Maternity Direct NMH



Taking care of your perineum before, during and after birthTaking care of your perineum before, during and after birthA Parent Information Leaflet Where is my perineum and what happens during childbirth?Your perineum is the area between your vaginal opening and your rectum. This area stretches during childbirth and sometimes it tears.What is a perineal tear?What is a perineal tear?A perineal tear is tearing of the skin and/or muscles in the area between your vagina and rectum, there are four types of tears and these are known as 1st, 2nd, 3rd and 4th degree tears. 1st degree tears involve injury to the skin only2nd degree tears involve injury to the perineal muscles3rd degree tears involve injury to the perineal muscles and the anal sphincter4th degree tears involve injury to the perineal muscles, anal sphincter and the lining of the rectum.How will my perineum be repaired if a tear occurs?Repair of 1st and 2nd degree tears can be done by a midwife in your home or in the hospital. Tears that are 3rd and 4th degree have to be stitched by a doctor in a hospital theatre. This allows the proper pain relief to be used, normally a spinal block given by an anaesthetist. If I have a repair what do I need to do afterwards?The stitches will dissolve after approximately 30 days, it is important to keep the area clean but avoid long periods in the bath as this may interfere with healing (10 minutes soak should be sufficient).A community midwife will check that your perineum is healing well at your home or in a post natal clinic.How do I do pelvic floor exercises?It is advisable for all women, even those without tears, to commence pelvic floor exercises as soon as possible after giving birth.Sit comfortably or lie on your side. These are good starting positions if these exercises are new to you:Close your back passage as if you are trying to stop yourself from passing wind. Once you feel your back passage ‘drawing in’, try and work this feeling forward into your vagina.The stomach muscles can also help the muscles of the pelvic floor to work. First of all relax your stomach wall, then gently draw in the lower part of your stomach wall towards your spine. Hold with easy effort and with easy breathing for a few seconds before letting go.Now try and work these two muscles groups at the same time. Pull up the pelvic floor muscles and draw in the lower part of the stomach wall. Feel the support these ‘core stability’ muscles provide to your pelvis and spine, and to the pelvic tissues.It is important to do these exercises correctly. Always try to work with easy effort and easy breathing: no jaw clenching or tightening your buttocks as you do these exercises. Spend a little time finding out how to work these muscles. Once you are sure that you are working these muscles correctly and once any soreness is settling, you are ready to start a strengthening programme. You will need to build up to at least 30 tightening’s a day to strengthen weak muscles. You will need to think about bracing the pelvic floor and stomach muscles if you need to lift anything heavy. Try to keep the amount of lifting you do to a minimum, particularly in the early days after your baby is born, ideally lifting nothing heavier than your baby, and try not to stand for long periods. Do ask your midwife to check that you are doing the exercises properly before you leave the hospital or when your community midwife visits you. Can I do anything to help prepare my perineum for childbirth?Perineal massage in pregnancy aims to gradually soften and stretch the vagina and the area around it in preparation for birth. Research studies have found that in your first pregnancy perineal massage from the 34th week can reduce the amount of perineal tearing. It will also help you to become familiar with the feeling of pressure or stretching of the perineum that you feel when your baby is being born.How do I do perineal massage?Perineal massage should be done three or four times a week for five minutes at a time, beginning six weeks before your baby is due.Either you or your partner can do the massage. Use a mirror for the first few times so you can see what you are doing. It is more comfortable to do the massage after a bath as this will soften the tissues.Before starting empty your bladder if you need to and wash your hands. Find a comfortable position: sitting, lying down supported by pillows, squatting against a wall or standing with one foot raised and resting on the bath, toilet or a chair.Use a lubricant such as Vitamin E oil, almond oil or any vegetable oil such as olive oil. You may also use a water-soluble jelly such as KY Jelly. Do not use baby oil, mineral oil or petroleum jelly (Vaseline).The lubricant will help your fingers move smoothly over your perineum and lower vaginal wall.If you are doing the massage yourself, it is probably easiest to use your thumbs. If your partner is doing it for you they can face you and use their index fingers.Place the thumbs or fingers about two inches (five centimetres) into the vagina (up to your second knuckles).Using a sweeping motion and pressing downwards, move each thumb/finger from right to left and back again as shown in the diagram below.As you or your partner carry out the massage; apply steady pressure downwards towards your bottom until you feel a tingling sensation. This will help you to become familiar with the feeling that you will have when your baby’s head begins to come out of your vagina.Use more oil if you need to reduce friction and make the massage more comfortable. You can also massage the skin of the perineum between the thumb and the forefinger. Try and relax your pelvic floor during the massage.With time and practice the tissues will stretch and you will become used to the feeling. The massage should not be painful, if it is please ask your midwife for further advice.What will help me to reduce tears to my perineum during childbirth?Research studies have shown that when having your first baby applying a warm pack to your perineum whilst your baby’s head is being born will help reduce perineal tearing particularly the more severe 3rd and 4th degree tears. It also helps reduce pain at delivery and pain in the first few days after birth.What do I need?You will need a soft pad (a thick sanitary pad is fine) and warm water.How do I do it?When you start pushing in the second stage of labour eventually your perineum will start to be stretched by your baby’s head. The warm pad is held with gentle pressure against the perineum during your contractions.Your midwife will check the warmth of the pad first against the inside of their arm to ensure that it is a safe temperature.Can any pregnant woman use them?Any woman, in any birth position having a spontaneous vaginal delivery can use them.For best results do both, perineal massage from 34 weeks and use a warm pack in labour. ................
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