Easily Tips to Reduce Tearing During Delivery

There can be a lot of anxiety during pregnancy, one anxiety provoking thought is delivery and tearing during delivery.

PRE-NATAL PERINEAL MASSAGE HELPS REDUCE BOTH PERINEAL TRAUMA DURING BIRTH AND PAIN AFTERWARDS.

Perineal Massage can be beneficial beginning at 34-35 weeks of gestation through to the second stage of labour (once you’re fully dilated). During the last month of pregnancy, performing perineal massage has been suggested as a possible way of enabling the perineal tissue to expand more easily during birth and reduces the risk of tearing requiring stitches by 10% and the need for an episiotomy by 16% (1, 2). During the second stage of labour, perineal massage has been shown to lessen the severity of the tear, but not the risk of tear (2).

BASED ON A COCHRANE REVIEW PUBLISHED IN 2013:

A review of four trials (2497 women) showed that perineal massage, undertaken by the woman or her partner (for as little as once or twice a week from 35 weeks), reduced the likelihood of perineal trauma (mainly episiotomies) and ongoing perineal pain. The impact was clear for women who had not given birth vaginally before, but was less clear for women who had (1).

A Cochrane Review is a trusted source for information. They are systematic reviews of primary research in human health care and health policy, and are internationally recognized as the highest standard in evidence-based health care.

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Getting Started:

1. Begin at 34-35 weeks gestation.

2. Practice 3-10 minutes 1-2 times per week.

3. Choose a space where you feel comfortable and have privacy.

4. Some people like to take a shower or sit in a bath first to soften the skin.

5. Clean your hands and trim your fingernails.

6. Have lubricant within reach.

7. Find a position where you can comfortably reach the vaginal opening. You can try lying down with knees bent and your head and trunk propped up on pillows, sitting on the toilet, or standing with one foot up on a stool.

8. Place lubricant around the lower half of the vaginal opening and on one finger or thumb.

9. Gently insert your finger or thumb about one inch into the vagina.

LIGHT PRESSURE MASSAGE

1. Press down towards the anus until you feel a stretch. Hold here a few seconds.

2. Press in, side to side, clockwise circles and counter clockwise circles. Then advance by inserting your finger or thumb inside your vaginal canal.

DEEP PRESSURE MASSAGE

1. Once inside the vaginal canal, press downwards toward your rectum and then also make a sweeping motion side to side. Visualize your vaginal canal like a clock with 12:00 being at your pubic bone and 6:00 at your rectum. You are stretching from 3:00-9:00 like a U. Avoid pressing towards your pubic bone as this may be uncomfortable and it is not the target tissue to stretch. Gradually increase the pressure to your tolerance. The stretch will be intense but should not be painful.

2. If it is comfortable insert a second finger or thumb to work both sides at once.

3. Throughout the massage focus on taking smooth slow breaths.

4. Try to keep your body relaxed. If the first position you tried is not comfortable, pause and reposition. This may take many tries before you find the best position for you.

POINT PRESSURE

1. Another option for internal stretching is to hold a clock position for 30-60 seconds- especially if you feel increased tension. For example, during your sweep of 3:00-9:00, if you feel increased tension at 4:30, stop and hold that for 30-60 seconds or until you feel the tissue soften. 

POST STRETCHING:

It’s normal to feel mild soreness (like what you may feel after a massage) but if you have pain, difficulty using the restroom, or difficulty sitting, you may have done too much. If you’re not sure, check with your pelvic floor health physiotherapist. 

During Labour:

• A warm compress on the perineum during pushing may reduce third- and fourth-degree laceration (2).

• The physical position of your body during delivery can also lower the risk of tearing - more on this in an upcoming blog.

There are numerous benefits to pre-natal physiotherapy. Have questions - feel free to reach out, or discuss this with your Pelvic Floor Physiotherapist.

If you found this information to be helpful, please share! Knowledge is power.

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References

1. BeckmannMM, StockOM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD005123. DOI: 10.1002/14651858.CD005123.pub3.

2. Gunter, J. (2019). The Vagina Bible: the vulva and the vagina — separating the myth from the medicine (1st ed.). Toronto, Canada. Penguin Random House Canada Limited.