Protecting your perineum (from the inside out)
Someone I love gave birth last week for the first time. We talked on the phone about her experience a few days later. While she felt really good about how everything went, she was hurting. An episiotomy+tearing, back pain from her epidural, plus the normal pain associated with initiating breastfeeding were wearing on her. Having experienced some severe tearing with my first birth, I gave her my solidarity. Recovering from perineal trauma was some of the most excruciating physical pain I’ve ever experienced! I’d take labor pains over that any day.
During our phone conversation, she mentioned that one of the nurses at the hospital had asked her if she ate meat (she does eat a little, mostly chicken). Seems like a strange question, but apparently the nurses at that hospital had noticed a trend among the women they attended in labor: in their experience, women who were vegetarians were more likely to tear. A statement like that calls for some follow-up research, no? I jumped on it and starting digging around in the scientific literature to see what dietary substances are associated with increased skin elasticity. I never really found a clear-cut answer to the vegetarian question, but I did find lots of other cool information.
I’ve posted before about how to prevent tears from the outside in, but now I know a whole slew of ways we may be able to protect our perineums from the inside out. These are some dietary additions you may want to make if you’re hoping to prevent tears (and improve your skin and health in general):
1. Healthy Fats
Earlier this year, Japanese researchers published their findings: “After controlling for covariates including age, smoking status, BMI and lifetime sun exposure, the results showed that higher intakes of total fat, saturated fat and monounsaturated fat were significantly associated with increased skin elasticity” (Source). The study also found that adding a high intake of green and yellow vegetables to that fat consumption improved skin health even further. That’s not to say we should eat just any fats. If you’re going to consume animal fats, your best bets are those coming from organic, grass-fed, free-range, or wild-caught animal sources. Plant sources of healthy fats, include olive oil, coconut oil, avocados, nuts, and seeds.
Then there are the fatty big guns: the omega-3s. Research indicates that supplementing with fish oil can significantly improve skin elasticity. Regularly consuming fatty fish like wild-caught salmon will also boost your omega-3 levels. Plant sources of omega-3 fatty acids include flaxseeds, chia seeds, pumpkin seeds, and walnuts. Personally, I try to eat from a wide variety of omega-3 sources to cover all my bases–DHA, EPA, and ALA.
Fats to limit/avoid: processed fats such as hydrogenated oils, trans fats, and any oils that go rancid easily… vegetable oils, corn oil, soybean oil, safflower oil, etc. Hydrogenated and rancid oils can lead to free radical damage which will reduce the health and elasticity of your skin (and contribute to a long list of other health problems).
2. Vitamin C
“(Vitamin) C is for Collagen,” says Allison Tannis in her book Feed Your Skin, Starve Your Wrinkles. Collagen, she explains, “is a protein with a triple helix structure that provides a strong framework to support cells. Its tensile strength (the ability to resist force without tearing apart) is greater than that of steel, which explains why your skin is so strong” (p. 20). Or why your skin should be strong, that is. Reduced collagen levels lead to unhealthy, weak, aging skin. Vitamin C has been shown to stimulate collagen production (source). Logic would suggest, then, that increasing your intake of vitamin C would give your perineal skin added health and strength (a perineum of steel!) to resist trauma.
What are the best dietary sources of vitamin C? Papaya, red bell peppers, broccoli, brussel sprouts, and strawberries. Find more here. Vitamin C will also boost collagen production (and overall health) when applied topically to the skin (source).
3. Cysteine
Now here’s where the vegetarians and vegans could be low. Cysteine is an amino acid as well as a powerful antioxidant. It promotes healthy skin elasticity and is necessary for skin repair. Most of the potent dietary sources of cysteine are animal products (meats, poultry, eggs, cottage cheese, yogurt, etc), but there are plant sources (red peppers, garlic, onions, broccoli, brussels sprouts, oats, granola, wheat germ) (source). Cysteine deficiencies are rare, but “strict amino acid-imbalanced vegetarian diets may lead to poor sulfur amino acid intake and [cysteine] deficiency signs” (source). Our bodies will actually produce cysteine on their own as long as enough methionine (another amino acid) is available. Vegans and vegetarians can pre-empt a cysteine deficiency by supplying their bodies with ample methionine. Good sources of methionine include eggs, fish, sesame seeds, brazil nuts, soy protein, parmesan cheese, meats, and cereal grains (see more here).
