Midwife in Berlin

Can you prevent vaginal and perineal tearing in labour from happening?

Talking about vaginal and perineal tearing in labour is never easy I find myself thinking as I am typing.

No matter where this delicate topic is mentioned the facial expression is nearly always the same. 

About breastfeeding we can gather lots of information, about vaginal and perineal tearing it gets harder in my opinion. 

Sitting down and reflecting on where to start and what to say, this part of my body, your body is very private, isn’t it.

The perineum is the area between your vagina and your anus. 

In German we call the perineal area – Damm

As a midwifery student I was taught to prevent a vaginal and perineal tear from happening ( if it is even possible)  and I had to learn how to suture such a lesion after. So, we sat down at my kitchen table and practiced with chicken breasts on how to do stitches. Is this too much information? ( then maybe do not continue reading )

Perineal tears are classed into 4 degrees. 

• The first degree, in most cases, is a minor tear, sometimes it doesn’t even need stitches , it is more of a laceration and is not bleeding or just the skin gets sutured. 

• For the second and third / fourth degree muscles are involved and yes, the midwife or the doctor will have to suture. 

• A second degree tear is mostly straightforward.
• The third and fourth degree tear, however, is more severe and will (mostly )involve antibiotic and lots of patience for the healing process.

The campaigners for anti vaginal birth will feel confirmed while reading above.

But the numbers are very little. In 2015 1,39% of all the vaginal deliveries in Germany ended with a third degree tear. (Source IQTIG )

You won’t believe me now when I tell you most women do not even feel that a vaginal or perineal tear is happening.

The reason is: while the vaginal and or perineal tissue parts the pressure of the baby’s head is most intense and that is what you will feel, nothing tearing. 

How to prevent vaginal and perineal tearing during labour?

• A vaginal and or perineal tear can always happen, not necessarily because the baby or its head is too big.  ( This is what some people want us to believe ). We know it has to do with positioning and our environment. 

• We know that tearing is more likely to happen if you give birth lying on your back and less tears are happening in water during a water birth.

• Studies have proven there is no difference if a midwifes guides the baby and protects your perineum. ( Controversial hands on or not approach)

Perineal tear and repair

What happens :

• The procedure will be you lying in a bed ,on your back, in the hospital you will be lying in the hospital bed and your legs will be supported by stirups.

• At home or in a birthing house you will be lying too with your feet flat on the bed.

• Midwife or doctor will take care of you and after 10-40 mins a vaginal and or perineal tear should be done and dusted.

• With an epidural you will hardly feel the suturing, if you have managed without pain relief up till now they will give you a local anesthesia. 

Vaginal and perineal tearing during labour and stitches

• Midwives are trained to suture, but in German hospitals, doctors in most cases take care of a vaginal and or perineal tear. So Midwives lack in experience and I guess in the end of confidence. (Isn’t it with everything we don’t do on a day to day basis ?)

• On the other hand a birthing house midwife and a home birth midwife is well experienced in providing adequate help. 

• It always helps to look and or hold your newborn baby during this procedure and personally I found chatting and being somehow distracted did the trick to me. 

How long a perineal tear takes for healing and how to relieve perineal tear pain you can continue reading here.

Lots of love & Go leor de ghrá,