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Reduce Your Risk of Tearing During Childbirth

Most women who give birth for the first time experience some form of perineal trauma. These tears can have long term consequences on a women’s pelvic floor and contribute to pain, incontinence, pelvic organ prolapse and sexual dysfunctions. The perineum is the area between the anus and vagina. 

Perineal tears can be graded from first to fourth degree. In a first degree tear the tear is limited to superficial perineal skin and vaginal mucosa. In a second degree tear the cut extends past the vaginal opening to the perineal muscles and fascia. In a third-degree tear, the vaginal opening, skin, muscles and anal sphincter are torn. And in a fourth-degree tear, all of the above, plus the rectal mucosa are torn. All perineal tears can benefit from seeing a Pelvic Health Physiotherapist in order to prevent the development of persistent pain and to learn how to mobilize the scar tissue to prevent further complications like incontinence and prolapse. 

If you’re experiencing your first birth, practicing perineal massage during your pregnancy can reduce your risk of tearing. Approximately 25% of birthing people who used perineal massage during their pregnancy did not tear at all. This is in contrast to people who did not use perineal massage, where approximately 15% did not tear at all (Labrecque et al., 1999). 

In addition, use of a Midwife is also known to reduce the risk of severe tears (Mizrachi et al., 2017). In one recent study of 15,146 birthing people, working with an experienced midwife during your childbirth was associated with a lower rate of third- and fourth-degree perineal tears. Of the 15,146 people studied, only 51 (0.33%) of birthing people experienced a third- or fourth-degree tear. 

The application of a warm compress to the perineum may result in fewer third- and fourth-degree tears during childbirth (Asheim et al., 20017). This data comes from a review of different studies with >15,000 birthing people. This is a simple and cost effective technique you can ask your health care provider to use. 

Spontaneous pushing (i.e., pushing when YOU feel like it) and choosing your own pushing position are both associated with a decreased risk of tearing. Positions like side-lying, that allow the tailbone to move, and having your knees together and ankles apart are some of the best for reducing risk of tearing (Edqvist et al., 2017). 

Nicole Guitar PhD(c) is a member of the Compass Rose Wellness Inc. team, practicing Orthopaedic and Pelvic Floor Physiotherapy. She has a Master of Science in Neuroscience and is a researcher and PhD Candidate at The University of Western Ontario.


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