4. Evening Primrose Oil
A 2005 study found that adults taking capsules of evening primrose oil for twelve weeks had significantly improved skin elasticity, moisture, firmness, and fatigue resistance compared to adults taking a placebo (source). Evening primrose oil provides health-promoting forms of omega 6 essential fatty acids—linoleic acid (LA) and gamma-linolenic acid (GLA). While it has many medicinal uses, midwives have long encouraged evening primrose oil at the end of pregnancy as a means of ripening the cervix (through its prostaglandin content) for childbirth. Given that traditional usage, it may be wise to delay taking evening primrose oil until the 37th week of pregnancy and only in consultation with your maternity care provider. I’ve heard mixed reviews about whether it will help put you into labor, but research does indicate that it will improve the elasticity and health of your skin. I’ve also heard that it can be massaged into the perineum to prime the tissue to stretch well, and it is also supposed to be helpful when applied topically to prior perineal scars to loosen and soften them in preparation for a subsequent birth to prevent re-tearing.
5. Et Cetera
Other dietary additions that may benefit the strength and elasticity of your perineum…
- Silica—strengthens the skin and promotes elasticity and wound healing. Dietary sources: whole grains, dark leafy greens, leeks, green beans, garbanzo beans, strawberries, cucumber, mango, celery, asparagus and rhubarb.
- Selenium—promotes skin elasticity and prevents free radical cell damage. Dietary sources: brazil nuts are the most potent source (I hear you can even get too much selenium by eating more than a few per day), wheat germ, fish, garlic, eggs, brown rice, and whole-wheat bread.
- Vitamin E—promotes overall skin health and promotes wound healing. Dietary sources: sunflower seeds, almonds, olives, papaya, and dark leafy greens.
Other external preventative measures to reduce perineal trauma…
- Perineal massage during pushing stage (two fingers inside the vagina with a gentle sweeping motion to stretch the perineum). (Source) Massaging with lavender essence in the pushing stage has also been shown to prevent tears. (Source)
- Warm compresses (warm, wet cloths applied to the region during the pushing stage). (Source)
- Side-lying delivery position (lithotomy position increases tear risk). (Source)
- Optimal fetal positioning (abnormal cephalic presentations are associated with more severe perineal tearing). (Source) See these sites for tips on getting your baby into an ideal delivery position during the last weeks of pregnancy:
- Optimal Fetal Positioning, by Michelle McClafferty
- Spinning Babies
- Optimal Fetal Positioning, Avoiding a Posterior Baby, by Elizabeth Petrucelli
- See more preventative tips in my prior blogpost here: Avoiding tearing and episiotomies
Related stuff:
Honey for healing tears
Healing advantages of lavender essential oil during episiotomy recovery
What Do Episiotomy and Cesarean Have to Do with Copernicus, Galileo, and Newton?
*****
Given all of the information above, it’s no surprise to me that I tore so severely during the delivery of my first baby. I had been eating a steady diet of mostly garbage for years. There’s no doubt in my mind that I was low on many of the key nutrients for skin elasticity and health. I was also doing purple pushing in the standard hospital position without any perineal support from the resident who caught my baby. A slightly improved diet and perineal massage by my midwife enabled me to give birth to my second baby (posterior!) with only a tiny tear. A vastly improved diet, prenatal exercise, optimal fetal positioning, warm compresses, and perineal massage kept my perineum intact during my third birth. Here’s hoping my fourth birth will follow suit!
Are you a vegetarian or vegan? Did you experience perineal trauma giving birth to your babies?
Do you have any other tips or experiences to share?
