How to prepare perineum for labor?

Hi there! Preparing your perineum for labor is a vital step in ensuring a smoother and less traumatic childbirth experience. As a midwife, doula, and acupuncturist who is passionate about the physiology of birth, I’ve seen how important it is to have a flexible and strong perineum to minimize the risk of tearing and support the natural birthing process.

In this article, I’ll share practical tips on perineal massage, optimal labor positions, dietary recommendations, and why it's so important to trust your body’s natural capabilities.

🌸 What is perineum and why we should take care of it? 🌸

The perineum is the area of tissue between the anus and the vulva in women, and between the anus and the scrotum in men. It's a critical area that includes muscles and tissues that support the pelvic organs and play key roles in bodily functions. Here are the main functions of the perineum in women:

• Support for Pelvic Organs:

The perineum contains muscles that are part of the pelvic floor. These muscles help support the bladder, uterus, and bowel, holding these organs in place and aiding in their proper function.

• Sexual Function:

The perineal area contains a concentration of nerve endings and blood vessels, contributing to sexual arousal and pleasure.

• Childbirth:

During childbirth, the perineum is the area that needs to stretch to allow the baby to be born. The flexibility and strength of the perineal muscles can significantly affect childbirth, influencing the likelihood of tearing or the need for an episiotomy (a surgical cut made at the opening of the vagina during childbirth).

• Continence:

The perineum is crucial for continence control. The muscles in this area help control the external anal sphincter and the urethral sphincter, aiding in the regulation of bowel and bladder movements. Strong and healthy perineal muscles contribute to effective control over these bodily functions, preventing incontinence.

🌼 Importance of a Flexible Perineum for Labor 🌼

A flexible perineum is crucial during childbirth to minimize the risk of tearing as the baby descends through the birth canal. Starting at around 36 weeks of pregnancy, you can begin preparing the perineum through massage and stretching. Here's how you can do it:

• Wash your hands and ensure your nails are trimmed.

• Find a comfortable position, such as sitting or reclining.

• Apply a natural oil, like almond or olive oil, to your thumbs and the perineal area.

• Insert your thumbs about 1-2 inches into the vagina and press downwards and sideways, stretching the tissue gently.

• Massage in a U-shaped motion, maintaining gentle pressure for a few minutes.

• Then massage in between your thumb and index the point that is located mid-distance between the vagina and the anus: this is where all the muscles of your perineum meet. If you relax this area, then you relax the entire perineum: cool, right?

• Repeat this process daily to enhance flexibility.

🌼 Strength of the Perineum 🌼

A lot of people don’t know but we also need a strong perineum to optimize the labor process. A strong perineum supports the baby's head in flexing properly during labor, reducing the head's diameter as it passes through the pelvis. This can help avoid the occurrence of "sunny-side up" babies, where the baby faces upwards during delivery.

Why is a Sunny-Side Up Baby Harder to Push?:

• The baby's head is in a less optimal position, making it larger as it moves through the birth canal.

• This increases the risk of tearing due to the larger surface area.

• Anatomically, the baby's head pressing against the mother's sacrum can cause more pain and prolonged labor.

• To avoid sunny side presentation, you can also favor forward-leaning positions during labor, such as being on your hands and knees or adopting the child’s pose, to encourage your baby's back to rotate towards the front.

🌟 Know in what position to push! 🌟

Knowing how to position yourself and manage your labor can greatly reduce the risk of perineal tearing. Here are some key points:

• Optimal Positions:

  • Side-lying

  • Hands-and-knees

• Avoid pushing on your back as it goes against natural physiology and increases the risk of tearing. While this position is convenient for the healthcare provider, it is not ideal for the mother.

• Warm Compresses:

  • Applying warm compresses to the perineum as the baby crowns can help relax and protect the tissue. The warmth is dilating the vessels so it helps the perineum to dilate as well!

• Gentle Pushing:

  • Slow, controlled pushing during the crowning phase can also reduce the likelihood of tears. Your perineum needs some time to stretch and benefit from the hormones. Give it some time with gentle pushing.

🌿 Diet and Perineal Elasticity 🌿

Nutrition plays a role in the elasticity of the perineum. Consider incorporating the following into your diet:

Hydration:

• Water: Staying well-hydrated is crucial for maintaining tissue elasticity. Aim for at least 8-10 glasses of water per day.

