From Tara’s “prenatal-ask-a-midwife” One Huddle channel
Hi Tara and Dr. Meredith,
I had a couple questions for you both that I would love your thoughts on –
- Best ways to prevent tearing in labor – anything I can be doing now?
- Best exercises for pelvic floor and avoiding diastasis recti? Thank you!
I have also heard drinking raspberry leaf tea helps a lot with labor – what is recommended dose wise and when should I start?
The Experts’ Response:
Hi! Thanks so much for the great question. For preventing tearing during labor (perineal laceration), one thing that has been shown to be helpful is using a warm compress in labor to help the skin be soft and moist and stretchy. You can definitely ask your labor and delivery nurse (or your doula!) to show you how.
For pelvic floor exercises – I generally recommend strengthening during the first two trimesters and then learning how to relax the pelvic floor and open the pelvis in the third.
For diastasis – You want to avoid all exercises during pregnancy that cause “coning” of your belly where you can see a bulge start to develop between your abdominal muscles. Those muscles naturally separate as the uterus grows and we don’t want to put lots of extra pressure on them. I’m sure One Huddle Experts Tara and Dilini will have some great specifics of what you can try!
Hi Huddler! Here is a great resource for more information on Red Raspberry Leaf Tea: https://evidencebasedbirth.com/ebb-139-red-raspberry-leaf-tea/
Also, I would highly recommend seeking out a pelvic floor PT during pregnancy so that they can assess your body and make recommendations accordingly! I’d say more often people have tight pelvic floor muscles and need to practice relaxation with breath. This would also tie into pushing your baby out effectively. It’s amazing how connected your breath, abdominal muscles, and pelvic floor are all connected. At the end of the day, we truly only have some control over tearing. Tearing can be linked to how a baby decides to come out, tissue integrity (genetics and diet) and having the midwife, OB, nurse or doula trying and help support during the crowning phase. As far as I know, there is no evidence to prove that perineal massage in pregnancy reduces tearing, but it can, however, help you connect to that area and train you to relax into the sensation. I’d be curious to hear what Dilini has to say!
I’m so proud of you for choosing to look at some things that may be scary. I know the possibility of tearing and separation (diastasis recti) scared me when I was pregnant. I felt stronger and more empowered when I felt I was able to do things to help myself through and I hope the same for you.
First, I love perineal massage for pre-delivery prep. We spend so much of our lives building tension in our pelvic floors and being taught that tight is where it’s at. Like Tara said, perineal massage is an opportunity for you to teach your body slowly to relax and open up. I find that gentle outward pressure (not pulling) combined with a full breath works best. See if you can notice your pelvic floor stretching outward just a little when you breathe in and then relaxing inward when you breathe out. You’ll need to access both of these states during labour and delivery. I agree with Dr. Meredith that it’s helpful to focus on stretching during the third trimester, but I typically encourage practicing some light pressure/contact at your perineum even during the first and second trimester, especially if you’re not used to masturbating or are otherwise uncomfortable with touch at your perineal area.
I usually suggest using a discomfort scale to decide how much pressure to apply. As yourself: How uncomfortable is this on a scale of 0-10?
0=no pain; you’re in you comfort zone and there is no change happening
10=trauma; you’re so far out of your comfort zone your body and creating a traumatic experience
Ideally you want to find a stretch where you rate yourself at a 2 or 3, which basically means you feel some discomfort, but only to a level that you feel you can handle, physically and emotionally. Over 3? Ease off. Under 2? Add a little more pressure. Over time, what you can tolerate at 2 or 3 will increase.
Diastasis recti is when there is too much outward force on our abdominal muscles, so there is some stretching or separation at the midline. So, during pregnancy:
- Make sure you’re breathing fully. Ie. letting your ribcage and pelvic floor expand (on inhale) and contract (with exhale) too. This is so important because our breath influences how our core distributes force. If your ribcage and pelvic floor aren’t expanding well, then your abs end up bearing all that pressure from the inside.
- Avoid crunching your body – that’s to eliminate the doming that Dr. Meredith was talking about. These movements can sneak up on us, though, so keep your eyes open! For example, when you get out of bed in the morning, instead of crunching to sit up in bed, turn onto your side and push up with your arm. This will minimize how much pressure you put on your midline.
Finally, I totally agree with Tara – a pelvic floor therapist is a great resource during pregnancy and post-partum! Hope this helps!