Worried about tearing during childbirth? Read this!

By Julia Kitching of Baba Doula Services & Hypnobirthing

Many of my clients often say to me that they are worried about tearing during labour and birth. They ask ‘What can I do to reduce tearing, when giving birth?’.

During a vaginal birth, when the baby’s head is crowning, the vagina stretches. The vagina is designed to stretch during birth, just as an elastic band can be stretched and can grow significantly in size. As the vagina stretches, it is then capable of allowing space for the birth of your baby’s head. However, as much as a woman’s body has been perfectly designed to birth a baby, sometimes the vagina or the area between the vagina and anus (perineum) can tear. 

Many women do experience some degree of tearing, especially if it is their first vaginal birth. However, there are things that you can do to reduce tearing…

 

What are the different types of tears during birth?

The degree of tearing during childbirth can be categorised into 4 sections:

  • 1st degree tears – These are small skin deep tears and usually heal on their own, naturally.
  • 2nd degree tears – Deeper tears, that affect the muscle of the perineum and usually require stitches.
  • 3rd degree tears – A tear that extends into the muscle that controls the anus (the anal sphincter). This will require stitches in theatre and you will be given anaesthetic, either as a spinal block or epidural.
  • 4th degree tears – The tear extends further into the lining of the anus or rectum. This will require stitches in theatre and you will be given anaesthetic, either as a spinal block or epidural.

If you endure a 3rd or 4th degree tear, you will be given a catheter (a tube in your bladder to drain the urine) until you are able to go to the toilet by yourself. Once you are out of theatre and your anaesthetic has worn off, you will be given paracetamol and ibuprofen to manage any pain you might be in or you might be offered stronger pain relief, should you need it. 

You will be advised to take antibiotics to reduce any infection risk and laxatives, to help you to go to the toilet with more comfort and ease. Your midwife might refer you to a physiotherapist, depending on how severe your tear is.

WHY DOES TEARING OCCUR DURING BIRTH?

Often, tearing occurs during birth when the baby is born very quickly. The tissues around the perineum don’t have the same time to stretch as with slower exits. Methods such as hypnobirthing can reportedly help women to slow down the pushing phase for a gentler birth, allowing time for the tissues to stretch carefully.

 

HOW CAN I REDUCE TEARING DURING BIRTH?

There are a variety of things that you can try, to reduce the severity of tearing during a vaginal birth. 

  • Allow your baby to be born slowly and gently. When your baby’s head becomes visible, your midwife will ask you to do some quick short breaths or pant. Do not use strong, forced pushes or coached pushing. Your midwife may support your baby’s head and guide it out of your vagina. Listen to your body and allow your baby to emerge by themselves, slowly and gently, allowing the skin and muscles of the perineum to stretch slowly, reducing the risk of tearing. 
  • If you feel the urge to push, go with your instincts. Your midwife might also place a warm pad on your perineum to reduce any discomfort and tearing. Many women refer to the moment when the baby’s head is crowning, as the ring of fire. As your vagina stretches, you might feel a burning sensation for a short period of time. It is really helpful to do use hypnobirthing techniques and deep breathing at this time. 
  • Being calm and relaxed will help the vagina to stretch more easily, so using your Hypnobirthing toolkit to help you to do this, can be really useful.  Doing some visualisation, reciting some positive birth affirmations or saying a power word can be really helpful.  
  • Certain positions can help reduce tearing. Such as kneeling, lying on your side or being on all fours. Being Upright, Forward and Open is an ideal position to be in.
  • Using water. Some studies have shown that birthing your baby in water can be a really useful way to reduce tearing. The warm, lubricating water can help soften the vagina and allow it to stretch more easily and comfortably. Many studies have found that water birth can lead to a lower rate of tears and a lower rate of episiotomy.  In addition, a large observational study found that waterbirth is associated with a lower rate of severe perineal tears. (Bovbjerg et al 2021)
  • Perineal massage. Perineal massage during pregnancy can be a great way to stretch the perineum in preparation for birth, making it stretch more easily during the birth. The ideal time to start perineal massage is in the 3rd trimester. The National Childbirth Trust (NCT) have a useful information sheet on how to do perineal massage. 
  • There are also devices that you can buy, that help you to do perineal massage, if the idea of doing it yourself makes you feel a bit gross, uncomfortable or uneasy.

What is an episiotomy?

Sometimes during birth, your midwife or medical professional might recommend that they carry out an episiotomy. An episiotomy is a small cut made to the perineum. A local anaesthetic will be used, to help numb any discomfort and stitches will be required after your baby has been born. An episiotomy will help to make the vagina a bit wider and help the baby to come out more easily. Sometimes an episiotomy is advised if severe tearing is likely, to speed up delivery if your baby needs to be born quickly or if forceps or ventouse (instrumental assistance) are recommended. 

In England, episiotomies are not performed routinely and you will need to give your permission.

How can I heal from an episiotomy or tear?

If you have had an episiotomy, you might find it a bit uncomfortable for a few weeks, until the area heals. You will initially be given paracetamol, ibuprofen or other stronger pain relief medication, shortly after your birth, to help with any discomfort. Some people find that freezing a maternity pad can help with pain relief once they are back at home.

Pouring warm water onto your vagina/perineum when having a wee can also be helpful. You can also gently press a clean pad onto the wound to help reduce any pain and to protect it from any bodily fluids whilst sitting on the toilet. 

Make sure that you keep your perineum and vagina area clean to avoid the risk of infection. 

If you are at all worried about your recovery after experiencing vaginal tearing or after having an episiotomy, then contact your medical professional for advice.

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Julia Kitching of Baba Doula Services and Hypnobirthing

Not just a one trick pony, Julia is a Fertility, Antenatal, Birth and Postnatal Doula living in Leeds, near Wakefield, West Yorkshire. She is also a fully trained and certified hypnobirthing teacher, offering hypnobirthing courses to families in person and online. She is also the Co-Chair for Leeds Maternity Voices Partnership.

Julia is extremely passionate about supporting women and families during pre-conception, pregnancy, birth and beyond.