“But natural childbirth damages the perineum!”
For many women, this is a cry to go and book that C-section. For me, it signals the need for midwives to step forward once again and provide accurate and unbiased information – and a big dose of encouragement – for these misinformed and understandably anxious women.
Firstly, moms need the facts. Yes, perineal tears can occur during vaginal delivery, but the more natural the birth, and the better the perineal preparation, the less likely this is. Also, any perineal tearing in a physiologically-true birth is usually not serious. Less well-known is the fact that the likelihood of perineal tears and ongoing perineal pain after giving birth can be reduced through regular perineal massages during the final weeks of pregnancy.
Perineal massage is a simple do-it-yourself antenatal procedure which is particularly effective for first-time vaginal births. It can be a bit tricky to teach moms and, if they can’t reach the area, they may need to ask their partner for a hand. However, the benefits far outweigh any inconvenience! Perineal massage should be avoided if moms have vaginal thrush or any other vaginal infection; otherwise, moms can start massaging about five times a week from 34 weeks.
You should explain to expectant women that they should:
- Wash their hands and pour some good quality perineal massage or almond oil onto their fingertips
- Get into a comfortable position, lying on their backs or standing with one foot on a chair
- Place their thumbs into their vaginal outlet and massage the perineum between their index finger, middle finger, and thumbs for a few minutes until the perineum feels softer
- Keep their thumbs in position and stretch the vaginal outlet sideways, downwards, and slightly forwards a few times
- If you’re an antenatal teacher, advise mothers to do perineal stretch exercises, by sitting on the floor with their buttocks against the wall, backs straight, shoulders relaxed, knees bent, and the soles of their feet together. Instruct moms to then push their knees up and down a few times like butterfly wings.
During birth, it usually falls to you, the midwife to help protect the perineum. You can do this by:
- Advising moms against unnecessary episiotomies, as these hurt more and heal more slowly
- Ensuring labour hormones are supported so that there are increased vaginal secretions and blood flow
- Avoiding intravenous over-hydration, because vaginal tissue swelling reduces elasticity
- Avoiding unnecessary pelvic examinations, as vaginal protective mechanisms may cause the vaginal muscles to contract
- Encouraging moms to birth in an upright position so that Baby’s head helps to stretch the perineum
- Never forcing moms to push, even if they are fully dilated
- Encouraging moms to only give small pushes when the head is crowning, to allow the perineum to stretch and adapt