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The Wax and the Wane of the Web
I offer a single bit of advice to friends and family when they become new parents: When you start to think that you’ve got everything figured out, everything will change. Just as you start to get the hang of feedings, diapers, and regular naps, it’s time for solid food, potty training, and overnight sleeping. When you figure those out, it’s time for preschool and rare naps. The cycle goes on and on.
The same applies for those of us working in design and development these days. Having worked on the web for almost three decades at this point, I’ve seen the regular wax and wane of ideas, techniques, and technologies. Each time that we as developers and designers get into a regular rhythm, some new idea or technology comes along to shake things up and remake our world.
How we got here
I built my first website in the mid-’90s. Design and development on the web back then was a free-for-all, with few established norms. For any layout aside from a single column, we used table elements, often with empty cells containing a single pixel spacer GIF to add empty space. We styled text with numerous font tags, nesting the tags every time we wanted to vary the font style. And we had only three or four typefaces to choose from: Arial, Courier, or Times New Roman. When Verdana and Georgia came out in 1996, we rejoiced because our options had nearly doubled. The only safe colors to choose from were the 216 “web safe” colors known to work across platforms. The few interactive elements (like contact forms, guest books, and counters) were mostly powered by CGI scripts (predominantly written in Perl at the time). Achieving any kind of unique look involved a pile of hacks all the way down. Interaction was often limited to specific pages in a site.
The birth of web standards
At the turn of the century, a new cycle started. Crufty code littered with table layouts and font tags waned, and a push for web standards waxed. Newer technologies like CSS got more widespread adoption by browsers makers, developers, and designers. This shift toward standards didn’t happen accidentally or overnight. It took active engagement between the W3C and browser vendors and heavy evangelism from folks like the Web Standards Project to build standards. A List Apart and books like Designing with Web Standards by Jeffrey Zeldman played key roles in teaching developers and designers why standards are important, how to implement them, and how to sell them to their organizations. And approaches like progressive enhancement introduced the idea that content should be available for all browsers—with additional enhancements available for more advanced browsers. Meanwhile, sites like the CSS Zen Garden showcased just how powerful and versatile CSS can be when combined with a solid semantic HTML structure.
Server-side languages like PHP, Java, and .NET overtook Perl as the predominant back-end processors, and the cgi-bin was tossed in the trash bin. With these better server-side tools came the first era of web applications, starting with content-management systems (particularly in the blogging space with tools like Blogger, Grey Matter, Movable Type, and WordPress). In the mid-2000s, AJAX opened doors for asynchronous interaction between the front end and back end. Suddenly, pages could update their content without needing to reload. A crop of JavaScript frameworks like Prototype, YUI, and jQuery arose to help developers build more reliable client-side interaction across browsers that had wildly varying levels of standards support. Techniques like image replacement let crafty designers and developers display fonts of their choosing. And technologies like Flash made it possible to add animations, games, and even more interactivity.
These new technologies, standards, and techniques reinvigorated the industry in many ways. Web design flourished as designers and developers explored more diverse styles and layouts. But we still relied on tons of hacks. Early CSS was a huge improvement over table-based layouts when it came to basic layout and text styling, but its limitations at the time meant that designers and developers still relied heavily on images for complex shapes (such as rounded or angled corners) and tiled backgrounds for the appearance of full-length columns (among other hacks). Complicated layouts required all manner of nested floats or absolute positioning (or both). Flash and image replacement for custom fonts was a great start toward varying the typefaces from the big five, but both hacks introduced accessibility and performance problems. And JavaScript libraries made it easy for anyone to add a dash of interaction to pages, although at the cost of doubling or even quadrupling the download size of simple websites.
The web as software platform
The symbiosis between the front end and back end continued to improve, and that led to the current era of modern web applications. Between expanded server-side programming languages (which kept growing to include Ruby, Python, Go, and others) and newer front-end tools like React, Vue, and Angular, we could build fully capable software on the web. Alongside these tools came others, including collaborative version control, build automation, and shared package libraries. What was once primarily an environment for linked documents became a realm of infinite possibilities.
At the same time, mobile devices became more capable, and they gave us internet access in our pockets. Mobile apps and responsive design opened up opportunities for new interactions anywhere and any time.
This combination of capable mobile devices and powerful development tools contributed to the waxing of social media and other centralized tools for people to connect and consume. As it became easier and more common to connect with others directly on Twitter, Facebook, and even Slack, the desire for hosted personal sites waned. Social media offered connections on a global scale, with both the good and bad that that entails.
Want a much more extensive history of how we got here, with some other takes on ways that we can improve? Jeremy Keith wrote “Of Time and the Web.” Or check out the “Web Design History Timeline” at the Web Design Museum. Neal Agarwal also has a fun tour through “Internet Artifacts.”
Where we are now
In the last couple of years, it’s felt like we’ve begun to reach another major inflection point. As social-media platforms fracture and wane, there’s been a growing interest in owning our own content again. There are many different ways to make a website, from the tried-and-true classic of hosting plain HTML files to static site generators to content management systems of all flavors. The fracturing of social media also comes with a cost: we lose crucial infrastructure for discovery and connection. Webmentions, RSS, ActivityPub, and other tools of the IndieWeb can help with this, but they’re still relatively underimplemented and hard to use for the less nerdy. We can build amazing personal websites and add to them regularly, but without discovery and connection, it can sometimes feel like we may as well be shouting into the void.
Browser support for CSS, JavaScript, and other standards like web components has accelerated, especially through efforts like Interop. New technologies gain support across the board in a fraction of the time that they used to. I often learn about a new feature and check its browser support only to find that its coverage is already above 80 percent. Nowadays, the barrier to using newer techniques often isn’t browser support but simply the limits of how quickly designers and developers can learn what’s available and how to adopt it.
Today, with a few commands and a couple of lines of code, we can prototype almost any idea. All the tools that we now have available make it easier than ever to start something new. But the upfront cost that these frameworks may save in initial delivery eventually comes due as upgrading and maintaining them becomes a part of our technical debt.
If we rely on third-party frameworks, adopting new standards can sometimes take longer since we may have to wait for those frameworks to adopt those standards. These frameworks—which used to let us adopt new techniques sooner—have now become hindrances instead. These same frameworks often come with performance costs too, forcing users to wait for scripts to load before they can read or interact with pages. And when scripts fail (whether through poor code, network issues, or other environmental factors), there’s often no alternative, leaving users with blank or broken pages.
Where do we go from here?
Today’s hacks help to shape tomorrow’s standards. And there’s nothing inherently wrong with embracing hacks—for now—to move the present forward. Problems only arise when we’re unwilling to admit that they’re hacks or we hesitate to replace them. So what can we do to create the future we want for the web?
Build for the long haul. Optimize for performance, for accessibility, and for the user. Weigh the costs of those developer-friendly tools. They may make your job a little easier today, but how do they affect everything else? What’s the cost to users? To future developers? To standards adoption? Sometimes the convenience may be worth it. Sometimes it’s just a hack that you’ve grown accustomed to. And sometimes it’s holding you back from even better options.
Start from standards. Standards continue to evolve over time, but browsers have done a remarkably good job of continuing to support older standards. The same isn’t always true of third-party frameworks. Sites built with even the hackiest of HTML from the ’90s still work just fine today. The same can’t always be said of sites built with frameworks even after just a couple years.
Design with care. Whether your craft is code, pixels, or processes, consider the impacts of each decision. The convenience of many a modern tool comes at the cost of not always understanding the underlying decisions that have led to its design and not always considering the impact that those decisions can have. Rather than rushing headlong to “move fast and break things,” use the time saved by modern tools to consider more carefully and design with deliberation.
Always be learning. If you’re always learning, you’re also growing. Sometimes it may be hard to pinpoint what’s worth learning and what’s just today’s hack. You might end up focusing on something that won’t matter next year, even if you were to focus solely on learning standards. (Remember XHTML?) But constant learning opens up new connections in your brain, and the hacks that you learn one day may help to inform different experiments another day.
Play, experiment, and be weird! This web that we’ve built is the ultimate experiment. It’s the single largest human endeavor in history, and yet each of us can create our own pocket within it. Be courageous and try new things. Build a playground for ideas. Make goofy experiments in your own mad science lab. Start your own small business. There has never been a more empowering place to be creative, take risks, and explore what we’re capable of.
Share and amplify. As you experiment, play, and learn, share what’s worked for you. Write on your own website, post on whichever social media site you prefer, or shout it from a TikTok. Write something for A List Apart! But take the time to amplify others too: find new voices, learn from them, and share what they’ve taught you.
Go forth and make
As designers and developers for the web (and beyond), we’re responsible for building the future every day, whether that may take the shape of personal websites, social media tools used by billions, or anything in between. Let’s imbue our values into the things that we create, and let’s make the web a better place for everyone. Create that thing that only you are uniquely qualified to make. Then share it, make it better, make it again, or make something new. Learn. Make. Share. Grow. Rinse and repeat. Every time you think that you’ve mastered the web, everything will change.
Opportunities for AI in Accessibility
In reading Joe Dolson’s recent piece on the intersection of AI and accessibility, I absolutely appreciated the skepticism that he has for AI in general as well as for the ways that many have been using it. In fact, I’m very skeptical of AI myself, despite my role at Microsoft as an accessibility innovation strategist who helps run the AI for Accessibility grant program. As with any tool, AI can be used in very constructive, inclusive, and accessible ways; and it can also be used in destructive, exclusive, and harmful ones. And there are a ton of uses somewhere in the mediocre middle as well.
I’d like you to consider this a “yes… and” piece to complement Joe’s post. I’m not trying to refute any of what he’s saying but rather provide some visibility to projects and opportunities where AI can make meaningful differences for people with disabilities. To be clear, I’m not saying that there aren’t real risks or pressing issues with AI that need to be addressed—there are, and we’ve needed to address them, like, yesterday—but I want to take a little time to talk about what’s possible in hopes that we’ll get there one day.
Alternative text
Joe’s piece spends a lot of time talking about computer-vision models generating alternative text. He highlights a ton of valid issues with the current state of things. And while computer-vision models continue to improve in the quality and richness of detail in their descriptions, their results aren’t great. As he rightly points out, the current state of image analysis is pretty poor—especially for certain image types—in large part because current AI systems examine images in isolation rather than within the contexts that they’re in (which is a consequence of having separate “foundation” models for text analysis and image analysis). Today’s models aren’t trained to distinguish between images that are contextually relevant (that should probably have descriptions) and those that are purely decorative (which might not need a description) either. Still, I still think there’s potential in this space.
As Joe mentions, human-in-the-loop authoring of alt text should absolutely be a thing. And if AI can pop in to offer a starting point for alt text—even if that starting point might be a prompt saying What is this BS? That’s not right at all… Let me try to offer a starting point—I think that’s a win.
Taking things a step further, if we can specifically train a model to analyze image usage in context, it could help us more quickly identify which images are likely to be decorative and which ones likely require a description. That will help reinforce which contexts call for image descriptions and it’ll improve authors’ efficiency toward making their pages more accessible.
While complex images—like graphs and charts—are challenging to describe in any sort of succinct way (even for humans), the image example shared in the GPT4 announcement points to an interesting opportunity as well. Let’s suppose that you came across a chart whose description was simply the title of the chart and the kind of visualization it was, such as: Pie chart comparing smartphone usage to feature phone usage among US households making under $30,000 a year. (That would be a pretty awful alt text for a chart since that would tend to leave many questions about the data unanswered, but then again, let’s suppose that that was the description that was in place.) If your browser knew that that image was a pie chart (because an onboard model concluded this), imagine a world where users could ask questions like these about the graphic:
- Do more people use smartphones or feature phones?
- How many more?
- Is there a group of people that don’t fall into either of these buckets?
- How many is that?
Setting aside the realities of large language model (LLM) hallucinations—where a model just makes up plausible-sounding “facts”—for a moment, the opportunity to learn more about images and data in this way could be revolutionary for blind and low-vision folks as well as for people with various forms of color blindness, cognitive disabilities, and so on. It could also be useful in educational contexts to help people who can see these charts, as is, to understand the data in the charts.
Taking things a step further: What if you could ask your browser to simplify a complex chart? What if you could ask it to isolate a single line on a line graph? What if you could ask your browser to transpose the colors of the different lines to work better for form of color blindness you have? What if you could ask it to swap colors for patterns? Given these tools’ chat-based interfaces and our existing ability to manipulate images in today’s AI tools, that seems like a possibility.
Now imagine a purpose-built model that could extract the information from that chart and convert it to another format. For example, perhaps it could turn that pie chart (or better yet, a series of pie charts) into more accessible (and useful) formats, like spreadsheets. That would be amazing!
Matching algorithms
Safiya Umoja Noble absolutely hit the nail on the head when she titled her book Algorithms of Oppression. While her book was focused on the ways that search engines reinforce racism, I think that it’s equally true that all computer models have the potential to amplify conflict, bias, and intolerance. Whether it’s Twitter always showing you the latest tweet from a bored billionaire, YouTube sending us into a Q-hole, or Instagram warping our ideas of what natural bodies look like, we know that poorly authored and maintained algorithms are incredibly harmful. A lot of this stems from a lack of diversity among the people who shape and build them. When these platforms are built with inclusively baked in, however, there’s real potential for algorithm development to help people with disabilities.
Take Mentra, for example. They are an employment network for neurodivergent people. They use an algorithm to match job seekers with potential employers based on over 75 data points. On the job-seeker side of things, it considers each candidate’s strengths, their necessary and preferred workplace accommodations, environmental sensitivities, and so on. On the employer side, it considers each work environment, communication factors related to each job, and the like. As a company run by neurodivergent folks, Mentra made the decision to flip the script when it came to typical employment sites. They use their algorithm to propose available candidates to companies, who can then connect with job seekers that they are interested in; reducing the emotional and physical labor on the job-seeker side of things.
When more people with disabilities are involved in the creation of algorithms, that can reduce the chances that these algorithms will inflict harm on their communities. That’s why diverse teams are so important.
Imagine that a social media company’s recommendation engine was tuned to analyze who you’re following and if it was tuned to prioritize follow recommendations for people who talked about similar things but who were different in some key ways from your existing sphere of influence. For example, if you were to follow a bunch of nondisabled white male academics who talk about AI, it could suggest that you follow academics who are disabled or aren’t white or aren’t male who also talk about AI. If you took its recommendations, perhaps you’d get a more holistic and nuanced understanding of what’s happening in the AI field. These same systems should also use their understanding of biases about particular communities—including, for instance, the disability community—to make sure that they aren’t recommending any of their users follow accounts that perpetuate biases against (or, worse, spewing hate toward) those groups.
Other ways that AI can helps people with disabilities
If I weren’t trying to put this together between other tasks, I’m sure that I could go on and on, providing all kinds of examples of how AI could be used to help people with disabilities, but I’m going to make this last section into a bit of a lightning round. In no particular order:
- Voice preservation. You may have seen the VALL-E paper or Apple’s Global Accessibility Awareness Day announcement or you may be familiar with the voice-preservation offerings from Microsoft, Acapela, or others. It’s possible to train an AI model to replicate your voice, which can be a tremendous boon for people who have ALS (Lou Gehrig’s disease) or motor-neuron disease or other medical conditions that can lead to an inability to talk. This is, of course, the same tech that can also be used to create audio deepfakes, so it’s something that we need to approach responsibly, but the tech has truly transformative potential.
- Voice recognition. Researchers like those in the Speech Accessibility Project are paying people with disabilities for their help in collecting recordings of people with atypical speech. As I type, they are actively recruiting people with Parkinson’s and related conditions, and they have plans to expand this to other conditions as the project progresses. This research will result in more inclusive data sets that will let more people with disabilities use voice assistants, dictation software, and voice-response services as well as control their computers and other devices more easily, using only their voice.
- Text transformation. The current generation of LLMs is quite capable of adjusting existing text content without injecting hallucinations. This is hugely empowering for people with cognitive disabilities who may benefit from text summaries or simplified versions of text or even text that’s prepped for Bionic Reading.
