By Amanda Fisher, PT, DPT - Pelvic Floor Physical Therapist at Empower Your Pelvis

Bringing a new baby into the world is an incredible experience, but it definitely comes with its share of challenges. One concern that many expecting moms have is the risk of perineal tearing during childbirth. Let’s talk about the top risk factors that might affect perineal tearing, including episiotomy, instrumental assist births, birthing positions, pushing time, and perineal massage. Before your big day, it’s so important to have an open conversation with your birth provider to make sure everyone is on the same page.

Episiotomy: A Double-Edged Sword

Episiotomy, which is a surgical cut made to widen the vaginal opening during delivery, used to be pretty common. However, many providers now avoid episiotomies unless they’re absolutely necessary. This is something you’ll want to discuss with your provider ahead of time. It’s crucial to understand their approach so you can make informed decisions about your birthing experience.

Instrumental Assist Births: Tools to Know About

In some cases, tools like forceps or vacuum extraction are used to assist in delivery. While these tools can be helpful in certain situations, they may increase the risk of perineal tearing. Be sure to talk to your birth team about the possibility of instrumental assistance, so you’re aware of the potential risks and benefits beforehand.

Birthing Positions: Find What Works for You

The position you choose during labor can impact the risk of perineal tearing. Squatting, hands-and-knees, and side-lying positions may reduce the risk compared to the more traditional lithotomy position (lying on your back with legs in stirrups). Talk with your provider about different birthing positions that might be right for you, so you can make choices that align with your comfort and preferences.

Pushing Time: Finding the Balance

How long you push during labor can play a role in perineal tearing. A slow, controlled approach might reduce the risk, but pushing for too long can actually increase it. This is why it’s so important to keep an open line of communication with your provider during labor. Finding that balance between controlled pushing and not prolonging the process too much can help minimize the risk.

Perineal Massage: A Proactive Approach

Perineal massage is a technique that involves gently stretching the perineum, and it has been shown to reduce the risk of tearing during childbirth. Learning and practicing perineal massage during pregnancy can be empowering! Make sure to discuss this technique with your provider to ensure you’re doing it correctly and to address any concerns.

The Importance of Communication with Your Birth Provider

Before the big day, have a candid chat with your birth provider about your preferences, concerns, and all the topics we just covered. Understanding their approach to episiotomy, instrumental assistance, birthing positions, pushing time, and perineal massage will help you create a collaborative birthing plan that aligns with your needs. Don’t be afraid to ask those tough questions, like why and when they might consider using an episiotomy or forceps/vacuum.

When it comes to childbirth, knowledge is power. By understanding the factors that might contribute to perineal tearing and openly communicating with your birth provider, you’re setting yourself up for a birthing experience that aligns with your values and preferences. Every birth is unique, and having a supportive team around you can make all the difference. Here’s to a healthy, empowered birthing experience!