Freakishly short perineum???

[SaveTheWild]

Hi gals,

OK, so I have been thinking about my perineum lately. (I mean, who doesn't, right? LOL) and here's the thing. I think it might be freakishly short. I haven't had a baby yet, but will be TTC in the next few months. So I have been thinking more and more about childbirth, and tearing, etc.

The amount of space between my yoni and my, ahem, butt, is soooo small. I mean, really, like tiny. Not so much a perineum, like I feel people talk about, just kind of a small swatch of tendony-feeling skin.

so am I doomed? does this mean that if I tear even a little that I will be tearing through? Is this normal?

help me out ladies.

[Ruthla]

Your uterus isn't the only thing that grows during pregnancy.

[Kathryn]

Originally Posted by Ruthla

Your uterus isn't the only thing that grows during pregnancy.

:
Mine was pretty small before I got pregnant and it grew with the rest of my body. You will be fine.

[MizLiz]

How long is average??? I have no idea how short too short would be... I'm sure there are some massage and other techniques that would help prevent and reduce tearing, whatever the length it may be...

Good luck!

[SaveTheWild]

OK, so I just went looking to find out if there is an average lenght, and now I am even more freaked out. See this: http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

It said that average length was 4.6 cm !!!! Mine is seriously like maybe 1.5cm.

Then it says this "Women with a short perineum (<4 cm) or a small anal position index (<0.42) [whatever that is] had significantly higher rates of episiotomy, perineal tears and instrumented delivery. . . . It was concluded that a short perineum and anterior displacement of the anus were associated with traumatic vaginal delivery in primigravidae."

oh sh*t! OK, now I seriously need to hear from other shorty gals out there. Get out your mirrors and rulers, ladies, I need data!!

Did/do you have a short perineum? Did you tear badly?

ack! (add to this that I am fair skinned and practically get stretch marks from eating too much at thanksgiving dinner (seriously, everytime I gain or lose a little weight (were talking 5 lbs only), I have the stretch marks to show it).

[Ruthla]

Is that the average for women about to give birth or the average woman who'd never been pg?

[SaveTheWild]

good question. dunno. Let me see if i can find out ...

edited...

OK, so it said that the measurement was made "during the first stage of labor". so that's better, right? but how much can I expect it to grow. I mean do my yoni and my butt really grow further apart, or what? And will it more than triple in size (cuz that's what it'll need to do to be "average"?

[SaveTheWild]

OK, so here is the whole little summary of the medical journal. (unfortuanley the full text version doesn't seem to be available)

The aim of the study was to determine perineal length and anal position in primigravidae and to evaluate their effect on vaginal delivery. The distances between the fourchette and each of the center of the anal orifice and the inferior margin of the coccyx were measured in 212 primigravidae with singleton term pregnancies during the first stage of labor. Anal position index was calculated by dividing the first measurement by the second. The mean +/- SD length of perineum was 4.6 +/- 0.9 cm. The mean +/- SD anal position index was 0.49 +/- 0.12. Women with a short perineum (<4 cm) or a small anal position index (<0.42) had significantly higher rates of episiotomy, perineal tears and instrumented delivery. This association was also significant by multiple logistic regression analysis. It was concluded that a short perineum and anterior displacement of the anus were associated with traumatic vaginal delivery in primigravidae.

Can any of you nurses / midwives / docs (or others) interpret this?

[Moon Faerie]

Just want to make sure you're not getting your in and cm confused. 4.6 cm is about 1.8 in.

[QueenOfTheMeadow]

Hmm, I'm not sure where I was before babies, but I know perinium stretches a lot, and massage can help avoid tearing if your concerned. Maybe you should Xpost in the pregnancy forum.

[Irishmommy]

Moving this to Health and Healing...

[SaveTheWild]

Originally Posted by Nikel1979

Just want to make sure you're not getting your in and cm confused. 4.6 cm is about 1.8 in.

nope. no confusion whatsoever. It really is that small.

[Elowyn]

I'm a PA, does that count?

They're measuring from the fourchette (where the labia minora meet on the side closest to your anus) to the anus (self-explanatory ) and from the fourchette to the tailbone (feel behind your anus up into your "gluteal cleft" (that's buttcrack for those following along at home) you should feel your tailbone begin somewhere past the anus a few cm. The anal position index is the fourchette-anus distance divided by the fourchette-tailbone distance. And yes, I think 4 cm or so for the fourchette-anus distance (i.e. your perineum) is pretty average, regardless of birth status. I do quite a few pelvics (though not as many as our MW friends, and if they'd like to chime in and disagree, I'll certainly defer to their expertise) and would estimate 3-4 cm is normal in nulliparous (no births) women. I really don't notice a huge difference on average between nulliparous and parous women, but I haven't been measuring, either!

