I've shared my son Matteo's birth story before, but I recently revised it to submit to some essay contests so I wanted to share the updated version with you. At the end of the essay, I'll also share some takeaways of how you can prevent perineal tearing whether you are a survivor of sexual assault, childhood abuse, medical trauma, or just have general fears or worries about giving birth.
Birth of A Survivor
I remember the exact day. But only because it was New Year’s Eve, and each time I try to think of the year, I have to start with the year I graduated high school and count forward two years. Or was it one? I know it was after the first Mike I dated and before the second. Yes, okay, it was 2008. I was 19 years old. I was a virgin when 2008 ended. In the morning, I was not.
I’ll spare you the details not only to avoid saying trigger warning, but because I don’t fully remember. Somewhere in between clinking red solo cups and kissing a stranger in the new year, I woke up naked in the middle of a chokehold. That was the first time I was sexually assaulted. The other assaults line the streets in Shadyside, sit in Fenwick with friends, and the others fall somewhere in the years I drank to numb the pain in college.
I felt the stars rise in my head and my breath leave me the moment I took the first pregnancy test eleven years later. We had not planned to get pregnant yet. I walked out of the bathroom and stood next to my husband in the small hallway between our bedroom and stairs, my eyes wide and mouth agape. He had me take a second pregnancy test, just to be sure. The second one was clear, in little pink letters: PREGNANT.
I knew even before I got pregnant that my trauma would shape the way I gave birth. As a Pelvic Physical Therapist, I had seen how fear and anxiety surrounding birth could stall labor, make labor more painful, and even prevent a vaginal birth. I was determined not to let this happen to me. I put it all out on the table at my first midwife appointment. The nurse and midwife echoed each other: “Just let us know what we can do to support you.” When I presented my birth plan after months of research with the words “do not offer any pain medications,” the midwife with the mousy brown hair and kind face, looked down at me with her hands on my belly said, “you really should consider an epidural.”
I found others to support me.
I knew from the moment I saw a birth in a movie that I wanted to wait to find out the sex of my baby until the doctor lifted the baby up in the delivery room and exclaimed, “it’s a _____.” But not knowing, I found myself somehow putting space between myself and the baby. My husband wanted to know, so we decided to close that space the unknown created. When we got home from my 20-week ultrasound, I ripped open the envelope the ultrasound tech gave us and pulled out a little slip of paper. In blue, it read BOY😊.
Most of my nights were spent in the bathtub, my fingers moving the skin on the belly that connected my ligaments to my uterus, creating space and symmetry for him. I explored the cavern of my vagina, stretching the walls with my fingers. I repeated “The only way out is through. You are safe. You are safe.” As I lay in the warm water, I focused on the sensation of the air massaging the inside of my nostrils as I imagined the sensation of Matteo crowning.
I took my own knowledge further. People always talk about the mind-body connection, but what about the body-mind connection? I knew my muscles and bones held things. I knew that I would need to unhinge these memories, these fears from my body if I wanted to approach birth with confidence. I re-read research articles from my Obstetric training. One Swedish study stood out to me: “Fear causes tears—perineal injuries in home birth settings.” I knew my fear could stall labor, could cause my pelvic floor to tighten instead of open. It could cause me to tear. This is what I feared the most. If I tore, this would be the proof I needed. It would be proof that I was broken. So, I did the work that I do with my clients. I practiced pushing in positions that would open my pelvic outlet. I did specific stretches for my pelvic muscles and uterine ligaments. I meditated. I breathed deeply. I journaled. I voiced my fears while punching the heavy bag. I walked my dog up and down the streets of Greenfield and devised mantras for specific triggers during labor.
