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COPYRIGHT 2003 Midwifery Today, Inc.
This is on edited version of an excerpt from her book, Get Through Childbirth in One Piece! How to Prevent Episiotomies and Tearing
Risks for Tearing
When a woman wisely decides to forgo an episiotomy, is it realistic to expect her not to tear? Certain fetal positions contribute to tearing, even when labor is managed properly. Posterior position, where the back of the baby's skull rests on the mother's spine, often causes tearing because the head is not optimally positioned to emerge. Sometimes a baby has a compound presentation, where a hand emerges alongside the head. Obviously, this position requires more space than if the head presents alone. In birth, there will always be circumstances that are out of our control. The good news for the expectant mother is that most factors are well within her control, especially if she does her homework ahead of time.
Ironically, one of the biggest contributors to perineal tearing is episiotomy, which has long been heralded as the great preventer of tearing. One recent study, which only assessed the effects of episiotomy on third- and fourth-degree tearing, found a definite correlation between episiotomy and tearing. The risk of severe lacerations was found to be nearly four times higher with episiotomy than without. Another study involving thousands of women found that the number-one risk factor for perineal tearing was episiotomy. It really should not be surprising that, like cloth, cut perineal tissue tears easier than intact tissue.
There are some other independent risk factors for tearing, such as maternal age (older women giving birth for the first time are more likely to tear), birth weight and assisted vaginal delivery (e.g. forceps). Given the choice between the lesser of two evils, a vacuum-assisted delivery is statistically less likely to make a woman tear than a forceps delivery, although it is standard practice to perform an episiotomy with assisted hospital deliveries. Take note: there have even been studies where women having forceps deliveries were not cut and did not tear. So anything is possible. First-time moms are more likely to tear deeply (82 percent vs. 38 percent with later babies).
Interestingly, stretch marks have also proven to be a fair predictor of tearing. As with maternal age, this is most likely due to a correlation with poor skin elasticity in general. A woman's basic physiology also affects her likelihood of tearing. Women with a short perineum, where the anus is close to the vagina, are more likely to tear during delivery. A childbirth educator friend of mine had a short perineum and tore with each birth except her last, in which she delivered on hands-and-knees.
Women who have scarring from a previous episiotomy or tear often worry that they will tear again along the same line. While tears sometimes do occur along the old episiotomy line, in general, scar tissue is stronger than regular skin. Because scar tissue can be less pliable, some midwives recommend rubbing hypericum ointment into the area prenatally to prevent re-tearing. Susun Weed, author of Herbal for the Childbearing Year, recommends hot compresses of herbs like plantain or comfrey leaves during labor. Certainly, one wants to be extra careful to avoid tearing, but many women with previous episiotomies have gone on to give birth intact, often to bigger babies!
Before Delivery: Simple, but Effective Preparations
Two things that women can do before the birth are to get good nutrition and do Kegel exercises. Vitamins C and E and the bioflavinoids...
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