Related posts:
Very interesting article. It supports some other things that I’ve heard regarding protein. I have also heard avoiding simple sugars is key and here is why: Jonell Francis of “My Feel Good Foods” told me this, “High glucose levels in the body sustained over time play into a process known as glycation, which is the same process that toughens and browns proteins in food storage. Glycation happens when glucose binds with protein which is primarily what our bodies are made of, plus a whole bunch of water. So, what happens to the elastin (a protein) in our skin is that glucose in the bloodstream binds with this protein like a clump of glue on an elastic waistband which prevents the elastin from stretching it’s full distance or from bouncing back when the stretching is over. Scientists have now linked this glycation process with deep wrinkles and a browning, toughening or thickening of the skin that we associate with old age. But it also happens to our insides as well, making connective tissue not as stretchy, and blood vessels less pliable, etc. This is why diabetics are 30% more likely to have heart disease than everyone else, and why their skin appears to age more quickly. There are a handful of books by Nicholas Perricone, MD you could preview online about aging and sugar.”
Interesting right? I haven’t done the research on it myself but when I find the time I would like to. She was talking about avoiding stretch marks when she told this to me but I think it could apply to perenium as well.
Wow, Sydney! That’s totally fascinating! And actually having lots of stretch marks is also a risk factor for perineal tearing, so it all makes sense. Really cool. Thanks for sharing!
I am a vegan and I have had two vaginal births. The first birth I had a small “skid mark” not deep enough to be considered a tear. I was in a side-lying position on a bed.
The second birth I had a water birth and I was semi-reclned and a bit to the side with one leg up on the bath tub. I had no tearing.
I had no stretch marks with my first pregnancy.
I got one small stretch mark with my second pregnancy.
Wow I was going to write a comment but you wrote almost exactly my experience too!!
We went over a lot of this at doula training, and I remember thinking that I should forward you the info for a post!! And then you go ahead and blow my knowledge out of the water!!
Thank you for this. I have one friend in particular that will REALLY love this (pregnant with her 2nd, hoping to avoid a repeat 3rd degree tear). THANK YOU!
I have been vegan for a few yrs now. I am not super strict about it though and will eat lacto-ovo stuff if I’m out and there are no vegan offerings but haven’t had meat in forever. I did NOT tear my perinium at all! I had one small internal tear on the lower right side just inside, but that’s it and there was no need for stitches. However, I had a homebirth with a midwife, pushed while squating on a birth stool, and had tons of “perinium support” as you call it (my midwife rubbed my perinium with olive oil and used some counter-pressure I belive… kinda hurt at the time but was better than tear). As for my diet, I eat fairly healthy but am not perfect (I have a huge sweet tooth but don’t care so much for greens, though I try to sneak ‘em in as much as I can). I make sure I get lots of protein- I usually have some nuts, PB, seeds, beans or some type of soy with every meal and most snacks. I’m pretty sure I have more than enough methionine and I take vitamins- towards the end of pregnancy I was on prenatals, vegetarian DHA, probiotics, Floridex for iron, and calcium. I don’t avoid fats and I buy mostly organic groceries. BTW this was my first:)
Great article! Wish I had known more about this before I had a baby. I was a vegetarian when I was pregnant, had been for more than half of my life (17+ years). I did have a beautiful home/water birth – could have been in the water sooner, I did tear, requiring stitches. I am no longer a vegetarian (was a vegan for the last 2 years of that) and I would never go back knowing what I have learned now. That being said, I am only comfortable eating meat from local farmers that I know, they treat their animals right and feed them species appropriate diet (like pastured or grassfed). The book Full Moon Feast by Jessica Prentice really helped me with this decision (the transition from vegetarian to eating meat).
I had a pretty bad diet with my vbacs and I tore. I definitely eat better now and I hope that would help protect my perineum. This is great information!!!
