Why getting ready for the natural childbirth?
At the preparation for childbirth classes (held by professional doula and obstetrician for many years) some of the pregnant women always ask: “Is there any special way to prepare the perineum to completely avoid or, at least, to reduce the risk of vaginal tear during childbirth?”
Under the vaginal tear prevention, women usually mean perineal massage, a technique which is described in some books for pregnant women. As a rule, the other question appears: “If you do not massage the perineum, is the risk of getting vaginal tear high at childbirth?” Why are the women so worried, since childbirth is a natural process? The thing is that our nature has survived a lot of changes within the past centuries. So have changed the demands of the women towards the process of the natural childbirth. Less pregnancies, less experiences, more medical knowledge in the field. In the past centuries the risk of death at pregnancy was high and it was meaningful to avoid such a terrible outcome. Today women are quite safe and they want to know, what can they actually do for the vaginal tear prevention, reduce pain in and avoid any damage to the tissues in the natural childbirth.
Vaginal tear in childbirth – the risk factors
To start with, it is necessary to understand what the risk of emergence of vaginal tear at childbirth depends on. Some are important:
- the elasticity of the tissues of the pelvic floor;
- the size of the baby’s head;
- the speed of appearance of the head and shoulders (just these parts of the baby’s body are able to break the maternal tissue).
In turn, the elasticity of the perineal tissues depends on genetic factors (dermatologists and cosmetologists are well aware that there is a low-stretch skin by nature, and there are skin-types that are prone to rupture), on the quality of the local food and on the date of childbirth.
It appears that if a woman gives birth prematurely, her crotch more susceptible to tearing during childbirth. It seems evident that in case a baby is born prematurely, and therefore, with a small head and narrow shoulders, the risk of the vaginal tear is lower. But in fact, the mother, in that case, risks more to have vaginal tears.
This phenomenon is easy to explain: It’s a woman’s body during pregnancy is consistent with the purpose of pregnancy and safe childbirth.
So close to childbirth, i.e. 37 – 38 weeks, the elasticity of perineal tissues rises a lot, and many mothers don’t have tears and even cracks while giving birth to a very large baby.
The second factor: the size of the baby’s head. As was noted above, even a very small head can tear the perineum if the woman gives birth prematurely. However, if the birth happens in time, and the baby is big, the risk of rupture during childbirth is still higher than during the birth of medium size baby. It’s very difficult to influence on the baby’s size, it depends primarily on genes, and in less a degree on nutrition and lifestyle of the pregnant woman.
The third factor: the speed of passage of baby’s head and shoulders through the female crotch. In the case of rapid childbirth, the speed can be quite high. In addition, even if the birth goes slowly, the last two-three attempts (that lead to the appearance of head, shoulders and all body) are usually very powerful. At this moment, the actions of the midwife are extremely important. She leads a woman and can influence the speed of baby’s appearance.
How to give birth without the vaginal tear.
Here, actually, we came to practical conclusions. So, in order not to tear in childbirth, you must:
- Do everything in your power to give birth on time.
- Take care of the local nutrition of a crotch.
- Learn to recognize and, if it’s possible, to lead the muscles of the vagina and the pelvic floor, to be in labor an active participant of your own childbirth.
Let’s discuss each point in details.
Premature birth, besides physiological reasons, has, of course, psychological basis, but that is a topic of another article. In order to avoid pregnancy prolongation (thus leads to increasing of the head, and, that is no less important, to the sealing of the skull bones) you’d also have to mind the whole process, but not to be obsessed with vaginal tear risk. On the contrary, the kind of obsession may lead to the prolongation of pregnancy and, as a result, to the vaginal tear.
Vaginal tear prevention. Oiling.
In the literature for pregnant women, there are recommendations for the vaginal tear prevention during childbirth, about the preparation of female perineum for the birth. There is even a special oil created for perineum massage (I know a couple of brands). I usually recommend oiling not only the perineum but the body, as during pregnancy, skin of the whole body usually dries and its elasticity decreases. Although nature intended so that, due to the hormonal changes, the elasticity of the perineum is clearly increasing for childbirth, it’s not superfluous to make it better.