The importance of diverse teams and data
We need to recognize that our differences matter. Our lived experiences are influenced by the intersections of the identities that we exist in. These lived experiences—with all their complexities (and joys and pain)—are valuable inputs to the software, services, and societies that we shape. Our differences need to be represented in the data that we use to train new models, and the folks who contribute that valuable information need to be compensated for sharing it with us. Inclusive data sets yield more robust models that foster more equitable outcomes.
Want a model that doesn’t demean or patronize or objectify people with disabilities? Make sure that you have content about disabilities that’s authored by people with a range of disabilities, and make sure that that’s well represented in the training data.
Want a model that doesn’t use ableist language? You may be able to use existing data sets to build a filter that can intercept and remediate ableist language before it reaches readers. That being said, when it comes to sensitivity reading, AI models won’t be replacing human copy editors anytime soon.
Want a coding copilot that gives you accessible recommendations from the jump? Train it on code that you know to be accessible.
I have no doubt that AI can and will harm people… today, tomorrow, and well into the future. But I also believe that we can acknowledge that and, with an eye towards accessibility (and, more broadly, inclusion), make thoughtful, considerate, and intentional changes in our approaches to AI that will reduce harm over time as well. Today, tomorrow, and well into the future.
Many thanks to Kartik Sawhney for helping me with the development of this piece, Ashley Bischoff for her invaluable editorial assistance, and, of course, Joe Dolson for the prompt.
I am a creative.
I am a creative. What I do is alchemy. It is a mystery. I do not so much do it, as let it be done through me.
I am a creative. Not all creative people like this label. Not all see themselves this way. Some creative people see science in what they do. That is their truth, and I respect it. Maybe I even envy them, a little. But my process is different—my being is different.
Apologizing and qualifying in advance is a distraction. That’s what my brain does to sabotage me. I set it aside for now. I can come back later to apologize and qualify. After I’ve said what I came to say. Which is hard enough.
Except when it is easy and flows like a river of wine.
Sometimes it does come that way. Sometimes what I need to create comes in an instant. I have learned not to say it at that moment, because if you admit that sometimes the idea just comes and it is the best idea and you know it is the best idea, they think you don’t work hard enough.
Sometimes I work and work and work until the idea comes. Sometimes it comes instantly and I don’t tell anyone for three days. Sometimes I’m so excited by the idea that came instantly that I blurt it out, can’t help myself. Like a boy who found a prize in his Cracker Jacks. Sometimes I get away with this. Sometimes other people agree: yes, that is the best idea. Most times they don’t and I regret having given way to enthusiasm.
Enthusiasm is best saved for the meeting where it will make a difference. Not the casual get-together that precedes that meeting by two other meetings. Nobody knows why we have all these meetings. We keep saying we’re doing away with them, but then just finding other ways to have them. Sometimes they are even good. But other times they are a distraction from the actual work. The proportion between when meetings are useful, and when they are a pitiful distraction, varies, depending on what you do and where you do it. And who you are and how you do it. Again I digress. I am a creative. That is the theme.
Sometimes many hours of hard and patient work produce something that is barely serviceable. Sometimes I have to accept that and move on to the next project.
Don’t ask about process. I am a creative.
I am a creative. I don’t control my dreams. And I don’t control my best ideas.
I can hammer away, surround myself with facts or images, and sometimes that works. I can go for a walk, and sometimes that works. I can be making dinner and there’s a Eureka having nothing to do with sizzling oil and bubbling pots. Often I know what to do the instant I wake up. And then, almost as often, as I become conscious and part of the world again, the idea that would have saved me turns to vanishing dust in a mindless wind of oblivion. For creativity, I believe, comes from that other world. The one we enter in dreams, and perhaps, before birth and after death. But that’s for poets to wonder, and I am not a poet. I am a creative. And it’s for theologians to mass armies about in their creative world that they insist is real. But that is another digression. And a depressing one. Maybe on a much more important topic than whether I am a creative or not. But still a digression from what I came here to say.
Sometimes the process is avoidance. And agony. You know the cliché about the tortured artist? It’s true, even when the artist (and let’s put that noun in quotes) is trying to write a soft drink jingle, a callback in a tired sitcom, a budget request.
Some people who hate being called creative may be closeted creatives, but that’s between them and their gods. No offense meant. Your truth is true, too. But mine is for me.
Creatives recognize creatives.
Creatives recognize creatives like queers recognize queers, like real rappers recognize real rappers, like cons know cons. Creatives feel massive respect for creatives. We love, honor, emulate, and practically deify the great ones. To deify any human is, of course, a tragic mistake. We have been warned. We know better. We know people are just people. They squabble, they are lonely, they regret their most important decisions, they are poor and hungry, they can be cruel, they can be just as stupid as we can, because, like us, they are clay. But. But. But they make this amazing thing. They birth something that did not exist before them, and could not exist without them. They are the mothers of ideas. And I suppose, since it’s just lying there, I have to add that they are the mothers of invention. Ba dum bum! OK, that’s done. Continue.
Creatives belittle our own small achievements, because we compare them to those of the great ones. Beautiful animation! Well, I’m no Miyazaki. Now THAT is greatness. That is greatness straight from the mind of God. This half-starved little thing that I made? It more or less fell off the back of the turnip truck. And the turnips weren’t even fresh.
Creatives knows that, at best, they are Salieri. Even the creatives who are Mozart believe that.
I am a creative. I haven’t worked in advertising in 30 years, but in my nightmares, it’s my former creative directors who judge me. And they are right to do so. I am too lazy, too facile, and when it really counts, my mind goes blank. There is no pill for creative dysfunction.
I am a creative. Every deadline I make is an adventure that makes Indiana Jones look like a pensioner snoring in a deck chair. The longer I remain a creative, the faster I am when I do my work and the longer I brood and walk in circles and stare blankly before I do that work.
I am still 10 times faster than people who are not creative, or people who have only been creative a short while, or people who have only been professionally creative a short while. It’s just that, before I work 10 times as fast as they do, I spend twice as long as they do putting the work off. I am that confident in my ability to do a great job when I put my mind to it. I am that addicted to the adrenaline rush of postponement. I am still that afraid of the jump.
I am not an artist.
I am a creative. Not an artist. Though I dreamed, as a lad, of someday being that. Some of us belittle our gifts and dislike ourselves because we are not Michelangelos and Warhols. That is narcissism—but at least we aren’t in politics.
I am a creative. Though I believe in reason and science, I decide by intuition and impulse. And live with what follows—the catastrophes as well as the triumphs.
I am a creative. Every word I’ve said here will annoy other creatives, who see things differently. Ask two creatives a question, get three opinions. Our disagreement, our passion about it, and our commitment to our own truth are, at least to me, the proofs that we are creatives, no matter how we may feel about it.
I am a creative. I lament my lack of taste in the areas about which I know very little, which is to say almost all areas of human knowledge. And I trust my taste above all other things in the areas closest to my heart, or perhaps, more accurately, to my obsessions. Without my obsessions, I would probably have to spend my time looking life in the eye, and almost none of us can do that for long. Not honestly. Not really. Because much in life, if you really look at it, is unbearable.
I am a creative. I believe, as a parent believes, that when I am gone, some small good part of me will carry on in the mind of at least one other person.
Working saves me from worrying about work.
I am a creative. I live in dread of my small gift suddenly going away.
I am a creative. I am too busy making the next thing to spend too much time deeply considering that almost nothing I make will come anywhere near the greatness I comically aspire to.
I am a creative. I believe in the ultimate mystery of process. I believe in it so much, I am even fool enough to publish an essay I dictated into a tiny machine and didn’t take time to review or revise. I won’t do this often, I promise. But I did it just now, because, as afraid as I might be of your seeing through my pitiful gestures toward the beautiful, I was even more afraid of forgetting what I came to say.
There. I think I’ve said it.
User Research Is Storytelling
Ever since I was a boy, I’ve been fascinated with movies. I loved the characters and the excitement—but most of all the stories. I wanted to be an actor. And I believed that I’d get to do the things that Indiana Jones did and go on exciting adventures. I even dreamed up ideas for movies that my friends and I could make and star in. But they never went any further. I did, however, end up working in user experience (UX). Now, I realize that there’s an element of theater to UX—I hadn’t really considered it before, but user research is storytelling. And to get the most out of user research, you need to tell a good story where you bring stakeholders—the product team and decision makers—along and get them interested in learning more.
Think of your favorite movie. More than likely it follows a three-act structure that’s commonly seen in storytelling: the setup, the conflict, and the resolution. The first act shows what exists today, and it helps you get to know the characters and the challenges and problems that they face. Act two introduces the conflict, where the action is. Here, problems grow or get worse. And the third and final act is the resolution. This is where the issues are resolved and the characters learn and change. I believe that this structure is also a great way to think about user research, and I think that it can be especially helpful in explaining user research to others.
Use storytelling as a structure to do research
It’s sad to say, but many have come to see research as being expendable. If budgets or timelines are tight, research tends to be one of the first things to go. Instead of investing in research, some product managers rely on designers or—worse—their own opinion to make the “right” choices for users based on their experience or accepted best practices. That may get teams some of the way, but that approach can so easily miss out on solving users’ real problems. To remain user-centered, this is something we should avoid. User research elevates design. It keeps it on track, pointing to problems and opportunities. Being aware of the issues with your product and reacting to them can help you stay ahead of your competitors.
In the three-act structure, each act corresponds to a part of the process, and each part is critical to telling the whole story. Let’s look at the different acts and how they align with user research.
Act one: setup
The setup is all about understanding the background, and that’s where foundational research comes in. Foundational research (also called generative, discovery, or initial research) helps you understand users and identify their problems. You’re learning about what exists today, the challenges users have, and how the challenges affect them—just like in the movies. To do foundational research, you can conduct contextual inquiries or diary studies (or both!), which can help you start to identify problems as well as opportunities. It doesn’t need to be a huge investment in time or money.
Erika Hall writes about minimum viable ethnography, which can be as simple as spending 15 minutes with a user and asking them one thing: “‘Walk me through your day yesterday.’ That’s it. Present that one request. Shut up and listen to them for 15 minutes. Do your damndest to keep yourself and your interests out of it. Bam, you’re doing ethnography.” According to Hall, “[This] will probably prove quite illuminating. In the highly unlikely case that you didn’t learn anything new or useful, carry on with enhanced confidence in your direction.”
This makes total sense to me. And I love that this makes user research so accessible. You don’t need to prepare a lot of documentation; you can just recruit participants and do it! This can yield a wealth of information about your users, and it’ll help you better understand them and what’s going on in their lives. That’s really what act one is all about: understanding where users are coming from.
Jared Spool talks about the importance of foundational research and how it should form the bulk of your research. If you can draw from any additional user data that you can get your hands on, such as surveys or analytics, that can supplement what you’ve heard in the foundational studies or even point to areas that need further investigation. Together, all this data paints a clearer picture of the state of things and all its shortcomings. And that’s the beginning of a compelling story. It’s the point in the plot where you realize that the main characters—or the users in this case—are facing challenges that they need to overcome. Like in the movies, this is where you start to build empathy for the characters and root for them to succeed. And hopefully stakeholders are now doing the same. Their sympathy may be with their business, which could be losing money because users can’t complete certain tasks. Or maybe they do empathize with users’ struggles. Either way, act one is your initial hook to get the stakeholders interested and invested.
Once stakeholders begin to understand the value of foundational research, that can open doors to more opportunities that involve users in the decision-making process. And that can guide product teams toward being more user-centered. This benefits everyone—users, the product, and stakeholders. It’s like winning an Oscar in movie terms—it often leads to your product being well received and successful. And this can be an incentive for stakeholders to repeat this process with other products. Storytelling is the key to this process, and knowing how to tell a good story is the only way to get stakeholders to really care about doing more research.
This brings us to act two, where you iteratively evaluate a design or concept to see whether it addresses the issues.
Act two: conflict
Act two is all about digging deeper into the problems that you identified in act one. This usually involves directional research, such as usability tests, where you assess a potential solution (such as a design) to see whether it addresses the issues that you found. The issues could include unmet needs or problems with a flow or process that’s tripping users up. Like act two in a movie, more issues will crop up along the way. It’s here that you learn more about the characters as they grow and develop through this act.
Usability tests should typically include around five participants according to Jakob Nielsen, who found that that number of users can usually identify most of the problems: “As you add more and more users, you learn less and less because you will keep seeing the same things again and again… After the fifth user, you are wasting your time by observing the same findings repeatedly but not learning much new.”
There are parallels with storytelling here too; if you try to tell a story with too many characters, the plot may get lost. Having fewer participants means that each user’s struggles will be more memorable and easier to relay to other stakeholders when talking about the research. This can help convey the issues that need to be addressed while also highlighting the value of doing the research in the first place.
Researchers have run usability tests in person for decades, but you can also conduct usability tests remotely using tools like Microsoft Teams, Zoom, or other teleconferencing software. This approach has become increasingly popular since the beginning of the pandemic, and it works well. You can think of in-person usability tests like going to a play and remote sessions as more like watching a movie. There are advantages and disadvantages to each. In-person usability research is a much richer experience. Stakeholders can experience the sessions with other stakeholders. You also get real-time reactions—including surprise, agreement, disagreement, and discussions about what they’re seeing. Much like going to a play, where audiences get to take in the stage, the costumes, the lighting, and the actors’ interactions, in-person research lets you see users up close, including their body language, how they interact with the moderator, and how the scene is set up.
If in-person usability testing is like watching a play—staged and controlled—then conducting usability testing in the field is like immersive theater where any two sessions might be very different from one another. You can take usability testing into the field by creating a replica of the space where users interact with the product and then conduct your research there. Or you can go out to meet users at their location to do your research. With either option, you get to see how things work in context, things come up that wouldn’t have in a lab environment—and conversion can shift in entirely different directions. As researchers, you have less control over how these sessions go, but this can sometimes help you understand users even better. Meeting users where they are can provide clues to the external forces that could be affecting how they use your product. In-person usability tests provide another level of detail that’s often missing from remote usability tests.
That’s not to say that the “movies”—remote sessions—aren’t a good option. Remote sessions can reach a wider audience. They allow a lot more stakeholders to be involved in the research and to see what’s going on. And they open the doors to a much wider geographical pool of users. But with any remote session there is the potential of time wasted if participants can’t log in or get their microphone working.
The benefit of usability testing, whether remote or in person, is that you get to see real users interact with the designs in real time, and you can ask them questions to understand their thought processes and grasp of the solution. This can help you not only identify problems but also glean why they’re problems in the first place. Furthermore, you can test hypotheses and gauge whether your thinking is correct. By the end of the sessions, you’ll have a much clearer picture of how usable the designs are and whether they work for their intended purposes. Act two is the heart of the story—where the excitement is—but there can be surprises too. This is equally true of usability tests. Often, participants will say unexpected things, which change the way that you look at things—and these twists in the story can move things in new directions.
Unfortunately, user research is sometimes seen as expendable. And too often usability testing is the only research process that some stakeholders think that they ever need. In fact, if the designs that you’re evaluating in the usability test aren’t grounded in a solid understanding of your users (foundational research), there’s not much to be gained by doing usability testing in the first place. That’s because you’re narrowing the focus of what you’re getting feedback on, without understanding the users’ needs. As a result, there’s no way of knowing whether the designs might solve a problem that users have. It’s only feedback on a particular design in the context of a usability test.
On the other hand, if you only do foundational research, while you might have set out to solve the right problem, you won’t know whether the thing that you’re building will actually solve that. This illustrates the importance of doing both foundational and directional research.
In act two, stakeholders will—hopefully—get to watch the story unfold in the user sessions, which creates the conflict and tension in the current design by surfacing their highs and lows. And in turn, this can help motivate stakeholders to address the issues that come up.
