Your perineum before and after birth
It’s a part of your body you’ve probably never given a great deal of thought to, never mind worked out exactly where it is, but it will be affected by childbirth, so it pays to find out a bit more about it.
What is my perineum and where is it?
If you’re wondering exactly where it is, your perineum is the area between the vagina and the anus – and yes, it’s the bit that will be cut should you need an episiotomy. Even if you don’t need an episiotomy, it will stretch during childbirth and may tear (and this may require stitches). Prevention, as ever, is better than cure, and there are a few things you can do to minimise your chances of things going wrong (but do remember, none of these is guaranteed).
Preparing your perineum for childbirth
It’s a practice that’s been going on for centuries and there is some evidence that daily massage to the perineum in the 6-8 weeks before the birth can help to pre-stretch the area so that it’s more elastic on the day and therefore less likely to tear.
This can also be done in labour, but pre-stretching seems to be more beneficial. See our separate piece on perineal massage to find out exactly how to do it.
You can use lubricating jelly or a simple plant-based oil such as almond. There are also a few specialised oils available, so the choice is yours.
Perineal massage oils
• AromaMum Perineum Oil, £13.95 for 100ml, available from www.mumstuff.co.uk
• Green Baby Perineal Gel, £8 for 70g, available from www.greenbaby.co.uk
• Perineum and Bump massage oil spray, £12 for 150ml, available from www.yummymummymaternity.co.uk
• Zita West Preconditioning Down Under Oil, £16.50 for 100ml, available from www.zitawest.com
Consider your birth position There is evidence to show that certain positions, eg all fours, can help reduce the risk of tearing, so do chat to your midwife so that she can advise you. Also, check out this article on active birthing for more about these positions.
Much will depend on the position of your baby and how fast your labour is progressing – you are more likely to tear during a fast delivery so if things seem to be going at too cracking a pace, see what your midwife can do to help slow things down. You may also want to consider a water birth, as this has been shown to be gentle on the perineum.
Your perineum after giving birth
Even following a normal vaginal birth, your perineum will probably feel a little battered and bruised, unsurprising given the relative size of a baby’s head and your vagina. Some factors have the potential to make matters worse, eg, having a big baby, pushing for over an hour, using forceps, tearing and episiotomy.
Give your perineum some TLC and you should make a good recovery. If you’ve had stitches, either for a tear or an episiotomy, the wound itself will probably take up to 10 days to heal, although you still feel some pain for up to a month.
Your midwife will give advice on hygiene and how to ease the discomfort, plus painkillers (don’t scrimp on these, you won’t be prescribed anything that’s harmful when breastfeeding, and they really can help you feel more human).
Perineal recovery tips
- Change your maternity or sanitary pad - frequently, at least every four hours, and ensure it’s firmly in place.
- Pour warm water on your perineum as you wee - The water will dilute the urine so that it doesn’t sting.
- Keep maternity pads in the freezer - so they are cool and soothing when you put them on. You could also spray them with cooled witch hazel from the fridge.
- Don’t rub yourself dry - just dab as gently as you can.
- Do pelvic floor exercises - as soon as you can after the birth; you may not feel much at first, but it will increase blood circulation in the area and aid recovery (it will of course help with any incontinence problems you may be having).
- Apply a cooled gel pad - (available from chemist shops) intermittently for the first 12 to 24 hours. Avoid ice packs as you may get ice burn.
- Let the fresh air in - lie on the bed on an absorbent pad (the sort you use as a bed protector for toddlers is a good idea) or old towels and remove your sanitary pad and knickers.
- Take a bath - or a sitz bath (nether regions only) if you don’t feel like the full monty. Adding lavender essential oil may be soothing (dilute in milk first so it doesn’t just sit on top of the water. Don’t stay in the bath too long, tempting as this may be, as it will make the perineal tissues soggy.
- Try a ‘valley cushions’ - these are specially designed to ease pressure on your perineum when sitting. To find one, contact the National Childbirth Trust (NCT)
- Avoid standing - or sitting for too long at a time.
- If the pain persists - or you start to get a fever, contact your midwife or GP at once, as you may have an infection, and need antibiotics.