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Victory in my quest to avoid perineal massage

post #1 of 7
Thread Starter 

Looked up the evidence for perineal massage today now that I'm past 34 weeks. Avoiding a tear is important to me as I had a minor hemorrhage last time and we're not sure if it was uterine or related to the tear I had. But I found having to do perineal massage last time such a chore and don't want to this time unless I'm convinced it will help. 

 

Good news for me...although there is some evidence that PM can help a first-time mom a *little* to avoid tearing, it seems to do nothing for second time moms. There are plenty of other things that seem more likely to help, though. For me this feels very instinctually true, because I seriously doubt women throughout the ages around the world were doing regimented perineal massage. 

 

Here's the article I read, by Rebecca of Evidence Based Birth: http://www.scienceandsensibility.org/?p=5899

 

Here's some of the things I found that may help: 

  • Not lying on your back while pushing
  • Not pushing too hard
  • Pushing only when you feel the urge to
  • Being the one to catch your own baby - you feel your perineum and baby's head and have a better sense of what's going on down there
  • Warm compresses during labor/pushing (not sure which)
  • Good nutrition, healthy fats rather than typical vegetable oils
  • Oil on the perineum during pushing
  • Avoiding aggressive perineal massage by your care provider during labor/pushing - just inflames the perineum and makes it more vulnerable to a tear
  • Most interesting of all, Ina May Gaskin says in her Guide to Childbirth that women who perform clitoral stimulation on themselves during pushing don't tear because the vaginal tissue naturally engorges - I guess the blood flow helps too?

 

Still trying to work up the nerve to talk to my midwife about the last one! 

 

I'd love to hear additions to this list if you have any. 

post #2 of 7

Thanks for the info.  I'm in the same boat.  I had a 4th degree episiotomy/tear last time and hemorrhage.  I am hoping I don't have that type of recovery again.  

 

Gotta love Ina May!

post #3 of 7
Thanks for looking into this! Definitely not attempting the last one. Have you seen anything else about position during pushing? I pushed while squatting and had a second degree tear. Since then I've seen people who love squatting as a position and people who think it increases risk of tearing and pelvic floor damage. It was super effective for me so I don't want to give it up if I don't have to.

Ugh Kelly, I'm so sorry about your tear. I hope you can avoid it this time.
post #4 of 7
Excellent info. I had three huge tears last time (two up, one down) from pushing too hard, squatting and genetics (I get tons of stretch marks, as does my mom and she tore BADLY).

I was planning to push on my time frame instead of listening to the nurse and pushing as hard as I could and cranking out a baby in 4 pushes. Oof.
post #5 of 7

I looked into position a little.  Evidence-based birth has an article about that too.  Apparently pushing while upright does increase your risk of a 2nd degree tear as well as your risk of losing more than 500 mL of blood - which I probably did last time.  I passed out a couple times after the birth with a low H & H and they were debating whether I should have a blood transfusion or not.  Upright pushing does other good things though ... I'll have to ask my OB what his experience has been.  I know his back-up was not psyched that I was squatting. 

 

And yes Pamela, last time I "practice pushed" for almost 2 hours.  The nurse didn't care either way, she just offered it as an option and I was like, YEAH GET BABY OUT!  Different pushing strategy this time!

post #6 of 7
I thought both birthing lying on the left side and also water births reduced tears. I have no idea why i think that or where i read it, though.

I lost a chunk of the outer part of my vag when i pushed out number 1. She came out nuchal hand, and that hand took a piece. Nothing to sew up! Didnt cause any major bleeding bc it was very external. With that birth they used warm compresses and olive oil during pushing to help prevent tearing. Land birth. Squatted until crowning, then relaxed onto back for birth. But it changed the shape of my opening. Now it is kinda tear dropped instead of round? So idk if that made more room for number 2, or made stretching easier, but no issues with second birth. Second was a water birth.
post #7 of 7
Good conversation. .. I had a 1st degree tear with my first, a uc waterbirth. I know it could easily have happened anyway, but sometimes wonder if that's the moment I could have used some experienced help. Not to deliver the baby, just to help me relax and slow down... cause truth be told, I kind of panicked when I realized I was crowning and (I'm not ready yet! Ahhh!) decided to just push as hard as I could and get it over with. In retrospect, not the best decision! And as someone else said, the shape of my vaginal opening has changed, as the edges didn't really come together when it healed; I'm hoping this little bit of extra space will be all I need this time to get the baby through.

As for position, of course water changes the gravitational forces and whatnot, but I instinctively kneeled upright while delivering the head and then leaned back to deliver the body... nothing consciously decided but I doubt anyone could have made me get in any other position!

As for that last suggestion of In May's, I could never ever do this if not a uc... but being alone, did decide to try it during my last labor (before pushing) just to see if it helped. It didn't feel good and thus was quickly abandoned in favor of floating and moaning my way through contractions...
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