Tearing, what are the chances?
In a normal, uncomplicated birth, tears to the genital area can be a very unpredictable occurrence. Some caregivers will try to pre-empt the likelihood of a woman tearing by looking at her skin type, her ethnicity, whether she is physically fit, or if she has stretch marks, but in reality it is not possible to know. Even
perineal massage or using a
childbirth trainer holds no guarantees.
There are some factors though, that are associated or correlated with tearing or with avoiding tearing. These can include:
The position you are in when you give birth
Your pelvic floor relaxation
If it is your first or subsequent baby
Perineal massage
Using a childbirth trainer
Panting, not pushing
Water birth
The speed of the birth
Assisted delivery
Larger babies
Hands 'on or off'?
Fiddling with the perineum
Swollen perineum
The position you are in when you give birth
It is possible to give birth without tearing in any birth position as it is possible to tear in any birth position, but different positions for birth can influence the likelihood of a tear, the extent of the tear and where on the genitals the tear will happen. Some women wish to optimise their chances of an intact perineum by assuming a certain position for birth.
It has also been shown that when women are allowed to assume the position of their choice, the incidence of all tears and the use of episiotomy are greatly reduced. The following section discusses the likelihood of tearing for various birth positions.
All fours or kneeling
Side-lying
Squatting, birth stool, toilet
Standing
Semi-reclining on pillows, lying on back and stirrups
All fours or kneeling. These positions are the most likely to achieve an intact perineum. The pressure is taken off the perineal tissues, the actual birth is slowed and the woman is less able to physically tighten the pelvic floor muscles.