Simple device to reduce the risk of tearing during childbirth

A simple, flexible plastic device developed by doctors in Sweden could help prevent women from suffering a perineal tear during childbirth.

The device, called Babyslide, reduced the risk of a serious tear in new mothers (the group at highest risk) by up to 60 percent, new research shows. The device is inserted between the vaginal wall and the baby’s head at the time of coronation (when the head becomes visible) and is said to help distribute the pressure of the baby’s head over a larger surface area, reducing the chance of a tear is reduced.

Tearing of the perineum – the area between the vagina and the anus – can happen during the baby’s passage, due to stretching of the tissue. It’s very common: according to the NHS, up to nine in 10 new mothers who have a vaginal birth will have some kind of tearing.

As Dr Kristin Andre, a doctor of obstetrics and gynecology at Helsingborg Hospital in Sweden, who led the recent study, explains, tears can cause short-term problems such as pain and irritation due to damage to the lining of the vagina; as well as long-term problems including incontinence and sexual dysfunction due to damage to the muscles in the pelvic floor.

Tears are graded based on their severity. Grade 1 or first-degree tears are minor cuts or scrapes that affect only the skin and usually heal quickly without treatment. Grade 2 (second degree) tears affect the muscles of the perineum and skin, and usually require stitches.

A third or fourth degree tear is deeper and involves the posterior passage/anal sphincter (a group of muscles around the anus that controls bowel movements) and must be repaired in an operating room.

The Swedish team said studies suggest as many as seven in 10 new mothers experience grade 2-4 perineal tearing – but most are grade 2.

Second-degree tears can affect sexual function and increase the risk of painful sex, urinary incontinence, and pelvic organ prolapse. And according to previous research, 15 percent of women with a second-degree tear may experience anal incontinence a year after giving birth.

A third- or fourth-degree tear, meanwhile, “may be a major cause of anal incontinence in women and can lead to long-term morbidity (disease),” researchers said.

But despite the number of women affected and the impact of these injuries on their quality of life, ‘few preventive measures have been shown to reduce the amount of perineal tearing’.

Currently, midwives can use warm compresses and perineal massage, which aim to make the tissue more supple.

However, a highly regarded 2017 Cochrane review found that these did not help reduce second-degree tears, although there was some ‘moderate quality’ evidence that they might reduce third- and fourth-degree tears.

The new Babyslide device reduced grade 2 to 4 tears by 60 percent. It is made of santoprene, a soft, flexible plastic. It consists of a longer flat strip of soft plastic (called the ‘tongue’) and has two smaller wings on each side at a 90 degree angle, made of the same material.

During crowning, the larger strip is inserted between the baby’s head and the back wall of the vagina. The shorter wings are on the outside, where they are held in place by the doctor or nurse, to provide continuous manual pressure on the perineum throughout the birth.

For the new study, 92 pregnant women were randomly divided into two groups: one used the Babyslide during labor, while the other group received standard care.

Results published in the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine showed that women in the Babyslide group had a significantly lower risk of sustaining a more extensive perineal tear than those in the control group.

Furthermore, despite concerns that the device itself might increase tearing of the labia (the folds of skin around the vaginal opening), they found that it actually reduced tearing of the labia, possibly because the pressure was distributed over a larger area.

Dr. Andre says the Baby-slide device, which costs £44 to buy privately, is easy for doctors and midwives to use and does not appear to be uncomfortable for mothers, although this was not evaluated in the study. She adds that warm compresses can still be applied while the device is in place.

Commenting on the research, Soo Downe, professor of obstetric studies at the University of Central Lancashire, said: ‘Reducing perineal tears is important for fertile women.

‘We know that some treatments, such as warm compresses and massage, can reduce the most severe tears, and these should be offered to women routinely.

‘This study suggests there may also be a way to prevent mid-level (second-degree) tears. This is an important finding. However, as the authors said, the study is small and comes from just one hospital in Sweden.

‘Before the device is widely used, the results need to be tested in more locations, in different women and with different approaches to delivery, to see if they still hold true.’