Perineal Tearing: Tips, Tools and Massage...

[BahamaLlama]

This is my first pregnancy and I'm terrified - one of my many fears being tearing...

I understand tearing has a likelihood of approximately 80% in first pregnancy and with the degree of tearing varying...

I have so far heard warm compresses, water birth, minimal medical intervention (e.g. forceps, etc ideally) and exercise/strengthening can help to minimise tearing.

As Mama's and considering your birthing experiences, what advice can you offer to me please?

Has anyone used perineal massage techniques? Strengthening tools/devices such as using the 'EPI-NO', 'Aniball'?

Do you think they work?

Hey lovely, congratulations on your pregnancy! FTM here to a 4 month old DS. I religiously did perineal massage with special oil and I still ended up with a third degree tear as my DS did some crazy flip on the way out. However I have heard it has worked for some so you've got nothing to loose and may as well try it when it is safe to do so!

@DisneyGirl2387 thank you

It's so hard not knowing what to expect as well as being under the impression you are able to control things... Yours and your DS flip is a case in point!!

Honestly, I don't know how/where it ever got to the point I somehow became a person who was interested in perineal massage!! xx

I know what you mean! My DH had to do mine as I couldn't reach properly with my big bump. That was a whole new step in our marriage! Haha

I think the best advice is not to worry too much about it because, to be honest, what will happen will happen. Some people do no prep and have no tear, some people do everything and do. I think the idea of it is sometimes much worse than the reality, a lot of people just get on with it and it heals and you move on. If you're terrified you're more likely to be tense and that may not help. Have you thought of hypnobirthing to give you more confidence?

DH did perineal massage for me too. Hurt like a bitch. In the end I had a ventouse birth with an episiotomy but I didn't have any other tearing, so who knows if it helped or not. I'm pregnant again now and I think I'm going to try the aniball as the research on their website looks promising. I had a complication whilst my episiotomy was healing and my pelvic floor muscles are weak since the birth so very keen to try and avoid more significant damage this time around.

There is only one thing that will save you from a year, and it's an excellent midwife. She needs to be watching very carefully in the final stage and coaching you. Most midwives don't do that to be honest. You'd think they do but they don't. I had one of my 4 who did it properly and oh my god, the difference it made. Only time I didn't tear. I begged the last one to coach me and control the delivery but I actually don't think she knew what I meant. And I tore.

I would say being prepared mentally is more important than massage of the minge!!
Get clued up on what to expect op... Write a birth plan. Be happy to negotiate on some things op... Ask your mw anything at all. Even what you may think is daft!!
Knowing what to expect - even the scarey bits will help you be able to concentrate on your breathing and listening.. Your mw will help you - this isn't a go it alone scenario!
I have had 10 vaginal births. No tears. No stitches...
Try and enjoy the birth!! It is possible!

I have to disagree with what a previous poster said about coached pushing avoiding tearing, that's complete rubbish! See Midwife Thinking blog for evidence based suggestions on tearing in labour.

Might sound a funny question but what is your fear about? Maybe we can reassure you. Some tearing is completely normal, and usually very quick to heal. Even with no tears or grazes ones vag will be a bit sore for a few days but its really not that bad, especially with squirty bottle to wash water over it when you pee.

Obvs a 3rd or 4th degree tear is more serious, but again read the blog above to read about birthing positions and practices that can minimise the risk.

FWIW I had an episiotomy in my first Labour, whixh had to be stitched. In subsequent labours I tore in that area to scar tissue but was very mild and hot an issue.

This is the blog: midwifethinking.com/2016/01/13/perineal-protectors/

I didn't do perineal massage, fully intended to but never got round to it. I ended up having a quick birth and no tears - much to my surprise!

I would echo what others have said, being mentally ready is probably more important. If you can massage then it's not going to do any harm but equally don't stress yourself out about it.

