7 ways to reduce perineal tearing during childbirth

Many women are anxious about child birth. Shutterstock

In Australia, the latest statistics^[6] show more than one in four women have no perineal tearing during the birth (more likely when not the first baby), 21% have a 1st degree tear, 30% have a 2nd degree tear and less than 3% have a 3rd or 4th^[7] degree tear (more common with the first baby).

Around 24% have an episiotomy, which is worrying^[8] as this has doubled in the past ten years (12% in 2009), and there is evidence^[9] the recovery is more painful than if the perineum tears naturally.

Read more: Episiotomy during childbirth: not just a 'little snip'^[10]

There is little doubt the rates of perineal trauma have increased over the past 100 years, with early midwife records^[11] indicating most women had no tearing.

An increase in the use of birthing interventions such as vacuum, forceps^[12] and episiotomy (which can cause further tearing), women giving birth at an older age to fewer babies, and greater vigilance by midwives and doctors when examining the perineum after birth have all played a role in the increased perineal trauma rates we see today.

Rates of perineal trauma vary across the country, with one report^[13] finding a 12-fold difference between hospitals, ranging from six per 1,000 births in some hospitals to 71 per 1,000 births in others.

This difference could come from varying hospital practices such as more frequent use of forceps and vacuum, or from the demographics of the women in a given area (more women having their first baby, or even the country of birth^[14] of the women).

There are ways to reduce the risk of perineal tearing. Jimmy Conover/Unsplash

How to reduce perineal tearing

There are recommendations^[15] on how to reduce^[16] the chance of perineal tearing and trauma, based in part on our research.

During pregnancy:

1) perineal self-massage^[17] (or with help from your partner) after 34 weeks of pregnancy can help protect your perineum and reduce the risk of third- and fourth-degree perineal tears

2) pelvic floor muscle training^[18] may help prepare you for labour and birth and reduce the possibility of a third- or fourth-degree perineal tear.

Warm compresses and pre-birth exercises have been shown to reduce perineal tearing. Shutterstock

During a vaginal birth:

3) applying warm compresses^[19] to the perineum during the second stage of labour (when pushing and giving birth) can significantly reduce^[20] the risk of a third or fourth degree perineal tear

4) slowing the rate at which the baby’s head and shoulders^[21] emerge, with the help of your birth attendants, may help prevent perineal injuries

5) perineal massage^[22] performed by your health-care professional during the second stage of labour may reduce the risk of third- and fourth-degree perineal tears. However, some women may not feel comfortable with this option, and it is not recommended for everyone

6) listening carefully to your midwife’s voice and following their instructions can help the baby emerge from your vagina gently and slowly. For example, your midwife will tell you to breathe and not push just before your baby is born

7) perineal trauma is less common^[23] when women give birth in home-like environments such as at home or in a birth centre, where they have less medical intervention, can use water for pain relief and give birth in upright birth positions.

In a new paper^[24] we have also found having two midwives in the room in the late stage of birth, instead of one, can reduce perineal trauma by up to 31%. Our study found having a second midwife in the room meant one of them was focused on the woman at all times, and was not distracted by other things that needed to be done. It also meant they could give suggestions and reinforce^[25] the first midwife’s words to the mother during the birth.

Read more: Vaginal birth after caesarean increases the risk of serious perineal tear by 20%, our large-scale review shows^[26]

Treatment and recovery

Following the birth, your midwife or doctor will stitch any perineal trauma that needs to be repaired in the birthing room, and these stitches dissolve over the coming weeks. Some tears are minor and do not require stitches.

Most perineal wounds heal well by resting, applying ice for the first day or two if swollen, changing sanitary pads and keeping the perineum clean, gentle pelvic floor exercises after a couple of days to help healing, and adequate pain relief.

After birth, if you have problems with your perineum, don’t just put up with it. Contact your midwife or doctor to get further advice.

Read more https://theconversation.com/7-ways-to-reduce-perineal-tearing-during-childbirth-176670