Episode 40: Childbirth and vaginal / vulva tears

Dr. Sophia:
Hello everyone. Welcome to the Dr. Sophia ObGyn podcast. I'm an obgyn practicing for over 15 years in my native New York City. And I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Hello everyone and welcome to the Dr. Sophia ObGyn podcast today. And I know I'm always super excited for every episode, but I'm so excited about this episode . We're gonna be talking about vaginal lacerations during childbirth. And the reason why I'm so excited about it is because no one ever talks about it and the fact that it is such a common thing that happens at delivery and that women go through on an every single day basis. And as always, it all started from a conversation that Touseef and I were having. And so, without further ado, I am joined by my good friend and co-host Touseef Mirza.

Touseef Mirza:
Hello, everybody. So just to be clear, when we say lacerations, we mean tears.

Dr. Sophia:
Tears, cuts, abrasions.

Touseef Mirza:
So one of the things we started to talk about was like, you know, different aspects of pregnancy, and we talked about, you know, what are different things that we could bring to all of you that's not talked about a lot. And then I remember this was a long time ago, time flies, but it was with Cardi B and Cardi B, when she had her first baby, which was in 2018. She just went on like a talk show host. And, and you know, usually people say, oh, how was your pregnancy? How's it going? And everybody's like, oh, you know, it was an amazing experience and it was beautiful. And Cardi B, being the badass that she is, said those things as well. And then she said, I didn't realize that the baby was gonna break my vagina. Just dropped it right there, you know, mic drop.

And I think that is so interesting to me that it's something that happens all the time. We never talk about it. And then Cardi B opens, it's a little bit like what menopause has happened, right? Nobody used to talk about it. Now we've opened that aperture and now everybody's talking about it. I don't think we're there yet with the vaginal tears, but we should.

Dr. Sophia:
We absolutely should. Because vaginal tears happen in about 80% of vaginal delivery, which

Touseef Mirza:
It's so wild that it's so much. When we were doing the research, I had no idea that it was 80%. I thought it was maybe, I don't know, 30, 40%. But it's almost the norm.

Dr. Sophia:
No, it's, it happens. And when we say vaginal tears, we're talking about the entire gamut, right? So whether we're talking about just a small cut, an abrasion, a deeper laceration, or a deeper cut. And in medical terms, we have varying degrees of how severe, from the least severe being a first-degree tear to a more severe or the most severe tear being a fourth-degree tear or laceration.

Touseef Mirza:
So let's start from the beginning. So when a woman is in labor, yes. Is the vagina already starting to be a little bit different? So what, basically this episode is about everything that happens to the vagina and the vulva during delivery, and certain effects that can happen as well. So, during labor, are we already seeing certain changes in the vagina?

Dr. Sophia:
Absolutely. The changes of the vagina start from the pregnancy itself. The hormonal changes that happen in the body because of pregnancy have a big influence on the vagina and the cervix, and the vulva. And so one major thing is that there's a dramatic increase in estrogen. For example, estrogen is going to help the vagina become a lot more full of blood and just more vascular. And so it also kind of, because of “beefing” up the tissue, the vaginal tissue becomes thicker, more elastic.

Touseef Mirza:
So you're saying vascular meaning there's more blood vessels. Blood vessels, okay. That appears in order to accommodate what's gonna happen.

Dr. Sophia:
That is correct. And that, and that increase in blood vessels is also adding more nutrients to the vagina, and therefore increasing the thickness and elasticity of the vaginal tissue to help it become more elastic.

Touseef Mirza:
When did these changes actually happen when you are pregnant? Does it happen like closer to when you're about to deliver or

Dr. Sophia:
The changes start from the pregnancy? From the beginning of the pregnancy, you already have a surge that's happening in terms of estrogen, both estrogen and progesterone. So progesterone is having a relaxing effect on ligaments and other tissues in order to just accommodate the baby that's going to be coming through. The vagina also becomes a lot more moist. So there's a lot more discharge that's happening at the level of the vagina. And all of that is happening throughout the pregnancy.

