Will I tear during vaginal birth?

Will I tear during vaginal birth?

 It's the anxiety felt 'round the world, and the question on everyone's mind...

Will I tear during vaginal birth?

The short answer kind of sucks: probably...

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Take it as a testament to just how common tearing is. Studies have even shown that rates of “spontaneous tearing” – classified as first, second, third or fourth degree tearing – are anywhere from 44-79%. 

What about perineal massage?

Enter perineal massage, which you may have heard can help.

For those who are going, huh? Perineal massage is a technique thought to increase muscle and tissue elasticity, therefore reducing your risk of tearing. 

Sounds good, sure, but keep in mind that you (or your partner) will need to insert 1-2 lubricated fingers into the vagina by about 2 inches, then apply firm pressure downward and sideways for 2 minutes each. Suffice to say, many people find this uncomfortable or even painful.

But if it works, it's worth it, right?

While you will see a lot of online resources recommend this technique, the actual evidence is nuanced. In a randomized study, first time birthers did see a slight decrease in relative risk of tears requiring stitches, and episiotomy. 

But your absolute risk will have only decreased marginally. So imagine, essentially, your efforts resulting in a difference from a 50% chance of tearing to 45%.

What's that expression...?

Meaning, if you absolutely hate doing perineal massage, or worse, find it really painful, then you have to ask yourself whether those numbers make it worth it for you.

Nothing about pregnancy and birth is one size fits all, and so many decisions are going to come down to you as a unique individual.

Also, it's absolutely worth noting that if you've already given birth before, perineal massage seems to make no difference in tearing outcomes for subsequent births (though 32% did report less ongoing pain at 3 months postpartum).

So the real question to ask is: how do I help myself heal?

 

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