During the birth, push in a position that doesn’t put undue stress on the perineum. Semi-sitting and side-lying are good positions as long as your legs aren’t pulled back too far.
Hand-and knees works well. Lying in traditional lithotomy (on your back with your legs pulled way back) is the worst position—you are pushing uphill, so you may need to push harder, and there is a lot of pressure on your perineum.
Although squatting is a great position because it can open up the bones of your pelvis, a deep squat can put a lot of pressure on the perineum as well.
As the baby is being born, push in gentle, short pushes instead of holding your breath and pushing as long as you can. If the baby emerges too quickly, your tissues might not have time to stretch.
What your medical provider can do:
Encourage you to be in a physiologic position for birth, as above.
Encourage you to push in gentle, short pushes at the very end, instead of yelling at you to hold your breath and counting to 10.
Use warm compresses and/or arnica massage oil on your perineum, which help to decrease swelling and increase elasticity.
If the baby is doing fine, be comfortable with the head being born slowly.
Don’t cut an episiotomy. Besides making the cut, it increases the chances of additional tearing. (Every once in a while, an episiotomy can be helpful—maybe 3-5% of the time.)
Hold on to baby’s elbows and hands as they are emerging so they stay close to baby’s chest instead of opening wide and causing a tear.
Sometimes all of these things are done, and a tear happens anyway.
Sometimes the tear happens before the baby even comes out, such as from the position of a pointy elbow.
Discuss with your care provider how they will work with you to decrease tears and what their episiotomy and tear rates are. If this is a priority for you, find out if it is also a priority for them.
The Content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition