WEBVTT
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Welcome to Prepare, the Mercy Perinatal podcast dedicated to helping parents prepare for the journey of pregnancy, childbirth, and early parenthood.
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Mercy Perinatal would like to begin by acknowledging the Wawundri Woiwarung people, traditional custodians of the land on which we gather today, and also the traditional custodians of the lands in which you're listening from today.
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We'd like to pay our respects to the elders past, present, and emerging, and we extend that respect to Aboriginal and Torres Strait Islander peoples listening today.
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Hi everyone, welcome to Prepare.
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My name is Dr.
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Rangi, and I am an obstetrician and gynecologist and perinatal researcher here at Mercy Perinatal.
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And we are so excited to be joined by the lovely Melanie Francis today.
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We're going to be talking about a really important topic, which is birth tears.
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And birth tears are a really common part of vaginal birth, but they're often not talked about openly.
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But it's a really important topic and a topic where people have lots of questions and concerns.
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And whilst it can be a bit confronting to hear about them, I think it's important that you feel informed and prepared rather than fearful.
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So hopefully we're going to help do that for you today.
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So I'd love to introduce Melanie.
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Thank you so much for joining us, Mel.
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Thank you for having me.
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Melanie is a clinical midwifery educator and experienced midwife with a really special interest in perineal trauma and women's health.
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She spent many years working as a clinical midwife before moving into education, where she now helps clinicians develop the knowledge and skills needed to support women through pregnancy, birth, and postpartum recovery.
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Thanks so much, Mel.
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Thank you for having me.
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Excited to be here.
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So, Mel, can you tell us a little bit about why you've developed such a strong interest in this particular topic?
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Yeah, I think it comes initially from my just my general interest in women's health.
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And when I first became midwife, I always wanted to make sure I was working to my full scope of practice.
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And so incorporating perineal repair into that was really important to me.
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And once I did learn how to suture, I think that's when it became really obvious to me how fundamental it is for us as care providers to be able to inform women of the facts around vaginal birth and also be able to give them the support that they need to be able to reduce their risk of tears and how we can manage their birth so that they have really good outcomes afterwards.
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So that's sort of where that passion has come from.
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And then since moving into the space of Gind Zone and being able to support more midwives to be able to not only suture but increase their knowledge on diagnostics and assessment of tears, that's just become even more evident of how important this work is.
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Yeah, yeah, so important, isn't it?
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So by suturing, you're talking about stitching and repairing the Yeah, that's the most common method of repairing a perinal laceration.
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Um there is some more research being done around the use of glue, which is ongoing and I think would be really amazing if we have something other than stitches that we could use for tears.
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But at the moment, particularly with the larger tears, it is the best option to use suture material for those kinds of injuries.
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Yeah.
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We'll talk about that in a little bit more detail.
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But can we first talk about what how do you describe what happens when a tear is happening during vagina birth?
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Yeah, so tears are really, really common.
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I think it's really important for women to understand that up to 90% of first-time mums will sustain a tear.
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And although that can sound like a really scary statistic, it doesn't mean that these are life-altering injuries.
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For the majority of women, these are really superficial and they heal really, really well.
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The reason they occur is because the skin around the vagina or between the vagina and the rectum stretches and sometimes it just reaches capacity before the baby's head can be born, and that's when that tear can sometimes occur.
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Yeah.
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I think it's really important that you said that it is quite common, but it doesn't necessarily mean it's going to be a terrible injury.
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Yeah.
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And there's lots of things that we can do to try and prevent it or minimise the extent of tearing, and also important to try and repair those really well.
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Absolutely, absolutely.
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And those really minor ones, sometimes we don't need to do anything at all.
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It might just be an ice pack and some panatol, and that's all they need, and within a week they're healed.
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No long-term effects really occur from them.
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Yeah.
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Yeah.
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But there's definitely lots of things that we can do to prevent the risk of those larger tears from happening for sure.
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Yeah.
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So what are some of those things that we know in the evidence has been shown to reduce those risks?
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Yeah, so things in the antenatal period that can be really helpful is perineal massage.
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So that's something that not all women are really familiar with.
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It's not an easy thing to do having my having my own baby and actually trying it myself when you've got a pregnant baby.
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Yeah, when you're 36 weeks pregnant, you're trying to put your hands down there, it can actually be quite challenging.
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But the goal is to just softly massage that perineal space.
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So, as I said, the perineum is that skin between the entrance of the vagina and the anus that stretches at birth.
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So if we can try and soften the tissue around that area, it'll allow it to stretch.
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The idea is that it will stretch a lot easier.
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Also, I think just having women massage that area and get used to the sensation of that of pressure and stretch actually happening in that area can make it a little less scary when it's actually happening when the baby's head's putting pressure on there too.
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That's a good point.
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Yeah.
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Yeah.
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So that particular method or technique can really reduce the risk of severe tears during childbirth.
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Yeah.
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Other things can be during the birth itself, can be the use of warm compressors, which are usually supported by the midwife or the doctor who's assisting with the birth.
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But birth positions is a really, really important factor.
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So we know that any position that puts pressure on that perineal area is going to cause an increased risk of tearing.
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So women lying on their side or kneeling can really reduce that risk because if you think of gravity, there's not that ongoing pressure, persistent pressure on that space.
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Great.
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And going back to the perineal massage, when would we recommend people start to do that and how often do they need to do it for there to be a benefit?
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Yeah, so anytime from sort of, I would say 36 weeks onwards is fine.
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There's not really evidence to suggest that doing it any earlier is going to make much of a difference.
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Okay.
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But just daily, if the woman's comfortable with, or even just as much as they are comfortable with.
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So if it's just every second day or once a week, as long as they're happy to have a go.
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But ideally, based on the evidence, once a day from sort of 36 weeks, just for a five minutes or so, yeah, it can really make a difference.
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And do you usually recommend just going into the real practical aspects?
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Do you recommend they use some lubrication?
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Yeah, so lubrication will definitely help.
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So olive oil, really cheap, you'll probably already have it in your kitchen, can be really helpful.
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Yeah.
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You can get other water-based lubricants.
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Really important that anything with like heavy fragrances or stuff like other emollients and oil.
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Avoid those.
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Yeah, avoid those.
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So yeah, just your really natural stuff is really helpful.
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Cool.
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And as you said, sometimes it can be difficult physically to do that yourself, particularly when you are 36 weeks pregnant and beyond.
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Is it helpful to sometimes see if your partner can support you if they're comfortable and you're comfortable with that?
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Yeah, absolutely.
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I think most partners are really they want to help.
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I think they get, you know, during pregnancy, they've got to just sit and just watch their partner go through this experience on their own.
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And so if they can be involved in any way, they often will do that.
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And if, you know, obviously as a woman, if you're comfortable having them support you, then that's really important too.
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But yeah, it can be really, really beneficial for you to both to do it, and that can be sort of a bonding moment as well as a couple and in terms of the preparation of welcoming your baby.
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Definitely, definitely.
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But as you mentioned, there are some people who might find that difficult or the idea of it difficult for whatever reason, and that's okay, isn't it?
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Absolutely, absolutely.
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You've got to do what's right for you.
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Um, you've got to feel comfortable in your own body and being pregnant is a really big change, you know, physically.
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So if you're not comfortable, having someone else help you with that, if you just want to do it, try it yourself, that's totally fine.
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Trying to get into a position that's gonna make it the easiest for you.
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Generally on your back is probably the easiest, but sometimes even if it's just in the shower, if you can sort of if you're able to reach down, at least the water can sometimes distract you sort of from what else.
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Or the bath.
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Yeah, or the bath.
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Yeah, absolutely.
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Yeah.
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So importantly, there are different types of tears.
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As you mentioned, some are more mild than others.
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Yes.
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How do you usually describe them in terms of defining them for people?
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Yeah, so from I guess an obstetric point of view, there's four categories that we generally will talk about in terms of classification.
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So you've got first degree tears which are really, really superficial.
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Yeah.
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They usually just involve the perineal skin or a little bit of the tissue behind the skin.
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These heal really, really well.
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Often they don't need anything to be done about them at all unless there's a bleeding problem or maybe an alignment issue.
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So if the midwife or obstetrician feels that it might not actually heal evenly, they might recommend having something done to support that.
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First degree tears also encompass labial lacerations and tears that could be around the clitoris or the urethra.
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These are quite sensitive and tears because of just the amount of nerve sensations.
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But they heal extremely quickly.
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And there's usually no long-term issues for women who experience these types of tears.
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Yeah, that's really reassuring.
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And for I think I would agree with you that obviously those tears can be quite painful, but I think also in my experience, many people have healed quite quickly and feel a lot of symptomatic relief in the first couple of days.
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Yeah, and there's things that we can do to try and like relieve some of that discomfort as well.
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So you know, you can take things like panatol and neurophin, but also just when you go to the toilet, just running some water over your vagina as your wean can severely improve that sort of stinging sensation that you can get.
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So, yeah, really simple things that you can do, and within a matter of days, those symptoms resolve.
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I sometimes compare it to patients to if you've got like a cut in your mouth.
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Yeah.
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Because the tissue is sort of similar in a way that it can actually heal quite quickly before you even notice it.
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It's kind of like that, isn't it?
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That's a really good comparison.
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And you can think about how quickly those little wounds can heal in your mouth.
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It's the same as as the perineal.
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Yeah.
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Great.
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So that's a good summary of the first degree tears.
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What about the second degree tears, which are probably the more common?
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Yeah, so they're slightly more common than the first degree tears, and they they are the most common out of all of the categories.
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So these involve the muscles of the perineal bodies.
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So the superficial muscles of the pelvic floor that help keep all of the female organs up inside our bodies.
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And there's two superficial muscles that can be torn during this time.
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Sometimes only one gets torn, so your doctor or your midwife might say, Oh, it's just a small second, or it's just a little bit larger.
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It depends on sort of how much of those muscles have been torn.
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Yeah.
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But again, they heal really well.
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It's becoming a lot more common for women to choose not to have these injuries repaired.
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And as much as it's important that we're respecting those choices, it's important for women to understand that even though they will actually heal quite well on their own without any intervention, the muscles themselves will never actually grow back together without support.
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And that support usually involves stitches.
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Stitches.
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Yeah.
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Yeah.
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So that's usually the reason why we recommend stitching is so that we can bring those muscles back together because they're going to help support that pelvic floor with its function postnatally.
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But also one of those muscles in particular is responsible for assisting women to orgasm through penetrative sex.
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And so when that muscle is not brought back together, some women can complain later on that they're not experiencing orgasm in the same way that they did beforehand.
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Yeah, that's really important.
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So we're really just trying to maintain function.
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Absolutely.
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Back to what it was originally.
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Yeah, absolutely.
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And look, sometimes it might just be a matter of trying to stop bleeding.
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Some of the these tears can can tend to bleed quite a bit.
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And so, yeah, functionality, bleeding, and also alignment of the tissue as well.
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So we can do a much better job at restoring the alignment of that tissue and the skin better with suturing than we could if it heals on its own.
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Yeah.
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But it's not to say that the healing isn't good without it.
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The healing's just accelerated and optimized.
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And optimized with sutures.
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Yeah.
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With stitches.
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And important to note that those stitches are dissolvable.
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Yes.
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Yes.
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So you don't need to get them removed or anything.
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Correct.
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You don't you shouldn't need to get them removed.
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And most hospitals or midwives and obstetricians will use a rapidly absorbable suture.
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So within two weeks, 50% of that suture material has already lost most of its strength and started to break down.
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So women shouldn't feel tension around that area because of the stitches after those sort of two weeks.
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So yeah, very, very Yeah, it's a bit like that.
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Yeah.
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It's great.
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It's important to note.
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Yeah.
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Going on to the next type of tear, third degree tears.
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Now I think we'll have an episode on this separately, third and fourth degree tears, but just quickly to talk about it, third degree tears are a little bit deeper, aren't they?
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Yeah, so they involve part of the sphincter muscle.
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So there's two sphincter muscles that wrap around the anus, and they're responsible for helping us hold in our farts and our poos.
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So if you're in a public space and you think now's really not the time to go, these muscles are going to help keep it until you can find a safe space to do your business.
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So critical muscles.
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Critical, yeah.
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So third degree tears will affect the external muscle, one of these muscles.
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The one on the outside.
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The one on the outside, yeah.
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None of us can see, but yeah, is inside our bodies, but on the outside of the anus.
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And so it evolved that.
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And sometimes the deeper third degree tears might involve a little bit of the internal sphincter as well.
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Yeah.
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It's really important that these are diagnosed correctly.
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Outcomes can be still quite good if they are diagnosed correctly and they're managed promptly.
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Yeah.
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And with the right physio, women have really, really good prognosis in the future.
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Yeah.
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Yeah, I think that's really important to note that you might be scared of a third-degree tear, which is completely fair enough.
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And we're obviously always trying to minimize those.
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Yes.
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And it's one of those outcomes that we take real notice of in terms of the quality of birth and the injury.
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And we do want to be repairing it quite quickly and well.
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Yes.
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And we will, of course, have another topic about this in a separate episode, but the way we repair it is with really good lighting, really good pain relief.
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And that's often done in the theater so that we can make sure that those muscle layers that you mentioned well are brought together almost perfectly.
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Yeah.
