One aspect of my job is to inform women about looking after themselves during pregnancy, labour and the recovery stages afterwards. I love being able to give tips to make any of the above less painful, less stressful and therefore more enjoyable. A key bit of advice I can give is about how to look after your perineum (the skin between your vaginal opening and back passage) during labour.
The risk factors for tearing
Unfortunately, 85% of first-time mums will have a vaginal tear during labour, for which there are many reasons. You could have a large baby (over 4 kg/8.8lbs). You might have an epidural, making it difficult to know how hard you are pushing. An epidural also means you will likely be on your back which is generally a harder position to deliver in. If the baby is back to back or if you end up having an instrumental delivery (forceps or ventouse) this will also increase the risk of tearing.
Types of tears
1st degree – involves just the skin around the labia. Generally no stitches needed and will heal on its own.
2nd degree tear/episiotomy (cut) – through the outer skin and the muscles underneath. These need repairing with stitches.
3rd degree – as above but also involves the sphincters that control your back passage. Requires intervention with stitches.
4th degree – this is very rare and involves the sphincters and the tissue into the rectum.
The 3rd and 4th degree tears generally need to be repaired in theatre. This may involve you having an epidural if you haven’t already had one.
Reducing the risk of tearing
So enough about the bad stuff, let’s talk about reducing the risk of any of these tears happening. The best way to do this is by doing something called perineal massage.
- In sitting or lying apply some lubricant or olive oil to your finger or thumb and place it inside your vagina only 1-2cm.
- Slide your finger/thumb side to side applying a firm pressure. It should feel like a moderate stretch. You can also think of a clock face moving from 3 o’clock to 9 o’clock, stretching as you go. This should be done for up to 5 mins if possible, ideally every day from 36 weeks.
Other ways to help prevent tears
If you don’t fancy doing it yourself, you can buy an EPI-NO. This is a balloon that you insert into your vagina and slowly inflate. The goal is to gradually work up to 10cm. You can also use it to get the feeling of how to push which is very helpful as it is surprising how many women struggle to work out the technique of pushing when it comes to it. I advise only doing this a few times though as at this stage in the pregnancy we don’t want you to strain or put stress on your pelvic floor muscles. The EPI-NO has also shown that when women are more informed about stretching and delivery they are less anxious, which can mean the labour is shorter and less complicated.
Perineal massage is not a guarantee that you won’t tear, but it will significantly reduce your risk.
There are a couple of things you can do that may also help to prevent tearing.
- Put a warm flannel over the perineum in the second stage of labour. This can help relax the muscles and also feel calming for you.
- Try to avoid being on your back during delivery. It is better to be on your knees or leaning forward to allow gravity to help deliver your baby so you don’t need to push as hard. Plus, because of the way the vagina is angled you won’t be pushing uphill if you are not on your back.
If you would like more information on any of the above points or if you need help or advice relating to women’s health during or after pregnancy then please contact your local women’s health physiotherapist who will be happy to explain things in more detail and assist you with any enquiries.
By Jenny Constable, Specialist women’s and men’s health Physiotherapist at Six Physio