So, AGES ago, I wrote a blog post about what you can do during pregnancy to stack the odds in your favour of birthing your baby with an intact perineum. I intended to follow up with another post on what you or your birth partner can do during labour too, but completely forgot! So here it is, a couple of months late…..

  1. Birth in an upright position.

    We have loads of research confirming the benefits of labouring and giving birth to your baby in upright positions. Unfortunately, it doesn’t always (or even often) happen. Women may be well informed and intend to birth in an upright position, but often are directed towards the bed and end up in the lithotomy (on your back with legs up) position.

    When you’re in labour, often it’s difficult to think clearly or find your voice and this is where the birth partners come in. So, birth partners, suggest upright positions! Kneeling, standing, squatting, hands and knees or sitting on a birth stool or CUB are all positions where women are less likely to sustain significant perineal tearing. Any position the labouring woman feels like moving into, is probably the position she needs to be in. Use peanut ball, lie on your side, kneel up on the back of the bed if you have an epidural.

  2. Use warm compresses on the perineum.

    There are several studies that indicate that a warm compress on the perineum can reduce the likelihood of significant perineal tearing. Just bring a facecloth, run it under warm water and hold against the perineum as your baby’s head is crowning. Be sure to have your partner test it against his or her skin first! Your birth partner, midwife or obstetrician can do this for you.

  3. Avoid an episiotomy if you can. 

    A common reason suggested for performing an episiotomy is that it will  reduce your chance of third or fourth degree tear, particularly if a vacuum or forceps is used to help you birth your baby. However, research seems to indicate that, in most cases, having an episiotomy actually increases the risk of a large tear. Of course, there are a couple of situations where the research supports the use of episiotomy. These would include baby or mother (or both) getting very tired and/or distressed. Also, the research shows that if a forceps birth is necessary, a woman is less likely to have a 3rd or 4th degree tear if she has an episiotomy.

  4. Birth in water.

    Labouring in water can reduce the need for epidural. As a result, you’ll be able to use labour positions that feel right for you and move around freely. It seems that women who birth their babies in water are more likely to have 1st or 2nd degree perineal tears but they are less likely to have episiotomies or 3rd and 4th degree tears.

  5. Breathing techniques. 

    There is no research to recommend any particular breathing techniques to reduce perineal tearing. However, slowing the birth of the baby’s head reduces tearing. It makes sense that ‘breathing your baby down’ with spontaneous pushing rather than forcefully pushing your baby out with coached pushing should protect the perineum.

  6. Coached v Spontaneous Pushing.

    Present research shows little difference with regards chances of perineal tearing. Since slowing the birth of the baby’s head is important, as mentioned above, it makes sense that spontaneous pushing might reduce perineal tearing.

 

References

Otigbah, Chineze M. et al. A retrospective comparison of water births and conventional vaginal deliveries European Journal of Obstetrics and Gynecology and Reproductive Biology , Volume 91 , Issue 1 , 15 – 20

Dahlen, Hannah G. et al. Maternal and perinatal outcomes amongst low risk women giving birth in water compared to six birth positions on land. A descriptive cross sectional study in a birth centre over 12 yearsMidwifery , Volume 29 , Issue 7 , 759 – 764

Madhu Naidu, Abdul H. Sultan, Ranee Thakar. Reducing obstetric anal sphincter injuries using perineal support: our preliminary experience. International Urogynecology Journal, 2017, Volume 28, Number 3, Page 381

Mora-Hervás, I. S. E., Francisco Carmona, and M. Espuña-Pons. “Perineal trauma in primiparous women with spontaneous vaginal delivery: Episiotomy or second degree perineal tear.” Int J Women’s Health Reprod Sci 3.2 (2015): 84-88.

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