Coping with fears of tearing and episiotomy

Pregnancy and impending labour and birth can make many women fearful about their own bodies. Aside from fear of not coping with the pain of labour and birth, one of the most common fears for pregnant women is tearing and the need for an episiotomy (the cutting of the perineum, the skin between the vagina and anus) during childbirth.

The fear of the effect of childbirth on a woman’s birth canal, and the delicate skin and tissue around the vagina and anus, can lead some pregnant women to suffer vagina anxiety. Many women suffer small tears during birth, and an episiotomy is sometimes necessary to help prevent a ragged tear occurring, which takes longer to heal than a cut.

How many women tear during birth?

While health experts don’t know exactly how many women tear during birth, as small tears often aren’t recorded, a UK study found seven out of ten women needed stitches for a cut or tear during birth. Bad tears, (known as third or fourth-degree tears), going all the way from the vagina to the anal opening, are much less common, with a Canadian study finding seven in 100 women suffered a bad tear during birth.

Why an episiotomy might be necessary

There are various reasons why you might need an episiotomy, such as if your baby is in distress, if your baby is in a breech position and there’s a complication, or the birth is progressing quickly and your perineum is at risk of tearing, as it hasn’t had time to stretch slowly. “The use of forceps does mean that an episiotomy is likely, but not inevitable,” confirms Dr Miriam Stoppard, author of Pregnancy, Conception and Birth (Penguin), adding that a vacuum suction delivery means less chance of an episiotomy, although it may still be necessary.

Don’t push too hard

When your baby’s head is about to be born, otherwise known as ‘crowning’, you’ll feel a stinging sensation as your vaginal opening stretches. Try not to push too hard at this point, as it can cause tears to occur. “As soon as you feel this, try to stop bearing down, pant, and allow the contractions of your uterus to push your baby,” says Dr Stoppard. “This may be difficult as you’ll probably still feel like pushing, but if you continue to push you run a greater risk of tearing or needing an episiotomy.”

Other ways to reduce tearing

Studies show that massaging your perineum, or rubbing and stretching the skin between your vagina and anus using natural oil, can help prevent tearing when you give birth. Birthing trainers, such as the Epi-no, have the same effect, helping stretch your perineum before birth. Water births can also help, along with midwives pressing hot flannels or towels on the perineum to reduce tearing.

Add ‘no episiotomy’ to your birth plan

If you want to reduce your chance of having an episiotomy, make it part of your birth plan before your baby arrives. “If you want to avoid an episiotomy, it’s a good idea to make it clear in your notes and birth plan that you don’t want it to be done unless entirely necessary,” says Dr Stoppard. “If you do have to have an episiotomy, you have the right to have a local anaesthetic in the perineum before it’s done, so insist on that.”