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Because we want that bottom muscle to be working really well for you.
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Absolutely.
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But if that's done, as you said, most people don't have any symptoms later on, depending on the severity of their tear.
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Yeah, absolutely.
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And it's important to know that these are like the least common tears.
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So they do happen, and certain populations are sometimes a little bit more susceptible to them.
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As we'll we'll talk about shortly, there's a lot of things that we can do to try and minimize that.
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But yeah, they account for a very small percentage of the overall tears that women experience.
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Yeah.
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And then an even smaller percentage is those fourth degree tears, which is of course something we we never want to happen.
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No.
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But that is where the tear might go through the outer muscle and the inner muscle around the bottom, but then go through to the bottom or the rectum.
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Yeah, that's right.
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Yeah.
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So these are quite serious.
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And again, with the correct diagnosis and management, again, women can have still really good long-term outcomes, but they can take a lot longer to heal.
00:16:19.440 --> 00:16:21.600
They're a lot more painful to recover from as well.
00:16:21.840 --> 00:16:24.559
And physio is really, really important for these women.
00:16:24.960 --> 00:16:32.639
And decision around type of birth if women choose to have more babies is a conversation that's really important to have with their care provider.
00:16:32.960 --> 00:16:34.080
Yeah, definitely.
00:16:36.320 --> 00:16:52.399
Going back to before these tears happened, what are some of the risk factors that we might see in someone's pregnancy for the patient or the health provider to be keeping in mind that might increase your risk of any of these tears?
00:16:53.120 --> 00:16:58.320
Yeah, so there's a few factors such as size of baby, how many babies you've had before.
00:16:58.399 --> 00:17:05.359
So if it's your first baby, there's always that slightly higher risk because your body's never done this before, so none of us are to know how you're gonna go.
00:17:05.920 --> 00:17:07.920
Ethnicity can play a part.
00:17:08.319 --> 00:17:11.519
And things like other comorbidities.
00:17:11.599 --> 00:17:22.400
So women who have, say, for example, gestational diabetes, or if they have other conditions where they potentially might have challenges with healing and even that elasticity of the skin.
00:17:22.559 --> 00:17:29.920
So if you've got a woman who's 22 years old versus a woman who's 45 years old, their skin's probably got to be a little bit more elastic and stretchy, unfortunately.
00:17:30.240 --> 00:17:31.440
We can't get away from that, can we?
00:17:31.599 --> 00:17:31.759
No.
00:17:32.240 --> 00:17:39.039
So these things can play a part in that overall risk, but it's also important that they're not assessed in isolation.
00:17:39.200 --> 00:17:46.160
So just because you have potentially a larger baby on board, it does not mean that you're going to have a third or fourth degree tear.
00:17:46.319 --> 00:17:48.319
You could have a completely intact perineum.
00:17:48.400 --> 00:17:59.680
But it's important to know that these are potentially a risk factor, and then so management of that, particularly during that labor and birth, are really important to try and reduce that risk of it actually happening.
00:18:00.319 --> 00:18:03.839
And other things that can impact is I suppose how long you've been pushing for.
00:18:04.079 --> 00:18:04.400
Absolutely.
00:18:04.720 --> 00:18:11.119
And the baby's position when they're coming out, if you've had a previous tear is always something to keep in mind.
00:18:11.359 --> 00:18:11.519
Yeah.
00:18:12.160 --> 00:18:28.720
And something that we often talk about is if we need to help out with instruments like a forceps or a vacuum, particularly forceps, absolutely might increase that chance that you might have a tear or an episiotomy, which we'll talk about in the next episode.
00:18:29.039 --> 00:18:29.680
Yeah, absolutely.
00:18:29.759 --> 00:18:31.359
They're really important things to note.
00:18:31.519 --> 00:18:46.400
And I think it's important to understand, particularly in that antenatal space again, what that sort of means, so that when it comes time to to giving birth, if you know the doctor walks in the room and says, I need to help your baby out with a vacuum, you have a better understanding of what that actually involves.
00:18:46.640 --> 00:18:51.119
And then yeah, understanding that that might increase your your risk slightly of sustaining your tear.
00:18:51.680 --> 00:18:52.559
Really important.
00:18:53.599 --> 00:19:02.720
We did talk about things that can help, such as perineal massage and warm compressoring labour and the positioning of pushing and when baby's coming out.
00:19:03.359 --> 00:19:16.319
It's also really important when you're pushing, isn't it, to be guided in that and have someone who's an experienced, what we say, a kusha or someone who's experienced at delivering babies to help you through that to minimise tears.
00:19:16.720 --> 00:19:22.720
Yeah, so one thing that can, I guess, help as well is women's own mental health, like mental space.
00:19:22.880 --> 00:19:23.279
Yeah.
00:19:23.519 --> 00:19:34.000
And so if they're feeling very calm and in control, then they might not need as much verbal guidance as someone who's struggling to be in that space.
00:19:34.160 --> 00:19:37.680
And so feeling safe in your birth environment's really, really important.
00:19:38.319 --> 00:19:50.160
But one thing that's helpful when you've got a midwife and obstetrician at the other end of the bed or at the other end of the, you know, at the bottom of the shower or wherever you're choosing to birth is that they can visually see what's happening.
00:19:50.319 --> 00:19:54.480
So as a woman birthing, you'll be able to feel what's happening, but they can actually see what's going on.
00:19:54.559 --> 00:20:00.960
And so you might hear them say, just you know, slow it down a little bit more or just take a breath, you know, stop pushing for the minute.
00:20:01.119 --> 00:20:12.960
So listening to that instruction is really important because making sure that your baby's head is coming down and birthing really slowly is going to really be a massive factor in whether you or not you tear at the end of the day.
00:20:13.119 --> 00:20:13.279
Yeah.
00:20:13.839 --> 00:20:15.839
And it might push you to be stretching too quickly.
00:20:16.240 --> 00:20:16.720
Absolutely.
00:20:16.880 --> 00:20:23.680
And it might involve, with your consent, the midwife or obstetrician applying a little bit of counter pressure on your baby's head just to help slow them down.
00:20:23.839 --> 00:20:29.680
And it might be supporting your perineum with their hand, and that's where the warm compress comes in as well.
00:20:29.759 --> 00:20:31.279
So there's usually a warm cloth.
00:20:31.440 --> 00:20:36.240
Again, if you're comfortable with that, just holding that up against the perineum to help slow that down.
00:20:36.319 --> 00:20:42.799
And the warmth of the cloth can actually really help with pain relief as well, and also help with that stretching of that skin and tissue.
00:20:43.440 --> 00:20:44.480
Really good method, isn't it?
00:20:44.720 --> 00:20:44.880
Yeah.
00:20:45.519 --> 00:20:55.200
Talking about warm compressors, that of course makes sense trying to make the tissue a bit more flexible and make that more comfortable when the head is coming out.
00:20:56.400 --> 00:20:57.599
What about water birth?
00:20:57.759 --> 00:21:03.279
How about if someone's giving birth in water and and what kind of effect does that have on the risk of tearing?
00:21:03.839 --> 00:21:08.000
Yeah, so it actually doesn't really change the statistics at all.
00:21:08.240 --> 00:21:23.200
Um the benefit of water birth for a lot of women can be it's a natural pain reliever and it can help women stay calm or calm them down, especially during that sort of transition period towards that late stage of labor when birth's sort of imminent.
00:21:23.519 --> 00:21:31.839
So those factors, if you've got a woman who's really calm and in a good headspace, that in itself, as we said, is going to help reduce the risk of tear.
00:21:32.160 --> 00:21:36.960
But the water itself is not going to assist in reducing that risk.
00:21:37.359 --> 00:21:41.359
With warm compressors, the temperature of the water is really important.
00:21:41.519 --> 00:21:49.200
So there's a Hannah Darlin study I have a couple years ago that spoke about research on the temperature of water for warm compressors to be the most optimal.
00:21:49.359 --> 00:21:51.839
And that was between 38 and 44 degrees.
00:21:52.079 --> 00:21:59.839
And so even when you were using warm compressors, it's important for midwives and doctors to continue to make sure that that water temperature actually is maintained.
00:22:00.640 --> 00:22:03.359
And then we're not just putting cold water because that's there's no point.
00:22:04.319 --> 00:22:05.279
It's also not very comfortable.
00:22:05.519 --> 00:22:06.720
It's not comfortable, no.
00:22:06.960 --> 00:22:10.880
But with water birth, usually the temperature is around 37 degrees.
00:22:10.960 --> 00:22:13.920
So it's slightly lower than what we use for warm compressors.
00:22:14.160 --> 00:22:20.559
It doesn't mean it's harmful, but it's just it's not a I guess a substitute for warm compressors.
00:22:20.799 --> 00:22:20.960
Okay.
00:22:21.119 --> 00:22:25.279
But the benefits of water birth also can help reduce that risk of tearing anyway.
00:22:25.759 --> 00:22:26.640
Yeah, that makes sense.
00:22:26.960 --> 00:22:27.200
Great.
00:22:27.680 --> 00:22:30.720
What's happened and then how to manage it afterwards.
00:22:31.279 --> 00:22:38.000
And then once the vaginal assessment has been done, they might also recommend a rectal examination.
00:22:38.319 --> 00:22:41.200
So this can be a little bit more awkward and a little bit more uncomfortable.
00:22:41.519 --> 00:22:44.079
But and again, it can only be done with your consent.
00:22:44.240 --> 00:22:53.599
But it's really, really important to consider because there is one other tear that could occur that doesn't really fall into any of the other categories, and that's a button-hole tear.
00:22:53.839 --> 00:22:59.200
And it doesn't actually involve any of the sphincter muscles or any of the perineal muscles, really, either.
00:22:59.440 --> 00:23:04.880
It's sort of in isolation, but it can have really catastrophic effects if it's not diagnosed.
00:23:05.200 --> 00:23:12.079
Women can experience feces coming through their vagina because it sort of creates a tunnel, I guess, if it's not identified.
00:23:12.640 --> 00:23:16.880
And so the only way to really diagnose this at all is by doing a rectal examination.
00:23:16.960 --> 00:23:20.480
It can still be tricky to identify with a vaginal assessment.
00:23:20.960 --> 00:23:24.640
So that's when that sort of discussion might be had as well.
00:23:24.960 --> 00:23:37.599
And it's quite common for us to ask every woman, even when we see that the entire perineum or vagina is in completely intact, we might still offer it to you because it's again just to rule out that final details that could have occurred.
00:23:38.000 --> 00:23:38.319
Exactly.
00:23:38.799 --> 00:23:52.000
And by buttonhole, we mean a small hole between the bottom and the vagina that happens higher up than where we can see on the outside of the vaginal opening.
00:23:52.240 --> 00:23:52.720
Yeah, that's right.
00:23:53.039 --> 00:23:56.480
Where the baby's head may put some pressure on as it's coming down.
00:23:56.880 --> 00:23:57.440
Very rare.
00:23:57.759 --> 00:23:58.160
Very rare.
00:23:58.400 --> 00:24:00.720
But as you said, something that we we don't want to miss.
00:24:00.880 --> 00:24:00.960
Yeah.
00:24:01.200 --> 00:24:02.640
As a consequence, it's going to be quite bad.
00:24:03.119 --> 00:24:03.519
That's right.
00:24:22.319 --> 00:24:27.440
After we've examined thoroughly, we usually then try and repair things.
00:24:27.759 --> 00:24:32.720
As you said, we don't have to do it straight away unless there's concerns about pain or bleeding.
00:24:33.200 --> 00:24:43.519
But it is often nice to get it done quickly so that obviously we can get you just feeling back to normal and recovering and enjoying that time with the baby as quickly as possible.
00:24:43.920 --> 00:24:54.880
So and often that will be, particularly if you've had any pedural, it will be quite quickly so that we can make sure that that pain relief and the epidural is still working so you don't have any discomfort.
00:24:56.079 --> 00:25:04.000
Importantly, when we do repair the stitches, if you don't have an epidural, we make sure we put in some local pain relief.
00:25:04.319 --> 00:25:08.319
And that will usually be in the form of some local anesthetic with an injection.
00:25:08.720 --> 00:25:08.960
Yes.
00:25:09.599 --> 00:25:17.839
Or sometimes an injection into the nerves around the pelvic area called a pudendal block, which is a bigger needle.
00:25:18.000 --> 00:25:20.799
But usually it's at least some local anesthetic.
00:25:20.880 --> 00:25:23.680
So we we want to make sure that the process is comfortable for you.
00:25:24.160 --> 00:25:25.039
Yeah, absolutely.
00:25:25.119 --> 00:25:34.319
And just going back to sort of the timing of repair, women have a rush of adrenaline running through their bodies after birth, and that adrenaline itself can be a natural anesthetic condition.
00:25:35.039 --> 00:25:45.440
So it can be helpful to do it quite soon after, just so that we're optimizing all those amazing hormones after birth to sort of help support you as well, so you're not feeling as much discomfort.
00:25:45.680 --> 00:25:50.240
As you said, Rangi, those are usually the main forms of analgesia that we would give.
00:25:50.480 --> 00:25:52.319
You can use the gas as well.
00:25:52.400 --> 00:26:02.000
So if you've used gas during your labour or your birth, or even if you haven't had time to use that, but you want to give it a go, this is your last chance to use it.