On January 1, 2020, after a week of prodromal labor, I went into active labor. I rocked on my birth ball at home, called my doula, and headed to the hospital at 9:45 pm. Things slowed when I got to the hospital, giving me ample time to get settled in the labor and delivery room. My doula filled the tub with water, waved essential oils under my nose, and massaged my back in the tub through a few contractions. Things started to speed, swell, and squash together after that. I got into bed and lied on my side to labor through the night. I was able to sleep for minutes at a time, but it was a restless sleep. Contractions pulled me from my dreams and into the shadows of the hospital room. Opening my eyes felt like a slap each time, the room spiraling around me. I woke in a panic, my brain confusing the pain of labor with pain from my past. Twice, I screamed, “No, No, No!” but I settled as my doula and husband gripped me and repeated “You are safe. You are safe.” I sucked honey from a stick and slept a few longer stretches. When I awoke in the middle of another contraction, my eyes still closed, I heard my voice reverberate in the room: “It’s not my fault.”
Closer to morning, labor intensified and the weight of it started to blur things even more: warm hands on my face, a sip of water through a straw, red-purple blood running down my leg, the brown-black of the shades colored by night, pinks and purples gripping hospital rails and throats. I heard myself groan low, long, again, again as the sun started to make its way around the earth and yellow light started to color the room. I looked down and at my belly, the lack of Matteo high in my belly looked funny, foreign. I stared at my pale leg as it moved up and down against the scratchy hospital sheet. I focused on the sensation, up and down, scratchy and smooth to cope with the pain. Low groans echoed, joining the chorus of millions of women who had come before me. I felt my doula’s breath on my skin as she reminded me, “Breathe, breathe.” I did. I heard my voice again through the din, “I’m going to be okay if I tear.” I groaned and pushed, then pushed some more, and at last, the pressure was gone, and we were separate for a moment as my midwife caught him. I can’t remember how long it took Matteo to cry, but I will never forget the weight of him on my belly, the feeling of him: slimy, warm, wet, yet soft. I tried to pull him up to my chest, but the cord was too short, so I curled into him. I felt the world move away for a moment. Relief spread over my body like warmth from a fire. I brought him to my breast as my midwife checked my perineum. “Just a few brush burns. No tearing.” I felt something change deep in my bones.
Later, we re-hashed the moments after Matteo was born. My husband was both shaken up by my cries for help and amazed at how calm I was afterward. It took me time to process. I wrote, talked to therapists, and wrote some more. At first, I attributed the calm to hormones. Oxytocin, I quipped. Yes, of course, but after more reflection, I think it was something more: a reprieve, a reset, a kind of healing.
The sun rose outside my hospital room window when Matteo came bloody and full into this world, illuminating my belly clawed with stretch marks, my fat teardrop breasts, and my arms encircling him: the conduit for my transformation from victim to survivor. For me, there will be no escaping the shards of memories from my past, but somehow, some way his birth allowed me to reclaim some of my light and power.
Your takeaway tips:
You need to work through your fears surrounding labor to prevent perineal tearing. A bulk of the work we do with clients in our labor prep program is to identify and work through fears. If left unchecked, fears will cause your pelvic floor to tense, which is the opposite of what we want in labor. Pelvic floor tension and fear can cause tears and stall labor. Start by setting a timer for 15 minutes and write down all your fears about labor. Identifying is the first step. Then, remember, you don't have to do this alone. We can help you work through fears and teach your pelvic floor to relax instead of tense in the face of your fears
Work on diaphragmatic breathing. Diaphragmatic breathing can help stimulate the vagus nerve to calm your nervous system and help your pelvic floor relax. If you need guidance on this, download our relax your pelvic floor guide. This will help you move in the right direction and get you on our email list so you're the first to know when our mind-body skills mini series is released. These mind and body hacks help to calm anxiety and pain and can be great coping skills during pregnancy!
Get support. Doulas can be extremely helpful to prevent traumatic birth and reduce fear in labor. Pick one who has either given birth themselves or has attended many births. We encourage clients in our labor prep program to have doulas so they can have support sticking to their birth plan and train their doula what to do in certain triggering situations and remind them what positions work best for their pelvic floor. That way, you don't have to remember everything we taught you, your doula can remind you if you forget!
If you want to ensure you're doing everything you can to prevent perineal tearing and traumatic birth, book a free consult in one of our clinics in Wexford, PA, Greensburg, PA, or virtually if you're not in Western PA or if you're in the South Hills (Mount Lebanon, Cannonsburg, Peters Township, etc.).