As a childbirth educator, I give my class participants plenty of time to process and voice their fears and concerns about their upcoming births.
The two most common concerns I hear are fear of tearing and fear of pain.
Nearly every participant has heard a tearing horror story – from a mother, sister, cousin, or even from a stranger at the grocery store.
Fear of episiotomies, stitches, and discomfort can cloud a mother’s excitement over meeting her baby.
Worried About Tearing During Childbirth? How To Reduce The Risk Of Severe Tears
But what if there were a way to reduce your risk of severe tearing by 85%?
How would you feel about a solution that didn’t require medication or increased risks?
You would think this information would spread like wildfire, considering what a concern it is among birthing women.
But it hasn’t. I’m not entirely sure of the reason, but every midwife who reads this is probably thinking, “I’ve been trying forever to spread the word”.
Don’t Want To Tear? Just Don’t Push
Wait a second. You’re saying if I don’t push my baby out I reduce my risk of tearing? But how else will baby come out?
If the only births you’ve witnessed include dramatised movie scenes, or reality TV births (which are about as ‘real’ as any other reality show), then you’re probably utterly confused. How can a woman possibly give birth without actively pushing?
Surely, I’m not suggesting women should just have a c-section?
No. As it turns out, our bodies are designed to give birth without severe trauma to the vagina or perineum (the area of tissue between the vaginal opening and anus).
Unfortunately, for decades we’ve been doing things that get in the way of this normal physiological process.
Before birth became a medicalised hospital experience, many women gave birth while staying upright and active. They listened to their bodies and went with the urge to push or not to push.
They didn’t pull their knees to their chests, hold their breath, and push with all their might while someone counted down.
Evidence is finally catching up with what our bodies already know.
The Royal College of Midwives, with the support of the Royal College of Obstetricians and Gynecologists, implemented a trial program at Medway Maritime Hospital in Kent (UK).
All they did was to stop telling women to lie on their backs and push.
Instead, they encouraged women to stand upright, to squat, or to go on their hands and knees during birth. Women were encouraged to breathe naturally through contractions rather than be told to, “Push, push, push harder”.
This simple measure reduced the rate of third and fourth degree tears from 7% to 1% – an 85% reduction. Their research was so successful, it was published in the European Journal of Obstetrics and Gynecology.
What About Minor Tears? I Don’t Want To Tear At All
The research above is extremely compelling in showing the importance of support for normal physiological birth.
The choices we make during birth affect our immediate and even long term postpartum recovery. This is something that isn’t always shared in childbirth preparation classes.
This study was about reducing the risk of severe tears, which always require stitches, and occasionally need ongoing support such as physiotherapy.
Midwives at the Kent hospital where the research took place were concerned about the extreme frequency of severe tearing. Seeing 22 cases of severe tears in just one month pushed them to start the trial program.
Although the study was about reducing third and fourth degree tears, taking the same steps reduces the overall risk of tearing.
Here are some things you can do, to reduce your overall risk of tearing and drastically reduce your risk of severe tearing:
- Prepare your body with proper nutrition and pelvic floor strengthening exercises during the prenatal period
- Labour in water
- Give birth upright, and stay off your back
- Breathe through contractions rather than push with all your might
- Use warm compresses
- Choose a maternity care provider who practises up-to-date evidence based care, and who doesn’t routinely perform episiotomies.
You can learn more by reading Tearing During Birth – 9 Ways To Help Prevent Tearing.
Even if you experience a tear during childbirth, the good news is almost 99% of all tears are considered minor. Minor tears might not even require stitches – or perhaps just a few. They often heal up very well, and usually aren’t noticeable by your six-week postnatal checkup.
Is It Really True? Can I Not Push During A Vaginal Birth?
During my childbirth preparation class before my oldest child was born, I learned about the fetal ejection reflex, which is likened to other reflexes in the body. I learned that baby would make its way out, with the help of the fetal ejection reflex, whether I actively tried to push or not.
Being a first-time birther, I didn’t quite get it. I was tired, I wanted to lie down, and I didn’t trust my body as much as I should have.
However, I still enjoyed the ‘rest and be thankful’ stage – a pause in contractions once I was fully dilated but not feeling the urge to push. Because of my education, and my evidence based practising midwife, no one told me to push simply because I was fully dilated.
I also had an unmedicated birth, so I could feel when I was contracting and when I had urges to push. Although I probably could have given myself more time to feel the fetal ejection reflex fully, I got in my body’s way by lying down.
Eventually, my midwife encouraged me to get up into a supported upright position. With her guidance, and my body’s urge, I birthed my son. I experienced only a minor tear, with just a few stitches. I did, however, experience some pelvic floor strain from pushing hard, and not always with the urge. This wasn’t my midwife’s suggestion; it was more about my being stubborn.
After that experience, although my tear was very minor, I really didn’t want to tear again, or to strain my pelvic floor. With my next births, I refused to push, out of fear. Although this is not the best motivator, I ended up breathing through contractions until my body pushed the baby out whether I wanted to or not.
I experienced a very minor tear that didn’t require any stitches, and I didn’t experience any tears with the others. I found my pelvic floor had less strain, my back didn’t hurt, and I wasn’t so exhausted during the immediate postnatal recovery.
As it turned out, this fetal ejection reflex really did exist. The trial program the midwives implemented, which supported women being upright and not pushing without the strong urge to do so, drastically reduces the risk of severe tearing.
You can learn more about the fetal ejection reflex by reading Fetal Ejection Reflex – What Is It And How Does It Happen?.
In an effort to speed up birth, to take away pain, or to medicate (e.g. an epidural that affects normal physiological birth), it seems we’re actually setting women up to experience a much more difficult and painful postnatal recovery.
Why Aren’t Women Taught About Reducing Tearing?
Birth used to be a process we saw long before we gave birth ourselves. In past generations, we might have seen our mothers, sisters or cousins giving birth in their homes. When birth moved to the hospital, few women witnessed normal physiological birth.
Our education about birth was made up of small anecdotes shared by relatives, birth horror stories, and unrealistic births dramatised in the media.
We began to see birth as a medicalised event that could go wrong at any second, rather than a normal body process which typically unfolds well, where complications are the exception rather than the rule.
We all have a goal: to reduce maternal and infant complications and death. But it seems in an effort to control birth, we’ve actually increased complications.
Fortunately, evidence is now catching up and we’re relearning how to support physiological birth. Many midwifery providers maintained this support when birth moved to the hospital but, as a whole, few birthing women learned about how to reduce their risks during birth.
With a rise in midwifery care and independent childbirth preparation classes, and because science is catching up to what our bodies already know, more birthing women are now learning how to reduce their risks.