Vaginal Tearing 101
Vaginal tearing aka the fear of all mamas everywhere. Can you imagine if men had to search for a way to prevent penile tearing? Being a woman brings some hardships, I mean really who wants their vagina to tear?
But here is my insider pro tip for all of you. STOP SWEATING THE TEARING! I promise it’s not as bad as it seems. Even if you are unmedicated, you most likely won’t even know it happened. I PROMISE!
There are 4 different classifications for tearing. 1st and 2nd degree being the most common and the easiest to heal from. 3rd and 4th degree are much more difficult but VERY RARE.
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I posted a post on Facebook asking, What is one thing you wanted to know when you find out you were pregnant. It was a resounding answer. How do we keep our Vah-JJ from tearing? Experiencing vaginal tearing is one of our biggest fears when we find ourselves pregnant. Right? It’s up there with the other big concern. The poop dilemma?
However, the thought of our girl parts tearing is enough to bring us to our knees. Is it preventable? The jury is out on that one. I’ve delivered a few patients who have done all they could, and they still tore. It happens. Sorry. I’ve mentioned before that I am here to inform but also to be real. I’ve been doing this for a long time, my friends. I would LOVE to tell you that if you do some magic this or that, you won’t tear, but it’s not true. Cause sometimes vaginal tearing just gonna happen.
What If I could give to you are some ways to prevent vaginal tearing to the BEST of your abilities and arm you with some knowledge along the way? I’m going to go out on a limb here and say that you answered: Yes, please tell me.
There are some factors that you can’t control and a few that you can. So let’s go over the different aspects of vaginal tearing and hopefully, you will leave this post feeling a bit more informed. (you can comment with questions)
1. RISK FACTORS for Vaginal Tearing
Most of these are out of your control.
- A BIG BABY – Big baby equals big head! 2 ways to potentially prevent this, control your diet…and don’t make a baby with a linebacker who has a big head.
- HIGH WEIGHT GAIN – eat a healthy diet, DO NOT succumb to “you’re eating for two” bandwagon. Check out this Prenatal Nutritional Infographic from What to Expect.
- YOUR AGE (YOUNG OR OLD) – Teens and Older moms tend to tear. Hey, I’ve been both!
- Use of Assistive devices – Forceps, Vacuums I am all for natural birth and hate these devices. However, I have witnessed many births that without help, the baby would have not done well. Therefore, there is a time and place for the use of vacuums. Unfortunately, the use of one of these devices ups the risk of a vaginal tearing.
- First vaginal birth – The road hasn’t been paved…think bulldozer.
2. Choosing an Epidural
Okay, the jury is out on this one. But according to my experience and research, unmedicated patients are less likely to tear. If an “epiduralized” patient has a prolonged second stage of labor, their risk escalates. Most natural patients can guide the pushing based on what their body is telling them. So weigh your options, potentially pain-free labor with a painful recovery or painful labor with a more comfortable recovery. However, there is always that natural patient who goes cray-cray and pushes like a madwoman and tears things up.
3. Positions for Pushing that Reduce the Chance of Vaginal Tearing
So, this is a tricky one because most of you will deliver in the hospital and many doctors will impose their wishes on you. (sorry to my good friends who are OB’s, obviously I’m not talking about you)
Soap Box: YOU HAVE RIGHTS. In fact, when being admitted, the admitting RN will inform you that you have rights and you will shake your head in agreement. However, most women in the birth setting when told to do something; they just do it. YOU CAN ASK TO DO SOMETHING DIFFERENT. Be respectful of your caregivers and tell them your wishes. Ask why and also why not?
Ok, back on track. There are upright positions, and there are horizontal positions. I won’t get into all the details, but I included a GRAPHIC handout for you to check out.
i.e., sitting, kneeling, all four, squatting, birth stool and standing.
i.e., laying on back, laying on side, on back with leg in the “stirrups” in what’s known as the lithotomy position.
