Perineal care

Your perineum is the area between your vaginal opening and the rectum. This area stretches a lot during childbirth and sometimes tears. Perineal massage in pregnancy aims to gradually soften and stretch the vagina and area around it in preparation for birth. This page explains why this is important and gives instructions on how you or your partner can carry out this exercise.

ORB Project at BSUH

At Brighton and Sussex University Hospitals we have launched a new project to reduce major tears that can occasionally occur in childbirth. These tears are termed 3rd degree and are referred to as OASI (Obstetric Anal Sphincter Injuries). We are joining other NHS Trusts who have successfully implemented similar projects and have seen a significant reduction in these injuries.

Our project is called ‘ORB’, which stands for OASI Reduction at BSUH. We hope this project will help to improve consistency of practice and raise awareness of perineal care amongst childbirth practitioners and lead to a reduction in major tears.

The ORB project incorporates four main principles during delivery of your baby’s head:


It helps if the midwife can see your perineum to assess and apply a warm pack. It is also advised that you adopt the best positions to reduce the likelihood of a major tear, such as being on hands and knees and avoid positions that can increase the risk. Your midwife will guide you with this and help you to feel comfortable and safe. It is recommended to remain mobile and upright during labour.


Your midwife will support you to have a slow, controlled delivery, talking you through and helping to keep your birth calm and gentle.


With your consent, a warm pack may be applied to your perineum by your midwife whilst the baby’s head is birthing, and she may place a hand on the baby’s head to help this.


With guidance and gentle use of her hands on baby’s head together you and your midwife will aim to achieve a S-L-O-W delivery of your baby’s head, helping to avoid or minimise any damage.