There are several actions that can be taken prenatally and during delivery to help maintain good perineal integrity. First make sure you are eating a good diet. This will help maintain healthy tissue. Perineal massage, begun around 32 to 34 weeks of pregnancy has been shown to help decrease the incidence of tearing and episiotomy with delivery. This massage is done in the following manner:

1. Wash hands first

2. Put some lubricant on your fingers and on your perineum. Some recommendations are surgilube, astrglide, unscented massage oil. The inside of the vagina is a water-soluble membrane so a water-soluble lubricant should be used on the fingers that go inside the vagina. The oil-based lubricants can be used on the outside perineal body tissue.

3.If your partner is performing the massage for you, fingers should be placed gently inside the vagina about one to one and a half inches. If you are performing the massage yourself you will need to place you thumbs into the vagina. Press down until a stinging or burning sensation is felt.

4. Hold the pressure for about two minutes until a numb sensation is felt.

5. Gently and slowly sweep the fingers or thumbs side to side in the vagina, keeping the pressure down toward the rectum. Avoid the urinary opening.

6. Massage this way for three to four minutes, rest one minute and repeat this routine two more times (about 15 minutes). 7. Do not do perineal massage if you have an active vaginal infection or perineal herpes lesion.

Kegel exercises should also be practiced regularly during the prenatal period. I recommend 20 power kegels per day. You tighten the vaginal muscle and hold for 20 seconds for 20 times a day. You can do these in groups of five, four times per day.

At the time of delivery try to change positions during pushing and consider delivering in some position other that flat on your back. Some suggestions are side lying, hands and knees and squatting. A slow, controlled delivery of the head is also helpful in decreasing injury to the perineum. Open glottis pushing, especially as the head is crowning, or sometimes even no pushing at all as the head is crowning is helpful. Talk with your provider in advance and make sure that they are as committed as you are to avoiding any interruption of perineal integrity. Good coaching from the person catching your infant is essential to your success.

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