During vaginal birth, around 9 out of 10 first time mums and 7 out of 10 mums having subsequent births will have some type of damage to their perineum.
The perineum is the skin and muscular area between your vagina and anus (your back passage) which stretches during childbirth.
Some of the risks of having a tear are predetermined by genetics, the position of your baby during birth and the position you are in when you give birth.
Here are some things you can do to reduce the extent of tearing in childbirth.
- Avoid active pushing or the ‘Valsalva’ manoeuvre, where you hold your breath and push during the pushing stage of labour. Push 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. Upright positions are advisable but, if you are on the bed, lying on your left or right side are good positions, too.
- Practice a simple technique called perineal massage which has been clinically proven to help make the perineum more elastic and to stretch better during childbirth, therefore reducing your risk of tearing and the 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).
You may want to discuss perineal massage with your midwife, but below is a simple guide to help you.
How to do Perineal Massage
It is recommended to start perineal massage from 34 weeks pregnant, doing it three to four times a week, for around three or four minutes at a time.
Here is a guide to doing perineal massage:
- First find a perineal massage oil. You can use one specially blended and designed for perineal massage or an oil such as almond oil.
- Wash your hands.
- Sit 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 would insert a tampon.
- Put a small amount of the massage oil on your perineum to make the massage more comfortable.
- Using your thumbs, insert them into your vagina and then place your forefingers on the skin of your perineum.
- 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
- Hold the stretch for 1 to 2 minutes.
- Then massage the area between your thumb and fingers upwards and outwards and back again in a “U” shape.
As your pregnancy progresses you may find it easier to invite your partner to perform this for you. Perineal massage should not be painful, and, with time and practice, it will become effortless.
Partners and Perineal Massage
- Make preparations to be as comfortable and relaxed as possible. This may mean adapting your environment such as dimming lights, adding pillows and cushions for support.
- Explain in as much detail as possible to your partner prior to this about perineal massage. This will help them to understand the method required, why you are doing it and how often it needs to be done.
- The easiest position for a partner to perform perineal massage is probably in a semi upright position-as the diagram demonstrates- on a bed or sofa. However, it is fine to experiment with other positions, such as lying on your left or right side.
- Your partner will probably find it easiest to use their fingers rather than their thumbs, but again it is fine to try both to see what works best for you.
- Once comfortable, apply some perineal massage oil on the patch of skin between your vagina and anus. Using both hands, your partner should gently insert their index finger and middle finger on either side into the vagina, up to about the 2nd knuckle (try starting with just the index finger of each side if you don’t find this comfortable to start with).
- Using the same method as demonstrated above, they need to move their fingers in a ‘U’ shape for a few minutes, whilst you guide them as to what feels comfortable and when to start and stop.
Perineal massage is best avoided if you have a known vaginal infection, thrush or genital herpes.
Here is an animated video demonstrating how to do perineal massage
Perineal massage, when undertaken from 34 -35 weeks, has been proven by research to reduce the extent of deep and superficial perineal tearing, particularly in women having their first vaginal births. It has also been shown to reduce the amount of discomfort felt by women who are having a second or subsequent baby 3 months after their birth.