Act three: resolution
While the first two acts are about understanding the background and the tensions that can propel stakeholders into action, the third part is about resolving the problems from the first two acts. While it’s important to have an audience for the first two acts, it’s crucial that they stick around for the final act. That means the whole product team, including developers, UX practitioners, business analysts, delivery managers, product managers, and any other stakeholders that have a say in the next steps. It allows the whole team to hear users’ feedback together, ask questions, and discuss what’s possible within the project’s constraints. And it lets the UX research and design teams clarify, suggest alternatives, or give more context behind their decisions. So you can get everyone on the same page and get agreement on the way forward.
This act is mostly told in voiceover with some audience participation. The researcher is the narrator, who paints a picture of the issues and what the future of the product could look like given the things that the team has learned. They give the stakeholders their recommendations and their guidance on creating this vision.
Nancy Duarte in the Harvard Business Review offers an approach to structuring presentations that follow a persuasive story. “The most effective presenters use the same techniques as great storytellers: By reminding people of the status quo and then revealing the path to a better way, they set up a conflict that needs to be resolved,” writes Duarte. “That tension helps them persuade the audience to adopt a new mindset or behave differently.”
This type of structure aligns well with research results, and particularly results from usability tests. It provides evidence for “what is”—the problems that you’ve identified. And “what could be”—your recommendations on how to address them. And so on and so forth.
You can reinforce your recommendations with examples of things that competitors are doing that could address these issues or with examples where competitors are gaining an edge. Or they can be visual, like quick mockups of how a new design could look that solves a problem. These can help generate conversation and momentum. And this continues until the end of the session when you’ve wrapped everything up in the conclusion by summarizing the main issues and suggesting a way forward. This is the part where you reiterate the main themes or problems and what they mean for the product—the denouement of the story. This stage gives stakeholders the next steps and hopefully the momentum to take those steps!
While we are nearly at the end of this story, let’s reflect on the idea that user research is storytelling. All the elements of a good story are there in the three-act structure of user research:
- Act one: You meet the protagonists (the users) and the antagonists (the problems affecting users). This is the beginning of the plot. In act one, researchers might use methods including contextual inquiry, ethnography, diary studies, surveys, and analytics. The output of these methods can include personas, empathy maps, user journeys, and analytics dashboards.
- Act two: Next, there’s character development. There’s conflict and tension as the protagonists encounter problems and challenges, which they must overcome. In act two, researchers might use methods including usability testing, competitive benchmarking, and heuristics evaluation. The output of these can include usability findings reports, UX strategy documents, usability guidelines, and best practices.
- Act three: The protagonists triumph and you see what a better future looks like. In act three, researchers may use methods including presentation decks, storytelling, and digital media. The output of these can be: presentation decks, video clips, audio clips, and pictures.
The researcher has multiple roles: they’re the storyteller, the director, and the producer. The participants have a small role, but they are significant characters (in the research). And the stakeholders are the audience. But the most important thing is to get the story right and to use storytelling to tell users’ stories through research. By the end, the stakeholders should walk away with a purpose and an eagerness to resolve the product’s ills.
So the next time that you’re planning research with clients or you’re speaking to stakeholders about research that you’ve done, think about how you can weave in some storytelling. Ultimately, user research is a win-win for everyone, and you just need to get stakeholders interested in how the story ends.
I Traded My Leftover Takeout Containers for the Sports Car of Adult Lunch Boxes—And Now I No Longer Want to Steal My Kids’ Bento Boxes
Welcome to adulthood, in which food organization is (legitimately) thrilling.
As you head into your third trimester, you’re getting more and more excited to meet your baby. But some worries surrounding labor and delivery surface, too—and that’s totally okay! While your body is designed to give birth, the idea of pushing out a baby (or getting a C-section) can be intimidating. On top of that, there’s potential side effects to think about, like constipation, pain, or vaginal tearing. You may even wonder if it’s possible to prevent tearing during birth.
Vaginal tearing happens when the skin or muscle around your vagina and perineum (the area between your vagina and anus) rip because they can’t stretch enough. It’s pretty common (between 53 and 79 percent of people tear, per the American College of Obstetricians and Gynecologists (ACOG)), and can vary in severity depending on how deep it goes. Some different degrees include the following, per Penn Medicine:
- First-degree tear (the least severe type of tear): only affects the perineal skin and often doesn’t require any stitches
- Second-degree tear (the most common): affects both the skin and muscle of the perineum and requires stitches to repair
- Third-degree tear: extends into the anal sphincter (the muscle that surrounds the anus) and repairs may require general anesthesia in an operating room
- Fourth-degree tear (the least common, but most severe type of tear): extends from the vagina into the anal sphincter, but also into the rectum itself, and repairs may require care of a specialist
Sooo…can tears be prevented? Unfortunately, many (if not most) vaginal tears are unavoidable and are due to risk factors beyond your control (more on this later). Still, there are some things you can do during pregnancy and labor to try to prevent tearing (or reduce its severity).
Because there’s no guarantee that you can prevent vaginal tearing during birth, try not to beat yourself up if you do. Every body is different and will react differently to birth.
What to do before labor to avoid tearing
In preparation for labor, there are certain things you can try in pregnancy to help prevent tearing.
1. Try perineal massage
Your perineum is small (about 1.5 inches long on average), but it plays a big role in childbirth. The skin and tissues “down there” must be pliable enough to stretch and allow your baby to pass through the birth canal.
Some say that gently stretching your perineum—known a perineal massage—can help your body prepare for labor and lower your risk of tearing, says Marcy Crouch, PT, DPT, a pelvic floor physical therapist and co-host of the No Mama Left Behind podcast.
In fact, some research shows that “perineal massage may reduce serious tears involving both the vagina and rectum,” says midwife Karen Jefferson, DM, CM, FACNM, director of professional practice and policy at the American College of Nurse-Midwives. She points to an October 2023 systematic review in the Journal of Gynecology Obstetrics and Human Reproduction, which concluded that prenatal perineal massage protects the perineum from injuries in birth. The authors also said it can lessen the likelihood of fecal and gas incontinence (i.e., when you can’t control the release of your poops or farts) in the postpartum period.
Still, “the evidence that prenatal perineal massage helps prevent tearing is pretty limited,” says Nicole Rankins, MD, an OB/GYN and host of All About Pregnancy & Birth Podcast. She’s right: The data hasn’t been totally consistent. While some studies show perineal massage can reduce your risk of severe tears, others have found it makes little or no impact on tearing outcomes, according to the Cleveland Clinic.
The research is mixed because perineal massage is usually done at home, so it’s hard to know if everyone is doing it the same way. Plus, there are many other factors that can affect whether you’ll tear or not (like how big your baby is, how fast they crowned, and what interventions your doctor used). This is why it’s important to not blame yourself if you tear (it’s never your fault!).
Ultimately, the choice to try perineal massage is yours! It’s not a make-or-break decision, says Dr. Rankins. Don’t feel pressure to keep going if it’s uncomfortable (it’s not like a relaxing back massage, BTW) or if it’s not your thing.
But if you are interested in trying perineal massage, give it a try at around 34 weeks (to reduce your risk of third- or fourth-degree tears), Crouch says. Do these steps at least three to four times a week for five to 10 minutes at at time, per Crouch and the Cleveland Clinic:
- Wash your hands with a mild soap to prevent bacteria from entering your vagina. You’ll also want to make sure your fingernails are trimmed short to keep from scratching your delicate tissue.
- Lie on your back with your legs wide and knees bent, making sure that your back is supported the entire time.
- Apply a natural oil (like coconut oil or olive oil) or a water-soluble lubricant to your fingers, thumbs, and perineum.
- Place a single, lubricated thumb about 1 to 1.5 inches (that’s about to your first knuckle) into your vagina. Gently insert your other thumb.
- Press both thumbs on the back wall of your vagina toward your anus, applying enough pressure to feel slight stretching in your vagina. Hold this position for a minute or two.
- Move both thumbs slowly in a U-like motion so you feel a gentle stretch.
Note: If you have a vaginal infection, like thrush or genital herpes, you should avoid perineal massage because it can cause the infection to spread.
2. Choose the best medical provider for you
The things your medical provider does during labor can either reduce or increase your chances of tearing. For instance, you have a higher chance of severe tears with doctors who perform routine episiotomies (i.e., a cut made in the tissue between the vaginal opening and anus), per a November 2022 paper in Cureus.
But working with someone who’s “experienced in delivering babies with minimal intervention can significantly affect your birthing experience,” says Crouch. Interventions like episiotomies (or forceps or vacuum during delivery) should only be used when the health of you or your baby is in danger.
The best way to determine if your doctor’s right for you? Ask about their episiotomy and C-section rates at the beginning of your pregnancy. “These rates should be very low and these procedures should occur with consent in a situation where it is medically necessary,” Crouch says.
Your doctor should also be patient and give you time to let your perineum stretch slowly, when your baby is crowning, Jefferson says. The more gradually this area stretches, the less likely it’ll rip. “Providers who are patient and allow the labor process to proceed at a natural pace without rushing can help reduce the risk of tears,” Crouch agrees.
You may find a midwife fits all these requirements. In fact, an April 2016 review in the Cochrane Database of Systematic Reviews found that midwives tended to use fewer interventions (forceps, vacuum, and episiotomy). Plus, people under their care were more likely to feel satisfied with their birthing experience (a big plus).
3. Communicate with your team
“Keep the lines of communication open with your delivery team,” Crouch says. “Let them know your concerns about tearing and your desire to try positions or strategies that can help minimize the risk.” Ask your doctor or midwife what they do to prevent tears, and what they suggest you do to help prepare for delivery.
No matter who you choose—OB/GYN or midwife—it’s important you feel comfortable enough to voice your concerns. You want a provider who listens to your fears and respects and supports your birth plan. If you’re feeling rushed or dismissed, they may not be the right one for you.
4. Incorporate push prep
Just like you would train for a marathon, you can also train for giving birth. “Push prep,” in particular, can prepare your body for labor. This can potentially protect your perineum from severe tears. “Push prep involves training the pelvic floor muscles to relax and stretch, complementing the natural birthing process,” Crouch says. “It is especially helpful to train the pelvic floor muscles in specific positions you would like to try during birth.”
Wondering what that looks like? It’s doing perineal massage in different birthing positions (think: on your hands and knees, lying on your side, squatting, etc.) as well as practicing breathing techniques. “This awareness allows for more controlled and effective pushing, which can reduce trauma to the tissue,” Crouch says.
Keep in mind, though, “push prep is not universally defined, so it can be difficult to assess how well it reduces tearing,” Dr. Rankin says. Even so, it generally includes education about positions, pushing, pain management, and/or pelvic floor exercises, and all that is beneficial for birth, she says.
5. Invest in childbirth education
“In general, childbirth education is helpful to understand what is happening in your body during birth and to help you know what your options are (like different positions) so that you can better advocate for yourself,” Dr. Rankins says. For example, many people don’t know you don’t have to give birth on your back, Crouch says.
That said, “a lot of birthing classes are very focused on baby and not so much on the person giving birth,” Crouch says. You might have to do a little research to find a birth-prep program that centers around the birthing person’s experience. Crouch’s online birth prep and recovery course called Down There Done Right covers ways to reduce your risk of tearing and strategies to speed up your postpartum recovery.
6. Focus on a nutrient-dense diet
While eating fruits and veggies can’t prevent you from tearing, what you put on your plate can play a part in the health of your tissues. “Good nutrition is important for skin integrity and healing,” Jefferson says. Getting plenty of protein and vitamin-rich foods (already recommended in pregnancy for a healthy baby) can support your skin through all the changes it goes through in both birth and postpartum.
What to do during labor to avoid tearing
Here are a few things you can try during labor to potentially lower your likelihood of vaginal tearing.
1. Apply warm compresses
“Some say that applying a warm compress to the perineum during the second stage of labor (when you’re pushing) can help soften the tissue and increase its elasticity, potentially reducing the likelihood of tearing,” Crouch says. A June 2017 Cochrane Review supports this theory in certain cases. The authors found that people who got moist, warm compresses in labor had fewer third‐ or fourth‐degree perineal tears.
That said, evidence is limited. “It’s hard to say if this is a wives’ tale or not, though, because researchers can’t come to a consensus,” Crouch says. Case in point: While warm cloths may reduce the risk of severe tearing, the same 2017 Cochrane Review concluded that the effect of this practice on other outcomes (like first- or second-degree tears or the need for episiotomies) was unclear or mixed.
2. Practice controlled pushing
If your baby comes out of the birth canal quickly, you might have a higher chance of tearing. That’s because the tissues won’t have time to stretch. “Slow, controlled pushing, which is sometimes referred to as spontaneous pushing, allows the perineum to stretch gradually and can reduce tearing,” Dr. Rankins says. A slower pace allows “the tissues to adapt more effectively to the pressure and stretching that happens during childbirth,” she says.
Crouch seconds this: “When the baby’s head crowns, gentle, controlled pushing and breathing techniques can significantly help manage the pressure on the perineum and reduce tearing.”
But sometimes you may not have a choice to slow things down. “Don’t sweat this too much,” Crouch says. “The speed of labor is something we can’t really control.” In other words, if the baby is coming fast, and you need to push, you do you. Listen to your body and go with the flow.
3. Try certain birthing positions
Contrary to popular belief, you don’t have to labor on your back. There are many other optimal birthing positions. “It used to be common practice to put women flat on their backs and put their feet in stirrups,” Jefferson says. But this immobilized position “is not ideal for pushing, for the health of the baby, and for the perineum,” she says.
“Giving birth while lying down, particularly on the back (supine position), may [actually] increase the risk of vaginal tearing,” Dr. Rankins says. “It also makes it easier for doctors to do episiotomies, which increases the risk of tearing,” she adds.
According to Crouch, evidence has shown upright positions that “free the sacrum” (i.e., the triangular bone at the base of the spine that connects to the pelvis) may reduce tearing, she says. These positions give your baby more room to pass by your sacrum. According to a March 2016 review in the British Journal of Midwifery, this includes kneeling and being on all-fours.
Still, it’s not all cut and dry. The same systematic review also concluded that certain upright positions (sitting, squatting, and using a birth-stool) might increase your risk of perineal injury.
The takeaway: Though some positions might be more protective, there’s no perfect pushing position, and no guarantee you won’t tear. At the end of the day, listen to your body. Whatever position feels good and helps you progress is the right one for you.
Can you give birth in an upright position with epidural?
An epidural (a pain medication injected through a needle and catheter into the lower part of your back) is given during labor to number the lower half of your body. This can make it a bit more challenging to birth in upright positions, says Dr. Rankins. But it’s not impossible.
“Contrary to popular belief, you can use different birthing positions with a low-dose epidural,” Crouch says. Like the name implies, it’s a lower dose of an anesthetic. It provides pain relief but allows you to stay somewhat mobile. “You just have to stay in the bed,” Crouch says. With help from your care team and/or your partner, you can maneuver into different positions like kneeling or all-fours. Side-lying positions with an epidural might help protect the perineum, too.
4. Incorporate perineal massage
Perineal massage may help during labor, too. In the pushing phase, your medical provider can can place their middle and index fingers into the vagina to stretch the perineum from side-to-side, which may help protect your perineum. In fact, the same June 2017 Cochrane Review found that perineal massage during the second stage of labor resulted in more people with an intact perineum and fewer third- or fourth-degree tears.
But again, the data is inconsistent. The authors also noted that perineal massage didn’t appear to reduce first- or second-degree tears or episiotomies.
Another note: If your doctor or midwife wants to do perineal massage, “there should be consent first,” Dr. Rankins says. This means, they should ask whether it’s okay to touch your genitals. They should also explain any risks and benefits, so you can make an informed decision.
Who is more at risk of tearing during birth?
Tearing in birth is common. But certain people are more likely to tear than others. Some risk factors that increase your odds include the following, per the Cleveland Clinic:
- It’s your first delivery.
- Your baby was face up instead of face down during delivery.
- Forceps (or a vacuum) were used during delivery.
- You have a large baby (more than 8 pounds).
- Your second stage of labor (pushing stage) was prolonged (or very short).
- You’re of Asian ethnicity or descent.
- You had an epidural.
