r/ScienceBasedParenting • u/goodday4agoodday • 1d ago
Question - Research required Reducing Tearing during Childbirth
When I’ve researched there is a lot of conflicting information. What does the science tell us about ways to reduce tearing during childbirth?
94
u/emancipationofdeedee 1d ago
“if your provider has a high tear rate then going to have a higher risk of tears. As I mentioned, you’re giving birth for the first time. Also, if the baby has a higher birth weight, if you experience an instrument assisted delivery with forceps or vacuum use, if you are given an episiotomy, if you experience something called shoulder dystocia, where there’s difficulty with the birth of your baby’s shoulders. Interestingly, if you have a very long or a very short pushing phase, that can also increase your risk for having severe tear. So a prolonged pushing phase where you’re pushing for hours and hours and hours, or if you have a super short pushing phase and you only push for like five to 10 minutes, those can both increase your risk. Something called occiput posterior fetal position, also known as sunny side up, when the baby’s head is coming out in the largest diameter, because the baby’s head is facing towards your spine, that can increase your risk for severe tears. And then having a family history of severe tears can also mean that you’re at higher risk.”
49
u/bionic25 1d ago
Evidence based birth has a lot of information on the topic of tearing and how to avoid it.
3
u/laviejoy 3h ago
Building on this with anecdotal evidence: I started doing perineal massage every other day around 36 weeks pregnant. I ended up going into labour at 39 weeks 5 days, so had done just shy of a month of regular perineal massage at that point.
I ended up delivering a sunny side up baby (i.e. she was facing towards my belly button, not my spine or side), which is notoriously more difficult and damaging because the largest part of the head travels through first. She also had a 97th percentile head. After 3 hours of pushing and her getting stuck, she was born with the assistance of a vacuum.
I ended up with a second degree (relatively mild, external) tear. When the OB started on my stitches, literally the first thing she said was "wow, did you do perineal massage??" When I told her that yes, I did, she responded "I can tell, I was absolutely expecting this to be a 4th degree tear given the birth you just had!"
TL;DR: Perineal massage likely saved me from a 4th degree tear.
-8
u/kp1794 1d ago
Is EBB legit? I listened to one of their podcasts once and they seemed SO biased and dismissive of science and research
13
u/roughandreadyrecarea 1d ago
What? She’s a nurse with a PhD whose entire platform is breaking down research for people to understand better.
5
u/bionic25 1d ago
This. She has a full team of professional researcher, midwifes, nurses, doctors... All articles/ episodes are dully researched and reviewed by professionals in the field. It lives up to it's name. Maybe the tone is strrange to you because they discuss the research and point out what could be flawed in studies like it's construction and make often no definitive statement has the outcome is unsure or there are conflicting papers.
1
u/kp1794 1d ago
The episode I’m referring to was on the ARRIVE study, it was a doctor and a student talking back and forth. The study is pretty clear in its findings that 39 week inductions have more favorable outcomes but they were super dismissive of this and just said the study was flawed and that the results were random. It was very odd considering it’s a legitimate study.
4
u/Current-Base1727 1d ago
Clear outcomes are not necessarily a good measure for the quality of the research. In fact it can be quite the opposite. This being said: I have neither listened to the podcast nor looked at the study. But if there are flaws to be pointed out the outcome is not reliable.
0
u/roughandreadyrecarea 1d ago
Thanks for answering this as I didn’t know how to respond. My main takeaways from that podcast were that the research was flawed because it’s essentially impossible to have a real blind study when performing inductions because the doctors know they’re participating in the study. Therefore they will have a bias toward the preferred outcome (less C-sections). And that difference in outcomes was so small that it really didn’t make much difference on an individual level. I agree with the other poster that it may be an unusual tone because they really didn’t finish with a definite yes or no answer on what’s right. That’s up to you.
1
u/haruspicat 13h ago
One of the skillets a scientist needs is understanding the flaws in others' research, so they can design studies that avoid those flaws. That's how the entire evidence base gets better over time - a flawed first study is followed by a less flawed study, or one that's flawed in a different way, and after that's happened enough times we reach a point where scientists mostly agree that something is true. That's when it shows up in public health advice.
Criticizing a study for legitimate flaws isn't anti-science; it's just about the most scientific thing there is.
-34
31
u/Adventurous-Step-363 1d ago
My experience, a journal article, and new resources I found through a prolapse group:
1) I tore internally and externally. My internal tear was stage 2 of my levator ani (mid-level pelvic muscle at 50% torn) and also led to tearing my obturator internus (large hip muscle) stage 2 due to compensation. Not to mention my lower levators stretched and have not come back together (I did not realize that could happen). Subsequently, I have two types of prolapse, two tears (the external tear was stitched and healed, the internal was left alone; a surgeon said even if the skin was stitched it wouldn't have healed underneath, and surgery couldn't fix it anyway), and a "gaping" vagina because my muscles are separated.
