Top Tips for Reducing the Risk of Perineal Tears in Labour

by | 26 Apr, 2020 | Midwifery Skills | 1 comment

Perineal Tears in LabourThe reduction of risk and prevention of  perineal tears when supporting birth is a core part of skilled midwifery practice. We know that perineal damage can have both short and long term impacts around discomfort, pain and sexual functioning and a Cochrane review considered the evidence behind perineal techniques for reducing perineal trauma in the second stage of labour.

However there is more to midwifery practice than randomised controlled trials, and empirical evidence is part of midwifery history – wisdom and techniques passed down from mentor to student; midwife to midwife. So after sharing the open access article Margaret Jowitt wrote about the OASI Care Bundle:First Do No Harm, we asked our followers on Facebook what tips they might have for helping to prevent perineal tears. We had a great response and here’s a curated selection of anonymised responses from our midwifery community.

 

Antenatally

Perineal massage from 36 weeks

Avoiding induction unless absolutely clinically necessary

A calm environment with a real sense of safety

Birthing at home

Communication

Trusting relationship with the midwife – continuity of carer

Explaining the sensations that may be felt

Position

Adopting the position that they feel comfortable in

Upright leaning forward

Left Lateral

Birth in water

The Second Stage

Slow birth of the head,  slow nudging of the head,

Breathing through those first feelings of pushing until the body takes over. Baby descends slowly allowing tissues plenty of time to stretch.

Not coached/purple pushing

Following their own instincts, placing a hand on the baby’s head

Giving a low deep ‘hum’ focused down into the bottom rather than breathing /pushing

A relaxed mouth and jaw

Watching for and gently controlling any nuchal arms present by using your hands to support the baby to maintain it’s tightly curled shape as it’s emerging, and then unfold after leaving the tissues

Warm compress on the perineum

Once almost crowning, closing the legs during contraction to improve blood flow to perineum.

Final Word…

Let the woman lead.

 

Further reading

The following article is on Research Gate – it’s free to join and lots of really great open access research to explore.

Fear causes tears – Perineal injuries in home birth settings. A Swedish interview study

But please feel free to add your thoughts in the comments below!

1 Comment

  1. Katherine Hales

    Thank you Evony this is perfect for us.

    Reply

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