Can You Avoid Tearing During Birth?
What Midwives Have Learned Over Generations
One of the questions we hear most often from first-time mothers is, "Am I going to tear?"
It's an understandable fear. Stories from friends and the internet can make it seem as though significant tearing during birth is inevitable.
The good news is that it isn't.
For more than 24 years, I've had the privilege of helping welcome nearly 2,000 babies into the world. During that time, I performed only three episiotomies. My daughter and colleague Midwife Brianna, has attended more than 1,500 births and has performed only one. Even more remarkably, between the two of us, we have never cared for a mother who experienced a third- or fourth-degree perineal tear. Further, our tear rate is less that 3% and most of those are only first degree tears. If it ends up being a second degree tear, we are skilled at suturing those, but thankfully suturing is rarely a necessity.
People are often surprised when they hear those numbers. The truth is, they aren't the result of luck. They are the result of generations of midwives learning how to patiently support a woman's tissues during one of the most important moments of birth.
Your Body Was Designed to Stretch
One of the greatest misconceptions about birth is that the perineum simply "tears." In reality, your tissues are incredibly dynamic. As labor progresses, hormones increase the elasticity of the tissues surrounding the birth canal. Given time, support, and a gentle birth of the baby's head, those tissues are capable of stretching in extraordinary ways. Small first- or second-degree tears can still happen, particularly with a first baby, but they often heal beautifully because they follow the natural direction of the tissue rather than creating a surgical incision from an episiotomy.
How Midwives Help Protect the Perineum
There isn't a single secret technique. Instead, it's the thoughtful combination of many small things that make a difference. We know nutrition plays an important role in the integrity of our tissues. Our midwives encourage tissue preparation which you learn about during childbirth classes and from our Pelvic Floor physical therapist. Those things combined with how midwives help during the birth minimize your chances of tearing.
At The Center for Birth, our midwives may use:
Warm compresses during the pushing stage.
Gentle hands-on support of the perineum when appropriate.
Counterpressure to help control the speed of the birth of the head.
Gentle massage of tissues to increase blood flow and keep the tissues pink
Water immersion, allowing tissues to soften naturally.
Position changes that reduce unnecessary pressure
We discourage birthing on their backs, studies show that increases tear risk
Calm coaching that encourages mothers to slow down and allow the tissues time to stretch.
Perhaps most importantly...
We don't rush the birth of the head. If the perineum is allowed time to stretch, it takes about 10 minutes before the baby is born. If baby is tolerating labor well, patience is always preferred. Sometimes the greatest gift we can give a mother is patience.
What About Episiotomies?
Years ago, routine episiotomies were common and were believed to protect women from more severe tears and complications of the pelvic floor like bladder and fecal incontinence later in life.
Today, decades of Ob/Gyn research and education from the Pelvic Floor Physical Therapists have shown otherwise.
Studies have demonstrated that routine episiotomy generally does not reduce severe perineal trauma and, in many cases, actually increases the likelihood of deeper tears, additional pain, and a longer recovery. As well as increasing the risks of future pelvic floor issues.
For this reason, organizations including the American College of Obstetricians and Gynecologists (ACOG) recommend against routine episiotomy, reserving it only for specific situations where it may truly benefit mother or baby.
At The Center for Birth, episiotomy is considered the rare exception not the routine as you can see from the number of episiotomies we have done.
Sometimes Science Catches Up
One of my favorite things about being a generational midwife is watching modern research explain what our grandmothers quietly taught us decades ago. Long before randomized clinical trials and long before professional guidelines. Midwives were already protecting the perineum with warm compresses, patient hands, gentle support, and an understanding that birth should never be rushed.
They couldn't explain collagen fibers; They didn't understand tissue biomechanics; But they knew that women were designed to stretch.
That wisdom was passed from one generation of midwives to the next. Not through textbooks, but through careful observation and thousands upon thousands of births. Midwives often place their hands over the student midwife and show her how much pressure to apply, how to help the tissues stretch, even the temperature of the hot compresses. That muscle memory is what gets handed down midwife to midwife and has for generations.
Today, modern research helps explain why those techniques work so well.
Sometimes science doesn't replace tradition.
Sometimes it catches up to it.
At The Center for Birth, we believe the best care honors both.
Where Timeless Wisdom Meets Modern Evidence.