As a midwife I’ve spent my career supporting women and teaching them the importance of on-going self care to underpin physical and emotional well-being and sexual health.
I’m sure you've heard how important maintaining your pelvic floor is and that performing pelvic floor exercises are vital; not only during pregnancy and after birth but a life long routine to continue in order to help prevent bladder leakage when you cough, sneeze or run.
Perhaps until you were pregnant or reading this you never knew you had a perineum, let alone why it's there or how to care for it during pregnancy and following childbirth.
Hopefully by the end of this blog you’ll have gained some insight into your perineum and how you can care, prepare and soothe during and after pregnancy. Read how, why and when to start performing perineal massage in preparation for childbirth and some self-help strategies you can implement following the birth of your baby to soothe any swelling and bruising and support the healing process.
FIRSTLY - WHAT IS A PERINEUM?
It’s the soft area of skin between your vagina and bottom (anus). It’s made up of layers of skin and muscles that support your pelvic floor and other internal organs. During childbirth the perineal skin and the muscles below it stretch to make room for your baby to be delivered. Sometimes the perineal skin and muscles are damaged or torn during a vaginal birth as your baby's head and shoulders are delivered. This can be more common in first time mums but not always so. Sometimes the perineum has to be cut (this is called an episiotomy) to allow some extra space or is performed in emergency situations.
In most cases, a perineal tear or episiotomy is relatively straightforward to repair and will be performed by your midwife or lead maternity carer (LMC). However sometimes the tear is more complex and may need you to go to theatre where there is stronger pain relief and better lighting.
It is not always possible to predict if perineal tears will occur but research in 2007* showed that 60-85% of women had some degree of perineal damage. However since 2009 ** there has been a significant reduction in these figures. This could be attributed to new information and education around education, benefits and techniques on perineal massage.
PREPARE YOUR PERINEUM FOR BIRTH !
Like most other part of the body, the three key elements to maintaining healthy skin tissue and muscle is by having a good balanced diet. Adequate fluid intake and regular exercise.
The addition of perineal massage from 34 weeks pregnant is said to reduce the occurrence of perineal tears or need for episiotomy by 16-20% ***. Perineal massage is also said to significantly reduce the perineal pain experienced three months post birth.
WHAT IS PERINEAL MASSAGE ? It’s exactly that!
Massaging the perineal skin between your vagina and bottom. This helps to improve the elasticity and flexibility of perineal skin, allowing the skin to stretch more easily during childbirth.
WHEN TO START PERINEAL MASSAGE
- From 34 or 35 weeks of pregnancy
- Performed 2-4 times a week (there is no research that more is better)
- Is best performed after a warm bath or shower.
- For a duration of 3- 5 minutes
- Using a natural plant based oil
Use the following link for full instructions on how to perform perineal massage.
PERINEAL CARE - Following a vaginal birth
Following childbirth most women will experience some form of discomfort regardless of whether stitches are required or not. If you have had stitches, your midwife may look at your perineum during her visits to make sure everything is healing well and that there is no signs of infection.
There are several things you can do to assist healing and ease some of the postpartum discomforts. Below are my top 7 self help tips to guide you through the first few days and weeks. However it is important to note that if you feel pain isn't settling or that swelling and/or pain is increasing please seek help and advice from your midwife or GP.
TOP 7 SELF HELP TIPS
- Use a postpartum, witch hazel RELIEF spray. This spray is designed to soothe, calm and reduce the discomforts of birth. Safe to use in the hours and days post birth (even if you have had stitches) it helps to soothe your bruised or swollen perineum and support the healing process. Application is easy with our ready to use, clever inverted bottle system, simply turn the bottle upside down and spray the tender area as required.
- Keep the perineum clean. Bath or shower daily and change sanitary pads often.
- Try applying a compress of chamomile or lavender hydrosol. Alternatively mix a few drops of chamomile, lavender or geranium essential oil to 1 tbsp of oil you can use leftover perineal massage oil and add to your bath. It’s important to note that you never apply undiluted essential oils directly onto the skin or directly into your bath as they sit on the water surface and can burn the skin.
- Ice packs can also be very useful, ALWAYS wrap them in a towel to avoid burns to your skin. Make sure to not use them for more than 1 hour consecutively, as this can reduce the blood supply and slow the healing process.
- Start your pelvic floor exercises as soon after delivery as you can, this will help to improve blood flow to the skin and muscles in the perineal area and promote healing.
- Although it may be tempting, whilst sitting for breastfeeding, avoid sitting on a ring pillow. These can increase swelling and pressure preventing healing. If you’re finding it very uncomfortable try feeding lying down on your side. Need breastfeeding tips? Then head to our breast feeding 101 blog page?
- Drink plenty of water and eat a good balanced diet, including fruit and veggies. This will help reduce constipation and the need for straining when on the toilet.
Hopefully you’ve learnt a little more about your perineum and how you can prepare and care for it during the last few weeks of pregnancy and following childbirth.
*WHA 2007**New Zealand Maternity Clinical Indicators 2016.
*** Beckmann and Garrett 2006