Was I imagining this? Downside to perineal massage??

[redvlagrl]

When I was pregnant with DD I seem to remember reading some studies which said that not only was perineal massage not helpful, but could actually weaken the tissue making it *more* susceptible to tearing.

Was i totally dreaming this? I'd like to read about it again as a friend has asked.

Thanks!

[organicpapayamama]

i remember reading this too. Im gonna see if I can find a link or something

[redvlagrl]

Tahnks, maybe you'll have more luck than me!

[nashvillemidwife]

I don't believe there is any proven benefit to intrapartal perineal massage. It can certainly make you swell and do more harm than good.

[organicpapayamama]

ok found something but its not what I read before but it does have some good info

http://www.babyzone.com/pregnancy/la...rineal-massage

[redvlagrl]

Yeah, that's the only thing I found, too! I am sure that I found something more convicing last time!

[MegBoz]

I think what I've encountered is that perineal massage during labor can increase the risk of tears (due to tissues swelling.)

But doing it during the weeks leading up to labor - that can be helpful.

Weird though, I haven't enountered any real, good, solid evidence on it.

[Calleiah]

I think it depends on how much you do it. I didnt do a lot with DD2 but I did some, gently and with lots of lube. Never to the point of pain or swelling. I have no doubt that it helped with DD2. I ended up with 6 stitches (not sure on degree of tear) with DD1, with DD2 (7 1/2 years later!) I had nothing, one little place my doc called a "skid mark", and the recovery was SO MUCH BETTER. I will probably do the same with this 3rd since it will have been 4 1/2 years since DD2.

I would imagine that over doing it, or doing it to the point of pain/swelling, etc may cause the issues mentioned in the study you read. Just my thoughts though.

[mwherbs]

so there are studies for and against and there is even a study from New Mexico I think that shows 50/50 with maybe a slight improvement for first time moms--- so with the evidence all over the place like that there is probably more to how it is done- like client preference, technique and procedures of the birth professionals either way
I personally do not want to do perineal massage, but sometimes I do hold a head from without touching the perineum , on the other hand the first midwives I worked with all did perineal massage and rarely had tears and their clients were fine with that-
on a different subject but related to what I am getting at- there was a recent study done by midwives in Oz that showed that they had better outcomes /less hemorrhages with midwife management of 3rd stage compared to active management and I know it is because they did not tug on the cord and do other behaviors that I have seen done repeatedly so just like this it could be that there are providers who have a skill set or style that lends it's self to either hands off or hands on

[evjolin]

this is no study but the info i have been given by my midwife and doulas is that it doesn't help. my hypnobabies class recommends it though. i think we are going to skip it....i think one thing that can really help (again--no proof!) is staying well hydrated in those last few weeks and during labor.

[redvlagrl]

Originally Posted by mwherbs

so there are studies for and against and there is even a study from New Mexico I think that shows 50/50 with maybe a slight improvement for first time moms--- so with the evidence all over the place like that there is probably more to how it is done- like client preference, technique and procedures of the birth professionals either way
I personally do not want to do perineal massage, but sometimes I do hold a head from without touching the perineum , on the other hand the first midwives I worked with all did perineal massage and rarely had tears and their clients were fine with that-
on a different subject but related to what I am getting at- there was a recent study done by midwives in Oz that showed that they had better outcomes /less hemorrhages with midwife management of 3rd stage compared to active management and I know it is because they did not tug on the cord and do other behaviors that I have seen done repeatedly so just like this it could be that there are providers who have a skill set or style that lends it's self to either hands off or hands on

Thank you for this - do you have links or authors of these studies so I can read for myself? Or even somewhere where I could do a search?

thanks

[mwherbs]

you could search "perineal massage"- at pub med and come up with several studies and some stuff that is not - but when I tried to narrow the search not all the articles showed up that would pertain- so you have to weed through a broad search or you could find a full text review and then find the supporting articles...

http://www.ncbi.nlm.nih.gov/sites/entrez

--------
here is a link to the New Mexico full text article- I just don't like randomized trials because I think that selection can be important

http://www.ncbi.nlm.nih.gov/pmc/arti...8/?tool=pubmed
----------------
a bit sideways from massage but warm packs- look over the abstract when doing your search- I like to use warm packs too

Midwifery. 2009 Apr;25(2):e39-48. Epub 2007 Nov 26.
'Soothing the ring of fire': Australian women's and midwives' experiences of using perineal warm packs in the second stage of labour.
Dahlen HG, Homer CS, Cooke M, Upton AM, Nunn RA, Brodrick BS.
Sydney South Western Area Health Service, Eastern Sector, Australia.

[redvlagrl]

Thanks so much for these links. I will check them out.

[LiLStar]

Incidentally.. I birthed my 10lb baby with SD with not a single tear. There was MASSIVE swelling. I was so swollen, I couldn't pee, and my mw had to come back and cath me (and 1600cc came out!!!) and it was so swollen it was difficult to even find my urethra. I was eating the arnica like candy. She said that the swelling may have been protective against tearing for me. (she had not been doing perineal massage) Soo.. what about that? Thats the first I've ever heard of swelling preventing tears. For me the swelling was simply from a looong pushing stage, pushing with everything I had!

So, is there a difference between the type of swelling that results from perineal massage, and the swelling thats simply a natural reaction to pushing and just.. everything happening down there! I'm sure part of my luck in not tearing was that nice slow stretch. I had to give everything I had for every last millimeter! Seriously, from crowning to head out was like half an hour. And I'd think that by the time I'd gotten him out to, idk, his ears? that the rest of his head would just pop right on out? Not so! But I think I can thank his big linebacker shoulders for that.

[claddaghmom]

Very interesting! I tore like crazy with DD and was thinking this might help.

[ann_of_loxley]

Originally Posted by MegBoz

I think what I've encountered is that perineal massage during labor can increase the risk of tears (due to tissues swelling.)

But doing it during the weeks leading up to labor - that can be helpful.

Weird though, I haven't enountered any real, good, solid evidence on it.

This is what I was thinking as well. A lot of what I have read about perineal massage is when it takes place during labour. Why on earth anyone would fancy a hand giving you perineal massage during labour will always baffle me - but whenever I see it done (like via youtube videos, etc), it seems to be 'OBs' doing it as the head is coming down the birth canal. I can't see how doing it at the last minute would be helpful at all. It could certainly only add to your discomfort too!

[MegBoz]

Originally Posted by ann_of_loxley

Why on earth anyone would fancy a hand giving you perineal massage during labour will always baffle me - but whenever I see it done (like via youtube videos, etc), it seems to be 'OBs' doing it as the head is coming down the birth canal. I can't see how doing it at the last minute would be helpful at all. It could certainly only add to your discomfort too!

Yeah & I read some terrifying stories on the birth professionals forum once. I believe the thread was called "Vagina wrenching" - they described yanking hard outwards (2 fingers each at 3 and 9 o'clock), & then stretching/pulling downwards.) --> NOT AT ALL the gentle "massage" I've read can be beneficial in late pregnancy. One birth professional said she saw an OB "bust a mama's perineum wide open" doing it. :Puke