We’re talking about how to naturally prevent tearing.
Alongside, the fear of being in pain during birth, tearing is the second most common fear I’ve come across.
So, in this content, we’re going to look at: a three-strike combo to avoid tearing.
Before we go into it, I want to reassure you that you are designed to stretch. There are practical ways to avoid tearing, which I’m going to teach you, but the most basic thing to remember is that you’re not trying to prevent the inevitable.
You don’t have to try hard to preserve your perineum—just follow these intuitive steps.
When I say they’re intuitive, I mean they’re all about giving your body space to do what it’s meant to do.
Okay, so let’s get into it.
The three-strike combo to prevent tearing is:
> Handoff support
> Intuitive positioning
> No-Push pushing
So, first up—
The way your birth environment is set up is vital. You need to be as undisturbed as possible, which includes during the crowning stage of birth.
This means not being touched on your perineum unless you request it.
Research has found that when care providers leave women untouched during crowning, it reduces tearing (specifically significant tearing and the chance of an episiotomy being used).
So, what does this look like practically?
A randomised control trial found that when care providers simply observed the steps of the birthing moment—(1) crowning, (2) automatic rotation of the baby’s head (restitution) and (3) delivery of the shoulders and (4) expulsion (delivery of the remainder of the body)—then tearing was less likely.
Sometimes these steps can happen all in one contraction (this is called Fetal Ejection Reflex).
Other times, the baby will come out in a handful of contractions, about one step per contraction.
So for this study, there were two groups.
The hands-off support group, as I mentioned, had care providers that, as a rule, didn’t touch these birthing women. They offered support to these women without holding the perineum. This may have been in the form of silence, patient waiting and calm presence. It doesn’t say.
The only time they did assist was if the baby’s head was born, which is step one, and then step 2 didn’t spontaneously occur within 15 minutes. This is rare because the steps usually happen almost instantaneously. So, in this rare instance, they helped a little with the rotation of the baby’s head.
In contrast, the randomised control group (i.e. the women in the other group) were given a more hands-on approach.
This group of women were assigned manual counter-pressure and hand positioning on the perineum.
To be honest, I thought this group would have done better, but they actually ended up being more likely to tear.
The study concluded that a hands-off approach is best.
A woman’s stance when the baby’s head is coming out (“crowning”) also influences whether tearing happens.
Research has found that being on all-fours or kneeling is the most protective stance.
And they’re also the most common, according to experienced Australian midwife, Teresa Walsh.
In a podcast interview with me, she explained that kneeling is by far the most frequent position women choose if they are not persuaded to lie on their back.
An upright position makes sense biologically.
Gravity helps in an upright position. If you lie down, you’re pushing against gravity.
Plus, your sacrum (the bit of your lower back) has a special ability to move outwards when you’re birthing to add extra space in the birth canal.
This extra wiggle room often comes at just the right time.
To problem, however, is that when women lie on their backs they stop this function.
The weight of their bodies on their lower back holds this
bulge out as your baby’s head moves down to give you an extra bit of space. You can’t access this space if your body weight is holding it down because you’re lying on that spot on your back.
Women make position decisions spontaneously. It’s common to just “know” what to do to get your baby out that last little bit. Or you might need your midwife to suggest a position to try—what if we get out of the bath now, or how about a lunge? Finding the best position intuitively is an example of how women already know how to give birth, even if they never have. You know how to respond to your body’s changing needs.
If you know this, then you know what’s required of you in each moment to keep the labour progressing.
In contrast, midwife Hines-Powell highlights the negative impact of a semi-reclined position on a bed when the baby’s head is appearing. She says this position often slows down labour.
In response, the mother may be encouraged to “push harder” by a care provider. This process can cause her to push before the tissues have had a chance to stretch around the baby’s head.
You don’t need to deliberately push your baby out.
This brings me to the topic of “pushing”.
Being familiar with the “pushing phase” process can help you relax into it.
Here’s what women report “crowning” and “pushing” feels like. (Then, I’ll give you a rundown of steps—what’s going on, what to do, what not to do.) Here we go!
