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Find out why some women tear during labor and why an episiotomy can be needed.
Daphne Metland: Emily, you're now 30 weeks pregnant, so the birth is looming on the horizon, and there comes a point in everyone's pregnancy where you have to think about the actual birth and consider the possibility that you might be dealing with either a cut or a tear. Have you thought about that?
Emily: I haven't, no. I'm trying not to think about it at the moment!
Daphne: But it's worth knowing why you might tear, or why you might need a cut, because then you can do quite a lot to prevent it. Our bodies are actually meant to give birth, and you're meant to stretch and accommodate the baby. So, as long as things are going well and the second stage is quite slow, then you minimize the chances of needing a tear or a cut.
It helps to be upright – to be sitting up, or kneeling, or standing, rather than lying flat on your back. And as the baby comes down the birth canal, your body stretches to accommodate the baby.
If you imagine that this is the birth canal here and here's the anal sphincter. And imagine you were lying down with your legs in the air, the bit you see in between is called the perineum, and usually it's thick and spongy. And that's because it's your natural expansion zone.
So as the baby comes down, this area stretches and thins, and then as the contraction goes back it relaxes, and as the baby comes down again, it stretches and thins.
And your midwife or doctor will be keeping an eye on this little area as you're pushing. And what they're looking for is to check that it is stretching and thinning, it is making space for the baby. Sometimes they'll be looking to see if there's little tiny drops of blood appearing here, which is called buttonholing, and if that is happening they'll know that it's about to tear, and they'll want to make sure it doesn't tear straight down to the anal sphincter. If they think it's going to, they'll redirect the tear away from the anal sphincter. If it's not thinning, if you're pushing and pushing and it's simply not thinning and giving way, or if the baby needs to be born really quickly, what they might do is make a cut there, to allow extra space for the baby to get born.
And if they do that, they will put a local anesthetic in before they do it, while it's thick and spongy. If it's stretching well but they can see it's going to tear, and the baby's head is there, at the peak of the contraction you're numb in that area, so they might do a cut without it at that point. Okay? Does that make sense?
Daphne: Okay! So now you know why you need to pant.
Daphne: The area will be stitched up afterward with a local anesthetic, so it's not painful then. But it does tend to be painful, the stitches and bruising can be painful for a few days afterward.
It's really important to look after that area. Make sure you've got nice thick maternity pads to wear so it's nice and soft. And when you go to the loo, take a little bottle of warm water in with you and pour that over the perineum as you pee, because that will stop it stinging. So if you look after your stitches, they'll heal really quickly.