How to Reduce Tears During Birth
New Reseach Shows that Providers Can Help to Avoid Tears
Until recently, many believed that the responsibility of reducing tearing fell almost exclusively on the mother. Either she was "just going to tear" (due to her skin or anatomy) or that she needed to take all of the measures to avoid it, such as doing prenatal perineal massage and giving birth in non-stirrups positions. While it is true that some mothers' tissues do stretch better than others and there are many things the mother can do herself to reduce the degree of tearing that occurs during labor, the reality is that her care provider is not off the hook in terms of whether or not tears occur during birth.
Researchers have now discovered that when care providers intentionally slow the birthing of the baby's head during the crowning phase and encourage the mother not to push while the baby's head is being born, that the chance of tears into the anal sphincter was reduced from 4% to 1%. This makes sense when we understand the physiology of labor as well as how cell tissue works. The longer the amount of time we can allow the tissues of the perineum to stretch, the more likely we can reduce tears during birth.
Mothers can certainly practice prenatal perineal massage beginning at 34 weeks of pregnancy, since this has also been shown to reduce tearing in first-time mothers. Trying to push in a variety of positions, especially off the mother's back, are other good ways to reduce tearing. Some of the best positions to reduce tearing include all fours/hands and knees positions as well as lying on the mother's side. Using a warm compress during the latter stages of pushing may also help stretching of the perineum to avoid tears. Mothers ought to include all of these preferences in their birth plan.
Episiotomies have shown to increase the amount of tearing, instead of preventing them. It is important then if you are interested in reducing tears during your own birth to discuss with your provider in what circumstances he or she would perform an episiotomy. Occasionally some providers still perform episiotomies routinely despite numerous studies that have shown that episiotomies do not improve outcomes for the mother.
Be sure to discuss all of these options in your birth plan with your care provider well in advance of labor. The reality is that there are ways to reduce tearing and working with your medical care provider is crucial in order for that to happen.
