Your Perineum: Not As Obscure As You Might Think

The perineum is the area of skin and muscle found between the vagina and anus.

During pregnancy and childbirth, this area undergoes a certain degree of tension and trauma. It plays a role in childbirth and makes it possible for a baby’s head to emerge from the relatively small opening of the vagina.

During childbirth, the perineum stretches as the baby’s head goes through the birth canal. It is at this point that the area experiences tension and trauma.

Perineal Trauma

Perineal trauma can be categorized into different types. They are grazes, which are the mildest forms of trauma, followed by first, second, third and fourth degree tears.

• A graze is a shallow injury (skin split) on the perineum that may heal easily on its own. It may sting each time you pass urine after birth. You can reduce the sting by squirting warm water onto the injuries while you urine. You can also try taking an urine alkaliniser such as Ural which may help reduce the acidity of your urine and in turn, reduce the sting.
• A first degree tear is a small tear in the perineum and only involves the skin. These types of tears also rarely require stitches. A second degree tear, however, involves the skin and some of the muscles in the perineum and these need to be stitched up for them to heal properly.
• The most severe tears are third and fourth degree tears and they are quite rare during childbirth. Third degree tears are similar to second degree ones but they also involve the anus. If the tear goes through the anus into the rectum however, then it is referred to as a fourth degree tear.

An inevitable part of natural birth

Women throughout the ages have been experiencing perineal trauma and have survived through them. It is part and parcel of giving birth vaginally. The difference is essentially, the degree of trauma and how long it takes to heal, especially if a tear or an episiotomy is involved.

What causes perineal tears?

A few factors have been identified as causes for perineal injury (tears) and they are:

• Having a forceps or vacuum birth
• Either pushing the baby out forcefully, very fast or taking several hours
• Giving birth lying on your back, especially with legs in stirrups
• The baby’s head is in an abnormal position
• The baby is very big

Perineum care during pregnancy

It is possible to reduce trauma to the perineum. One factor to look into is your overall health so that you will heal well. Hence, a healthy, balanced diet with all the essential body-healing nutrients such as proteins, vitamins and minerals are important. Regular exercise also helps maintain a healthy body which tends to recover faster from any minor situations.

Perineal massage

This is one of the best researched methods of reducing perineal trauma. It does not guarantee, however, that you will not experience a tear.

Researches on perineal massages done during pregnancy showed women could indeed reduce the chances of perineal tears and even episiotomies.

You can either carry out a perineal massage by yourself or you can engage a partner to help you. Around thirty four weeks gestation would be a good time to begin. Start with twice a day massages.

Perineal injury facts:

• The chances of tearing is generally higher when giving birth to your first baby.
• Women who choose to give birth in certain positions such as while lying on one side or while kneeling on all fours might escape tears in the perineum.
• Perineum massages during pregnancy has been known to help reduce the chances of perineal injury.
• Relaxing one’s pelvic floor during childbirth (something that can be learned through some natural birthing classes such as hypnobirthing classes) may reduce the chances of perineal tearing.