00:26:02.319 --> 00:26:07.440
And even just things like focusing on your baby or having your partner support.
00:26:07.599 --> 00:26:17.680
I don't think it's very popular or it's not been really established here in Australia, but there's a lot of research being done around virtual reality and how that can be actually like a natural anesthetic almost.
00:26:17.839 --> 00:26:25.279
So yeah, women are being sent on to beaches or in safari jungles just while they're being suited repaired.
00:26:25.839 --> 00:26:32.000
Yeah, and it's actually being shown to really reduce their um degree of pain and discomfort during that repair period.
00:26:32.160 --> 00:26:35.519
So anything to distract you can also be really, really helpful.
00:26:35.759 --> 00:26:37.519
Yep, and the best distraction is your baby.
00:26:37.839 --> 00:26:39.119
Yeah, yeah, absolutely.
00:26:39.200 --> 00:26:53.039
But it's important that if you are experiencing pain during the repair, it's normal to feel touching and some pressure, but actual pain itself, it's important that you're letting your midwife or doctor know about that so that they can give you some more pain relief.
00:26:53.279 --> 00:26:54.240
That's right, we don't want that.
00:26:54.480 --> 00:26:55.279
Absolutely not.
00:26:56.079 --> 00:27:02.559
Afterwards, we usually do give you some also local pain relief in the bottom as well, don't we?
00:27:02.799 --> 00:27:12.079
So we do that bottom check, as you mentioned, to check that there's no tears involving the bottom or the bottom muscles before we start stitching.
00:27:12.559 --> 00:27:32.240
But we also do another bottom check to again make sure that there's no stitches where uh the bottom is involved, but also to give you usually some suppositories of pain relief and that will work really well in that local area, be absorbed from the bottom, and basically just pan it all in and anti-inflammatory is what we give you.
00:27:32.319 --> 00:27:36.799
But it seems weird that we would give it to you in the bottom, but it works really well in that area, doesn't it?
00:27:37.039 --> 00:27:42.480
Yeah, I guess if you think about it, it just has less of a distance to travel to the pain, to the side of the pain.
00:27:42.640 --> 00:27:42.880
Yeah.
00:27:43.279 --> 00:27:50.640
You you really need to do that once, usually, and so um going forward you can just take oral um analgesia for to support you after that.
00:27:51.039 --> 00:27:52.240
Yeah, just tablets, yeah.
00:27:52.480 --> 00:27:52.799
I know.
00:27:52.880 --> 00:28:06.880
And then the reason why I mention it is because sometimes people are a bit confronted and surprised when you might ask them to do a rectal exam for either the first bit before you stitch or afterwards when you're putting the suppositories in.
00:28:06.960 --> 00:28:09.039
It's just good to be prepared for that.
00:28:09.200 --> 00:28:11.839
It's completely normal and will help with your recovery.
00:28:12.160 --> 00:28:12.480
Absolutely.
00:28:12.799 --> 00:28:13.759
Yeah, good point.
00:28:14.960 --> 00:28:16.480
It's not every day that that happens.
00:28:16.559 --> 00:28:17.359
So it's not.
00:28:17.680 --> 00:28:18.960
It's fair enough.
00:28:19.440 --> 00:28:26.079
We've talked a lot about how we can minimise tears and prepare for them, but we can't take away that risk completely, can we?
00:28:26.400 --> 00:28:27.440
No, no, we can't.
00:28:27.599 --> 00:28:31.599
And it's just part of the nature of birth, unfortunately.
00:28:31.920 --> 00:28:38.799
And it might be a a poor comparison, but if you compare it even to a C-section, there's a hundred percent chance that there's going to be a cut.
00:28:39.039 --> 00:28:39.200
Yes.
00:28:40.559 --> 00:28:54.559
So, you know, there's there's other factors that affect from a vaginal birth perspective, but there's a lot of reassurance around um, you know, for women to to understand that it doesn't, yeah, the tears, if they do sustain it, are often going to be very minimal.
00:28:55.279 --> 00:28:55.839
Yeah.
00:28:56.160 --> 00:29:05.279
Now, if you do have a tear, we've mentioned it briefly, but and it also, of course, depends on what type of tear and the extent of everything else that's going on.
00:29:05.359 --> 00:29:09.119
But what are some of the things that we can do to support recovery early on?
00:29:09.599 --> 00:29:11.279
Yeah, so plenty of rest.
00:29:11.440 --> 00:29:14.240
I think as a society, we're really bad at doing that.
00:29:14.400 --> 00:29:21.519
If we talk about building a village, but for some women that can actually be really challenging, depending on what kind of family or friendship that support that they have.
00:29:21.599 --> 00:29:26.079
But trying to get as much rest as possible is so important in the weeks post.
00:29:26.240 --> 00:29:31.279
But in that initial period, so rest, keeping pressure off that area if you have had stitches.
00:29:31.359 --> 00:29:34.400
So especially if it's a bit tender, still, put a pillow under.
00:29:34.480 --> 00:29:37.119
You can get those inflatable donut rings if they're helpful.
00:29:37.200 --> 00:29:39.039
But a pillow is often just fine.
00:29:39.119 --> 00:29:48.000
If you're breastfeeding, try and breastfeed baby on your side, or just tilt your hips a little bit so you're just not having that pressure on that area as much.
00:29:48.319 --> 00:29:52.079
You can use ice packs as well just to help reduce that pain.
00:29:52.319 --> 00:30:08.960
Changing a pad regularly so that you're not increasing the risk of infection to that area because you've got to remember it is still a wound that needs to heal, and keeping it clean, so giving it a little clean with just some water, number no soap in that area in those days following when your bleeding's the most heavy.
00:30:09.200 --> 00:30:21.440
Avoiding like baths and soaking because we just don't, again, want to increase risk of infection, but we also don't want to increase the pace at which those stitches are absorbing and breaking down as well.
00:30:21.759 --> 00:30:40.799
And then just being mindful of if the pain is increasing or you're feeling like there's swelling or a redness or burning or heat or abnormal discharge in that area, that you're letting your care provider know that this is happening so that they can review it and make sure that it's nothing worse that has happened.
00:30:41.200 --> 00:30:45.839
What we worry about in terms of complications with the tears might be an infection.
00:30:46.240 --> 00:30:46.559
Correct.
00:30:46.799 --> 00:30:47.519
Which is not common.
00:30:47.839 --> 00:30:48.559
It's not common at all.
00:30:49.039 --> 00:30:52.319
But certainly a possibility when you have any wound in your body.
00:30:52.640 --> 00:30:53.119
Absolutely.
00:30:53.359 --> 00:30:58.559
And particularly when that wound is in an area that already has a lot of bacteria, which is normal.
00:30:58.880 --> 00:31:01.599
But there we want to make sure that there's no infection.
00:31:02.640 --> 00:31:06.880
So, as you said, if you have any of the symptoms, important to let your health provider know.
00:31:07.200 --> 00:31:07.359
Yeah.
00:31:07.680 --> 00:31:12.480
And it might be just a case of watching and seeing or some tablet antibiotics.
00:31:12.799 --> 00:31:17.359
And very rarely, if you're very unwell, you might need some intravenous antibiotics.
00:31:18.559 --> 00:31:25.759
It's really uncommon that any infection or problems with your tear might need to have another procedure.
00:31:26.640 --> 00:31:28.640
We usually try not to do that, don't we?
00:31:28.880 --> 00:31:29.759
Yeah, yeah, yeah, we do.
00:31:29.839 --> 00:31:31.440
And like you said, it's really uncommon.
00:31:31.599 --> 00:31:38.319
And it you will usually stem from initially like an infection that's then just started to affect the healing process of that actual wound.
00:31:38.559 --> 00:31:38.799
Yeah.
00:31:39.039 --> 00:31:40.319
So getting onto it early is important.
00:31:40.720 --> 00:31:41.759
Getting onto it early is important.
00:31:41.839 --> 00:31:53.920
And often we don't necessarily need to re-stitch the wound or anything, it's just a bit like you said, watch and wait, antibiotics and just yeah, managing those symptoms until that healing starts to progress a little bit further.
00:31:54.400 --> 00:31:59.279
I thought as well, in terms of sort of those couple of days following bow motions.
00:31:59.680 --> 00:32:01.599
Yeah, I was about to say, yes.
00:32:02.160 --> 00:32:14.799
I think one of the big things that, and and we'll talk about this on a separate episode, but one of the big things that people often fear after they've given birth, particularly vaginally, is that first time they have to open their bowels afterwards.
00:32:15.359 --> 00:32:17.119
It's really a confronting experience.
00:32:17.279 --> 00:32:22.000
Then if you add stitches on top of that, so many women have said to me, What if I tear my stitches?
00:32:22.480 --> 00:32:23.119
You won't.
00:32:23.359 --> 00:32:26.799
You won't tear your stitches, but it I know it can definitely feel like you might.
00:32:26.880 --> 00:32:29.920
So it's important to make sure that you're not constipated.
00:32:30.000 --> 00:32:30.079
Yeah.
00:32:30.319 --> 00:32:35.599
And taking medication if you need to to help soften your poo so that you can go without too much straining.
00:32:35.759 --> 00:32:37.440
So avoid straining at all costs.
00:32:37.519 --> 00:32:43.759
Just like in pregnancy, we advise to you know reduce your the risk of of constipation because of your pelvic floor.
00:32:43.920 --> 00:32:44.880
We've got to let that rest.
00:32:44.960 --> 00:32:47.119
So it's the same in the postpartum period as well.
00:32:47.359 --> 00:32:47.759
Yeah.
00:32:48.079 --> 00:32:48.559
Important.
00:32:48.720 --> 00:32:49.039
Yep.
00:32:49.359 --> 00:32:50.799
What about in the long term?
00:32:50.960 --> 00:32:57.920
Well, now we had a really great episode with um Professor Helena Frawley that people can listen to, where we go into this in detail.
00:32:58.079 --> 00:33:11.599
But just briefly, after those first few weeks of rest and recovery for these tears and wounds, what else do you think people can do in the long term to make sure their tears and their pelvic floor are best managed?
00:33:11.839 --> 00:33:15.039
Yeah, so pelvic floor exercises is generally the answer for that.
00:33:15.359 --> 00:33:17.599
And pelvic floor exercises are encouraged.
00:33:17.920 --> 00:33:19.440
We should have been doing them before pregnancy.
00:33:19.680 --> 00:33:21.599
So long before everybody should do that.
00:33:21.759 --> 00:33:22.400
Everyone just should do that.
00:33:22.640 --> 00:33:23.519
Should be taught in high school.
00:33:23.759 --> 00:33:26.079
Absolutely, absolutely should be taught in high school.
00:33:26.240 --> 00:33:29.680
Um so if you haven't done it yet and you're pregnant, start doing them now.
00:33:29.839 --> 00:33:35.279
They're going to not only support your recovery, but they can also actually support you to have an easier labour and birth as well.
00:33:35.359 --> 00:33:43.279
Because if you've got strong pelvic floor muscles, then your ability to mobilize them and push is going to be a lot better than if you don't.
00:33:43.440 --> 00:33:46.240
And when I mean strong pelvic floor muscles, I don't mean tight.
00:33:46.400 --> 00:33:47.359
You want them to be mobile.
00:33:47.519 --> 00:33:50.720
So you want to be able to relax and contract them evenly.
00:33:50.880 --> 00:33:57.920
But there's lots of apps and there's lots of, you know, YouTube videos that you can Google to just show you how to do pelvic floor exercises.
00:33:58.079 --> 00:34:04.079
And I think you said you have a physio episode prior to this, so I'm sure she goes into a lot of detail about them.
00:34:04.480 --> 00:34:17.760
But yeah, within sort of the first two weeks of giving birth, like start your pelvic floor exercises, but also know that even if you were able to do 20 kegels before birth, and you can only do one now, that's okay.
00:34:17.840 --> 00:34:19.519
And so don't overdo it.
00:34:19.760 --> 00:34:21.199
Do what works for you.
00:34:21.440 --> 00:34:22.159
And what feels comfortable.
00:34:22.400 --> 00:34:23.920
And what feels comfortable, absolutely.
00:34:24.079 --> 00:34:24.320
Yeah.
00:34:24.480 --> 00:34:26.239
But they're going to help your recovery.
00:34:26.400 --> 00:34:35.280
They're going to help if you're choosing to have more children after your first one in the future, then that's going to make pregnancy and birth easier for you the second, third, and fourth time round as well.
00:34:35.840 --> 00:34:43.199
And reduce some of those other complications that we want to avoid, like problems with keeping your farts and your poos in and your wee.
00:34:43.679 --> 00:34:44.480
Yeah, absolutely.
00:34:44.639 --> 00:34:44.960
That's it.
00:34:45.280 --> 00:34:46.639
Strengthening the pelvic floor.
00:34:46.800 --> 00:34:47.280
Yeah.
00:34:47.920 --> 00:35:02.159
One other question that commonly comes up, and you know, not everyone is always thinking about this or may take longer to think about it, but it's an important point is when can people resume sexual intercourse after they've had a tear?
00:35:02.480 --> 00:35:03.519
When you're ready.
00:35:04.320 --> 00:35:05.679
It's a good answer.
00:35:06.000 --> 00:35:13.360
I know we have this sort of six-week rule, and that's usually because women will generally fit stop bleeding by six weeks.
