When I work with moms in preparation for labor and delivery I always give this advice: “There are things in L&D that we can control, and there will be things that we can’t control. Let’s do our best with the things we CAN control.”
I can’t tell you that you’ll totally avoid tearing if you do #1-4, but I’ve seen women who’ve had great deliveries when they’ve applied these techniques, and most are backed by research as well, so here we go:
1. Get off your back. The research on this is CLEAR – pushing babies out on your back has the HIGHEST rates of perineal trauma. Why? One reason is that your tailbone has no room to rotate, decreasing the size of the pelvic out. And yet 70% of women give birth on their backs. Besides perineal trauma, it also has the highest rates of suction/forceps delivery, nerve damage, etc. If you really WANT to push this way, you can try propping with pillows/towels rolls to give the sacrum some room, but if you want to try something different, start talking to your OB, or consider working with a midwife, doula, or scheduling an L&D appt with myself. 🙂
2. Perineal Massage – Research does indeed support perineal massage 35 weeks prior to delivery. Tip – more isn’t necessarily better. Latest research I’ve seen showed that women who performed massage 1-2x/week vs. daily had the same results! Perineal massage DURING labor is also supported by research as being effective in preventing 3rd and 4th-degree tears!
3. Manual Techniques – I teach all the partners of my OB package patients manual techniques that they can utilize to help OPEN the pelvic inlet and outlet. This can help decrease length of labor, pain, AND can be utilized during pushing to help open the pelvic outlet and decrease potential trauma.
4. Laboring Down – this has mixed research out there – some research shows laboring down to be very beneficial to moms in decreasing second stage of delivery as well as trauma – there is also some research that shows that there is no significant difference, but that study was done on women who gave birth with epidurals. I’ve seen in my clinical practice that when mommas are in an environment where they’re allowed to follow their natural instincts to push when they’re ready vs. pushing just b/c they’re at 10 cm, they have a shorter pushing phase and often less tearing compared to moms who are instructed to start pushing just b/c they’ve reached full dilation. I think it’s important to acknowledge that other factors may also play into these results as well (such as the above-mentioned tips!).
How about you? Have you tried any of these? Which one worked+ well for you?