Perhaps until you were pregnant you’d never heard of a perineum, let alone know how important it is during pregnancy and childbirth. However I’m sure you’ve heard about how important your pelvic floor muscles are and how important it is to do your pelvic floor exercises after the birth of your baby to prevent bladder leakage when you cough, sneeze or run later in life. As a midwife I’ve spent my career supporting women and teaching them the importance of self care for their ongoing, short and long term physical and emotional well-being.
Hopefully by the end of this blog you’ll know a little more about your perineum and how you can look after it during and after pregnancy. I’ll discuss what you can do to prepare your perineum for childbirth and what you can do after your baby is born to soothe and help healing. Firstly we need to know a few basics.
WHAT IS A PERINEUM?
It’s the soft area of skin between your vagina and bottom. It’s made up of skin and muscles. 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 call an episiotomy) to allow some extra space or is performed in emergency situations. In most cases repair of a perineal tear or episiotomy is relatively straightforward and will be performed by your midwife or lead maternity carer (LMC). However sometimes the tear is more complex and may need you go to theatre for repair.
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 reasons, benefits and techniques on perineal massage.
WHAT CAN YOU DO TO HELP PREPARE YOUR PERINEUM FOR BIRTH?
Like most other part of the body, the three key elements to maintaining healthy skin tissue and muscles is having a good balanced diet, adequate fluid intake and regular exercise. However 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 perineal pain experienced at 3 months post birth.
So what is perineal massage? It’s exactly that! Massaging of the perineal skin regularly from 34 weeks of your pregnancy; makes the perineal skin more supple and flexible, allowing the skin to stretch easily.
- Is best performed after a warm bath or shower.
- Performed 2-4 times a week
- For a duration of 5-10 minutes
- Using a natural plant based oil
Use the following link for full instructions on how to perform perineal massage.
POST VAGINAL BIRTH PERINEAL CARE
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 discomfort. Below are my top 7 self help tips to guide you through the first few weeks. However it is important that if you feel the pain isn't settling or that it is increasing please seek help and advice from your midwife or GP.
TOP 7 SELF HELP TIPS
- Use perineal RELIEF spray as required. This spray is designed to soothe, calm and reduce perineal swelling and assist the healing process. Easy to apply with a clever inverted bottle system, simply turn the bottle upside down and spray the tender area.
- Keep the perineum clean. Bath or shower daily and change sanitary pads regularly.
- 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 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?
- Drink plenty of water and eating 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