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Isn't Tearing Super Normal?
Well, I can tell you it’s not really like that (except for that split second that I thought “WHY???”). It’s a pretty cool dance that the baby and the birthing body does together!
By pretty cool, I of course mean *magic*. 😜
Recently, my L&D nurse friend, Hanna, from Babytalk blog, got really passionate about this “normal” question after rereading parts of Ina May’s Guide to Childbirth. Here’s the excerpt: "Of the first fifty births that Pamela and I attended, forty-three gave birth without episiotomy or laceration. The seven women who needed stitches had only minor tears and no complications from them. This experience so early in my career ... taught me that most women are well equipped to give birth without the slightest injury, given the appropriate help, preparation, atmosphere, and consideration."
So NO, it’s not true that everyone tears. But what can we do to decrease the chances?
Also, episiotomies are not routinely recommended and haven’t been since the early 2000’s.
A 2017 Cochrane review found that when episiotomies are done on a small, selective number of birthing people when appropriate (such as when a baby’s shoulder is severely stuck during birth or women how have undergone certain types of genital mutilation) instead of routinely on the majority of birthing people, it “may result in 30% fewer women experiencing severe perineal/vaginal trauma.”
During our chat, Hanna says something like,
If we are open to physiologic birth and are in-tuned with our bodies and our urges, contractions, pushes and even the effacement and dilation of our perineum our body and our mind can work together to get the baby out!
But How Do We Get In-Tuned With Our Bodies?
- Spinning Babies® Parent Class – improves trust in yourself, strength in your body, awareness of your baby’s job, and great daily practice at being the expert of your body
- Yoga – great breath awareness practice, opportunity to feel how body changes from week to week
- Fear Clearing or Anxiety Work – work with an expert to personalize your journey to overcome fear or anxieties about pregnancy or birth
Connecting with your baby can also help to improve your understanding of your own body that houses that little human.
- Belly Butter Routine – this can even be considered a ritual that is calming and done to create sensory patterns (touch, smell) My fav belly oil. Mmmmmm, belly butter
- Bath Time = Baby Time – a simple way to notice baby movements and body awareness while soaking in a warm, relaxing bath. Lavender is my fav way to unwind! (Check with your provider if unsure about epsom salts or bath temps)
- Bump Pics + Journaling – a baby book on steroids, these daily/weekly/monthly entries can include your body changes and feelings to help you sort through your feels and document how far you and baby have journeyed together
All of these ideas may help you understand your body and your baby and that connection better. Feeling in-tuned with your body may help you listen to it without judgement or expectation, like when you’re feeling the start of contractions. You’ll be deciding if they’re feeling stronger. When do they start and stop?
How does the baby feel throughout the day or while your body is contracting?
Are you able to consciously relax tensing muscles before sleep? When asking your doctor questions? During an exam? During contractions?
Can you see how understanding how your body feels and how you feel about your body can play a major role in the rest of your pregnancy and your birth experience?
Knowing what to expect in physiologic birth can help reduce some of that fear around childbirth and can also empower you in the birth experience when your team reminds you that what you’re feeling is expected and normal. That understanding can help you relate new feelings, like the sensations felt while pushing, to what you’ve learned is expected during that stage in labor.
The Ultimate Guide to Taking Control of Your Childbirth is a great way to learn what to expect! 
What is Hands-On Pushing?
Perineal massage is the rubbing of the opening of the vagina, done by a physician, nurse, or midwife. During and/or between pushes, the care provider massages or stretches the tissue with the index and middle fingers, using a water-soluble lubricant.
It looks as fabulous as it sounds, and Hanna and I discuss it further in the video below.
In the video, we also discuss the Cochrane review from 2011 (link below) that concluded that a hands-on approach during pushing decreased severe perineal tearing but also increased the changes of an episiotomy. (YIKES!) I’ve often heard from a provider that the birthing person’s perineum is very tight, and an episiotomy would give the baby more room.
Um, duh! The head isn’t stretching that tissue yet. That’s the tissue that the baby’s head affects last! (Yeah, I’ve got some feelings about episiotomies)
The review from 2018, however, notes that perineal massage showed an increase in intact perineums. Yay! No tears! The hands-on massage was noted to be performed by midwives, however, who tend to value a more physiologic approach to childbirth.
Unfortunately, it’s not clear cut. A hands-off approach might help one person, but it also might cause more swelling and trauma to another.
How to Avoid Hands-On Pushing?
If the hands-on rubbing of your vaginal tissue from the outside while you’re easing that baby watermelon through the vagina from the inside doesn’t sound as pleasing as a more undisturbed approach, I’ve got some ideas.
Ideas to avoid hands-on pushing:
- Don’t push in the bed (remember pushing and giving birth are different things. Pushing usually takes longer and doesn’t have to be done in the same place.)
- Don’t push on your back
- If your provider or nurse is performing perineal massage and you’re feeling “meh” about it (or worse), could say, “That’s now helping me.” or “Stop please.” Direct and to the point. They don’t always know what’s best for you and your body.
Know Your Rights
Ultimately, we encourage you to know your rights and get comfortable with the fact that, as the birthing person, YOU are the owner of the vagina, so YOU ultimately make all of the decisions about it. Even if it’s an emergency and your provider recommends an episiotomy for safety concerns of the baby, there is always time for a short discussion and your informed choice.
I encourage you to have this discussion early with your provider, ideally before labor, so that you’re both comfortable that you’re the Boss of your Vagina.
Click on the video below for more discussion on the evidence about vaginal tearing and MORE tips to reduce your risk for tearing! 👇
Cochrane review 2011: https://www.ncbi.nlm.nih.gov/pubmed?term=22161407
Cochrane review 2017: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000081.pub3/abstract
Cochrane review 2018: https://www.ncbi.nlm.nih.gov/pubmed/30107756
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