- Step 1: When you begin to feel like bearing down (often called the ‘pushing phase’), it will feel like a lot of pressure in your bum and may feel like a bowel movement. The pushing feeling is deep, like heaving, and usually involuntary. One woman described the pushing surges as a substantial relief. When you feel this, it’s essential to do the least amount of pushing as possible. This will allow your perineum to stretch.
- Step 2: The feeling in your bum will increase as your baby moves lower down through your pelvis. It may feel like more than you can stand or like you’re splitting in two. This is normal, and no one has ever “split in two”, so you won’t be the first. Now that you know to expect it, you can relax even as you find it a weird experience.
- Step 3: The next distinct feeling could be a burning, pins-and-needles feeling at the opening of the vagina or a skin-stretch feeling. Some women describe this as a “ring of fire” around the vaginal opening, though not all women have this impression. It is instinctive to slap your hand down on the now-bulging vulva and try to control where the baby’s head is starting to emerge. This impulse should be followed! It seems to genuinely help to have your own hands there. Note: Sometimes, women also like to have very hot face cloths applied to their perineum now. Research has shown this to be helpful. If you want this feeling, say so, and if you don’t, say so. Your care provider should do whatever you feel like.
- Step 4: Most women like to push more than to dilate. When you’re bearing down, you feel like you’re getting somewhere and that there really is a goal for your efforts. This is a time of great concentration and focus for you. Unnecessary conversation should not be allowed in the room. Everyone should be silent and respectful in between sensations while you regather your focus. Once you begin feeling the ring of fire, there is no need to hurry. You will be guided to push as you feel like until the most significant part of the back top of your baby’s head is visible. All that will be touching your tissues is the hot face cloth (if you like) and your own hands. Your care provider needs to keep their hands off because the blood-filled tissues can be easily bruised and weakened by poking, external fingers. These types of disturbances can lead to tearing. Your care provider may use a plastic mirror and a flashlight to see what’s happening, so they can guide you if needed. They shouldn’t touch you or the baby.
- Step 5: The point of full crowning is very intense and requires extreme focus on the feelings—the burning, if you feel it, is a safe, healthy feeling but unlike anything, you will have felt before. You may hear a “devil voice” inside your head saying, “All you have to do is give one hefty push, and this will all be over. Who gives a flip if you rip? Just push like your life depends on it and get that forehead off your butt!” This voice is not your friend! Remind yourself to just hang in there a little longer. Just think to yourself: “It’s okay, I’m almost there.” You may ask your midwife or husband in advance to say, softly and calmly, “easy, easy, easy” or “pant like a dog” during this stage to remind you. Panting is your best friend! Rise above the pushing urges with panting. This will help you stay together, and you’ll have less discomfort in the long run. Your care provider should only give positive commands at this point if anything at all is spoken. They should keep words as simple as possible to help maintain your focus. They may offer you plain water with a bendable straw throughout this phase because hydration seems to be important when pushing. You should take the water or leave it as you desire.
- Step 6: Once the head is fully born, you will feel a great sense of relief. You will keep focused on the next sensation, which will bring the baby’s shoulders out, and the baby’s whole body will come quickly after that with minimal effort on your part. The baby will go up onto your bare skin immediately, and it is the most ecstatic feeling in the world to have that slippery, crawling, unique little baby with you on the outside of your body. Your perineum may feel somewhat hot and tender in the first hour after birth, and believe it or not, the remedy that helps the most is to apply very hot, wet facecloths. Women report that they feel immediately more comfortable when the heat is used, and any swelling reduces quickly.
- Step 7: When the placenta comes out, it will feel like a big, soft tampon plopping out. It is a good feeling to complete the entire process of birth with the placenta coming out. You may like a quick shower, and then it’s good to try to pee. After that, it’s time to pop into bed with your bub and beau and rest.
What Does It Feel Like?
Did you know that from a survey of 1267 birthing women, 60% (763) preferred the “pushing stage” (second stage) and found labour more challenging than literally giving birth? That’s a perspective you don’t hear on the news!
