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Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier

The perineum is the region between the vulva and the anus. In the second stage of labour, the perineum distends as the baby's head descends towards the vulva. The majority of women who have a vaginal birth will sustain some degree of perineal trauma, either from a spontaneous perineal tear or episiotomy or both. (See Episiotomy).

Perineal trauma

Spontaneous trauma may be of the labia anteriorly, the perineum posteriorly or both. A gentle, thorough examination must be carried out to assess the extent of the trauma accurately and to determine who should carry out the repair.

  • Anterior labial tears. A suture may be necessary to secure haemostasis
  • Posterior perineal trauma. Usually classified in degrees. Third- and fourth-degree tears should be repaired by an experienced obstetrician, under general anaesthetic or effective epidural or spinal anaesthesia
  • First degree tear - involves the fourchette only
  • Second degree tear - involves the fourchette and the perineal muscles
  • Third degree tear - involves the fourchette, the perineal muscles and the anal sphincter
  • Fourth degree tear - sometimes used to describe trauma that extends into the rectal mucosa

The Practising Midwife featured articles

Enhancing postnatal perineal care 2012; 15(6): 26 - 28 Author: Judith Stolberg

Hands-on or hands-poised: what does the evidence say? 2015; 18(7): 10 - 12 Authors: Petra Petrocnik, Jayne Marshall

Advancing Practice: Perineal protection 2015; 18(7): 14 - 16 Suyal Steinhauer

Midwifery Basics: 7. Perineal suturing 2016; 18(4): 29 - 32 Blease M, Taylor K;

Further reading

Royal College of Midwives. (2012) Evidence Based Guidelines for Midwifery-Led Care in Labour: Care of the perineum.


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