My WHAT needs priority care? Your perineum, it is the unsung hero of pregnancy, labour and birth and deserves way more credit than it currently receives. Located between your vaginal opening and your anus (back passage) the perineum forms the base of your pelvic floor muscles which support the reproductive organs, bladder, and bowels. Internally, your perineum helps you to have control over peeing and pooing, having sex, and giving birth vaginally. In a non-pregnant woman, the perineum measures approximately 1.5 inches but stretches and thins out by on average 65% to around 2.5 inches making it much more vulnerable to trauma during labour. 

As baby progresses through your vagina (birth canal) this is the time when your perineum really stretches, and by the time baby starts to crown (the top of the head is visible on pushing) you are likely to experience a stretching and burning sensation as the skin thins out more than it ever has before. This is the point at which your midwife will encourage you to stop pushing to avoid baby birthing too quickly and tearing that delicate perineal skin. Through a combination of controlled breathing, gentle nudges rather than big pushes the aim is to minimise any perineal tears.  

How likely am I to have a tear? 

Approximately 90% of women who have a vaginal birth for the first time will experience some degree of perineal trauma, be that a graze, a tear, or an episiotomy. Some grazes and tears do not need stitches, however others will do to repair the damaged tissue dependent on the severity. Tears are classified as 1st, 2nd, 3rd, and 4th degree tears: 

• 1st degree tear. Small tears affecting only the skin which usually heal quickly and without treatment. 

• 2nd degree tear. Tears affecting the muscle of the perineum and the skin which usually require stitches. 

• 3rd degree tear. Third-degree tears go into the muscle that surrounds the anus, called the anal sphincter, and will be repaired by an experienced Obstetrician in theatre.  

• 4th degree tear. Fourth-degree vaginal tears are the most severe extending through the anal sphincter into the mucous membrane that lines the rectum. This will always be repaired in theatre by a senior obstetrician. 

The majority of perineal tears are minor (1st and 2nd degree) and heal in time with strict hygiene to reduce your risk of introducing infection. If you need stitches for a minor tear this will usually be carried out by your Midwife in your birth room. Major tears (3rd and 4th degree) impact on the nearby pelvic floor muscles or the anal sphincter causing difficulties with weeing, pooing, or having sex, and so will always be repaired by an experienced surgeon in an operating theatre under a spinal block (heavy local anaesthetic). 

Will I need an episiotomy? 

An episiotomy is a cut made by a healthcare professional into the perineum and vaginal wall to make more space for your baby to be born when there is a concern about fetal wellbeing or if an instrumental birth is indicated. The procedure will be carried out following infiltration of the perineum with a local anaesthetic to ensure the area is fully numb before the cut is made. During labour and birth your midwife will be keeping a close eye on your perineum to reduce the risk of any trauma and will be prepared to perform an episiotomy if indicated. Episiotomies are only ever performed with your consent, and your Midwife should always explain why they are advising one so that you are fully informed of your options. If you consent to an episiotomy a small cut will be made using a sharp pair of perineal scissors making for a more straightforward repair. Occasionally, an episiotomy may have to be extended, and unfortunately, despite every effort, there are also some which go on to spontaneously tear as well. An episiotomy is made on an angle to direct any trauma away from the anal sphincter to reduce the risk of a severe 3rd or 4th degree tear. If you have had an episiotomy, you will need stitches to repair it. This is normally done in the room where you had your episiotomy and usually heals well. 

How do I care for my perineum after giving birth? 

If you have had stitches either for a teaar or for an episiotomy good hygiene is vitally important to the healing process. Your healthcare team should advise you on how to care for your perineum, but the Midwives at My Expert Midwife have compiled a short list of useful tips: 

• Wash or shower at least twice a day during the first week to keep the perineal area clean 

• Wash and dry your hands thoroughly before and after going to the toilet and when changing your maternity pad to help reduce the risk of introducing infection 

• Change your maternity pad at least every four hours. This helps to prevent the build-up of bacteria and reduces the chances of an infection developing 

• You will probably want to pass urine more often as this is how your body rids itself of extra fluid after the birth. Always ensure you are wiping from front to back, so you don’t spread any bacteria from the anus to the perineal/vaginal area. This will reduce chances of infection especially if there are sore areas or you have stitches 

• You can use My Expert Midwife’s award-winning perineal spray Spritz for Bits from day one after you give birth even if you have stitches. Packed with essential oils such as Witch Hazel, Tea-tree, and Lavender this incredible spray can provide instant relief for perineal soreness, bruising and swelling 

• Try to have time each day when your perineum is not covered with a pad and pants to allow air to circulate, especially once your postpartum bleeding has reduced in flow. The air flow helps the area from being the moist breeding ground that bacteria thrive in 

• Many women find having a jug next to the toilet is useful for douching their perineum with warm water after passing urine. If you do use a jug, ensure it has been sterilised first to minimise the risk of infection. 

• Ensure you maintain good hydration as this will dilute your urine and it will be less stingy when you wee if you have sore areas. You can also spray Spritz for Bits before and after having a wee 

• Start gentle pelvic floor exercises as soon as you can after the birth to increase the blood supply to the area and help the healing process. These exercises will also help your pelvic floor regain its tone and control 

• Ensure you have some paracetamol at home and take some if your perineum is uncomfortable. Follow the guidance and never take more than the recommended dose.  

• Always seek medical advice from your Midwife or GP who will happily examine the area and offer further support if needed if you have any concerns about your perineum; pain, offensive smell, discharge, flu-like symptoms, etc. 

Caring for your perineum after the birth of your baby is so important to your long-term health. Not only will your significantly reduce the risk of introducing infection to the area but you will help to promote healing 

For more information about how to care for your perineum during pregnancy and labour visit www.myexpertmidwife.com where you will find lots of useful information including  

Blog - How To Protect Your Perineum During Birth and  

Blog - Warm Perineal Compress in Labour – Protecting Your Perineum 

On Demand Webinar - Perineal Massage  

Blog - How To Do Perineal Massage & Why You Should Try It 

Downloadable Free Guide on Perineal Massage 

Peri Prep Your Bits Perineal Massage Oil developed by midwives to help you prepare for you baby’s birth this oil is ideal for encouraging the skin around your perineum to stretch more easily during childbirth. This award winning, mum approved perineal massage oil contains a unique blend of natural essential oils to help nourish, protect, and promote skin elasticity. 

You can also visit the Midwives on Stand P60 at The Baby Show with Lidl GB at EXCEL London 1-3 March 2024. Midwives Lesley Gilchrist and Cathy Tabner will be talking on The Live Talks Stage which you can attend for FREE with your ticket to the Baby Show.