I have had three children, all born vaginally. Almost every mom I have spoken to about their birth experience had a perineal laceration, or a tear from their vagina to their perineum at birth for at least one of their children if they delivered vaginally. However, I am one of the very few women that has not experienced perineal lacerations or an episiotomy with any of my three births. In fact, according to the Journal of Midwifery and Women’s Health between 4 and 8 of every 10 women will experience a tear during delivery. In addition, about two-thirds of the women that do tear during a vaginal delivery will need stitches.

Where (and what) is the perineum?

According to Healthline.com, your perineum is that small area of tissue between a woman’s vagina and her anus. Although it is small and seemingly inconsequential to your labor and delivery process, as well as your recovery, it is quite important. In fact, it directly attaches to the muscles that support your pelvic floor. And when it comes to pregnancy, labor and delivery, and recovery these muscles are important in that they support your reproductive organs, bowels, and bladder.

What is a perineal laceration?

A perineal laceration is a tear that occurs from the vagina to the anus, via the perineum. It often occurs during active labor in childbirth as the baby crowns and exits the mother’s vaginal canal.

Manual perineal lacerations are often caused by episiotomies, which are small cuts that a doctor or midwife will perform along your perineum in order to make more space for a baby to come through a birth canal.

There are several different levels, or degrees of severity, for perineal lacerations. Most perineal lacerations are first and second-degree tears, but some are third and fourth-degree tears. Most perineal lacerations require stitches but first-degree tears usually heal on their own. Here are the different designations:

  • First-degree tear- Only the skin around the perineum is torn.
  • Second-degree tear- The skin and the muscle around the perineum is torn.
  • A third and fourth-degree tear- According to the Royal College of Gynecology and Obstetrics, “some women (3.5 out of 100) the tear may [have]..third- or fourth-degree tears, also known as obstetric anal sphincter injuries (OASI). [These tears] extend into the muscle that controls the anus (anal sphincter). These deeper tears need repair in an operating [room].”

Below are some ways to help prevent a perineal laceration and/or episiotomy. These exercises can be performed during pregnancy as well as during active labor. We have also discussed some ways you can help the healing process if you do experience a perineal laceration during birth.

What can I do to prevent a perineal laceration?

Although sometimes a perineal laceration is inevitable, there are some things you can do before you go into labor to prepare your body for the intense stretching that often causes perineal lacerations, as well as things you can do during labor with your doctor’s, midwife’s, or doula’s help to help prevent a laceration.

Perineal Massage

A perineal massage basically stretches and manipulates the perineal tissue. It can be done on your own, with the help of your partner, or by your doctor or midwife. A person uses one or two fingers to gently push and stretch the tissue in order to get it more malleable when it comes time to push your baby’s very large head out of a very tiny hole.

A perineal massage can be done in the weeks leading up to your due date as well as during your birth. In fact, your doctor or midwife may be able to prevent tearing or an episiotomy if they do a perineal massage while you’re in the pushing phase of delivery. My OB/GYN did a perineal massage during my first and second delivery which may have helped prevent me from tearing and needing stitches.

How to do a perineal massage at home to help perineal lacerations

Several studies have been conducted that have found that regular perineal massage 2 to 6 weeks before birth can reduce the risk of tearing, stitches, and the need for an episiotomy. Studies have also found that regular perineal massage may also help in a woman’s recovery after birth and make birth less painful.

The good news about perineal massages is that they can be done at home. According to the Journal of Midwifery and Women’s Health, you can do perineal massages using the techniques below two to four times per week.

Wash your hands well, and make sure your fingernails are short. Relax in a private place where you can rest with your legs open and your knees bent. Some women like to lean on pillows for back support.

Lubricate your thumbs and the perineal tissues. Use a lubricant such as vitamin E oil, coconut oil, almond oil, or any vegetable oil used for cooking—like olive oil. You may also try a water‐soluble jelly, such as K‐Y jelly, or your body's natural vaginal lubricant. Do not use baby oil, mineral oil, or petroleum jelly (Vaseline).

Place your thumbs about 1 to 1.5 inches inside your vagina (see Figure 1). Press down (toward the anus) and to the sides until you feel a slight burning, stretching sensation.

Hold that stretched position for 1 or 2 minutes.

