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How to Protect Your Perineum & Why It’s Important to Start NOW

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Great idea! I like protection! But what’s my perineum?

Your perineum, also known as “the pelvic floor”, consists of two layers of muscles that are interwoven. They basically enclose the bottom of the pelvis. These muscles form a sort of hammock (I’ve also heard it referred to as a trampoline) for some pretty essential internal organs of yours: the bladder, uterus and rectum.

Where is it?

Your perineum is located just under your vagina and just above your anus (see below).

Why do I need to protect it?

During any type of vaginal birth (medicated or unmedicated) there is a risk of tearing your perineum. In the birthing world the severity of these tears are called (1st degree, 2nd degree, 3rd degree, 4th degree). Tears can occur because of you pushing or can occur due to an episiotomy (when the perineum is cut by your provider). The more severe the tear (3rd and 4th) the greater issues you could have with urinary and fecal incontinence, which can impact you in the future.

Episiotomies- We definitely need to talk about these. These are a BIG DEAL. Instead of you naturally tearing, this is when your provider makes a surgical cut widening the vagina so baby can get out easier. Evidence based care does not support routine use of episiotomies. We’re most definitely not telling you that you may never need one, because we’re most def not your provider. The overwhelming evidence from the medical community says routine use is not beneficial to you. In fact, it may be harmful.

One of the major concerns is that episiotomies weaken the perineum and actually cause you to tear more than you would without one. Think about a sheet that you want in two pieces, you cut with scissors and then can easily tear the rest (since the fabric has been weakened by the cut). Yet there are providers who still routinely cut women when No Medical Need exists. This goes against the Medical Evidence {and there are women who let this happen}.

Doesn’t that sound like a BIG DEAL? Especially when you could be the affected one for years to come. Ask your provider questions on this.

*It’s important you understand how Evidence Based Care talks about “routine use”. Episiotomies can be important interventions when time is of the essence & baby needs to get out now. The point is, some providers use episiotomies without any time critical occurrence happening. 

And there will always be “pressure down there”, that’s just the way it works. So when you ask questions, it’s been suggested by multiple Ob/Gyns that you’re specific by asking “what specific circumstances do you think Episiotomies are necessary? Why?” as opposed to accepting an ambiguous answer from a provider like “sometimes they are necessary.” Well WHEN are they necessary? If your provider doesn’t/can’t give you a straight forward & clear answer, that’s red flag city.

For example- we grilled a well-respected Ob/Gyn about Protecting the Perineum & Episiotomies… she said “I have not seen a 3rd or 4th degree tear since I have been out of residency. I only do an episiotomy if there is a crisis requiring immediate delivery with a vacuum, maybe once a year.

We’ve talked with women who never knew they were cut (their provider decided themselves it wasn’t important to bring up) & some who said they didn’t want an episiotomy & were cut anyways. This isn’t something to freak out about.

It’s something to learn about, talk over with your provider & be very intentional about what YOU want. Especially if the provider who catches your baby isn’t your primary provider (i.e. the provider on call)…be crystal clear what YOU want.

This is when a Doula can be so helpful. They can be your assertive sidekicks! Check out this study that looked at women from 1950-2004 from Center for Women’s Health Research at University of North Carolina… Evidence here

What can be done to protect the perineum?

  • Massage is one way you can protect your perineum. Particularly for first time mamas, it’s helpful to start doing the massage at about 35 weeks, every day. Evidence here

  • Warm compresses (during labor) can be used on your perineum to help it limber up, by increasing circulation to the area which aids in stretching & helps provide some pain relief. 
  • Going easy on the pushing. Breathing, talking, singing WHILE pushing disengages your diaphragm and makes your pushes less powerful so you can warm up your perineum. This isn’t hokie-pokey stuff, it works. 
  • Giving birth in an upright position (using gravity to bring baby down) may mean that you don’t have to push with as much oomph. 
  •  Water Births are another way to protect the perineum for the same reasons that warm compresses are- the warm water soothes the perineum 
  • Doctors & Midwives usually help you protect your perineum differently & have differing rates of episiotomies. Ask what they are & expect care consistent with those rates. 
  • Giving birth on your side has also been shown to result in less tearing.

 Here is evidence from University of British Colombia about protecting your perineum.

Perineal Massage 101

1. Wash your hands (make sure you don‘t have any sharp, long nails. Ouch.)

2. Get some cold pressed oil (like olive oil)

3. Locate your perineum/ your central tendon of the perineum-the area above your anus and below your vaginal opening, apply some oil there. (see illustration above)

4. Put the oil on your thumbs and slide your thumbs up your vagina (to the first knuckle).

5. Pull gently outward and forward around the opening of your vajayjay ( you will probably feel some tingling or burning). Do this for a couple minutes.

Summary

Research shows over and over that protecting your perineum is possible to keep tearing to a minimum (and recommended). There are things such as baby’s size, baby’s position & length of labor, which are out of your control and which could impact the perineum.

There is one thing you definitely have control over: talk to your provider about tearing & exactly when & why they’d consider giving you an episiotomy. Get clarity during an appointment, not when you’re ‘bout to birth that baby.

“If we all did the things we are capable of, we would astound ourselves.” Thomas Edison (tweet that awesome quote)

 

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  • Veronica

    how often should you do this (beg. week 35)? every day? twice a day?

    • yourbabybooty

      I would do once a day…if you notice particular irritation or acute sensitivity, then stop for a couple days and see how you feel.