what happens down there during childbirth? + tips for preparation
/Becoming aware of common childbirth outcomes and empowered with tools to prepare “down there” is what this blog post is all about. Take a deep breath and let’s get to it.
the facts
During vaginal delivery, the tissues of the pelvis soften and stretch to accommodate the passage of baby. If you’ve ever watched a birth video (highly recommend), you’ve probably visualized the remarkable expansion of the tissues of the pelvis as baby begins to emerge.
When I say remarkable, I’m not exaggerating.
The physiologic adaptation of the pelvic region around childbirth is worth learning more about. During vaginal childbirth, portions of the levator ani muscles which make up the largest component of the pelvic floor reach a maximum stretch ratio (tissue length under stretch/original tissue length) of 3.26 to make room for baby (Lien et al., 2014). In many cases, this confirms that the birthing pelvis is made to stretch without leading to long-term injury.
However, as you might imagine, vaginal birth may result in obstetric tears or more severe pelvic floor muscle injury. Obstetric tear may involve the perineum, vagina, or rectal tissue. The perineum is the region of the pelvis that includes the external portions of the vulva and anus. A perineal tear is defined as a laceration of the skin and other soft tissue structures of the vulvar region and it turns out that perineal tearing is the most common obstetric injury. Graded from 1-4, perineal tears vary is severity and need for follow up care. 1st + 2nd degree tears are the most common. They sometimes require stitching and tend to heal most quickly. 3rd + 4th degree tears involve more tissues, will require stitching, and tend to take longer to heal. Things like avulsion injuries may lead to longer term symptoms and may require aftercare from a trained pelvic floor physio.
A systematic review found that perineal tearing of some degree occurs in ~85% of folks who have a vaginal birth. Spontaneous tears requiring suturing are estimated to occur in at least 1/3 of births in the UK and US.
Risk factors for severe perineal trauma include first vaginal delivery, large or malpositioned baby, older mother, abnormal collagen synthesis, prolonged second stage of labor, and forceps delivery (Frohlich and Kettle, 2015).
deep breath
Research suggests a few strategies that may help reduce the incidence and severity of tearing. While honoring that you can’t control everything, there are a few things you CAN do to prepare your mindset and pelvic floor for childbirth.
Let’s talk preparation
Antepartum perineal massage is an opportunity to practice the somatic experience of trust and breath while gently getting used to the feeling of stretch in the tissues of the pelvis, physiologically supporting your birthing process.
Birth position: Side-lying, or kneeling on hands and knees may be beneficial for reducing the severity of tearing.
Go slow + gentle as baby’s head emerges to allow tissues to accommodate to the stretch. In general, breathing continuously in and out, avoiding breath holding, is particularly useful in the second stage of labor, the part where your baby makes their grand exit from your womb. Should the urge to push be present, you can sometimes use your breath to slow the process by inhaling then releasing puffs of air through your mouth. Follow your instincts when it comes to pushing with an urge rather than directed pushing when possible.
Manual compression of the perineum using a warm compress may reduce the likelihood and severity of perineal trauma.
If you are concerned about tears or have any questions, speak to your healthcare professional + birth team. They will be able to discuss any increased risk factors related to your birth, and what they and you can do to try to prevent them as well as support healing after.
Important to note
There are many factors involved in birth outcomes and the need for interventions. We simply can’t predict or control as much as we wish we could (these are perhaps the first lessons of parenthood). Just because you do x y + z doesn’t mean that you are guaranteed a certain outcome. But there are things we can do to help prepare our minds and bodies for these events that help us connect to our breath and pelvic floor, areas that are often under subconscious control. By deepening our conscious relationship to these areas, we not only help prepare for birth but for postpartum healing, no matter how labor unfolds.
Interested in joining me for a personalized deep dive on this very topic?
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Resources
Abdelhakim AM, Eldesouky E, Elmagd IA, Mohammed A, Farag EA, Mohammed AE, Hamam KM, Hussein AS, Ali AS, Keshta NHA, Hamza M, Samy A, Abdel-Latif AA. Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. Int Urogynecol J. 2020 Sep;31(9):1735-1745. doi: 10.1007/s00192-020-04302-8. Epub 2020 May 12.PMID: 32399905
Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD005123. doi: 10.1002/14651858.CD005123.pub3. PMID: 23633325.
Frohlich J, Kettle C. Perineal care. BMJ Clin Evid. 2015 Mar 10;2015:1401. PMID: 25752310; PMCID: PMC4356152.
Lien KC, Mooney B, DeLancey JO, Ashton-Miller JA. Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol. 2004;103(1):31-40. doi:10.1097/01.AOG.0000109207.22354.65.