I have been vegetarian my entire life (have never eaten any kind of meat/fish). I eat a lot of the foods mentioned in your article, but have never taken supplements of any kind other than vitamins during pregnancy. During my first pregnancy, I tried to go vegan most of the time. I had a homebirth, with a midwife who gave perineal support. Only a very small tear (no stitches or anything), no pain associated with the tear worth mentioning. My second baby (almost 8 years later) was also a homebirth, with the same wonderful midwife. Three-hour labor, no tear. After the birth, the assisting midwife commented on how great the placenta looked, to which the other midwife responded, “They’re vegetarian!”
I’ve been a mostly healthy eating vegetarian for over 20 years, and birthed 3 times within the past 8 years. I also am very well read on natural birth as it one of my great interests. I totally blame tearing on modern birth practices of epidurals so women can’t feel anything, and are put on their backs and told when and how to push. I am also very well read on nutrition and fully believe in good nutrition, but I think tearing is far more influenced by the above rather than nutrition. Of course, great nutrition helps in every way, but if women are left alone to birth as they instinctively know they need to birth, blowout tears are very unlikely. Most women will birth vertically and will push when, how, and if they need to push. A woman doped up in a hospital has none of these options and is basically set up for massive problems. If she escapes a c-section, she’s still likely to get major tearing and hemorrhoids. As for me, I had an episiotomy with my first, born in a birth center, due to low baby heart rate, which I fully blame on them wanting me to push while lying on back. I was very comfortable upright sitting on the toilet before they wanted me to switch to that dreaded position on the bed. Next two were born at home, both in vertical positions, one squatting and one sitting on the toilet. My body pushed them out in three contractions with no effort on my part. I had a very tiny tear with one and a tiny skid mark with the next, and that one I had rubbed coconut oil on my perineum just prior to birth. I did no perineum support with either, but just let them come on out. My placentas always looked great, too, very large and a deep, rich red. Since someone mentioned it, I never got stretch marks, but I do have many from puberty elsewhere on my body, and they do run in my family, but I attribute that to my daily applying of coco butter, coconut oil, shea butter, and whatever other great lotions I had. I just kept my belly slathered up in that stuff.
Before I gave birth to my first child, I would’ve agreed whole-heartedly with you. I still do, for the most part. I was the exception. Before getting pregnant, I was semi-vegetarian rarely eating anything other than fish. When I got pregnant, I began eating meat again, most chicken and turkey. I had a model pregnancy, with no complications. I gave birth at home with a mid-wife and was allowed to labor and push how I felt best. It was a quick and relatively easy labor. I pushed for a couple of contractions up-right on the toilet until crowning, then semi-sitting on the bed. I began to tear so severely that my mid-wife cut the 3rd episiotomy of her career. I had to go to the hospital to be repaired and the OB said he had only seen something like it with a forcep extraction. I am a very active person and in great shape, dancing up until the day before I gave birth. I am very much in touch with my body and relied on my own body’s cues during. No one could explain to me why I tore so severely. Simply that, “You just didn’t stretch at all.” So, though rare, it does happen.
Hi Stacey,
I know you put this post up an age ago but I couldn’t help wanting to answer your question. You tore because you are a dancer. Dancers and athletes almost always have tight perineal muscles. If you have another baby do perineal massage from 35 weeks and learn how to relax your perineum with focused breath.
Just a follow up note that we had another baby six months ago, another homebirth with only my husband and kids. This time, I birthed on hands and knees, again with no pushing. I went from normal contractions to the baby being born in the next contraction. I never even felt this baby move down the birth canal. I had no tearing or even any discomfort afterward. I felt fantastic as soon as he popped out. My diet is still about the same, too.
I’m vegetarian (and 8/9 years before both of my births at 35/36 years old). I used to have stretch marks from when my weight fluctuated when I was younger. I did not have any stretch marks during pregnancy. I tore slightly with both children, requiring 2 stitches, I think. Water births with no perineum support.
During my pregnancies, I consumed a lot of Omega3/6/9 (Udo’s Oil), and Vit C, Bs, Iron, and calcium, and a protien supplement. Over the last couple of years, I’ve improved my diet (more greens/green juicing/less grains and sugars), and the stretch marks I had from when I was younger have virtually disappeared. I swear that the Vit C was key in preventing stretch marks. I never thought to correlate it to the tearing to diet, but it totally makes sense (and positioning, as someone else commented.)