00:35:13.679 --> 00:35:19.519
In terms of any tears that have needed to be repaired, the healing should have completed by that time.
00:35:19.679 --> 00:35:24.639
But I think it's important that women understand that there's no golden rule around sexual intercourse.
00:35:24.719 --> 00:35:27.760
It's really up to how you feel and what's comfortable for you.
00:35:27.920 --> 00:35:30.239
And knowing that it might take a bit of time.
00:35:30.400 --> 00:35:35.039
I remember Physio said to me after my first baby, it's just like your first time all over again.
00:35:35.199 --> 00:35:37.519
You just gotta sometimes rip the band-aid off.
00:35:38.719 --> 00:35:41.119
And then after the first time, you realise it's not so bad.
00:35:41.360 --> 00:35:42.000
It's not so bad.
00:35:42.079 --> 00:35:42.239
Yeah.
00:35:43.199 --> 00:35:51.280
But if you are having any sexual function issues, I think historically we've been told as women or that you've had a baby, so you could probably expect to feel that.
00:35:51.360 --> 00:35:53.440
But it's important you understand it's not normal.
00:35:53.679 --> 00:36:03.840
Um, and you know, we can do things to help women recover from any ongoing or issues that maybe uh have carried out a little longer post-birth than what they should have.
00:36:04.159 --> 00:36:05.440
Yeah, that's that's really important.
00:36:05.679 --> 00:36:05.840
Yeah.
00:36:06.079 --> 00:36:07.199
We don't want you to be feeling like that.
00:36:07.679 --> 00:36:09.360
No, you don't have to suffer in silence.
00:36:09.679 --> 00:36:10.239
Yeah.
00:36:10.559 --> 00:36:11.119
Great.
00:36:11.440 --> 00:36:19.039
We did talk about not trying to soak too much in baths, but we have previously recommended things like cis baths and things like that.
00:36:19.119 --> 00:36:20.159
What are your thoughts on that?
00:36:20.559 --> 00:36:23.920
There's not a whole lot of strong evidence around sort of whether they're helpful or not.
00:36:24.079 --> 00:36:28.159
I think in terms of if it's pain that you're really worried about, then that can sometimes be helpful.
00:36:28.239 --> 00:36:30.400
And again, it can be quite soothing to sit in a bath.
00:36:30.559 --> 00:36:39.199
It's more probably whether you put things in the bath, or I know some women will put witch hazel on their pads to help with pain and and healing and that kind of thing.
00:36:39.440 --> 00:36:42.000
It's important to know that that can actually cause more problems.
00:36:42.159 --> 00:36:49.840
So just avoiding anything to apply directly over that area, that perineal area after birth is really important to avoid for the first couple of weeks.
00:36:50.159 --> 00:36:51.039
That's really important.
00:36:51.280 --> 00:36:55.760
There's actually no evidence that there's m any benefit with those things and it can cause harm.
00:36:56.000 --> 00:36:56.239
Yep.
00:36:56.320 --> 00:36:56.480
Yeah.
00:36:56.639 --> 00:36:56.800
Yeah.
00:36:57.119 --> 00:37:01.199
It doesn't necessarily mean that it will definitely cause harm, but it's not going to be of really any benefit.
00:37:01.920 --> 00:37:02.079
Yeah.
00:37:02.159 --> 00:37:02.639
Yeah.
00:37:03.119 --> 00:37:08.800
I think it's really important to know that just because you've had a tear once doesn't necessarily mean you'll have another one.
00:37:09.599 --> 00:37:14.480
You've actually got less of a chance of having another one the second or third time round than you do the first time.
00:37:14.880 --> 00:37:18.880
So that's can be really reassuring, especially if you've had only a small tear the first time.
00:37:19.039 --> 00:37:22.079
You will likely maybe only have that again or or nothing at all.
00:37:22.239 --> 00:37:22.400
Yeah.
00:37:22.880 --> 00:37:25.199
Because that tissue has stretched already.
00:37:25.440 --> 00:37:25.599
Yeah.
00:37:25.920 --> 00:37:26.400
Is the theory.
00:37:26.880 --> 00:37:27.360
Absolutely.
00:37:27.599 --> 00:37:28.000
Absolutely.
00:37:28.639 --> 00:37:37.840
There are obviously other factors that go into that, as you said, like size of baby and length of labour, which of course is hard to predict the second time, but in general, less likely.
00:37:38.159 --> 00:37:38.960
Yes, yeah.
00:37:40.159 --> 00:37:46.559
And when people have a tear in their perineal area, it can be quite confronting.
00:37:46.800 --> 00:37:59.280
And sometimes it can affect the way you might feel about your body and particularly that area, whether it comes to your confidence or even, as we mentioned, your sexual function and your intimacy.
00:37:59.599 --> 00:38:03.039
What are some things that you would say about that and advice you might give people?
00:38:03.360 --> 00:38:04.880
I'm gonna quote my boss here.
00:38:05.679 --> 00:38:11.360
And she will always tell her women to take a vulfi before birth.
00:38:11.599 --> 00:38:13.920
So a selfie essentially of your vulva.
00:38:14.320 --> 00:38:14.800
Oh wow!
00:38:16.239 --> 00:38:16.719
That's great!
00:38:17.039 --> 00:38:17.920
Cause it's a vulfi.
00:38:18.239 --> 00:38:26.320
Now that could also be quite confronting, I think, for a lot of women, and again, this is just this is just growing up as a woman, as you know, as a young girl and a woman.
00:38:26.400 --> 00:38:30.960
We're not encouraged to explore our bodies or even look down there.
00:38:31.119 --> 00:38:35.679
So the first time you ever look down there might actually be when you're pregnant or after you've given birth.
00:38:36.159 --> 00:38:47.760
But if you can look down there before you give birth and you can see what your normal is, because I think it's really important women know that your anatomy is going to be very different to your friend's anatomy or the woman birthing next to you.
00:38:47.920 --> 00:38:48.159
That's right.
00:38:48.320 --> 00:38:56.000
So if you can know what your normal is, especially after birth, whether you've torn or not, you can have a look again and say, well, yep, it all looks the same.
00:38:56.159 --> 00:38:59.280
Or if you have torn, hey, they did a really good job.
00:38:59.599 --> 00:39:02.000
Or perhaps something doesn't look right.
00:39:02.079 --> 00:39:06.559
And so if you you're able to do that, then you could report that and we can address that.
00:39:06.800 --> 00:39:10.400
So yeah, have it doing it's a really great idea.
00:39:10.480 --> 00:39:10.960
I love it.
00:39:11.199 --> 00:39:12.159
It's a really great idea.
00:39:12.320 --> 00:39:21.840
And even um, you know, even if again with your partner, if you're comfortable with your partner sort of, I mean, I'm sure they've probably probably know your body better than you know yourself, your own sometimes.
00:39:22.159 --> 00:39:29.039
But I've even had to ask partners before when I've done a repair for a woman, does that look right?
00:39:29.679 --> 00:39:30.719
Just double checking.
00:39:30.960 --> 00:39:38.880
I mean, they can usually tell us so and they're usually very inquisitive and keen to, again, keen to be a part of anything that they can be.
00:39:39.039 --> 00:39:54.239
But that I guess is probably the most helpful, and it sort of reduces that overall fear about what's happened to your body as well, because we know that pregnancy is a completely transformative experience, physically and emotionally, that continues to evolve after you've given birth as well.
00:39:54.320 --> 00:40:05.599
Yes, and so it's important that you're feeling comfortable in your own skin, and that can take a little bit of time, um, but just be kind to yourselves, and if you are concerned in any way, it's important that you seek help.
00:40:05.760 --> 00:40:06.960
Yeah, really good advice.
00:40:07.440 --> 00:40:08.000
Thanks, Mel.
00:40:08.239 --> 00:40:09.119
Yeah, take a ball fit.
00:40:09.360 --> 00:40:11.840
Yeah, I've never heard that, but that's fantastic.
00:40:12.000 --> 00:40:14.159
I'm gonna use that from now on.
00:40:14.639 --> 00:40:15.360
Fantastic.
00:40:15.519 --> 00:40:15.840
Thank you.
00:40:16.079 --> 00:40:16.960
No worries, thank you.
00:40:17.199 --> 00:40:18.079
Thanks so much, Mel.
00:40:18.159 --> 00:40:18.880
That was really great.
00:40:19.039 --> 00:40:30.559
Um, I think we covered some really important topics about what exactly tears are, how we manage them, and hopefully that gives people information and makes them less fearful and concerned about it.
00:40:30.639 --> 00:40:33.440
And information is is power when it comes to this.
00:40:33.760 --> 00:40:34.480
It definitely is.
00:40:34.639 --> 00:40:43.440
As scary as some of the information can sometimes be, I think going into birth prepared will definitely help with your feelings around your birth afterwards as well.
00:40:44.079 --> 00:40:44.800
Fantastic.
00:40:44.960 --> 00:40:46.000
Thanks so much, Melanie.
00:40:46.239 --> 00:40:46.559
Thank you.
00:40:47.039 --> 00:40:47.920
We'll see you next time.
00:40:48.159 --> 00:40:48.960
See you next time.
00:40:49.280 --> 00:40:50.880
Every pregnancy is unique.
00:40:51.039 --> 00:40:56.320
The information provided in today's podcast is for educational and general purposes only.
00:40:56.480 --> 00:41:00.320
It is not intended to be substitute for professional medical advice.
00:41:00.480 --> 00:41:10.320
It is important that you always seek the guidance of qualified health professionals with any questions you may have regarding your health, pregnancy, or any medical conditions.
00:00:01.439 --> 00:00:09.919
Welcome to Prepare, the Mercy Perinatal podcast dedicated to helping parents prepare for the journey of pregnancy, childbirth, and early parenthood.
00:00:10.160 --> 00:00:22.399
Mercy Perinatal would like to begin by acknowledging the Wawundri Woiwarung people, traditional custodians of the land on which we gather today, and also the traditional custodians of the lands in which you're listening from today.
00:00:22.640 --> 00:00:31.679
We'd like to pay our respects to the elders past, present, and emerging, and we extend that respect to Aboriginal and Torres Strait Islander peoples listening today.
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Hi everyone, welcome to Prepare.
00:00:34.079 --> 00:00:34.719
My name is Dr.
00:00:34.880 --> 00:00:40.399
Rangi, and I am an obstetrician and gynecologist and perinatal researcher here at Mercy Perinatal.
00:00:40.799 --> 00:00:45.359
And we are so excited to be joined by the lovely Melanie Francis today.
00:00:45.600 --> 00:00:49.679
We're going to be talking about a really important topic, which is birth tears.
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And birth tears are a really common part of vaginal birth, but they're often not talked about openly.
00:00:55.840 --> 00:01:01.200
But it's a really important topic and a topic where people have lots of questions and concerns.
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And whilst it can be a bit confronting to hear about them, I think it's important that you feel informed and prepared rather than fearful.
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So hopefully we're going to help do that for you today.
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So I'd love to introduce Melanie.
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Thank you so much for joining us, Mel.
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Thank you for having me.
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Melanie is a clinical midwifery educator and experienced midwife with a really special interest in perineal trauma and women's health.
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She spent many years working as a clinical midwife before moving into education, where she now helps clinicians develop the knowledge and skills needed to support women through pregnancy, birth, and postpartum recovery.
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Thanks so much, Mel.
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Thank you for having me.
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Excited to be here.
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So, Mel, can you tell us a little bit about why you've developed such a strong interest in this particular topic?
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Yeah, I think it comes initially from my just my general interest in women's health.
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And when I first became midwife, I always wanted to make sure I was working to my full scope of practice.
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And so incorporating perineal repair into that was really important to me.
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And once I did learn how to suture, I think that's when it became really obvious to me how fundamental it is for us as care providers to be able to inform women of the facts around vaginal birth and also be able to give them the support that they need to be able to reduce their risk of tears and how we can manage their birth so that they have really good outcomes afterwards.
00:02:21.680 --> 00:02:24.080
So that's sort of where that passion has come from.
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And then since moving into the space of Gind Zone and being able to support more midwives to be able to not only suture but increase their knowledge on diagnostics and assessment of tears, that's just become even more evident of how important this work is.
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Yeah, yeah, so important, isn't it?
00:02:39.919 --> 00:02:48.080
So by suturing, you're talking about stitching and repairing the Yeah, that's the most common method of repairing a perinal laceration.
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Um there is some more research being done around the use of glue, which is ongoing and I think would be really amazing if we have something other than stitches that we could use for tears.
00:03:01.280 --> 00:03:08.560
But at the moment, particularly with the larger tears, it is the best option to use suture material for those kinds of injuries.
00:03:08.639 --> 00:03:08.960
Yeah.
00:03:09.439 --> 00:03:11.759
We'll talk about that in a little bit more detail.
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But can we first talk about what how do you describe what happens when a tear is happening during vagina birth?
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Yeah, so tears are really, really common.
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I think it's really important for women to understand that up to 90% of first-time mums will sustain a tear.
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And although that can sound like a really scary statistic, it doesn't mean that these are life-altering injuries.
00:03:36.800 --> 00:03:41.360
For the majority of women, these are really superficial and they heal really, really well.