Other possible risk factors include:
- Your choice of care provider (some have higher rates of severe tearing and use of interventions like episiotomy, forceps, or vacuum)
- Shoulder dystocia (when one or both of your baby’s shoulders get stuck inside your pelvis during a vaginal delivery)
How to recover from tearing
Vaginal tears often require stitches, which dissolve on their own after about six weeks, per the Cleveland Clinic. The tear itself, though, will often heal within two weeks (though it can take longer for severe tears). In the meantime, you might feel discomfort doing ordinary things, like pooping, coughing, or sneezing. Anything that puts pressure on your perineum can be pretty painful.
Fortunately, there are a few things you can do for relief. Try these tips for any type of tear, per the Cleveland Clinic:
- Use a peri-bottle (a squirt bottle) to wash yourself clean after using the bathroom. Lukewarm water feels the best.
- Gently pat yourself dry with toilet paper instead of wiping.
- Apply ice packs or wear special sanitary pads that have a cold pack inside. These pads are often available in the hospital or at your local drugstore.
- Avoid constipation by drinking plenty of water and using a stool softener.
- Take a sitz bath. Fill your bathtub with a few inches of warm water and sit in it for a few minutes.
- Sit on a donut pillow. This relieves pressure from your bottom, which can be especially helpful if you had a third- or fourth-degree tear.
- Avoid exercises or uncomfortable movements that aggravate your perineal area. This could include squats or walking down steps.
- Take an over-the-counter pain medication. Always check with your doctors beforehand if you’re breastfeeding, chestfeeding, or pumping.
- Use a pain-relieving numbing spray like Dermoplast.
- Line your sanitary pads with witch hazel pads like Tucks.
Potential complications of vaginal tears
While incredibly uncomfortable, most vaginal tears heal within two weeks. However, if your pain persists, and it’s accompanied by other symptoms, you might be dealing with an infection. Keep an eye out for these possible signs of an infection, per Penn Medicine:
- Painful swelling
- Redness
- Unpleasant odor (or discharge)
You’re also more likely to have certain complications with third- and fourth-degree tears, which may include the following, per the Cleveland Clinic:
- Bleeding
- Painful intercourse (once you’re given the “okay” to have sex)
- Fecal incontinence (leaking poop)
- Ongoing pain and soreness
Tearing during childbirth—and the continuing complications—can also be traumatic for some people, which can have a major effect on mental health. If you feel any of these issues, let your provider know ASAP. While fairly common, these problems are not normal, and you do not have to learn to live with them. Treatments are available (from pelvic floor physical therapy to talk therapy) to help.
The bottom line
Vaginal tearing during birth is not completely preventable. In fact, most people tear just a little. But doing certain things during pregnancy and labor may help reduce the risk (and severity) of tearing. Ultimately, it all depends on your body and birth experience; you can’t control the size of your baby, shape of your pelvis, or speed of labor.
Of course, it’s still important to prep. But if you do tear, remember: it’s not your fault. Try to focus on healing and recovery, and ask for help if you need it.
Why Preparing Matcha Is a Key Way To Unlock a Zen State of Mind, According to a Japanese Buddhist Priest
Plus, the golden ratio for the perfect at-home matcha latte recipe.
As you head into your third trimester, you’re getting more and more excited to meet your baby. But some worries surrounding labor and delivery surface, too—and that’s totally okay! While your body is designed to give birth, the idea of pushing out a baby (or getting a C-section) can be intimidating. On top of that, there’s potential side effects to think about, like constipation, pain, or vaginal tearing. You may even wonder if it’s possible to prevent tearing during birth.
Vaginal tearing happens when the skin or muscle around your vagina and perineum (the area between your vagina and anus) rip because they can’t stretch enough. It’s pretty common (between 53 and 79 percent of people tear, per the American College of Obstetricians and Gynecologists (ACOG)), and can vary in severity depending on how deep it goes. Some different degrees include the following, per Penn Medicine:
- First-degree tear (the least severe type of tear): only affects the perineal skin and often doesn’t require any stitches
- Second-degree tear (the most common): affects both the skin and muscle of the perineum and requires stitches to repair
- Third-degree tear: extends into the anal sphincter (the muscle that surrounds the anus) and repairs may require general anesthesia in an operating room
- Fourth-degree tear (the least common, but most severe type of tear): extends from the vagina into the anal sphincter, but also into the rectum itself, and repairs may require care of a specialist
Sooo…can tears be prevented? Unfortunately, many (if not most) vaginal tears are unavoidable and are due to risk factors beyond your control (more on this later). Still, there are some things you can do during pregnancy and labor to try to prevent tearing (or reduce its severity).
Because there’s no guarantee that you can prevent vaginal tearing during birth, try not to beat yourself up if you do. Every body is different and will react differently to birth.
What to do before labor to avoid tearing
In preparation for labor, there are certain things you can try in pregnancy to help prevent tearing.
1. Try perineal massage
Your perineum is small (about 1.5 inches long on average), but it plays a big role in childbirth. The skin and tissues “down there” must be pliable enough to stretch and allow your baby to pass through the birth canal.
Some say that gently stretching your perineum—known a perineal massage—can help your body prepare for labor and lower your risk of tearing, says Marcy Crouch, PT, DPT, a pelvic floor physical therapist and co-host of the No Mama Left Behind podcast.
In fact, some research shows that “perineal massage may reduce serious tears involving both the vagina and rectum,” says midwife Karen Jefferson, DM, CM, FACNM, director of professional practice and policy at the American College of Nurse-Midwives. She points to an October 2023 systematic review in the Journal of Gynecology Obstetrics and Human Reproduction, which concluded that prenatal perineal massage protects the perineum from injuries in birth. The authors also said it can lessen the likelihood of fecal and gas incontinence (i.e., when you can’t control the release of your poops or farts) in the postpartum period.
Still, “the evidence that prenatal perineal massage helps prevent tearing is pretty limited,” says Nicole Rankins, MD, an OB/GYN and host of All About Pregnancy & Birth Podcast. She’s right: The data hasn’t been totally consistent. While some studies show perineal massage can reduce your risk of severe tears, others have found it makes little or no impact on tearing outcomes, according to the Cleveland Clinic.
The research is mixed because perineal massage is usually done at home, so it’s hard to know if everyone is doing it the same way. Plus, there are many other factors that can affect whether you’ll tear or not (like how big your baby is, how fast they crowned, and what interventions your doctor used). This is why it’s important to not blame yourself if you tear (it’s never your fault!).
Ultimately, the choice to try perineal massage is yours! It’s not a make-or-break decision, says Dr. Rankins. Don’t feel pressure to keep going if it’s uncomfortable (it’s not like a relaxing back massage, BTW) or if it’s not your thing.
But if you are interested in trying perineal massage, give it a try at around 34 weeks (to reduce your risk of third- or fourth-degree tears), Crouch says. Do these steps at least three to four times a week for five to 10 minutes at at time, per Crouch and the Cleveland Clinic:
- Wash your hands with a mild soap to prevent bacteria from entering your vagina. You’ll also want to make sure your fingernails are trimmed short to keep from scratching your delicate tissue.
- Lie on your back with your legs wide and knees bent, making sure that your back is supported the entire time.
- Apply a natural oil (like coconut oil or olive oil) or a water-soluble lubricant to your fingers, thumbs, and perineum.
- Place a single, lubricated thumb about 1 to 1.5 inches (that’s about to your first knuckle) into your vagina. Gently insert your other thumb.
- Press both thumbs on the back wall of your vagina toward your anus, applying enough pressure to feel slight stretching in your vagina. Hold this position for a minute or two.
- Move both thumbs slowly in a U-like motion so you feel a gentle stretch.
Note: If you have a vaginal infection, like thrush or genital herpes, you should avoid perineal massage because it can cause the infection to spread.
2. Choose the best medical provider for you
The things your medical provider does during labor can either reduce or increase your chances of tearing. For instance, you have a higher chance of severe tears with doctors who perform routine episiotomies (i.e., a cut made in the tissue between the vaginal opening and anus), per a November 2022 paper in Cureus.
But working with someone who’s “experienced in delivering babies with minimal intervention can significantly affect your birthing experience,” says Crouch. Interventions like episiotomies (or forceps or vacuum during delivery) should only be used when the health of you or your baby is in danger.
The best way to determine if your doctor’s right for you? Ask about their episiotomy and C-section rates at the beginning of your pregnancy. “These rates should be very low and these procedures should occur with consent in a situation where it is medically necessary,” Crouch says.
Your doctor should also be patient and give you time to let your perineum stretch slowly, when your baby is crowning, Jefferson says. The more gradually this area stretches, the less likely it’ll rip. “Providers who are patient and allow the labor process to proceed at a natural pace without rushing can help reduce the risk of tears,” Crouch agrees.
You may find a midwife fits all these requirements. In fact, an April 2016 review in the Cochrane Database of Systematic Reviews found that midwives tended to use fewer interventions (forceps, vacuum, and episiotomy). Plus, people under their care were more likely to feel satisfied with their birthing experience (a big plus).
3. Communicate with your team
“Keep the lines of communication open with your delivery team,” Crouch says. “Let them know your concerns about tearing and your desire to try positions or strategies that can help minimize the risk.” Ask your doctor or midwife what they do to prevent tears, and what they suggest you do to help prepare for delivery.
No matter who you choose—OB/GYN or midwife—it’s important you feel comfortable enough to voice your concerns. You want a provider who listens to your fears and respects and supports your birth plan. If you’re feeling rushed or dismissed, they may not be the right one for you.
4. Incorporate push prep
Just like you would train for a marathon, you can also train for giving birth. “Push prep,” in particular, can prepare your body for labor. This can potentially protect your perineum from severe tears. “Push prep involves training the pelvic floor muscles to relax and stretch, complementing the natural birthing process,” Crouch says. “It is especially helpful to train the pelvic floor muscles in specific positions you would like to try during birth.”
Wondering what that looks like? It’s doing perineal massage in different birthing positions (think: on your hands and knees, lying on your side, squatting, etc.) as well as practicing breathing techniques. “This awareness allows for more controlled and effective pushing, which can reduce trauma to the tissue,” Crouch says.
Keep in mind, though, “push prep is not universally defined, so it can be difficult to assess how well it reduces tearing,” Dr. Rankin says. Even so, it generally includes education about positions, pushing, pain management, and/or pelvic floor exercises, and all that is beneficial for birth, she says.
5. Invest in childbirth education
“In general, childbirth education is helpful to understand what is happening in your body during birth and to help you know what your options are (like different positions) so that you can better advocate for yourself,” Dr. Rankins says. For example, many people don’t know you don’t have to give birth on your back, Crouch says.
That said, “a lot of birthing classes are very focused on baby and not so much on the person giving birth,” Crouch says. You might have to do a little research to find a birth-prep program that centers around the birthing person’s experience. Crouch’s online birth prep and recovery course called Down There Done Right covers ways to reduce your risk of tearing and strategies to speed up your postpartum recovery.
6. Focus on a nutrient-dense diet
While eating fruits and veggies can’t prevent you from tearing, what you put on your plate can play a part in the health of your tissues. “Good nutrition is important for skin integrity and healing,” Jefferson says. Getting plenty of protein and vitamin-rich foods (already recommended in pregnancy for a healthy baby) can support your skin through all the changes it goes through in both birth and postpartum.
What to do during labor to avoid tearing
Here are a few things you can try during labor to potentially lower your likelihood of vaginal tearing.
1. Apply warm compresses
“Some say that applying a warm compress to the perineum during the second stage of labor (when you’re pushing) can help soften the tissue and increase its elasticity, potentially reducing the likelihood of tearing,” Crouch says. A June 2017 Cochrane Review supports this theory in certain cases. The authors found that people who got moist, warm compresses in labor had fewer third‐ or fourth‐degree perineal tears.
That said, evidence is limited. “It’s hard to say if this is a wives’ tale or not, though, because researchers can’t come to a consensus,” Crouch says. Case in point: While warm cloths may reduce the risk of severe tearing, the same 2017 Cochrane Review concluded that the effect of this practice on other outcomes (like first- or second-degree tears or the need for episiotomies) was unclear or mixed.
2. Practice controlled pushing
If your baby comes out of the birth canal quickly, you might have a higher chance of tearing. That’s because the tissues won’t have time to stretch. “Slow, controlled pushing, which is sometimes referred to as spontaneous pushing, allows the perineum to stretch gradually and can reduce tearing,” Dr. Rankins says. A slower pace allows “the tissues to adapt more effectively to the pressure and stretching that happens during childbirth,” she says.
Crouch seconds this: “When the baby’s head crowns, gentle, controlled pushing and breathing techniques can significantly help manage the pressure on the perineum and reduce tearing.”
But sometimes you may not have a choice to slow things down. “Don’t sweat this too much,” Crouch says. “The speed of labor is something we can’t really control.” In other words, if the baby is coming fast, and you need to push, you do you. Listen to your body and go with the flow.
3. Try certain birthing positions
Contrary to popular belief, you don’t have to labor on your back. There are many other optimal birthing positions. “It used to be common practice to put women flat on their backs and put their feet in stirrups,” Jefferson says. But this immobilized position “is not ideal for pushing, for the health of the baby, and for the perineum,” she says.
“Giving birth while lying down, particularly on the back (supine position), may [actually] increase the risk of vaginal tearing,” Dr. Rankins says. “It also makes it easier for doctors to do episiotomies, which increases the risk of tearing,” she adds.
According to Crouch, evidence has shown upright positions that “free the sacrum” (i.e., the triangular bone at the base of the spine that connects to the pelvis) may reduce tearing, she says. These positions give your baby more room to pass by your sacrum. According to a March 2016 review in the British Journal of Midwifery, this includes kneeling and being on all-fours.
Still, it’s not all cut and dry. The same systematic review also concluded that certain upright positions (sitting, squatting, and using a birth-stool) might increase your risk of perineal injury.
The takeaway: Though some positions might be more protective, there’s no perfect pushing position, and no guarantee you won’t tear. At the end of the day, listen to your body. Whatever position feels good and helps you progress is the right one for you.
Can you give birth in an upright position with epidural?
An epidural (a pain medication injected through a needle and catheter into the lower part of your back) is given during labor to number the lower half of your body. This can make it a bit more challenging to birth in upright positions, says Dr. Rankins. But it’s not impossible.
“Contrary to popular belief, you can use different birthing positions with a low-dose epidural,” Crouch says. Like the name implies, it’s a lower dose of an anesthetic. It provides pain relief but allows you to stay somewhat mobile. “You just have to stay in the bed,” Crouch says. With help from your care team and/or your partner, you can maneuver into different positions like kneeling or all-fours. Side-lying positions with an epidural might help protect the perineum, too.
4. Incorporate perineal massage
Perineal massage may help during labor, too. In the pushing phase, your medical provider can can place their middle and index fingers into the vagina to stretch the perineum from side-to-side, which may help protect your perineum. In fact, the same June 2017 Cochrane Review found that perineal massage during the second stage of labor resulted in more people with an intact perineum and fewer third- or fourth-degree tears.
But again, the data is inconsistent. The authors also noted that perineal massage didn’t appear to reduce first- or second-degree tears or episiotomies.
Another note: If your doctor or midwife wants to do perineal massage, “there should be consent first,” Dr. Rankins says. This means, they should ask whether it’s okay to touch your genitals. They should also explain any risks and benefits, so you can make an informed decision.
Who is more at risk of tearing during birth?
Tearing in birth is common. But certain people are more likely to tear than others. Some risk factors that increase your odds include the following, per the Cleveland Clinic:
- It’s your first delivery.
- Your baby was face up instead of face down during delivery.
- Forceps (or a vacuum) were used during delivery.
- You have a large baby (more than 8 pounds).
- Your second stage of labor (pushing stage) was prolonged (or very short).
- You’re of Asian ethnicity or descent.
- You had an epidural.
Other possible risk factors include:
- Your choice of care provider (some have higher rates of severe tearing and use of interventions like episiotomy, forceps, or vacuum)
- Shoulder dystocia (when one or both of your baby’s shoulders get stuck inside your pelvis during a vaginal delivery)
How to recover from tearing
Vaginal tears often require stitches, which dissolve on their own after about six weeks, per the Cleveland Clinic. The tear itself, though, will often heal within two weeks (though it can take longer for severe tears). In the meantime, you might feel discomfort doing ordinary things, like pooping, coughing, or sneezing. Anything that puts pressure on your perineum can be pretty painful.
