Natural childbirth puts the most strain on the perineum, reason enough to pay special attention to it. It is ideal that the care of the perineum is done already during pregnancy, so it will be less traumatized. Also called the “muscle of femininity”, the perineum is the area between the anus and the genitals.
A muscle made up of ligaments and membranes, the perineum is a kind of hammock that supports the large intestine, the uterus and the urinary bladder. Imagine how a bookshelf in a library has to support a crowded row of books. In the same way, the perineum is also forced to maintain the kilograms accumulated during the nine months, but especially the uterus, which grows and continues to grow until birth. Greater pressure is exerted on the perineal muscles during pregnancy, this is why they weaken.
The culminating point in which the tone of the perineum is put to the test is natural childbirth. The good news is that the perineum can be “educated” from the time of pregnancy. The more trained they are, the faster the perineal muscles will recover after birth. Even if you give birth by caesarean section, you still need to tone the perineal muscles.
What you can do during pregnancy
Exercises. Very easy to do, Kegel exercises help strengthen and tone the perineum. Their advantage is that they can be done at any time and do not involve physical effort that could endanger the pregnancy. Kegel exercises involve tensing the muscles of the perineum, just like trying to stop urination or eliminate gas.
“Kegel exercises can be practiced throughout pregnancy, having the effect of intensifying perineal circulation, toning and relaxing the perineum at birth. The exercise technique consists in contracting the anal, vaginal and urinary sphincters on exhalation and relaxation on inhalation, 3 x 8 exercises daily”, recommends midwife Vania Limban.
The massage. From the 34th week of pregnancy, you can massage your perineum, which will help to avoid episiotomy, the surgical cut that doctors resort to to increase the vaginal opening and to prevent rupture at this level. Before starting the massage, empty your bladder and wash your hands well (nails must be cut). Sit in a comfortable position with your legs apart and lean on a pillow. Apply a little olive oil in the perineum area and on the hands.
“The massage technique consists in inserting the thumbs into the vagina (about 1 cm); press down and hold for approx. 2 minutes. Then massage the vagina, from the middle to the right and left. Perineal massage is not recommended if the pregnant woman has a history of vaginal infection, premature ruptured membranes, premature labor, uterine contractions, feeling of discomfort during the previous birth,” explains midwife Vania Limban.
In most women, the episiotomy heals after a month. You can start your sexual life six weeks after giving birth, after which the lochia disappears (secretions that can also contain traces of blood, especially in the first days after giving birth). During the wound period, it is very important to maintain proper hygiene of the perineum, which speeds up the healing of the cut.
• Stinging and swelling can be combated with the help of cold compresses.
• In general, the perineum should be kept as dry as possible.
• Wash the private area with soap and water after each stool.
• Wear cotton underwear.
• Avoid foods that promote constipation.
• Put a pillow or a special roll under the seat, available in specialty stores, to reduce pressure on the cut.
independent midwife, Active Center
Pregnancy affects the perineum
The perineum represents the muscular area located in the structure of the walls of the vagina and pelvis. Urogenital health and the quality of a woman’s intimate life during her reproductive life depend on the perineum. Its tone is influenced by hormonal changes during pregnancy and menopause, but also by diseases and operations in the urogenital area. During pregnancy, hormonal changes, in particular the secretion of elastin, soften this muscle area.
It has been found that in the first birth, if the perineum is prepared and toned during pregnancy, there is always a much greater opportunity for it to remain intact, perhaps with only a few minor tears, without the need for an episiotomy. This fact makes the risk of rupture or episiotomy in subsequent births decrease substantially.
Midwives can offer more advice on perineal care.