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As a certified childbirth educator and doula, the number one fear I hear from my clients is usually:

I don’t want to poop on the table!!!

But the closest runner-up is:

I don’t want to tear! And I DON’T want an episiotomy! How can I avoid tearing when pushing during birth?

While you may have seen the statistic that 90% of women tear during birth, few of those tears are severe enough to have a lasting impact on the vagina or rectum. 99% of tears are minor, either superficial tears near the vagina or what they call a “skid mark” down the labia, many not requiring more than one or two stitches (if at all–some providers do not stitch a very minor tear).

So what can you do to avoid a severe tear? One of the best things you can do prenatally is to feed your body well and stay hydrated. Plenty of good fats, especially from foods containing omega-3 fatty acids (think fish, flax, chia, certain eggs, fortified foods) can help support the health and elasticity of your tissues. So can Vitamin E, and research suggests that at least 1000 mg per day is the level that supports skin health. Sunflower seeds, almonds, pecans, and peanuts are great food sources of Vitamin E that you can easily add to your oatmeal, salads, and sandwiches or wraps. (Check with your doctor if you have any history of postpartum hemorrhage or bleeding disorders, as some of these nutrients may increase your bleeding risk in certain cases). 

While you may have heard of the idea of “perineal massage” (inserting fingers into the vagina and gently stretching the tissues) prenatally to help prevent tearing, some research is finding that there is a possibility of too much perineal massage causing tissues to be more susceptible to tearing than if you hadn’t done anything at all.

During the pushing phase, massaging the perineum with oil, having someone (a nurse, your partner, your doula, or your care provider) apply a warm compress to the perineum, your care provider supporting your perineum during crowning, using a care provider who practices a hands-off approach to delivering your baby’s head, and (when feasible) waiting until you have an unbearable urge to push down, pushing with your body’s urges (rather than bearing down as hard and as long as you can as soon as you reach 10 centimeters) are all practices that can help reduce the likelihood of severe tearing.

Now…for that dreaded episiotomy…we all know that at one time, providers routinely made a cut between the vagina and the anus in order to make an easier-to-stitch opening than a tear. It was thought to reduce more severe tearing, but time and research have demonstrated that *routine* episiotomies actually contribute to an increased incidence of tears that open from the vagina all the way to the anus (a 4th degree tear). This is leading some providers to make their episiotomies extend diagonally (called a mediolateral episiotomy) rather than straight down toward the anus.

These days, very few care providers perform episiotomies routinely (you should ask yours if you are concerned about it!). Times when an episiotomy can be necessary include a tight band of tissue at the vaginal opening that cannot stretch to allow your baby’s head through, if your baby needs to be delivered quickly because of medical emergency, or in the case of you developing a tear that extends upward, toward your clitoris.

Ask your questions about tearing and episiotomy prenatally, so that in the moments just before you are about to meet your baby for the first time, you can trust that your care provider will take care of you and you can focus on the moment!

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About Kate Herzel

Kate Herzel is the co-owner of Heartland Doulas alongside Stacy Ash, and together with their combined 20 years of experience and 7 doulas, they help people have really amazing birth and postpartum experiences. In her spare time, Kate enjoys cooking with her kids, brewing beer with her husband, and entertaining for her friends.