Preventing Tears in Labor

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Preventing Tears in Labor

One of the worst parts of postpartum can be healing from tears (or episiotomies). If you have been there, you know what I’m talking about. If not, I hope you never have to experience that pain. This is when you want to enjoy your new baby but you cannot move or sit because your bottom is in excruciating pain. This is when every time you pee you have to be in water or use pain medicine because the pain on the raw flesh is so intense. It may not be that bad, but for lots of women it is and the repercussions are long term. Tears are the real deal. Not to scare any first time moms-to-be, but it is worth putting some energy into a plan not to tear.

Nutrition
Healthy tissue is the starting point for not tearing and good nutrition is the gateway to healthy tissue. Good nutrition allows your tissue to have elasticity in order to stretch during birth. During the last trimester hormones will cause your vagina, cervix, and perineum (the tissue between your vagina and your rectum) to become thick and elastic. For this to happen you need:

  • Adequate protein
  • Vitamin E--- at least 1,000 mg per day either from a good supplement or from food sources which include wheat germ oil, sunflower seeds, almonds, and pecans.
  • Vitamin C is essential for tissue health, cellular integrity, elasticity and regeneration.
  • Bioflavanoids strengthen tissues. These give foods color and taste and are very medicinal. Food sources are blueberries, cherries, citrus fruits, pears, plums, grapes, cabbage, legumes, and onions. I recommend taking vitamin C with bioflavonoids in the last trimester of pregnancy to strengthen your amniotic sac.
  • Omega 3s and Omega 6s. Great sources of these are nuts and seeds, cold pressed oils, beans, and fish.
  • I especially recommend taking fermented cod liver oil. I like the raw butter and fermented cod liver oil mix from Green Pasture. Take 1 ¼ tsp. a day of this rich nutrient. You can also get it here: Green Pasture Fermented Cod Liver Oil
  • Hydration is also very important. Make sure you are drinking enough water. Also, red raspberry leaf tea near the end of pregnancy will give your tissue more health and elasticity. 

Active Life
The more exercise you get the better your circulation and the more elasticity in your skin. Having frequent orgasms can also improve blood flow to the perineum and vagina and improve tissue health.

Squatting- Don’t Just Do It, Do It Right!
Squatting increases the birthing space by activating the gluteal muscles and pulling the sacrum back to open the birthing space. This extra space means less pressure on the pelvic floor and less tearing of the muscles and tendons. This is great if you start in the first trimester, but starting squatting in the third trimester is not optimal because of the heaviness of your body and your leg muscles not being strong enough and putting pressure on the ligaments that support you. According to Katy Bowman, a pelvic floor expert, you can still make progress in widening the birthing space and strengthening the pelvic floor by doing squat prep work. She walks you through lower leg and hip opening stretches here on her blog about squatting https://nutritiousmovement.com/you-dont-know-squat/ This is a whole other blog topic here. If you do one thing to prepare for your labor, this could be it. Squatting is so powerful, especially for first time moms to bring that baby down the birth canal.

Tissue preparation
Starting at 34 weeks do perineal massage. You can do this on yourself or have your partner do it with you. To do this you or your partner insert one or two fingers three to four centimeters into the vagina and apply pressure downwards on the perineum, the muscle between the vagina and the rectum. Apply pressure first downward and then massage outward. This is the most effective with first time moms in preventing tears but can also help if you have torn before and have scar tissue. This can help women practice breathing with the sensation of pressure on the pelvic floor, which is huge when it comes to not panicking but pushing your baby out.

Vitamin Enema
Believe me, the health of the tissue has everything to do with if you tear and how bad. I recommend, especially if you have torn before, you take a capsule of Wholistic Solutions Vitamin-Mineral-Antioxidant and put it in two ounces of filtered water and slowly insert it into your rectum. Do this daily in the last few weeks of pregnancy to increase nutrients to your tissue in that area. Get Vitamin-Mineral-Antioxidant Here

Birth Position

  • Consider a water birth. The warm water helps bring more blood to the tissues and lowers the intensity of the pressure making it easier to breath the baby out. Though no study that I can find confirmed less tears in the water, most midwives I know swear that women tear less in the water.
  • The best positions not to tear are hands and knees, kneeling, lying on your side, or sitting upright.
  • Positions that increase likelihood of tearing are lying on your back, lying down with your legs up (called lithotomy position), or semi reclining. These all put pressure on the tailbone and perineum and reduce the size of the pelvic floor.  Boo! Hiss!
  • Squatting and kneeling, though they are great positions for pushing, if the knees are too far apart may stretch the perineum and increase tearing.

Delivery Techniques
Laboring down means not pushing until the baby is well descended into the pelvis. This allows the tissue to stretch and the baby’s head to mold. Or some women don’t actively push at all but breath the baby out. In order to do this you need the right labor coach to help you breath and pant. Powerful! Remember, you don’t have to blast your baby out. It is worth taking time to discuss your care provider’s delivery technique.

  • Ask: At what point, if ever, would they do an episiotomy (a surgical cut in the perineum made just before delivery)?
  • Do they do perineal massage and if so at what point? Using warm compresses and arnica oil can help the tissue stretch, but not too much is needed.
  • Consider asking them to do a double handed delivery. This is where an assistant holds a warm compress firmly at the top and bottom of the vaginal opening to support the tissue from tearing. The goal is to not touch the top of the baby’s head but simply support the tissue. This is probably not needed on women who have had babies before unless they tore badly or had an episiotomy.
  • Many times women tear with the birth of the baby’s shoulder, not the head. Is your care provider ok with letting the head sit on the perineum as long as everything is good with the baby? Most babies will rotate and deliver and the less the care provider’s hands are in there the better!
  • Ask your care provider how many internal exams they do and if they use iodine? Internal exams can irritate the tissue and iodine is hard on tissue.

Believe me, the more you do to prevent tearing the happier you will be and the better your postpartum will go. I would love to chat with you about any of these suggestions or help you make a birth plan. My next blog is on what to do if you do tear.

Sources:

  • https://www.birthingbasics.net/2013/12/09/birth-protecting-perineum/
  • Avoiding an Episiotomy", Nancy Griffin, Mothering Magazine, # 75, summer 1995, (p 60).
  • https://www.bellybelly.com.au/birth/tearing-during-birth/

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