Is it possible to give birth without tearing

During my first trimester, I also started working with an experienced birth doula whose reassuring demeanor put me at ease. My husband and I initially balked at the idea of inviting a relative stranger into such an intimate moment in our lives, but I was intrigued. We discussed everything from the downsides of castor oil at-home inductions, to how to decide when to leave for the hospital.

On her recommendation, my husband and I also arranged for a postpartum doula to come to our apartment for several days of support once the baby arrived. By the time I went into labor two days before my due date, I felt ready. But soon after we arrived at the hospital, it became obvious this was not going to be an easy birth.

The anesthesiologist seemed impatient with my intense fear of needles as he administered the epidural. The pain came back with renewed intensity. In order to feel the pressure of the baby, and to push more effectively downwards against her, the epidural was turned down and an overwhelming pressure coursed through my pelvis in waves so acute I vomited between contractions. After about an hour, exhausted, I could tell I had made little progress. According to the monitors attached to my belly, my baby was still doing just fine, but she was showing no interest in moving closer to the open air of the hospital room.

For the first time that day, I asked my doctor about the possibility of a c-section. She told me to keep bearing down, projecting the focus of a high school football coach on gameday. My doula was gentler, telling me when I had given a particularly effective push and giving me images to help me visualize the baby descending.

After 90 minutes of what felt like fruitless effort, my OB called a time out and cranked the epidural back up. I was told to rest. Finally, four hours later, I felt the unmistakable urge. With a renewed sense of optimism—maybe this was it!

I felt like I was drowning in the pain. Each contraction came as a wave crashing down on me and I could barely come up for air before I felt the next one swallowing me up. At one point between contractions I looked her dead in the eye—her face was visible between my knees—and calmly and directly requested a caesarean. She wanted to do a vacuum extraction. The sensation of my daughter exiting my own body felt mortal.

It was my doula who, as the nurses ferried my healthy, wailing newborn across the room to check her vitals, explained to me that I had a 4th degree tear. Vaginal tears , or perineal lacerations, are a common result of vaginal deliveries. They occur when the baby emerges from the vaginal opening. The severity of the tears is measured in degrees, ranging from common 1st and 2nd degree minor cuts or abrasions to severe 3rd and 4th degree deep lacerations to muscles and tissue.

Though most women who give birth vaginally will tear to some degree, there is little agreement about the incidence rate for 3rd and 4th degree lacerations. A study published in the official journal of the American College of Obstetricians and Gynecology estimates that more than 3 percent of vaginal deliveries incur a 3rd degree tear, and just over 1 percent incur a 4th degree tear. However, further studies suggest the incidence rate for severe tears to be as high as 11 percent.

When Chrissy Teigen revealed on Twitter recently that the birth of her first child had resulted in a tear, repaired with many stitches, people responded in bewilderment. I thought they only used stitches in c-sections? Baby boy: 1 point. Luna: 0. Truthfully, it took me weeks to fully comprehend the severity of my own injury. After two nights at the hospital, my OB-GYN sent me home with stool softeners and a prescription for Percocet for the pain.

The doctor told me to return to see her in six weeks—the standard level of care for most postpartum mothers. I also felt a profound sense of mystery about my injury. What did it look like? And discomfort during sex , or while having a bowel movement, may last for several months.

Stool softeners and a diet of fiber-rich foods can help with the latter, says Page, as can cold compresses and herbal sitz baths. Stitches after birth are necessary with these types of lacerations. Since severe tears into the vagina or rectum can cause pelvic floor dysfunction and prolapse, urinary problems, bowel movement difficulties, and discomfort during intercourse, it's important to share all of your symptoms with your doctor, no matter how embarrassing they may seem.

These professionals are trained to understand your vagina before and after birth. To decrease the severity of vaginal tearing, try to get into a labor position that puts less pressure on your perineum and vaginal floor, like upright squatting or side-lying, Page says.

Hands-and-knees and other more forward-leaning positions can reduce perineal tears, too. It also helps if you lead the pushing phase of labor. On the flip side, when you're directed to push as hard as you can while someone counts, there's a lot of additional pressure on your perineum, which can increase chances of tearing.

In addition, you may reduce your odds of vaginal tears by applying a warm compress to the perineum during the pushing phase of labor, says Dr. Finally, four to six weeks before your due date, practice a to minute perineal massage daily. Always consult your doctor before beginning the practice, especially if you have a history of herpes, as practicing perineal massage with an active herpes outbreak increases the risk of the virus spreading throughout the genital tract. You might want to retain the look and feel of your vagina before and after birth, and are wondering if you should ask for an episiotomy.

An episiotomy—an incision made in the perineum to widen the vaginal opening—is sometimes necessary, but is no longer routine during a vaginal delivery, says Dr. By Holly Pevzner Updated July 31, Recent research suggests that upright positions in general are less likely to lead to tears Rocha et al.

Use of an epidural has not been found to increase the risk of severe perineal tearing Loewenberg-Weisband et al. Labor induction studies on the risk of perineal tearing show mixed results.

Make a visit to the midwife or obstetrician to talk about ways they can help reduce the risk of perineal tearing during birth. It is much easier to include perineal tear prevention strategies in the birth process if they have been agreed upon before labor starts.

Here are some of the common ways a midwife or obstetrician might try to reduce the risk of perineal tearing:. Good visualization of the perineum during pushing Sveinsdottir et al. Warm compress on the perineum during pushing Magoga et al. Occasionally, birthing people will decide that an episiotomy is a safe choice for their vaginal delivery. Similarly, if given the option to choose, some birthing people know that they would rather have a Cesarean delivery than risk developing a large perineal tear through the application of forceps or vacuum extraction.

Having five or more vaginal examinations is associated with a higher risk of a severe perineal tear, even when other factors are controlled for Gluck et al. A birthing person might consider requesting the medical team to only perform medically necessary examinations.

Waterbirth has been associated with having fewer severe perineal tears Sidebottom, et al. If a birthing person is interested in a water birth, they should be sure to check a that they have a provider who will honor their wish to birth in the water and b that a tub will be available.

A tub may need to be rented or purchased depending on the birthing location. Some birthing people are instructed to push right when they reach 10 centimeters of dilation, while others wait until they feel the urge to push. More recent studies have also found that blowing during pushing is associated with a lower risk of perineal tearing, when compared to breath holding Ahmadi, et al.

If someone plans on doing delayed pushing without breath holding, it can be helpful to discuss this decision with the midwife or obstetrician ahead of time, so that the birthing person does not receive unwanted coaching.

Keep in mind that regardless of the amount or type of tearing, the human body has a tremendous capacity for healing. This includes the ability to heal from tears and episiotomies. There are many forms of support for recovering from a perineal tear, from medical treatments to support groups. Regardless of the outcome, birthing people have options for feeling restored.

These days, there are many specialists from pelvic floor physical therapists to medical doctors who are board-certified in female pelvic medicine and reconstructive surgery FPMRS and colorectal surgery. No one should have to suffer alone. If you have a student, client or patient with a significant tear who needs support, please share the resource Life after Fourth Degree Tears.

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Epidural analgesia and severe perineal tears: a literature review and large cohort study. Magoga, G. Warm perineal compresses during the second stage of labor for reducing perineal trauma: A meta-analysis. Marty, N. Rocha, B. Upright positions in childbirth and the prevention of perineal lacerations: a systematic review and meta-analysis. Schantz, C. Sidebottom, A. Obstetrics and Gynecology, 4 , Simpson, K.

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