You are designed to stretch. There are practical ways to avoid tearing, but the most vital thing to remember is that you’re not trying to prevent the inevitable. You don’t have to step outside of your original design to preserve your perineum. Whether you feel confident about your in-built capacity to stretch or not, this article is here to show you how perfectly designed you are for birth. There are simple ways to avoid tearing, and most of the methods and about giving space for the mother to do her thing.
Three-Strike Combo To Prevent Tearing:
The way the birth environment is set-up is vital. Women need to be “undisturbed”—physically, this means not being touched on their perineum unless requested.
Research has found that when the care provider’s leave birth undisturbed during this stage, it reduces tearing; specifically significant tearing and the chance of an episiotomy being used. What does “not intervene” look like practically? The randomised control study found that when care providers observed the birthing moment—crowning, automatic rotation of the baby’s head (restitution), delivery of the shoulders and expulsion (delivery of the remainder of the body)—then there was less tearing. These three “steps” in the delivery usually happen quickly. Sometimes all in one contraction (called Fetal Ejection Reflex). Other times, the baby will come out in two or three contractions. In this study, the care provider only assisted the women if 15 minutes elapsed after when the baby’s head had been born. In this instance, they helped a little with the rotation of the baby’s head. The randomised control group (i.e. the ones in the opposite group that tore more) were given a more “hands-on” approach. This turned out to be less favourable, though it objectively sounds like it would be helpful. This group of women, who ended up tearing more often, were supported with manual counter-pressure and hand positioning on their perineum. The study concluded that an “undisturbed” or “hands-off” approach offers a safer alternative during labour to reduce the risk of tearing.
A woman’s stance during “crowning” is also an essential determinant for whether tearing occurs. Research has found kneeling and all-fours are the most protective stances. An experienced midwife Pamela Hines-Powell explains that being in an upright position is normal for labour and giving birth. While labouring, this could mean standing, a supported squat, kneeling or bending over while standing. Experienced Australian midwife, Teresa Walsh, agrees. She explained to me in a podcast interview that kneeling is by far the most frequent position birthing women choose if they are not influenced to take up a semi-reclined position.
An upright position makes sense biologically. The uterus is aligned with the pelvis, and gravity is helping. The mother’s sacrum bulges out as the baby’s head moves down. If the birthing mother is standing, she will often lean forward as the baby’s head comes out. If she is on “hands and knees”, she may lift herself off her hands, into a more upright position for the crowning of the head. Birthing women spontaneously make these decisions. This is an example of how birthing women already know how to give birth, even if they never have. You know how to respond to your body’s changing needs. If you know this, then, you know what’s required of you in each moment to keep the labour progressing. In contrast, midwife Hines-Powell highlights the negative impact of a semi-reclined position on a bed when the baby’s head is emerging. She says this position often slows down labour. In response, the mother may be encouraged to “push harder” by a care provider. This process can cause her to push before the tissues have had a chance to stretch around the baby’s head. “In a normal physiological birth, the mother has no need to deliberately push her baby into the world,” says midwife and former engineer Jean Sutton.
Be familiar with the process of the “pushing phase”. Here’s what women report “crowning” and “pushing” feels like. Then, I’ll give you a step-by-step rundown of each part of this phase—what’s going on, what to do, what not to do. Here we go!
- Step 1: When you begin to feel like bearing down (often called the ‘pushing phase’), it will feel like a lot of pressure in your bum and may feel like a bowel-movement. The pushing feeling is deep, like heaving and usually involuntary. One woman described the pushing surges as a substantial relief. When you feel this, it’s essential to do the least amount of pushing as possible. This will allow your perineum to stretch.
- Step 2: The feeling in your bum will increase as your baby moves lower down through your pelvis. It may feel like more than you can stand or like you’re splitting in two. This is normal, and no one has ever “split in two”, so you won’t be the first. Now that you know to expect it, you can relax even as you find it a weird experience.
- Step 3: The next distinct feeling could be a burning, pins-and-needles feeling at the opening of the vagina, or a skin-stretch feeling. Some women describe this as a “ring of fire” around the vaginal opening, though not all women have this impression. It is instinctive to slap your hand down on the now-bulging vulva and try to control where the baby’s head is starting to emerge. This impulse should be followed! It seems to genuinely help to have your own hands there. Note: Sometimes, women also like to have very hot face cloths applied to their perineum now. Research has shown this to be helpful. If you want the feeling of this, say so, and if you don’t, say so. Your care provider should do whatever you feel like.
- Step 4 Most women like pushing more than dilating. When you’re bearing down, you feel like you’re getting somewhere and that there really is a goal for your efforts. This is a time of great concentration and focuses for you. The unessential conversation should not be allowed in the room. Everyone should be silent and respectful in between sensations while you regather your focus. Once you begin feeling the ring of fire, there is no need to hurry. You will be guided to push as you feel like until the most significant part of the back top of your baby’s head is visible. All that will be touching your tissues is the hot face cloth (if you like) and your own hands. Your care provider needs to keep their hands off because the blood-filled tissues can be easily bruised and weakened by poking, external fingers. These types of disturbances can lead to tearing. Your care provider may use a plastic mirror and a flashlight to see what’s happening, so they can guide you if needed. They shouldn’t touch you or the baby.
