Avoiding perineal damage, part 2

Last post, I discussed the need to have a plan for avoiding damage to the perineum during labor. Don’t wait until labor to start thinking about it! While the perineum is designed to give way when necessary, and then to heal afterward, why not do everything you can now to avoid serious damage?

These are some things you can try before giving birth:


A varied, nutrient-rich diet of unprocessed foods is the best way to make your skin supple and healthy.  There are a few foods you can add to your diet if you’re trying to improve your skin’s health. And of course, better nutrition can only benefit you and your baby!

Perineal Massage

Massaging and gently stretching the perineum before birth (NOT to be confused with the “ironing it out” some caregivers perform during labor) can help the perineum stretch during birth. The idea is to gently stretch the perineum gradually over a period of time, just like people who gauge their ears increase the size of their gauges very, very slowly. Doing daily massage increases the blood flow to the perineal tissues and makes tears less likely. It will make you aware of the “ring of fire” feeling that usually accompanies crowning so that in labor, you can relax the pelvic muscles and know when to stop pushing and let the baby ease out gently.  An excellent pdf instruction sheet produced by the American College of Nurse-Midwives can be found here.

The Cochrane says that “Antenatal perineal massage helps reduce both perineal trauma during birth and pain afterwards.” and, “Women should be informed about the benefits of antenatal perineal massage.”

It also goes without saying that you are the best person to massage your own perineum, since only you know how it feels and when enough stretch is enough. Alternately, your partner can also do this massage. It has been proven effective with a first baby, although if you’ve already given birth,there are norisks so you certainly can massage if you choose.


When baby is posterior (back of baby’s head faces mom’s spine), tears are more likely because the position increases the diameter of the part of the baby’s head that is coming out.  If you’ve been told your baby is posterior, there are a series of exercises you can do, plus changing the way you normally sit, that can help your baby rotate around to an anterior position.  I reference www.spinningbabies.com often because it’s such a wonderful resource for helping moms to understand their baby’s position in the womb, and also for techniques to help get baby lined up in the best position possible for easier birth.


Positions such as squatting and tailor-sitting stretch the perineum gradually over a period of time.  If you wait until labor to try squats, you are more likely to tear.  This may be one reason why midwives report more tears when a birth stool is used – women are unused to squatting in daily life.  It only makes sense to begin gently stretching your perineum earlier in pregnancy.  I recommend you try sitting in a squat, half-squat, or cross-legged while reading or watching tv, at least 30 minutes a day total or more if you’re comfortable.




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