How to prevent vaginal tearing during labor

Vaginal tears also called perineal lacerations or tears occur when the baby’s head is coming through the vaginal opening and it is either too large for the vagina to stretch around or it is a normal size but the vagina doesn’t stretch easily. These tears are classified in degrees:

1st degree tears involve only the perineal skin or the skin between the vaginal opening and the rectum and the tissue directly beneath the skin. You might experience some mild pain or stinging during urination with this type of tear. Squirting warm water into the stream of urine from a peri bottle can ease this discomfort. These tears are the least severe.  They might or might not require stitches and typically heal within a few weeks.

2nd degree tears involve the skin and muscle of the perineum and might extend further back into the vagina. Second-degree tears typically require stitches and heal within a few weeks.

3rd degree tears extend into all of the aforementioned tissue & includes the muscle that surrounds the anus (anal sphincter). The repair of these tears sometimes require anesthesia & are performed in an operating room vs the birthing suite.  Third-degree tears might take longer than a few weeks to heal.

4th degree tears are the most severe. They extend through the anal sphincter and into the mucous membrane that lines the rectum (rectal mucosa). These tears typically require anesthesia & are performed in an operating room.  They sometimes require more specialized repair. Healing also might take longer than a few weeks.

First- and second-degree perineal tears are the most common type and are unlikely to cause long-term problems. You may be sad to hear that there is no guaranteed way to prevent vaginal tears but here are some things that may decrease your risk:

Research has shown that a baby in the “Op position” or occiput posterior position increases the risk of vaginal tears.  Work with your healthcare provider on the antenatal position of your baby starting around 34-35 weeks. Research studies have also shown that warm compresses on the perineum during labor have a significant effect on decreasing the risk of perineal trauma – particularly third & fourth-degree tears.

Perineal Massage

Perineal massage is another technique some pregnant people use to prevent vaginal tears.  The massage can be performed by either you or your partner & can be started at 34 weeks.  Ideally, you would conduct perineal massages for 10 minutes daily or at a minimum of twice weekly until you give birth.  Your birth attendant may also perform perineal massage during labor.  Some advantages of perineal massage:

  • It increases the stretchiness (elasticity) of the perineum by improving blood flow & the ability to stretch more easily & less painfully during birth.

  • It helps to prepare your mind to focus on letting your perineum open up.

Here are some tips on performing perineal massage:

  • Start with good handwashing & trimming your fingernails.

  • After a shower or bath is a good time because blood vessels will be dilated in the perineal region.  This makes the perineum softer.  It also increases your ability to relax during the message

  • Position yourself in a semi-reclined position with your legs apart and knees bent.

  • You can use an unscented natural oil (organic sunflower, grapeseed, coconut, almond, or olive) to lubricate your fingers.

  • Place your thumbs about 1 to 1 1/2 inches in the vagina, pressing gently down toward the rectum and the sides of the vagina, stretching the skin with your fingers. Some stinging can be normal in the beginning but if the stinging turns into discomfort or pain, stop.

  • With your thumbs, use a U-shaped movement to slowly massage the lower half of the vagina. Then gently pull the tissue in the vagina forward and hold for a few more minutes.

Dietary Vitamin C & Protein:

A diet high in dietary vitamin C & a protein called elastin can help maintain tissue integrity & promotes healing.  Elastin is the protein that creates elasticity in adult tissue.

The richest fruit sources of vitamin C include:

  • Orange

  • Kiwi

  • Strawberries

  • Grapefruit

  • Cantaloupe

For vegetables, a half-cup serving of any of the following will provide plenty of your daily vitamin C:

  • Red or green pepper

  • Broccoli

  • Brussels sprouts

  • Cabbage

  • Cauliflower

Protein foods that will support the growth and maintenance of collagen and elastin fibers:

  • Turkey breast

  • Beef

  • Soybeans

  • Chicken breast

  • Cheese

  • Spirulina

  • Salmon, sardines and other fatty fish

  • Beans and legumes

Preventing or reversing iron deficiency anemia diagnosed during the pregnancy helps prevent vaginal tearing.  Adequate iron stores promote tissue integrity & healing.

DO NOT perform perineal massage if you:

  • Have vaginal herpes

  • Have yeast or any other vaginal infection

The research on antenatal perineal massage provides mixed results.  Some studies have shown perineal massage to be effective at decreasing the risk of tears & episiotomies.  Others have shown no statistical significance between control groups & those that performed perineal massage.  Before beginning perineal massage or any of the aforementioned tips consult your obstetric provider.

If you wish to learn more about labor & birth, check out our online childbirth class especially designed for first time expectant parents.

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