With your thumbs, slowly massage the lower half of the vagina using a U‐shaped movement for 2 to 3 minutes at most. Concentrate on relaxing your muscles. This is a good time to practice slow, deep breathing techniques.

If you would like your partner to do the perineal massage, they can follow the same techniques but they should use their index fingers instead of their thumbs when doing the massage.

What your doctor, midwife, or doula can do during birth to help prevent a perineal laceration

Once you are in active labor, your midwife or partner can continue to do perineal massages. You can also ask your midwife, doctor, or even a labor and delivery nurse to do a perineal massage any time they check your dilation and effacement. Your doctor or midwife can continue to give you a perineal massage even as you push. Many doctors and midwives will help support the birthing process by manually stretching the perineum as the baby crowns as well.

However, you can ask your doctor or midwife to help prevent tearing during birth in other ways as well. First of all, and most importantly, is communication. If you plan to have a vaginal birth, let your doctor know that you do not want forceps or a vacuum to be used. You can also let them know that you don’t want an episiotomy. Luckily, episiotomies are pretty rare nowadays and are often only used if the baby needs to come out quickly.

You can also ask your doctor or midwife to apply a warm compress to the perineum just as your baby comes out to help soften the tissue. They can also provide gentle downward pressure to the baby’s head to help prevent tearing. Pushing between contractions rather than with them has also been found to be helpful to prevent tearing.

There are also several birthing positions that can help prevent tearing. Kneeling, all-fours, or lying on your side protect your perineum and help reduce the risk of tearing during birth.

What are the benefits of a perineal massage?

A perineal massage is beneficial in many ways. It not only helps to prepare your body for a vaginal birth but it can also help with recovery. In fact, damage to the perineum during birth can cause issues with the pelvic floor like incontinence (hello moms that pee when they laugh, run, cough, or sneeze), uterine prolapse, or even sexual discomfort.

However, there are many other benefits to a perineal massage than just helping your pelvic floor and reduce the risk of tearing. Some of these benefits include:

Less pain during childbirth- A perineal massage helps to stretch the skin and tissues which increases blood flow. This may help lessen the pain experienced during birth as a result of the stretched vaginal opening.

Lower risk of tearing- A study done by the Journal of Midwifery and Women’s Health found that 1 in 15 women who do regular perineal massages before birth do not need an episiotomy or have a tear that requires stitches.

Lowers the risk of needing stitches- Even if you do tear you may not need any stitches. A study published by Evidence-Based Practices found that a regular perineal massage may reduce the need for stitches after birth by up to 10 percent.

Are you a dance or horseback rider? You might want to try a perineal massage- Women who are dancers or horseback riders often have more rigid perineum because of regular force and stretching to that area. There is often increased scar tissue, and a regular massage can relieve some of the scar tissue buildups and create softer perineum which makes for a smoother and more comfortable birth.

How to recover from a perineal laceration

Of course, even if you do all the things right including regular perineal massages, there is still a chance that you could tear.

First and second-degree tears can be treated at home. Even if you need stitches, they are often dissolvable. Here are some ways you can treat your perineal tear at home:

Keep it clean and dry- Clean the area by squirting warm water over it when going to the bathroom. Pat it dry. Do not rub. If you are using a sanitary napkin or maxi pad, be sure to change it out every 4 to 6 hours.

No sex- The doctors say this for a reason. Keep your hands, and other body parts, away until you’re fully healed.

Poop regularly- Many women become constipated after birth because of the changing hormones, but staying regular will ensure that nothing gets so blocked up that it becomes painful to push out. Mild over-the-counter laxatives can help keep you regular if staying hydrated and eating high-fiber foods doesn’t help.

If you are experiencing pain, you can ice the area in different ways. Chilled witch hazel pads or a cold maxi-pad can help ease the pain. You can also try to take a warm sitz bath for 20 minutes three times per day or use a warm compress. If the pain is extreme, you can also get an anesthetic to numb the area.

Sit on a doughnut- Not the kind you eat, but an inflatable seat cushion that has a hole in the middle. But you can always eat a donut while you sit on one!

Perineal massages are something every mom should consider before giving birth. Studies have shown that they are most helpful to first-time moms, moms over 30, and those who have had previous tears or episiotomies. So even though it isn’t exactly the prenatal massage you might expect, it is one that is very useful!

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