How can I prevent a tear during delivery?

Many patients will ask their doctors, “How do I prevent a tear during my vaginal delivery? This has been studied and new recommendations have been released regarding the topic. First to note is that 53-79% of women will have some type of tear at vaginal delivery.  Most are first and second degree tears.  These are tears that involve the skin and muscles over the perineum. A second degree laceration is the most common type of tear. These usually have no long-term effects and most women heal quickly and without problems. The severe tears are called third and fourth degree tears that involve the anal sphincter and can have significant long term complications. This means the tear has gone beyond the vagina and into the rectal area, the spincter that holds your stool in. Tears can happen naturally or with an episiotomy.  National episiotomy rates have decreased steadily since 2006.  Now 12% of births include an episiotomy, and declining even as you read this article.

But is there anything you can be doing prior to delivery to prevent natural tears? Digital perineal massage from 34 weeks of gestation onward was associated with a modest reduction in perineal trauma that required suture and decreased episiotomy rates in women without a previous delivery. How do I massage something I don’t even know where it’s located, you ask? The perineum in the space between the vagina and the anus. When a woman is delivering, this area really spreads and stretches for delivery.

Perineal massage is done by the following method:

  • Sit in a comfortable area, with your knees bent and your legs apart. Use something to lubricate your fingers and perineum. Make sure you hands and nails are clean.
  • Place your thumbs inside your vagina. With the thumbs, press downward and toward the sides at the same time. Basically, stretch the tissue between the vagina and anus.
  • Hold the tretch for about two minutes.
  • You can also stretch the vaginal tissue outward, exactly what would happen with delivery of a baby’s head.
  • Do this  once daily, if you have the time.

This can be done at home, but what can be done in the delivery room?  Warm compresses applied to the perineum during the second stage of labor (when you are pushing) has been shown to significantly decrease third and fourth degree lacerations.   So does perineal massage!  Delayed pushing- from 1-3hours after complete cervical dilation may decrease your risk of tears.  Lateral positioning during pushing may also decrease your risk of tears.

Talk to your doctor.  Talk to your nurses.  We can all work together to decrease tears and help you have a great delivery experience!

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Dr. Megan McEllistrem has been in private practice for the past 11 years. Her interests are obstetrical care and teaching young physicians.