@intheFamilyTree. I think rubbish is a bit strong😂 But I do know my own experience and despite it being my third I was very surprised at when the midwife told me to hold on and breath etc as it wasn't instinctive but she was watching very carefully. I definitely would have torn without her. Also just a story about one midwife in a maternity hospital I know of (my sister worked with her) but she was known for never ever having a mother tear on her watch. She apparently have an unbelievable record which would indicate that she did something very different in her deliveries. Most midwives don't constantly stare and apply counter pressure and give very specific instruction like my one who saved me a tear did. It was a different experience.

I did perineal massage from 35/36 weeks last pregnancy. Hypnobirth classes. No tearing.

I had some slight grazing with Ds2 (Ds1 was an emcs). It was sore for about a week especially while weeing. I'd recommend having a jug kept next to the loo that you can use to dribble water over yourself while you wee.

It was a home water birth and I was on my knees in the pool. No directed pushing.

The midwife thinking blog post is a good reference. A lot of the evidence around things you can do to reduce tears is about birth position.

You are unlikely to be comfortable birthing in a position where you're likely to tear (think about if you've been constipated and torn while relieving yourself- your body will tell you how to minimise the damage). Being clear and assertive with your midwives during labour regarding who decides what position you are in is important.

@NaturalStudy Thank you for commenting.

I've not been able to afford the cost of attending Hypnobirthing classes - particularly at this time when you're unable to attend in person and I seem to be permanently stuck on online calls/meetings for work and pregnancy too.
However, I do intend to hopefully consult YouTube to provide me with an overview and with some techniques

However, you are right in regard to not feeling at all confident or relaxed about the experience and what is ahead which I am sure must be compounding things further too

@WishingHopingThinkingPraying Thank you for posting.

What you have said makes sense and adds to my fears and insecurities since I have never so far been able to even see the same midwife more than twice, visit the birthing unit or meet any of the team etc...

I can't help but to think/worry that when I do end up going into labour on the ward I'll be treated by a newly qualified midwife who will leave after a few hours as it's the end of her shift - it's just the kind of luck I always seem to have to be honest!! xx

@Easterbunnygettingready Thank you for posting.

Wow - you really are a pro!!

I will need to take your word for the experience not needing to be too bad since you seem to have kept going back for more!

I think my anxiety isn't helped as I don't feel very supported and its going to my first child - Covid restrictions obviously do not assist and my currently assigned local midwife is often not available and/or on annual leave...

I am attending online antenatal classes though and one of the other mums said that worst case I would be within my rights on the day of being in labour that I can ask for another midwife if I don't feel it's going well. Hopefully that won't need to be the case though!! xx

@BahamaLlama, if it's any comfort, I've had three labours with tears and they were all a non event. Gave me a good reason to insist on quiet baths twice a day with witchazel and without baby 😉

A good midwife is great but you do all the work yourself and honestly could do without any at all! So if you don't love your midwife on the day, them being there just to keep you safe is enough I think. Once you go into labour I think you will understand what I mean. It becomes all about you and your baby.

@WishingHopingThinkingPraying

Thank you and I do hope so!

I think its difficult, as with so many things there is potentially a huge commercialism attached where money can be made from fear mongering, naivety, etc and I have to admit I am finding it hard to extricate the facts from fiction a lot of the time since I am feeling very unprepared.

I do try as much as I can to maintain a balance by thinking of women giving birth in mud huts assisted by a village elder with a pair of rusty scissors. But then I hear and/or read more information, something comes up on my newsfeed and I am back to square one again!!

I also have to admit that I am also not the most 'practical' and laid back with things as a person either and so I can tend to panic a bit - especially since giving birth and being a mama is undoubtedly the biggest thing I will ever do in my life. Eeeeeek!! xx

I was terrified of tearing when I was pregnant but found the massages too uncomfortable. I ended up with a 2nd degree tear and 3 stitches and honestly it wasn’t even that bad. As someone else said further up in the post, it was the general soreness and bruised feeling than the tear that was uncomfortable! I had this spray that I used called spritz for bits and it was really soothing and definitely helped with feeling more comfortable in those first couple of weeks after birth.