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The reason they occur is because the skin around the vagina or between the vagina and the rectum stretches and sometimes it just reaches capacity before the baby's head can be born, and that's when that tear can sometimes occur.
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Yeah.
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I think it's really important that you said that it is quite common, but it doesn't necessarily mean it's going to be a terrible injury.
00:04:03.280 --> 00:04:03.439
Yeah.
00:04:03.680 --> 00:04:12.319
And there's lots of things that we can do to try and prevent it or minimise the extent of tearing, and also important to try and repair those really well.
00:04:12.719 --> 00:04:13.759
Absolutely, absolutely.
00:04:13.840 --> 00:04:16.800
And those really minor ones, sometimes we don't need to do anything at all.
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It might just be an ice pack and some panatol, and that's all they need, and within a week they're healed.
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No long-term effects really occur from them.
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Yeah.
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Yeah.
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But there's definitely lots of things that we can do to prevent the risk of those larger tears from happening for sure.
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Yeah.
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So what are some of those things that we know in the evidence has been shown to reduce those risks?
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Yeah, so things in the antenatal period that can be really helpful is perineal massage.
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So that's something that not all women are really familiar with.
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It's not an easy thing to do having my having my own baby and actually trying it myself when you've got a pregnant baby.
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Yeah, when you're 36 weeks pregnant, you're trying to put your hands down there, it can actually be quite challenging.
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But the goal is to just softly massage that perineal space.
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So, as I said, the perineum is that skin between the entrance of the vagina and the anus that stretches at birth.
00:05:05.759 --> 00:05:12.160
So if we can try and soften the tissue around that area, it'll allow it to stretch.
00:05:12.319 --> 00:05:14.399
The idea is that it will stretch a lot easier.
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Also, I think just having women massage that area and get used to the sensation of that of pressure and stretch actually happening in that area can make it a little less scary when it's actually happening when the baby's head's putting pressure on there too.
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That's a good point.
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Yeah.
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Yeah.
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So that particular method or technique can really reduce the risk of severe tears during childbirth.
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Yeah.
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Other things can be during the birth itself, can be the use of warm compressors, which are usually supported by the midwife or the doctor who's assisting with the birth.
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But birth positions is a really, really important factor.
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So we know that any position that puts pressure on that perineal area is going to cause an increased risk of tearing.
00:06:00.319 --> 00:06:10.720
So women lying on their side or kneeling can really reduce that risk because if you think of gravity, there's not that ongoing pressure, persistent pressure on that space.
00:06:11.199 --> 00:06:11.759
Great.
00:06:11.920 --> 00:06:21.199
And going back to the perineal massage, when would we recommend people start to do that and how often do they need to do it for there to be a benefit?
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Yeah, so anytime from sort of, I would say 36 weeks onwards is fine.
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There's not really evidence to suggest that doing it any earlier is going to make much of a difference.
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Okay.
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But just daily, if the woman's comfortable with, or even just as much as they are comfortable with.
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So if it's just every second day or once a week, as long as they're happy to have a go.
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But ideally, based on the evidence, once a day from sort of 36 weeks, just for a five minutes or so, yeah, it can really make a difference.
00:06:49.439 --> 00:06:53.040
And do you usually recommend just going into the real practical aspects?
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Do you recommend they use some lubrication?
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Yeah, so lubrication will definitely help.
00:06:57.920 --> 00:07:02.480
So olive oil, really cheap, you'll probably already have it in your kitchen, can be really helpful.
00:07:02.639 --> 00:07:02.720
Yeah.
00:07:02.879 --> 00:07:04.560
You can get other water-based lubricants.
00:07:04.720 --> 00:07:09.360
Really important that anything with like heavy fragrances or stuff like other emollients and oil.
00:07:09.680 --> 00:07:10.160
Avoid those.
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Yeah, avoid those.
00:07:11.199 --> 00:07:14.240
So yeah, just your really natural stuff is really helpful.
00:07:14.560 --> 00:07:14.800
Cool.
00:07:15.040 --> 00:07:23.279
And as you said, sometimes it can be difficult physically to do that yourself, particularly when you are 36 weeks pregnant and beyond.
00:07:23.600 --> 00:07:28.639
Is it helpful to sometimes see if your partner can support you if they're comfortable and you're comfortable with that?
00:07:28.879 --> 00:07:29.759
Yeah, absolutely.
00:07:29.920 --> 00:07:32.879
I think most partners are really they want to help.
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I think they get, you know, during pregnancy, they've got to just sit and just watch their partner go through this experience on their own.
00:07:39.600 --> 00:07:43.199
And so if they can be involved in any way, they often will do that.
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And if, you know, obviously as a woman, if you're comfortable having them support you, then that's really important too.
00:07:48.879 --> 00:07:57.920
But yeah, it can be really, really beneficial for you to both to do it, and that can be sort of a bonding moment as well as a couple and in terms of the preparation of welcoming your baby.
00:07:58.240 --> 00:07:59.519
Definitely, definitely.
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But as you mentioned, there are some people who might find that difficult or the idea of it difficult for whatever reason, and that's okay, isn't it?
00:08:07.680 --> 00:08:08.560
Absolutely, absolutely.
00:08:08.639 --> 00:08:10.399
You've got to do what's right for you.
00:08:10.480 --> 00:08:16.160
Um, you've got to feel comfortable in your own body and being pregnant is a really big change, you know, physically.
00:08:16.240 --> 00:08:22.240
So if you're not comfortable, having someone else help you with that, if you just want to do it, try it yourself, that's totally fine.
00:08:22.560 --> 00:08:25.680
Trying to get into a position that's gonna make it the easiest for you.
00:08:25.839 --> 00:08:36.159
Generally on your back is probably the easiest, but sometimes even if it's just in the shower, if you can sort of if you're able to reach down, at least the water can sometimes distract you sort of from what else.
00:08:36.480 --> 00:08:36.799
Or the bath.
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Yeah, or the bath.
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Yeah, absolutely.
00:08:39.120 --> 00:08:39.360
Yeah.
00:08:39.919 --> 00:08:42.960
So importantly, there are different types of tears.
00:08:43.360 --> 00:08:45.840
As you mentioned, some are more mild than others.
00:08:46.080 --> 00:08:46.559
Yes.
00:08:46.879 --> 00:08:50.720
How do you usually describe them in terms of defining them for people?
00:08:51.120 --> 00:09:00.240
Yeah, so from I guess an obstetric point of view, there's four categories that we generally will talk about in terms of classification.
00:09:00.639 --> 00:09:03.919
So you've got first degree tears which are really, really superficial.
00:09:04.080 --> 00:09:04.240
Yeah.
00:09:04.399 --> 00:09:09.039
They usually just involve the perineal skin or a little bit of the tissue behind the skin.
00:09:09.279 --> 00:09:10.799
These heal really, really well.
00:09:11.039 --> 00:09:17.919
Often they don't need anything to be done about them at all unless there's a bleeding problem or maybe an alignment issue.
00:09:18.080 --> 00:09:24.960
So if the midwife or obstetrician feels that it might not actually heal evenly, they might recommend having something done to support that.
00:09:25.120 --> 00:09:31.360
First degree tears also encompass labial lacerations and tears that could be around the clitoris or the urethra.
00:09:31.519 --> 00:09:36.159
These are quite sensitive and tears because of just the amount of nerve sensations.
00:09:37.600 --> 00:09:40.080
But they heal extremely quickly.
00:09:40.399 --> 00:09:45.279
And there's usually no long-term issues for women who experience these types of tears.
00:09:45.679 --> 00:09:47.279
Yeah, that's really reassuring.
00:09:47.600 --> 00:10:00.240
And for I think I would agree with you that obviously those tears can be quite painful, but I think also in my experience, many people have healed quite quickly and feel a lot of symptomatic relief in the first couple of days.
00:10:00.639 --> 00:10:04.720
Yeah, and there's things that we can do to try and like relieve some of that discomfort as well.
00:10:04.799 --> 00:10:16.720
So you know, you can take things like panatol and neurophin, but also just when you go to the toilet, just running some water over your vagina as your wean can severely improve that sort of stinging sensation that you can get.
00:10:16.879 --> 00:10:22.000
So, yeah, really simple things that you can do, and within a matter of days, those symptoms resolve.
00:10:22.799 --> 00:10:27.759
I sometimes compare it to patients to if you've got like a cut in your mouth.
00:10:28.000 --> 00:10:28.240
Yeah.
00:10:28.720 --> 00:10:35.039
Because the tissue is sort of similar in a way that it can actually heal quite quickly before you even notice it.
00:10:35.279 --> 00:10:36.320
It's kind of like that, isn't it?
00:10:36.639 --> 00:10:37.679
That's a really good comparison.
00:10:37.840 --> 00:10:41.679
And you can think about how quickly those little wounds can heal in your mouth.
00:10:41.759 --> 00:10:43.120
It's the same as as the perineal.
00:10:43.279 --> 00:10:43.440
Yeah.
00:10:44.000 --> 00:10:44.240
Great.
00:10:44.480 --> 00:10:47.360
So that's a good summary of the first degree tears.
00:10:47.600 --> 00:10:50.799
What about the second degree tears, which are probably the more common?
00:10:51.200 --> 00:10:57.039
Yeah, so they're slightly more common than the first degree tears, and they they are the most common out of all of the categories.
00:10:57.279 --> 00:11:00.639
So these involve the muscles of the perineal bodies.
00:11:00.720 --> 00:11:07.360
So the superficial muscles of the pelvic floor that help keep all of the female organs up inside our bodies.
00:11:07.679 --> 00:11:12.240
And there's two superficial muscles that can be torn during this time.
00:11:12.480 --> 00:11:18.879
Sometimes only one gets torn, so your doctor or your midwife might say, Oh, it's just a small second, or it's just a little bit larger.
00:11:19.120 --> 00:11:22.159
It depends on sort of how much of those muscles have been torn.
00:11:22.240 --> 00:11:22.480
Yeah.
00:11:22.720 --> 00:11:24.879
But again, they heal really well.
00:11:25.120 --> 00:11:30.799
It's becoming a lot more common for women to choose not to have these injuries repaired.
00:11:31.039 --> 00:11:46.720
And as much as it's important that we're respecting those choices, it's important for women to understand that even though they will actually heal quite well on their own without any intervention, the muscles themselves will never actually grow back together without support.
00:11:47.120 --> 00:11:49.360
And that support usually involves stitches.
00:11:49.679 --> 00:11:49.919
Stitches.
00:11:50.240 --> 00:11:50.399
Yeah.
00:11:50.559 --> 00:11:50.799
Yeah.
00:11:50.960 --> 00:12:00.960
So that's usually the reason why we recommend stitching is so that we can bring those muscles back together because they're going to help support that pelvic floor with its function postnatally.
00:12:01.200 --> 00:12:07.440
But also one of those muscles in particular is responsible for assisting women to orgasm through penetrative sex.
00:12:07.759 --> 00:12:16.639
And so when that muscle is not brought back together, some women can complain later on that they're not experiencing orgasm in the same way that they did beforehand.
00:12:16.960 --> 00:12:18.080
Yeah, that's really important.
00:12:18.720 --> 00:12:22.399
So we're really just trying to maintain function.
00:12:22.720 --> 00:12:23.120
Absolutely.
00:12:23.519 --> 00:12:24.559
Back to what it was originally.
00:12:24.879 --> 00:12:25.759
Yeah, absolutely.
00:12:25.840 --> 00:12:28.639
And look, sometimes it might just be a matter of trying to stop bleeding.
00:12:28.720 --> 00:12:31.200
Some of the these tears can can tend to bleed quite a bit.
00:12:31.600 --> 00:12:36.240
And so, yeah, functionality, bleeding, and also alignment of the tissue as well.
00:12:36.480 --> 00:12:44.720
So we can do a much better job at restoring the alignment of that tissue and the skin better with suturing than we could if it heals on its own.
00:12:44.879 --> 00:12:45.039
Yeah.
00:12:45.360 --> 00:12:48.639
But it's not to say that the healing isn't good without it.
00:12:48.799 --> 00:12:51.759
The healing's just accelerated and optimized.
00:12:52.000 --> 00:12:53.679
And optimized with sutures.
00:12:53.840 --> 00:12:54.000
Yeah.
00:12:54.159 --> 00:12:54.799
With stitches.
00:12:55.440 --> 00:12:58.720
And important to note that those stitches are dissolvable.
00:12:59.039 --> 00:12:59.279
Yes.
00:12:59.440 --> 00:12:59.600
Yes.
00:12:59.919 --> 00:13:01.679
So you don't need to get them removed or anything.
00:13:02.240 --> 00:13:02.559
Correct.
00:13:02.639 --> 00:13:04.240
You don't you shouldn't need to get them removed.
00:13:04.399 --> 00:13:09.679
And most hospitals or midwives and obstetricians will use a rapidly absorbable suture.
00:13:09.759 --> 00:13:15.440
So within two weeks, 50% of that suture material has already lost most of its strength and started to break down.
00:13:15.679 --> 00:13:21.759
So women shouldn't feel tension around that area because of the stitches after those sort of two weeks.
00:13:22.159 --> 00:13:25.679
So yeah, very, very Yeah, it's a bit like that.
00:13:27.279 --> 00:13:27.679
Yeah.
00:13:28.320 --> 00:13:29.039
It's great.
