Around 8 out of 10 women and birthing people have some damage to their perineum after giving birth. Your midwife will offer to examine your perineum, including the muscles of your back passage (anus and rectum), after you give birth. They may recommend some sutures (stitches) to help reduce any bleeding, reduce your chance of infection and improve healing.
About 3% of women and birthing people have more extensive tears involving the muscles of the anus, which are repaired by a doctor in an operating theatre.
There are some evidence-based ways to help reduce the risk of a severe tear:
Perineal massage in the third trimester of pregnancy: This can help to increase the elasticity of the muscles of the perineum, helping them to stretch more during birth and reduce tearing (Cochrane, 2017). Perineal techniques during the second stage of labour for reducing perineal trauma Your midwife can discuss with you how to do this, or you can read an online guide, for example, on the NCT website. How to do perineal massage: a step-by-step guide
Warm compress on the perineum while pushing: This can help to relax the muscles of the perineum during birth, increasing the elasticity of the muscles. (Cochrane, 2017) Perineal techniques during the second stage of labour for reducing perineal trauma. Your midwife will be familiar with this technique, please feel free to ask more about it.
Finnish technique (hands on support of your perineum and baby’s head): This is a technique used by midwives to reduce perineal tearing during birth. Your midwife will use one hand to apply counter pressure to your perineum as your baby’s head and shoulders are born. They will use their other hand to support your baby’s head and control how quickly it is born, reducing the pressure placed on your perineum. This cannot be offered during a waterbirth*, or in birth positions such as standing or squatting. Your midwife will be familiar with this technique, please feel free to ask more about it.
*Note about waterbirth: Using a bath or birth pool is a very effective form of pain relief in labour. A Cochrane review of 15 trials determined that giving birth in water was not associated with an increase in severe perineal tears over giving birth on dry land (Cochrane, 2018) Immersion in water during labour and birth. As stated above, we are not able to offer hands-on support to your perineum, or an episiotomy, if you are having a waterbirth.
Episiotomy: An episiotomy is a cut made in the skin and muscle of the perineum and vaginal wall. It is offered if:
- You are having an assisted birth (forceps or ventouse)
- There is a need for your baby to be born more quickly (for example, concerns about your baby’s heart rate)
- Your midwife/doctor is concerned you may have a serious tear.
You will always be asked for consent before an episiotomy is done, and local anaesthetic will be given to numb the area first. It is sutured following the birth in the same way as a natural tear.
