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Five Ways To Prevent Perineal Tears During Childbirth

Five Ways To Prevent Perineal Tears During Childbirth

There are many things women fear when they think about giving birth, especially for the first time. I would bet that towards the top of most expectant mothers', I hope that doesn't happen to me lists, is the dreaded 'perineal tear'.

Make no mistake, perineal tears can be life-changing, especially third and fourth degree tears that are not spotted and fixed immediately or repaired incorrectly.

However, although you can never eliminate the risk of a perineal tear occurring during labour, there are certain things you can do to reduce the chances of one occurring.

What causes a perineal tear?

During the second stage of labour, the baby's head descends into the vagina and moves down onto the perineum (the tissue between your vagina and anus). As the baby's head begins to crown, the labia and vaginal opening begins to bulge and stretch around the head, in turn placing considerable pressure on the perineum. If the perineal skin has not stretched enough then it can tear.

Mercifully, most women are totally unaware that they have torn during labour. Certain factors such as a large baby or a first birth can increase the risk of a tear occurring. Most perineal tears are minor and may require a few simple stiches, which can be done by your midwife. However, a third-degree tear involves damage to the vaginal skin, perineal skin and the muscles that extend up to the anal sphincter (muscle around your anus). A fourth-degree tear is the same as a third degree tear except that it further extends into the anal sphincter and the tissue around it. Both can impact on the pelvic floor function and anal muscles, and cause long term complications.

Ways to lessen the chance of a tear occurring in childbirth

There are a few things expectant mothers can do to prevent a tear occurring in childbirth. Again, we must re-iterate that the risks cannot be prevented completely and you may still tear regardless of these measures; however, taking the following actions may minimise the degree of tear you receive.

1. Do your pelvic floor (Kegal) exercises

Before you became pregnant you likely had not even heard of your pelvic floor muscles, let alone the important function they perform. During the second stage of labour, you want your pelvis and vagina to open and the muscles to relax, maximising the space for the baby to move down. Spending time lengthening and improving the coordination of pelvic floor muscles through squats and pelvic floor exercises can help you become more aware of them during the pushing process.

2. Listen to your midwife/doctor when pushing

When you reach the pushing stage during birth, you should to go nice and slow. Pushing the baby out gently and slowly can allow your tissue time to stretch and give way for the baby. Try exhale pushing instead of holding your breath. During exhale pushing, you slowly breathe in and slowly exhale, perhaps making a low or deep sound as you push. When the baby starts to crown, you might switch to using short almost grunting pushes.

Your midwife should direct you through this process, telling you to stop pushing if she suspects a tear is imminent. If it is clear that you are likely to tear badly, your midwife or your doctor are likely to perform an episiotomy to give the baby more room and minimise or prevent the tear.

3. Massage the perineum during pregnancy

Preparing the perineum during pregnancy has been shown to reduce the risk of tearing in mothers having their first vaginal birth. Perineal massage can help a woman to become familiar with her own body and have confidence in its ability to stretch and birth her baby.

To massage the perineum, rub sunflower, olive oil, vitamin E oil or coconut oil into the skin between your vagina and anus once or twice a day, starting from around 34 weeks onwards. Place your thumbs shallowly into your vagina (no more than three to four centimetres) and press the perineal floor down towards the bowel and to both sides until you feel a slight burning or stretching sensation. Maintain the pressure for about a minute before resting.

4. Warm the perineum during labour

Placing soft, warm towels on the perineum during labour can help soften the skin and allow it to stretch.

5. Avoid giving birth on your back

Studies show that giving birth in a squatting, standing or kneeling position helps keep the perineum intact as you are working with gravity rather than against it. However, this is not always possible (for example, if you have an epidural after being induced).

What to do if you receive a tear through medical negligence

Midwives and doctors can make mistakes and sometimes oversights can be made due to negligence. For example, if your midwife failed to spot signs that you were likely to tear badly in the second stage of labour and therefore an episiotomy, which could have reduced the damage, was not performed, then you may be able to claim compensation if you ended up with a third or fourth-degree tear.

The first step in establishing negligence is to contact an experienced personal injury law specialist who will discuss your case with you and support you if a compensation claim exists.

At Glynns Solicitors we have the expertise required to successfully act for women who have received a third-degree tear caused by medical negligence.

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