Touseef Mirza:
So when you say discharge, you're basically seeing different spots coming out on your underwear throughout your pregnancy.

Dr. Sophia:
Yes. So we love to talk about discharge, of course, on this podcast, but the thing is, the understanding that you'll have a little bit more typically when you're pregnant.

Touseef Mirza:
And it doesn't mean that you're dirty, it doesn't mean that something's wrong. This is just the vagina preparing itself.

Dr. Sophia:
That is correct. No, there's definitely nothing wrong. Certainly, of course, if it's not smelly or itchy or causing you any kind of discomfort. But yes, this is the normal stuff. And so when we actually get to the delivery process, I just think the vagina is such an amazing organ. The concept of the fact that a baby can pass through the vagina, which has an opening that's not more than typically three or four centimeters, and then a baby's head that's fully 10 centimeters typically has to pass through. Granted, the vagina obviously also accommodates sexual intercourse, but it's still not 10 centimeters.

Touseef Mirza:
So just to back up for those of you that, just to make sure we understand all the anatomical aspects of the vagina and the vulva, can you just explain where exactly the vagina, the vulva, and the cervix are? 'Cause we're gonna be talking about those.

Dr. Sophia:
The cervix is the lowest, most part of the womb. And it is at the apex or inside, deep inside the vagina.

Touseef Mirza:
It's at the bottom of the uterus

Dr. Sophia:
At the bottom of the uterus, at the top of the vagina, on the inside. This is where your cervix is located. The cervix has to open completely in order to allow for the passage of the baby. The vagina is the tunnel or tube that the baby has to travel down in order to get out and be delivered and be born. The vulva includes the labia or the lips of the vagina. It includes the clitoris, it includes the perineum, and the connection between the vagina and the anal region. That part of the pelvic floor that connects where the vagina ends and where the anus then will begin.

Touseef Mirza:
So the vulva is mostly the exterior part?

Dr. Sophia:
That is correct.

Touseef Mirza:
So when we're getting close to delivery and the mom-to-be is in labor, I know we talked about how the vagina has already thickened and it's now vascular. Are there certain changes even happening just moments before the baby comes out, or is it just getting ready to become more stretchy?

Dr. Sophia:
It really is just becoming more stretchy, as you say. The vagina will have a lot more pressure on top of it, just because of the fact that the baby is now coming down a lot. It will have a lot more pressure. So those blood vessels are going to be even more thickened or more pronounced, I should say. Some women, even during their pregnancy, can experience this because of the weight of the pregnancy and the pressure on the blood vessels that are at the level of the vagina and vulva, at the level of the vulva. They may even experience things such as varicose veins, something that we usually think of happening on our legs, or the, you know, like spider veins or varicose veins that we think of that can happen at the level of the legs, but can actually be happening even on the vulva just because of that increased pressure.

Touseef Mirza:
So then labor starts, the baby starts to make its way into the vagina-

Dr. Sophia:
The vaginal canal.

Touseef Mirza:
The vaginal canal. So can you just talk us through like, as you being the, the obgyn and welcoming, how, how do you say?

Dr. Sophia:
I like to usher.

Touseef Mirza:
Usher, exactly. I love that term as you are ushering the baby into this world. Can you tell us a little bit about, like, what are you seeing or how is the baby coming out and how is the vaginal canal changing or the vulva and how do you just approach all of these elements?

Dr. Sophia:
So vaginal birth is still my favorite, favorite part of what I do. And it's different for everyone, and it changes even for me. However, some things definitely stay the same. You get excited as you start to see the top of the baby's head kind of poking through with every contraction and every push, as the baby's head is slowly making its way to allow for the opening of the vagina. And it opens ever so slightly. And then a little bit more, and then a little bit more and a little bit more as the mom has her contractions and, and pushing efforts when we're at that point. Now, in order to get to pushing, let's just go back a step because your cervix has to open fully to 10 centimeters, which we call fully dilated. And the head of the baby has to become low enough so that way the mom's pushing actually has an effective change. Like the baby's actually moving down the vaginal canal. And we want that to happen in a very, kind of a rhythmic kind of way, is the best way for me to put it.

