Verified and reviewed by: Midwife Maria Midstam

Protecting the perineum during childbirth is an important part of reducing the risk of rupture. This is done through the so-called perineal protection, which is performed by the midwife or obstetrician. The aim is to ensure a slow birth, allowing the tissues to stretch as the baby progresses.

What is perineal protection?

Perineal protection involves the midwife or doctor using their hands to support the tissues around the perineum during the birth of the baby. There are different ways to keep a perineal cover, but no single hand technique has been shown in research to be more effective than others in reducing the risk of rupture.

Reducing the risk of sphincter injuries

Research shows that the risk of sphincter injuries (ruptures involving the rectal sphincter) decrease as

• the baby's head and shoulders is born during two contractions
• the head slips out at the end of a pain or during a break in pain
• the shoulders are then brought forward during the next labor

The midwife does a individual assessment of how quickly the baby should be born. The only protection that has strong scientific support to reduce the risk of rupture are heat towards the middle yard.

Communication and birth position

Perineal protection is not just about the hands - also communication and birthing position are important elements.

Most birthing positions allow the midwife to see and protect the perineum, except when squatting. If the midwife has difficulty seeing the perineum, she should explain this and, in consultation with the woman giving birth propose a more favorable position.

How perineal protection works in practice

The midwife inspects the color, elasticity, swelling and possible bleeding of the tissue.
If signs of risk of rupture appear, measures can be taken, for example

• that changing the birthing position
• that let your head slide back during a break in labor to allow the tissues to stretch

This helps to relieve the tissues and optimize blood circulation in the mezzanine. The person giving birth wishes are always taken into account. The midwife informs about the purpose of the perineal protection and the birthing woman may be involved in the decisions. Please note that most people get some kind of rupture after childbirth, even when perineal protection is used.

Rapid responses

What does perineal protection mean?

A method where the midwife protects the perineum with her hands during labor to reduce the risk of rupture.

What technology is used?

There are several approaches, but no specific method has proven to be the most effective.

What protection works best against stretch marks?

Heat towards the perineum has the strongest scientific support.

What does the midwife do during the expulsion phase?

She assesses the elasticity of the tissue, follows the movement of the head and may suggest a change of birthing position.

Does everyone get stretch marks?

Most people experience some form of rupture, but the degree varies and perineal protection often reduces the extent.

FAQ - frequently asked questions

1. Why is perineal protection used?
To reduce the risk of tears when the baby is born.

2. What technology is used?
There are several ways in which the midwife can hold the perineal protection device, but no one particular grip has been shown to be most effective.

3. When does the risk of sphincter damage decrease?
When the baby's head and shoulders are delivered during two contractions, to give the tissues time to adjust.

4. What has the best scientific support for reducing ruptures?
Heat towards the perimeter.

5. What role does the birth position play?
Most positions work well, but if the midwife cannot see the perineum clearly, she may suggest another position.

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