Fortunately, there are a few things you can do for relief. Try these tips for any type of tear, per the Cleveland Clinic:
- Use a peri-bottle (a squirt bottle) to wash yourself clean after using the bathroom. Lukewarm water feels the best.
- Gently pat yourself dry with toilet paper instead of wiping.
- Apply ice packs or wear special sanitary pads that have a cold pack inside. These pads are often available in the hospital or at your local drugstore.
- Avoid constipation by drinking plenty of water and using a stool softener.
- Take a sitz bath. Fill your bathtub with a few inches of warm water and sit in it for a few minutes.
- Sit on a donut pillow. This relieves pressure from your bottom, which can be especially helpful if you had a third- or fourth-degree tear.
- Avoid exercises or uncomfortable movements that aggravate your perineal area. This could include squats or walking down steps.
- Take an over-the-counter pain medication. Always check with your doctors beforehand if you’re breastfeeding, chestfeeding, or pumping.
- Use a pain-relieving numbing spray like Dermoplast.
- Line your sanitary pads with witch hazel pads like Tucks.
Potential complications of vaginal tears
While incredibly uncomfortable, most vaginal tears heal within two weeks. However, if your pain persists, and it’s accompanied by other symptoms, you might be dealing with an infection. Keep an eye out for these possible signs of an infection, per Penn Medicine:
- Painful swelling
- Redness
- Unpleasant odor (or discharge)
You’re also more likely to have certain complications with third- and fourth-degree tears, which may include the following, per the Cleveland Clinic:
- Bleeding
- Painful intercourse (once you’re given the “okay” to have sex)
- Fecal incontinence (leaking poop)
- Ongoing pain and soreness
Tearing during childbirth—and the continuing complications—can also be traumatic for some people, which can have a major effect on mental health. If you feel any of these issues, let your provider know ASAP. While fairly common, these problems are not normal, and you do not have to learn to live with them. Treatments are available (from pelvic floor physical therapy to talk therapy) to help.
The bottom line
Vaginal tearing during birth is not completely preventable. In fact, most people tear just a little. But doing certain things during pregnancy and labor may help reduce the risk (and severity) of tearing. Ultimately, it all depends on your body and birth experience; you can’t control the size of your baby, shape of your pelvis, or speed of labor.
Of course, it’s still important to prep. But if you do tear, remember: it’s not your fault. Try to focus on healing and recovery, and ask for help if you need it.
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As you head into your third trimester, you’re getting more and more excited to meet your baby. But some worries surrounding labor and delivery surface, too—and that’s totally okay! While your body is designed to give birth, the idea of pushing out a baby (or getting a C-section) can be intimidating. On top of that, there’s potential side effects to think about, like constipation, pain, or vaginal tearing. You may even wonder if it’s possible to prevent tearing during birth.
Vaginal tearing happens when the skin or muscle around your vagina and perineum (the area between your vagina and anus) rip because they can’t stretch enough. It’s pretty common (between 53 and 79 percent of people tear, per the American College of Obstetricians and Gynecologists (ACOG)), and can vary in severity depending on how deep it goes. Some different degrees include the following, per Penn Medicine:
- First-degree tear (the least severe type of tear): only affects the perineal skin and often doesn’t require any stitches
- Second-degree tear (the most common): affects both the skin and muscle of the perineum and requires stitches to repair
- Third-degree tear: extends into the anal sphincter (the muscle that surrounds the anus) and repairs may require general anesthesia in an operating room
- Fourth-degree tear (the least common, but most severe type of tear): extends from the vagina into the anal sphincter, but also into the rectum itself, and repairs may require care of a specialist
Sooo…can tears be prevented? Unfortunately, many (if not most) vaginal tears are unavoidable and are due to risk factors beyond your control (more on this later). Still, there are some things you can do during pregnancy and labor to try to prevent tearing (or reduce its severity).
Because there’s no guarantee that you can prevent vaginal tearing during birth, try not to beat yourself up if you do. Every body is different and will react differently to birth.
What to do before labor to avoid tearing
In preparation for labor, there are certain things you can try in pregnancy to help prevent tearing.
1. Try perineal massage
Your perineum is small (about 1.5 inches long on average), but it plays a big role in childbirth. The skin and tissues “down there” must be pliable enough to stretch and allow your baby to pass through the birth canal.
Some say that gently stretching your perineum—known a perineal massage—can help your body prepare for labor and lower your risk of tearing, says Marcy Crouch, PT, DPT, a pelvic floor physical therapist and co-host of the No Mama Left Behind podcast.
In fact, some research shows that “perineal massage may reduce serious tears involving both the vagina and rectum,” says midwife Karen Jefferson, DM, CM, FACNM, director of professional practice and policy at the American College of Nurse-Midwives. She points to an October 2023 systematic review in the Journal of Gynecology Obstetrics and Human Reproduction, which concluded that prenatal perineal massage protects the perineum from injuries in birth. The authors also said it can lessen the likelihood of fecal and gas incontinence (i.e., when you can’t control the release of your poops or farts) in the postpartum period.
Still, “the evidence that prenatal perineal massage helps prevent tearing is pretty limited,” says Nicole Rankins, MD, an OB/GYN and host of All About Pregnancy & Birth Podcast. She’s right: The data hasn’t been totally consistent. While some studies show perineal massage can reduce your risk of severe tears, others have found it makes little or no impact on tearing outcomes, according to the Cleveland Clinic.
The research is mixed because perineal massage is usually done at home, so it’s hard to know if everyone is doing it the same way. Plus, there are many other factors that can affect whether you’ll tear or not (like how big your baby is, how fast they crowned, and what interventions your doctor used). This is why it’s important to not blame yourself if you tear (it’s never your fault!).
Ultimately, the choice to try perineal massage is yours! It’s not a make-or-break decision, says Dr. Rankins. Don’t feel pressure to keep going if it’s uncomfortable (it’s not like a relaxing back massage, BTW) or if it’s not your thing.
But if you are interested in trying perineal massage, give it a try at around 34 weeks (to reduce your risk of third- or fourth-degree tears), Crouch says. Do these steps at least three to four times a week for five to 10 minutes at at time, per Crouch and the Cleveland Clinic:
- Wash your hands with a mild soap to prevent bacteria from entering your vagina. You’ll also want to make sure your fingernails are trimmed short to keep from scratching your delicate tissue.
- Lie on your back with your legs wide and knees bent, making sure that your back is supported the entire time.
- Apply a natural oil (like coconut oil or olive oil) or a water-soluble lubricant to your fingers, thumbs, and perineum.
- Place a single, lubricated thumb about 1 to 1.5 inches (that’s about to your first knuckle) into your vagina. Gently insert your other thumb.
- Press both thumbs on the back wall of your vagina toward your anus, applying enough pressure to feel slight stretching in your vagina. Hold this position for a minute or two.
- Move both thumbs slowly in a U-like motion so you feel a gentle stretch.
Note: If you have a vaginal infection, like thrush or genital herpes, you should avoid perineal massage because it can cause the infection to spread.
2. Choose the best medical provider for you
The things your medical provider does during labor can either reduce or increase your chances of tearing. For instance, you have a higher chance of severe tears with doctors who perform routine episiotomies (i.e., a cut made in the tissue between the vaginal opening and anus), per a November 2022 paper in Cureus.
But working with someone who’s “experienced in delivering babies with minimal intervention can significantly affect your birthing experience,” says Crouch. Interventions like episiotomies (or forceps or vacuum during delivery) should only be used when the health of you or your baby is in danger.
The best way to determine if your doctor’s right for you? Ask about their episiotomy and C-section rates at the beginning of your pregnancy. “These rates should be very low and these procedures should occur with consent in a situation where it is medically necessary,” Crouch says.
Your doctor should also be patient and give you time to let your perineum stretch slowly, when your baby is crowning, Jefferson says. The more gradually this area stretches, the less likely it’ll rip. “Providers who are patient and allow the labor process to proceed at a natural pace without rushing can help reduce the risk of tears,” Crouch agrees.
You may find a midwife fits all these requirements. In fact, an April 2016 review in the Cochrane Database of Systematic Reviews found that midwives tended to use fewer interventions (forceps, vacuum, and episiotomy). Plus, people under their care were more likely to feel satisfied with their birthing experience (a big plus).
3. Communicate with your team
“Keep the lines of communication open with your delivery team,” Crouch says. “Let them know your concerns about tearing and your desire to try positions or strategies that can help minimize the risk.” Ask your doctor or midwife what they do to prevent tears, and what they suggest you do to help prepare for delivery.
No matter who you choose—OB/GYN or midwife—it’s important you feel comfortable enough to voice your concerns. You want a provider who listens to your fears and respects and supports your birth plan. If you’re feeling rushed or dismissed, they may not be the right one for you.
4. Incorporate push prep
Just like you would train for a marathon, you can also train for giving birth. “Push prep,” in particular, can prepare your body for labor. This can potentially protect your perineum from severe tears. “Push prep involves training the pelvic floor muscles to relax and stretch, complementing the natural birthing process,” Crouch says. “It is especially helpful to train the pelvic floor muscles in specific positions you would like to try during birth.”
Wondering what that looks like? It’s doing perineal massage in different birthing positions (think: on your hands and knees, lying on your side, squatting, etc.) as well as practicing breathing techniques. “This awareness allows for more controlled and effective pushing, which can reduce trauma to the tissue,” Crouch says.
Keep in mind, though, “push prep is not universally defined, so it can be difficult to assess how well it reduces tearing,” Dr. Rankin says. Even so, it generally includes education about positions, pushing, pain management, and/or pelvic floor exercises, and all that is beneficial for birth, she says.
5. Invest in childbirth education
“In general, childbirth education is helpful to understand what is happening in your body during birth and to help you know what your options are (like different positions) so that you can better advocate for yourself,” Dr. Rankins says. For example, many people don’t know you don’t have to give birth on your back, Crouch says.
That said, “a lot of birthing classes are very focused on baby and not so much on the person giving birth,” Crouch says. You might have to do a little research to find a birth-prep program that centers around the birthing person’s experience. Crouch’s online birth prep and recovery course called Down There Done Right covers ways to reduce your risk of tearing and strategies to speed up your postpartum recovery.
6. Focus on a nutrient-dense diet
While eating fruits and veggies can’t prevent you from tearing, what you put on your plate can play a part in the health of your tissues. “Good nutrition is important for skin integrity and healing,” Jefferson says. Getting plenty of protein and vitamin-rich foods (already recommended in pregnancy for a healthy baby) can support your skin through all the changes it goes through in both birth and postpartum.
What to do during labor to avoid tearing
Here are a few things you can try during labor to potentially lower your likelihood of vaginal tearing.
1. Apply warm compresses
“Some say that applying a warm compress to the perineum during the second stage of labor (when you’re pushing) can help soften the tissue and increase its elasticity, potentially reducing the likelihood of tearing,” Crouch says. A June 2017 Cochrane Review supports this theory in certain cases. The authors found that people who got moist, warm compresses in labor had fewer third‐ or fourth‐degree perineal tears.
That said, evidence is limited. “It’s hard to say if this is a wives’ tale or not, though, because researchers can’t come to a consensus,” Crouch says. Case in point: While warm cloths may reduce the risk of severe tearing, the same 2017 Cochrane Review concluded that the effect of this practice on other outcomes (like first- or second-degree tears or the need for episiotomies) was unclear or mixed.
2. Practice controlled pushing
If your baby comes out of the birth canal quickly, you might have a higher chance of tearing. That’s because the tissues won’t have time to stretch. “Slow, controlled pushing, which is sometimes referred to as spontaneous pushing, allows the perineum to stretch gradually and can reduce tearing,” Dr. Rankins says. A slower pace allows “the tissues to adapt more effectively to the pressure and stretching that happens during childbirth,” she says.
Crouch seconds this: “When the baby’s head crowns, gentle, controlled pushing and breathing techniques can significantly help manage the pressure on the perineum and reduce tearing.”
But sometimes you may not have a choice to slow things down. “Don’t sweat this too much,” Crouch says. “The speed of labor is something we can’t really control.” In other words, if the baby is coming fast, and you need to push, you do you. Listen to your body and go with the flow.
3. Try certain birthing positions
Contrary to popular belief, you don’t have to labor on your back. There are many other optimal birthing positions. “It used to be common practice to put women flat on their backs and put their feet in stirrups,” Jefferson says. But this immobilized position “is not ideal for pushing, for the health of the baby, and for the perineum,” she says.
“Giving birth while lying down, particularly on the back (supine position), may [actually] increase the risk of vaginal tearing,” Dr. Rankins says. “It also makes it easier for doctors to do episiotomies, which increases the risk of tearing,” she adds.
According to Crouch, evidence has shown upright positions that “free the sacrum” (i.e., the triangular bone at the base of the spine that connects to the pelvis) may reduce tearing, she says. These positions give your baby more room to pass by your sacrum. According to a March 2016 review in the British Journal of Midwifery, this includes kneeling and being on all-fours.
Still, it’s not all cut and dry. The same systematic review also concluded that certain upright positions (sitting, squatting, and using a birth-stool) might increase your risk of perineal injury.
The takeaway: Though some positions might be more protective, there’s no perfect pushing position, and no guarantee you won’t tear. At the end of the day, listen to your body. Whatever position feels good and helps you progress is the right one for you.
Can you give birth in an upright position with epidural?
An epidural (a pain medication injected through a needle and catheter into the lower part of your back) is given during labor to number the lower half of your body. This can make it a bit more challenging to birth in upright positions, says Dr. Rankins. But it’s not impossible.
“Contrary to popular belief, you can use different birthing positions with a low-dose epidural,” Crouch says. Like the name implies, it’s a lower dose of an anesthetic. It provides pain relief but allows you to stay somewhat mobile. “You just have to stay in the bed,” Crouch says. With help from your care team and/or your partner, you can maneuver into different positions like kneeling or all-fours. Side-lying positions with an epidural might help protect the perineum, too.
4. Incorporate perineal massage
Perineal massage may help during labor, too. In the pushing phase, your medical provider can can place their middle and index fingers into the vagina to stretch the perineum from side-to-side, which may help protect your perineum. In fact, the same June 2017 Cochrane Review found that perineal massage during the second stage of labor resulted in more people with an intact perineum and fewer third- or fourth-degree tears.
But again, the data is inconsistent. The authors also noted that perineal massage didn’t appear to reduce first- or second-degree tears or episiotomies.
Another note: If your doctor or midwife wants to do perineal massage, “there should be consent first,” Dr. Rankins says. This means, they should ask whether it’s okay to touch your genitals. They should also explain any risks and benefits, so you can make an informed decision.
Who is more at risk of tearing during birth?
Tearing in birth is common. But certain people are more likely to tear than others. Some risk factors that increase your odds include the following, per the Cleveland Clinic:
- It’s your first delivery.
- Your baby was face up instead of face down during delivery.
- Forceps (or a vacuum) were used during delivery.
- You have a large baby (more than 8 pounds).
- Your second stage of labor (pushing stage) was prolonged (or very short).
- You’re of Asian ethnicity or descent.
- You had an epidural.
Other possible risk factors include:
- Your choice of care provider (some have higher rates of severe tearing and use of interventions like episiotomy, forceps, or vacuum)
- Shoulder dystocia (when one or both of your baby’s shoulders get stuck inside your pelvis during a vaginal delivery)
How to recover from tearing
Vaginal tears often require stitches, which dissolve on their own after about six weeks, per the Cleveland Clinic. The tear itself, though, will often heal within two weeks (though it can take longer for severe tears). In the meantime, you might feel discomfort doing ordinary things, like pooping, coughing, or sneezing. Anything that puts pressure on your perineum can be pretty painful.