For oiling the body, you can take any vegetable oil. The almond is considered to be the most valuable, but olive, and sesame, and sunflower are also useful. You can choose any oil and add to it a few drops of aromatic flavor. In my experience, the majority of pregnant women choose orange, lemon, cedar or eucalyptus. In this matter, you should listen to your own preferences.
Oiling procedure itself is most convenient to do in a sauna, but if you don’t go there you can use the bathroom. Having prepared the oil, you have to undress and oil the body abundantly, including the intimate area. Then you need to sit at least 10 – 15 minutes, then add the oil to those areas of the body that have absorbed the previous portion (feet, shins, forearms, and elbows are often especially dry).
After another 5 – 10 minutes you can start washing. To wash away the oil, you must first smear the body with “porridge”, prepared from oats, corn or pea flour (simply add warm water to flour until the consistency of liquid sour cream). The skin gets extra food from this porridge, and excess of oil can be easily removed. You don’t need to use gels and scrubs.
It should be noted that in India, pregnant women oiled this way every day, you will get a good result doing this procedure even once a week.
In addition, for the vaginal tear prevention during childbirth, you can use oiling right before the birth (about a month) to begin oiling vagina directly. For this oiling, you can use ghee butter. I advise you to prepare it by yourself because ready ghee does not always have a good quality.
In the evening, before going to sleep, you need to detach a piece of melted butter the size of a walnut and put it into the vagina as deep as possible, at night oil will impregnate well its sides. Contraindications for this oiling are expressions of the inflammatory processes, accompanied with itching and abundant selection. In these cases, you must first conduct a sanation, and only then start oiling.
Vaginal tear prevention. Intimate gymnastics.
In order to increase blood flow, and thus improve the nutrition of any muscle of the body, you should regularly tense and relax this muscle. Therefore, in order to influence the elasticity of the tissue of the pelvic floor, you must do intimate gymnastics daily.
I offer three exercises of such a gymnastic. You can perform them in any body position: lying down, sitting, standing in the “cat pose.” They don’t take a lot of time and bring good results in the case of regular performance. These exercises help to improve blood flow to the tissues of the pelvic floor and increase elasticity. In addition, you are training the ability to control vaginal and perineum muscles, which also reduces the risk of the vaginal tear.
Exercise 1. Kegel Exercises
Alternately tense and relax the muscles of the perineum. At the moment of maximum tension, tense the muscles of the anus and vagina. The regular exercising may help the vaginal tear prevention.
Exercise 2. “Bag”
Imagine that the bag is in front of you. Grab imaginary knobs of the bag with your vagina and try to lift the bag over the floor. Hold it in this position a few seconds. Now put the bag on the floor.
Again, grab the knobs and lift the bag over the floor, now lift the bag even higher and hold it in this position a few seconds.
Repeat this exercise several times, trying to lift the bag higher and higher above the floor.
Exercise 3. “Elevator”
For this exercise, imagine that your vagina – is an elevator shaft. Begin to rise a cabin from the entrance of the vagina up its depths to the cervix, alternately floor by floor, clutching the different parts of the vagina. Feeling the vagina compressed at all, start slowly, floor by floor, to relax it from neck to the exit. At the end of the exercise “go down to zero level”, with a little sticking out the vagina outside.
In conclusion, I want to say that we shouldn’t be afraid so much of the vaginal tear during childbirth. First, all the obstetricians make good stitches, which in most cases heal quickly. Second, the experienced midwives may predict the risk of appearance of the vaginal tear during childbirth, it’s determined by the color of the perineal tissues. And in that case, the doctor makes the episiotomy. The smooth edge of the incision is much easier to sew up than a vaginal tear.
Do everything that depends on you and the rest rely on people who will take birth! However, when meeting with the doctor and the midwife is not superfluous to say that you were preparing very seriously and don’t want to have the stitches in such an intimate part of the body. It is clear that not every doctor is ready to take it adequately. However, remember that not so long ago it was difficult to discuss the question of putting a baby on the mother’s belly. Now it’s done everywhere, and largely due to many persistent requests of pregnant women.