How to Support Yourself Through Perineal Trauma

There are some incredibly practical steps you can take to assist your healing.

Navigating perineal trauma can be a significant physical and mental challenge. Sophie Walker from Australian Birth Stories podcast shares her own experience and outlines the steps you can take to heal and support yourself. 

My first birth experience was traumatic; along with an episiotomy and forceps assisted-birth, I sustained severe trauma to my pelvic floor muscles which resulted in a significant prolapse. I went on to have two more vaginal births and both were positive experiences. 

While my prolapse definitely didn’t hinder my birthing ability, it is something I will live with for the rest of my life. I admit, there have been many days when I’ve cursed the associated symptoms, when it’s made me feel vulnerable and frustrated when I wished it hadn’t happened in the first place. But I also regularly see a women’s health physiotherapist and I embrace lifestyle habits to ensure I’m strengthening my pelvic floor, prioritising my health and fitness and not letting my prolapse dictate my life. 

If you have recently sustained severe perineal trauma from a vaginal birth; either an episiotomy, third or fourth degree tear or prolapse, I know exactly how confronting it can be. But please know that you’re not alone and that there are some incredibly practical steps you can take to assist your healing. 

What is severe perineal tearing?

In 2020, 2.9 percent of Australian women who birthed vaginally sustained a third or fourth degree tear. That number is slightly higher for first-time mothers, with 5 percent of vaginal births associated with third and fourth degree tears. Severe perineal tears can occur spontaneously or as a result of obstetric intervention (vacuum or forceps assisted birth) and are described as lacerations to the muscles and soft tissue of the perineum (the skin between the vagina and anus). A fourth-degree tear also includes damage to the anal sphincter which can lead to fecal incontinence. These tears are repaired in the operating theatre where pain relief can be administered by an anaesthetist and the obstetrician has the support of a medical team. Severe perineal trauma is associated with ongoing perineal pain, incontinence and painful or difficult sexual intercourse. Subsequently, your care provider will typically refer you to a women’s health physiotherapist for ongoing postpartum care. 

What is pelvic organ prolapse? 

After birth, up to 50 per cent of women will experience some form of prolapse. This occurs when the ligaments and muscles that support the pelvic organs have been stretched, which causes the organs to drop down and bulge from the vagina or rectum. It’s more common for women who have had a long pushing stage, an instrumental birth or a third or fourth degree tear but the hormones in pregnancy and the weight of your growing baby can also be contributing factors. 

Practical Ways to Support Yourself

1. See a women’s health physiotherapist  

If you have suffered severe perineal trauma, consider a women’s health physio a vital part of your recovery plan. They will accurately diagnose what type/stage of prolapse you have (if any) and give you lots of reassurance and advice to help heal from perineal trauma and manage any associated symptoms. Early intervention is incredibly beneficial so consider it an important to-do during your postpartum.  Guidance from a physio will ensure that you know how to locate your pelvic floor muscles, you understand the difference between contracting and relaxing them and you know exactly what exercises will aid your symptoms. If you do have a significant prolapse, your physio may suggest a pessary, a small plastic or silicone support that is placed inside the vagina to decrease the symptoms and discomfort associated with a prolapse. Consider it a push-up bra for your pelvic floor. 

2. Listen to other women’s stories

I’ve interviewed over 300 women on my podcast, Australian Birth Stories, and many have shared their experience with physical birth trauma and outlined their physical and emotional recovery journey. Everyone’s experience is different but there is an undeniable comfort in knowing that you aren’t alone and can seek guidance from those 

3. Seek mental health support

One in three Australian women describe their birth experience as traumatic and there’s a strong link between physical birth trauma and postnatal depression, anxiety and post-traumatic stress disorder. If you notice that your perineal trauma is affecting your mental health and that periods of depression, sadness, anxiety and overwhelm are persisting for longer than two weeks, it’s a good idea to reach out for professional support. Your GP is a big first step, they’ll be able to set you up with a mental health care plan through Medicare which offers you 10 subsidised sessions with a psychologist. If you feel you want to access online support first, the Australiasian Birth Trauma Asosciation offers peer-to-peer support, advice and guidance for the treatment and prevention of birth trauma. Find them at

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