Labor and Delivery dawn upon some curiosity around questions like, ‘Will I poop?’, ‘What if I don’t feel the urge to push?’ etc. There is one more thing which you need to muddle through – Vaginal Tearing. Vaginal Tearing is very common and yet, not a lot of women know what it is and how to deal with it. Here are some tips to prevent vaginal tearing during childbirth.
What, exactly are Vaginal Tears?
Vaginal Tears can range from normal abrasions and scratches to deep lacerations. However, the cases of latter are very rare (around 1%) as compared to former. Almost 75-80% of the women suffer from some form of tearing during vaginal childbirth. Vaginal Tears and Perineum Tears occur because of stretching when the baby is passing through the vagina to out in this world. It happens more commonly when the baby’s head is coming out of the opening. The rest of the body is easier to come out once the head has made its way out.
What are the types of vaginal tears?
There are 5 different kinds of tears that can happen during childbirth:
- Periurethral Tears: They are tears close to your urethra. They are generally not that deep and mostly gets cured on their own without the need of any stitching. If you suffer from periurethral tears, you might get stitched to make sure that there are no complications later on. Small stitches also make it easy to urinate after childbirth.
- First-Degree Tear: A first-degree tear only involves only vaginal skin and perineal skin with scarring not reaching to the muscles or going deep down. Everything beneath the surface of the skin remains unharmed. You do require stitches for first degree tears as they do result in soreness if not pain. Stitching is often done in a continuous manner so there is no number of stitches to define. Stitches dissolve on their own and don’t have to be removed.
- Second-Degree Tear: A second-degree tear involves muscles beneath the skin of vagina and perineum. They are deeper and the most frequent and common among all others. Second-degree tear also involves stitches that dissolve over time. An episiotomy is a cut that’s made in your perineum to form a safe exit for your baby. It involves stitches too, which generally counts in a second-degree tear. However, in some cases, it can extend to third or fourth-degree tear.
- Third-Degree Tear: A third-degree tear involves muscles from the anus along with vaginal and perineal muscles. The anal muscles involved are part of the external anal sphincter. A sphincter is a set of muscles that help in holding the stool together. So, the doctor has to take extra care to stitch each layer of the muscle and closing the muscles that involve the sphincter too.
- Fourth-Degree Tear: A fourth-degree tear is very severe and very rare. It involves all the muscles that are present in the rectum and affects the passage between vagina and rectum. Stitching up a fourth-degree tear is like an operation where the woman is on sedation throughout the process. The stitching can take longer to be done and involves a lot of care.
What are the factors that increase the chances of Vaginal Tearing?
As the baby moves through the birth canal, the skin around the vagina and perineum starts to thin out and stretch. As the baby’s head moves towards the vaginal opening, the labia and the perineum starts to swell and expand. When the elasticity of the surrounding area is not enough and the skin gets stretched beyond the elasticity it can bear, then it can tear and lacerate.
Factors that increase the chance of vaginal tearing are:
- First Time Birth. (Vaginal)
- Big Baby
- Posterior Position at Birth
- Asian Ethnicity
- Increased Weight Gain in Pregnancy
- Mother who has long delivery
- Mothers who have assisted deliveries
- Episiotomy also increases chances and degree of tearing.
You will probably not feel the pain during tearing due to pain and pressure which already exists during childbirth.
What are the 10 Ways to Prevent Vaginal Tearing During Childbirth?
#1 Make Water Your Best Friend – Hydration is the Key!
Water helps in nourishing the outer layer of the skin called the epidermis. Epidermis helps in maintaining elasticity of the skin. Water helps in maintaining suppleness of the skin. If the outer layer of skin loses hydration, then it becomes difficult for it to stretch and elasticize. Therefore, it’s necessary that you drink at least 2-3 liters of water daily even if it makes you pee a lot. Water also plays an important role in transporting nutrients from mother’s body to fetus and preventing cramps.
#2 Eat Nourishing foods – You Are What You Eat!
Green, red and orange colored vegetables and fruits are excellent for boosting collagen and elasticity in the skin. The more the elasticity, the easier it is for the skin around the pelvis to extend and elongate when the baby descends down the birth canal and eventually comes out of the vagina. So, eating a variety of foods like 10-12 different kinds of fruits/vegetables, nuts, Omega 3 rich foods etc. Indulging in cravings is okay once in awhile but having a healthy diet is important too.
#3 Move Your Body – Circulation Promotes Elasticity!
Exercising helps in promoting proper blood circulation in the body. Even brisk walking counts as exercise so do that if you find yoga, pilates or strength training uncomfortable to do. There are some ground rules that you should establish while exercising like not lying on your back, not exercising in the excessive heat, not practicing high impact and contact sports etc. Kegels also seems to be a good choice since they strengthen the muscles. Practice Kegels along with squats and not alone because only then will it help in lengthening and coordinating those muscles.
#4 Squatting – Because it’s Best for those Pelvic Muscles!
Squats help in strengthening both the pelvic floor muscles and leg muscles. Squatting helps in elongating the muscles and prepares them for stretching through labor. Squats also help develop endurance in the pelvic muscles making it easier for you to undergo the labor pains. Make sure that you don’t squat too deep as pelvic muscles are relaxed due to progesterone and deep squatting can increase your chances of falling down.