Fortunately, there are a few things you can do for relief. Try these tips for any type of tear, per the Cleveland Clinic:
- Use a peri-bottle (a squirt bottle) to wash yourself clean after using the bathroom. Lukewarm water feels the best.
- Gently pat yourself dry with toilet paper instead of wiping.
- Apply ice packs or wear special sanitary pads that have a cold pack inside. These pads are often available in the hospital or at your local drugstore.
- Avoid constipation by drinking plenty of water and using a stool softener.
- Take a sitz bath. Fill your bathtub with a few inches of warm water and sit in it for a few minutes.
- Sit on a donut pillow. This relieves pressure from your bottom, which can be especially helpful if you had a third- or fourth-degree tear.
- Avoid exercises or uncomfortable movements that aggravate your perineal area. This could include squats or walking down steps.
- Take an over-the-counter pain medication. Always check with your doctors beforehand if you’re breastfeeding, chestfeeding, or pumping.
- Use a pain-relieving numbing spray like Dermoplast.
- Line your sanitary pads with witch hazel pads like Tucks.
Potential complications of vaginal tears
While incredibly uncomfortable, most vaginal tears heal within two weeks. However, if your pain persists, and it’s accompanied by other symptoms, you might be dealing with an infection. Keep an eye out for these possible signs of an infection, per Penn Medicine:
- Painful swelling
- Redness
- Unpleasant odor (or discharge)
You’re also more likely to have certain complications with third- and fourth-degree tears, which may include the following, per the Cleveland Clinic:
- Bleeding
- Painful intercourse (once you’re given the “okay” to have sex)
- Fecal incontinence (leaking poop)
- Ongoing pain and soreness
Tearing during childbirth—and the continuing complications—can also be traumatic for some people, which can have a major effect on mental health. If you feel any of these issues, let your provider know ASAP. While fairly common, these problems are not normal, and you do not have to learn to live with them. Treatments are available (from pelvic floor physical therapy to talk therapy) to help.
The bottom line
Vaginal tearing during birth is not completely preventable. In fact, most people tear just a little. But doing certain things during pregnancy and labor may help reduce the risk (and severity) of tearing. Ultimately, it all depends on your body and birth experience; you can’t control the size of your baby, shape of your pelvis, or speed of labor.
Of course, it’s still important to prep. But if you do tear, remember: it’s not your fault. Try to focus on healing and recovery, and ask for help if you need it.
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As you head into your third trimester, you’re getting more and more excited to meet your baby. But some worries surrounding labor and delivery surface, too—and that’s totally okay! While your body is designed to give birth, the idea of pushing out a baby (or getting a C-section) can be intimidating. On top of that, there’s potential side effects to think about, like constipation, pain, or vaginal tearing. You may even wonder if it’s possible to prevent tearing during birth.
Vaginal tearing happens when the skin or muscle around your vagina and perineum (the area between your vagina and anus) rip because they can’t stretch enough. It’s pretty common (between 53 and 79 percent of people tear, per the American College of Obstetricians and Gynecologists (ACOG)), and can vary in severity depending on how deep it goes. Some different degrees include the following, per Penn Medicine:
- First-degree tear (the least severe type of tear): only affects the perineal skin and often doesn’t require any stitches
- Second-degree tear (the most common): affects both the skin and muscle of the perineum and requires stitches to repair
- Third-degree tear: extends into the anal sphincter (the muscle that surrounds the anus) and repairs may require general anesthesia in an operating room
- Fourth-degree tear (the least common, but most severe type of tear): extends from the vagina into the anal sphincter, but also into the rectum itself, and repairs may require care of a specialist
Sooo…can tears be prevented? Unfortunately, many (if not most) vaginal tears are unavoidable and are due to risk factors beyond your control (more on this later). Still, there are some things you can do during pregnancy and labor to try to prevent tearing (or reduce its severity).
Because there’s no guarantee that you can prevent vaginal tearing during birth, try not to beat yourself up if you do. Every body is different and will react differently to birth.
What to do before labor to avoid tearing
In preparation for labor, there are certain things you can try in pregnancy to help prevent tearing.
1. Try perineal massage
Your perineum is small (about 1.5 inches long on average), but it plays a big role in childbirth. The skin and tissues “down there” must be pliable enough to stretch and allow your baby to pass through the birth canal.
Some say that gently stretching your perineum—known a perineal massage—can help your body prepare for labor and lower your risk of tearing, says Marcy Crouch, PT, DPT, a pelvic floor physical therapist and co-host of the No Mama Left Behind podcast.
In fact, some research shows that “perineal massage may reduce serious tears involving both the vagina and rectum,” says midwife Karen Jefferson, DM, CM, FACNM, director of professional practice and policy at the American College of Nurse-Midwives. She points to an October 2023 systematic review in the Journal of Gynecology Obstetrics and Human Reproduction, which concluded that prenatal perineal massage protects the perineum from injuries in birth. The authors also said it can lessen the likelihood of fecal and gas incontinence (i.e., when you can’t control the release of your poops or farts) in the postpartum period.
Still, “the evidence that prenatal perineal massage helps prevent tearing is pretty limited,” says Nicole Rankins, MD, an OB/GYN and host of All About Pregnancy & Birth Podcast. She’s right: The data hasn’t been totally consistent. While some studies show perineal massage can reduce your risk of severe tears, others have found it makes little or no impact on tearing outcomes, according to the Cleveland Clinic.
The research is mixed because perineal massage is usually done at home, so it’s hard to know if everyone is doing it the same way. Plus, there are many other factors that can affect whether you’ll tear or not (like how big your baby is, how fast they crowned, and what interventions your doctor used). This is why it’s important to not blame yourself if you tear (it’s never your fault!).
Ultimately, the choice to try perineal massage is yours! It’s not a make-or-break decision, says Dr. Rankins. Don’t feel pressure to keep going if it’s uncomfortable (it’s not like a relaxing back massage, BTW) or if it’s not your thing.
But if you are interested in trying perineal massage, give it a try at around 34 weeks (to reduce your risk of third- or fourth-degree tears), Crouch says. Do these steps at least three to four times a week for five to 10 minutes at at time, per Crouch and the Cleveland Clinic:
- Wash your hands with a mild soap to prevent bacteria from entering your vagina. You’ll also want to make sure your fingernails are trimmed short to keep from scratching your delicate tissue.
- Lie on your back with your legs wide and knees bent, making sure that your back is supported the entire time.
- Apply a natural oil (like coconut oil or olive oil) or a water-soluble lubricant to your fingers, thumbs, and perineum.
- Place a single, lubricated thumb about 1 to 1.5 inches (that’s about to your first knuckle) into your vagina. Gently insert your other thumb.
- Press both thumbs on the back wall of your vagina toward your anus, applying enough pressure to feel slight stretching in your vagina. Hold this position for a minute or two.
- Move both thumbs slowly in a U-like motion so you feel a gentle stretch.
Note: If you have a vaginal infection, like thrush or genital herpes, you should avoid perineal massage because it can cause the infection to spread.
2. Choose the best medical provider for you
The things your medical provider does during labor can either reduce or increase your chances of tearing. For instance, you have a higher chance of severe tears with doctors who perform routine episiotomies (i.e., a cut made in the tissue between the vaginal opening and anus), per a November 2022 paper in Cureus.
But working with someone who’s “experienced in delivering babies with minimal intervention can significantly affect your birthing experience,” says Crouch. Interventions like episiotomies (or forceps or vacuum during delivery) should only be used when the health of you or your baby is in danger.
The best way to determine if your doctor’s right for you? Ask about their episiotomy and C-section rates at the beginning of your pregnancy. “These rates should be very low and these procedures should occur with consent in a situation where it is medically necessary,” Crouch says.
Your doctor should also be patient and give you time to let your perineum stretch slowly, when your baby is crowning, Jefferson says. The more gradually this area stretches, the less likely it’ll rip. “Providers who are patient and allow the labor process to proceed at a natural pace without rushing can help reduce the risk of tears,” Crouch agrees.
You may find a midwife fits all these requirements. In fact, an April 2016 review in the Cochrane Database of Systematic Reviews found that midwives tended to use fewer interventions (forceps, vacuum, and episiotomy). Plus, people under their care were more likely to feel satisfied with their birthing experience (a big plus).
3. Communicate with your team
“Keep the lines of communication open with your delivery team,” Crouch says. “Let them know your concerns about tearing and your desire to try positions or strategies that can help minimize the risk.” Ask your doctor or midwife what they do to prevent tears, and what they suggest you do to help prepare for delivery.
No matter who you choose—OB/GYN or midwife—it’s important you feel comfortable enough to voice your concerns. You want a provider who listens to your fears and respects and supports your birth plan. If you’re feeling rushed or dismissed, they may not be the right one for you.
4. Incorporate push prep
Just like you would train for a marathon, you can also train for giving birth. “Push prep,” in particular, can prepare your body for labor. This can potentially protect your perineum from severe tears. “Push prep involves training the pelvic floor muscles to relax and stretch, complementing the natural birthing process,” Crouch says. “It is especially helpful to train the pelvic floor muscles in specific positions you would like to try during birth.”
Wondering what that looks like? It’s doing perineal massage in different birthing positions (think: on your hands and knees, lying on your side, squatting, etc.) as well as practicing breathing techniques. “This awareness allows for more controlled and effective pushing, which can reduce trauma to the tissue,” Crouch says.
Keep in mind, though, “push prep is not universally defined, so it can be difficult to assess how well it reduces tearing,” Dr. Rankin says. Even so, it generally includes education about positions, pushing, pain management, and/or pelvic floor exercises, and all that is beneficial for birth, she says.
5. Invest in childbirth education
“In general, childbirth education is helpful to understand what is happening in your body during birth and to help you know what your options are (like different positions) so that you can better advocate for yourself,” Dr. Rankins says. For example, many people don’t know you don’t have to give birth on your back, Crouch says.
That said, “a lot of birthing classes are very focused on baby and not so much on the person giving birth,” Crouch says. You might have to do a little research to find a birth-prep program that centers around the birthing person’s experience. Crouch’s online birth prep and recovery course called Down There Done Right covers ways to reduce your risk of tearing and strategies to speed up your postpartum recovery.
6. Focus on a nutrient-dense diet
While eating fruits and veggies can’t prevent you from tearing, what you put on your plate can play a part in the health of your tissues. “Good nutrition is important for skin integrity and healing,” Jefferson says. Getting plenty of protein and vitamin-rich foods (already recommended in pregnancy for a healthy baby) can support your skin through all the changes it goes through in both birth and postpartum.
What to do during labor to avoid tearing
Here are a few things you can try during labor to potentially lower your likelihood of vaginal tearing.
1. Apply warm compresses
“Some say that applying a warm compress to the perineum during the second stage of labor (when you’re pushing) can help soften the tissue and increase its elasticity, potentially reducing the likelihood of tearing,” Crouch says. A June 2017 Cochrane Review supports this theory in certain cases. The authors found that people who got moist, warm compresses in labor had fewer third‐ or fourth‐degree perineal tears.
That said, evidence is limited. “It’s hard to say if this is a wives’ tale or not, though, because researchers can’t come to a consensus,” Crouch says. Case in point: While warm cloths may reduce the risk of severe tearing, the same 2017 Cochrane Review concluded that the effect of this practice on other outcomes (like first- or second-degree tears or the need for episiotomies) was unclear or mixed.
2. Practice controlled pushing
If your baby comes out of the birth canal quickly, you might have a higher chance of tearing. That’s because the tissues won’t have time to stretch. “Slow, controlled pushing, which is sometimes referred to as spontaneous pushing, allows the perineum to stretch gradually and can reduce tearing,” Dr. Rankins says. A slower pace allows “the tissues to adapt more effectively to the pressure and stretching that happens during childbirth,” she says.
Crouch seconds this: “When the baby’s head crowns, gentle, controlled pushing and breathing techniques can significantly help manage the pressure on the perineum and reduce tearing.”
But sometimes you may not have a choice to slow things down. “Don’t sweat this too much,” Crouch says. “The speed of labor is something we can’t really control.” In other words, if the baby is coming fast, and you need to push, you do you. Listen to your body and go with the flow.
3. Try certain birthing positions
Contrary to popular belief, you don’t have to labor on your back. There are many other optimal birthing positions. “It used to be common practice to put women flat on their backs and put their feet in stirrups,” Jefferson says. But this immobilized position “is not ideal for pushing, for the health of the baby, and for the perineum,” she says.
“Giving birth while lying down, particularly on the back (supine position), may [actually] increase the risk of vaginal tearing,” Dr. Rankins says. “It also makes it easier for doctors to do episiotomies, which increases the risk of tearing,” she adds.
According to Crouch, evidence has shown upright positions that “free the sacrum” (i.e., the triangular bone at the base of the spine that connects to the pelvis) may reduce tearing, she says. These positions give your baby more room to pass by your sacrum. According to a March 2016 review in the British Journal of Midwifery, this includes kneeling and being on all-fours.
Still, it’s not all cut and dry. The same systematic review also concluded that certain upright positions (sitting, squatting, and using a birth-stool) might increase your risk of perineal injury.
The takeaway: Though some positions might be more protective, there’s no perfect pushing position, and no guarantee you won’t tear. At the end of the day, listen to your body. Whatever position feels good and helps you progress is the right one for you.
Can you give birth in an upright position with epidural?
An epidural (a pain medication injected through a needle and catheter into the lower part of your back) is given during labor to number the lower half of your body. This can make it a bit more challenging to birth in upright positions, says Dr. Rankins. But it’s not impossible.
“Contrary to popular belief, you can use different birthing positions with a low-dose epidural,” Crouch says. Like the name implies, it’s a lower dose of an anesthetic. It provides pain relief but allows you to stay somewhat mobile. “You just have to stay in the bed,” Crouch says. With help from your care team and/or your partner, you can maneuver into different positions like kneeling or all-fours. Side-lying positions with an epidural might help protect the perineum, too.
4. Incorporate perineal massage
Perineal massage may help during labor, too. In the pushing phase, your medical provider can can place their middle and index fingers into the vagina to stretch the perineum from side-to-side, which may help protect your perineum. In fact, the same June 2017 Cochrane Review found that perineal massage during the second stage of labor resulted in more people with an intact perineum and fewer third- or fourth-degree tears.
But again, the data is inconsistent. The authors also noted that perineal massage didn’t appear to reduce first- or second-degree tears or episiotomies.
Another note: If your doctor or midwife wants to do perineal massage, “there should be consent first,” Dr. Rankins says. This means, they should ask whether it’s okay to touch your genitals. They should also explain any risks and benefits, so you can make an informed decision.
Who is more at risk of tearing during birth?
Tearing in birth is common. But certain people are more likely to tear than others. Some risk factors that increase your odds include the following, per the Cleveland Clinic:
- It’s your first delivery.
- Your baby was face up instead of face down during delivery.
- Forceps (or a vacuum) were used during delivery.
- You have a large baby (more than 8 pounds).
- Your second stage of labor (pushing stage) was prolonged (or very short).
- You’re of Asian ethnicity or descent.
- You had an epidural.
Other possible risk factors include:
- Your choice of care provider (some have higher rates of severe tearing and use of interventions like episiotomy, forceps, or vacuum)
- Shoulder dystocia (when one or both of your baby’s shoulders get stuck inside your pelvis during a vaginal delivery)
How to recover from tearing
Vaginal tears often require stitches, which dissolve on their own after about six weeks, per the Cleveland Clinic. The tear itself, though, will often heal within two weeks (though it can take longer for severe tears). In the meantime, you might feel discomfort doing ordinary things, like pooping, coughing, or sneezing. Anything that puts pressure on your perineum can be pretty painful.
Fortunately, there are a few things you can do for relief. Try these tips for any type of tear, per the Cleveland Clinic:
- Use a peri-bottle (a squirt bottle) to wash yourself clean after using the bathroom. Lukewarm water feels the best.
- Gently pat yourself dry with toilet paper instead of wiping.
- Apply ice packs or wear special sanitary pads that have a cold pack inside. These pads are often available in the hospital or at your local drugstore.
- Avoid constipation by drinking plenty of water and using a stool softener.
