perineal massage?

[camip1225]

Having my second baby and wanting to have him naturally.  I am nervous about tearing since I did tear with my first....would doing perineal massage for a couple weeks before my due date be helpful?  SHould I stay home and labor in the tub for a long time?  any other tricks to avoid tearing???? 

[1love4ever]

I feel the same- my first was born with epidural and a doctor who did not care or try to prevent tearing, and I tore badly.  This time I am much more informed, am choosing to have a home birth with a midwife who cares.  I asked my midwife this very question, she said massage will probably help a little but that an active sex life throughout the pregnancy helps too because it is like massage and helps it stretch.  She also uses warm compresses (washcloths soaked in a crock pot thats on low) while you are pushing if your not in a tub.  I would labor at home as long as possible no matter what honestly, and I would imagine that if your tissues have been softened by being in the tub for awhile it would help.

My midwife also said that if you are in a pushing position that you choose at the time (not the flat on your back as required while you are under anesthesia) then you are less likely to tear. 

[jenrose]

Perineal massage should NOT be done during labor. Before labor, I'm not convinced it does anything productive.

The most convincing things I've heard of for preventing tearing include:

1. Walking for exercise

2. Simple, clean diet without a lot of processed crap

3. Birth position (not semisitting with the legs wide spread)

4. No forced coaching during the peak of crowning (you know, "Push, 2, 3, 4...")

5. Respect for the perineum (no massage, no epis, no forceps, no vacuum)

And at some level, not all tearing can be prevented, but a whole lot of things about hospital birth can make things worse. 

All that said, my second child's head was much larger than her sister's, and it hurt like hell to push her out, but I didn't tear. #1 was in the hospital, easy to push out, but they forced me into a semi sit and pulled my legs apart. #2, I was in water and totally in control of second stage myself, no one messed with me. 

[1love4ever]

Originally Posted by jenrose 

Perineal massage should NOT be done during labor. Before labor, I'm not convinced it does anything productive.

The most convincing things I've heard of for preventing tearing include:

1. Walking for exercise

2. Simple, clean diet without a lot of processed crap

3. Birth position (not semisitting with the legs wide spread)

4. No forced coaching during the peak of crowning (you know, "Push, 2, 3, 4...")

5. Respect for the perineum (no massage, no epis, no forceps, no vacuum)

And at some level, not all tearing can be prevented, but a whole lot of things about hospital birth can make things worse. 

All that said, my second child's head was much larger than her sister's, and it hurt like hell to push her out, but I didn't tear. #1 was in the hospital, easy to push out, but they forced me into a semi sit and pulled my legs apart. #2, I was in water and totally in control of second stage myself, no one messed with me. 

Why shouldnt perineal massage be done during labor?  I've never heard that before.  And yes birthing in water is supposed to greatly reduce the chance of tearing.  I have also heard that good diet without processed crap helps

[jenrose]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC31922/?rendertype=abstract

This, and other studies, show no statistically significant benefit to perineal massage.

Over-vigorous massage in labor can increase friability of the tissues.

Perineal massage in pregnancy helps first time moms reduce the likelihood of tears in labor, but there's just no benefit to doing it while the baby's coming down, and most of the doctors I've seen use it have been really, really aggressive with the massage. 

In any event, with a second vaginally born baby, massage doesn't help even prenatally, so why deal with the extra hassle?

[treehugginhippie]

http://birthfaith.org/nutrition/protecting-your-perineum-from-the-inside-out

[AbbieB]

 to everything jenrose said.