Protect Your Perineum!

Afraid of tearing during birth? Don’t want to be routinely cut? (Ack, me neither!!!) Here are some simple measures you can take to protect your perineum (tissue between the vagina and the anus) for birthing time.

  • Prepare ahead of time with Kegel exercises for an easier time with pushing. These are super easy, can be done any time, and help to strengthen your pelvic floor and protect against incontinence after pregnancy regardless of what happens to your bottom at birth.
  • Consider preparing during the last weeks of pregnancy with perineal massage (of course, with your caregiver’s permission). The verdict is still uncertain as to whether or not this definitively prevents tearing at birth, but some women say it really helps! 
  • Avoid the lithotomy position for pushing. This puts extra pressure on the perineum and makes tearing or the need for episiotomy much more likely.
  • Ask for perineal massage and perineal support (gentle counter-pressure, often with a warm compress) during pushing. Your caregiver’s role should be, whenever possibile, to protect your perineum rather than cut it open.
  • Let the perineum stretch on its own during pushing. Don’t feel the need for “purple-pushing”- blowing your brains out while everyone is yelling at you to do it harder, harder! Don’t rush. When you feel the urge, breathe your baby down at your own pace. Remember, the longer your baby’s head comes forward and recedes gently, the more your perineum will have a chance to stretch. Patience is a virtue- especially in second stage labor.
  • At crowning, take it easy. Let your baby open you up slowly and freely. Take a moment and breathe when you feel that infamous searing (or “burning,” if you prefer the milder term).  Feel free to reach down and touch your baby! Peaceful Parenting, in an article on Perineal Massage and Support, states that “Dr. Michael Rosenthal of the Family Birthing Center in Upland, California reports that mothers who use their own hands to feel their baby at crowning, and help him/her enter the world, very rarely tear.”
  • Make sure you pick a care provider who has a very low episiotomy rate. (Many suggest that a decent rate is under 20%.) Watch for scissors during pushing. Have your birth team ready to alert you if they see scissors or lidocaine being pulled out before you do (seeing as you’ll be rather busy at that point!). Remember, you can always remind your caregiver that you do not consent to an episiotomy if it is very important to you.
  • Generally speaking, in a normal birth, episiotomies are usually only truly necessary if the baby is in distress at the last moment or if the mother is utterly exhausted from pushing. Episiotomies can shorten the pushing phase by about 15 minutes on average (from Thinking Woman’s Guide to a Better Birth, Henci Goer), but I personally wouldn’t consider 15 minutes worth the time a cut takes to heal, especially when you count in the increased possibility of incontinece and future tears after an episiotomy. Of course, this is not meant to be medical advice- it’s merely my opinion. 🙂

What about you? Did you discover any tricks or tips during birth to help protect your perineum? Please share your wisdom!

2 responses to this post.

  1. I have no wisdom in this regard yet, but I have to tell you when I saw the picture and title of this post in my feed, I about died of the humor :). Thanks as always for the good info :).


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