By Dr. Kristin Stetzel, PT
Did you know there are some easy things you can try to help reduce the risk of birth injuries, like vaginal tearing? If you want to be extra prepared for your birth, print out these tips and keep them in your hospital bag, so they’re ready to go for your OB, midwife, nurse, or doula!
Tip 1: Begin performing perineal massage 3-5 times per week before you give birth, around 34-35 weeks gestation.
How to do this:
Wash your hands and get into a comfortable reclined position.
Apply lubrication to your thumbs or any pelvic floor tools you plan to use, such as a pelvic wand or dilator, and along the perineum.
Place your thumb (or wand or dilator) about 1 inch inside the vagina, press down, and gently pull toward the side of the vagina. This should feel like a moderate muscular stretch. Some women may feel tingling or light burning.
Hold the stretch in one area for 45 seconds to a minute while you practice belly breathing and relaxing your pelvic floor muscles, and then move your finger in a slightly different direction and hold the stretch there. Do this until you feel you’ve reached the side walls and bottom of your vaginal opening.
There should be NO severe pain. Perform for up to 10 minutes.
Tip 2: Try using a warm compress during contractions to help relax your pelvic floor muscles. Research shows that the use of a warm compress over the perineum(the area between your vagina and rectal opening) during the second stage of labor resulted in lower rates of severe vaginal tearing and lower rates of episiotomy.
How to do this:
Warm compresses are usually started when the baby's head begins to distend the perineum or when there is active fetal descent in the second stage of labor. This will help to bring blood flow to the area to help the tissue and muscles to stretch better, as well as keeping everything well-moisturized.
Ask your OB or midwife if they can provide you with warm compresses made from clean washcloths or perineal pads immersed in warm tap water in a clean hospital bowl.
Hold the compress over the perineum during contractions as the baby’s head is distending. This will help to soothe some of the burning and stinging sensation as the perineum is stretching. Rewarm the compress in the bowl of water between contractions as needed. You can continue the application until the baby’s head is birthed. If the cloth becomes soiled, replace it with a clean cloth.
Tip 3: You don’t have to give birth on your back! Try out different positions when you’re pushing. If you opt for an epidural, you won’t be able to move around as freely as normal, but there are positions you can birth in that are still safe for your baby and your pelvic floor. See some ideas below.
If you don’t have an epidural, try these:
Hands and knees with feet wider than knees to open the pelvic outlet
Standing with arms resting on bed
Supported squat- leaning against a birthing bar or partner, sitting on a birthing stool
Kneeling and leaning forward over a birthing ball
If you do have an epidural, try these:
Laying on your side with your top leg resting on a birthing ball or held by a helper- your foot should be positioned higher than your knee: this position helps to open the back side of the pelvis when the baby is coming through the birth canal.
Laying on your back with two small towel rolls under either side of your pelvis, creating space for your sacrum and tailbone to move freely, as shown in the photo below
Doing any or all of the above will help to prevent severe injuries to your pelvic floor and contribute to a smooth recovery. It’s also extremely beneficial to work with a pelvic floor therapist during your third trimester to help with birth prep and to establish care for the postpartum period.
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