I just received a message from a dear friend, who is planning a home birth for her next baby, soon to arrive in just a few weeks. She asked me if I had any advice on how to avoid perineal tearing. I know I have written about this before, but I suppose I felt the need to reiterate… Here goes:
The only way to possibly minimize perineal tearing is to stay away any situation in which anyone might try to “manage” your birth in any way (the hospital!). Stay as relaxed as you can during the birth process, and continually tell yourself throughout the birth process (in your head as well as out loud if you need to): YES, I am calm, my baby is coming, I love my baby, this is good, this is wonderful, YES.
I would recommend that you get comfortable with the idea of being in charge of your birth. Even if you have people present with you at home who have attended births before, I would practice thinking about and affirming your authority over the process. My personal preference during the birth process is to ask people not to speak to me unless I address them, and to just give me my space, and to fulfill my every desire and need if I ask. Anyone present at my birth is my servant. This is also a good dynamic for preventing tears. When you have people around who are telling you to push, or telling you what a great job you’re doing, this can have the effect of pulling you out of your head, and away from listening to your body, and of being centred and of deeply tuning into yourself, all of which are of primary importance when birthing.
Other than this, all the crap about massaging the perineum with olive oil and other oils, blah blah blah, is, in my view (and in the view of many birth attendants) totally bogus. Do it if you want, but remember that excessive perineal massage can actually cause bruising and pain, and really doesn’t do a darn thing to actually actively prevent tearing.
But what I really want to emphasize here is that it is SO important to understand that our bodies are *perfectly* designed to give birth. Tearing is sometimes part of this perfect process: completely normal, and perfect. Tearing does NOT “hurt”. It happens in an instant as your baby’s head is emerging. You will likely only notice after the fact, that you tore, because during the birth, your perineum is stretched white and the tear will happen at the exact point that your baby’s head comes out, which is a glorious feeling. And when you are holding your beautiful baby, nothing (NOTHING!) else will matter.
Ultimately, I urge you, (lovingly!!) to get over the fact that your perineum may tear. It is completely normal, and if NO ONE is touching you, or “examining” you, or pulling your baby out with foreceps, the tearing will be minimal, and no big deal at all. We are all paranoid about perineal tearing, and I believe this has to do with our general fear about birth and bodies in general.
Also remember, and be thankful, that you are going to be birthing at home, which means that NO ONE will be giving you an episiotomy. (And please confirm this with all your potential birth attendants. Episiotomy is barbaric and unnecessary, and will INCREASE tearing–think of a piece of paper: if it is intact, it is unlikely to tear. Once you make a cut in a piece of paper, if you pull it just a bit, it will tear *much* more readily and severely).
I tore quite badly during my first birth, and while I whined a little bit afterwards, it was not a big deal at all. I did NOT receive any stitches (thank goodness). The grand majority of tears will heal perfectly well on their own, stitches can cause additional problems that Mums really shouldn’t have to deal with. Our bodies are designed to birth, designed to open for our babies’ passage, and designed to heal.
I did treat myself with comfrey sitz baths (comfrey should only be taken externally), and I did put my own breastmilk on my yoni, which, yes, has near-magical healing properties (only YOUR OWN breastmilk, natch).
Also, you should know that tearing **does not*** negatively affect your sexual experience. I am so sick of hearing women say self-hating things about what beautiful childbirth does to our bodies. When we tear during childbirth, it is the outer and inner labia that tear, and this has nothing to do with the internal muscles of the vagina. The clitoris, also, is out of play during the potential tearing that occurs during the birth process. No woman’s clitoris has ever torn during childbirth.
My own yoni is lopsided, with a hangy-down bit. I can honestly say that I LOVE that I have been marked by the births of my babies, and it hasn’t even crossed my mind that I would be self-conscious about this. Fabulous.
If you do tear a bit, know that peeing afterwards will be painful for a few days. This also, is normal. I think that tearing and being a bit sore and having ouchy pees serves a PURPOSE: to keep us in bed, skin-to-skin with our babies, not running around all over the place, wearing ourselves out, and making ourselves sick.
With my second baby, I tore a little bit, but it was very minimal and no biggie at all, and I was over it after a couple of days. With my 3rd, 4th and 5th babies I did not tear at all.
I also want you to know that you should feel totally comfortable making love as soon as you feel comfortable making love. Nevermind the 6 weeks after business, or that business about waiting until you have absolutely no lochia (discharge) whatsoever (when might that be, 2 months after? silly). These are arbitrary rules made by people who don’t respect or understand women’s bodies and who are still being unconsciously influenced by sexism and a fear and hatred of women’s sexuality. With my first baby, my body wasn’t ready for sex until a month and a half later. When Treva was born, I had sex with Lee the next day. Contrary to popular opinion, the risk of infection is really minimal–IF you have had an un-disturbed totally spontaneous birth (again, hospital birth is a totally different story). I think sexual expression should be encouraged after birth (as soon as mum is ready). Taking care of a baby can be tiring, and dads can sometimes feel left out. Making love is connecting and healing.
In a nutshell, relax. Your body is a brilliant genius.