Upright positions are usually less painful, utilize gravity, and also better for the fetal well being. However, they also lead to vaginal tearing. More blood flows to your labia in these positions which leads to tearing. The traditional Lithotomy position is also more likely to result in vaginal tearing. (I would love to see a man lay flat with his legs up and pass a kidney stone.)
From the studies I’ve read, it seems that side-lying and all fours are great positions to decrease the risk of vaginal tearing while pushing.
During my births, I would use many different positions to relieve pain during labor, however, when it was go time, I would naturally get into the position my body needed, and my midwife just went with it. Keep in mind, that I discussed all this with her during my office visits and we were both aware of my desires. She also knew that I respected her and I knew she respected me. Had any issues indeed concerned her, I would have deferred to her wishes. Otherwise, it was my show. You hear that, It’s your show!
4. Support of the Perineum During Pushing
Warm compresses are an excellent way to support the perineum. Most women love this; however, you might not, you never know what you will tolerate until you are in labor.
It is an effective way to support the area while pushing and helps to minimize vaginal tearing. I have also had a few natural patients who instinctively place their hands on their perineum as the baby begins to emerge, thus naturally giving support. I’ve seen a movement towards Dr’s not discouraging women from this as they did at the beginning of my career.
5. Massaging the Area with Lubricant
Perineal massage can be done throughout pregnancy to stretch and prepare. You should always use therapeutic grade oils, using something made for massaging the perineum. Try this one or here is another.
Ok, as far as massaging the area during delivery. Soap Box: This is sometimes horrific to watch as a labor and delivery nurse. The dr scoops up a hunk of KY jelly and goes to town. Sometimes for a long dang time, he/she “stretch” things out, around and around with those fingers. Ladies, this area is tender tissue. It can be bruised and weakened by doing this. SPEAK UP!!! During pushing, I believe a hands-off approach is wiser and less likely to lead to vaginal tearing.
6. Giving Birth in Water
Giving birth in a birthing pool or water is a great way to ease the burden of pressure on the girl parts. Less pressure means you are less likely to experience the good old vaginal tearing. Watch this beautiful example of a home water birth. (I’m super excited that the hospital I am now working at has a labor tub) I almost gave birth in one when I was in labor with my son, twenty years ago. But I got moody and got out, then I had him. Thus ending my almost water birth story!
7. Controlled Pushing during Delivery of the Baby’s Head
Slowly pushing the head out can help combat ending up with vaginal tearing. Let that area stretch slowly and gently to accommodate the head. Your body does this great (frustrating to momma) little trick. The baby’s head moves forward then back and all over again. Slowly gaining ground by stretching the perineum then releasing. Its pretty miraculous to watch this during my deliveries.
Listen to your body. Breathe. If you allow this natural process to work its magic, you will have a better delivery and less problematic recovery.
8. Momma’s Basic Instincts
Sometimes, we as professionals need to stop saying no, don’t do that, move your hands, open your legs, hold your breath. I know I’m one of those professionals but trust me. I’m not that nurse. Birth is natural, not medical. Let me rephrase, most births are natural. There are high-risk factors that trump basic instincts. You are the one pushing a human being out of your hoo-hah. So, you should listen to your body and let it guide you as well as listening to the provider you chose.
Again, educate yo-self.
So basically, there are things you can’t do a stinking thing about when it comes to vaginal tearing. Like if it’s the first baby to exit the stage or what ethnicity you are.
Sometimes vaginal tearing is just a natural part of birth. That’s the crux of it. But there are some aspects of childbirth that you control which allow you to decrease your risk of experiencing vaginal tearing.
Strengthening your pelvic floor is key. Check out this awesome class on just that topic.
Now, Head over and check out my recommendations for choosing a natural labor.
If you are interested in learning how to prepare your body for labor, read this post!
Read what it’s like to be a labor nurse!
Just a little Disclaimer: As always, I am just writing my thoughts and what I’ve learned along the way. Although I am in fact a labor and delivery RN, This is not medical advice. You should always seek and follow the advice of your care provider.