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.