One of the biggest fears women have about giving birth is this: How will my baby fit through my hoo-ha? It's an understandable concern. "Vaginal tearing is very common during vaginal birth," says Fahimeh Sasan, MD, an OB/GYN in New York and assistant professor of Obstetrics and Gynecology at Icahn School of Medicine at Mount Sinai Hospital.
In fact, approximately 75 percent of women will experience vaginal tearing, also called perineal tearing, during their first vaginal delivery (second births are generally easier for the obvious reason that the area's been stretched out before).
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Sadly, in some cases vaginal tearing can't be avoided. But there are ways to lower those odds. Consider these tips to get your baby out with minimal damage:
1. Adjust your position. Lying on your back can increase the odds of vaginal tearing due to plain old gravity, which puts the added weight of your baby's head right on the perineum (that's the area between your vagina and your anus). To ease this pressure, lie on your side, or get up on all fours. If your nether regions are excessively swollen (which often happens if you're been pushing longer than three hours), another position you may want to avoid is squatting, since this increases pressure on the vaginal area.
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2. Massage the perineum. By massage, we're not talking about breaking out the coconut oil and New Age music. With perineal massage, a health care provider inserts a finger or two into your vagina and stretches it by pressing toward your anus, typically while you push during contractions. Some women also do perineal massage on themselves (or have their partner help) in the days leading up to delivery. That said, "Studies have not demonstrated a significant difference in vaginal tearing in women who did perineal massage during pregnancy compared to women who did not, especially for a first vaginal delivery," says Dr. Sasan. Still, during your delivery, it definitely pays to ask your health care provider for a hand.
3. Apply a warm compress to the area. It's basic science: Heat causes tissue to expand. And expansion is good when you want to prevent tearing. Studies have shown that a perineal compress can even help prevent deeper third- and fourth-degree tears, with researchers arguing perhaps they should become a standard part of maternal care.
4. Hold off on forceps or the vacuum if possible. While getting a little help in the form of forceps or a vacuum sounds like some welcome relief when you're sick of pushing, try to avoid them as long as your baby is in no danger and you feel you can keep going. The reason: Your body knows best what it can stand. Introducing force from a third party could literally push your nether regions past their breaking point.
5. Refuse an unnecessary episiotomy. In the past, doctors would purposely make an incision in the perineum to enlarge the vaginal opening, which supposedly kept it from tearing more extensively when the baby came out. But no more. "Doctors are falling away from the trend of routinely performing episiotomies," says Dr. Jessica Shepherd, MD, an OB/GYN at Her Viewpoint. While an episiotomy should be performed in certain circumstances, like an abnormally positioned baby or shoulder dystocia (the baby's shoulder blade behind the mother's pubic bone), risk of vaginal tearing should not be one of those reasons … because honestly now, why cut what isn't broken yet?
And if you do tear anyway? "Even though having a tear in your vagina sounds horrifying, the recovery is quite easy," assures Dr. Sasan. Most tears are repaired with absorbable sutures; most of the pain from mild tears fades in two to three weeks, with a full recovery in six weeks (during which time you should avoid intercourse or strenuous exercise). After that, "for most women you can barely see, if at all, the site of the tear by six weeks," she says.
