby down and therefore will lessen your need to push with as much force as you would if you were lying on your back. It is also said that birthing on your side can prevent tearing. Of course, the best position to birth in is the one that feels instinctively right for the mother – these are simply examples of positions that can lessen the stress on the perineum.

During labor, using a warm compress can help relax your muscles, relieve some of the pain you may be experiencing and increases circulation to your pelvic floor which in turn allows for easier stretching. 

If you are planning for a water birth, the same benefits apply, but are much more effective as you are immersed in warm water.

When you feel your baby crowning (the ring of fire), focusing on your breath can help you take pause to allow the perineal tissue to slowly stretch and accommodate the baby’s head. Instinctively most women will pant or blow and when the time is right, will follow their natural urge to push.

The jury is still out on whether perineal massage during pregnancy is in fact effective in reducing the amount of tearing a mother experiences. However, becoming familiar with the sensation of perineal stretching during pregnancy can help reduce the fear associated with it. Perineal massage or perineal support can also be helpful during birth. Initiating a conversation about this with your care provider at a prenatal visit can be helpful in knowing your providers thoughts on it, and how likely they are to perform perineal massage/support on you during your birth.

Are you wondering, “When will my vaginal tear heal?”

There are different degrees of perineal tears classified as first-degree through fourth-degree. First-degree lacerations (most common) involve only the superficial perineal skin while fourth-degree (the most severe) involve the vaginal tissue as well as the perineal muscles and anal sphincter. 

In most cases, stitches are used to close these wounds. Proper postpartum perineal care is important to promote healing, and to reduce the risk of infection. 

Keeping the area clean, rinsing with warm water after urination, blotting vs. wiping, frequently changing sanitary pads, and soaking in a sitz bath are all simple steps that will support your body in healing itself. 

It is likely that this area will be tender and somewhat painful for a few weeks after giving birth. Wounds like this, depending on the severity usually take 2 to 4 weeks to heal, but the tender sensations can linger a bit longer. In the meantime, using an inflatable doughnut pillow (or inflatable ring float for the pool) can be very helpful for sitting more comfortably.

The above steps may also help reduce the risk of needing an episiotomy, which is a cut made in the muscles of the perineum to further widen your vagina, allowing baby to more easily pass through the birth canal. 

Unfortunately, there are some factors that are not in our control such as baby’s size or positioning, that could affect your perineum. However, educating yourself and taking strides to ease the impacts of childbirth we think are always worth the extra effort. 

Disclaimer: Please note that any information presented in this blog and/or Doulas of Austin materials and website is never intended to be a substitute for the medical advice of a properly licensed healthcare professional.