Push Prep Crash Course: Day 2
Episiotomies and Vaginal Tearing
Learn what vaginal tearing is, why it occurs, and how to reduce the risk of it happening to you.
In order to rehab correctly, you need to understand the types of vaginal tearing and trauma that can occur during birth.
In this lesson, we’ll go over vaginal tearing and episiotomies.
Episiotomies
An episiotomy is a surgical incision that is performed midline or off to the side to “help” the delivery.
Episiotomies used to be performed routinely, which meant everyone got them, however, it was found that women who had these done had a harder time with recovery and more pelvic floor issues (shocker).
Now they should only be used in medical necessity or emergencies.
What is a vaginal tear and what causes them?
A vaginal tear (perineal laceration) is an injury to the tissue around your vagina and rectum that can happen during childbirth.
Vaginal tearing happens for a number of reasons, some that we can control and some that we cannot.
The main reasons that pelvic floor tearing occurs are:
- Genetics — Some women have less stretchy skin than others
- Size and position of the baby (sunny side up babies for example)
- Use of instruments for delivery (e.g. forceps or vacuum)
- Pushing position for mama
- Speed of delivery — Fast babies or long pushing phases can cause more problems
- Improper “coaching” for pushing
Different types of tearing
We group vaginal tears into 4 categories based on the amount of muscle damage that occurs, a grade 1 tear being the least amount of damage and grade 4 being the most severe.
A grade 1-2 tear does the best with conservative management and our goal is to stay around a grade 2 or below (ideally none!).
Grade 3-4 tears involve more tissue and usually need to be repaired in the OR (Operating Room) for various reasons.
Our goal is to reduce the risk of higher-level tears
If you do end up with a higher-level tear, don’t worry, you will recover (with proper help) and we can make sure you have what you need rehab-wise.
I have had many women in the clinic over the years manage this quite well, however you do need consistent rehab and help from us here at The DownThere Doc.
The way we prevent or reduce the risk of these higher-level tears is by using my “3P” system: Perineal Massage, Push Prep, and Practice Like You Play.
We’ll cover the 3 Ps in more detail over the next couple of days.
