Nov. 18, 2021

053 How to Prevent Vaginal Tearing in Labor.

053 How to Prevent Vaginal Tearing in Labor.

Is it even possible to minimize or prevent vaginal lacerations during birth?


One of the most asked questions during an office visit is: "Doc, how do I prevent tearing?"  In this episode, we discuss how to prevent perineal tearing during delivery.

Tearing and Contractions

[1:56]

When Kristin was pregnant, her biggest fear wasn’t the tearing but the contractions. Seeing other women with contractions made her feel that it was painful. She says that tearing is more of having an injury that you overlook until it happens.

Infections in Tearing

[2:29]

The body is designed to tear. If a woman has a baby and tears, they should keep their legs together, and it will heal. With thousands of adult women living with tearing, there hasn’t been one infection. Though there are vaginal infections postoperatively, there hasn’t been a repaired tear that got infected.

[3:35]

The Human body is designed for tearing. A human design where a specific area would not be infected, but other areas would be contaminated.

The Fear of Women about Tearing

[4:52]

There are all these things that women make themselves crazy about how to prevent tearing. They make themselves crazy about things like perineal massage. They’re looking it up on the internet and massaging their perineum.

Massaging to Prevent Tears

[5:30]

The skin stretches better when you use mineral oil as a lubricant instead of a surgery loop. Dr. Yaakov is constantly massaging and stretching the skin as much as possible because if the head of a baby comes out slowly, the skin has more time to accommodate and stretch. Those quick deliveries are more common to have a tear.

 

Using Mineral Oils

[6:36]

Mineral oil is very good. But when the head is coming out, Dr. Yaakov milks the skin on the sides and just pushes it back on the head. With the head coming out and the skin bulging with it, he is trying to milk it back while putting a lot of pressure right on the perineal skin because he is spreading that pressure out across the whole perineal body.

[7:27]

Even with all of Dr. Yaakov’s strategies, 80% of first-time mothers tear. So he thinks that mineral oils and milking the skin over the head are beneficial.

Controlling Tears

[8:07]

The more you control the tear of the bottom, the more likely she’s going to have a tear on the anterior perineum, which is near the urethra, clitoris, and labia. The more you prevent it on the bottom, the more likely it is to go up. The worst thing that can happen is uncontrolled delivery, where the baby's head just pushes and pops out. They head back, and the baby will headbutt you right into the most sensitive part of the body. That will easily cause real trauma. So you have to control that. You have to control the head and not let it extend too quickly control the extension while you’re trying to prevent a tear.

[10:35]

Experienced providers have a better ability to prevent a tear. The more deliveries you’ve done, the more little tricks you have up your sleeve.

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