- Take a sitz bath. Fill your bathtub with a few inches of warm water and sit in it for a few minutes.
- Sit on a donut pillow. This relieves pressure from your bottom, which can be especially helpful if you had a third- or fourth-degree tear.
- Avoid exercises or uncomfortable movements that aggravate your perineal area. This could include squats or walking down steps.
- Take an over-the-counter pain medication. Always check with your doctors beforehand if you’re breastfeeding, chestfeeding, or pumping.
- Use a pain-relieving numbing spray like Dermoplast.
- Line your sanitary pads with witch hazel pads like Tucks.
Potential complications of vaginal tears
While incredibly uncomfortable, most vaginal tears heal within two weeks. However, if your pain persists, and it’s accompanied by other symptoms, you might be dealing with an infection. Keep an eye out for these possible signs of an infection, per Penn Medicine:
- Painful swelling
- Redness
- Unpleasant odor (or discharge)
You’re also more likely to have certain complications with third- and fourth-degree tears, which may include the following, per the Cleveland Clinic:
- Bleeding
- Painful intercourse (once you’re given the “okay” to have sex)
- Fecal incontinence (leaking poop)
- Ongoing pain and soreness
Tearing during childbirth—and the continuing complications—can also be traumatic for some people, which can have a major effect on mental health. If you feel any of these issues, let your provider know ASAP. While fairly common, these problems are not normal, and you do not have to learn to live with them. Treatments are available (from pelvic floor physical therapy to talk therapy) to help.
The bottom line
Vaginal tearing during birth is not completely preventable. In fact, most people tear just a little. But doing certain things during pregnancy and labor may help reduce the risk (and severity) of tearing. Ultimately, it all depends on your body and birth experience; you can’t control the size of your baby, shape of your pelvis, or speed of labor.
Of course, it’s still important to prep. But if you do tear, remember: it’s not your fault. Try to focus on healing and recovery, and ask for help if you need it.
You Can’t *Completely* Avoid Tearing During Birth, but These 10 Midwife-Approved Tips May Help Reduce the Severity
It’s never your fault if you do, BTW!
As you head into your third trimester, you’re getting more and more excited to meet your baby. But some worries surrounding labor and delivery surface, too—and that’s totally okay! While your body is designed to give birth, the idea of pushing out a baby (or getting a C-section) can be intimidating. On top of that, there’s potential side effects to think about, like constipation, pain, or vaginal tearing. You may even wonder if it’s possible to prevent tearing during birth.
Vaginal tearing happens when the skin or muscle around your vagina and perineum (the area between your vagina and anus) rip because they can’t stretch enough. It’s pretty common (between 53 and 79 percent of people tear, per the American College of Obstetricians and Gynecologists (ACOG)), and can vary in severity depending on how deep it goes. Some different degrees include the following, per Penn Medicine:
- First-degree tear (the least severe type of tear): only affects the perineal skin and often doesn’t require any stitches
- Second-degree tear (the most common): affects both the skin and muscle of the perineum and requires stitches to repair
- Third-degree tear: extends into the anal sphincter (the muscle that surrounds the anus) and repairs may require general anesthesia in an operating room
- Fourth-degree tear (the least common, but most severe type of tear): extends from the vagina into the anal sphincter, but also into the rectum itself, and repairs may require care of a specialist
Sooo…can tears be prevented? Unfortunately, many (if not most) vaginal tears are unavoidable and are due to risk factors beyond your control (more on this later). Still, there are some things you can do during pregnancy and labor to try to prevent tearing (or reduce its severity).
Because there’s no guarantee that you can prevent vaginal tearing during birth, try not to beat yourself up if you do. Every body is different and will react differently to birth.
What to do before labor to avoid tearing
In preparation for labor, there are certain things you can try in pregnancy to help prevent tearing.
1. Try perineal massage
Your perineum is small (about 1.5 inches long on average), but it plays a big role in childbirth. The skin and tissues “down there” must be pliable enough to stretch and allow your baby to pass through the birth canal.
Some say that gently stretching your perineum—known a perineal massage—can help your body prepare for labor and lower your risk of tearing, says Marcy Crouch, PT, DPT, a pelvic floor physical therapist and co-host of the No Mama Left Behind podcast.
In fact, some research shows that “perineal massage may reduce serious tears involving both the vagina and rectum,” says midwife Karen Jefferson, DM, CM, FACNM, director of professional practice and policy at the American College of Nurse-Midwives. She points to an October 2023 systematic review in the Journal of Gynecology Obstetrics and Human Reproduction, which concluded that prenatal perineal massage protects the perineum from injuries in birth. The authors also said it can lessen the likelihood of fecal and gas incontinence (i.e., when you can’t control the release of your poops or farts) in the postpartum period.
Still, “the evidence that prenatal perineal massage helps prevent tearing is pretty limited,” says Nicole Rankins, MD, an OB/GYN and host of All About Pregnancy & Birth Podcast. She’s right: The data hasn’t been totally consistent. While some studies show perineal massage can reduce your risk of severe tears, others have found it makes little or no impact on tearing outcomes, according to the Cleveland Clinic.
The research is mixed because perineal massage is usually done at home, so it’s hard to know if everyone is doing it the same way. Plus, there are many other factors that can affect whether you’ll tear or not (like how big your baby is, how fast they crowned, and what interventions your doctor used). This is why it’s important to not blame yourself if you tear (it’s never your fault!).
Ultimately, the choice to try perineal massage is yours! It’s not a make-or-break decision, says Dr. Rankins. Don’t feel pressure to keep going if it’s uncomfortable (it’s not like a relaxing back massage, BTW) or if it’s not your thing.
But if you are interested in trying perineal massage, give it a try at around 34 weeks (to reduce your risk of third- or fourth-degree tears), Crouch says. Do these steps at least three to four times a week for five to 10 minutes at at time, per Crouch and the Cleveland Clinic:
- Wash your hands with a mild soap to prevent bacteria from entering your vagina. You’ll also want to make sure your fingernails are trimmed short to keep from scratching your delicate tissue.
- Lie on your back with your legs wide and knees bent, making sure that your back is supported the entire time.
- Apply a natural oil (like coconut oil or olive oil) or a water-soluble lubricant to your fingers, thumbs, and perineum.
- Place a single, lubricated thumb about 1 to 1.5 inches (that’s about to your first knuckle) into your vagina. Gently insert your other thumb.
- Press both thumbs on the back wall of your vagina toward your anus, applying enough pressure to feel slight stretching in your vagina. Hold this position for a minute or two.
- Move both thumbs slowly in a U-like motion so you feel a gentle stretch.
Note: If you have a vaginal infection, like thrush or genital herpes, you should avoid perineal massage because it can cause the infection to spread.
2. Choose the best medical provider for you
The things your medical provider does during labor can either reduce or increase your chances of tearing. For instance, you have a higher chance of severe tears with doctors who perform routine episiotomies (i.e., a cut made in the tissue between the vaginal opening and anus), per a November 2022 paper in Cureus.
But working with someone who’s “experienced in delivering babies with minimal intervention can significantly affect your birthing experience,” says Crouch. Interventions like episiotomies (or forceps or vacuum during delivery) should only be used when the health of you or your baby is in danger.
The best way to determine if your doctor’s right for you? Ask about their episiotomy and C-section rates at the beginning of your pregnancy. “These rates should be very low and these procedures should occur with consent in a situation where it is medically necessary,” Crouch says.
Your doctor should also be patient and give you time to let your perineum stretch slowly, when your baby is crowning, Jefferson says. The more gradually this area stretches, the less likely it’ll rip. “Providers who are patient and allow the labor process to proceed at a natural pace without rushing can help reduce the risk of tears,” Crouch agrees.
You may find a midwife fits all these requirements. In fact, an April 2016 review in the Cochrane Database of Systematic Reviews found that midwives tended to use fewer interventions (forceps, vacuum, and episiotomy). Plus, people under their care were more likely to feel satisfied with their birthing experience (a big plus).
3. Communicate with your team
“Keep the lines of communication open with your delivery team,” Crouch says. “Let them know your concerns about tearing and your desire to try positions or strategies that can help minimize the risk.” Ask your doctor or midwife what they do to prevent tears, and what they suggest you do to help prepare for delivery.
No matter who you choose—OB/GYN or midwife—it’s important you feel comfortable enough to voice your concerns. You want a provider who listens to your fears and respects and supports your birth plan. If you’re feeling rushed or dismissed, they may not be the right one for you.
4. Incorporate push prep
Just like you would train for a marathon, you can also train for giving birth. “Push prep,” in particular, can prepare your body for labor. This can potentially protect your perineum from severe tears. “Push prep involves training the pelvic floor muscles to relax and stretch, complementing the natural birthing process,” Crouch says. “It is especially helpful to train the pelvic floor muscles in specific positions you would like to try during birth.”
Wondering what that looks like? It’s doing perineal massage in different birthing positions (think: on your hands and knees, lying on your side, squatting, etc.) as well as practicing breathing techniques. “This awareness allows for more controlled and effective pushing, which can reduce trauma to the tissue,” Crouch says.
Keep in mind, though, “push prep is not universally defined, so it can be difficult to assess how well it reduces tearing,” Dr. Rankin says. Even so, it generally includes education about positions, pushing, pain management, and/or pelvic floor exercises, and all that is beneficial for birth, she says.
5. Invest in childbirth education
“In general, childbirth education is helpful to understand what is happening in your body during birth and to help you know what your options are (like different positions) so that you can better advocate for yourself,” Dr. Rankins says. For example, many people don’t know you don’t have to give birth on your back, Crouch says.
That said, “a lot of birthing classes are very focused on baby and not so much on the person giving birth,” Crouch says. You might have to do a little research to find a birth-prep program that centers around the birthing person’s experience. Crouch’s online birth prep and recovery course called Down There Done Right covers ways to reduce your risk of tearing and strategies to speed up your postpartum recovery.
6. Focus on a nutrient-dense diet
While eating fruits and veggies can’t prevent you from tearing, what you put on your plate can play a part in the health of your tissues. “Good nutrition is important for skin integrity and healing,” Jefferson says. Getting plenty of protein and vitamin-rich foods (already recommended in pregnancy for a healthy baby) can support your skin through all the changes it goes through in both birth and postpartum.
What to do during labor to avoid tearing
Here are a few things you can try during labor to potentially lower your likelihood of vaginal tearing.
1. Apply warm compresses
“Some say that applying a warm compress to the perineum during the second stage of labor (when you’re pushing) can help soften the tissue and increase its elasticity, potentially reducing the likelihood of tearing,” Crouch says. A June 2017 Cochrane Review supports this theory in certain cases. The authors found that people who got moist, warm compresses in labor had fewer third‐ or fourth‐degree perineal tears.
That said, evidence is limited. “It’s hard to say if this is a wives’ tale or not, though, because researchers can’t come to a consensus,” Crouch says. Case in point: While warm cloths may reduce the risk of severe tearing, the same 2017 Cochrane Review concluded that the effect of this practice on other outcomes (like first- or second-degree tears or the need for episiotomies) was unclear or mixed.
2. Practice controlled pushing
If your baby comes out of the birth canal quickly, you might have a higher chance of tearing. That’s because the tissues won’t have time to stretch. “Slow, controlled pushing, which is sometimes referred to as spontaneous pushing, allows the perineum to stretch gradually and can reduce tearing,” Dr. Rankins says. A slower pace allows “the tissues to adapt more effectively to the pressure and stretching that happens during childbirth,” she says.
Crouch seconds this: “When the baby’s head crowns, gentle, controlled pushing and breathing techniques can significantly help manage the pressure on the perineum and reduce tearing.”
But sometimes you may not have a choice to slow things down. “Don’t sweat this too much,” Crouch says. “The speed of labor is something we can’t really control.” In other words, if the baby is coming fast, and you need to push, you do you. Listen to your body and go with the flow.
3. Try certain birthing positions
Contrary to popular belief, you don’t have to labor on your back. There are many other optimal birthing positions. “It used to be common practice to put women flat on their backs and put their feet in stirrups,” Jefferson says. But this immobilized position “is not ideal for pushing, for the health of the baby, and for the perineum,” she says.
“Giving birth while lying down, particularly on the back (supine position), may [actually] increase the risk of vaginal tearing,” Dr. Rankins says. “It also makes it easier for doctors to do episiotomies, which increases the risk of tearing,” she adds.
According to Crouch, evidence has shown upright positions that “free the sacrum” (i.e., the triangular bone at the base of the spine that connects to the pelvis) may reduce tearing, she says. These positions give your baby more room to pass by your sacrum. According to a March 2016 review in the British Journal of Midwifery, this includes kneeling and being on all-fours.
Still, it’s not all cut and dry. The same systematic review also concluded that certain upright positions (sitting, squatting, and using a birth-stool) might increase your risk of perineal injury.
The takeaway: Though some positions might be more protective, there’s no perfect pushing position, and no guarantee you won’t tear. At the end of the day, listen to your body. Whatever position feels good and helps you progress is the right one for you.
Can you give birth in an upright position with epidural?
An epidural (a pain medication injected through a needle and catheter into the lower part of your back) is given during labor to number the lower half of your body. This can make it a bit more challenging to birth in upright positions, says Dr. Rankins. But it’s not impossible.
“Contrary to popular belief, you can use different birthing positions with a low-dose epidural,” Crouch says. Like the name implies, it’s a lower dose of an anesthetic. It provides pain relief but allows you to stay somewhat mobile. “You just have to stay in the bed,” Crouch says. With help from your care team and/or your partner, you can maneuver into different positions like kneeling or all-fours. Side-lying positions with an epidural might help protect the perineum, too.
4. Incorporate perineal massage
Perineal massage may help during labor, too. In the pushing phase, your medical provider can can place their middle and index fingers into the vagina to stretch the perineum from side-to-side, which may help protect your perineum. In fact, the same June 2017 Cochrane Review found that perineal massage during the second stage of labor resulted in more people with an intact perineum and fewer third- or fourth-degree tears.
But again, the data is inconsistent. The authors also noted that perineal massage didn’t appear to reduce first- or second-degree tears or episiotomies.
Another note: If your doctor or midwife wants to do perineal massage, “there should be consent first,” Dr. Rankins says. This means, they should ask whether it’s okay to touch your genitals. They should also explain any risks and benefits, so you can make an informed decision.
Who is more at risk of tearing during birth?
Tearing in birth is common. But certain people are more likely to tear than others. Some risk factors that increase your odds include the following, per the Cleveland Clinic:
- It’s your first delivery.
- Your baby was face up instead of face down during delivery.
- Forceps (or a vacuum) were used during delivery.
- You have a large baby (more than 8 pounds).
- Your second stage of labor (pushing stage) was prolonged (or very short).
- You’re of Asian ethnicity or descent.
- You had an epidural.
Other possible risk factors include:
- Your choice of care provider (some have higher rates of severe tearing and use of interventions like episiotomy, forceps, or vacuum)
- Shoulder dystocia (when one or both of your baby’s shoulders get stuck inside your pelvis during a vaginal delivery)
How to recover from tearing
Vaginal tears often require stitches, which dissolve on their own after about six weeks, per the Cleveland Clinic. The tear itself, though, will often heal within two weeks (though it can take longer for severe tears). In the meantime, you might feel discomfort doing ordinary things, like pooping, coughing, or sneezing. Anything that puts pressure on your perineum can be pretty painful.
Fortunately, there are a few things you can do for relief. Try these tips for any type of tear, per the Cleveland Clinic:
- Use a peri-bottle (a squirt bottle) to wash yourself clean after using the bathroom. Lukewarm water feels the best.
- Gently pat yourself dry with toilet paper instead of wiping.
- Apply ice packs or wear special sanitary pads that have a cold pack inside. These pads are often available in the hospital or at your local drugstore.
- Avoid constipation by drinking plenty of water and using a stool softener.
- Take a sitz bath. Fill your bathtub with a few inches of warm water and sit in it for a few minutes.
- Sit on a donut pillow. This relieves pressure from your bottom, which can be especially helpful if you had a third- or fourth-degree tear.
