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Perineal Check After Birth - a frequently under considered event.

Like all checks/tests/interventions the perineal check is optional. Unfortunately, offers of care & medical assessment, are often worded in such a way that they sound far from a offer, and more like a compulsory action. The truth is, YOU decide if you would like a midwife/doctor to check your vulva, vagina, perineum & sometimes rectum. The perineal check is offered after you have birthed your placenta.

If you’ve already given birth vaginally you’ll know, first hand (or should I say first perineum) , that this area does a lot of work to allow your baby to be born. The purpose of the examination is to assess whether there are any areas of the tissues/muscles that could benefit from attentive & cautious repair.

There are many birthing people that feel fully able to assess for themselves without medics, and there are also those that can feel that something needs attention & repair.

Take your time to decide if and when you would like the assessment. If you do decide you would like the check & you need a bit of alone time with your baby/babies and your placenta/placentas before any checks, you can ask for this and it should be respected by any health care professionals.

You can keep your baby on you skin to skin during the check, if you so wish. You can generally ask for gas and air aka Entonox for any part of the examination, right from the start to finish. Remember you can stop and/or pause the examination at any point.

The exam begins with your midwife’s visual assessment: they will gently clean the area with warm water to be able to clearly see the vulva & perineum externally. The condition of the perineal skin externally, can give an indication of any damage that might have occurred. You should be given information on what they can see. You will be offered and internal examination of the vagina to check for any internal tears that are not visible externally, & to assess the extent of a visible external tear internally.

You will be offered an internal exam of your rectum, though if there’s no vaginal, or labial damage damage or it’s very limited it is often declined because it’s very unlikely there’s damage in this area if there’s no, or very minimal damage elsewhere.

Any tears are graded by the midwives (1 being least severe, 3 & 4 being severe) and they can explained the extent of any grazes, tears and your options for any repair that might be offered. They can provide you with answers as to whether any tears/grazes etc are superficial… cosmetic, or if the pose a chance of long term physical difficulties. They can provide you with their medical opinion on whether stitches are necessary, and why… you can ask all the questions you need to, to be able to make an informed choice for yourself. There is some controversy as to whether stitching grade 2 tears is better than allowing them to heal without. However, it’s clear that grade 3 & 4 tears being repaired is beneficial to long term pelvic health.

If you’re birthing at home & assessment indicates that you have severe tears (3 or 4) you will generally be offered repair in hospital and will be calmly & quietly transferred by ambulance. If you have a grade 2 tear, at a home birth you are likely to be offered repair at home.

Knowing & considering some aspects the perineal check, can assist you to have a less stressful & more positive experience, immediately after birth and for the longer postpartum period. Remember ‘your body, your baby, your choice’ is not some glib phrase, it’s backed up by the law & it’s fundamental to your positive navigation of the maternity system.

Further info:

This link includes some clear drawings of the external areas and grades of tears

This link is an article aimed at midwives, therefore there is clinical language and some graphic pictures of examinations. It clearly shows the internal structure of the perineum which can aid understanding of what an examination is assessing and there is some discussion of the digital (i.e. finger inside) anal examinations. This may be a useful article to skim read and look at internal diagram or if you're interested in understanding more about the examination

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