2) This is a 2024 paper by one of the best researchers I've found on this topic: https://pubmed.ncbi.nlm.nih.gov/38168908/
3) Additionally, for your FYI, there is a sports medicine doctor in DC, USA who teamed up with a physical therapist and they now do ultrasound-guided PRP injections for pelvic floor muscles. Here's his first published case study: https://www.ijcriog.com/archive/2025/pdf/100194Z08IS2025.pdf
Here's a podcast episode he did late last year so you can learn more about what he does: https://youtu.be/9yNpF9eCkcA?si=v0GBKIc2MVokuMd-
I'm going for my second treatment in May, and they'll look using ultrasound to see how much my tears have healed from my last visit. (No doctor I spoke with gave me a solution for healing my muscle aside from surgically stitching it together and hoping it regained function, essentially. I found out about PRP on a Facebook prolapse group.) I will say my symptoms are 50% better than pre-first treatment, and I regained function of my lower levators, even though I'm still "gaping". They previously were not moving at all.
I think some of the patients from Dr. Siddiqui will be on a live with this pelvic floor and ortho therapist, Dr. Margo, soon (this is another interview from Dr. Siddiqui, but she also mentions she'll be talking with some of his patients soon): https://www.instagram.com/reel/DGqdqv5pnUO/?igsh=Z21zcXlmeTIxdzcx
I wish you luck!
17
u/goodday4agoodday 1d ago
Oh my gosh. I’m glad you have hopefully found a treatment to help. This makes me just want a c section lol
44
u/Adventurous-Step-363 1d ago
My story definitely isn't everyone's story, but I do think most people talk about perineum tears. Mine was a deeper muscle and externally up to the clitoris (crazy! Missed by two cm). We did do a lot of perineum stretches, which may have helped. The first paper I linked talks more about ways to prevent deeper tears.
I wish I had been less adamant about a natural birth, lol. (Some women with C-sections still get prolapse, but vaginal delivery is still the most common cause.) A lot of women don't notice prolapse if it happens (and apparently the vaginal rugae falls typically, and many women don't notice and it isn't considered a prolapse by doctors, and many surgeons don't fix it if you do have surgery). I think it's weird that we are told we'll bounce back up until after we have a baby, and then it's "duh, of course your vag will never be the same!"
Anyway, it's been 19 months and my life isn't over like I thought it was, lmao. I hope to get back to sports next year. But if you are at all familiar with your vagina or are attuned to discomfort in your pelvic floor at all, you will absolutely notice changes. Doesn't mean there's permanent damage, and you can definitely become symptom-free regardless.
G to PT, before if you can, but definitely after even if you think you feel fine. Go for 6 months, bc your core will be separated and your butt will be gone (unless you are in excellent shape and working out) and you'll need to know how to re-engage those things - my brain literally wasn't connected to my pelvic floor anymore after birth, I had rib flare, my psoas was impossibly tight, etc.
Don't have a Pelvic Floor PT nearby? Great at home programs include: MUTU, Get Mom Strong (weights based), Restore Your Core (yoga-based, excellent library of resources for all sorts of things). And join Facebook groups if needed. Those women saved my life, bc I was truly depressed. Now I have a ton of tools for comfy sex (OhNut and a pelvic floor wand to release muscle tension), PRP to heal my tears, a Pessary to wear internally and hold my organs up, understanding of different surgery types if I choose to go that route after PRP(e.g. a Urogynocologist vs a cosmetic Urogynocologist, for example).
Sorry for being so long-winded. This has been an obsession bc I thought I'd never play sports or lift my kid again (and many doctors say this!), but I'm on such a good path now. Hope I didn't freak you out!
4
21
u/BogeyJudy 1d ago
The effect of late pregnancy consumption of date fruit on labour and delivery
Eating dates! Per this study, 6 dates per day during the last 4 weeks of pregnancy. I followed this guidance for both my pregnancies (starting at 34 weeks) and had minimal tearing for both births.
Same experience for a couple people I know who did the same thing.
0
u/Space_Croissant_101 1d ago
I have been reading about this too and feel so sad that I have IBS and dates are part of the food my body cannot process 😭
16
u/chickpeahummus 1d ago
Here is one article about the EpiNo device, designed to stretch the perineum and prevent episiotomies and tearing (episiotomies are less common nowadays, but were very common when the device was invented): https://pmc.ncbi.nlm.nih.gov/articles/PMC4769774/
Without a good trial, it’s hard to say if the effectiveness is being measured accurately, since compliance is all self-reported. It looks like there is some benefit in spite of the low quality data.
13
10
u/pooponastoop 1d ago
I know it's completely anecdotal, but I used a device similar to the EpiNo after week 37 and didn't tear for my first. I think it just got me used to the breathing techniques and focusing on not bearing down too hard/trying to slow things down.
Edit: forgot to mention, I also did perineal massage after week 35.
2
u/Kindly-Olive-3537 1d ago
Anecdotally I have heard great things about EpiNo. My doctor recommended it with our first but it didn’t arrive in time.
8
u/sapphire_green 1d ago
Also anecdotally, I used the Epino myself. Started at 35 weeks with diameter of 5.5cm. At 40weeks I was streched to 10cm. And I did not tear one single bit. Even went to pee 1h after birth and nothing burned. I was well. Extra plus: With the epino I could train which muscles to (not) use to press out the ballon (which simulates the baby head). Experience 10/10 would use it again.
