3 Things You Need to Know before Deciding on a Vaginal Delivery

Having a vaginal birth can be a wonderful miracle! It really is a joyous experience but it’s not without complications and understanding those complications and your risk factors for those complications can help you make a more informed decision. 

How long is your perineal body?

I know, you have no idea because who measures the perineal body? What even is the perineal body? Well… I do because it helps me know how likely you are to have severe tearing in birth. 

3rd and 4th degree tearing involves the anal sphincter and can lead to fecal incontinence (leaking), fecal urgency and pain. Once you have this injury it can be healed but there is a possibility of the symptoms returning with subsequent pregnancies, births and menopause. 

The perineal body is measured from the back of the vaginal opening to mid-anus while you are bearing down. If that measurement is more than 3cm the risk of tearing is 11% but if it is less than 3 cm that risk jumps to 40%.  Now this is only one factor but it’s a huge factor that can be changed by working with a pelvic physical therapist. 

How big is your baby? 

Measurements with ultrasound are not 100% accurate and can be off 1-2 lbs in either direction so a 8 lb baby on ultrasound could be 6 or 10 in reality. Really big babies (over 9lbs 8 oz) have a harder time getting through the birth canal and will increase your risk for tearing. You won’t know the size of your baby until close to birth (often at the 36 wk ultrasounds) and big babies are born vaginally all the time so this doesn’t mean you have to have a C-section but it’s something to consider. 

If your provider is talking about the size of your baby being a concern, you can do these things to feel more confident: 

• Start a conversation to get more information from the doctor.

Ask them at what weight would make them feel nervous to deliver vaginally and why. Ask if the baby gets “stuck” or stops progressing what would be the next steps and what are the risks and benefits of each option. 

• Train your body and pelvic floor to create space for baby and allow for more stretching and less tearing. 

How much hip and sacral mobility do you have?

As the baby travels through the birth canal they will push up against your sacrum (tailbone) your hip flexors, your pubic bone and your hip rotators.  All of these need to be able to move freely to allow the baby to make space, rotate and drop down into position. 

Signs you don’t have enough mobility: 

• You always sit with 1 leg crossed over the other or leaning on the same hip with your legs tucked under you to the side. 

• You have low back pain or SI joint pain in pregnancy. P.S. It’s not normal even though it’s common. 

• When you squat, lunge or walk up stairs your knee falls in toward the other knee. 

• When you sit cross legged on the floor, one leg or both feel tight.

• You have tailbone pain, pain with sex or pubic symphysis pain. 

All of this can be fixed during pregnancy to get you moving well and creating space for baby to come into this world and into your arms! 

After looking at these things, do you feel confident in having a vaginal birth or do you want a C-section?  Neither is easy and they both can have complications and be magical. It’s all about making the right decision for you, preparing your body and mind and being on the same page with your doctor.