One concern that we hear from nearly all of our clients is their fear of tearing or receiving an episiotomy during birth. A vaginal tear is a spontaneous laceration to the perineum that occurs when the baby is coming out the vagina. An episiotomy is when the care provider uses surgical scissors to manually cut the perineum and increase the space for baby to be born. (Thankfully, these are not typically routine practice anymore as the evidence that the body will heal quicker from a natural tear than an episiotomy has become more widespread.) While the vagina is made to stretch and expand to accommodate Baby's passage, it is also made to tear when necessary to allow the baby to pass through. When they do occur, most tears are minor. Our bodies have a miraculous ability to repair themselves and heal from injuries- and vaginal tearing is no different! In fact, similar to oral tissue, vaginal tissue heals relatively quickly. Even still, most of us would rather avoid tearing if possible, and sometimes significant perineal injury may occur and necessitate pelvic therapy. So taking steps to prevent/minimze injury certainly makes sense. Here are some of our best recommendations for minimizing tearing/injury.
Talk to your functional medicine doctor or a nutritionist about the best foods and supplements to support supple, healthy tissue. Don't have access to that expertise? Many local midwives will also offer nutritional consults. (Try South Bay Homebirth Collective or Ronnie Falcao.) Most OBs have minimal training in this kind of nutritional support. Diet and ample hydration have a huge impact on healthy tissue, so start here. Our favorite book is Real Food for Pregnancy by Lily Nichols.
The perineum is the skin between the vagina and the rectum and perineal massage a gentle way to stretch the vaginal tissues, muscles surrounding the vagina, and the skin of the perineum. In addition to preparing the tissue ahead of time, it also serves to familiarize the birthing person with stretching sensations, and may help her to relax as baby is crowing and she is feeling the intense stretching of delivery. We see this lessen anxiety and increase confidence as baby is crowning. The research backs this up and shows decreased chances of an episiotomy or tear when