What is the perineum?
The perineum is the area between your vaginal opening and your anus. During childbirth the perineum area stretches to allow the birth of your baby. Most women get a small tear, and it usually heals well.
Fit for birth
It is highly recommended that you begin regular pelvic floor muscle exercises early in your pregnancy. These exercises will help the muscles to cope with changes during the pregnancy, such as the increasing weight of your baby and, help you to recover postnatally. Pelvic floor muscle training, including both tightening and properly releasing the muscles can help make labour more efficient.
Perineal massage
Perineal massage is a gentle technique that involves massaging and stretching the area between your vagina and anus (called the perineum). This can help prepare your body for the birth of your baby by increasing the flexibility of the tissues in that area.
Perineal massage tips…
- Sit in a warm bath before you start. This may help you to relax before the massage and loosen the muscles around your perineum
- The tissues in your vagina and perineum are very delicate. Make sure your nails are short to prevent scratching the skin, or any discomfort to the area
- You need to be relaxed during the massage, so it’s important you find a comfortable position. The best place to perform this massage is in bed. Prop yourself up with pillows to support your back and bend your knees
- Use a lubricant like vitamin E oil, almond oil or olive oil
- Hold your thumbs in the position shown for about 1 minute. Press down towards the anus and to the sides of the vagina walls. Hold your thumbs in this position for about 1 minute. You will begin to feel a stretching sensation. Breathe deeply
- Gently massage the lower half of your vagina using a U-shaped movement for 2-3minutes. Repeat this 2-3 times
- It may take a couple of weeks of daily massage before you notice more elasticity in your perineal area
Perineal protection at the time of birth
Birth position
Your healthcare professional will work with you so that you can birth in your chosen position. A kneeling, or all-fours position, or lying on your side, may be beneficial and reduce the severity of tearing.
Warm compress
Your healthcare professional can gently place a warm compress (pad, swab or gauze) on the perineum as the baby’s head stretches the perineal tissues. This can help to reduce the severity of tearing.
A ‘hands-on’ birth
Your healthcare professional can support your perineum as your baby is being born. This is called manual perineal protection, or a ‘hands on birth’.
Manual perineal protection can be provided in almost any birth position, apart from in the water or on a birthing stool.
It is only used for a short period, during the birth of your baby and it can help to reduce the severity of tearing.
What is a perineal tear?
Many women experience a perineal tear when having a baby, especially for the first time. They happen when the skin and muscles of the perineum stretch and tear as the baby is delivered. Most tears occur in the perineum, the area between the vaginal opening and the anus (back passage).
First-degree tears: These are usually small skin-deep tears that usually heal naturally.
Second-degree tears: These are deeper and affect the muscle of the perineum and usually require stitches.
Episiotomy: This is where a cut made by a doctor or midwife through the vaginal wall and perineum to make more space to deliver the baby.
Third- or fourth-degree tear: For some women the tear may be deeper. A tear that also involves the muscle that controls the anus (the anal sphincter) is known as a third-degree tear. If the tear extends further into the lining of the anus or rectum it is known as a fourth-degree tear.
Dissolvable stitches are used to repair tears, so you will not need to return to hospital to have them removed. Most tears heal within a few weeks. It is important that you follow care and hygiene precautions as advised and have your stitches checked by your health professional to check healing.
Your healthcare professional should work with you to discuss your preferences for birth
If you are concerned about tears or have any questions, speak to your healthcare professional. They will be able to discuss any increased risk factors related to your birth, and what they and you can do to try to prevent them.
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