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 or read 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 wellbeing.
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 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 muscle layers. During childbirth the perineal skin and the muscles below it stretch to make room for your baby to be delivered. Quite often 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 performed in emergency situations such as the need for a ventouse or forceps delivery. 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 you may need to go to theatre for stitches.
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 more recent information and education around benefits and techniques of perineal massage.
SO 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 are 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. This maintains elasticity in perineal skin keeping it supple and flexible, allowing the skin to easily stretch during birth.
PERINEAL MASSAGE
Is best performed after a warm bath or shower.
Performed 3-4 times a week
Duration 5-10 minute
Use a natural, fragrance free, plant based oil
Continue reading for full instructions on How to Perform Perineal Massage in preparation of birth
POST VAGINAL BIRTH PERINEAL CARE
Following childbirth most women will experience some form of discomfort regardless of if stitches were required or not. Your midwife may look at your perineum during her visits if you've had stitches to make sure everything is healing well and that there is no signs of infection.
Below are my top 7 self help tips to guide you through way you can ease some of these discomforts. However it is important to note that if you feel that your pain isn't settling or that it is increasing over time please seek help and advice from your midwife or GP.
TOP 7 SELF HELP TIPS
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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 bottle upside down and spray tender area.
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Keep perineum clean and dry. Bath or shower daily and change sanitary pads regularly.
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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 sunflower or olive 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.
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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.
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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.
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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.
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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. Now here's the full instruction sheet on how to perform perineal massage in preparation for childbirth.
PERINEAL MASSAGE INSTRUCTIONS
From 34 weeks pregnant, start a 5-10 minute perineal massage session 2-4 times a week. Best performed after a warm bath or shower.
Before you start:
Make sure your bladder is empty.
Use clean washed hands with short trimmed nails.
Get comfortable, prop yourself upright with a pillow to support your back. With your legs bent and feet apart.
Place a soft towel under your bottom.
Have a mirror at hand if you want to see better (optional)
Use a warm compress (a soft warmed washcloth) on your perineum or alternatively have a warm bath to soften skin tissues.
DO NOT perform perineal massage if you have a vaginal infection such as thrush or vaginal herpes
Follow these steps:
When you're ready, apply perineal massage oil to your perineum (the skin between your vagina and bottom) and massage paying special attention to any previous scar tissue.
Place one or both thumbs inside the vagina and press down towards your rectum (bottom). Apply gentle pressure on your perineum for around 60 seconds then move your thumbs up and outwards in a 'U' type movement. Continue with gentle pressure for 60 seconds or until the tingling sensation stops.
Apply more oil if required and massage the perineal skin tissues between your thumb and forefinger in a sweeping motion from left to right for about 3-4 minutes.
Repeat the above steps.
You should feel a tingling or slight burning sensation as the muscles are stretched. This is a similar feeling when the baby's head is crowning. Perineal massage should not be painful. If you experience pain stop, try more gentle pressure or discontinue. Being too vigorous can result in bruising and swelling of the tissues.
If you are unable to reach comfortably you may wish to try an alternative position such as standing with one foot on a stool or chair. Alternatively you could get your partner to perform the massage but instead of using their thumbs use 1-2 index fingers and follow the above steps.
*WHA 2007
**New Zealand Maternity Clinical Indicators 2016
*** Beckmann and Garrett 2006