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Protecting Your Perineum

We all want a whole and healthy body.

By Sam The Doula (Blooming Miracle)Published about a year ago 8 min read
Protecting Your Perineum
Photo by Nik on Unsplash

"Will I tear during labour?"

This is such a worry for so many pregnant women. I believe almost all first time mums have this concern: what is going to happen to my vag??

I am going to address this for you as thoroughly as I can.

There are lots of things you can do to protect your perineum during the birth of your baby, and hopefully🤞🤞 avoid (or at least minimise) any need for stitches! This knowledge will give you confidence and help you to relax when you most need to. This alone will also help.

First of all let me reassure you:

  1. Yes you CAN birth over an intact perineum! YES, including if you have never had a baby before 👍 I sincerely believe this is totally possible for lots and lots of women!
  2. MOST physical trauma that happens is mild, not felt as it happens, and usually repaired easily. Often, it doesn't even need a repair - often it is only a graze. The tissue in that area is very resilient - it expects a baby to pass through, remember - and is extremely likely to heal well.
  3. YES, your vagina can and will go back to normal. There are times when it doesn't, and if this happens PLEASE do seek support to get this sorted out! But it is like how SOMETIMES people break their leg when they fall down the stairs. It is a serious incident that requires medical attention, not a normal outcome that you can expect.

I'm going to be sharing with you TEN things you can do - antenatally and during birth - to help support and protect your vagina and keep it comfortable and healthy. These are all simple things almost every mum can do.

How can I prevent tearing in labour?

#1 TOUCH YOUR BABY'S HEAD DURING CROWINING.

I believe this could be the number one thing to help protect your perineum and prevent tears. I discussed this in more detail in another post.

#2: RELAX THE JAW

Some women look at me like I've sprouted an extra head the first time I say it, as if the idea that your jaw and pelvis are connected is a bunch of woo. Stay with me! I promise it makes sense.

First, consider that there are panty liners and underwear marketed at women who pee when they sneeze. (This is not normal and in my opinion those women should be offered physiotherapy to address this, as is normal in other parts of Europe.)

Next, pay close attention to your pelvic floor. Clench your jaw and feel what happens. Do you notice it?

Okay, relax for a second.... take a few breaths and soften those muscles again.

Next, try a little high pitched scream. How does that feel? Loose or tight?

So....

Relax the jaw to release the pelvic floor.

This is a mantra repeated OFTEN during my weekly antental classes. Every week, I have mums practising this with breathing techniques and linking it to muscle memory so it will be remembered when most needed.

Give it a go - blow out slowly and softly through a relaxed jaw. If you need to vocalise, keep that pitch lowwwwww and sensual.

I once read somewhere that cats purr through labour, and it stuck with me. Try it - purr. Sighhhhhhhh and groan with a loose jaw. It'll help you open.

#3: CLOSE YOUR LEGS

I know, right? It sounds counter intuitive. Surely I need to open my legs to give my baby room to emerge?

Nope. A natural width in all fours position (roughly hip width) is usually ample for your baby to pass through.

Widely spread legs puts stress on your perineum and greatly increases the chance of tearing.

Think of it this way: a hammock stretched taut between two widely spaced trees has no give in it. Plant those trees close together and the fabric has lots of slack. Your perineum is the "fabric" - we want it to have lots of slack as your baby's head is about to emerge.

So when you feel that tell tale tingle, the stinging sensation that tells you you are opening slowly for your baby: plant those trees close together.

Plant your trees close together

#4: RAISE YOUR ARMS

Raised arms is another thing we practise in my weekly antenatal classes. I encourage everyone to visualise using this simple motion in labour, to shift the weight of their baby's head, and help the perineum stay intact.

Did you know this?

#5: ENCOURAGE OPTIMAL FOETAL POSITION

This is a core element for us every week, because it can positively impact you in other ways, even if you've had babies before, or are planning a caesarean birth.

A baby in a good position can usually be born much more easily than one in a poor position. The general rule is this:

The better their position, the smoother the birth.

We do this primarily by gently aligning the body, bringing balance through release, and creating space for your baby to move. I am confident that babies will usually move if they need to, provided they can.

I know some mums are concerned about their baby's size, but truthfully, some ten pounders shoot out on rails and barely leave a graze, and little 6 or 7 pound babies can have a trickier time being born, and their mum needs some stitches. Size really is not everything. It's not something you can control - but you can influence your baby's position.

Of course, there are no guarantees! A well positioned baby can become wonky in labour, and vice versa. I have gone into a bit more detail on this in another post. This approach is benign, and the movements are ones that you can take with you into labour, when it will really count.

Do you know what position your baby was in when they were born?