- Avoid exercises or uncomfortable movements that aggravate your perineal area. This could include squats or walking down steps.
- Take an over-the-counter pain medication. Always check with your doctors beforehand if you’re breastfeeding, chestfeeding, or pumping.
- Use a pain-relieving numbing spray like Dermoplast.
- Line your sanitary pads with witch hazel pads like Tucks.
Potential complications of vaginal tears
While incredibly uncomfortable, most vaginal tears heal within two weeks. However, if your pain persists, and it’s accompanied by other symptoms, you might be dealing with an infection. Keep an eye out for these possible signs of an infection, per Penn Medicine:
- Painful swelling
- Redness
- Unpleasant odor (or discharge)
You’re also more likely to have certain complications with third- and fourth-degree tears, which may include the following, per the Cleveland Clinic:
- Bleeding
- Painful intercourse (once you’re given the “okay” to have sex)
- Fecal incontinence (leaking poop)
- Ongoing pain and soreness
Tearing during childbirth—and the continuing complications—can also be traumatic for some people, which can have a major effect on mental health. If you feel any of these issues, let your provider know ASAP. While fairly common, these problems are not normal, and you do not have to learn to live with them. Treatments are available (from pelvic floor physical therapy to talk therapy) to help.
The bottom line
Vaginal tearing during birth is not completely preventable. In fact, most people tear just a little. But doing certain things during pregnancy and labor may help reduce the risk (and severity) of tearing. Ultimately, it all depends on your body and birth experience; you can’t control the size of your baby, shape of your pelvis, or speed of labor.
Of course, it’s still important to prep. But if you do tear, remember: it’s not your fault. Try to focus on healing and recovery, and ask for help if you need it.
How to Sell UX Research with Two Simple Questions
Do you find yourself designing screens with only a vague idea of how the things on the screen relate to the things elsewhere in the system? Do you leave stakeholder meetings with unclear directives that often seem to contradict previous conversations? You know a better understanding of user needs would help the team get clear on what you are actually trying to accomplish, but time and budget for research is tight. When it comes to asking for more direct contact with your users, you might feel like poor Oliver Twist, timidly asking, “Please, sir, I want some more.”
Here’s the trick. You need to get stakeholders themselves to identify high-risk assumptions and hidden complexity, so that they become just as motivated as you to get answers from users. Basically, you need to make them think it’s their idea.
In this article, I’ll show you how to collaboratively expose misalignment and gaps in the team’s shared understanding by bringing the team together around two simple questions:
- What are the objects?
- What are the relationships between those objects?
A gauntlet between research and screen design
These two questions align to the first two steps of the ORCA process, which might become your new best friend when it comes to reducing guesswork. Wait, what’s ORCA?! Glad you asked.
ORCA stands for Objects, Relationships, CTAs, and Attributes, and it outlines a process for creating solid object-oriented user experiences. Object-oriented UX is my design philosophy. ORCA is an iterative methodology for synthesizing user research into an elegant structural foundation to support screen and interaction design. OOUX and ORCA have made my work as a UX designer more collaborative, effective, efficient, fun, strategic, and meaningful.
The ORCA process has four iterative rounds and a whopping fifteen steps. In each round we get more clarity on our Os, Rs, Cs, and As.
I sometimes say that ORCA is a “garbage in, garbage out” process. To ensure that the testable prototype produced in the final round actually tests well, the process needs to be fed by good research. But if you don’t have a ton of research, the beginning of the ORCA process serves another purpose: it helps you sell the need for research.
In other words, the ORCA process serves as a gauntlet between research and design. With good research, you can gracefully ride the killer whale from research into design. But without good research, the process effectively spits you back into research and with a cache of specific open questions.
Getting in the same curiosity-boat
What gets us into trouble is not what we don’t know. It’s what we know for sure that just ain’t so.
Mark Twain
The first two steps of the ORCA process—Object Discovery and Relationship Discovery—shine a spotlight on the dark, dusty corners of your team’s misalignments and any inherent complexity that’s been swept under the rug. It begins to expose what this classic comic so beautifully illustrates:
This is one reason why so many UX designers are frustrated in their job and why many projects fail. And this is also why we often can’t sell research: every decision-maker is confident in their own mental picture.
Once we expose hidden fuzzy patches in each picture and the differences between them all, the case for user research makes itself.
But how we do this is important. However much we might want to, we can’t just tell everyone, “YOU ARE WRONG!” Instead, we need to facilitate and guide our team members to self-identify holes in their picture. When stakeholders take ownership of assumptions and gaps in understanding, BAM! Suddenly, UX research is not such a hard sell, and everyone is aboard the same curiosity-boat.
Say your users are doctors. And you have no idea how doctors use the system you are tasked with redesigning.
You might try to sell research by honestly saying: “We need to understand doctors better! What are their pain points? How do they use the current app?” But here’s the problem with that. Those questions are vague, and the answers to them don’t feel acutely actionable.
Instead, you want your stakeholders themselves to ask super-specific questions. This is more like the kind of conversation you need to facilitate. Let’s listen in:
“Wait a sec, how often do doctors share patients? Does a patient in this system have primary and secondary doctors?”
“Can a patient even have more than one primary doctor?”
“Is it a ‘primary doctor’ or just a ‘primary caregiver’… Can’t that role be a nurse practitioner?”
“No, caregivers are something else… That’s the patient’s family contacts, right?”
“So are caregivers in scope for this redesign?”
“Yeah, because if a caregiver is present at an appointment, the doctor needs to note that. Like, tag the caregiver on the note… Or on the appointment?”
Now we are getting somewhere. Do you see how powerful it can be getting stakeholders to debate these questions themselves? The diabolical goal here is to shake their confidence—gently and diplomatically.
When these kinds of questions bubble up collaboratively and come directly from the mouths of your stakeholders and decision-makers, suddenly, designing screens without knowing the answers to these questions seems incredibly risky, even silly.
If we create software without understanding the real-world information environment of our users, we will likely create software that does not align to the real-world information environment of our users. And this will, hands down, result in a more confusing, more complex, and less intuitive software product.
The two questions
But how do we get to these kinds of meaty questions diplomatically, efficiently, collaboratively, and reliably?
We can do this by starting with those two big questions that align to the first two steps of the ORCA process:
- What are the objects?
- What are the relationships between those objects?
In practice, getting to these answers is easier said than done. I’m going to show you how these two simple questions can provide the outline for an Object Definition Workshop. During this workshop, these “seed” questions will blossom into dozens of specific questions and shine a spotlight on the need for more user research.
Prep work: Noun foraging
In the next section, I’ll show you how to run an Object Definition Workshop with your stakeholders (and entire cross-functional team, hopefully). But first, you need to do some prep work.
Basically, look for nouns that are particular to the business or industry of your project, and do it across at least a few sources. I call this noun foraging.
Here are just a few great noun foraging sources:
- the product’s marketing site
- the product’s competitors’ marketing sites (competitive analysis, anyone?)
- the existing product (look at labels!)
- user interview transcripts
- notes from stakeholder interviews or vision docs from stakeholders
Put your detective hat on, my dear Watson. Get resourceful and leverage what you have. If all you have is a marketing website, some screenshots of the existing legacy system, and access to customer service chat logs, then use those.
As you peruse these sources, watch for the nouns that are used over and over again, and start listing them (preferably on blue sticky notes if you’ll be creating an object map later!).
You’ll want to focus on nouns that might represent objects in your system. If you are having trouble determining if a noun might be object-worthy, remember the acronym SIP and test for:
- Structure
- Instances
- Purpose
Think of a library app, for example. Is “book” an object?
Structure: can you think of a few attributes for this potential object? Title, author, publish date… Yep, it has structure. Check!
Instance: what are some examples of this potential “book” object? Can you name a few? The Alchemist, Ready Player One, Everybody Poops… OK, check!
Purpose: why is this object important to the users and business? Well, “book” is what our library client is providing to people and books are why people come to the library… Check, check, check!
As you are noun foraging, focus on capturing the nouns that have SIP. Avoid capturing components like dropdowns, checkboxes, and calendar pickers—your UX system is not your design system! Components are just the packaging for objects—they are a means to an end. No one is coming to your digital place to play with your dropdown! They are coming for the VALUABLE THINGS and what they can do with them. Those things, or objects, are what we are trying to identify.
Let’s say we work for a startup disrupting the email experience. This is how I’d start my noun foraging.
First I’d look at my own email client, which happens to be Gmail. I’d then look at Outlook and the new HEY email. I’d look at Yahoo, Hotmail…I’d even look at Slack and Basecamp and other so-called “email replacers.” I’d read some articles, reviews, and forum threads where people are complaining about email. While doing all this, I would look for and write down the nouns.
(Before moving on, feel free to go noun foraging for this hypothetical product, too, and then scroll down to see how much our lists match up. Just don’t get lost in your own emails! Come back to me!)
Drumroll, please…
Here are a few nouns I came up with during my noun foraging:
- email message
- thread
- contact
- client
- rule/automation
- email address that is not a contact?
- contact groups
- attachment
- Google doc file / other integrated file
- newsletter? (HEY treats this differently)
- saved responses and templates
Scan your list of nouns and pick out words that you are completely clueless about. In our email example, it might be client or automation. Do as much homework as you can before your session with stakeholders: google what’s googleable. But other terms might be so specific to the product or domain that you need to have a conversation about them.
Aside: here are some real nouns foraged during my own past project work that I needed my stakeholders to help me understand:
- Record Locator
- Incentive Home
- Augmented Line Item
- Curriculum-Based Measurement Probe
This is really all you need to prepare for the workshop session: a list of nouns that represent potential objects and a short list of nouns that need to be defined further.
Facilitate an Object Definition Workshop
You could actually start your workshop with noun foraging—this activity can be done collaboratively. If you have five people in the room, pick five sources, assign one to every person, and give everyone ten minutes to find the objects within their source. When the time’s up, come together and find the overlap. Affinity mapping is your friend here!
If your team is short on time and might be reluctant to do this kind of grunt work (which is usually the case) do your own noun foraging beforehand, but be prepared to show your work. I love presenting screenshots of documents and screens with all the nouns already highlighted. Bring the artifacts of your process, and start the workshop with a five-minute overview of your noun foraging journey.
HOT TIP: before jumping into the workshop, frame the conversation as a requirements-gathering session to help you better understand the scope and details of the system. You don’t need to let them know that you’re looking for gaps in the team’s understanding so that you can prove the need for more user research—that will be our little secret. Instead, go into the session optimistically, as if your knowledgeable stakeholders and PMs and biz folks already have all the answers.
Then, let the question whack-a-mole commence.
1. What is this thing?
Want to have some real fun? At the beginning of your session, ask stakeholders to privately write definitions for the handful of obscure nouns you might be uncertain about. Then, have everyone show their cards at the same time and see if you get different definitions (you will). This is gold for exposing misalignment and starting great conversations.
As your discussion unfolds, capture any agreed-upon definitions. And when uncertainty emerges, quietly (but visibly) start an “open questions” parking lot. 😉
After definitions solidify, here’s a great follow-up:
2. Do our users know what these things are? What do users call this thing?
Stakeholder 1: They probably call email clients “apps.” But I’m not sure.
Stakeholder 2: Automations are often called “workflows,” I think. Or, maybe users think workflows are something different.
If a more user-friendly term emerges, ask the group if they can agree to use only that term moving forward. This way, the team can better align to the users’ language and mindset.
OK, moving on.
If you have two or more objects that seem to overlap in purpose, ask one of these questions:
3. Are these the same thing? Or are these different? If they are not the same, how are they different?
You: Is a saved response the same as a template?
Stakeholder 1: Yes! Definitely.
Stakeholder 2: I don’t think so… A saved response is text with links and variables, but a template is more about the look and feel, like default fonts, colors, and placeholder images.
Continue to build out your growing glossary of objects. And continue to capture areas of uncertainty in your “open questions” parking lot.
If you successfully determine that two similar things are, in fact, different, here’s your next follow-up question:
4. What’s the relationship between these objects?
You: Are saved responses and templates related in any way?
Stakeholder 3: Yeah, a template can be applied to a saved response.
You, always with the follow-ups: When is the template applied to a saved response? Does that happen when the user is constructing the saved response? Or when they apply the saved response to an email? How does that actually work?
Listen. Capture uncertainty. Once the list of “open questions” grows to a critical mass, pause to start assigning questions to groups or individuals. Some questions might be for the dev team (hopefully at least one developer is in the room with you). One question might be specifically for someone who couldn’t make it to the workshop. And many questions will need to be labeled “user.”
Do you see how we are building up to our UXR sales pitch?
5. Is this object in scope?
Your next question narrows the team’s focus toward what’s most important to your users. You can simply ask, “Are saved responses in scope for our first release?,” but I’ve got a better, more devious strategy.
By now, you should have a list of clearly defined objects. Ask participants to sort these objects from most to least important, either in small breakout groups or individually. Then, like you did with the definitions, have everyone reveal their sort order at once. Surprisingly—or not so surprisingly—it’s not unusual for the VP to rank something like “saved responses” as #2 while everyone else puts it at the bottom of the list. Try not to look too smug as you inevitably expose more misalignment.
I did this for a startup a few years ago. We posted the three groups’ wildly different sort orders on the whiteboard.
The CEO stood back, looked at it, and said, “This is why we haven’t been able to move forward in two years.”
Admittedly, it’s tragic to hear that, but as a professional, it feels pretty awesome to be the one who facilitated a watershed realization.
Once you have a good idea of in-scope, clearly defined things, this is when you move on to doing more relationship mapping.
6. Create a visual representation of the objects’ relationships
We’ve already done a bit of this while trying to determine if two things are different, but this time, ask the team about every potential relationship. For each object, ask how it relates to all the other objects. In what ways are the objects connected? To visualize all the connections, pull out your trusty boxes-and-arrows technique. Here, we are connecting our objects with verbs. I like to keep my verbs to simple “has a” and “has many” statements.
This system modeling activity brings up all sorts of new questions:
- Can a saved response have attachments?
- Can a saved response use a template? If so, if an email uses a saved response with a template, can the user override that template?
- Do users want to see all the emails they sent that included a particular attachment? For example, “show me all the emails I sent with ProfessionalImage.jpg attached. I’ve changed my professional photo and I want to alert everyone to update it.”
Solid answers might emerge directly from the workshop participants. Great! Capture that new shared understanding. But when uncertainty surfaces, continue to add questions to your growing parking lot.
Light the fuse
You’ve positioned the explosives all along the floodgates. Now you simply have to light the fuse and BOOM. Watch the buy-in for user research flooooow.
Before your workshop wraps up, have the group reflect on the list of open questions. Make plans for getting answers internally, then focus on the questions that need to be brought before users.
Here’s your final step. Take those questions you’ve compiled for user research and discuss the level of risk associated with NOT answering them. Ask, “if we design without an answer to this question, if we make up our own answer and we are wrong, how bad might that turn out?”
With this methodology, we are cornering our decision-makers into advocating for user research as they themselves label questions as high-risk. Sorry, not sorry.
Now is your moment of truth. With everyone in the room, ask for a reasonable budget of time and money to conduct 6–8 user interviews focused specifically on these questions.
HOT TIP: if you are new to UX research, please note that you’ll likely need to rephrase the questions that came up during the workshop before you present them to users. Make sure your questions are open-ended and don’t lead the user into any default answers.
Final words: Hold the screen design!
Seriously, if at all possible, do not ever design screens again without first answering these fundamental questions: what are the objects and how do they relate?
I promise you this: if you can secure a shared understanding between the business, design, and development teams before you start designing screens, you will have less heartache and save more time and money, and (it almost feels like a bonus at this point!) users will be more receptive to what you put out into the world.
I sincerely hope this helps you win time and budget to go talk to your users and gain clarity on what you are designing before you start building screens. If you find success using noun foraging and the Object Definition Workshop, there’s more where that came from in the rest of the ORCA process, which will help prevent even more late-in-the-game scope tugs-of-war and strategy pivots.
All the best of luck! Now go sell research!