Tips to Reduce Risk of Perineal Tears During Childbirth

Expectant mothers all over the world are always anxious about the possibility of perineal tears during childbirth. Perineal tears are common occurrences during vaginal birth, and they can range from mild to severe causing pain and discomfort and can even lead to long-term complications. However, the good news is that there are ways to reduce the risk of perineal tears. The tips below will enhance elasticity, improve blood circulation and foster muscle relaxation.

How Can I Reduce the Risk of Tearing During Childbirth?

Minimizing the likelihood of perineal tearing in childbirth involves employing a blend of prenatal and birthing strategies. These tips include everything from perineal massage to birthing positions.

Prenatal Tips to Reduce Risk of Perineal Tears During Birth:

1. Practice Perineal Massage:

   Perineal massage is a simple technique that involves gently massaging the perineum (the area between the vaginal opening and anus) using lubricating oil, like olive oil or vitamin E oil. After week 35, it is safe to massage the perineum a couple times per week.This helps soften the tissue and make it more pliable and better able to accommodate the stretching that occurs during childbirth, reducing the risk of perineal tears during childbirth. This massage also increases blood circulation to the perineum, which is essential for maintaining tissue health and resilience. The process of childbirth in and of itself requires the tensing of muscles with the contractions. By incorporating this massage technique into prenatal care, women can learn to consciously relax and release tension in the perineum. Remember, it is important to get the guidance of a qualified healthcare provider before starting perineal massage.
   Tips for an effective perineal massage:
   • Start with clean hands.
   • Choose a high-quality organic oil like sunflower, grapeseed, coconut, almond or olive. Do not use synthetic oils or petroleum jelly.
   • Place your thumbs one to one-and-a half inches into your vagina and press along the back wall in a U-shaped motion to stretch the tissues inside the vagina.
   • Hold the stretch for one to two minutes with gentle pressure.
   • Be consistent by performing the massage a few times per week to maximize the benefits of perineal massage.

2. Strengthen the Pelvic Floor Muscles:

   Pelvic floor health plays a vital role in the overall well-being of women, particularly during pregnancy and childbirth. Strengthening these muscles is a proactive and effective approach to reducing the risk of perineal tearing while promoting resilience and support during the birthing process. Kegel exercises, deep squats, bridge exercises, yoga, pilates, and the balloon breathing technique are all examples of exercises that can strengthen your pelvic floor.
   • Kegel exercises involve contracting and relaxing the muscles around the vagina and anus. Regular practice enhances muscle tone, improving the ability of the pelvic floor to withstand the pressure exerted during childbirth and reducing the likelihood of perineal tearing.
   • Incorporating deep squats into an exercise routine engages the pelvic floor muscles along with the surrounding muscles in the thighs and buttocks.
   • Bridge exercises involve lifting the hips towards the ceiling while lying on the back to engage the pelvic floor muscles, promoting strength and stability.
   • Both yoga and pilates focus on core strength and stability to enhance flexibility and strength. A prenatal yoga class provides targeted exercises for pelvic floor health.

Birthing Tips to Reduce Perineal Tearing:

1. Use a Warm Compress:

   Warm compresses provide a comforting and analgesic effect, alleviating discomfort associated with the stretching and pressure experienced during labor. This pain relief not only enhances the overall birthing experience but also contributes to the relaxation of the perineal muscles, further reducing the risk of tears. Applying a warm, damp towel or cloth to the perineum for around 20 minutes before delivery can help the tissue stretch more easily and reduce the chance of tearing. 

2. Consider a Water Birth:

   Water birth involves giving birth in a warm, filled tub or pool, reducing the risk of perineal tears. The warm water relaxes and softens tissues, providing natural pain relief. Water's buoyancy reduces gravitational pull, lessening pressure on the perineum for a gentler baby descent, lowering the risk of tears. Immersion promotes perineal muscle relaxation, enhancing elasticity to accomodate natural stretching during childbirth. 

3. Controlled Pushing Techniques:

   Pushing during the second stage of labor is a crucial part of childbirth, but it is important to use controlled pushing techniques. Uncontrolled or forceful pushing can increase the pressure on the perineal tissue and increase the risk of tearing, so it is important to push slowly and allow the tissue to stretch gradually while the baby descends naturally through contractions. Your healthcare provider may guide you through the controlled pushing techniques through verbal cues to optimize the effectiveness of each push. Intentional breathing techniques such as “panting” or “blowing” breaths also help maintain a controlled pressure on the perineum as well as different birthing positions.   

4. Open Pelvic Positions:

   The choice of delivery positions during childbirth can significantly impact the mechanics of labor, potentially influencing the risk of perineal tearing. Opting for positions that facilitate the opening of the pelvic outlet can contribute to a smoother delivery and reduce the likelihood of perineal trauma. Optimal delivery positions include the following:
   • Hands and knees position: This is also known as the all-fours position, which aligns the baby's head with the pelvis.
   • Squatting position: a natural and gravity-assisted position using a birthing stool or support from a partner or bed.
   • Side-Lying Position: This position is a more comfortable alternative for women who may find it difficult to maintain other positions.
   • Upright positions such as standing, kneeling, or using a birthing ball once again, use gravity to reduce pressure on the perineum.

5. Get the Support of a Doula:

   A doula is a trained professional who provides emotional and physical support during childbirth. Studies have shown that having a doula present during childbirth can significantly reduce the risk of perineal tears. Doulas can provide comfort measures, suggest helpful positions, and offer advice on how to push effectively.​

Can Mesenchymal Stromal Cells (MSCs) from Cord Tissue Repair Perineal Tears?

Perineal tears during childbirth can be distressing, but emerging research highlights the potential of mesenchymal stromal cells (MSCs) in the repair process. MSCs, known for their regenerative properties, have shown promise in promoting tissue healing and reducing inflammation. A recent study explores the application of MSCs in perineal tear repair, demonstrating their ability to enhance tissue regeneration and improve overall healing outcomes. This groundbreaking avenue offers a glimpse into the future of obstetric care, where innovative approaches, such as harnessing the reparative potential of MSCs, may contribute to minimizing the impact of perineal tears on postpartum recovery. This is just one more reason to store your baby’s cord blood and cord tissue.

Final Thoughts on Reducing Perineal Tearing During Childbirth

The journey to reduce the risk of perineal tears during childbirth encompasses a holistic approach, combining both prenatal and birthing techniques. Expectant mothers can empower themselves with proactive measures to enhance perineal health and mitigate potential challenges during labor. Prenatal practices such as perineal massage and pelvic floor exercises foster elasticity and strength, laying the foundation for a more resilient perineum. Birthing strategies, including warm compresses, water birth, controlled pushing techniques, and optimal delivery positions, further contribute to minimizing the risk of perineal tearing. Additionally, the invaluable support of a doula during childbirth can make a significant difference, providing guidance, comfort, and advocacy. By incorporating these tips into a birthing plan, expectant mothers can strive for a more positive and empowered childbirth experience, reducing the likelihood of perineal tears and promoting overall well-being. As always, consulting with healthcare providers and seeking personalized guidance ensures a tailored and safe approach to childbirth.