Damage to the perineum can have a serious impact on women’s health: stretching or tearing of the area can remove vital support from the back wall of the vagina in turn making prolapse of the uterus more likely. Scarring and perineal trauma can cause severe discomfort or pain during sex and those who have suffered the indignity of bowel or bladder incontinence will tell you just how important the pelvic floor muscles are. But, perhaps most of all, damage to the perineum can be hugely upsetting and demoralising in those early weeks of motherhood, when going to the toilet or even sitting down feels terrifying, and it can compound postnatal depression and affect bonding with your baby. In cases of third and fourth degree tears (which many attribute to episiotomies tearing further) in which the vaginal and rectal canals are damaged, the emotional impact of such an injury can be enormous.
Antenatal perineal massage
One way to avoid serious perineum injury during childbirth is to prepare the area. Research shows that massaging the perineum from 34 weeks onwards of your pregnancy reduces the likelihood of ‘perineal trauma’. One woman on Mumsnet wrote: “Perineal massage is the secret wonder of the birthing world! Two births and no tears or cuts – I cannot understand why the practice is not more encouraged by NHS – my NHS midwife team never mentioned it, only private midwife.” For the novice, perineal massage can take a bit of getting used to but the benefits are worth it. Use a base oil such as sunflower oil, olive oil or vitamin E oil to lubricate the area. There’s a How To instruction on perineal massage here http://www.wikihow.com/Do-Perineal-Massage with instructions for either doing it yourself or getting help from your partner. The idea is to gently prepare the perineum by stretching it manually and it is a good opportunity to practise your breathing as you stretch. It can be much easier to do with a partner as you can relax back on some cushions, but if you do have to do it alone make sure you can get as comfortable as you can with a bump in the way. The best time to practise perineal massage is after a bath when your skin is warm and supple with increased blood flow.
Ways to heal post-birth
Arnica: Even with perineal massage or stretching preparation, there can still be some damage to the tissues during childbirth especially if you have a very fast labour. Most women can expect some bruising as the crowning of the baby’s head pushes the whole area to its limits. That’s where the wonder of arnica – a homeopathic remedy for bruising, shock and trauma – comes in. Even those who are sceptical about homeopathy tend to change their mind after using arnica – a great big bruise on the face which threatens to swell up to comic proportions can be dramatically healed in the space of a few days. Honestly, it really does seem miraculous! Pack some arnica in your birth kit: pillules to be taken orally directly after birth and an arnica-infused oil to massage into your buttocks, thighs and around your vagina.
Raw honey is well known for its wound-healing properties. It’s antibacterial and is said to speed healing; there is a vast array of anecdotal evidence which describes incredible healing in situations that seemed dire. Raw honey oxygenates the tissues and kills off bad bacteria and because of its moist consistency it is great as a healing agent for tears and cuts to the perineum. This potent gift from nature is also anti-inflammatory so reduces swollen tissues. Always choose raw honey as this contains the healing ingredients that haven’t been destroyed by pasteurisation, some find that their local honey is the most powerful.
Aloe vera is cooling for inflamed skin and has long been used as a healing agent for burns. Purchase a little aloe vera plant pre-birth, pop it on your windowsill and you have a ready supply of soothing aloe vera gel. This can be applied neat to irritated, inflamed skin, or you might like to make a blend of aloe vera and a drop of lavender oil, soak a pad in it and apply to the perineum area.
Lavender essential oil can be added either to a full bath, or if you prefer, a sitz bath. A sitz bath is basically a bath just big enough to sit in; it’s also called a hip bath. Lavender is probably one of the most well-known essential oils and healing agents and for good reason. It’s antibacterial, anti-fungal and anti-inflammatory to name but a few of its many, many properties. Research has shown that it aids relaxation, sleep and skin regeneration. Add 10 drops to a full bath or 3-4 to a sitz bath.
A peri bottle is a very useful addition to your post-birth kit if you have damage to the perineum. It is basically a squirty bottle you can use to apply water to the perineum, both to ease discomfort when you empty your bowels or bladder, and as a way to cleanse the area. You can use plain water or make a tea of herbs specifically suited to healing. These might include chamomile for inflammation or calendula for healing. Keep the peri bottle by the toilet and make sure the water is slightly warm – don’t use cold water.
Cool compresses can be a godsend when you’re burning and itching and stinging all at the same time. A compress is basically a clean piece of cloth soaked in liquid and held to the affected area to speed healing. Make up a blend of body temperature water (too cold and you might find yourself uncomfortably shocked, but it is a case of personal preference…however, bear in mind that cooling, rather than warming, compresses are advisable for areas of inflammation) and add a few drops of lavender and/or tea tree essential oil. You might prefer to make up a tea/infusion of calming and soothing herbs (calendula, chamomile, chickweed) and allow to cool before soaking your soft organic cloth and applying to the perineum.
Use natural organic sanitary pads after the birth as ones containing synthetic fibres and plastics can aggravate the area and could hinder the healing process. Loose, natural clothing also helps a great deal allowing air to circulate. Opt for the softest, comfiest pads you can find, either making your own pre-birth as a gift to post-birth self or choosing some of the fantastic reusables available from companies such as Honour Your Flow www.honouryourflow.co.uk.
If your tear or cut isn’t healing properly or you are concerned about the stitches you received, please don’t suffer in silence. Forums abound with tragic stories of women who thought that discomfort and pain were to be expected long after their children had grown up, or whose botched repair jobs meant that they can’t enjoy making love with their partner any more. Get help and expert advice where it’s needed, and don’t be afraid to demand the most skilled and experienced doctor available in the maternity ward if you do require stitches after birth (you don’t have to have the student just because they need to learn, honest).
Get support and advice from a variety of caregivers if you can, as you may find that the post-natal care your receive from your hospital or midwife is thin on the ground because funding our maternity services sadly just isn’t a priority in this country. So seek out a good homeopath, aromatherapist or post-natal doula if you can afford to – even one visit to a healing professional can really boost your confidence and give you that helping hand when you need it.
Wishing everyone intact, happy and healthy perineums!