How To Prevent Perineal Tears in Childbirth

How To Prevent Perineal Tears in Childbirth

August 10, 2023

When women are empowered to know how their body connects best with their breath, they create the best circumstances for effective pushing without their pelvic floor resisting efforts and increasing the chances of tearing.

Preparing Our Perineum Involves:

● Learning how to connect our pelvic floor muscles with our breath is crucial for effectively pushing and protecting our perineum. We want to lengthen and release our pelvic floor with INHALE and maintain this release as we exhale and PUSH using our transverse abdominals with our contracting uterus. This may sound confusing or impossible to some, and that is why breathwork throughout our pregnancy is so very important. When I see one-to-one clients for birth coaching, we work on what we call “zen” breathing (no thought of pushing yet) up through weeks 34-35. When mamas are closer to their due date with their belly much larger by week 34-35, we then begin practicing INHALE to release and then creating the downward force with exhale while working to keep the pelvic floor lengthened and even untuck the tailbone to further release tension.

● Screening for tender or tight points before the third trimester so we have time to resolve issues in time. This is something a pelvic floor therapist can assess and screen as well as help us resolve any issues. An expecting person can do a self-assessment by using a mirror and lightly pressing on the muscles that line the vaginal opening. Does the soft tissue feel soft? Or does it feel tense and non-pliable? Are there tender points? Can we create more release of tension if we work to bulge with our inhale? If you find that your muscles are tense or tender, it would be very appropriate to find your local pelvic floor therapist to help you best prepare for your birth.

But please note… having tense pelvic floor muscles does not guarantee that there will be perineal tears just as having relaxed muscles does not guarantee an intact perineum.

Is Perineal Massage Helpful?

● There is recent research that suggests that perineal massage done starting at 35 weeks can reduce our risk of having perineal tearing during birth, but I think this is only part of the picture. Those who have access to information about pelvic health and are aware of pelvic floor massage are naturally going to be at a lower risk of perineal tear. Connecting to our pelvic floor muscles by doing self-massage with a finger, thumb, or pelvic wand (our favorite is the Intimate Rose wand) can help us first screen for muscle and fascia tension as well as gently work to reduce sensitivity and tension. When doing perineal massage, it is VERY important to note that our pelvic floor muscles do not respond well to excessive pressure and stretch. It is best that we work WITH our breathing and create a gentle stretch with our inhales while trying to bulge and lengthen our pelvic floor muscles. Pelvic floor therapists can teach effective perineal massage to expecting women.

How We Push Matters… An open glottis push with our breath reduces risk as well as stage 2 optimal postures.

● If you tried to aggressively hold your breath right now, you would find that your pelvic floor muscles would reflexively tense. When women are routinely told to hold their breath to push, they will physically cause their pelvic floor muscles to tense while trying to create downward pressure with their abdominals. Unfortunately, many birth professionals are not trained in how the deep core system works and are used to working with patients that are not coordinated with their core and pelvic floor.

Asking women to hold their breath and push for 10 counts at a time just does not make physiologic sense. It is also not optimal for good-quality oxygenation for the mother or baby. No athletic sport involves prolonged breath holding for 10 or more seconds with a maximal physical effort, so why would this make sense during one of the most physically challenging events in a woman’s life?

The biggest takeaway is this: Pushing Power = Connecting to our core and pelvic floor + Effective labor positions + Breathing WITH our Pushes.

If you have questions about preparing for your upcoming birth or would like in-person or virtual support, contact us to help you get started. Empowering women to have the birth experience they hope for is our passion!

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