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Childbirth Perineum Tearing & Massage

Childbirth Perineum Tearing & Massage
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According to the HSE about 40% to 85% of all women who give birth vaginally will experience perineum tearing with two thirds of these women needing stitches. Your perineum is the area between your vaginal opening and your rectum. This area stretches a lot during childbirth, and sometimes it tears. If your health care provider performs an episiotomy during birth, it is this area that is cut. Perineal massage during the late stage of pregnancy can be to prepare the perineum for delivery. It loosens the tight perineal muscles, which softens and flexes the birth canal.

Follow these steps to massage your perineum:

  • Get comfortable.
  • Place a thumb inside your vagina, against the back wall.
  • Rest your forefinger on your bottom.
  • Press down a little towards your rectum
  • Gently massage by moving your thumb and forefinger together in a “U” shape, inside your vagina.
  • You should feel a stretching sensation. This should not be uncomfortable or painful.
  • Aim to do this for 5 minutes.

Do not do perineal massage if you have:

  • Genital herpes
  • Thrush
  • Bacterial vaginosis

Preventing a perineal tear:

  • A midwife can help you avoid a tear during labour when the baby's head becomes visible.
  • The midwife will ask you to stop pushing and to take a couple of quick short breaths, blowing out through your mouth.
  • This is so your baby's head can emerge slowly and gently, giving the skin and muscles of the perineum time to stretch without tearing.
  • The skin of the perineum may tear in women who are giving birth for the first time.
  • Massaging the perineum in the last few weeks of pregnancy can reduce the chances of having an episiotomy during birth.

Types of tears that may occur:

  • First degree tears are small skin-deep tears which usually heal naturally
  • Second degree tears are deeper tears affecting the muscles of the perineum as well as the skin. These usually require stitches.
  • Third degree tears extend downwards from the vagina and perineum to the anal sphincter, the muscle that controls the anus.
  • Fourth degree tears extend to the anal canal as well as the rectum (further into the anus).

Treatment to repair your tear:

  • Antibiotics will help decrease the risk of infection because the stitches are very close to the anus.
  • You will be offered pain-relieving drugs such as paracetamol, ibuprofen, or diclofenac to relieve any pain.
  • You will be prescribed laxatives to make it easier and more comfortable to open your bowels.
  • You may have a catheter in your bladder to collect urine until you feel able to walk to the toilet.
  • You will need to strengthen the muscles of the perineum/pelvic floor to prevent possible problems with bowel control.

Ways to help your body after a tear:

  • Keep the area clean. Bathe at least once a day and change your maternity pads regularly.
  • Regular handwashing before, as well as after using the toilet will reduce the risk of infection.
  • Drink 2-3 litres of water every day and eat a healthy, balanced high-fibre diet.
  • Avoid heavy lifting, pushing, or pulling while allowing the perineum to heal.
  • An ice pack may be helpful if your perineum is bruised and/or swollen. Wrap a small ice pack in a damp cloth and apply for ten minutes every few hours.
  • You can take the pressure off the perineum by sitting on two rolled up towels placed parallel to each other under your sit bones to take pressure off the perineum.
  • Lying with a wedge pillow under the lower back can also help to raise the perineum and assist in decreasing the swelling.
  • Pelvic floor exercises can be started as soon as your catheter has been removed. These exercises help increase the circulation of blood to the area and aid the healing process.

What is an Episiotomy?

Sometimes a doctor or midwife may need to make a cut in the area between the vagina and anus (perineum) during childbirth. This is called an episiotomy. An episiotomy makes the opening of the vagina a bit wider, allowing the baby to come through it more easily. In some births, an episiotomy can help to prevent a severe tear or speed up delivery if the baby needs to be born quickly. If your doctor or midwife feels you need an episiotomy when you're in labour, they will discuss this with you.

Why might you need an episiotomy?

  • If your baby develops a condition known as foetal distress, where the baby's heart rate gets faster or slower before birth.
  • When it is necessary to widen your vagina so instruments, such as forceps or ventose suction, can be used to help with the birth.
  • If you're having a breech birth, where the baby is being born with their bottom or feet first
  • When you have been trying to give birth for several hours and are now tired after pushing
  • If you have a serious health condition, such as heart disease and it's recommended that delivery should be as quick as possible to reduce further health risks

How an episiotomy is done:

  • A local anaesthetic is used to numb the area around the vagina, so you do not feel any pain.
  • If you have already had an epidural, the dose can be topped up before the cut is made.
  • Whenever possible, the doctor or midwife will make a small diagonal cut from the back of the vagina, directed down and out to one side.
  • The cut is stitched together using dissolvable stitches after the birth.

Recovering from an episiotomy:

Episiotomy cuts are usually repaired within an hour of your baby's birth. The cut may bleed quite a lot at first, but this should stop with pressure and stitches. Stitches should heal within 1 month of the birth. Talk to your midwife or obstetrician about which activities you should avoid during the healing period.

Perineal Massage in Pregnancy.doc (hse.ie)
Preparing your body for labour and birth - HSE.ie
Episiotomy and perineal tears - NHS (www.nhs.uk)
About Perineal Massager: A Guide for 2022 | Perimom Perineal Massager
Draft: Irish Guidelines for Management of Obstetric Anal Sphincter Injury 2011 (hse.ie)