• Herbal Teas: Certain herbal teas, such as red raspberry leaf tea, can tone the uterus and support overall reproductive health.

Healthy Fats:

• Avocados: Rich in healthy fats and vitamins that support skin and tissue health.

• Nuts and Seeds: Almonds, walnuts, flaxseeds, and chia seeds are excellent sources of omega-3 fatty acids and vitamin E, which promote skin elasticity.

• Olive Oil: Use extra virgin olive oil in your cooking and salads for added healthy fats.

Collagen-Rich Foods:

• Bone Broth: As mentioned, bone broth is rich in collagen, but you can also get collagen from other sources like chicken skin and fish skin.

• Gelatin: Incorporate gelatin into your diet through homemade gummies or adding it to smoothies.

Vitamin C-Rich Foods:

• Citrus Fruits: Oranges, grapefruits, lemons, and limes are high in vitamin C, which is essential for collagen production.

• Berries: Strawberries, blueberries, and raspberries are also great sources of vitamin C.

Leafy Greens:

• Spinach: Packed with vitamins A, C, and K, spinach supports skin health and elasticity.

• Kale: Another excellent source of vitamins and minerals that promote healthy tissue.

Whole Grains:

• Quinoa: Rich in protein and essential amino acids, quinoa supports tissue repair and health.

• Brown Rice: Provides a good source of energy and essential nutrients for overall health.

Lean Proteins:

• Fish: Especially fatty fish like salmon, which is rich in omega-3 fatty acids that promote skin health.

• Chicken and Turkey: Lean sources of protein that are important for muscle and tissue repair.

🌷 Personal Experience as a Midwife 🌷

In my experience as a midwife, incorporating these tips significantly reduces the incidence of severe perineal tearing, especially in women who choose to avoid epidurals. Trust in your body is crucial during labor. The hormone relaxin, which is naturally produced during pregnancy, helps to relax tissues and muscles, making the pelvis more flexible and aiding in a smoother delivery. Women’s body is designed for childbirth, and when we allow it to follow its natural course without unnecessary interventions, the process can be remarkably beautiful and effective.

How to take care of Perineum after delivery?

🌸 European pelvic floor rehabilitation: a model to follow 🌸

In Europe, perineal care is taken very seriously. Every single woman is encouraged to undergo pelvic floor rehabilitation with a specialist, whether you had a vaginal delivery or a C-section, whether you have symptoms or not —usually a midwife who understands the full physiology of pregnancy, childbirth, and the importance of postpartum perineal care. Starting about six weeks after birth, this rehabilitation helps strengthen the pelvic floor to prevent future issues such as urinary leakage and prolapse.

In contrast, in the US, there's a significant public health concern regarding incontinence, yet there’s a lack of emphasis on proactive pelvic floor care. This oversight often means that women are only treated after problems become apparent, rather than preventing them in the first place. Many French women I meet here in the US express difficulties in finding adequate care. Prevention is key, and it is far more effective to address potential issues while you're still young, ensuring a healthier later life. And just to note: the typical three hours of rehabilitation often prescribed here is simply not sufficient. In France, we usually see women for five to ten sessions, with additional ones as needed. It's about ongoing care, not just a one-time fix.

✨Work with me to strengthen your perineum!✨

In my office, I offer a comprehensive approach to pelvic floor rehabilitation. More than just occasional exercises, I focus on integrating daily care practices that strengthen and maintain the health of your perineum. I teach you how to care for your pelvic floor every single day, turning these methods into preventative life skills that enhance and protect your pelvic health over the long term.

And rest assured, we won’t be doing a single Kegel exercise! That’s not my approach. Instead, I guide you through understanding how your pelvic floor functions within your body, and how it interacts with everyday postures, exercises, and breathing techniques. This isn’t just about temporary fixes; it's about giving you lifelong skills that will significantly improve your quality of life. You'll be grateful for these tools every day!

As a French midwife, doula, and acupuncturist, I strongly believe in the body’s physiology and natural skills and I would be honored to give you the chance of a healthy pregnancy, labor, and postpartum. Trust your body, embrace the journey, and let nature do its job.

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I wish you a happy pregnancy and a beautiful baby!