Touseef Mirza:
And is the reason for that is because if it's coming in, in the rhythmic way, like you're saying, then the vagina has more time to slowly open

Dr. Sophia:
The vagina then has time to accommodate that baby's head that's coming down. Because what we hopefully can try to, I don't wanna say avoid, because women, listen, we have been having babies for centuries. Right? For years, for millennia, right? We've been delivering our own babies, and the majority of the time has actually been not in a hospital, not in a medicated place, you know, in this very sterile kind of environment. We've been doing it in villages, we've been doing it in homes. So I don't wanna take anything away from what the body is naturally fit for, but me as the obgyn who is happy to usher in the baby, I would like to see that the baby is coming in down in this rhythmic kind of way. Because then it kind of gives, like I said, the opportunity for the vagina to accommodate, for that head to come down slowly for those tissues to kind of become accustomed to what's happening at that moment in order to hopefully prevent big tears.

Touseef Mirza:
But if she does start to push too much, if she can't help it and she goes, oh my God, I can't help it. It has to just come out. I can't, you know, and it's just coming out. Do you try to slow her down in that situation? What do you do?

Dr. Sophia:
I would say that vaginal birth has so many different ways in which women give birth. And so sometimes they're medicated in the sense that they can have like an epidural, for example. Or they can have other IV medications that can make them a lot more relaxed perhaps during the birth, and in other times can make them not even feel the pressure or the pain of going through the birth. So we have to take into account the two different situations. One that is an unmedicated birth, meaning no pain medication, no medications that are going to help take away the pain aspect, versus a medicated birth for which in both scenarios, you can still have lacerations, you can still have vaginal tears. But certainly, in a woman who has no pain medication on board, you want to have as much control in how she's pushing and helping her to manage her pain so that you don't have the explosive forces that women really have. Like women are like, we are strong, we are like a Mac truck, tons strong. Okay. And when we're pushing all of that strength comes out. And so we can have vaginal tears that happen just due to shearing, what we call shearing forces. So it's like the head coming out with so much force and with so and so quick that the vagina doesn't have an opportunity to accommodate. And so it shears or tears right straight down the actual vagina tissues.

Touseef Mirza:
I didn't realize that the vaginal tears are as prominent as the vulva tears in my mind that there would be a lot of tears around the vulva because everything, it's true, the whole baby is coming through the vaginal canal and eventually through the vulva. But I, in my mind, I just didn't know if the vulva would be that elastic. So I always thought the vulva would cause more tears. But

Dr. Sophia:
You mean like the labia you mean?

Touseef Mirza:
Yeah, around the labia

Dr. Sophia:
Labia, oh, the lips.

Touseef Mirza:
You know, like when the baby is actually coming out. I thought, you know, probably that area isn't, it's not very stretchy, and so that's where the main tears would be. But as you're, you're talking, there's a lot of that that actually happens in the vaginal canal.

Dr. Sophia:
Sometimes even before the head even comes out, the woman can experience tears that are happening inside of the vagina as the baby is coming down the vaginal canal. Those tears are called sulcal tears that can happen along with the different varying degrees of the tears as we talked about. And the degree of the tears matters because something called a first degree tear is only going to be a tear that's through the vaginal skin and through the vaginal mucosa. Something called a fourth degree tear, which is usually the most, is considered the most severe type is going to tear through the vagina, the tissue of the vagina. It's gonna tear through the muscles or the pelvic floor muscles or perineal muscles.

It's gonna tear through all of those muscles. It's gonna tear through what we call the anal sphincter or around the anus, and then tear through the anus and even through the rectum. So you have multiple layers that can have tears. And so the varying degrees are the varying degrees of how deep, how many layers of tissue have we gone through. And the most common, I would say are the first degree and the second degree tears, which involve the skin of the vagina, the mucosa or the tissue of the vagina. And sometimes partially a little bit of the muscle tissue of the vagina or the, what we call the perineal body or the perineal muscles,

Touseef Mirza:
Which is at the bottom.

