Maybe you’ve heard that vaginal birth is bad for vaginas. The whole melon being squeezed through an opening the size of a lemon thing. The stretching. The virgin pelvis.

There’s no data showing that vaginal birth in and of itself is bad for your body. But there is data showing that certain maternity care practices will do your bottom harm.

• episiotomy — This practice of cutting the perineum as the baby’s head crowns to widen the vaginal opening came into vogue in the 1930s, decades before any research determined if it was helpful. By the ’60s, most women were cut. Research began in the 1980s and has continued since, and now we know: routine episiotomy causes deeper tearing, longer and more painful recoveries, sexual pain, and incontinence. This surgical procedure is rarely, if at all, necessary, yet one-third of U.S. women who give birth vaginally are still cut.
• bad vaginal tears — It’s not uncommon to tear a little when giving birth vaginally for the first time. Ideally you don’t tear at all or you tear superficially and don’t need many stitches, if any. But it is possible to tear badly, the most severe tear extending into the anus. Not good. This is why it’s so important to have a provider who not only swears off episiotomy, but one who will help protect your perineum.
• directed pushing — Also called “purple pushing,” this practice of asking women to hold their breath, count to ten, and PUSH! has been shown to increase the chance of a severe tear, along with incontinence and other undesirable consequences. The best way to avoid relying on the direction of others is to avoid or turn off immobilizing anesthesia, feel the urge to push, and give birth in an upright position with gravity on your side.
• forceps and vacuum — These instruments are used to hasten or achieve a delivery when pushing isn’t enough, and they are almost always accompanied by an episiotomy. Both are associated with more severe vaginal tears and incontinence. And either instrument can damage the baby’s head.
• laboring supine — When you’re on your back, the weight of the baby puts tremendous pressure on your pelvic floor, the muscle that’s essential for normal bladder function. You’re also compressing your vena cava, the major vein that keeps you and the baby oxygenated. Keeping upright and active is best for both of you.
• pushing supine — A.k.a. lithotomy position, or “pushing uphill.” A Uruguayan obstetrician once said there is no worse position in which to give birth, save being hung upside down by the feet. Lying or leaning back while you push lengthens labor, delivers less oxygen to the baby, and increases the chance of pelvic injury.
• fundal pressure — This is when your birth attendant presses down on your abdomen (technically the top of your uterus, called the “fundus”) while you are pushing. Like all of the above, this can be damaging, and it can also cause the placenta to detach prematurely. If your provider’s hands are anywhere, they should be supporting your perineum, not putting more pressure on it.

A note about incontinence: Some studies have shown that women who give birth vaginally have more short-term urinary problems than women who give birth by cesarean. But these studies do not control for the damaging labor practices common in standard American maternity wards. To really examine the physical impact of vaginal birth itself, we’d need to compare women having cesareans to women having spontaneous, physiological, supported births. So far we have no such study.

A note about size: it generally doesn’t matter. For the past century, physicians have tried various means to predict whether a woman’s pelvis was “adequate.” They tried using a tool called a pelvimeter; they took X-rays (to the developing fetus’s detriment); they examined with their hands. But unless a woman has a physical deformity or a truly enormous baby (we’re talking more than 12 lb), nobody can really predict whether the pelvis is too small or the baby too big, because the pelvis stretches during childbirth.

Tired of being pregnant? Doctor proposing an induction? Click here before you say “I do.”