5 Ways to Reduce Risk of Tearing During Birth
Cesareans are typically the number one intervention moms tell us they hope to avoid, and tearing is usually a close second.
Even when you do everything “right” you may still tear, and that is not a personal failing. However, there are evidence-based steps that help reduce your risk of more significant tearing and protect your perineum during birth.
Evidence Based Birth has reviewed the research on perineal protection, including episiotomy, warm compresses, provider practices, birth positions, and hands-on versus hands-off approaches. Here are five practical takeaways, but be sure to watch the full video for more detailed information!
1. Choose a Provider With Low Rates of Significant Tearing
Provider practice patterns matter. Some providers have lower rates of severe tearing, episiotomy, and instrumental birth than others. Many providers do not track this data, but you can ask your provider of their last 10 births:
“How often did your clients experience third- or fourth-degree tears?”
“How often did you perform episiotomies?”
“What positions did you see most of your clients birth in?”
“What techniques did you use for reducing risk of tearing?”
These questions can help you understand how your provider typically approaches the pushing stage and whether their routine practices align with your preferences.
2. Avoid Routine Episiotomy When Possible
An episiotomy is a surgical cut made in the perineum during birth. While it may be necessary in certain situations, routine episiotomy is not considered best practice. They are not routinely performed in the Chicagoland area (at least not that I am aware of), but it is a good conversation to have before you are in the intensity of pushing.
3. Consider Upright or Side-Lying Birth Positions
Studies have shown that in our western world, side-lying, and hands-and-knees are the positions that have most reduced risk of tearing. It is thought that they help create more space for baby and reduce pressure on the perineum. In other countries around the globe where squatting motions are more common, squatting may reduce risk of tearing as well.
4. Ask About a Hands-Off or Hands-Poised Approach
Many parents assume provider-led perineal massage during pushing prevents tears, but the research is more nuanced. Hands-on support is not always necessary or helpful, and some evidence supports a hands-off or hands-poised approach having more reduced risk.
5. Use Warm Compresses During Pushing
Warm compresses are one of the simplest evidence-supported tools for reducing severe tearing.
This usually looks like a warm, wet washcloth gently applied to the perineum during pushing. Research shows warm compresses may reduce third- and fourth-degree tears and can also help with pain.
You can add this to your birth plan by saying:
“During pushing, I would like warm compresses applied to my perineum.”
The Bottom Line
There are no bullet proof ways of preventing tearing, but you can make informed choices that may reduce your risk!
Just to recap, the biggest steps are:
Choose a provider with low rates of severe tearing and episiotomy
Avoid routine episiotomy when possible
Use upright or side-lying birth positions
Ask about a hands-off or hands-poised approach
Request warm compresses during pushing
Preparing ahead can help you feel more informed, confident, and supported as you move into the pushing stage. We would love to help advocate for your birth preferences! Inquire here about birth doula support!