I am not vegan or vegetarian, I eat quite a bit of meat, both chicken and beef. I’ve had two vaginal births and have torn with both of them. My first was in a hospital, with an epidural, on my back and a vacuum extraction at the last minute. This left me with a 3rd degree tear. My recovery was easily the hardest part of the adjustment to motherhood. I was in significant pain for at least 3 weeks, and wasn’t able to sit without my donut or other pillow until about 6-7 weeks postpartum. It was awful. It was the biggest motivating factor in seeking an unmedicated, natural, out of hospital birth with my second baby.
That ended up being a unmedicated, home, waterbirth. Because I never felt the urge to push with my first baby, it was overwhelming with my second and I could not control it. Therefore, I pushed out my baby quite quickly. That resulted in a 2nd degree tear. Both times it was just one tear and they both went straight back (when repairing my second tear, my midwife asked me if I’d had an episiotomy with my first because it was so straight. To my knowledge, there was no episiotomy, just a natural tear). The recovery from the second one was much easier. The bulk of the pain was gone within a week and I felt almost completely recovered 4 weeks after birth.
I am now pregnant with my third baby and in discussing with my midwife what my goal was for this birth, I told her, I wanted and needed the support to avoid a tear as much as possible. I had been through the unmedicated birth and feel confident in my ability to handle that, but I need her there to help emotionally and physically support me so that I can have an intact perineum. I’m not sure that it will be possible (based on something my midwife told me), but I want to minimize it as much as possible.
I greatly value posts like these and I definitely need to take up the suggestions. I know the pain of a bad tear and how much it affects everything. Walking around was difficult. Going to the bathroom was always a fearful experience, one that I tried to avoid, even though I knew I shouldn’t. Going somewhere outside of the house was embarrassing and nerve-wracking (church, restaurants, etc), because I had to bring my donut or a pillow with me.
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I don’t eat meat. 1st birth, a 2nd degree tear where nurses finger was, bad stitches poor healing. 2nd birth scratch on old scar after fast pushing and a 9lb baby, I’m gonna say without botched stitches the 1st time I’d have been fully intact and considered myself so when there was zero pain the 2nd time and it required no stitches or glue.
During my first birth I was kneeling upright and then asked to turn around so the nurse could loosen the cord, and was in a deep squat when she put her hand in to do so unfortunatly it was right at the peak of a ctx and big push so i tore where her finger was. I did take fish oils somewhat regularly.
My 2nd birth at home, I was kneeling upright and stayed that way and I was the only person besides my baby to touch my vagina, my midwives “kept their hands in their pockets” like I asked and my husband caught him while I kept a hand on him. I remembered my omegas sometimes, but this time they were vegan oils and I had a little scratch on my old scar that never healed well because my stiches held part of my tear open for the first 6weeks so I was not too suprised and it did not hurt at all after my 2nd birth. And this was 9lb baby.
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I’ve been a vegan 25+ years and going on three births now – my first was a hospital birth that included and episiotomy after 42 hours from an AROM at 2 weeks overdue. Subsequently I did retear down the scar but that is normal I hear.
I have no nutritional imbalances, get enough fats and would say the nurses were speculating at best. I would be interested what the body types and weights of these women were after years of being a vegan and prior to that suffering an ED I know that vegetarianism can be a great way to hide this disease (not saying we all are hiding under the label) but maybe women who limit fat/calorie intake as vegetarians or who eat a poor diet are more likely than it just being a plant based diet
Great information! In over 20 years of attending births, it is not the vegetarians and vegans I have noticed tearing the most, but those with a nutrient-deficient diet, especially those who eat a lot of sweets (desserts, sodas, sweet tea, etc). Most of the vegetarians and vegans I have served have had the most nutrient-rich diets and the least amount of tearing. The most beautiful placentas are from the vegans (avoiding dairy seems to make a difference) and the worst placentas have been from the moms with a poor diet (processed foods, sweets, lots of dairy products) or who smoked (even those who cut down to one cigarette a day).
