Protecting Your Perineum

The thought of perineal tearing can make any birthing person cringe. And let’s not even think about episiotomies. Are there ways to avoid tearing? What’s the evidence behind perineal massage? Will being told how to push make things worse? Rachel Reed tells us more about protecting your perineum during birth.

What we talked about:

• Perineal massage: might help, might hurt, may increase your confidence.
• Episiotomies: a thing of the past (hopefully!)
• During pregnancy, what may increase your risk of tearing in the pushing stage of labor? What may reduce it?
• During birth, what may increase your risk of tearing? What may reduce it?
• What really happens down there when you push in a hospital: the (useless?) management of second stage of labor.
• Things to include in your birth plan that can lessen your chances of tearing
• Why you should let your body do the pushing
• Are tears really all that bad?

Links for more on protecting your perineum:

• Perineal Protectors? Rachel Reed
• Supporting women’s instinctive pushing behaviour during birth, Rachel Reed
• Midwife’s Guide to an Intact Perineum, Gloria Lemay
• Birth Sensations & Protecting The Perineum Through It All, The Joy of This
• What Is the Evidence for Perineal Massage During Pregnancy to Prevent Tearing? Rebecca Dekker for the Science & Sensibility blog
• The Evidence on: Birthing Positions, Evidence Based Birth
• ACOG Recommends Restricted Use of Episiotomies, ACOG practice bulletin
• Episiotomy for vaginal birth, Cochrane

Links to the research that Rachel mentioned on the podcast:

(Thank you Rachel for passing these along!)

• Surgical repair versus non-surgical management of spontaneous perineal tears, Cochrane review
• Research on subsequent tears in women who experienced severe perineal trauma in a first birth
• Systematic literature review on hands on vs. hands off approach to pushing stage
• PDF download with the Queensland Clinical Guidelines for Perineal Care (because doing stronger massage, more often, is not really better)
• Perineal stretching instructions: leaflet (the video is no longer available and, as it turns out, is not with Penny Simkin 🙂 ).

Related Birthful episodes:

• Rethinking the Pushing Stage
• Can Exercise During Pregnancy Make Labor Harder?
• All About Your Pelvic Floor
• Structural Body Changes during Pregnancy & Postpartum
• Vaginal Rehab

Courtesy of Rachel Reed

About Rachel Reed

Dr. Rachel Reed is a Senior Lecturer and Discipline Leader in Midwifery at the University of the Sunshine Coast, Australia. She has provided midwifery care for hundreds of women in a range of settings in the United Kingdom and Australia. Rachel is a writer and presenter, and is the author of the MidwifeThinking blog.

Rachel’s book Why Induction Matters was released on the 6th September 2018.

Find out more on her blog, follow her tweets at @MidwifeThinking, or join the conversation on her Facebook page.