Dr. Sophia:
Which is at the bottom. Yes. Okay. The bottom part of the vagina. Okay.

Touseef Mirza:
So then when the baby is coming out in the vaginal canal, what can you do as an obgyn to try to maybe not prevent the tear, but at least well try to prevent the tear first, or at least reduce the potential intensity of the tear?

Dr. Sophia:
So I want women to have the birth that they want, whether that is an unmedicated birth or a medicated birth. And what I will say is that women who have a medicated birth can have a little bit more control if they are able to have their pain better controlled. I think women who have an unmedicated birth can have the same amount of control, but may take a lot more coaching, or they may do a lot more prep, mental prep, emotional prep before they get to the actual pushing part. And for a lot of women, it's not even the pushing part that's so dramatic as much as the contractions, which are so painful. When they actually get the opportunity to be at the level of pushing, that's actually when they feel a lot more relief because you're pushing against that pressure, and it feels so much more. You can actually get a sense of relief. Now granted, nothing takes away what's called the ring of fire. The ring of fire when the baby's head is there. And it's that maximal stretch that's happening at the introitus or the opening of the vagina, what we call crowning, when that baby's head is almost halfway out. And that ring of fire, woo, I remember.

It feels like fire. You feel like you're trying to deliver a hot brick. Like, I have no other way of describing it at times other than to say that it feels like you're trying to deliver a hot brick. It's a very intense feeling. And that's with or without medication. So, without medication, you can just imagine you can double and triple that feeling. And so it takes coaching.

Touseef Mirza:
So can you give us an example? I remember you were telling me once, with one of your patients, you know, how you were helping that control back and forth. And when I asked you, well, you know, could you talk about it on the podcast? You're just like, I do that all the time. So can you? So can you, can you just, just share with us that part?

Dr. Sophia:
So when I say coaching, you want the mom to push effectively, but you, you know, when we're at that end, that last phase, the head is coming out, I want her to give her all she has, I want her to give me all she has, but at the same time to really be listening. So that way, when I say, okay, give me a soft push, give me a little baby push, because I'm trying to get the head to come out as slowly as possible. Okay. And I'm giving what we call counter pressure, and I have to give a shout out to someone named TP, you know who you are, because she taught me the art of balance and control and counter pressure.

Touseef Mirza:
So when you say counter pressure, you're basically saying you're asking the woman to push, but if she's pushing too much, you yourself, with your hand and your arm, have to push against the baby.

Dr. Sophia:
That is correct.

Touseef Mirza:
So that it doesn't come out too fast. And if it comes out too fast, then

Dr. Sophia:
What happens when the baby comes out, kind of with this big explosive force, then that's when you can have major tears. The more severe tears and lacerations, there is something called an episiotomy, which is a cut that the provider, the obstetrician, the midwife, the provider, the person who's delivering the baby can cut the vagina. If they see that the vagina is going to tear in order to accommodate or make space, however, there's enough evidence to show that there it is, it's better for a woman to have her own natural tear than to have an episiotomy. And the reason why is because once you've started to make the cut, if the tear is going to be a bad tear, it ends up being worse when there isn't an episiotomy cut. And so for me, in my practice, I can count on one hand how many times I've cut an episiotomy.

Touseef Mirza:
All right. Let's go back to the counterpart pressure. So you are there and you're pushing the head of the baby back, and just like, it's almost like going back and forth a little bit.

Dr. Sophia:
Yes. it's like literally it's a rocking. And let me tell you, like I said, women have Mac truck energy and strength when it comes to pushing out a baby. So imagine that I have to now be trying to put my little you know, I'm not that little, but regardless of my size. Pushing against this woman who's pushing, like basically her life depends on it.

Touseef Mirza:
Right, right. So you're getting a workout.

Dr. Sophia:
I am getting a workout with every delivery. Yes, that is very true. I have to maintain my upper body strength. I do my pushups every day. And those pushups are to be able to deliver babies.

Touseef Mirza:
And that, that whole point is because you're trying to save that woman's vagina.

