If you follow my blog you might have noticed a theme in many of my posts - how to reduce your chances of having perineal injury. If you’re a first time mom it’s probably high on your list of concerns - if it’s not then it really should be. If this isn’t your first vaginal birth it’s still worth a discussion.

How your careprovider takes care of this precious part of your body can have life long implications for your physical and mental health and your relationship with your partner.

There are plenty of evidence based ways to reduce perineal injury (we can’t always prevent it) so it’s time to have a conversation with your OB/Midwife about how they plan to reduce your risk of having perineal and pelvic floor injury. It’s quite a reasonable question to ask - but don’t assume this is high on your careprovider’s priorities. Hand on heart some of what I’ve seen made me realise this is probably the last priority on a careprovider’s list which is why this is such an important question to ask as soon as you can.

How will you know if your perineal/pelvic health is important to your careprovider? They’ll respond to the question with some or all of the following.

“Doctor Smith - I’m worried about tearing, how can you help me reduce my chances of tearing and help me stop worrying?”

“Great question Debra, let’s talk about that”

Are you seeing a women’s pelvic health physio for your pregnancy? You’re not! Let me give you a referral right away.
I follow the two step birth process - it’s so much gentler on mom and baby.
Prenatal perineal massage is shown to reduce perineal injury and pain.
I don’t break the waters routinely - it can make labor too fast before the tissues have had an opportunity to expand.
Laboring in water is associated with reduced tearing. I think you’ll find the pool/bath really helpful.
I don’t follow coached pushing - you’ll just push when it feels good to you.
I never stretch the perineum in labor - are people still doing that?
The nurse/midwife will apply a warm compress to your perineum (with or without an epidural) as soon as we see a tiny bit of baby’s head). Your partner or doula could do it if you’d prefer.
I’ll encourage you to choose the best position for you when you start to feel pressure.
I’m not at all worried about the size of your baby.
The epidural is associated with more perineal injury BUT I’m going to give you plenty of time to labor down if you and baby are doing well. There’s still lots we can do together.
If you have an epidural and can still move your legs we’ll try out some different positions. I like to avoid the stirrups as much as possible.
If you and baby are well I won’t put any time limits on how long the pushing stage is.
I definitely won’t pull on your baby’s head as he’s being born - I’m there to receive your baby into my hands (or yours - or your partners. Would they like to be more involved?
I haven’t done an episiotomy in forever - it’s rarely indicated.
What are my rates of 3rd/4th degree injuries? I haven’t had a 4th degree injury in 6 years.

Now you have the questions - the next part is up to you. The answers you get will either reassure you or confirm that your longterm perineal and pelvic floor health is not a priority to your careprovider - and you have some decisions to make.

If you don’t know who will be attending on the day - connect with your local doulas - they will have the inside track on the hospital’s overall approach to perineal care in labor and which providers provide professional, evidence based personalized care.

Even if your OB hasn’t got the best ‘bedside manner’ ask the question.

Wouldn’t you rather a few moments of emotional discomfort to avoid the mental, physical and emotional discomfort that can come with an injury that may have been preventable?

Learn more in the new GentleBirth book - free in the new GentleBirth App (no purchase required) and available on Amazon.com and other Amazon worldwide sites.

Note: A lot of these would be standard for midwife led care rather than obstetric led but even if you are planning a homebirth it’s worth asking.