The rest of the quote is pretty self-explanatory - higher rates of issues with shorter perineum and/or smaller "anal position index". Good luck, regardless, and I'd take this up with your health care provider - she/he may be able to speak more directly to your particular anatomy.

[mothernurture]

Apparently I have a "short perineal body" according to the male OB at my first birth almost 6 years ago. I know this because I requested and obtained some of the records of my labor/birth from my doctor's office. He cut a major episiotomy, among other unnecessary interventions, and I ended up with a long and painful recovery with subsequent infection of the episiotomy site that had to be treated with silver nitrate (something you want to avoid at all costs -- it is not fun) even 3-4 months post partum.

This doctor used the length of my perineum to justify cutting a significant episiotomy....

Here's the good news... I went on to have a natural birth the 2nd time with midwives and a doula present, 3 years ago. I had a natural water birth without any intervention (other than catching the babe). I did not tear, I did not have an episiotomy... it was the most healing, empowering experience...

length of perineum may be far less important than your choice of birth provider and location (I was in a freestanding birth center and therefore had the option for a waterbirth).

Good luck! Research midwives/birth centers/birth doulas in your area!!

[fremontmama]

Originally Posted by mothernurture

length of perineum may be far less important than your choice of birth provider and location

I definitely second that!
And other people have mentioned it, but perineal massage I think would help quite a bit. And also, once you are in labor, remembering to relax instead of tensing up will help too. Easy to say, much harder to do :LOL
I think you'll be fine!

[blessedwithboys]

Originally Posted by SaveTheWild

Then it says this "Women with a short perineum (<4 cm) or a small anal position index (<0.42) [whatever that is] had significantly higher rates of episiotomy, perineal tears and instrumented delivery. . . . It was concluded that a short perineum and anterior displacement of the anus were associated with traumatic vaginal delivery in primigravidae."

ok, first i have to be immature and laugh at "displacement of the anus"...ahhh, that's better. ok, now- was this study conducted among those who had sOB's as birth attendants? sOB's have higher rates of epis, tears, and intrumented delivery regardless. i am sure that to a midwife, your short perinuem is only a variation of normal. so b4 you start ttc, make sure you ahve found a midwife (hb preferrably) who will understand and support your desire to protect your perineal integrity.

and now i must stick the kids in front of the tv and go hide in my room with the afore-mentioned mirror and ruler...thanks a lot! lol

[SaveTheWild]

thanks. I am feeling slightly calmer.... breathe in... breathe out.

and blessedwithboys....I am dying to know the results of the mirror and ruler test! I want to hear from someone else whose yoni and anus are close neighbors...

this whole things makes me think in two opposite directions. One one side, I think -- if I am at risk of tearing, all the more reason to stay out of a hospital so that they won't interfere and make things worse.

but one the other hand I think -- oh my! If I am likely to tear totally through, I want to have a team of surgeons there to properly put everything back into place...

[Glittergal]

OMG savethewild,
even though i'm late to this thread i had to respond! i fret over my short perineum all the time! seriously! my husband thinks i am nutto. i seriously have no idea what it was like before i had my daughter but i had a pretty bad tear and things have just not been the same since. not trying to worry you, just looking for info as well.
i did everything right, had a homebirth, easy labor, midwife got there 10 min before birth of babe. then she encouraged me to squat, i had so much freakin pressure, i knew i had to blow her out in one fell swoop :LOL
i was convinced i had a 3rd degree but she told me i had "a short perineum and a big 2nd degree". 2 yrs later and it is still tender and i literally have no space between my bum and vagina.

my advice to you would be to follow your instincts with pushing - i really felt like pushing on my side and hands and knees and my midwife had me squat and splat, i felt myself tear open as my daughter blew out.

whoo, i know many people don't tear the second time around BUT, it is nerve wracking to have a short perineum, isn't it?

[SaveTheWild]

Thanks for responding Glittergal. Good to know I am not alone. that's good advice re: trusting how my body wants to push so I don't tear unnecessarily.


but i am still scared...Yikes!

[SaveTheWild]

bumping this up. I am now preggo and this has again risen to the top of my list of anxieties. I am planning either a home birth or a freestanding birth center birth and while on the one hand I think this is where I am least likely to tear badly, on the other hand, if I do tear badly and need a ton of stiching/repair, I dread having to get up and drive to the hospital right after having my baby....

any more thoughts on this?