Everyone wants their vaginal canal and perineum to come through birth intact and without the need for repairs. While having a hospital birth is a risk factor, there are many ways to preserve your perinieum including…
spontaneous labor
upright birth positions (not birthing on your back or in stirups)
gentle, mother/birthing parent controlled pushing
birthing without an epidural (the lack of feeling and muscle coordination leads to too forcefull pushing)
supporting the perineum with warm compresses
NUTRITION
Nutrition? Yep! Nutrition.
In your third trimester, start adding an avacado a day to your meals. Consume good olive oil. Learn some tips HERE. The monounsaturated fats and saturated fats from good food sources have been proven to increase skin elasticity in a Japanese study. If you consume animal fats, do you best to choose organic, grass-fed, and/or wild caught options. Plant sources besides the olive oil and avacados include nuts, coconut oil and seeds.
A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM) as well as reduces perineal tearing.
Include omega 3s. Wild caught salmon is your best bet. I knew a midwife in NY that insisted her clients get canned wild caught salmon and consume this at least twice a week. I’ll include a great recipe below. Plant resources for omega 3s are flax seeds, chia seeds, pumpkin seeds and walnuts. Of course, you can take a good fish oil supplement, but getting these things from foods is always best.
Avoid trans fats, hydrogenated oils and oils that go bad quickly such as vegetable, corn, safflower, and soybean oils. Hydrogenated oils and rancid oils can lead to free radicals that are shown to damage the health and elasticity of skin.
Include Vitamin C. Collagen is a triple helix protein that is stronger than steel! This is why our skin is so strong, or should be. By adding Vitamin C our bodies can stimulae collagen production (source) and so many help skin elasticity. Plus, Vitamin C is great for immune systems and keeping amniotic sacs from rupturing prematurely.
For those who aren’t vegan or vegetarian, incluging foods that are high in cysteine such as eggs, poultry, meats (organic and grass fed as much as possible), yogurt, cottage cheese will get this amino acid known to improve skin elasticity and it’s ability to repair itself (so if you do tear, you’ll be more apt to heal faster). For vegetarians and vegans, you’ll find cysteine in brussel sprouts, red peppers, garlic, onions, broccoli, oats, granola, and wheat germ.
This is recipe I got from Cooks.com in 2008. If you saw the state of this piece of paper you’d know how often I’ve made this for my kids!
Basic Salmon Loaf
1 can (24 3/4 oz) or 2 cans (7 1.2 oz) pink salmon
2 cups soft bread crumbs (about 3 slices of bread, cut into small pieces. I put in my blender to do it quick)
1/3 cup finely minced onion
1/3 cup finely minced celery (optional)
1/4 cup milk
2 eggs
2 tbsp. minced parsley
1 tbsp. lemon juice
1/4 tsp. each salt and dill weed
dash of pepper ( i use more than a dash so use what you like)
Drain salmon, reserving 2 tablespoons of liquid. Flake with a fork. You’ll see tiny pieces of bone, often the spine. Don’t worry! They cook to softness. Combine all ingredients, mixing well. Place in a well-greased loaf pan (mine is a bread loaf pan) 8.5 x 4.5 x 2.5. Pour reserved liquid on top. Refridgerate for an hour (if you have time. I’ve absolutely skipped this and it’s fine). Bake at 350 degrees for 45 minutes.
Makes 4 - 6 servings
Perineal Massage
Perineal massage in labour and prevention of perineal trauma: randomised controlled trial: What this stud found was that in during labor, perineal massage was not shown to reduce perineal tearing. However, antenatally (during pregnancy) there was some data that showed those who did such massage had less tearing. Keep in mind that spontaneous, physiological labor, upright pushing positions, no use of pain medication and a proper diet are really the biggest factors in tear prevention.
Healing the Perineum
Sometimes, tears do happen regardless. Should you choose suturing (it actually is an option to not suture a 1st or second degree tear), ice packs may help the associated swelling. However, it’s known that non-suture related swelling can actually be made worse by ice.
TOPICAL COOLING (ICING) DELAYS RECOVERY FROM ECCENTRIC EXERCISE–INDUCED MUSCLE DAMAGE
“Lowering tissue temperature during the cooling period can reduce peripheral blood perfusion (5,7). However, blood perfusion may return after removal of the treatment. This hemodynamic fluctuation may influence the magnitude of muscle damage, healing rate, and the associated fatigue feelings during recovery (32). Tissue damage caused by such fluctuations in blood perfusion has been well demonstrated in the ischemic reperfusion model that can elicit acute inflammation (22). In addition, this change profoundly alters circulating cytokine levels (21,35). Although temperature shifts can influence tissue blood perfusion (16,17), no investigation has focused on the moderate change in tissue perfusion after topical cooling and the influence of this condition on recovery rates after eccentric exercise–induced muscle damage.”
Honey: An immunomodulator in wound healing: a possibility in healing tears. Antimicrobial and speeds up healing.
The use of non-surgical glue to repair perineal first-degree lacerations in normal birth: A non-inferiority randomised trial -
“Conclusions: Non-surgical glue was not inferior to traditional sutures to repair postpartum first-degree lacerations. In addition, non-surgical glue was associated with less pain and greater satisfaction.”
This would be a topic to bring up prenatally with your care provider should you want to choose this option over suturing, as I’ve not seen glue on the table for births. It seems like a good option and should be offered to women, however at this point it is something you’ll need to request ahead of time I’m sure.
Postpartum Herbs
Check back soon, as I’ll be adding my own blended Postpartum Bath Blends available for purchase. With these hand-blended herbs, responsibily sourced, organic when possible, and sometimes grown and harvested by me, you’ll be able to make peripads (for those without sutues), do vaginal steams and take yummy full body baths. I’ve had desperate clients ask for help wih suture related pain and find that after just one vaginal steam with postpartum herbs, their pain levels drop dramaticaly!
Coming soon…