What’s your biggest fear with labor and delivery?

Pooing while pushing? Tearing? The pain? Emergency c-section?

Well, unfortunately, there’s not much you can do about the first one (but, thankfully, the nurse will whisk that stinker right away), but there are a lot of steps to take to prevent tearing and emergency c-section and to reduce pain. I’m going to break it down into a few blog posts. But for today..

Perineal Tearing

Many women who have vaginal births experience perineal tearing (up to 50%!). This is the laceration of the skin and pelvic floor muscles. There are many reasons why you can tear during delivery—poor positioning, purple pushing, uncoordinated and tight muscles…


is a major one. For so long, women were put into dorsal lithotomy—on your back, legs up in stirrups. You know, the position in the gyne’s office that we all know and love? Yeah. Not so much. Turns out, this is a terrible position to give birth in. It was initially used for the ease of the baby catcher (OB or midwife) and is still often used when women have an epidural. It essentially closes the pelvic outlet, so it’s like trying to get an elephant through the eye of the needle. Either that elephant is not going to get through (read-emergency c-section…but more on that later) or eye of the needle is going to have to make room (read- perineal tearing). Luckily for all of us with vaginas, there are plenty of positions to choose from that allow the pelvis to be in a more open position and allow the pelvic floor muscles to stttttreettttch. 

  1. All fours- This is my fave birthing position. This position allows for a lot of movement in the low back, tailbone, and hips which will let you move through contractions, change the position of your legs or back if needed, and is one of the positions that I work on with my clients (there’s a ton of specifics to do in this position, but I can’t give away all my secrets 😉)

  2. Squatting/standing- this can be a good position if you aren’t super tired- a.k.a. you haven’t been laboring for hours. Now, I’m not talking squatting like you’re weight lifting but ass to grass—a deep, deep squat where your bum is almost touching the floor. You will probably want to have someone (your doula, PT, or partner) hold your hands to support you and so you don’t have to do all the work. This is a position where the pelvic floor is very relaxed, so it’s a great position to work through some contractions and allow the baby to move down. 

  3. Lying on your side—this position is great if you have had an epidural (and if you haven’t). Have your birth partner hold your top leg so you can let it relax and focus on pushing the baby out

Purple pushing

...what is purple pushing, you may ask? Well, picture Violet from Willy Wonka as a woman giving birth in a movie—eyes bulging and filled with burst blood vessels. It’s what childbirth scenes in movies typically depict. This is when (directed by the nurse, midwife, or physician) you take a deep breath, hold it and push as hard as you can. Often, providers direct women to do this too early and when they don’t feel the urge to push. This increases intraabdominal pressure (the pressure inside the abdomen) which increases the pressure on the pelvic floor muscles and can lead to tearing exhaustion, and a spike in blood pressure. 

Instead, you should wait until you have the urge to push—called the fetal ejection reflex. Michael Odent, the OB who discovered the fetal ejection reflex, describes it like so:

  • The first stage of labor occurs in a quiet, calm environment.

  • The mother then has a sudden and transitory fear expressed in an irrational way (i.e. by saying “kill me” or “let me die”).

  • The mother is suddenly full of energy and wants to be upright.

One last contraction is seen as a “sudden, strong, muscular energy, grasping something or somebody, hanging on to something or somebody, or needing to have her shoulder supported.”

When this reflex occurs, you may instinctively “know” how to push, but it’s best to practice in the last few weeks before going into labor. 

To push effectively and minimize the risk of perineal tearing, you want to take a deep breath, expanding your ribs, engage your transverse abdominis (your deep abdominal muscles), and bulge or “let go” of your pelvic floor muscles. If this sounds French to you, it’s best to learn how to do this from a PT who can demonstrate and use hands-on-techniques to teach your brain and body how to do this. Which brings us to…

Uncoordinated and tight muscles

Typically, women start to have more trouble using their deep core team—the deep abdominals, diaphragm, and pelvic floor as pregnancy changes their bodies—ribs expand, belly grows…you get the picture. If these muscles aren’t working well for 30 some weeks leading up to delivery, they won’t be able to help you push effectively during labor and delivery. And if these muscles aren’t supporting your body during pregnancy, other muscles will compensate or take over and become tight—the groin muscles, low back muscles, and bum muscles. These muscles support the pelvis, but if they’re too tight, you’ll have trouble getting into certain positions and relaxing the pelvis and pelvic floor. 

One of the best ways to calm your fears about labor and delivery is to practice, practice, practice. Make your birth plan (a.k.a your ideal birth) and practice the positions you will use and your 'push.' The next best? Listen to your body and follow your gut.