Hello and welcome to part 1 of our series dedicated to preparing your perineum for a vaginal birth!

There’s so much more to good pelvic prep than just perineal massage. We’re going to arm you with some knowledge to help you and your pelvic floor successfully navigate a vaginal birth (hooray!).

If you want to feel prepared and in charge of your birthing journey, you’ll need to know what is actually going on down there, how best to prepare and recover, plus what can happen during delivery.

But first, let’s get to know the vulva. It’s made up of:

• the urethra (where urine comes out),
• the clitoris (fun times),
• the labia minora/majora, and;
• the opening to the vagina.

The area between your vulva and anus is your perineum. Beneath your skin, your vulva and anus are surrounded by circular muscles that make up the first layer of your pelvic floor.

What is a perineal tear and how are they named?

Tears are classified into scaled degrees of injury and depend on which structures are involved; 1st degree involves the least amount of damage, while 4th degree tears involve more parts of the perineum being injured.

1st degree tears involve a grazing or tearing of the skin around your vulva/perineum, and is the lowest grade of tears.

2nd degree tears involve injury of the skin as well as muscle that surrounds the opening of your vagina. If you have an episiotomy (a surgical cut made by your obstetrician/midwife), that’s considered as equivalent to a 2nd degree tear.

Both 1st and 2nd degree tears may require stitches, with 2nd degree tears being more commonly sutured by your midwife or obstetrician in the birthing suite (if delivering in a hospital).

Recovery from 1st and 2nd degree tears is generally quite good, provided you follow proper postpartum care (see our future blog post for more info).

Be sure to visit your pelvic health physio after 6-8 weeks to check how your pelvic floor is functioning, as common symptoms like discomfort with penetrative sex, constipation, or issues with bladder leakage (urinary incontinence) can all be improved by seeing a physio.

3rd and 4th degree tears are less common, affecting around 1:10 of first time mums. They involve the muscles and/or lining of the anus, and require repair by an obstetrician in an operating theatre, usually within 24 hours of delivery.

These injuries can increase the risk of developing uncontrolled leakage of wind or stool (flatal/faecal incontinence), pain with sex (dyspareunia), and damage to the deep parts of the pelvic floor (levator avulsions).

These issues can affect a woman’s quality of life to a huge extent, and therefore require a whole team of specialists to help them recover; gynaecologists, colorectal surgeons, nurses, psychologists, GP’s, and of course; pelvic health physios. We got you, boo.

But fear not! There are many things you can do to help decrease your risk of sustaining these tears.

Until then, happy birth prepping, mammas-to-be!