- Step 5: The point of full crowning is very intense and requires extreme focus on the feelings—the burning, if you feel it, is a safe, healthy feeling but unlike anything, you will have felt before. You may hear a “devil voice” inside your head saying, “All you have to do is give one hefty push, and this will all be over. Who gives a flip if you rip, just push like your life depends on it and get that forehead off your butt!” This voice is not your friend! Remind yourself to just hang in there a little longer. Just think to yourself: “It’s okay, I’m almost there”. You may ask your midwife or husband in advance to say, softly and calmly, “easy, easy, easy” or “pant like a dog” during this stage to remind you. Panting is your best friend! Rise above the pushing urges with panting. This will help you stay together, and you’ll have less discomfort in the long run. Your care provider should only give positive commands at this point if anything at all is spoken. They should keep words as simple as possible to maintain your focus. They may offer you plain water with a bendable straw throughout this phase because hydration seems to be important when pushing. You should take the water or leave it, as you desire.
- Step 6: Once the head is fully born, you will feel a great sense of relief. You will keep focused for the next sensation, which will bring the baby’s shoulders out, and the baby’s whole body will come quickly after that with minimal effort on your part. The baby will go up onto your bare skin immediately, and it is the most ecstatic feeling in the world to have that slippery, crawling, unique little baby with you on the outside of your body. Note: Your perineum may feel somewhat hot and tender in the first hour after birth, and believe it or not, the remedy that helps the most is to apply very hot, wet face cloths. Women report that they feel immediately more comfortable when the heat is used, and any swelling reduces rapidly.
- Step 7: When the placenta comes out it will feeling like a big, soft tampon plopping out. It is a good feeling to complete the entire process of birth with the placenta coming out. You may like a quick shower and, then it’s good to try to pee. After that it’s time to pop into bed with your bub and beau and rest.
What Does It Feel Like?
Did you know that from a survey of 1267 birthing women, 60% (763) preferred the “pushing stage” (second stage) and found labour more challenging than literally giving birth. That’s a perspective you don’t hear on the news!
Mothers from around the world submitted these responses to the question, “What did it feel like to push your baby out?” on the Ina May Gaskin Instagram page. Here’s what they had to say:
- “I didn’t push, my body did it for me. It was euphoric and empowering” — Sydney
- “Incredible release of tension” — Romaine
- “Like my body knew what it was doing…I was just along for the ride.” — Zena
- “Like I was made to get that thing outta me hahaha no control” — Shelby
- “Didn’t even hurt! Was easier than contractions” —Zoi
- “Sweet relief” — Sandra
- “Wonderful!!!!! No ring of fire” — Jaryn
- “Like my body was a trash compactor and someone pushed the button “— Lauren
- “Amazing! Everyone warned me about the ‘Ring Of Fire’ but I didn’t feel that. It felt good to feel her head and head of hair come through. Pressure yes, but no pain.” — Sarah
- “Extreme rectal pressure then sheer relief” — Car
- “Pressure…I felt like a cow. Sounded like one too! Very out of body experience.” Jamieh
- “The greatest opening and expansions and also like [heaving]. And so exciting” — Jess
- “Just like a large poopie” —Patti
- “Like walking out of the hottest sauna on earth into a cool, clear stream of consciousness.” — Lauren
- “Pure bliss” — Sarah
- “Simply put, it felt good” — Michelle
- “I imagined breathing my baby down but I was gently coached by my midwife and doula. I didn’t think I could do it but once his head and shoulders were you, feeling him moving half in half out was something I will never forget. It was beautiful.” — Kate
- “I just gave birth to my second child (my first time doing it naturally). I didn’t have to deliberately push. I was amazed at how my body just sort of took over and did it for me – things were all lined up though – my baby was very, very low, and I had to wait for my midwife to arrive. Thus I didn’t allow myself to feel the urge to push (although I think if I had mentally allowed myself to feel it, I would have had the baby right then, without the midwife). Right, when my midwife came in, my body took over, I couldn’t help but push, and my baby was born 4 minutes later. I was on my hands and knees for the birth (I laboured on my side while waiting for the midwife to slow things down). I was in a different position than what I had imagined being in, yet I was able to birth my baby with no “active” pushing on my part…my body did it all! It was an amazing feeling.” — Kami
- “With my first child, I stood up the entire time, and I must say there was no active pushing, it just happened. I will definitely be standing again with my second, due in another week.” — Elena
Practical Ways To Prevent Tearing:
- Sexual touch: Get the blood supply from your head to your genitals through sexual touch, kissing, love. It’s almost impossible to tear if lots of blood is there to make the skin rich with resources. You may like to masturbate earlier in labour, either yourself or your partner could help.
- Mantra: Say to yourself Ina May’s words, “I’m going to get huge.”
- Prayer: Bless the muscles as your baby’s head is coming out.
- Moisturise: Lather your perineum in Avocado oil during labour. This type of product can penetrate through the skin layers, so it is easily absorbed by the skin and is exceptionally moisturising, though a natural oil would probably do just as well—olive, avocado, soybean, raspberry seed etc.
- Perineal Massage: Spend time in the last month before birth massaging your perineal area with oil. Research has shown that, especially for first-time mothers, this reduces the chance of tearing.
- Panting: Panting or “ho ho ho” when your baby is crowning, with a loose mouth and jaw. Keeping your body flexible, especially your jaw and mouth, mirrors to your vaginal what it needs to do.
- Vocalise: Sing and moan with deep/low ‘ahh’ sighs. Make the sound vibrate in your chest or try blowing ‘horse lips’ as your baby is coming.
- Breathe: You may like to breath using short quick breaths, in contrast to the longer style breaths you may use in labour.
- Visualise: Picture your vagina opening getting enormous!
- Feel Love: Kiss your partner a little and focus on feelings of love.
- Soft Touch: Have your husband touch you with loving strokes on your back during the transition and/or in the pushing phase/
- Hot Compress: Put a very hot wash cloth on your perineum.
This Mama Stretches Beautifully…
Stephanie Renee Cluff