Big WOW to our Amazing Vaginas in Birth - Wow Wednesday series 2

Is there any such thing as a pregnant Mama who hasn't wondered - how on earth does my baby get out of such a small hole? OMG how can I stretch that much? No wonder so many of us are frightened of birth – we have heard that it is like shitting a watermelon and that is enough to make you run mile in the opposite direction! Well if you have been following me for a while you’ll know that birth is nothing like shitting a watermelon & your body is beautifully designed to open for your baby! Welcome to WOW Wednesday where I share weekly tips that my clients love to hear, to help you on your pregnancy journey!

Fact - In birth, your Vagina doesn't stretch, it unfolds. Incredibly your amazing vagina can unfold by up to 10x it's usual size in birth....The walls of the vagina are covered in many folds called rugae. These are folded tightly, but during childbirth they open out to allow for stretching, a little like a drawstring purse. This means your baby has enough room to get outta there! One of the reasons birth tends to happen slowly first time round is because the rugae haven't stretched that much. And when birth is over? The rugae go back to their natural state. Wow!

Your vagina unfolds in birth, rather like a drawstring purse 💕

Remember that as your body is unfolding for birth, your baby’s skull can move and mould to ease their exit. Their malleable skull is designed to move closer together to allow them to move through your birth canal. You might have heard of fontanels, the An two major soft spots on the top of a baby’s head. These soft spots are spaces between the bones of the skull where bone formation isn't complete, allowing the skull to be moulded during birth - wow! The birth of your baby is an intricate dance between Mamma & babe - the foundation for life ahead!

Your baby’s malleable skull is designed to move closer together to allow them to move through your birth canal with greater ease.

As you unfold for birth, they mould and navigate their way through your birth canal.

The area that does stretch in birth is your perineum (the area of skin/muscle between your vagina and anus) and this stretching is responsible for the 'ring of fire' that you may have heard of. The best way to imagine the ring of fire - this is for you Mamas and your partners to try - hold the edge of mouth with your little fingers and pull... feel that burning sensation - that is a little taster of the ring of fire!! The truth of it is that by this time your baby is so close to being born that their arrival is what you are focused on – it may help that some say the longer you feel the burning sensation, the more likely it is that you are stretching rather than tearing. It will be brief and you will be through it, it is the closest to meeting your baby that you have yet got!

The perineum is the area that can graze or tear during crowning. It is really important to talk about tearing & episiotomies in labour. I am sure you are wincing again at the thought of such a thing! It is one of the most dreaded aspects of birth and I am a big fan for turning towards our fears, dealing with them and moving forward positively rather than letting them build and gain traction and diminish your confidence in your birthing power.

Unfortunately tearing is quite common… RCOG Royal College of Obstetricians & Gynacologists state that around 90% of women tear during childbirth and these can vary from a mild graze or small tear which are more common to a 3rd or 4th degree tear which are far less common. Around 61% of the 90% who tear will require stitches. The tear will be on your perineum, the skin btwn back of vagina & bottom. An episiotomy is a cut made by into the perineum and vaginal wall to make more space for your baby to be born and if it looks like a smaller episiotomy might reduce the chance of a deeper tear.

Episiotomies are done with your informed consent. Tears and episiotomies are typically easy to deal with – wherever you have given birth midwife will be trained, have the right equipment, can give you a local anaesthetic – and you’ll only need to transfer to an obstetrician if you have a significant tear – and these only happen in about 3% of cases.

The fact is that at the moment of birth, if you tear, you are unlikely to feel it – how I hear you ask? At the moment of birth, all your focus is on your baby – your body will be flooded with oxytocin which peaks beautifully at birth so you immediately bond & want to protect your baby, initiating your maternal instincts & stimulating your breast milk production. You will be on cloud 9, elated and, totally mesmerised by your gorgeous baby and feeling like a birthing goddess. The first time you may realise there is a tear, is likely to be when the midwife tells you.

It is important to know that any tear or episiotomy tend to heals really well & quickly with no scars & limited bleeding – unlike other parts of the body, the vagina heals well, and you won’t even be aware of where the tear is after a few months – there is such a good blood supply to the areas we helping it heal beautifully.

Waterbirth eases the pressure on the perineum 🙏

It is also important to know that there are several proactive steps that you can do to keep your perineum intact in birth:

+Perineal massage (massaged tissue stretches further - see this LushTums blog on how to perineal massage: https://www.lushtums.co.uk/blog/2020/4/27/antenatal-perineal-massage); Use any natural oil – coconut, olive oil –put thumb in vagina towards the back & gently massage, stretch, moisturise and make the skin supple. start from 36 weeks

+Water birth - reduces tear risk because it is warm, making your body more relaxed and easily able to stretch.

+Relaxed jaw during birth (floppy face, floppy fanny);

+Warm compress on your perineum - all can help prevent tearing or the need for episiotomy.

+Pelvic Floor exercises – the squeezy app is an excellent, graphic to follow to hold & release & set times to remind you – great for regular exercises. Important to be toned but also to release for birth – get familiar with how it feels to let go & release. When baby is arriving, want everything to soft, relaxed & released – don’t want baby coming down & pelvic floor coming up in tension, want to be relaxed & release to help your baby’s gentle & easy descent

*Homebirth – proven to reduce tearing –less women experience a tear at home because they are more relaxed.

*Slow birth –baby comes down & draws up, massage, kneading at the skin, vagina like dough, & baby’s head stretching & kneading vaginal walls to not cause any damage, come down with the surge & come back up as the surge releases.

*Breathing down your baby vs. coached pushing – working with your breath and using the Down Breathing technique (quick inhale through nose & long exhale focusing downwards as you imagine your body blooming your baby into life, like a glorious peony) facilitates slow, gentle birth. If you push & force your baby, you are more likely to create damage.

*Positions in birth – Mama keeping Upright Forward and Open (UFO eg:squatting, all 4s, benefitting from gravity) to assist the widening of the pelvis in birth by up to 28%!). Baby position - encouraging them into optimal foetal position in pregnancy eg: head down, back of their head towards pubic bone, eyes towards your back, so the pressure of their head puts uniform pressure on the cervix to dilate & facilitating a smoother birth.

In summary, the best ways to reduce risk of tearing are being in a good position, being relaxed & warm, relaxed jaw and a soft supple perineum. You might not experience any tear and if you do, please know it will most likely happen without your knowledge and will heal before you know it.

After birth it is very common for your vagina to feel bruised, sore and stingy when you do a wee. A top tip is a peri (short for perineum) bottle/ normal water bottle with a squirty end – fill it with warm water & a little witchhazel and squirt it over the area when you are sat on the loo peeing and will lessen the sting and speed up the healing.

Mama you are MAMAZING and please know that your vagina is perfectly designed for birth - you can rely on her - the perfect system is in place inside you. 🙏