#5 Birthing Position – It makes a difference on how you do it!
Birthing Position matters a lot when it comes to outcomes of the delivery. Lying down, semi reclining positions push the pelvis closer together, not giving it enough space to expand and elongate freely. However, these positions might work for you if you are not comfortable in positions which reduce the chances of tearing. These positions include being on your hands and knees, squatting or side lying.
#6 Perineal Massage – Yes, a massage down there!
Studies have consistently shown a vast effect on the reduction of episiotomy and second or third-degree tear. It can be as high as 77-79%.
Doing perineal massage twice or thrice a week is more than enough to notice such drastic and favorable changes. You can use extra virgin Coconut oil, Olive Oil or any other lubricant to massage the perineum. Make sure that your hands are clean and you have a mirror (it might be difficult to see down there without a hand held the mirror. You can start massaging by the end of the first trimester.
Here is a step by step guide:
Imagine your vagina as a face of a clock with 12 pointing towards the clitoris and six towards the anus. Then take two of your fingers and insert them around 3-4 cm deep. Start with lower half of your vagina by first moving towards 3 o’clock to 9 o’clock. Pull the fingers apart too so as for stretch the muscles. You can deepen them as long as it’s not hurting and all you feel is a little burning sensation. Stretch externally too.
Next, massage the outside area with your thumb, push the lips of the clitoris apart followed by the vaginal opening.
Then take fingers from both your hands and stretch the perineum towards your thighs.
Lastly. Move your thumb or fingers in a circular direction stretching and pulling all the muscles.
Repeat each step for 10-20 times. See a good perineal massage video here.
Perineal Massage not only prevents the tears but also increases blood circulation around the area, thus speeding up the healing after birth.
#7 Mindful Meditation – Connecting To Your Soul Always Does Good!
There are many reasons to practice mindfulness in your real life and your pregnancy, this is another one and an important one. Mindfulness promotes relaxation and helps in alleviating the fear of pain and childbirth. Once you try to let go of fear and let your body do what it’s naturally designed to do, your job will be much easier. Practice breathing exercises too as they can help you calm down and let labor move smoothly.
#8 Water Birth – Immersion can bring Relaxation!
Water Birth is not a common practice in India yet and many women are unaware of such a method of birth. Here is one such doctor, Dr.Fatima Poonawala based in Mumbai who does promote it.
Water Birth is delivering in a tub of warm water. Water Birth promotes relaxation and proposes ideology of birthing without intervention. There are many benefits of water birth such as buoyancy making it easier to cope up with the pain, relaxation promoting shorter and more effective contractions, mother needing fewer pain killers than normal etc.
And since the warm water calms the mother down, she doesn’t fight contractions and let the body do its job. Water also helps in stretching and relaxing the muscles around the vagina and perineum, thus, making it less likely to suffer from second or third-degree tears.
#9 Warm Compresses – Warmth Boosts Skin Stretching!
Placing a warm towel on the perineum and vaginal area can increase blood flow, soften the muscles and counter pressure can be relieving too. A warm compress helps especially in the crowning stage when the chances of tearing are the highest. Ask nurses to fill a warm tub of water and have at least 25-30 washcloths with them. (25-30 because using the same washcloth multiple times can increase risk of infection). Some doctors are already prepared for it but some aren’t, so do discuss with your doctor about it. Adding some ginger to the warm water works great to reduce inflammation and boost blood circulation.
#10 Choose Your Healthcare Provider Wisely!
If you are comfortable around your doctor, midwife or doula, it becomes easier for you to voice out your feelings, relax and move forward through the birthing process. It has been proven that having a constant support system around you in the form of doula or midwife reduces the chances of C-section, assisted delivery and other unfavorable outcomes during birth. Feeling comfortable and at ease around your surroundings during labor and delivery also helps in speeding up the contractions.
How is the recovery like for vaginal tears?
Unfortunately, you can’t do anything to speed up the healing process except to rest and not exert yourself. Any tears need stitches that will dissolve depending on the number and how deep the tear was.
Recovering from first and second-degree tears is relatively easier than third and fourth-degree tears. You will be sore and might feel pain in your perineal area for a week or so. The soreness will increase when you sneeze, cough or poop. By week 2, the stitches start to dissolve and your vaginal area will start to look the same. However, the strength of the muscles may take time to recover so any sexual activity is out of the question till you are completely healed.
Recovering from third and fourth-degree tear takes a little longer due to tearing passing through to the anal canal too. The soreness and pain stage can last for up to 2-3 weeks. It’s recommended that you follow a high fiber diet and don’t exert your pelvic muscles in any way. The tears generally don’t have any long term effect on you but some side effects like urinary incontinence, painful bowel movements, discomfort during sex can last for months. Since such a high degree tear can bring in complications, it’s important that you discuss all your symptoms with your doctor.
Vaginal Tearing should be normalized and women need to speak up about it more. Awareness is essential to something so prevalent. Share your story of Vaginal Tearing in the Comments section below or send us via email, we will post it and share it anonymously.