How to reduce your risk of perineal tears, according to a midwife
When you’re expecting a baby, there’s so much to think about (writing your labour plan, packing the hospital bag, washing baby clothes and scouring baby-name books for starters), that you perhaps haven’t given a second though to your perineum.
If you’re wondering, ‘My what?’, then read on. It’s worth being prepared because, while you cannot prevent a perineal tear from happening during childbirth, with a little pre-planning you can certainly lessen the extent of any trauma that may occur to the area.
We spoke with Lesley Gilchrist, registered midwife and co-founder of My Expert Midwife, to learn more about perineal trauma and find out how you can best protect yourself during childbirth.
What are perineal tears?
The perineum is the skin and muscular area between your vagina and anus (your back passage), which stretches during childbirth.
According to clinical data, nine out of 10 first-time mothers who have a vaginal birth will experience some sort of perineal trauma – this can be anything from a tear or graze to an episiotomy (a surgical incision to make the vaginal opening a little wider, or to help prevent a more serious tear).
And a recent survey conducted by My Expert Midwife found that despite the prevalence of perineal trauma, a shocking one in three (32 per cent) women did not know that they might sustain perineal trauma when giving birth.
Degrees of perineal tears
There are four different types of perineal tearing, which you can sustain during childbirth:
First degree tear
This is a minor tear of the skin only and often doesn’t need stitches.
Second degree tear
This is a little deeper, involving some layers of the muscles around the perineum.
Third and fourth degree tears
These are more severe, whereby the tear reaches your anus. These tears will have to be repaired by a doctor through surgery under spinal anaesthetic. If you sustain a third or fourth degree tear, you’ll be referred to a specialist physiotherapist to assist with recovery. Third and fourth degree tears occur in around three in 100 women who have a vaginal birth.
Treatment of perineal tears
Treatment of the tear very much depends on its severity, and it may or may not require stitches.
First degree tear
A first degree involves just the skin and, if small and not bleeding, will probably not need any stitches.
Second degree tears
Second degree tears involve the muscle layer and can range from being very simple to repair with local anaesthetic, to more complicated and needing regional anaesthetic (an epidural or spinal) and a trip to theatre. However, the former is much more common.
Third degree and fourth degree tears
These involve the anal sphincter and/or part of the rectum. They need to be repaired in theatre under regional anaesthetic.
Whether you have stitches or not, the aftercare of your tear will be important in optimal recovery – this includes keeping the area as clean as possible (with regular bathing or showering), as well as changing maternity pads regularly.
If uncomfortable, you can use either an ice pack or soothing, natural products on the area, as well as taking regular pain relief. As soon as you feel able, it’s recommended to start pelvic floor exercises, to help strengthen your muscles and aid bladder control.
How do you prevent perineal tears?
While you cannot prevent a perineal tear from occurring during childbirth, practicing a simple technique called perineal massage has been found to reduce the extent and severity of perineal tearing.
Perineal massage can help to make the perineum more elastic, giving it the ability to stretch more easily during childbirth and therefore reducing your risk of tearing or your need for an episiotomy (a cut to the perineum, which may be recommended for medical reasons and should only be performed with your informed consent).
For the most successful results, it’s recommended to start perineal massage from 34 weeks’ pregnant, carrying it out three to four times a week, for around four minutes at a time, with a perineal massage oil.
Your guide to perineal massage
1. First, find a perineal massage oil. You can use one specially blended and designed for perineal massage, or an oil such as almond oil.
2. Wash your hands.
3. Sitting comfortably, bring your knees together and towards your chest, and then open your knees like a book. Or you may find it easier to put one foot on the toilet/bath/stool, in a similar way to how you might insert a tampon.
4. Put a small amount of the massage oil on your perineum, to make the massage more comfortable.
5. Using your thumbs, insert them into your vagina and then place your forefingers on the skin of your perineum.
6. You now need to stretch this skin gently, by pressing downwards towards your anus and to the sides, until you feel a slight burning, stretching sensation.
7. Hold the stretch for one to two minutes.
8. Then massage the area between your thumb and fingers, upwards and outwards and back again in a ‘U’ shape.
How to reduce your risk of perineal tears
Aside from perineal massage, other measures you can take to reduce your risk of tearing in childbirth include:
• Avoid active pushing or the ‘Valsalva’ manoeuvre
This is where you hold your breath and push during the ‘pushing’ stage of labour. Push only when you get the urge and avoid holding your breath. Hypnobirthing techniques are good to help you learn how to ‘breathe’ your baby down, especially as their head crowns.
• Give birth in any position other than on your back
Research shows that giving birth on your back or in lithotomy (legs up in stirrups) increases the risk of more severe tearing. Kneeling, squatting, all-fours position, standing or lying on your side are all good positions that facilitate birth and decrease perineal damage.
• Apply a compress
Ask your midwife about using a warm perineal compress, as research has shown that a warm swab or flannel applied to the perineum at the point where your baby’s head is crowning can help tissues to stretch and reduce perineal trauma. Applying warm compresses to your perineum during labour is also thought to dilate the blood vessels and hydrate the skin, reducing the risk of a tear.
• Slow and steady
When your baby’s head (or bottom, if breech) is birthed slowly and in a controlled manner, the perineum has a chance to gradually stretch, which reduces the risk of tearing.
Last updated: 11-08-2020
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