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 likelihood of a severe tear in first-time mothers (the most at-risk group) by up to 60 per cent, new research shows. Inserted between the vaginal wall and baby’s head at the time of crowning (when the head becomes visible), the device is said to help distribute the pressure of the baby’s head across a larger surface area, thereby reducing the chance of a tear.
Tearing of the perineum – the area between the vagina and the anus – can happen as the baby passes through, as a result of the tissue being stretched. It’s very common: according to the NHS up to nine in ten first-time mothers who have a vaginal birth will have some sort of tear.
As Dr Kristin Andre, a doctor in obstetrics and gynaecology at Helsingborg Hospital in Sweden, who led the recent study, explains, tears can cause short-term problems such as pain and irritation as a result of damage to the mucous membrane in the vagina; as well as long-term problems including incontinence and sexual dysfunction due to damage to muscles in the pelvic floor.
Tears are graded according to their severity. Grade 1, or first-degree, tears are small cuts or grazes affecting only the skin and usually heal quickly, without treatment. Grade 2 (second-degree) tearing affects the muscle of the perineum and the skin, and usually requires stitches.
A third or fourth-degree tear is deeper and involves the back passage/anal sphincter (a group of muscles around the anus that controls the release of stools) –and needs repairing in an operating theatre.
The Swedish team said studies suggest as many as seven in ten first-time 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 15 per cent of women with a second-degree tear can suffer anal incontinence a year after delivering their baby, according to previous research.
A third or fourth-degree tear, meanwhile, can be ‘a leading cause of female anal incontinence and can lead to long-term morbidity [disease]’, researchers said.
Yet despite the number of women affected and the impact of these injuries on their quality of life, ‘few preventative 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 pliable.
However, a highly regarded 2017 Cochrane review found that these did not help reduce second-degree tears, although there was some ‘moderate quality’ evidence they may reduce third and fourth-degree tears.
The new Babyslide device reduced grade 2 to 4 tears by 60 per cent. It is made from santoprene, a soft, flexible plastic. It consists of a longer flat strip of soft plastic (called the ‘tongue’), and has two smaller wings at 90-degree angles on each side, made from 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 sit externally, where they are held in place by the doctor or nurse, to ensure continuous manual pressure on the perineum throughout the birth.
For the new study, 92 pregnant women were randomly divided into two groups – one had the Babyslide used during childbirth, while the other group received standard care.
Results published in the American Journal of Obstetrics and Gynaecology Maternal-Fetal Medicine, showed that women in the Babyslide group had a significantly lower risk of sustaining more extensive perineal tearing than those in the control group.
Plus, despite concern that the tool itself could increase tearing of the labia (the folds of skin around the vaginal opening), they found that in fact it reduced labial tearing, possibly because pressure was distributed over a wider area.
Dr Andre says the Baby-slide device, which costs £44 to buy privately, is easy for doctors and midwives to use and doesn’t seem to be uncomfortable for mothers, although this was not evaluated in the study. She adds warm compresses could still be applied with the device in place.
Commenting on the research, Soo Downe, a professor of midwifery studies at the University of Central Lancashire, said: ‘Reducing perineal tearing is important for childbearing women.
‘We know that some approaches, such as warm packs and massage, can reduce the most serious tears, and these should be offered to women routinely.
‘This study suggests there may also be a way of preventing middle level [second-degree] tears. This is an important finding. However, as the authors said, the study is small, from just one hospital in Sweden.
‘Before the device is used widely, results need to be tested in more sites, with a range of women, and with different approaches to childbirth to see if they still hold true.’