Dr. Sophia:
One hundred percent. I am trying to save the vagina from having an explosive delivery and an exploded vagina.

Touseef Mirza:
So when you say explosive delivery, does that mean basically that the baby's coming out too fast? Yes. Okay. An explosive vagina. What does that mean?

Dr. Sophia:
In my head? That everything tears.

Touseef Mirza:
Ah, okay. Alright.

Dr. Sophia:
Everything tears, the lips tear the vagina tears, the muscle tears, the perineall tears all the way through to the anus. I mean, this is what I'm trying to prevent the whole time.

Touseef Mirza:
And then you were telling me that you also had an experience, a personal experience with your first born.

Dr. Sophia:
That is correct. When I had my first child, I had what's called a third degree laceration, which is one of the more severe ones. And I think it's because, I mean, literally at that time, this is, we're talking like 25 years ago.

Touseef Mirza:
This is even before you were an obgyn.

Dr. Sophia:
This is way before I was a girl. Girl. I cannot say that I would have children right now if I had been an obgyn before I had kids, although I did really wanna be a mom. So I don't know the school's out on that one. But yeah, it was way before I had any idea, a clue of what is happening to my body.

Touseef Mirza:
I mean, did you even have knowledge that this might happen?

Dr. Sophia:
No. No. I had no idea. I had no idea what was gonna happen to my vagina. I had no, no, no idea.

Touseef Mirza:
Nobody said you might have some abrasions or tears. No,

Dr. Sophia:
No. I did not get any of that education. I did not get any of that. 80% by the way, listeners, it happens. Whether it's a little abrasion or a big tear. Okay. 80, let's say this again, 80% of vaginal deliveries have the potential to have a tear. Okay. And especially with the firstborn.

Touseef Mirza:
And what's crazy, if there's that many, why aren't women-

Dr. Sophia:
Talking about it?

Touseef Mirza:
Why, why don't women know about this? To be mentally prepared.

Dr. Sophia:
I was not prepared. Let me tell you again, my own personal experience. I was fully unprepared for the fact that I was going, and I had something called a third degree tear.

Touseef Mirza:
What does that mean?

Dr. Sophia:
It means that it went through the vaginal tissue. Well, the vaginal, the skin, the mucosa, and through the muscles of the perineal body or the, the perineial, the transverse perineal tissue.

The girl's muscle was totally torn and had to be repaired in layers. And no, I had no idea. And then, let me tell you back then, we don't do this anymore. Okay. But back then, the nurse was giving me what we call fundal pressure. Fundal pressure means literally applying pressure at the top of the uterus, because I was getting, I was so exhausted when it was, you know, pushing, I was exhausted and just couldn't do what felt like I couldn't push anymore. And I felt like my baby was so big. Like, how is this baby coming out? It's not happening. And I guess perhaps his heart rate was going down or, or something was happening that he needed to come out right then and there. Okay. And literally the nurse went on my belly with her knee

Touseef Mirza:
To try to push it out, to push him out.

Dr. Sophia:
I'm not kidding.

Touseef Mirza:
Wow. And obviously your vagina wasn't ready for that.

Dr. Sophia:
And so my son came out like, there he was, I mean, but he had to come out. I get it.

Touseef Mirza:
Right.

Dr. Sophia:
And, and thank God we don't do this anymore . Right. This is not how we affect vaginal births anymore with fundal pressure. But yeah, he came out and yes, I had what I consider as the exploded vagina. Okay. But there's more to it because afterwards, after the repair, there's the recovery, there is the, how do you deal with your bottom feeling? Swollen, irritated pain, just pain. I just remember the pain. So now you've done all this work to have a baby, and then there's more pain. So this is the part of the vaginal delivery part that I feel like we just don't talk about. And women need to know it's a possibility. And it depends. It matters how we are pushing. It matters the relationship you're having with the provider that is pushing you, that's helping you to usher in this baby. Because how aggressive we need to be at the time of birth and how that can impact the way the vagina accommodates or does not accommodate for that baby.