2
u/chickpeahummus 1d ago
I was a bit annoyed the instructions say not to start until week 37 because I’m at week 40 and I’m only at 9cm. If I had started at week 35 I would be in better shape.
1
2
u/whirl_without_motion 1d ago
I'm used it, still tore to 3rd degree, but glad I used it to get used to the sensation and feel more prepared for it mentally.
11
u/handyfruitcake 1d ago edited 1d ago
Anecdotal, but I had several risk factors when I gave birth to my first back in November (vacuum delivery, very long pushing phase, OP fetal presentation, in addition to nuchal cord) and I only had a first degree tear that needed two stitches. My doctor was very surprised because of all these risk factors and she told me she expected at least a 3rd or 4th degree tear. I personally think it’s because me and my partner did perineal massages for a couple weeks before delivery, but obviously I don’t know for sure. I did find an article that said perineal massages may reduce tearing or episiotomies but it doesn’t seem to make a huge difference and the impact is mostly for women having their first child: https://pmc.ncbi.nlm.nih.gov/articles/PMC1403252/#:~:text=The%20women%20in%20these%20trials,%25%20CI%200.86%20to%200.96).
Edit to add: In addition to vacuum assisted delivery, OP presentation, and long pushing phase, baby’s head was/is 97th percentile. Also, I don’t think this study would’ve captured the difference between a 4th degree or 1st degree tear because they’re both tears and both require stitches, but in my opinion that reduction would be a huge difference.
22
u/SecretScientist8 1d ago
As someone who had a 4th degree tear, it’s a huge difference.
12
u/Affectionate_Big8239 1d ago
Agreed. I had a third degree tear with my first and a first degree tear with my second and there is a world of difference. There’s a huge difference between 3rd and 4th, too.
5
10
u/_jajangmyeon_ 1d ago edited 1d ago
I practiced tons of breathing techniques at home and with doula during my pregnancy. One thing that contributes to tearing is “purple pushing” aka when you hold your breath and push. Holding your breath cuts of blood flow which minimizes the amount you’re able to “stretch.” My doula compared it to when you’re holding breath and straining while pooping. We all know that’s not good for pooping and contributes to hemorrhoids. Also pushing with the surges of your contractions helps a ton. Of course this could be hard if you have an epidural because some people say they can’t feel anything so they have to push with the nurses/midwives guiding them. From my experience, I had an epidural but was still able to feel all contractions and move my legs slightly. I breathed through pushes (something called horse lips) and I had no tearing. I did still end up with 1 stitch on each side due to very minimal cuts. Hope this is helpful!
Effect of Breathing Technique of Blowing on the Extent of Damage to the Perineum at the Moment of Delivery: A Randomized Clinical Trial https://pmc.ncbi.nlm.nih.gov/articles/PMC5364755/
Edit to add: also look into birthing positions. The position were traditionally shown (on back with legs apart) doesn’t allow for your pelvis to open up which can contribute to tearing. The bones that make up your pelvis move to allow for baby’s head to come out. Look up “knees in, calves out” which helps widen the pelvic opening and makes pushing easier.
3
u/toreadorable 1d ago
I did the same. I am all about the breathing. I had 2 babies, 8 and 9 pounds, epidurals both times, zero tearing either time. I had 72 hour labors both times, and just went to the hospital for epidural and delivery the last 4 hours each time. Anyway, after 2.5 days of breathing with contractions, I just breathed through the pushes too.
I also have a lot of dumb luck, and a lot of skin elasticity. Idk which part mattered more.
5
u/McNattron 1d ago
Waterbirth can help protect the perineum (the tissue between the vagina and rectum). Both randomized trials and observational studies have found that waterbirth is associated with a higher rate of intact perineum and lower episiotomy rates (Chaichian et al. 2009; Gayiti et al. 2015; Burns et al. 2022). In addition, the largest observational study found that waterbirth is associated with a lower rate of severe perineal tears (3rd or 4th degree lacerations) (Bovbjerg et al 2021).
I had an episiotomy for my first (on back mostly due to epidural).
For my second i had a waterbirth- despite increased risk factors due to my episiotomy i only had a 1st degree tear. Best advice from my midwife was that she recommended feeling baby crown and when you have the ring of fire feeling pause give your body time to adjust and be ready before pushing again.
If water birth isn't an option use gravity when you can. My third I couldn't use water due to fetal distress. I was upright over the back of the bed only 2nd degree tear despite only pushing for 5 minutes (couldn't go slow and let body adjsut when i would have due to fetal distress).
3
1
1d ago
[removed] — view removed comment
0
u/AutoModerator 1d ago
Thank you for your contribution. Please remember that all top-level comments on posts flaired "Question - Research required" must include a link to peer-reviewed research.
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.
1
1d ago
[removed] — view removed comment
0
u/AutoModerator 1d ago
Thank you for your contribution. Please remember that all top-level comments on posts flaired "Question - Research required" must include a link to peer-reviewed research.
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.
•
u/AutoModerator 1d ago
This post is flaired "Question - Expert consensus required". All top-level comments must include a link to an expert organization such as the CDC, AAP, NHS, etc.
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.