During labor, you want to protect the perineum from tearing. The midwife or obstetrician does this via something called perineal protection, which aims to ensure that the birth of the baby is slow so that the woman's tissues can be stretched slowly.

What exactly is perineal protection?

This includes the midwife or obstetrician using their hands! There are several different ways of holding a perineal protection device using the hands, but no particular hand grip stands out in the research as evidence for reducing the risk of rupture.

However, research has shown that the risk of sphincter injuries (rupture involving the sphincter) is reduced if the baby's head and shoulders are born during two contractions. This means that the head slips out at the end of a labor or during a break in labor, and the shoulders are then delivered during the next labor. In this case, staff must make an individual assessment of how quickly the baby needs to be born. The only protection that has high scientific evidence against rupture is heat to the perineum.

Perineal protection also includes communication and choice of birthing position. Most birthing positions allow the midwife to have a good view of the perineum, except if the woman is squatting. If it is difficult for the midwife to keep an eye on the perineum, she should tell her and suggest a more favorable birth position in consultation with the woman giving birth.

The midwife also inspects the color of the tissue, elasticity, possible swelling and bleeding. If risks of rupture are identified, measures can be taken, such as changing position, to relieve the tissues and optimize circulation in the perineum. In order for the tissues to stretch at the right pace, it is beneficial for the head to slide back during a break in labor in the pushing phase.

Of course, the woman's wishes are taken into account and the woman giving birth is both informed about the purpose of perineal protection and involved in the recommendations made. Note that most people get some kind of tear after giving birth.

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