Touseef Mirza:
That sounds so super scary. I've never had a child. Don't regret that. So lemme ask you, when we say a vaginal tear, when we say a tear at the level of the vulva, like what do you, what is it actually, and how do you actually repair it?

Dr. Sophia:
So the repair requires stitches and you repair it in layers. So every layer that has torn has to be brought back together in its own space. So

Touseef Mirza:
Let's say you have a vaginal tear, like you're going, once the baby comes out, you're going in the vagina to check, is everything okay? Yes. Okay. So, and then you see, oh, there's a, there's a tear, there's a laceration,

Dr. Sophia:
There's a tear. And, let's be clear, after a woman has had a baby, she's already gone through all of the pain and the contractions, and now she's to go through that ring of fire, pushing that baby out, her vagina becomes even more sensitive, right? She's already had to go through vaginal exams in order to see how dilated she is. The baby has to come out, et cetera. After the baby comes out. It's as if your vagina is on 10. And, and now I have to say, okay, I have to do your repair. And when you have to do the repair, especially in a mother who has been unmedicated, every single touch, every single, just just to, just to dab a little bit, to stop bleeding is like you're hitting her with a hammer. And so we as providers have to remember that, right? As providers, we have to remember, yes, I know she just pushed out this eight and a half pound baby, but her vagina feels on fire. And how do we accommodate cooling it down? How do we accommodate her to help her go through the repair?

Touseef Mirza:
And does it have to happen right after delivery?

Dr. Sophia:
It is because of a laceration or a cut or a tear, remember the vagina we talked about has all these blood vessels, and so you can bleed and you can bleed to death. If it's a big tear, deep tear, it's a big, deep tear that we are not able to see, or we are not able to repair in a very timely fashion like this. There's a lot of blood loss that can happen right there, just from your tears.

Touseef Mirza:
So it has to happen right then and there. Yes. And do you give numbing local anesthesia?

Dr. Sophia:
We give local anesthesia. We give local anesthesia, thank goodness. But again, like I said, the entire vagina becomes so uncomfortable. Painful even. I just, I don't want to even use the term uncomfortable because it's more than that, you know? And so giving the local numbing medication can be painful, you know? So it's important to wait to see that it actually is working to test, to make sure that it's you. The woman isn't gonna feel the sharpness of the needles and the suture that you have to use in order to actually repair the vagina.

And so there's a lot that goes to it. And that can happen whether the woman is medicated or not, even if she has an epidural and it's a good functioning epidural, you have at least that on your side, that she may not feel sharp, she may not feel all of the pain and the, the, the burning sensation that can happen. And so to that end, having adequate pain medication on board at the time of delivery can be very helpful in a woman who has a laceration for sure. And outside of that, once the repair happens is to really give the woman true, like expectations.

Use the cold ice packs, use the pads, use the numbing agents or ointments or whatever they can bring you in order to help the vagina feel a little bit better. Use what's called a peri bottle. It's like a little squeezy bottle that you fill with water every time you go to use the bathroom. Just imagine the agony/

Touseef Mirza:
Versus wiping yourself.

Dr. Sophia:
Versus wiping yourself. The agony of having to just to, just to pee after you've had a baby. How excruciating that can be.

Touseef Mirza:
If you have tears.

Dr. Sophia:
If you have tears. And even when you don't have tears, because just the head is passing through, remember when the head is passing through the vagina, it is pressing up against everything. It presses up against your bladder, it presses up against your urethra, presses up against all the walls of the vagina, that head coming through. And so the first few times that you have to go to void, to pee can even feel painful. . Burning discomfort, you know? So we are always happy for the women who feel, who are able to go through childbirth without any of this. But a lot of women go through childbirth experiencing some form of this. And this is just to give real world expectations. Now women, we are strong. We are strong, we can do anything.

We can have babies, we can have, we can get through and live through our vaginal deliveries and vaginal tears. And the vagina is so forgiving, it's such a forgiving place. It's such an amazing organ in that it, when repaired, when I see that woman again at six weeks, it looks like nothing happened because of all of those blood vessels, because of how that tissue comes back together and heals, and heals nicely as if nothing happened. You know? Now granted, she's not feeling that way, but-

Touseef Mirza:
Her vagina is doing it.

