How To Minimize Tearing During Labor (And Recover From It Postpartum)

A Quick Overview of the Perineum

The perineum is located between your vagina and your anus. It is connected to several muscles and ligaments attached to the pelvic bones and is involved in any movements that engage your pelvic floor. It’s used extensively during yoga, when lifting something heavy and when you have a bowel movement to name a few.

The Perineum & Childbirth

It’s easy to see the significant role the perineum plays in the birth process. It stretches and opens, bulging several inches past your sit bones as your baby’s head emerges from your body. There is no other muscle in your body that has the ability to stretch this far beyond its normal range. It is truly incredible.

That said, tearing of this muscle can occur during childbirth. Although, in the overwhelming number of instances when it does, it’s minor, requiring no or very few stitches. Studies show it is more common for first-time mothers, and with various medical interventions like: forceps, vacuum-assisted deliveries, and episiotomies.

How to Minimize Tearing During Delivery

Keep the Muscles Warm

The perineum is like any other muscle in the body in that it stretches best when it is warm. Having your delivery nurse, doula, midwife or partner apply a warm compress to your perineum just before and even during the pushing stage is extremely helpful. Taking showers during labor is another excellent approach. This warmth also helps to reduce the experience of pain for many women. Lastly, water births are another effective way to increase blood flow to the muscles during the birthing process.

Don’t Push Flat on Your Back

This is often required in a hospital because it’s convenient for the staff and makes it easier to have you hooked up to monitors, but as we have discussed in other posts, it is not the ideal position for intervention-free childbirth. Lying on your back collapses the pelvic floor and birth canal and doesn’t utilize gravity to help the baby descend.

The goal is to find the position that feels most comfortable. Some women get on their knees to birth, some lay on their side, some are standing, or in a birth tub, or birth stool. The key is to find the position that feels right for you. You may have to adjust or change your position several times if you have a long pushing stage. That’s okay, just be open to changing every thirty minutes or so. If you are not getting progress in a certain position, try another one. 

Knees Close Together

This is an extension of the previous point, but very important. If you are on your back, don’t allow your knees to be spread far apart. It’s not necessary and is more likely to produce tearing because it stretches the skin and muscles even further than is required. We’ve had women give birth with their knees completely together. If your knees are being forced apart without your permission, ask your practitioner to stop.

Push When Ready

Ask any high performing athlete and they’ll tell you the goal is always to be working with your body rather than forcing it to do something it’s not ready for. That’s the idea behind this next point. Push when you feel the urge to push. Just because you’re ten centimeters dilated, doesn’t automatically mean you’re ready to push. You’re ready when your body tells you, and it will. If you are unsure about what the urge to push will feel like, trust yourself and know that there is no other sensation like it. Women who wait for this urge usually have a shorter second stage and less stress for her and the baby.

It can be harder to know when to push when you’ve had an epidural because you’re not as connected to the lower half of your body. But, you will feel intense pressure in your pelvis. Respond to this pressure using your intuition. Push during contractions and go with what feels right for you. Strong, steady and direct you will get your baby out.

Recovering From Perineal Tears

Even under the best circumstances, tearing can occur, and that’s okay. Start by asking your midwife or doctor about your tear and if they anticipate any complications post-birth as well as how they suggest healing it. Here’s a nice FAQ page with useful information about some of the lesser discussed topics around perineal tearing and recovery.

In addition to any prescribed treatments, there’s a number of selfcare practices that can be performed from the comfort of your home. As difficult as it is to prioritize your own recovery while caring for a newborn, healing your perineum can help you to avoid long-term complications with urination, bowel movements and intimacy.

Move Less

Your entire bottom will hurt after a vaginal birth, even if you don’t tear. The best way to heal is to rest. Laying down or reclining with your baby for the first few days until you feel the swelling and soreness improve is the best medicine. Having a partner or other supports around to help with routine tasks like cooking and cleaning makes this a lot easier.

Another technique that is helpful for women is to loosely wrap an ace bandage around your knees and upper legs. This serves as a reminder to keep your legs together, take smaller strides and just move a little bit less in those first few days.

Peri Bottle

The inflammation in your vagina and perineum can make peeing a painful experience for the first few days. Enter the peri bottle, a water bottle with a nozzle that’s turned upwards allowing you to spray your vulva with warm water while you pee to reduce the stinging feeling. The MomWasher from FridaBaby is a good option.

Healing Salve

We created Repair Down There to accelerate perineal healing postpartum. It’s designed to reduce pain and inflammation, while healing your entire bottom, perineum and vaginal area. It’s also great for reducing the irritation caused by wearing menstrual pads postpartum as it lubricates your sensitive parts with soothing plant ingredients. This product can be applied as frequently as needed throughout the day and will significantly improve both short and long-term recovery.

Sitz Baths

A sitz bath consists of soaking your perineum and vaginal area in warm healing herbs chosen to reduce pain and inflammation and accelerate healing. Purchase a sitz bath collection of herbs from any number of companies or visit your local apothecary shop to have them make you a mixture using herbs like comfrey, calendula and plantain.

To prepare, bring two quarts of water to a boil, add dried healing herbs to the water and take it off the heat.  Let it steep for 10 minutes and cool to a temperature you feel comfortable sitting in. Add the herbal tea water to either a warm bath or a special sitz bath bowl that can be purchased from many online retailers. Soak for 10-15 minutes, making sure it is not too hot before you sit down. Here’s a sitz bath bowl that we like.

Massage Your Abdomen

Sounds odd. We’re talking about healing your perineal area. Why massage your belly? Well, your body has been holding a baby inside for nine months, pushing your insides up and out the way all the while. After delivering your baby your abdomen is floppy and loose. A gentle massage to your belly increases circulation and blood flow to the abdomen and by extension down to your pelvis. This increased blood flow to the pelvis is the basis for healing it.

Plus, abdominal massage feels good and helps the uterus to contract and shrink, decreasing bleeding. If you have any leftover Love Butter use it to lubricate the movements of your hands. Slow, gentle clockwise circles around your abdomen is all it takes.

Final Thoughts

Dedicating time to your own health is really challenging for women postpartum. Healing your perineum is quite possibly the most important thing for getting you back to feeling your best. 

Getting the things you need before your child’s birth with help with this. You can always return what you don’t need or pass it on to a friend. 

Your partner can be a huge part of your recovery if they know how to help you. They can prepare the sitz bath, make sure your salve is in the bathroom where you need it, and most importantly take care of household responsibilities that necessitate excessive movement. Consider sharing this post with them so they too have a better understanding of what to expect.

As always, please reach out to us with any questions.