The perineum is a very important part of a woman's body and it plays a special role during childbirth. It is the area of skin and muscle found between the vagina and anus. During childbirth it stretches to allow the baby's head through. As the pregnancy advances, women may worry increasingly about the trauma and pain that might be experienced during birth. They wonder how something as big as a baby's head can really come out of what appears to be a relatively small hole! The good news is there are things you can do to reduce perineal trauma and pain during childbirth.
Perineal trauma is more likely when:
- Having your first baby.
- Having a forceps or vacuum birth.
- Having an episiotomy.
- Pushing the baby out very fast or pushing for several hours.
- Giving birth lying on your back, especially with legs in stirrups.
- The baby's head is in an abnormal position.
- The baby is very big.
Perineal trauma is less likely when:
- Having your second or subsequent baby.
- Giving birth lying on your side, kneeling or in an all-fours position.
- Perineal massage has been done antenatally.
- Your pelvic floor is relaxed.
- When you follow your own urge to push rather than being instructed to hold your breath and push.
Perfecting the perineum before and during pregnancy
A health life style
Making sure you have a healthy balanced diet is very important, both before and during pregnancy. This will keep your body in good condition and also help you to heal well if you do have a tear during the birth. Vitamins, such as Vitamin E and Zinc, are important for maximising the health of your skin. Regular exercise also helps maintain a healthy body. Not being overweight before you become pregnant, and making sure you don't gain too much weight when you are pregnant, means you are less likely to get gestational diabetes (pregnancy diabetes) and less likely to have a big baby.
Perineal massage (gentle stretching of the perineum with fingers) is a well-researched method that has been shown to help reduce perineal trauma. It does not guarantee, however, that you will not tear. Most women start perineal massage around 34 weeks of pregnancy and massage the perineum once or twice a day. Before you start make sure you won't be disturbed and you feel relaxed.
Perfecting the perineum during labour and birth
During the labour and birth, there are also things you can do to reduce the likelihood or severity of perineal tearing. Using warm water for pain relief, such as a warm bath or shower, can also help to soften the perineal tissues and make you more relaxed.
For many years, midwives have used moist, warm packs on the perineum when women are pushing to help reduce pain and tearing as the baby's head is born. We have just completed a large study and found that warm packs significantly reduced the pain women experienced when giving birth. There were also some other benefits, including a reduction in the most severe form of perineal tear and urinary incontinence at three months.
It is important during birth that the widest part of the baby's head is eased out slowly (crowning). Women are often encouraged to pant or blow through their mouths to slow the birth down and minimise tearing. Strong forceful pushing is discouraged.
The position in which you give birth, can affect the level of trauma and pain you might experience during the birth. Giving birth lying on your side or kneeling forwards seems to lead to the least mount of perineal trauma and pain. The worst possible position for perineal trauma is lying on your back with your legs apart, especially when stirrups are used.
Restricting the use of episiotomy leads to lower rates of perineal trauma and healing complications, and also lessens the need for suturing. This major surgical intervention should be used far less frequently than it is. Midwives are less likely to perform episiotomies compared to obstetricians.
Studies have also shown that good support in labour leads to less perineal trauma. Continuity of midwifery care, especially, reduces the incidence of episiotomies.