Preparing For A Vaginal Birth After Tearing Or Episiotomy

In an ideal world, no birthing person would suffer vaginal or perineal trauma during birth, either spontaneous or by episiotomy. The reality is, these things do occur and can be quite traumatizing. If you are among those that has had to recover from a vaginal/perineal tear or episiotomy, the thought of having another vaginal birth may cause fear and anxiety around the trauma occurring again, the recovery after birth, or both. Of course each situation differs from person to person, but there are a few things you can control as you prepare for your next birth!

 

  1. Physical Therapy – Seek out a pelvic health physical therapist that will do an internal examination. They will be able to locate where the trauma occurred and can work to release any scar tissue that is present. They can also recommend exercises specific to you that will aid in your preparation. If you need help finding a trusted therapist, reach out to your local BIRTHFIT Regional Director for resources.
  2. Perineal Massage – After you’ve addressed any scar tissue, practice perineal massage. Although research shows a decreased risk of trauma for first births only (1), there is no harm in taking action to prevent tearing or the need for episiotomy again. It is recommended to begin at 34 weeks pregnant (2). You can find instructions here on how you or your partner can perform perineal massage.
  3. Mindset – Emotional healing and preparedness is equally as important as physical. Our root chakra is located at the base of the spine and corresponds to the perineum. Healing the root chakra readies our minds and bodies for birth and can alleviate the anxiety surrounding birth after a traumatic previous birth. If you already have an established mindset practice (journaling, meditation, prayer, etc.), you can focus your efforts on birth preparation.
  4. Release Your Fear – Even after working through the first three suggestions, your apprehension may be rooted in the belief that you will suffer perineal/vaginal trauma during birth again. Try this exercise in response to that belief (3).
    1. Is what you believe true? Can you absolutely know that it is true?
    2. Is there a peaceful reason to keep this belief?
    3. How would I live without this belief?
    4. Turn it around: can the opposite belief be true as well? Describe it.
  5. Teamwork – Surround yourself with a team of providers and loved ones that will work for and with you to have the birth you want. The support of others is crucial when navigating a difficult situation.

 

Sustaining a perineal, vaginal tear, or episiotomy during a vaginal birth can be the cause of negative or anxious feelings when preparing for a future birth. If you wish you to have another vaginal birth, take action around some of these options above and know that it can be done!

 

Alicia Van Balen

BIRTHFIT South Pittsburgh @birthfit_southpittsburgh

 

References:

  1. https://www.lamaze.org/Connecting-the-Dots/what-is-the-evidence-for-perineal-massage-during-pregnancy-to-prevent-tearing
  2. https://americanpregnancy.org/first-year-of-life/perineal-massage-pregnancy/
  3. Katie, Byron & Mitchell, Stephen (2002). Loving What Is: Four Questions That Can Change Your Life.
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