Bringing a new life into the world is a transformative journey that calls for understanding and informed decision-making. As expectant mothers, it's essential to educate ourselves about the various aspects of childbirth.
Up to 9 in every 10 first time mothers who have a vaginal birth will experience some sort of tear, graze or episiotomy. It is slightly less common for mothers who have had a vaginal birth before.
As always, the information I share in this blog has been written with a supportive and empowering perspective. We'll explore the benefits and risks to episiotomies and natural tearing, as well as ways to prepare and support your perineum before and during childbirth.
Remember, knowledge is power, and understanding your options can help you make informed decisions that align with your 'unique birth plan'.
Episiotomy
An episiotomy is a surgical cut in the muscular area between the vagina and the anus (the perineum) and vaginal wall, to make more space for baby to be born.
Episiotomies should only be performed with your fully-informed consent.
Although episiotomies used to be routine practice, research and guidelines now indicate that they should only be performed if absolutely necessary; often if you are having an instrumental (forceps or vacuum assisted) birth, or if you are at risk of a serious perineal tear.
Benefits:
Controlled incision: Episiotomy allows healthcare providers to have more control over the size and direction of the incision.
Faster delivery: By enlarging the vaginal opening, an episiotomy can expedite the birth process in case of an emergency.
Risks:
Increased pain and discomfort: The incision made may result in more pain and discomfort during the healing period compared to natural tearing.
Risk of infection: As with any surgical procedure, there is a risk of infection. Proper postpartum hygiene and wound care are essential to minimise this risk.
Possible complications: Episiotomy carries a risk of excessive bleeding, haematoma formation, or damage to nearby structures like the rectum.
Natural Tearing
It is common for the perineum to tear to some extent during childbirth. Tears can also occur inside the vagina or other parts of the vulva, including the labia.
What are the types of perineal tear?
First-degree Small tears affecting only the skin which usually heal quickly and without treatment. Read more about first degree tears
Second-degree Tears affecting the muscle of the perineum and the skin. These usually require stitches. Read more about second degree tears
Third- and fourth-degree tears For some women (3.5 out of 100) the tear may be deeper. Third- or fourth- degree tears, also known as obstetric anal sphincter injuries (OASI), extend into the muscle that controls the anus (anal sphincter). These deeper tears need repair in an operating theatre. Read more about third and fourth degree tears
Benefits:
Better healing: Natural tears tend to heal well and faster than surgical incisions, as they follow the body's natural healing processes.
Reduced pain: Women who experience natural tears often report less pain and discomfort during the healing phase.
Risks:
Unpredictable extent: The degree of tearing can vary, ranging from minor to severe tears (3.5 out of 100) that may involve the anal sphincter or rectum, requiring surgical repair.
Longer healing time: Extensive tears may take longer to heal and require careful postpartum monitoring and care.
Potential complications: Severe tearing can lead to long-term issues like faecal or urinary incontinence or discomfort during sexual intercourse.
Preparing the Body and Perineal Support:
There are things to consider to promote a more natural and empowered birth experience and to avoid severe tearing.
Perineal massage:
Benefits: Regular perineal massage before childbirth can increase tissue flexibility and elasticity, potentially reducing the risk of severe tearing.
How-to: Gently massage the perineal area with clean hands and a natural lubricant, following expert guidance.
Active labour:
Benefits: Following your body's cues and exploring different active positions, such as squatting, kneeling, or side-lying, optimises the physiological birthing process, reducing the risk of perineal trauma.
How-to: Choose a birth preparation course that includes active labour information, join pregnancy yoga classes, and discuss birth positions with your midwife. Also trust that what feels most comfortable for you during labour is most likely the right position for you and for baby.
Controlled pushing:
Benefits: Controlled pushing during the second stage of labour reduces the risk of rapid and forceful delivery, and minimises the risk of perineal trauma.
How-to: Join a Hypnobirthing Course! You'll learn about focused breathing techniques for the down stage of labour. Make sure that your care provider is giving you the space and support you need to fully tune in with your body and respond to it's cues.
Warm compresses:
Benefits: Applying warm compresses during labour relaxes tissues, increases blood flow, and decreases the risk of severe tearing.
How-to: Use warm, moist towels or specially designed warm packs on the perineum during pushing and crowning stages.
Supportive perineal management:
Benefits: Applying counter-pressure and gentle stretching during crowning can reduce the risk of tearing.
How-to: Communicate your preferences with your midwife, they can provide a more hands-on approach during crowning to help protect the perineum, or a completely hands-off approach if you wish to apply counter pressure yourself.
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Image and perineal tearing data source: Royal College of Obstetricians & Gynaecologists