Before I became pregnant and started planning a homebirth, I had only a fleeting relationship with my perineum. I knew vaguely that it occupied the space between my anus and vagina, but I had no idea that it played such a star role in childbirth.
Then I learned that perinea were prone to tearing, which leads some doctors to routinely perform episiotomies, the god-awful practice of slicing into a laboring mother to make more room for baby. Neither of those options - tearing or cutting - sounded good to me. And it goes without saying, you want to avoid either of these results. So if you're planning a homebirth, it's wise to get your perineum in shape. Here are some strategies to save that precious skin.
Try perineal massage.
Massaging your perineum gives you the chance to become more intimately acquainted with your perineum than you ever thought possible. Start about six weeks before your due date. Wash your hands, grab some water-soluble lubricant (KY Jelly) or vegetable oil, and - if you're like me - a glass of wine. Lay down, lube up, and insert your thumbs about an inch into your vaginal space. Press down on the skin toward your rectum. You might feel a little tingling, but if it hurts, stop. Keep working around the skin, pressing and releasing, stretching that stubborn little area for about three minutes. Do this stretch every night.
But does it work? Eh. I did perineal massage for awhile and had very little tearing (just one small stitch). But I don't know if it was related. Some studies show that perineal massage helps reduce severe tearing particularly in first-time moms. Other studies show it doesn't make much of a difference. So what? If it doesn't help, you've only wasted some time (and lube); if it does help, bonus!
Avoid squatting for long periods of time in labor.
Squatting is an awesome position for birth. But squatting continuously for long periods of time (think hours) puts a lot of pressure on your perineum and some midwives report higher incidences of tearing. So make sure to change up positions to avoid too much perineal pressure.
Just let go.
At a certain point in labor, I became aware that I was at risk of tearing. I had the "ring of fire" sensation and worried - for a split second - about my precious perineum. But the thought was quickly replaced by the overwhelming desire to squeeze that baby out of my vagina no matter the cost. I remember thinking, "I don't care if my entire pelvis rips open - I want this baby out." In other words, at a certain point, don't worry about it.
Do your kegels!
Your midwife told you to do them. Every book you've read told you to do them. Your friends and family with fabulously intact perinea told you to do them. Now I'm telling you. Kegel exercises are your friend. Even if you tear, you'll bounce back faster if you have a strong pelvic floor. Start here for some basic kegel exercises and do them everyday. I used to practice in the car on the way to work - an excellent use of commuting time.
Give it some love.
Whether or not you've had tearing, your whole vaginal area will feel pretty worked over after birth. So show that perineum some love! Here's a great way to ease a sore perineum: moisten a couple of maxi pads with water (you can also sprinkle on some tea tree oil) and pop them in the freezer. The cold packs feel refreshing and are a perfect shape for your perineal area.
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