One of the most common fears birthing people have is tearing during birth. Many of your clients will want to know ways to prevent tearing during birth. As a doula, you can help support, educate, and reassure them about typical birth.
Sometimes tears happen. However, the majority are quite minor and will heal well within six weeks. Occasionally, severe tears do occur.
The good news? There are many things you can share with your clients to help them reduce their risk of tearing.
Here are ways to prevent tearing during birth:
Choose an Evidenced Based Care Provider
Encouraging clients to choose a midwife or obstetrician who stays up to date with evidenced-based care is an important part of being a doula. We never should pressure, push, nor say negative things about their providers.
However, we can provide them with questions to help them make informed decisions. Things such as:
- You can ask your provider under what circumstances they recommend an episiotomy
- Are they used to patients giving birth in a variety of positions?
- What, if any, movement restrictions do you try to use with patients?
- Does your birthing facility (e.g. hospital) implement any restrictions?
When you share the evidence about birthing upright, the few situations an episiotomy may be warranted, and patients’ rights, they might decide a provider is no longer a good fit for their birth plan.
Prevent Tearing During Birth – Stay Upright!
When we look at the pelvic space, often called the pelvic floor, it is easy to understand why birth position matters. While pelvic floor is the typical term used by medical providers, as educators we understand how words impact thoughts.
In general, floors are hard, have no give, and are not flexible. The pelvic floor is made of muscles, ligaments, nerves, glands, and more. It is flexible and the space ebbs and flows.
As a doula, you can help educate clients about their pelvic area. Using language such as pelvic space can help them understand how it functions.
When people give birth in more upright positions, there is less pressure on the bottom of the pelvic space. Less nerves are compressed. Muscles have less weight and pressure on them. And in terms of tearing, there is less pressure on the perineum where most tearing occurs.
When one tears while giving birth upright, the tear is often minor.
Positions for reducing tearing can be used in unmedicated births as well as epidural births. For unmedicated births, some positions include:
- Standing upright
- Standing and leaning over the bed
- Leaning over the birth ball while on all fours
- Using the “throne” position on the L&D bed
- Using a CUB birthing device
- Assisted squat
- Using the squat position with the L&D bed
- Being on all fours on the bed
- A variety of positions in a birthing tub
For those who have had an epidural, these positions can help:
- Using squat bar in the bed with support
- The “throne” position with L&D bed
- Pushing on your left side – not upright but aids in keeping pelvis open
- Occasionally, if there’s some movement in legs, assisted all fours or leaning over headboard
Staying upright is an excellent way to reduce tearing. As a doula, having this discussion before birth can help prepare your clients for active birthing. Reminders during the pushing phase can also help.
Water Birth to Reduce Tearing During Birth
As a doula, you’re not going to tell clients where and how to give birth. However, you can provide information about birthing options. The option for water birth can vary significantly based on available practitioners and facilities in your clients’ area.
Some hospitals have birthing tubs. Most birth centers have birthing tubs and the option to birth baby in the water. Many homebirth midwives have rental tubs or assist with birthing in a home tub.
During prenatal consults, if a client is concerned about tearing, you can discuss water birth as one potential option for reducing their risks.
Warm Perineal Support During Pushing
This is a hands-on option which is typically done by a medical provider. In some cases, perhaps home births, doulas have aided with this. Be sure to never apply anything to a client without permission and only in a non-medical way (e.g. before crowning).
Perineal support can reduce tearing. However, not every birthing person is comfortable with any hands-on touch during the birthing process. Some birthers will even apply support themselves.
The warmth aids in improving circulation which can be beneficial for tissue stretching.
Avoid Episiotomy to Prevent Tearing During Birth
Once upon a time, episiotomies became a standard of care for a while. We quickly learned they were rarely beneficial, but practices can be slow to change.
As a doula you can help your clients understand the importance of asking their providers about episiotomies. Questions to ask include:
- Under what circumstance do you recommend an episiotomy? (A good answer is rarely, except if baby is in true distress, a tear is occurring upwards rather than down by perineum, angled to avoid rectal tear when it looks like a rectal tear is likely)
- Do you always ask for expressed, informed consent before giving an episiotomy?
- How frequently do your do episiotomies?
The reason episiotomies first became practice was providers assumed it would be easier to repair. However, there’s no evidence a straight cut is easier to repair. In fact, it increases the risk of a deeper tear due compromising in tact tissue.
Breath Baby Out, Don’t Push
Gone are the days of purple pushing. When birthing people push as hard as they possibly can, they are more likely to tear. Aggressive pushing does not allow much time for the tissue to expand.
Breathing, rather than pushing hard, as baby is crowning, allows time for the tissue to expand. This can greatly reduce the risk of a severe tear.
As a doula, you can spend time during the prenatal period helping to alleviate your client’s concern about tearing. During birth, you can remind them of all their options.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...