How should I push to reduce tearing during birth
So first, let me say that perineal tears with first time mothers are very common (> 80%) and minor tears are generally not a big deal. Grade I and II tears usually heal in about 6 weeks and may require some physical therapy treatment to address scar tissue. The purpose of these techniques are to help to minimize the amount of tearing you experience and reduce excess stress and pressure placed on your pelvic floor muscles and connective tissue.
The most commonly taught pushing technique in hospitals has been to Valsalva or bear down to push. Essentially you are holding your breath and pushing. The problem is that this approach can place excess stress on the structures that support your pelvic organs.
Open Glottis Pushing (Exhaling as you Push) has been shown to reduce perineal tearing and may shorten the second stage of labor.
How to do it: As you inhale, fill your belly with air, imagine also filling your pelvic bowl with air and widening the vaginal opening. As you exhale, keep your belly big and hard and your pelvic floor relaxed and open as you slowly exhale through your mouth.
The position that you push in matters as well! The lithotomy position (lying on your back) has the highest likelihood for GR III and IV tears per the research. Sidelying, in a squat, or on all fours have all shown better outcomes.
Thanks to Shereen Sairifi, DPT @shereezer Tyler Muffly MD and Sarah Barker MS, CNM for presenting this information and improving public awareness.
Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD005123. DOI: 10.1002/14651858.CD005123.pub3.
Tayrac, R. D., & Letouzey, V. (2016). Methods of pushing during vaginal delivery and pelvic floor and perineal outcomes. Current Opinion in Obstetrics and Gynecology, 28(6), 470–476. doi: 10.1097/gco.0000000000000325
Koyucu, R. G., & Demirci, N. (2017). Effects of pushing techniques during the second stage of labor: A randomized controlled trial. Taiwanese Journal of Obstetrics and Gynecology, 56(5), 606–612. doi: 10.1016/j.tjog.2017.02.005