Placing a warm cloth on the perineum during the second stage of labor might help. Perineal massage. During the second stage of labor, your health care provider might place two fingers of a lubricated gloved hand just inside your vagina and move them from side to side, exerting mild, downward pressure.
Perineal massage while pregnant
From 35 weeks onwards, you or your partner can use daily perineal massage until your baby is born which may reduce your risk of tearing. This is particularly beneficial for first-time mothers. You may choose to ask your partner to help you with this.
Birthing in the side-lying position has been shown to reduce perineal tearing by allowing the presenting part to descend more slowly (Shorten, Donsante, & Shorten, 2002).
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).
First-degree tears usually cause some pain or stinging when you urinate. They may not require stitches, although some of them do. If a first-degree tear does need stitches, that repair typically can be done in the delivery room. These tears usually heal within several weeks.
An episiotomy makes the opening of your vagina wider, which allows your baby to come through more easily. Sometimes your perineum will tear naturally as your baby comes out. This is called perineal tear (or laceration). Healthcare providers don't recommend routine episiotomies and prefer that you tear naturally.
But if you're close to 10 centimeters dilated the research suggests it's not an issue. Evidence suggests it's more of a theoretical fear that just adds additional stress and in some cases results in an epidural (or a higher dose of epidural) to mask that urge.
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.
You may feel pressure and the urge to push. Your doctor or midwife will let you know when to start pushing. How Long It Will Last: On average this stage can last 1 ½ to 2 hours with your first baby. However, you only push when you are having a contraction and you can rest in between.
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.
Consider deeply penetrating positions such as cowgirl or from behind. These may better stimulate your cervix and get the prostaglandins from sperm to induce labor. Avoid having sex once your water is broken. This can introduce harmful bacteria into the birth canal.
Take away: One study shows that epidurals increase the risk of tearing. Another says that the reason more tearing occurs with epidurals is that more first time moms choose epidurals and first vaginal deliveries are already associated with a higher risk of tearing.
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.
Transition to the second stage of labor
This can be the toughest and most painful part of labor. It can last 15 minutes to an hour. During the transition: Contractions come closer together and can last 60 to 90 seconds.
Most women find the most painful part of labor and delivery to be the contractions, while some others may feel pushing or post-delivery is most painful. Pain during labor and delivery may also be caused by pressure on the bladder and bowels by the baby's head and the stretching of the birth canal and vagina.
While slightly more than half said having contractions was the most painful aspect of delivery, about one in five noted pushing or post-delivery was most painful. Moms 18 to 39 were more likely to say post-delivery pain was the most painful aspect than those 40 and older.
The most common reason for telling a women not to push is that her cervix is not fully dilated. Often when a baby is in an occipito posterior position the woman will feel the urge to push before the cervix is completely open.
As of 2019, the American College of Obstetricians and Gynecologists (ACOG) no longer recommends laboring down for people who've had an epidural. They recommend that people should begin pushing once the second stage of labor begins, even if they don't feel a natural urge to push.
In first-time vaginal births, you're more likely to have worse injuries if the perineum tears on its own than if you get an episiotomy .
Up to 9 in every 10 first time mothers who have a vaginal birth will experience some sort of tear, graze or episiotomy. It is slightly less common for mothers who have had a vaginal birth before. For most women, these tears are minor and heal quickly.