Best Birthing Positions to Prevent Tearing
Written by Dr. Karah Charette, PT, DPT, RYT
Are you afraid of perineal tearing during vaginal delivery?
Do you want evidenced based approach to birthing positions to decrease perineal tear risk?
In this blog, you will learn evidence-backed strategies for giving birth from a licensed pelvic floor physical therapist!
Best Birth Positions to Avoid Perineal Tearing
There can be many factors that increase perineal tear risk. Some of these factors are not always in our control including the baby size, position, and the speed of delivery.
However, there are some factors that we can try to control for. One of these factors is the birthing position.
You know that classic position we all picture from movies and TV shows when someone is giving birth- the one where the person is on their back with their legs in stirrups? Turns out that is not the best position to give birth in!
What we now know is that positions such as side lying, hands and knees, and deep squats can be better alternatives.
Side-lying is the birthing position that is the least associated with tearing. This may be due to the decreased pressure on the perineum. The body is also fairly supported in this position and one key element to decreasing perineal tearing is also to decrease tissue tension in the body.
Hands and knees (all fours) is another great position. With four points of contact there is good stability, and there is also more room to play with hip mobility. Depending on where the baby is as it descends, you may need more hip internal or external rotation. All fours is a good position where you can more easily access both.
Deep squats are a nice position that can help open and lengthen the pelvic floor muscles. However, deep squats promote more external rotation so this may be more beneficial in the earlier pushing stages as the baby is trying to navigate through the pelvic inlet vs the outlet (top vs bottom).
Tips To Maximize Perineal Protection During Birth
One of the most important factors to decrease risk of tearing beyond birthing position is pelvic floor relaxation. This is what we specialize in teaching as pelvic floor physical therapists.
Pelvic floor relaxation is not just about the length of the pelvic floor. There is a lot of talk about perineal massages, and although this technique can be beneficial, it may not be enough alone. Massage can often be done as a passive technique, where the belief is if you just stretch the muscle enough it will be less likely to tear. What we now know is that muscles can be tight or relaxed in an instant depending on what the nervous system tells them to do. This means you could stretch your pelvic floor all day, but come time to give birth if you have never practiced deep regulating breathing for your pelvic floor under pressure and stretch, you may hold your breath and clench during delivery and increase your risk of tearing.
Because tissue tightness is related to nervous system states, at Bodyful we focus on nervous system informed approaches to perineal massage. This means that you can experience pressure and stretch at specific parts of your pelvic floor and you will be coached on diaphragmatic breathing techniques in order to be able to continue to regulate your nervous system and pelvic floor muscles during that experience. This can help prepare you for labor and delivery with more coordination and confidence.
At Bodyful, we can also teach you appropriate breathing strategies for pushing. Many birthing people actually contract their pelvic floor when they are asked to push or bulge. It is important to know how to coordinate the difference in your body as you do not want to be contracting and creating more tension when trying to push your baby out. The pelvic floor’s main job is yield, soften, and create room for the uterus to push your baby out.
Other techniques that can be explored in real time with your birthing team could be the application of a warm compress to help the muscles stay relaxed. As pelvic floor specialists, we are happy to speak with your doulas and midwives to make sure you feel empowered and have the options that will help you feel most comfortable throughout your birthing experience.
When Birthing Positions Might Not Be Enough to Prevent Perineal Tearing
It is important to mentally prepare that there are some factors we cannot always control during birth. Factors that can contribute to perineal tearing include the size and position of the baby and the speed of delivery. It is important to note these aspects so you do not feel that you did something wrong if you experience tearing. Everyone is going to have a unique birthing experience. All you can do is prepare in the ways you know how/have accessible to you, and have compassion for your body as it does its best to support you in this journey.
How Pelvic Floor Physical Therapy Can Help
Here in Oakland, CA our pelvic floor specialists can help you in person whenever you are ready to begin. At Bodyful Physical Therapy and Wellness, we can provide prenatal pelvic floor prep. This includes education on the birthing positions that are right for you, learning how to safely connect with your pelvic floor, and working on goals such as mobility, strength, and relaxation at the pelvic floor. We can help give you real time biofeedback on your coordination for bulging or pushing, as well as provide you techniques for in clinic and at home perineal massage. We even allow partners to be present to learn the best techniques to support you in your birthing journey.
Even if you have gone through the birthing process before, it is always a good idea to reconnect with the pelvic floor muscles in a specific and regulated environment. If you have previous birth trauma or scar tissue, our pelvic floor specialists can help you address this in order to best prepare for your next birth.
We can also help with postpartum services including beginning to heal diastasis rectus, pelvic organ prolapse, scar tissue massage (especially for perineal tears or c-sections), and getting your pelvic floor and core back online. We can help you return to exercise safely including weightlifting, running, Pilates, yoga, dance, and more!
Work with Pelvic Floor Physical Therapist in Oakland, CA to Prevent Perineal Tearing During Birth
If you are ready to work with a pelvic floor specialist for birth prep, look no further. At Bodyful, we are more than happy to be a part of your birthing team and to consult with your doulas, midwives, and medical providers.
We can help you find the best birthing positions for you, how to push appropriately, and how to prepare for postpartum recovery.
