Just like your abdominal wall stretches to make space for a growing baby, your pelvic floor and perineum can stretch and yes, even tear, to let baby out. Tears are not typically felt as discrete events in childbirth (you won't notice… it just all rolls into the big birth finale).
Due to the amount of pressure caused by your baby's head on your perineum, it is unlikely that you will feel any tearing. But everyone's birth is different and some women may find that they feel a lot of stinging, especially as the head is crowning (when your baby's head can be seen coming out of the birth canal).
Deliver in an upright, nonflat position.
There are a number of delivery positions that might reduce the risk of a vaginal tear during childbirth. Rather than lying down flat during delivery, deliver in an upright position. Your health care provider will help you find a comfortable and safe delivery position.
Background. Perineal tears affect about 80% of women during childbirth, with primiparous women being affected more frequently than multiparous women [1, 2].
The Odds of Vaginal Tearing
The position of the baby can be another factor—for example, babies facing up put extra pressure on the bottom of the vagina. Having a vacuum- or forceps-assisted delivery or an especially long labor that results in severe vaginal swelling increases your chance of tearing as well.
Background: Studies have shown increased incidence of severe vaginal lacerations (third and fourth degree) in women under the influence of epidural analgesia. This increase has been attributed to the increased the use of operative vaginal delivery (OVD), with attendant increased risk of laceration.
Most vaginal tears heal in about one or two weeks, whereas deeper tears can take longer, especially tears that require stitches (sutures), which typically dissolve within four to six weeks. Vaginal tears should be evaluated by a doctor and be treated appropriately.
Some people describe the feeling as being like intense period cramps, others say it feels like a tightening or pounding feeling in your uterus or across your belly, others describe the feeling as being like very intense muscle cramps, while still other people describe contractions as being like the sort of wrenching ...
Bleeding often lasts for around for four to six weeks, but could last up to 12 weeks after your baby's born (RCOG, 2016). If you're worried, you can talk to a health professional. Bleeding will start off heavy and red to browny red. It will become lighter in colour and flow over time (NHS, 2021).
To cleanse the area, use the "squirt" water bottle you got in the hospital. After you go to the bathroom, rinse from front to back with warm water. Continue these rinses for as long as you have vaginal bleeding. Pat (don't wipe) from front to back to dry.
For women with epidural anesthesia who do not feel the urge to push when they are completely dilated, delay pushing until the urge to push is felt (up to 2 hours for nulliparous women and up to 1 hour for multiparous women).
The American College of Obstetricians and Gynecologists considers 3 hours or more (especially with a first time mom and/or those with epidurals) to be perfectly normal.
The episiotomy tradition
Experts believed an incision would heal better than a natural tear. The procedure was also thought to help preserve the muscles and connective tissue that support the pelvic floor. Today, however, research suggests that routine episiotomies don't prevent these problems after all.
The most recent analysis (Pergialiotis 2014) combined the data from 22 studies with a total of 651,934 subjects. Its conclusion was that those with epidural anesthesia had a 1.95 times greater risk of perineal tearing than those who did not.
Pushing can be one of the most intense and exhausting parts of the labor and delivery process—and it can take anywhere from several minutes, up to a few hours to push your baby out.
Side-Lying
Howell explains that lying on your side has been known to reduce the risk of tearing. This is because it can open the pelvis more easily, and it gives control over pushing.
Most women will feel increased pressure in their perineum, rectum, and low back at this stage. For many women, the rectal pressure feels the same as having a bowel movement. As the baby's head begins to appear, you may feel a stretching or burning sensation.
However, there are still times you might be told not to push. Labor is the process that prepares a woman to deliver her baby into the world. Doctors tell a woman not to push during labor because she is not ready, there may be a problem with the baby or she may have had an epidural.
You can still push in all sorts of positions even with an epidural! At a minimum, you can push on your side or with support under your back to still make space for the sacrum. If you can move, you can even try all fours or kneeling, using the back of the bed as support!
“I encourage patients to be getting up and walking around almost immediately after delivery,” Prager says. “Even if it's a 10-minute walk around the block, it can be extremely helpful for the healing process.
Avoid stairs and lifting until your doctor says these activities are OK. Don't take a bath or go swimming until the doctor says it's OK. Don't drive until your doctor says it's OK. Also wait until you can make sudden movements and wear a safety belt properly without discomfort.
This also means that some activities and behaviors may need to be avoided or adjusted until you're at least 6 weeks postpartum, you're fully healed, or your doctor has confirmed it's OK to do so. Avoid: stomach sleeping.