Can Tearing During Childbirth Be Prevented?

New guidelines set forth by The American College of Obstetricians and Gynecologists aim to ease delivery.

Episiotomy On The Decline Olesia Bilkei/Shutterstock

Anyone who's had vaginal tearing during delivery knows that it's not a walk in the park—and a new bulletin by The American College of Obstetricians and Gynecologists suggests that these lacerations during childbirth could be more preventable than we think.

According to the ACOG, between 53 and 79 percent of all vaginal deliveries involve some sort of laceration, and while more often than not, these tears are harmless, it's important that medical practitioners take steps to ensure they don't cause obstetric anal sphincter injuries (OASIS). Similarly, doctors should practice increased caution under these new guidelines when performing episiotomies (surgical cuts into the perineum, or the area between the vagina and anus) if a woman is in serious need. 

The new bulletin recommends that doctors administer perineal massages either before or during the second stage of labor to decrease muscular resistance, which can lower the odds of laceration. Using warm compresses on the perineum can also make third and fourth-degree lacerations less likely.

These new guidelines may have the power to reduce the dangers associated with severe lacerations for first-time moms—they also could help women with previous OASIS during their subsequent pregnancies. Some women with histories of OASIS may be offered C-sections as a delivery option, especially if they'd suffered anal incontinence or wound infections after surgical lacerations during previous deliveries. With that being said, it's important to understand the increased risks that come with C-section deliveries.

“Without question, a vaginal delivery is an appropriate, safe option for women who have experienced severe obstetric lacerations during previous pregnancies,” Sara Cichowski, MD, one of the co-authors of the new guidelines, said. “However, women who have anal incontinence or who have suffered significant physical or emotional trauma as a result of previous experiences may find that a Cesarean delivery is the right choice for them.”

The ACOG recommended against routine episiotomies back in 2006—and rates of this procedure have dropped steadily since. By 2012, only 12 percent of vaginal births involved episiotomy. This is a positive trend: According to the ACOG, there's no evident long-term maternal benefit associated with routine episiotomies.

So, what happens if the preventative measures don't work fully and you do experience tearing during delivery? The new guidelines outline suturing techniques and treatment for OASIS, in addition to recommended postnatal practices, like encouraging women to complete exercises that will strengthen their pelvic floor muscles, and long-term monitoring of women who have had lacerations.

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