Mothers from around the world submitted these responses to the question, “What did it feel like to push your baby out?” on the Ina May Gaskin Instagram page.
Here’s what they had to say:
- “I didn’t push; my body did it for me. It was euphoric and empowering” — Sydney
- “Incredible release of tension” — Romaine
- “Like my body knew what it was doing…I was just along for the ride.” — Zena
- “Like I was made to get that thing outta me hahaha no control” — Shelby
- “Didn’t even hurt! Was easier than contractions” —Zoi
- “Sweet relief” — Sandra
- “Wonderful!!!!! No ring of fire” — Jaryn
- “Like my body was a trash compactor and someone pushed the button “— Lauren
- “Amazing! Everyone warned me about the ‘Ring Of Fire’, but I didn’t feel that. It felt good to feel her head and head of hair come through. Pressure, yes, but no pain.” — Sarah
- “Extreme rectal pressure then sheer relief” — Car
- “Pressure…I felt like a cow. Sounded like one too! Very out of body experience.” Jamie
- “The greatest opening and expansions and also like [heaving]. And so exciting” — Jess
- “Just like a large poopie” —Patti
- “Like walking out of the hottest sauna on earth into a cool, clear stream of consciousness.” — Lauren
- “Pure bliss” — Sarah
- “Simply put, it felt good” — Michelle
- “I imagined breathing my baby down, but I was gently coached by my midwife and doula. I didn’t think I could do it but once his head and shoulders were you, feeling him moving half in half out was something I will never forget. It was beautiful.” — Kate
- “I just gave birth to my second child (my first time doing it naturally). I didn’t have to deliberately push. I was amazed at how my body just sort of took over and did it for me – things were all lined up, though – my baby was very, very low, and I had to wait for my midwife to arrive. Thus, I didn’t feel the urge to push (although I think if I had mentally allowed myself to feel it, I would have had the baby right then, without the midwife). Right, when my midwife came in, my body took over, I couldn’t help but push, and my baby was born 4 minutes later. I was on my hands and knees for the birth (I laboured on my side while waiting for the midwife to slow things down). I was in a different position than what I had imagined being in, yet I could birth my baby with no “active” pushing on my part…my body did it all! It was an amazing feeling.” — Kami
- “With my first child, I stood up the entire time, and I must say there was no active pushing; it just happened. I will definitely be standing again with my second, due in another week.” — Elena
Practical Ways To Prevent Tearing:
- Sexy Touch: Get the blood supply from your head to your genitals through sexy cuddling, kissing, and love. It’s almost impossible to tear if lots of blood is there to make the skin rich with resources. You may like to masturbate in early labour with your husband.
- Mantra: Believe Ina May’s words, “I’m going to get huge.”
- Prayer: Bless the muscles as your baby’s head is coming out.
- Moisturise: Lather your perineum in avocado oil during labour. This oil can penetrate through the skin layers, so it is easily absorbed and exceptionally moisturising. However, a natural oil would probably do just as well—olive, soybean, raspberry seed etc.
- Perineal Massage: Spend time in the last month before birth massaging your perineal area with oil. Research has shown that, especially for first-time mothers. This reduces the chance of tearing.
- Panting: Panting or “ho ho ho” when your baby is crowning, with a loose mouth and jaw. Keep your body flexible, especially your jaw, because it mirrors your vaginal. Unclench the jaw!
- Vocalise: Sing and moan with deep/low ‘ahh’ sighs. Make the sound vibrate in your chest, or try blowing ‘horse lips’ as your baby is coming.
- Breathe: You may like to breathe using short quick breaths, in contrast to the longer style breaths you may have used in labour.
- Visualise: Picture your vagina opening and getting enormous!
- Feel Love: Kiss your partner a little and focus on feelings of love.
- Soft Touch: Have your husband touch you with loving strokes on your back during the transition and/or in the pushing phase/
- Hot Compress: Put a very hot washcloth on your perineum.