“I’m afraid of tearing during birth”
Tearing during childbirth is a huge fear for moms-to-be.
What are the chances of tearing while giving birth and is there anything I can do to prevent it? Also, if I do tear, can it cause any permanent damage? These are the kinds of questions many nervous moms ask. Midwife Marlise Van Onselen has all the information you could want to know about tearing in childbirth.

A birth plan can include the desire to avoid an episiotomy and reduce the amount of tearing during birth. Tearing is a reality during childbirth.  While a plan can’t be foolproof, it helps to prepare mentally and physically for birth.

Where do women tear?

There are different grades of tearing. It can be anything from a skin snatch up to a third degree tear where the perineal tearing affects the anal sphincter.  

Grade 1: Superficial tear of the vaginal mucosa and perineum
Grade 2: Deep perineal tear not affecting the anal sphincter
Grade 3: Partial or total tear through the anal sphincter, can have permanent damage.

How to prevent tearing or reduce the severity

Healthy lifestyle

A well-balanced diet during your pregnancy with proteins, fresh fruits and vegetables and fewer refined foods promotes elasticity and quick healing.  You should drink eight glasses of water per day. Greater oxygenation of tissues is not only accomplished by diet, but with also exercising . The toning of the pelvic floor enhances its integrity for life and will help prevent sagging organs later on. Walking, squatting, duck-walking, pelvic rocks, tailor sitting, kegels and swimming are all useful exercises.

Warm compressions

Using a warm compress during the latter stages of pushing may also help stretching of the perineum to avoid tears. Mothers ought to include all of these preferences in their birth plan.

Perennial support

During the birthing process your doctor or midwife will support the perineum with one hand and use the other hand to hold the baby's head. By doing this the baby’s head is flexed, the chin tucked in nicely and the head is in the optimal position to be delivered. This means less pressure on the perineum.

Controlled delivery

Researchers have now discovered that when your doctor or midwife intentionally slow the birthing of the baby's head during the crowning phase and encourage the mother not to push while the baby's head is being born, the chance of tears into the anal sphincter was reduced from 4% to 1%.  The longer we can allow the tissues of the perineum to stretch, the more we can reduce tears during birth.

Positioning during labour

Some of the best positions to reduce tearing include all fours/hands and knees positions as well as the mother lying on her side. Trying to push in a variety of positions, especially off your back, are other good ways to reduce tearing as it lessens the pressure on the perineum.

Antenatal perineum massaging

Perineum massaging from 34 weeks pregnant seems to reduce the tearing, but according to research, only in first-time mothers.  Massage during labour can result in swelling of the perineum and this will increases the likelihood of tearing.

Some mothers' tissues do stretch better than others.  This is genetic.

You can do it! Have a positive attitude during your birthing process and not even tearing will take away the joy of holding your bundle of joy in your arms.

Marlise has a "From Tummy to Mummy" practice. It focuses on antenatal classes, postnatal support groups, breastfeeding consultations & a Well Baby Clinic.

Read more by Marlise Van Onselen.

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