The muscles and skin that make up the area between your vulva and rectum are called the perineum.
KEY POINTS
There are some things you can do to prepare the area for birth, including
- pelvic floor exercises
- perineal massage
There is a risk that the skin and muscle may tear during the birth of the baby.
Some pregnant women choose to massage their perineum in the last month of pregnancy to prepare for the stretching and pressure that will occur during the birth process.
It has been shown to be most effective in first time mothers in reducing the rate of significant perineal tears.
What is a third or fourth degree perineal tear?
A perineal tear is an injury to the perineum, which is the area between the vagina and anus. Tears are usually graded by ‘degrees’ – you may hear terms such as first, second, third or fourth degree tears.
Third and fourth degree perineal tears are more serious tears – they extend from the perineum to the anus or rectum and include the muscle that controls the opening and closing of the anus (anal sphincter).
First and second degree tears may need stitches, but women tend to recover within a few weeks or months. Third and fourth degree perineal tears need surgical repair and may be associated with short- and long-term complications for women, affecting their physical, psychological and sexual wellbeing.
Most women who sustain a third or fourth degree perineal tear recover well with appropriate treatment and support, although some will need specialised care to optimise their recovery.
About 3% of all Australian women who have a vaginal birth, and 5% of women having their first vaginal birth, will experience a third or fourth degree perineal tear.
The effects associated with third and fourth degree tears can be considerable and may include complications such as: perineal pain, faecal and flatus incontinence and painful sexual intercourse. There may also be ongoing psychological effects.
It is not possible to prevent all third and fourth degree perineal tears, but there are ways to reduce their likelihood.
Perineal self-massage (or with help from your partner) after 34 weeks of pregnancy can help protect your perineum and reduce the risk of third and fourth degree perineal tears.
It is recommended to commence perineal massage after 35 weeks of pregnancy. Practising can help you to become more in tune with that area of your body, help you to relax as you feel the baby is putting pressure on the area and to alleviate some of the extreme sensations of the baby’s head passing through as it is being born.
a warm bath or warm compress on the perineum for 10 minutes may help to relax this area prior to massage.
- Massage a good quality vegetable oil, not mineral or baby oil, into the perineal area
- Place thumbs inside your vagina.
- Press gently downwards towards your rectum and to the sides at the same time
- Hold the pressure for one minute breathing deeply and slowly. Keep pressing with your thumbs and then slowly and gently massage back and forth over the sides of your vagina in a “U” movement for 3 minutes.
You should not do perineal massage if you are 34 weeks pregnant or less, if you have any problems with your placenta or any vaginal bleeding or if you have any vaginal infection such as thrush or herpes that may be worsened or spread by massaging the area.
Pelvic floor muscle training may help prepare you for labour and birth and reduce the possibility of a third or fourth degree perineal tear. – See out content page on pelvic floor exercises
During a vaginal birth:
- Applying warm compresses to the perineum during the second stage of labour can significantly reduce the risk of a third or fourth degree perineal tear.
REFERENCES
ACSQHC – Clinical Care Standard
Cochrane – antenatal perineal massage for reducing perineal trauma
Pregnancy Birth Baby – anatomy of pregnancy and birth, perineum and pelvic floor
