There are several ways to reduce your risk of birth injuries. This article summarises what
they are, the risk factors and what you can do to minimise the risk of these occurring.
Birth injuries
- Severe perineal tearing – 80% of vaginal births will result in a level of perineal
tearing. There are different levels of severity but most of these heal well with time and do not cause long term complications. - Prolapse – this is descent of one or more of the internal organs which can result in a ‘heaviness’ or ‘dragging’ sensation in the vagina.
- Levator Ani avulsion – during a vaginal delivery this muscle can tear away from the pubic bone which can cause various pelvic floor issues
Risk factors for birth injuries
- Fast second stage
- Second stage that is longer than 90 minutes
- Use of forceps during delivery
- Baby heavier than 4kg
- Poorly controlled gestational diabetes
Risk Reduction – what can we do to prepare?
1. Optimise the pelvic floor muscles
Improving pelvic floor muscle strength prior to giving birth can reduce the risk of perineal tears during birth and helps restore pelvic floor function post natally. There is also evidence to support that pelvic floor muscle training reduces antenatal and postnatal urinary incontinence.
An appointment with a pelvic floor physio for a pre-natal WOF will provide you with an individualised pelvic floor exercise programme which will address any specific exercise concerns. Other recommendations include:
- Avoiding constipation – increase your fluid intake (2 – 2.5 L of water per day) and maintain a healthy balanced diet
- Beyond 12 weeks into pregnancy reduce high impact or heavy weighted exercises as these can place excessive strain on the pelvic floor
- Look after your immune system by getting enough sleep and scheduling relaxation time as well as positive interactions with family/friends to support your mental well-being
- During the last stage of pregnancy, it is important to develop awareness of how to effectively relax the pelvic floor muscles as this will reduce the risk of tearing during delivery.
2. Keep physically active during pregnancy
Research shows that regular exercise during pregnancy is likely to reduce the length of labour and risk of C-section. It also supports behavioural maturation of the baby and leads to quicker recovery after birth.
- The UK NICE guidelines (2010), recommend 150 mins a week of moderate intensity a week – at least two of these exercise sessions should include some resistance work to maintain muscle strength and support overall metabolic health.
- Unity studios offer a pregnancy pilates programme that includes pelvic floor strengthening with specific guidelines for the different stages of pregnancy.
3. Perineal Massage
- Perineal massage from 35 weeks onwards has been shown to reduce the risk of severe tears by 64%. Please note contraindications include: bleeding after 20 weeks into pregnancy, herpes, shortened cervix, high blood pressure and thrush.
- Perineal massage involves improving the flexibility of the perineal tissues through applying sustained stretches to the region for 5 mins three times a week up until the birth. If you have any specific concerns as to how to perform this technique effectively, please book a 1:1 consult with a pelvic health physiotherapist for individualised guidance.
4. Birth Plan
Arrange a discussion with your lead maternity carer about an individualised birth plan that takes into account your specific concerns and relevant risk factors above.
Some considerations may include:
- Avoiding forceps during delivery where possible
- An epidural
- Application of warm compress to the perineal region during delivery