00:13:29.440 --> 00:13:30.639
It's important to note.
00:13:30.879 --> 00:13:31.200
Yeah.
00:13:31.519 --> 00:13:35.519
Going on to the next type of tear, third degree tears.
00:13:35.679 --> 00:13:44.799
Now I think we'll have an episode on this separately, third and fourth degree tears, but just quickly to talk about it, third degree tears are a little bit deeper, aren't they?
00:13:45.120 --> 00:13:49.120
Yeah, so they involve part of the sphincter muscle.
00:13:49.279 --> 00:13:56.480
So there's two sphincter muscles that wrap around the anus, and they're responsible for helping us hold in our farts and our poos.
00:13:56.879 --> 00:14:04.399
So if you're in a public space and you think now's really not the time to go, these muscles are going to help keep it until you can find a safe space to do your business.
00:14:04.559 --> 00:14:05.600
So critical muscles.
00:14:05.759 --> 00:14:06.879
Critical, yeah.
00:14:08.159 --> 00:14:12.960
So third degree tears will affect the external muscle, one of these muscles.
00:14:13.519 --> 00:14:14.240
The one on the outside.
00:14:14.480 --> 00:14:15.519
The one on the outside, yeah.
00:14:16.000 --> 00:14:20.000
None of us can see, but yeah, is inside our bodies, but on the outside of the anus.
00:14:20.080 --> 00:14:21.840
And so it evolved that.
00:14:22.000 --> 00:14:27.600
And sometimes the deeper third degree tears might involve a little bit of the internal sphincter as well.
00:14:27.679 --> 00:14:27.840
Yeah.
00:14:28.080 --> 00:14:30.559
It's really important that these are diagnosed correctly.
00:14:31.200 --> 00:14:36.879
Outcomes can be still quite good if they are diagnosed correctly and they're managed promptly.
00:14:36.960 --> 00:14:37.120
Yeah.
00:14:37.360 --> 00:14:41.360
And with the right physio, women have really, really good prognosis in the future.
00:14:41.679 --> 00:14:41.840
Yeah.
00:14:42.000 --> 00:14:47.840
Yeah, I think that's really important to note that you might be scared of a third-degree tear, which is completely fair enough.
00:14:48.000 --> 00:14:50.159
And we're obviously always trying to minimize those.
00:14:50.320 --> 00:14:50.559
Yes.
00:14:50.960 --> 00:14:57.200
And it's one of those outcomes that we take real notice of in terms of the quality of birth and the injury.
00:14:57.360 --> 00:15:00.639
And we do want to be repairing it quite quickly and well.
00:15:00.879 --> 00:15:01.039
Yes.
00:15:01.360 --> 00:15:10.399
And we will, of course, have another topic about this in a separate episode, but the way we repair it is with really good lighting, really good pain relief.
00:15:10.639 --> 00:15:19.039
And that's often done in the theater so that we can make sure that those muscle layers that you mentioned well are brought together almost perfectly.
00:15:19.279 --> 00:15:19.440
Yeah.
00:15:19.600 --> 00:15:23.279
Because we want that bottom muscle to be working really well for you.
00:15:23.600 --> 00:15:23.919
Absolutely.
00:15:24.159 --> 00:15:31.039
But if that's done, as you said, most people don't have any symptoms later on, depending on the severity of their tear.
00:15:31.519 --> 00:15:32.159
Yeah, absolutely.
00:15:32.240 --> 00:15:34.720
And it's important to know that these are like the least common tears.
00:15:35.200 --> 00:15:40.000
So they do happen, and certain populations are sometimes a little bit more susceptible to them.
00:15:40.320 --> 00:15:44.320
As we'll we'll talk about shortly, there's a lot of things that we can do to try and minimize that.
00:15:44.480 --> 00:15:48.559
But yeah, they account for a very small percentage of the overall tears that women experience.
00:15:48.879 --> 00:15:49.200
Yeah.
00:15:49.679 --> 00:15:55.919
And then an even smaller percentage is those fourth degree tears, which is of course something we we never want to happen.
00:15:56.159 --> 00:15:56.399
No.
00:15:56.639 --> 00:16:06.080
But that is where the tear might go through the outer muscle and the inner muscle around the bottom, but then go through to the bottom or the rectum.
00:16:06.480 --> 00:16:07.200
Yeah, that's right.
00:16:07.279 --> 00:16:07.440
Yeah.
00:16:07.519 --> 00:16:08.960
So these are quite serious.
00:16:09.200 --> 00:16:19.120
And again, with the correct diagnosis and management, again, women can have still really good long-term outcomes, but they can take a lot longer to heal.
00:16:19.440 --> 00:16:21.600
They're a lot more painful to recover from as well.
00:16:21.840 --> 00:16:24.559
And physio is really, really important for these women.
00:16:24.960 --> 00:16:32.639
And decision around type of birth if women choose to have more babies is a conversation that's really important to have with their care provider.
00:16:32.960 --> 00:16:34.080
Yeah, definitely.
00:16:36.320 --> 00:16:52.399
Going back to before these tears happened, what are some of the risk factors that we might see in someone's pregnancy for the patient or the health provider to be keeping in mind that might increase your risk of any of these tears?
00:16:53.120 --> 00:16:58.320
Yeah, so there's a few factors such as size of baby, how many babies you've had before.
00:16:58.399 --> 00:17:05.359
So if it's your first baby, there's always that slightly higher risk because your body's never done this before, so none of us are to know how you're gonna go.
00:17:05.920 --> 00:17:07.920
Ethnicity can play a part.
00:17:08.319 --> 00:17:11.519
And things like other comorbidities.
00:17:11.599 --> 00:17:22.400
So women who have, say, for example, gestational diabetes, or if they have other conditions where they potentially might have challenges with healing and even that elasticity of the skin.
00:17:22.559 --> 00:17:29.920
So if you've got a woman who's 22 years old versus a woman who's 45 years old, their skin's probably got to be a little bit more elastic and stretchy, unfortunately.
00:17:30.240 --> 00:17:31.440
We can't get away from that, can we?
00:17:31.599 --> 00:17:31.759
No.
00:17:32.240 --> 00:17:39.039
So these things can play a part in that overall risk, but it's also important that they're not assessed in isolation.
00:17:39.200 --> 00:17:46.160
So just because you have potentially a larger baby on board, it does not mean that you're going to have a third or fourth degree tear.
00:17:46.319 --> 00:17:48.319
You could have a completely intact perineum.
00:17:48.400 --> 00:17:59.680
But it's important to know that these are potentially a risk factor, and then so management of that, particularly during that labor and birth, are really important to try and reduce that risk of it actually happening.
00:18:00.319 --> 00:18:03.839
And other things that can impact is I suppose how long you've been pushing for.
00:18:04.079 --> 00:18:04.400
Absolutely.
00:18:04.720 --> 00:18:11.119
And the baby's position when they're coming out, if you've had a previous tear is always something to keep in mind.
00:18:11.359 --> 00:18:11.519
Yeah.
00:18:12.160 --> 00:18:28.720
And something that we often talk about is if we need to help out with instruments like a forceps or a vacuum, particularly forceps, absolutely might increase that chance that you might have a tear or an episiotomy, which we'll talk about in the next episode.
00:18:29.039 --> 00:18:29.680
Yeah, absolutely.
00:18:29.759 --> 00:18:31.359
They're really important things to note.
00:18:31.519 --> 00:18:46.400
And I think it's important to understand, particularly in that antenatal space again, what that sort of means, so that when it comes time to to giving birth, if you know the doctor walks in the room and says, I need to help your baby out with a vacuum, you have a better understanding of what that actually involves.
00:18:46.640 --> 00:18:51.119
And then yeah, understanding that that might increase your your risk slightly of sustaining your tear.
00:18:51.680 --> 00:18:52.559
Really important.
00:18:53.599 --> 00:19:02.720
We did talk about things that can help, such as perineal massage and warm compressoring labour and the positioning of pushing and when baby's coming out.
00:19:03.359 --> 00:19:16.319
It's also really important when you're pushing, isn't it, to be guided in that and have someone who's an experienced, what we say, a kusha or someone who's experienced at delivering babies to help you through that to minimise tears.
00:19:16.720 --> 00:19:22.720
Yeah, so one thing that can, I guess, help as well is women's own mental health, like mental space.
00:19:22.880 --> 00:19:23.279
Yeah.
00:19:23.519 --> 00:19:34.000
And so if they're feeling very calm and in control, then they might not need as much verbal guidance as someone who's struggling to be in that space.
00:19:34.160 --> 00:19:37.680
And so feeling safe in your birth environment's really, really important.
00:19:38.319 --> 00:19:50.160
But one thing that's helpful when you've got a midwife and obstetrician at the other end of the bed or at the other end of the, you know, at the bottom of the shower or wherever you're choosing to birth is that they can visually see what's happening.
00:19:50.319 --> 00:19:54.480
So as a woman birthing, you'll be able to feel what's happening, but they can actually see what's going on.
00:19:54.559 --> 00:20:00.960
And so you might hear them say, just you know, slow it down a little bit more or just take a breath, you know, stop pushing for the minute.
00:20:01.119 --> 00:20:12.960
So listening to that instruction is really important because making sure that your baby's head is coming down and birthing really slowly is going to really be a massive factor in whether you or not you tear at the end of the day.
00:20:13.119 --> 00:20:13.279
Yeah.
00:20:13.839 --> 00:20:15.839
And it might push you to be stretching too quickly.
00:20:16.240 --> 00:20:16.720
Absolutely.
00:20:16.880 --> 00:20:23.680
And it might involve, with your consent, the midwife or obstetrician applying a little bit of counter pressure on your baby's head just to help slow them down.
00:20:23.839 --> 00:20:29.680
And it might be supporting your perineum with their hand, and that's where the warm compress comes in as well.
00:20:29.759 --> 00:20:31.279
So there's usually a warm cloth.
00:20:31.440 --> 00:20:36.240
Again, if you're comfortable with that, just holding that up against the perineum to help slow that down.
00:20:36.319 --> 00:20:42.799
And the warmth of the cloth can actually really help with pain relief as well, and also help with that stretching of that skin and tissue.
00:20:43.440 --> 00:20:44.480
Really good method, isn't it?
00:20:44.720 --> 00:20:44.880
Yeah.
00:20:45.519 --> 00:20:55.200
Talking about warm compressors, that of course makes sense trying to make the tissue a bit more flexible and make that more comfortable when the head is coming out.
00:20:56.400 --> 00:20:57.599
What about water birth?
00:20:57.759 --> 00:21:03.279
How about if someone's giving birth in water and and what kind of effect does that have on the risk of tearing?
00:21:03.839 --> 00:21:08.000
Yeah, so it actually doesn't really change the statistics at all.
00:21:08.240 --> 00:21:23.200
Um the benefit of water birth for a lot of women can be it's a natural pain reliever and it can help women stay calm or calm them down, especially during that sort of transition period towards that late stage of labor when birth's sort of imminent.
00:21:23.519 --> 00:21:31.839
So those factors, if you've got a woman who's really calm and in a good headspace, that in itself, as we said, is going to help reduce the risk of tear.
00:21:32.160 --> 00:21:36.960
But the water itself is not going to assist in reducing that risk.
00:21:37.359 --> 00:21:41.359
With warm compressors, the temperature of the water is really important.
00:21:41.519 --> 00:21:49.200
So there's a Hannah Darlin study I have a couple years ago that spoke about research on the temperature of water for warm compressors to be the most optimal.
00:21:49.359 --> 00:21:51.839
And that was between 38 and 44 degrees.
00:21:52.079 --> 00:21:59.839
And so even when you were using warm compressors, it's important for midwives and doctors to continue to make sure that that water temperature actually is maintained.
00:22:00.640 --> 00:22:03.359
And then we're not just putting cold water because that's there's no point.
00:22:04.319 --> 00:22:05.279
It's also not very comfortable.
00:22:05.519 --> 00:22:06.720
It's not comfortable, no.
00:22:06.960 --> 00:22:10.880
But with water birth, usually the temperature is around 37 degrees.
00:22:10.960 --> 00:22:13.920
So it's slightly lower than what we use for warm compressors.
00:22:14.160 --> 00:22:20.559
It doesn't mean it's harmful, but it's just it's not a I guess a substitute for warm compressors.
00:22:20.799 --> 00:22:20.960
Okay.
00:22:21.119 --> 00:22:25.279
But the benefits of water birth also can help reduce that risk of tearing anyway.
00:22:25.759 --> 00:22:26.640
Yeah, that makes sense.
00:22:26.960 --> 00:22:27.200
Great.
00:22:27.680 --> 00:22:30.720
What's happened and then how to manage it afterwards.
00:22:31.279 --> 00:22:38.000
And then once the vaginal assessment has been done, they might also recommend a rectal examination.
00:22:38.319 --> 00:22:41.200
So this can be a little bit more awkward and a little bit more uncomfortable.
00:22:41.519 --> 00:22:44.079
But and again, it can only be done with your consent.
00:22:44.240 --> 00:22:53.599
But it's really, really important to consider because there is one other tear that could occur that doesn't really fall into any of the other categories, and that's a button-hole tear.
00:22:53.839 --> 00:22:59.200
And it doesn't actually involve any of the sphincter muscles or any of the perineal muscles, really, either.
