How to Prevent a Tear in Birth

As a pelvic floor therapist, I work with many women who have experienced tearing during birth. Their main concerns often include vaginal pain or bladder control issues, but these are not the only side effects of a tear.

To understand why preventing a tear is important, let’s first review the four degrees of tearing and their potential effects:

1. 1st Degree: A small, skin-deep tear that usually heals naturally.

2. 2nd Degree: A tear that affects the skin and perineal muscle, often requiring stitches.

3. 3rd Degree: A tear extending through the perineal muscle towards the anus, requiring stitches.

4. 4th Degree: A tear involving the anal sphincter and possibly the rectum, requiring surgical repair.

The severity of the tear typically correlates with the severity of symptoms, but not always. For example, a 4th-degree tear is more likely to result in bowel issues like leakage, while a 1st or 2nd-degree tear may not cause noticeable pelvic floor symptoms.

Common symptoms after tearing can include:

• Pain in the vagina, vulva, perineum, or rectum during touch, voiding, bowel movements, or intimacy

• Bladder control issues (urgency, frequency, incontinence)

• Bowel control issues (urgency, incontinence of gas or stool)

• Pelvic pressure or heaviness

Research shows that 9 in 10 women will experience some degree of tearing during birth, with 1 in 100 experiencing more severe tears. However, emerging evidence helps us understand how to reduce the risk of tearing and avoid potential long-term effects.

Risk factors that can increase your chances of tearing by 2-7% include:

• Baby size over 8 lbs, 13 oz

• Induced labor

• Epidural

• Baby facing up

• First baby

• Prolonged second stage of labor (more than 1 hour)

• Baby's shoulders getting stuck

• Assisted delivery (forceps or vacuum)

While some of these factors are beyond your control, there are strategies you can implement during pregnancy and labor to reduce your risk of tearing.

You’ve probably heard of perineal massage, but it’s more than just stretching the tissue. The pelvic floor must stretch up to three times its normal length during birth, but under stress, it can do the opposite and contract. This can be especially true if your pelvic floor is habitually tight or tends to contract under pressure.

Understanding your pelvic floor’s response to stress, pain, and distraction is key. The two main goals of practicing before birth are to improve your mind-body connection and your physical ability to relax.

Here are the four strategies I teach my patients:

1. Pelvic floor breathing: Focus on opening and lengthening the pelvic floor during inhalation.

2. Pelvic floor release: Practice releasing tension while sitting on a ball.

3. Perineal massage: Stretch the perineum and observe both physical and mental responses.

4. Pelvic floor massage: Internally massage the pelvic floor muscles to release tension and calm any involuntary contractions.

These techniques should be practiced starting at least four weeks before your due date, though exploring your pelvic floor earlier in your third trimester can also be beneficial.

Other factors influencing your pelvic floor during labor include your birthing position, baby’s position, how you push, and how safe you feel. Practicing pelvic floor breathing in positions that promote lengthening, like supported squats, and in positions that encourage optimal baby positioning, such as standing, all-fours, or side-lying, can help.

Understanding the mechanics of pushing is also crucial. You may be told to "push like you're doing a Kegel," which is the opposite of what you want to do. Instead, practice opening and lengthening the pelvic floor while bearing down gently. This helps establish the mind-body connection needed for the birthing process.

Lastly, work with your provider and birthing team ahead of time to ensure you feel safe and supported during labor. Feeling unsafe can cause involuntary contractions and slow labor. Additionally, using a warm compress on your perineum during labor can help reduce the risk of tearing.

Ready to feel confident and prepared for your upcoming birth? I've created the Gentle Birth Guide—a step-by-step roadmap based on what I personally did and what I recommend to my patients to help them prepare for a smoother, more empowered birth experience. You can download this guide now and take the first step toward a gentler birth!