The Perineal Check after Birth

*Addendum: this post has triggered so many responses of unawareness that this examination is optional, and stories of traumatic experiences. I’m so sorry this has been brought up for many of you, but I’m also glad that this post may actually bring some clarity around this examination, and the realisation that is is NOT mandatory……also, this should NEVER be traumatic. It CAN be done with gentleness and appropriate pain relief, and most importantly, with the birthing person in charge.*

Many people forget that this is a thing that will be offered after the birth of the placenta.

It is often presented as something that is *not* optional, though of course it is, with the caveat that it is possible to miss perineal damage that would actually benefit from careful repair if no one checks the perineum after birth. Most people are unfortunately not aware they can decline this.

However, some people feel very much able to judge themselves if their perineum feels ok or looks ok as they are very familiar with it, or trust their sense of bodily integrity.

If you would like a midwife to check your perineum after birth it usually goes something like this: it starts with a quick clean so it’s easier to see what is going on with your vulva/perineum as there is often some blood obscuring the view. This should be gentle, unrushed and ALWAYS led by your feedback.

*A *stop* from you MUST result in the HCP stopping whatever they are doing at once, at all times during the whole process of checking the perineum.*

After the gentle clean, a visual check of the outside of vulva and perineum follows.

This often gives some indication as to how much damage there is to your perineum, if any at all. But you will also be offered an internal examination, as usually, when there is some damage to the perineal skin, it also extends to the vaginal wall on the inside of the vagina…..this is done by parting your labia to get a good look at the perineum……and then very gently inserting 1 or two fingers into the vagina, wrapped with a little gauze swab (to soak up any blood that might obscure the view, again) to open up the vagina a little for visual assessment, to see if or how far any tearing may have extended into the vaginal wall, or if there are any isolated vaginal wall tears that can’t be seen from the outside.

Remember, your vagina will be fairly ‘open’ at the point as it has just birthed a baby, but this usually IS quite tender. Pain relief, very gentle movement from the midwife, being in charge of what goes ahead and when, being positioned in a comfortable place, feeling safe and heard all help with this check.

You will also be offered a rectal examination after that to see if any tearing has extended into the back passage from the inside, of course this is extremely unlikely if damage is minimal or non existent (and it’s even unlikely if there is more significant tearing), and many people decline this particular check.

As I said before, all of this is up to you, you should be offered some pain relief for this as it is usually considerably uncomfortable and you are able to stop the exam at any time should you change your mind at any point.

After the examination, the findings should be discussed with you in a nuanced way…..whether you accept repair of any damage is completely up to you. The more superficial a tear, the less likely it is to benefit from suturing, but even for more significant tears, the research about benefits vs downsides of suturing is not 100% clear. If a significant amount of muscle has been damaged, suturing may well protect pelvic floor function in the long run. If severe tearing is sustained, such as a 3rd or 4th degree tear, the benefits of a careful and skilful repair are clear, in terms of preserving functionality of the pelvic floor.

Suturing should always take place with you positioned comfortably, with appropriate pain relief and in charge….with a sensitive practitioner performing the procedure. This is a time (for many) where trauma informed practice is incredibly important, and small adjustments can make a huge difference in how the procedure is perceived. Please ask for what you need, and what is acceptable to you and what isn’t.

For HCPs: I know this is a daily procedure for you, one that you do 100s of times. This is a very very vulnerable time for your clients however, and the utmost care to do this check and repair with kindness, gentleness, and in the context of trauma informed care must be taken ♥️ illustration by Charlotte Illustrates ♥️