What effects does a vaginal birth have on the perineum?
Perineum pain is the most common reported symptom in the postnatal period. Perineum pain is defined as pain in the perineal body, which is the area of muscular and fibrous tissue between the symphysis pubis and the coccyx. (Kettle 1999)
Pain in the perineum is very common in the early puerperium but for some women this will be a persistent long-term problem. Studies have shown that the mode of delivery, extent of perineal trauma and the number of deliveries are the main risk factors with the way perineal trauma is managed affecting the outcome.
Mode of Delivery.
In a study by Glazener (1995) the highest rates of both short and long term perineal pain was reported by women following instrumental deliveries as opposed to spontaneous vaginal deliveries or caesarean sections. The results of this study showed: Women reporting pain in hospital
a 84% following instrumental delivery
a 42% following spontaneous vaginal delivery
a 5% following caesarean section
Women reporting pain between discharge and 8 weeks post partum
a 59% following instrumental delivery
a 19% following svd
a 4% following c-section
a Women reporting pain between 2 and 18 months post partum
a 30% following instrumental delivery
a 7% following svd
a 2% following c-section
Painful intercourse was significantly more common not surprisingly in the group of women delivered instrumentally.
HOOP Trial
The Hoop Trial-hands on or poised-carried out in 1998 examined the effect on the perineum and perineum pain at 10 days following delivery by two different approaches. In the first the midwife puts pressure on the head of the baby and protects the perineum. In the second the midwife does not intervene touching neither the babies head nor the perineum and allows spontaneous delivery of the shoulders.
Perineal pain at 10 days was higher in the group that the midwife's hands were poised and no intervention was made however...