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	pregnancy & birth birth preparation

How To Prevent Tearing

There are several steps you can take before and during birth to prevent tearing:

Good nutrition. It's important for keeping all of your tissues supple.

Kegel exercises. In the weeks leading up to birth, Kegels are helpful in maintaining tone and blood flow, although it is possible to do too many; between 20 and 30 a day is probably about the right number.

Perineal massage. Before the birth, some women use massage to stretch the perineal area, although this is not necessary. Practicing relaxing the area can be helpful, however, as you will need to do this during delivery.

Squat and shout. In her book Active Birth, Janet Balaskas lists several ways to avoid tearing during birth, including giving birth in a darkened, private place, using an upright or squatting position, following your body's cues about when and how to push, applying hot compresses (if it appears necessary), and feeling free to shout as the baby emerges.¹

Rest on all fours. The importance of being able to move around during labor cannot be overstated. Upright positions, including squatting, standing (supported), and all fours are ideal for taking pressure off the perineum, as is a side-lying position. Unfortunately, the semi-propped position that most hospitals now advocate is not a good one for keeping the perineum intact. Not only is the pelvic outlet smaller in this position, but the perineal tissues are stretched unnaturally.

Water birth. Giving birth in the water may also help prevent tears, as water distributes the pressure evenly and slows the birth.

Go slow. Whether in or out of the water, both Balaskas and Harper suggest that the birthing woman place her own hand on the perineum during crowning, so that she "can work with the contractions and slowly ease the baby out without tearing the perineum."²

Pant. When possible, panting can be encouraged instead of all-out pushing, to slow the birth; a woman feeling the baby emerge may do this instinctively.

Notes
1. Janet Balaskas, Active Birth (Boston: Harvard Common Press, 1992).
2. Christiane Northrup, Women's Bodies, Women's Wisdom (New York: Bantam, 1998), 469.