From the Guidelines
To prevent vaginal tearing during childbirth, a restrictive episiotomy policy, rather than liberal or routine use, is associated with less posterior perineal trauma and fewer complications, as evident from the study published in The Lancet Global Health in 2024 1.
Strategies to Prevent Vaginal Tearing
Several strategies can be employed before and during labor to prevent vaginal tearing, including:
- Perineal massage starting at 34-35 weeks of pregnancy, performed for 5-10 minutes daily using a lubricant like vitamin E oil or almond oil
- Warm compresses applied to the perineum during labor to help soften tissues
- Controlled pushing with guidance from a healthcare provider to allow tissues to stretch gradually
- Position changes during delivery, such as side-lying, hands-and-knees, or squatting positions, to reduce pressure on the perineum
- Maintaining good nutrition with adequate protein, vitamin C, and staying well-hydrated throughout pregnancy to maintain tissue elasticity
- Kegel exercises to strengthen pelvic floor muscles, potentially improving tissue resilience
Importance of Restrictive Episiotomy Policy
The study published in The Lancet Global Health in 2024 1 highlights the importance of a restrictive episiotomy policy, which is supported by other studies, such as the one published in the American Journal of Obstetrics and Gynecology in 2024 1. These studies emphasize the need for careful consideration and selective use of episiotomy to minimize the risk of complications and promote better outcomes for mothers.
Reducing Morbidity and Mortality
By adopting a restrictive episiotomy policy and employing the strategies mentioned above, healthcare providers can reduce the risk of vaginal tearing and associated morbidity, including persistent perineal pain, dyspareunia, and anal incontinence, as highlighted in the study published in the American Journal of Obstetrics and Gynecology in 2024 1. This, in turn, can improve the quality of life for new mothers and reduce the risk of long-term complications.
From the Research
Methods to Prevent Vaginal Tearing During Childbirth
- Antenatal perineal massage: Studies have shown that antenatal perineal massage can reduce the incidence of perineal trauma, particularly severe perineal tears and other postpartum complications 2, 3, 4.
- Perineal massage during labor: Perineal massage during labor has been associated with a lower risk of severe perineal trauma, such as third and fourth degree lacerations 5.
- Warm perineal compresses: However, the combination of warm perineal compresses with perineal massage during the second stage of labor did not show a significant reduction in perineal trauma compared to perineal massage alone 6.
- Manual perineal protection and mediolateral episiotomy: These techniques have been shown to reduce the incidence of obstetrical anal sphincter injury, particularly in assisted vaginal births 3.
- Restrictive use of episiotomy: The International Federation of Gynecology and Obstetrics recommends restrictive rather than routine use of episiotomy, especially with unassisted vaginal births 3.
Benefits of Preventive Measures
- Reduced incidence of perineal trauma: Antenatal perineal massage and perineal massage during labor have been shown to reduce the incidence of perineal trauma 2, 5, 4.
- Lower risk of severe perineal tears: Perineal massage during labor has been associated with a lower risk of severe perineal trauma, such as third and fourth degree lacerations 5.
- Reduced incidence of episiotomy: Antenatal perineal massage has been shown to reduce the incidence of episiotomy 2, 4.
- Improved wound healing and reduced perineal pain: Antenatal perineal massage has been associated with better wound healing and less perineal pain 2.