00:22:59.440 --> 00:23:04.880
It's sort of in isolation, but it can have really catastrophic effects if it's not diagnosed.
00:23:05.200 --> 00:23:12.079
Women can experience feces coming through their vagina because it sort of creates a tunnel, I guess, if it's not identified.
00:23:12.640 --> 00:23:16.880
And so the only way to really diagnose this at all is by doing a rectal examination.
00:23:16.960 --> 00:23:20.480
It can still be tricky to identify with a vaginal assessment.
00:23:20.960 --> 00:23:24.640
So that's when that sort of discussion might be had as well.
00:23:24.960 --> 00:23:37.599
And it's quite common for us to ask every woman, even when we see that the entire perineum or vagina is in completely intact, we might still offer it to you because it's again just to rule out that final details that could have occurred.
00:23:38.000 --> 00:23:38.319
Exactly.
00:23:38.799 --> 00:23:52.000
And by buttonhole, we mean a small hole between the bottom and the vagina that happens higher up than where we can see on the outside of the vaginal opening.
00:23:52.240 --> 00:23:52.720
Yeah, that's right.
00:23:53.039 --> 00:23:56.480
Where the baby's head may put some pressure on as it's coming down.
00:23:56.880 --> 00:23:57.440
Very rare.
00:23:57.759 --> 00:23:58.160
Very rare.
00:23:58.400 --> 00:24:00.720
But as you said, something that we we don't want to miss.
00:24:00.880 --> 00:24:00.960
Yeah.
00:24:01.200 --> 00:24:02.640
As a consequence, it's going to be quite bad.
00:24:03.119 --> 00:24:03.519
That's right.
00:24:22.319 --> 00:24:27.440
After we've examined thoroughly, we usually then try and repair things.
00:24:27.759 --> 00:24:32.720
As you said, we don't have to do it straight away unless there's concerns about pain or bleeding.
00:24:33.200 --> 00:24:43.519
But it is often nice to get it done quickly so that obviously we can get you just feeling back to normal and recovering and enjoying that time with the baby as quickly as possible.
00:24:43.920 --> 00:24:54.880
So and often that will be, particularly if you've had any pedural, it will be quite quickly so that we can make sure that that pain relief and the epidural is still working so you don't have any discomfort.
00:24:56.079 --> 00:25:04.000
Importantly, when we do repair the stitches, if you don't have an epidural, we make sure we put in some local pain relief.
00:25:04.319 --> 00:25:08.319
And that will usually be in the form of some local anesthetic with an injection.
00:25:08.720 --> 00:25:08.960
Yes.
00:25:09.599 --> 00:25:17.839
Or sometimes an injection into the nerves around the pelvic area called a pudendal block, which is a bigger needle.
00:25:18.000 --> 00:25:20.799
But usually it's at least some local anesthetic.
00:25:20.880 --> 00:25:23.680
So we we want to make sure that the process is comfortable for you.
00:25:24.160 --> 00:25:25.039
Yeah, absolutely.
00:25:25.119 --> 00:25:34.319
And just going back to sort of the timing of repair, women have a rush of adrenaline running through their bodies after birth, and that adrenaline itself can be a natural anesthetic condition.
00:25:35.039 --> 00:25:45.440
So it can be helpful to do it quite soon after, just so that we're optimizing all those amazing hormones after birth to sort of help support you as well, so you're not feeling as much discomfort.
00:25:45.680 --> 00:25:50.240
As you said, Rangi, those are usually the main forms of analgesia that we would give.
00:25:50.480 --> 00:25:52.319
You can use the gas as well.
00:25:52.400 --> 00:26:02.000
So if you've used gas during your labour or your birth, or even if you haven't had time to use that, but you want to give it a go, this is your last chance to use it.
00:26:02.319 --> 00:26:07.440
And even just things like focusing on your baby or having your partner support.
00:26:07.599 --> 00:26:17.680
I don't think it's very popular or it's not been really established here in Australia, but there's a lot of research being done around virtual reality and how that can be actually like a natural anesthetic almost.
00:26:17.839 --> 00:26:25.279
So yeah, women are being sent on to beaches or in safari jungles just while they're being suited repaired.
00:26:25.839 --> 00:26:32.000
Yeah, and it's actually being shown to really reduce their um degree of pain and discomfort during that repair period.
00:26:32.160 --> 00:26:35.519
So anything to distract you can also be really, really helpful.
00:26:35.759 --> 00:26:37.519
Yep, and the best distraction is your baby.
00:26:37.839 --> 00:26:39.119
Yeah, yeah, absolutely.
00:26:39.200 --> 00:26:53.039
But it's important that if you are experiencing pain during the repair, it's normal to feel touching and some pressure, but actual pain itself, it's important that you're letting your midwife or doctor know about that so that they can give you some more pain relief.
00:26:53.279 --> 00:26:54.240
That's right, we don't want that.
00:26:54.480 --> 00:26:55.279
Absolutely not.
00:26:56.079 --> 00:27:02.559
Afterwards, we usually do give you some also local pain relief in the bottom as well, don't we?
00:27:02.799 --> 00:27:12.079
So we do that bottom check, as you mentioned, to check that there's no tears involving the bottom or the bottom muscles before we start stitching.
00:27:12.559 --> 00:27:32.240
But we also do another bottom check to again make sure that there's no stitches where uh the bottom is involved, but also to give you usually some suppositories of pain relief and that will work really well in that local area, be absorbed from the bottom, and basically just pan it all in and anti-inflammatory is what we give you.
00:27:32.319 --> 00:27:36.799
But it seems weird that we would give it to you in the bottom, but it works really well in that area, doesn't it?
00:27:37.039 --> 00:27:42.480
Yeah, I guess if you think about it, it just has less of a distance to travel to the pain, to the side of the pain.
00:27:42.640 --> 00:27:42.880
Yeah.
00:27:43.279 --> 00:27:50.640
You you really need to do that once, usually, and so um going forward you can just take oral um analgesia for to support you after that.
00:27:51.039 --> 00:27:52.240
Yeah, just tablets, yeah.
00:27:52.480 --> 00:27:52.799
I know.
00:27:52.880 --> 00:28:06.880
And then the reason why I mention it is because sometimes people are a bit confronted and surprised when you might ask them to do a rectal exam for either the first bit before you stitch or afterwards when you're putting the suppositories in.
00:28:06.960 --> 00:28:09.039
It's just good to be prepared for that.
00:28:09.200 --> 00:28:11.839
It's completely normal and will help with your recovery.
00:28:12.160 --> 00:28:12.480
Absolutely.
00:28:12.799 --> 00:28:13.759
Yeah, good point.
00:28:14.960 --> 00:28:16.480
It's not every day that that happens.
00:28:16.559 --> 00:28:17.359
So it's not.
00:28:17.680 --> 00:28:18.960
It's fair enough.
00:28:19.440 --> 00:28:26.079
We've talked a lot about how we can minimise tears and prepare for them, but we can't take away that risk completely, can we?
00:28:26.400 --> 00:28:27.440
No, no, we can't.
00:28:27.599 --> 00:28:31.599
And it's just part of the nature of birth, unfortunately.
00:28:31.920 --> 00:28:38.799
And it might be a a poor comparison, but if you compare it even to a C-section, there's a hundred percent chance that there's going to be a cut.
00:28:39.039 --> 00:28:39.200
Yes.
00:28:40.559 --> 00:28:54.559
So, you know, there's there's other factors that affect from a vaginal birth perspective, but there's a lot of reassurance around um, you know, for women to to understand that it doesn't, yeah, the tears, if they do sustain it, are often going to be very minimal.
00:28:55.279 --> 00:28:55.839
Yeah.
00:28:56.160 --> 00:29:05.279
Now, if you do have a tear, we've mentioned it briefly, but and it also, of course, depends on what type of tear and the extent of everything else that's going on.
00:29:05.359 --> 00:29:09.119
But what are some of the things that we can do to support recovery early on?
00:29:09.599 --> 00:29:11.279
Yeah, so plenty of rest.
00:29:11.440 --> 00:29:14.240
I think as a society, we're really bad at doing that.
00:29:14.400 --> 00:29:21.519
If we talk about building a village, but for some women that can actually be really challenging, depending on what kind of family or friendship that support that they have.
00:29:21.599 --> 00:29:26.079
But trying to get as much rest as possible is so important in the weeks post.
00:29:26.240 --> 00:29:31.279
But in that initial period, so rest, keeping pressure off that area if you have had stitches.
00:29:31.359 --> 00:29:34.400
So especially if it's a bit tender, still, put a pillow under.
00:29:34.480 --> 00:29:37.119
You can get those inflatable donut rings if they're helpful.
00:29:37.200 --> 00:29:39.039
But a pillow is often just fine.
00:29:39.119 --> 00:29:48.000
If you're breastfeeding, try and breastfeed baby on your side, or just tilt your hips a little bit so you're just not having that pressure on that area as much.
00:29:48.319 --> 00:29:52.079
You can use ice packs as well just to help reduce that pain.
00:29:52.319 --> 00:30:08.960
Changing a pad regularly so that you're not increasing the risk of infection to that area because you've got to remember it is still a wound that needs to heal, and keeping it clean, so giving it a little clean with just some water, number no soap in that area in those days following when your bleeding's the most heavy.
00:30:09.200 --> 00:30:21.440
Avoiding like baths and soaking because we just don't, again, want to increase risk of infection, but we also don't want to increase the pace at which those stitches are absorbing and breaking down as well.
00:30:21.759 --> 00:30:40.799
And then just being mindful of if the pain is increasing or you're feeling like there's swelling or a redness or burning or heat or abnormal discharge in that area, that you're letting your care provider know that this is happening so that they can review it and make sure that it's nothing worse that has happened.
00:30:41.200 --> 00:30:45.839
What we worry about in terms of complications with the tears might be an infection.
00:30:46.240 --> 00:30:46.559
Correct.
00:30:46.799 --> 00:30:47.519
Which is not common.
00:30:47.839 --> 00:30:48.559
It's not common at all.
00:30:49.039 --> 00:30:52.319
But certainly a possibility when you have any wound in your body.
00:30:52.640 --> 00:30:53.119
Absolutely.
00:30:53.359 --> 00:30:58.559
And particularly when that wound is in an area that already has a lot of bacteria, which is normal.
00:30:58.880 --> 00:31:01.599
But there we want to make sure that there's no infection.
00:31:02.640 --> 00:31:06.880
So, as you said, if you have any of the symptoms, important to let your health provider know.
00:31:07.200 --> 00:31:07.359
Yeah.
00:31:07.680 --> 00:31:12.480
And it might be just a case of watching and seeing or some tablet antibiotics.
00:31:12.799 --> 00:31:17.359
And very rarely, if you're very unwell, you might need some intravenous antibiotics.
00:31:18.559 --> 00:31:25.759
It's really uncommon that any infection or problems with your tear might need to have another procedure.
00:31:26.640 --> 00:31:28.640
We usually try not to do that, don't we?
00:31:28.880 --> 00:31:29.759
Yeah, yeah, yeah, we do.
00:31:29.839 --> 00:31:31.440
And like you said, it's really uncommon.
00:31:31.599 --> 00:31:38.319
And it you will usually stem from initially like an infection that's then just started to affect the healing process of that actual wound.
00:31:38.559 --> 00:31:38.799
Yeah.
00:31:39.039 --> 00:31:40.319
So getting onto it early is important.
00:31:40.720 --> 00:31:41.759
Getting onto it early is important.
00:31:41.839 --> 00:31:53.920
And often we don't necessarily need to re-stitch the wound or anything, it's just a bit like you said, watch and wait, antibiotics and just yeah, managing those symptoms until that healing starts to progress a little bit further.
00:31:54.400 --> 00:31:59.279
I thought as well, in terms of sort of those couple of days following bow motions.
00:31:59.680 --> 00:32:01.599
Yeah, I was about to say, yes.
00:32:02.160 --> 00:32:14.799
I think one of the big things that, and and we'll talk about this on a separate episode, but one of the big things that people often fear after they've given birth, particularly vaginally, is that first time they have to open their bowels afterwards.
00:32:15.359 --> 00:32:17.119
It's really a confronting experience.
00:32:17.279 --> 00:32:22.000
Then if you add stitches on top of that, so many women have said to me, What if I tear my stitches?
00:32:22.480 --> 00:32:23.119
You won't.
00:32:23.359 --> 00:32:26.799
You won't tear your stitches, but it I know it can definitely feel like you might.
00:32:26.880 --> 00:32:29.920
So it's important to make sure that you're not constipated.
00:32:30.000 --> 00:32:30.079
Yeah.
00:32:30.319 --> 00:32:35.599
And taking medication if you need to to help soften your poo so that you can go without too much straining.
00:32:35.759 --> 00:32:37.440
So avoid straining at all costs.
00:32:37.519 --> 00:32:43.759
Just like in pregnancy, we advise to you know reduce your the risk of of constipation because of your pelvic floor.
00:32:43.920 --> 00:32:44.880
We've got to let that rest.
00:32:44.960 --> 00:32:47.119
So it's the same in the postpartum period as well.
00:32:47.359 --> 00:32:47.759
Yeah.
00:32:48.079 --> 00:32:48.559
Important.
