One of the biggest questions we are asked from our pregnant patients is, “How can I prevent tearing with a vaginal delivery?” While tearing might not entirely avoidable, there are things that can be done to decrease the severity of tearing.
What causes tearing during vaginal deliveries?
First, it is important to understand the different levels of severity of perineal (the area between the vaginal canal and the anus) tears.
Tears are divided into 4 degrees of severity:
1st degree-A superficial tear or abrasion that occurs during birth that affects the skin or mucosa. Does not require stitches.
2nd degree- A deeper tear that extends into the level of the muscles of the perineum. Usually requires stitches.
*1st and 2nd degree tears typically heal within a few weeks and have minimal complications
3rd degree- A deep tear that extends to the anal sphincter. Can be further subdivided into 3a, 3b, 3c depending on percentage of external/internal anal sphincter is involved. Sometimes repairable in the delivery room but may require surgical repair
4th degree-Involves internal and external anal sphincter as well as the anal mucosa. Often requires a surgical repair in the operating room.
*3rd and 4th degree tears typically require more complex suturing, take 4-6 weeks to heal, and can cause pelvic floor dysfunction such as fecal incontinence
Approximately 90% of expecting parents will experience some degree of tearing (~2% of those being 3rd or 4th degree tears).
Risk Factors for 3rd or 4th Degree Tears:
- First vaginal delivery
- Assisted deliveries with forceps or vacuum device
- Occiput posterior (“sunny side up”) fetal presentation
- Long duration of pushing or unusually short (“expediant”) pushing stage
- Genetics
What is Perineal Massage?
Perineal massage involves gently stretching and massaging the perineum. It can be done by the expectant parent or with the help of a partner. The goal is to improve blood flow to the area, increase flexibility, and help the tissues become more accustomed to the stretching sensation that occurs during childbirth.
Benefits of Perineal Massage
While research on the effectiveness of perineal massage is ongoing, some studies suggest potential benefits, such as:
- Reduced risk of perineal trauma or tearing during childbirth, particularly for first-time mothers.
- Decreased need for an episiotomy (a surgical cut made to widen the vaginal opening).
- Lower incidence of perineal pain after birth.
- Potential to reduce the need for stitches.
How to Perform Perineal Massage
It is generally recommended to start perineal massage around 34-35 weeks of pregnancy. Here’s a step-by-step guide:
- Preparation: Wash your hands thoroughly. Find a comfortable and private space (most like to perform perineal massage in bed or in the shower). You can use a mirror to help visualize the area. Empty your bladder before starting.
- Lubrication: Apply a natural oil, such as almond oil, olive oil, or a specific perineal massage oil, to your fingers and the perineum.
- Positioning: You can sit, squat, stand with one leg propped up, or lie down in a semi-reclined position. Choose a position that feels most comfortable for you.
- Massage Technique: Insert your thumb or index finger about 1-2 inches into the vagina. Apply gentle pressure downwards towards the anus and then outwards to the sides. You should feel a stretching sensation, but not pain.
- Stretching: Hold the stretch for about 1 minute, and then gently massage the area in a U-shape or back-and-forth motion for 5-10 minutes.
- Frequency: Aim to perform perineal massage 2-3 times a week.
Important Considerations
- Consult your healthcare provider: Before starting perineal massage, discuss it with your doctor or midwife. They can provide personalized advice and ensure it’s appropriate for your specific situation.
- Discomfort vs. Pain: It’s normal to feel some stretching or mild discomfort during the massage, but you should not experience sharp pain. If you feel pain, stop the massage and consult your healthcare provider.
- Infection or Irritation: If you notice any signs of infection or irritation, such as redness, swelling, or discharge, discontinue the massage and seek medical advice.
- Partner Involvement: If you choose to have your partner perform the massage, ensure they understand the technique and are gentle. Communication is key.
- Not a Guarantee: Perineal massage may help reduce the risk of tearing, but it doesn’t guarantee that you won’t experience any tears during childbirth.
Disclaimer
This blog post is for informational purposes only and does not constitute medical advice. Always consult with your healthcare provider before starting any new practices during pregnancy.