#6: LISTEN TO YOUR BODY

Another thing I say every week! If I got a pound for every time I said this in the last decade, surely I'd be a millionaire by now.

Keep in mind that pain is communication - often it is telling us to move! Retain freedom of movement if you possibly can, and move as your body prompts you.

Pain is communication. Often, it's telling us to move.

When the time comes, begin by pushing when you feel you need to, and only as much as you feel you need to.

As your baby descends, pay close attention to what you feel. You might feel a tingling, burning sensation, or something that feels a little like pins and needles. This is your tissues expanding to accommodate your baby. It's totally normal - it's your body reminding you to plant those trees close together (see #3) - ensure plenty of slack in the hammock

#7: BIRTH IN WATER

Lots of mums have found the pushing phase easier and gentler in water. It soothes the crowning sensation, helps you to relax, and can help reduce the need for stitches.

Is this something you've tried or considered? Were you supported to do this?

#8: DIET

Protect your skin from the inside!

Getting the right nutrients and staying hydrated will help ensure good elasticity of the skin. Vitamin E is important for this.

There's some evidence to show that eating dates can be helpful. A couple of studies have shown that mums who ate dates for the last few weeks of their pregnancy were more dilated on admission with higher bishop's scores, more likely to have intact membranes, had a lower chance of needing a caesarean or ventouse, and a shorter second stage.

Sounds like medically indicated sticky toffee pudding to me 😋

#9 GIVE BIRTH IN A RELAXED ENVIRONMENT

(Brace yourself, because I am going to talk about penis.)

Ina May Gaskin reminds us that all genitalia swells and gets bigger to do a job, and then shrinks back to normal afterwards. Our vaginas are no different in this respect, except that the men's trick is a tuppeny ha'penny one, and ours is more Olympian. 💪

Consider the environment a man usually needs to achieve an erection. It's such a little thing (stop it 🤪) but as paltry as it is, can he manage it strapped to a hospital bed, legs in stirrups, being measured periodically for progress? Aside from some pretty spectacularly niche kinks, I would say, no, he would probably experience "failure to progress" in that situation (which I am sure would do absolute wonders for his self esteem).

People sometimes talk about "being able to relax" as a frivolous nicety we bestow on birthing women; a crumb to make their task a smidge more bearable.

This is absolutely wrong. Being able to relax is essential for birth to unfold normally, and for the mother to emerge as healthy and comfortable as possible - which is no less than your right as far as I am concerned.

So, make it COSY 👍

#10: ANTENATAL PERINEUM MASSAGE

I've left this until last, because I don't set a lot of store by it. I question how effective it is likely to be if all the other ways to protect your perineum are used. I suspect those are the things that really count. That's just my opinion - your experience might be different!

Actually reaching down there to do it can be a bit awkward in later pregnancy, as well.

Research has shown that it does have some small benefit for mothers birthing vaginally for the first time (so, first time mums and VBAC mums). For mothers who have given birth vaginally before, the effect is most likely to be negligible at best in most cases.

But if this is something you want to try, we incorporate a gentle stretch each week which has the same effect - no olive oil coated thumbs, or twisting yourself in knots required!

"But seriously, tho.... What if i tear anyway?"

Here comes the kicker: sometimes, you can tick all the boxes, do all the "right" things - and still, things don't go as smoothly as we hope and expect.

If this happens, remember:

  • You won't feel it in the moment
  • Repair is normally very straightforward
  • Remember the tissues in that area are predisposed to be resilient and heal well

Be kind to yourself. We can twist ourselves in knots, sometimes, thinking, I could have done that, or I should have done more.

Remember that every body is different - some are more prone to stretch marks than others, for example. I know mums who didn't take any special steps to avoid them, and didn't get any, or only got one or two small ones. And others who slathered oils and creams on their tummies and took supplements and drank gallons of water.... and they got loads!

In Conclusion

I hope I've given you some tips that you've found interesting and accessible. I know that by applying them, you'll be stacking the odds in your favour, getting your ducks in a row. There are no guarantees, but you're giving yourself the best chance of the best outcome - and it's really likely that things really will be okay.

What do you think?

Will you try any of these?

If you've already had your baby, what was your experience?

If you aren't a Vocal member come and find me on Facebook.

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NB. I originally wrote this as a series of posts on social media. Some minor edits have been made.

pregnancyparents

About the Creator

Sam The Doula (Blooming Miracle)

Childbirth Eductator since 2011

Building a resource for mothers-to-be to feel informed and confident about their choices

You can find me on Facebook or book classes with me

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Comments (1)

  • Test10 months ago

    This was an incredibly well-written piece

Sam The Doula (Blooming Miracle)Written by Sam The Doula (Blooming Miracle)

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