What is perineal trauma and how can I avoid a vaginal tear during childbirth?
Picture: iStock
Nine out of ten first-time mums, and seven out of ten women who are on their second or subsequent baby, will sustain some form of perineal trauma during vaginal childbirth, according to international research.
Dr Maeve Eogan, consultant in obstetrics and gynaecology at the Rotunda Hospital, says: “Unfortunately, the biodynamics of birth is such that the baby’s head and shoulders can cause grazes or lacerations or indeed a decision may be made to cut an episiotomy during the birth either to speed up the birthing process, for example, if there are concerns about the baby’s wellbeing, or to limit more extensive tearing.”
Eogan says there is evidence that undertaking perineal massage from about 34 weeks of pregnancy can play a role in preventing tears. The grades of tears reflect the different extents of injury, with a first-degree tear indicating damage to the vaginal skin. A second-degree tear involves the vaginal skin and muscles and skin of the perineum, the space between the vagina and back passage. Third-degree tears include the muscle surrounding the back passage and fourth-degree tears involve the internal skin of the back passage.
“Generally, people who have a lower grade of tear heal quicker than those with more extensive perineal tearing,” says Eogan. “Episiotomies are similar to second-degree tears. They include the skin of the vagina and the muscle and skin of the perineum. If they need stitches dissolvable sutures are used so no stitches need to be removed afterwards.”
According to Eleanor Durkin, antenatal/parent education midwife at The National Maternity Hospital, “Perineal massage is increasingly practised in pregnancy as it is believed to reduce the incidence and severity of tears. Although there is a lack of high-quality research on perineal massage, it appears to be associated with a reduction in episiotomies and reduces the risk of third- and fourth-degree tears.”
My Expert Midwife, a British-based skincare brand for pregnancy, new mums, and newborns, conducted a survey of 1,000 women that found more than a third of women who have given birth did not know where their perineum was, and more than half of the women believed there was a stigma surrounding discussing perineal massage.
Lesley Gilchrist, midwife and Founder of My Expert Midwife, says: “Shining a light on this subject could help women understand the benefits, learn how to do perineal massage, and help to dispel embarrassment and taboos around perineal massage. Due to the perineum being an intimate area of the body, there can be a reluctance to discuss this openly, but perineal massage is a subject that all women who are planning a vaginal birth should be aware of.”
Perineal massage was not a concept mother-of-three Lorna Lyons was aware of when she became pregnant. “I had no knowledge of it beforehand,” says Lyons, a wellness coach. “I was a big fan of hypnobirthing and had bought books that followed the philosophy, and this is where I learned about perineal massage and how it can help stretch the perineum to reduce tearing during childbirth. I was willing to try anything that could help to avoid this outcome.”
Being one of the first of her friends to give birth, Lyons found that she didn’t talk openly with them about the practice, nor did she find information freely available from her maternity hospital at the time.
“I never had a conversation with midwives or doctors about perineal massage”, she says. “I had my husband’s support and that was invaluable. I was uniquely interested in evidenced-based practice when it comes to a positive birth experience, and I think many women miss out on this vital information because of a lack of knowledge in the area.”
The lack of information made it difficult for Lyons to actively practice perineal massage. “It made me consider whether I was doing something unnecessary during a time when I already felt extremely uncomfortable,” she says.
However, after three births and no tears, she would “without a doubt recommend it. It makes sense to massage that muscle to make it more flexible for the time in your life when it will be stretched to capacity.”
“It is best to view perineal massage within the context of a package of measures designed to protect the perineum and reduce tears,” says Durkin.
“In the National Maternity Hospital, women are invited to attend an early pregnancy class where the concept of labour as a marathon which must be trained for is introduced. From about 34 weeks onwards, it is advised to start practising perineal massage for about 10 minutes a day three or four times a week. Get comfortable, use lubricant, and listen to some relaxing music to help support you and keep you focused.
“Use this time to practice relaxed breathing and control your levels of anxiety so that you can confidently manage to stay calm during an uncomfortable process. Developing a mindset that aims to empower you to prioritise yourself and your own physical capabilities to give birth with ease will have a significant impact on your birth experience and your postnatal recovery.”
Eogan says most people who experience perineal trauma recover well, usually within 6-12 weeks. “It is important that people consult a healthcare professional if they are concerned about how the area is healing or any unexpected symptoms so that they can access appropriate care to treat the symptoms and prevent, or limit, long-term issues.”
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