The thought of tearing the vaginal walls at child birth is one that scares many expectant mothers. Many women experience second degree perineal tears and these occur between the anus and vaginal opening affecting the surrounding muscles and skin. While this sounds like a very painful experience, many women hardly recognize the stitching that goes on after the tear mostly because it is swallowed up by all the labour pains. However, the real pain occurs after the stitching has occurred as the torn area heals. We give you some effective tips that will help you recover quickly from this uncomfortable experience!
Who are more prone to perineal tears?
Factors that increase the likelihood of tearing are:
If baby is in a posterior position
If this is your first vaginal birth
What types of tears are there?
Tears or lacerations of the perineum are classified into four types.
The most common are first and second degree tears. A first degree laceration occurs when the skin has torn but is considered small and doesn’t require any or only a few stitches. A second degree tear involves skin and muscle underneath and usually needs a few stitches.
Third degree lacerations are a tear in the vaginal skin, perineal skin and the muscle that extend to the anal sphincter (muscle around your anus).
A fourth degree tear is the same as a third degree one except it extends into the anal sphincter and the tissue around it. Both can impact on the pelvic floor function and anal muscles. It’s hard to predict which women will have a tear but there are things you can do to minimise your risk of a tear, or the extent of a tear if it does happen.
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Can you prevent perineal tears?
A perineal massage can help as it stretches your perineum skin reducing your chances of tearing. It is more effective if you start perineal massage during your pregnancy, so start as early as you can!
Pelvic floor exercises
Common advice to pregnant women is to do pelvic floor exercises (known as Kegels) to strengthen the muscles in the pelvic floor. The idea is that after birth, the pelvic floor muscles will snap back into shape and you are less likely to experience incontinence (weeing yourself).
During the second stage of labour, you want your pelvis and vagina to open and the muscles to relax, maximising the space for baby to descend. It seems counter productive to spend all this time tightening the muscles in that area when we actually want the opposite to happen at the crucial time.
So what is the right thing to do? Lengthening and improving the coordination of pelvic floor muscles with the other muscles in the body can be achieved by using squats and pelvic floor exercises together. Learning to relax the pelvic muscles is also important and performing pelvic floor exercise correctly can help you to identify those muscles and then relax them.
Birth position plays a part
The position you are in when pushing has a big influence on whether you are more likely to tear.
Lying down, lithotomy position (lying down with legs held up) or semi-reclining positions puts pressure onto your tailbone and perineum, reduce the size of the pelvic floor and increase the likelihood you will tear.
The best position for birthing your baby is the one you choose instinctively for yourself and you feel most comfortable in. Women who are free to move about during labour will find the position that helps them cope with contractions at each particular stage. Some women like to float free of gravity in water, others like to have their feet firmly planted on the ground.
The least stressful positions for the perineum include:
On all fours, on hands and knees.
Leaning forward in a supported standing, kneeling, or sitting position
Lying on your side.
While squatting and kneeling are useful upright positions, if the woman’s knees are very wide apart the perineum is being stretched sideways and may increase the likelihood of tearing.
Take it slow Taking it slow during labour gives your perineum time to stretch out and accommodate your baby, thus reducing your likelihood of tearing. Resist the urge to push until your body and the baby are ready.
Accept that tears is very common
Sometimes, perineal tears are inevitable. There is no sure way of avoiding tears especially in cases where the baby is in a difficult position, large or when your tissue is fragile.
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