Hi Busconda
I have been reading your blog and really like it. You have some really unique perspectives. I am a midwife, midwifery teacher and author working in New Zealand. I wonder if you could contact me on my email address as I have something that I would like to ask you.
Many thanks
Lorna
great post! thanks for sharing this important information. :)
Very comprehensive information. Thanks for sharing. Just my experience dealing with tear. I sat on a big potty(for adult) with sea salt and warm water during shower and that helps to stretch the perineum and lessen or even helps to diminish the pain. No need pain killer.
I’ve been vegetarian for 20 years.
Three births. No tears. A small graze each time.
I held my hand over baby’s head as he crowned, supplied counter pressure and slowed him down. This allowed lots of time for my peri to stretch and allowed me to feel more connected and in better control.
Many women all over the world are stretching their perineums to prepare for a first birth or a birth after stitches by using the Epi-no Childbirth Trainer made by Tecsana in Germany. I was very sceptical at first, but after birthing dozens of women who used it in Israel, I discovered that it is an AMAZING device to prevent tearing. It makes a first birth act like a second birth in second stage, faster, easier, and way lowers the tear rate. My ladies nearly never tear and I NEVER cut episiotomies.It is a small silicon balloon inserted in the vagina and gradually blown up to stretch the perineum during a month. It goes back after birth! It really works! Unfortunaely not sold in U.S. as didn’t pass FDA yet, but is sold all over Europe and Australia etc. Check out the website http://www.epi-no.com. Ilana Shemesh, homebirth midwife
What a valuable resource! I don’t know why diet and tearing never crossed my mind before, but this is truly brilliant. Plus, all the foods that help with tearing also really support the developing child. Perfect! Thank you for taking the time to follow-up on the comment and share it with the rest of us!
It is a shame that so many of you did not know this info going into your 1st labor. Any midwife worth her salt should be giving this herbal/nutritional info prenatally! This is all pretty basic info ALL HCP’s SHOULD know,(& inform you of!) too bad more docs don’t know as much about nutrition & herbal remedies as midwives do.
Only one thing Buscando said, that I don’t agree with is about perineal massage. The 2000 CPM study found that perineal massage should be done prenatally, & that no one should be massaging it during the birth. Rationale: it is easier to relax if there is no one/nothing touching your perineum, or having just the steady pressure of perineal support, if that feels good, but not massage.
A few things she didn’t mention:
1. chronic yeast (or other vaginal)infections makes your perineum more friable & easily torn
2. having the skin integrity broken by an episiotomy, actually makes you more likely to tear.
3. having an epidural or any other numbing or pain-killing drugs (legal or illegal)makes you more likely to tear because you can’t feel when it’s time to stop pushing & breathe the baby out slowly. Even w/o drugs, often hospital staff are yelling at you to push, that you push right through the stinging that is your bodies signal to NOT PUSH! Also, waterbirths, as much as I love them, lessens that sensation to stop pushing, unless someone is there supporting your perineum, that tells you when to stop pushing.
I have not seen many tears worse than just skid marks. I have not seen a different tear rate in my vegan or vegetarian clients than in my meat-eaters. But then they all get the same dietary/herbal/supplement info during their prenatal care. Good nutrition is the cornerstone of a healthy pregnancy. I regularly review their diet sheets.
I have been vegetarian for years (more than half my life) but still eat fish, dairy and eggs. My body must instinctively be telling me what I need to be “stretchy” because my cravings have included olives, cottage cheese, nuts, and sunflower seeds, among other foods mentioned in this article! Also eating lots of eggs, tofu, and garbanzo beans (aka chick peas), plus tofu, and taking omega-3 supplements along with my prenatal vitamin. One of the prenatal clinic doctors did recommend the epi-no as well, though my doula seems to think ‘natural’ (gadget-free) message is better so I haven’t decided whether to use the epi-no yet or not; my husband thinks it might be good since I am “tight” (expecting our first in June!)