Are you worried about tearing during childbirth? You are far from alone. Many people have questions and concerns about this. It may help to know that the body has an impressive ability to heal, and that maternity care in recent years has worked actively to reduce the risk of severe tears. Since this work began, the number of major tears has decreased.
Perineal tears are classified from first- to fourth-degree tears. Around 80% of first-time vaginal births involve some type of tear, and the most common is a second-degree tear, which affects the vaginal tissue and the muscles of the perineum. More severe tears involving the anal sphincter are less common and affect around 2–6% of first vaginal births.
In this article, we go through what you can do yourself during pregnancy to help prepare your body, as well as measures your midwife or healthcare team may use during labour and birth.
Perineal massage
Research suggests that perineal massage during the final weeks of pregnancy may reduce the risk of more severe tears and the need for an episiotomy during birth. It is thought to help prepare the tissues and muscles to stretch more easily as the baby’s head is born.
Some people also feel that it helps them become more familiar with the muscles and tissues in the area, which can make it easier to relax during labour.
The good news is that this is something you can do yourself at home. All you need is an unscented oil and your fingers. It is generally recommended to begin around 4–6 weeks before your due date, ideally once or twice a day — or as often as feels manageable for you — for around 3–4 minutes at a time.
How to do perineal massage
Wash your hands thoroughly before you begin. If you have long nails, take extra care not to scratch the delicate tissue.
Find a comfortable position where you can easily reach your perineum. Many people prefer sitting on the toilet, reclining in bed or on the sofa, or standing with one leg raised on the side of the bath. A handheld mirror may also help.
Use an unscented oil such as olive oil, almond oil, canola/rapeseed oil or sunflower oil. Apply the oil to your thumbs or directly to the vaginal opening and perineum.
Insert one or two thumbs about 1–1.5 inches (2.5–4 cm) into the vagina. Gently stretch downward toward the anus and out toward the sides. You may feel stretching or mild burning, but it should not feel painful. Hold the stretch for around 1–2 minutes.
Then gently massage the lower part of the vagina using a U-shaped motion from the bottom of the vaginal opening and upward along the sides. Continue for around 3–4 minutes in total.
If you have scar tissue from a previous tear, it may help to spend a little extra time massaging that area, as scar tissue is often tighter than surrounding tissue.
Measures during labour that may reduce the risk of severe tears
Research supports several approaches that may help reduce the risk of more serious perineal tears during birth:
- A slow, controlled birth of the baby’s head, allowing the tissues time to stretch gradually.
- A birth position where you feel comfortable and relaxed, and where the midwife has a good view of the perineum.
- Warm compresses applied to the perineum during the pushing stage. Warmth may help improve blood flow to the tissues, making them more elastic and reducing the risk of tearing. Many people also find this soothing.
- Perineal massage during the pushing stage. Some people choose to bring their own oil for this.
- Good communication between you and your healthcare team. Feeling informed, safe and understood during labour is important. Interpreters or culturally trained doulas may also help improve communication when needed.
- Hands-on perineal support (sometimes referred to as the “Finnish grip”). Toward the end of the pushing stage, the midwife may support the baby’s head and the tissues of the perineum at the same time. This can help slow the birth slightly during the final contractions and allow the tissues more time to stretch.
- In some maternity units or hospitals, two midwives or clinicians may be present during the birth to provide additional support. This depends on staffing and local routines.
If there is time before the pushing stage begins, it can help to talk things through with your midwife and make a shared plan together. Understanding what is happening often makes it easier to relax, trust your body and work with the birth process.
Soon, you’ll finally get to meet your baby!
Sources:
- ACOG: Prevention and Management of Obstetric Lacerations at Vaginal Delivery.
- Beckmann MM, Garrett AJ. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2006;(1):CD005123.
- Aquino CI, Guida M, Saccone G, et al. Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials.
- Cleveland Clinic. Vaginal Tears During Childbirth.