00:32:48.720 --> 00:32:49.039
Yep.
00:32:49.359 --> 00:32:50.799
What about in the long term?
00:32:50.960 --> 00:32:57.920
Well, now we had a really great episode with um Professor Helena Frawley that people can listen to, where we go into this in detail.
00:32:58.079 --> 00:33:11.599
But just briefly, after those first few weeks of rest and recovery for these tears and wounds, what else do you think people can do in the long term to make sure their tears and their pelvic floor are best managed?
00:33:11.839 --> 00:33:15.039
Yeah, so pelvic floor exercises is generally the answer for that.
00:33:15.359 --> 00:33:17.599
And pelvic floor exercises are encouraged.
00:33:17.920 --> 00:33:19.440
We should have been doing them before pregnancy.
00:33:19.680 --> 00:33:21.599
So long before everybody should do that.
00:33:21.759 --> 00:33:22.400
Everyone just should do that.
00:33:22.640 --> 00:33:23.519
Should be taught in high school.
00:33:23.759 --> 00:33:26.079
Absolutely, absolutely should be taught in high school.
00:33:26.240 --> 00:33:29.680
Um so if you haven't done it yet and you're pregnant, start doing them now.
00:33:29.839 --> 00:33:35.279
They're going to not only support your recovery, but they can also actually support you to have an easier labour and birth as well.
00:33:35.359 --> 00:33:43.279
Because if you've got strong pelvic floor muscles, then your ability to mobilize them and push is going to be a lot better than if you don't.
00:33:43.440 --> 00:33:46.240
And when I mean strong pelvic floor muscles, I don't mean tight.
00:33:46.400 --> 00:33:47.359
You want them to be mobile.
00:33:47.519 --> 00:33:50.720
So you want to be able to relax and contract them evenly.
00:33:50.880 --> 00:33:57.920
But there's lots of apps and there's lots of, you know, YouTube videos that you can Google to just show you how to do pelvic floor exercises.
00:33:58.079 --> 00:34:04.079
And I think you said you have a physio episode prior to this, so I'm sure she goes into a lot of detail about them.
00:34:04.480 --> 00:34:17.760
But yeah, within sort of the first two weeks of giving birth, like start your pelvic floor exercises, but also know that even if you were able to do 20 kegels before birth, and you can only do one now, that's okay.
00:34:17.840 --> 00:34:19.519
And so don't overdo it.
00:34:19.760 --> 00:34:21.199
Do what works for you.
00:34:21.440 --> 00:34:22.159
And what feels comfortable.
00:34:22.400 --> 00:34:23.920
And what feels comfortable, absolutely.
00:34:24.079 --> 00:34:24.320
Yeah.
00:34:24.480 --> 00:34:26.239
But they're going to help your recovery.
00:34:26.400 --> 00:34:35.280
They're going to help if you're choosing to have more children after your first one in the future, then that's going to make pregnancy and birth easier for you the second, third, and fourth time round as well.
00:34:35.840 --> 00:34:43.199
And reduce some of those other complications that we want to avoid, like problems with keeping your farts and your poos in and your wee.
00:34:43.679 --> 00:34:44.480
Yeah, absolutely.
00:34:44.639 --> 00:34:44.960
That's it.
00:34:45.280 --> 00:34:46.639
Strengthening the pelvic floor.
00:34:46.800 --> 00:34:47.280
Yeah.
00:34:47.920 --> 00:35:02.159
One other question that commonly comes up, and you know, not everyone is always thinking about this or may take longer to think about it, but it's an important point is when can people resume sexual intercourse after they've had a tear?
00:35:02.480 --> 00:35:03.519
When you're ready.
00:35:04.320 --> 00:35:05.679
It's a good answer.
00:35:06.000 --> 00:35:13.360
I know we have this sort of six-week rule, and that's usually because women will generally fit stop bleeding by six weeks.
00:35:13.679 --> 00:35:19.519
In terms of any tears that have needed to be repaired, the healing should have completed by that time.
00:35:19.679 --> 00:35:24.639
But I think it's important that women understand that there's no golden rule around sexual intercourse.
00:35:24.719 --> 00:35:27.760
It's really up to how you feel and what's comfortable for you.
00:35:27.920 --> 00:35:30.239
And knowing that it might take a bit of time.
00:35:30.400 --> 00:35:35.039
I remember Physio said to me after my first baby, it's just like your first time all over again.
00:35:35.199 --> 00:35:37.519
You just gotta sometimes rip the band-aid off.
00:35:38.719 --> 00:35:41.119
And then after the first time, you realise it's not so bad.
00:35:41.360 --> 00:35:42.000
It's not so bad.
00:35:42.079 --> 00:35:42.239
Yeah.
00:35:43.199 --> 00:35:51.280
But if you are having any sexual function issues, I think historically we've been told as women or that you've had a baby, so you could probably expect to feel that.
00:35:51.360 --> 00:35:53.440
But it's important you understand it's not normal.
00:35:53.679 --> 00:36:03.840
Um, and you know, we can do things to help women recover from any ongoing or issues that maybe uh have carried out a little longer post-birth than what they should have.
00:36:04.159 --> 00:36:05.440
Yeah, that's that's really important.
00:36:05.679 --> 00:36:05.840
Yeah.
00:36:06.079 --> 00:36:07.199
We don't want you to be feeling like that.
00:36:07.679 --> 00:36:09.360
No, you don't have to suffer in silence.
00:36:09.679 --> 00:36:10.239
Yeah.
00:36:10.559 --> 00:36:11.119
Great.
00:36:11.440 --> 00:36:19.039
We did talk about not trying to soak too much in baths, but we have previously recommended things like cis baths and things like that.
00:36:19.119 --> 00:36:20.159
What are your thoughts on that?
00:36:20.559 --> 00:36:23.920
There's not a whole lot of strong evidence around sort of whether they're helpful or not.
00:36:24.079 --> 00:36:28.159
I think in terms of if it's pain that you're really worried about, then that can sometimes be helpful.
00:36:28.239 --> 00:36:30.400
And again, it can be quite soothing to sit in a bath.
00:36:30.559 --> 00:36:39.199
It's more probably whether you put things in the bath, or I know some women will put witch hazel on their pads to help with pain and and healing and that kind of thing.
00:36:39.440 --> 00:36:42.000
It's important to know that that can actually cause more problems.
00:36:42.159 --> 00:36:49.840
So just avoiding anything to apply directly over that area, that perineal area after birth is really important to avoid for the first couple of weeks.
00:36:50.159 --> 00:36:51.039
That's really important.
00:36:51.280 --> 00:36:55.760
There's actually no evidence that there's m any benefit with those things and it can cause harm.
00:36:56.000 --> 00:36:56.239
Yep.
00:36:56.320 --> 00:36:56.480
Yeah.
00:36:56.639 --> 00:36:56.800
Yeah.
00:36:57.119 --> 00:37:01.199
It doesn't necessarily mean that it will definitely cause harm, but it's not going to be of really any benefit.
00:37:01.920 --> 00:37:02.079
Yeah.
00:37:02.159 --> 00:37:02.639
Yeah.
00:37:03.119 --> 00:37:08.800
I think it's really important to know that just because you've had a tear once doesn't necessarily mean you'll have another one.
00:37:09.599 --> 00:37:14.480
You've actually got less of a chance of having another one the second or third time round than you do the first time.
00:37:14.880 --> 00:37:18.880
So that's can be really reassuring, especially if you've had only a small tear the first time.
00:37:19.039 --> 00:37:22.079
You will likely maybe only have that again or or nothing at all.
00:37:22.239 --> 00:37:22.400
Yeah.
00:37:22.880 --> 00:37:25.199
Because that tissue has stretched already.
00:37:25.440 --> 00:37:25.599
Yeah.
00:37:25.920 --> 00:37:26.400
Is the theory.
00:37:26.880 --> 00:37:27.360
Absolutely.
00:37:27.599 --> 00:37:28.000
Absolutely.
00:37:28.639 --> 00:37:37.840
There are obviously other factors that go into that, as you said, like size of baby and length of labour, which of course is hard to predict the second time, but in general, less likely.
00:37:38.159 --> 00:37:38.960
Yes, yeah.
00:37:40.159 --> 00:37:46.559
And when people have a tear in their perineal area, it can be quite confronting.
00:37:46.800 --> 00:37:59.280
And sometimes it can affect the way you might feel about your body and particularly that area, whether it comes to your confidence or even, as we mentioned, your sexual function and your intimacy.
00:37:59.599 --> 00:38:03.039
What are some things that you would say about that and advice you might give people?
00:38:03.360 --> 00:38:04.880
I'm gonna quote my boss here.
00:38:05.679 --> 00:38:11.360
And she will always tell her women to take a vulfi before birth.
00:38:11.599 --> 00:38:13.920
So a selfie essentially of your vulva.
00:38:14.320 --> 00:38:14.800
Oh wow!
00:38:16.239 --> 00:38:16.719
That's great!
00:38:17.039 --> 00:38:17.920
Cause it's a vulfi.
00:38:18.239 --> 00:38:26.320
Now that could also be quite confronting, I think, for a lot of women, and again, this is just this is just growing up as a woman, as you know, as a young girl and a woman.
00:38:26.400 --> 00:38:30.960
We're not encouraged to explore our bodies or even look down there.
00:38:31.119 --> 00:38:35.679
So the first time you ever look down there might actually be when you're pregnant or after you've given birth.
00:38:36.159 --> 00:38:47.760
But if you can look down there before you give birth and you can see what your normal is, because I think it's really important women know that your anatomy is going to be very different to your friend's anatomy or the woman birthing next to you.
00:38:47.920 --> 00:38:48.159
That's right.
00:38:48.320 --> 00:38:56.000
So if you can know what your normal is, especially after birth, whether you've torn or not, you can have a look again and say, well, yep, it all looks the same.
00:38:56.159 --> 00:38:59.280
Or if you have torn, hey, they did a really good job.
00:38:59.599 --> 00:39:02.000
Or perhaps something doesn't look right.
00:39:02.079 --> 00:39:06.559
And so if you you're able to do that, then you could report that and we can address that.
00:39:06.800 --> 00:39:10.400
So yeah, have it doing it's a really great idea.
00:39:10.480 --> 00:39:10.960
I love it.
00:39:11.199 --> 00:39:12.159
It's a really great idea.
00:39:12.320 --> 00:39:21.840
And even um, you know, even if again with your partner, if you're comfortable with your partner sort of, I mean, I'm sure they've probably probably know your body better than you know yourself, your own sometimes.
00:39:22.159 --> 00:39:29.039
But I've even had to ask partners before when I've done a repair for a woman, does that look right?
00:39:29.679 --> 00:39:30.719
Just double checking.
00:39:30.960 --> 00:39:38.880
I mean, they can usually tell us so and they're usually very inquisitive and keen to, again, keen to be a part of anything that they can be.
00:39:39.039 --> 00:39:54.239
But that I guess is probably the most helpful, and it sort of reduces that overall fear about what's happened to your body as well, because we know that pregnancy is a completely transformative experience, physically and emotionally, that continues to evolve after you've given birth as well.
00:39:54.320 --> 00:40:05.599
Yes, and so it's important that you're feeling comfortable in your own skin, and that can take a little bit of time, um, but just be kind to yourselves, and if you are concerned in any way, it's important that you seek help.
00:40:05.760 --> 00:40:06.960
Yeah, really good advice.
00:40:07.440 --> 00:40:08.000
Thanks, Mel.
00:40:08.239 --> 00:40:09.119
Yeah, take a ball fit.
00:40:09.360 --> 00:40:11.840
Yeah, I've never heard that, but that's fantastic.
00:40:12.000 --> 00:40:14.159
I'm gonna use that from now on.
00:40:14.639 --> 00:40:15.360
Fantastic.
00:40:15.519 --> 00:40:15.840
Thank you.
00:40:16.079 --> 00:40:16.960
No worries, thank you.
00:40:17.199 --> 00:40:18.079
Thanks so much, Mel.
00:40:18.159 --> 00:40:18.880
That was really great.
00:40:19.039 --> 00:40:30.559
Um, I think we covered some really important topics about what exactly tears are, how we manage them, and hopefully that gives people information and makes them less fearful and concerned about it.
00:40:30.639 --> 00:40:33.440
And information is is power when it comes to this.
00:40:33.760 --> 00:40:34.480
It definitely is.
00:40:34.639 --> 00:40:43.440
As scary as some of the information can sometimes be, I think going into birth prepared will definitely help with your feelings around your birth afterwards as well.
00:40:44.079 --> 00:40:44.800
Fantastic.
00:40:44.960 --> 00:40:46.000
Thanks so much, Melanie.
00:40:46.239 --> 00:40:46.559
Thank you.
00:40:47.039 --> 00:40:47.920
We'll see you next time.
00:40:48.159 --> 00:40:48.960
See you next time.
00:40:49.280 --> 00:40:50.880
Every pregnancy is unique.
00:40:51.039 --> 00:40:56.320
The information provided in today's podcast is for educational and general purposes only.
00:40:56.480 --> 00:41:00.320
It is not intended to be substitute for professional medical advice.
00:41:00.480 --> 00:41:10.320
It is important that you always seek the guidance of qualified health professionals with any questions you may have regarding your health, pregnancy, or any medical conditions.