Dr. Sophia:
Her vagina is doing a thing when it's repairing. And going back to what it once was before she had a baby. You know, I do wanna mention the fact that it's, and we'll have to do a whole nother podcast on this, but after delivery, the importance of women doing things like pelvic floor exercises, things that help the vagina to regain its muscle strength and elasticity with the way in which they do these exercises that help with the pelvic floor. And I wish we did much more of this in this country, which is pelvic floor therapy after vaginal delivery. Something that is, you know, a part of routine care in other countries, but unfortunately it's not here. But the importance of doing that in order to help a woman feel much more like herself when she's ready to go back into her sexual life, for example, again, a whole nother podcast.

Touseef Mirza:
Yes. Another one.

Dr. Sophia:
Sex after Delivery. But here the conversation was to be about vaginal lacerations and tears.

Touseef Mirza:
So as we talked about, this is a much more common thing that happens than most people realize. So what can women do? What are certain tips that women can do if they know they're going to be delivering this child? Like, are there any things, anything that they can do to prepare themselves or to ease the pain?

Dr. Sophia:
I would say that women need to, if they can really become as active as they can during pregnancy, stay active, do squats, do the things that are gonna just help you be as strong as possible. Have as much control as possible. What does that mean? Like, figure out what are gonna be the things that help you through painful situations. If that means for you getting an epidural, by all means get the epidural. If you are someone who's like, I can do this without medication, that's okay. But then really commit to how you're going to do this without medication. Whether that means diverting that pain center, like to something else. Like I've had patients who've had these metal combs that they squeeze every time they get a contraction, or that they were able to squeeze and hold onto when they had to actually do the pushing.

And that helped them to divert the concept of where the pain was happening. And it helped them to have a lot more control, whether it's your breathing exercises, whether it's who you have with you in the room, having a doula, having someone, a support person with you who can help with calming you down, keeping you in a state of zen, even if that's possible. . When you're delivering, having aromatherapy, having the music playing that you want in the room when your baby's coming out. All of these things, asking for a warm towel even while you're pushing your baby.

Touseef Mirza:
And also just the recognition and awareness and realizing that this is something that might happen so that you're mentally prepared.

Dr. Sophia:
Oh, 100%. Being mentally prepared is, I think, 80% of the battle, knowing that there's a possibility that it can happen. Having a conversation with your provider, understanding what are their methods to try to mitigate tears so that they don't happen, or that they, if they do that, they're not the worst type, like, you know, know your doctor's statistics. Personally, I have not had a fourth degree laceration in years. When I say years over 5, 6, 7 years, and even a third degree laceration I haven't had in years.

Touseef Mirza:
So can, can somebody literally say to their provider, can we try everything for, to have minimal or no tears? Can somebody literally ask that to their provider?

Dr. Sophia:
Yes. And I think probably the number one thing they should ask is whether or not their provider routinely cuts something called an episiotomy.

Touseef Mirza:
Okay. Because that's not ideal to do that

Dr. Sophia:
Well, because it can lead to a lot of, you know, post-delivery vaginal pain.

Touseef Mirza:
I'm so glad we did this episode. Like this knowledge should be known by everyone, all pregnant women, all non-pregnant women, all men, like everybody, to really understand the full journey that women go through. And by the way, the journey that we all went through when we were going through the vaginal canal, like this is such good information. So thank you for just being so open and sharing all your experiences through it too.

Dr. Sophia:
I mean, I'm just so thankful that women allow me to be a part of that experience for them. It is an experience that still brings me a lot of joy is vaginal delivery. And I think this isn't valid information that a woman should talk about, understand, know, so that she can, as we said, mentally prepare. And this all goes back to our model. Embrace your body, know your body, know your own abilities. Have a clear conversation so that you can best embrace yourself. Until next time, thank you so much for listening to the Dr. Sophia ObGyn podcast. See you later.

Touseef Mirza:
Bye

Dr. Sophia:
Bye.

This is General Medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.