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Perineal tearing: the controversy of hands on vs hands off - Page 4

post #61 of 87
Quote:
Originally Posted by Arwyn
This is where I totally blanked. A couple years ago, before I knew better, I probably would have suggested pre-labor perineal massage (by herself or with a partner) or warm compresses or perineal support - all that hands-on crap. Now? After a pause where I marveled at the stupidity of the question (how does one avoid shooting oneself in the head? don't shoot yourself in the head!!!), I told her about an article I had read in Midwifery Today recently that answered that very question: "How do you avoid episiotomy? Don't do one." And told her it really was that simple - just tell her provider not to do an episiotomy under any circumstances without explicit consent in the case of an emergency.
Well, I will say one thing for perineal massage/support. If the OB is doing that, they can't be doing an episiotomy. Hmmm...I wonder if episiotomy rates go down if the mother "accidentally" knocks over the tray of tools? Hmmm....
post #62 of 87
Quote:
Originally Posted by sapphire_chan
Well, I will say one thing for perineal massage/support. If the OB is doing that, they can't be doing an episiotomy. Hmmm...I wonder if episiotomy rates go down if the mother "accidentally" knocks over the tray of tools? Hmmm....
Well, not really... I ended up with both.

post #63 of 87
MomOf3Girlz, it is Mary, at Community Midwives of Toronto

Edited to change ontario to toronto!
post #64 of 87
Hi Brisen,

I'm in Durham Region. We just may have the same midwife...

Anywho, getting back on topic I must say I quite appreciated the warm compresses during pushing with my 2nd daughter. I always tell folks that I felt that eased the "ring of fire" and gave me the confidence to really push her out. My midwife did *ask* before doing it and I said yes. I'm glad I did.

With my 3rd child there wasn't any time for that she came so quickly.

I've never had any tearing with any of my children so far...

This time I planning a home waterbirth so I'm thinking that bone-cracking and ring of fire sensation will be lessened in the water as one poster mentioned previously.

I guess whatever the labouring woman wants is what's best for her. Our bodies really do tell us everything we need to know.
post #65 of 87
Oh, I'm with Sages Femme. I have Lisa Weston.
post #66 of 87
Quote:
Originally Posted by Brisen
I had 2 homebirths in London -- they did check every 15 mins. It is once active labour starts, though, maybe that's the diff for you? They are supposed to enter it on the chart. My mw today said that they've only had one mom who didn't want doppler in labour, and they decided that they should ask her every 15 mins and have her verbally decline so they could record it. She said that they could probably just have me say no once & for all when they show up -- I think they just weren't sure what they were allowed to do with the first mom who declined.

I'm in Toronto now.
No, they didn't check that often even when I was in active labour, and they used a fetoscope rather than a doppler. They did have a doppler in case I wanted to hear it, but I was fine.

I was with the Community Midwives of Hamilton. I am currently seeing a midwife at the St. Jacobs' Midwives, but I am moving back to Hamilton, and was lucky enough to call the CMOH when they were in the process of hiring a new midwife or else I wouldn't have got in.
post #67 of 87
Ah, I see. Did you find it uncomfortable being checked with the fetoscope? I've only ever had a doppler used to hear in the past, this is my first time declining the doppler. I have a friend who UC'd her last pg, and brought a borrowed fetoscope over to my place to see if I could hear the heartbeat. I totally failed. But, I'm not at all trained on it.
post #68 of 87
No I didn't find it uncomfortable really. I actually prefer that to the doppler because the gel annoys me with doppler.
post #69 of 87
Pam, thank you so much for that article. It was beautiful.

I had a perineal "massage" during my dd's birth and it was horribly painful. Maybe I'll have to drive down to Salem for my next birth
post #70 of 87
Quote:
Originally Posted by Momof3Girlz
Anywho, getting back on topic I must say I quite appreciated the warm compresses during pushing with my 2nd daughter. I always tell folks that I felt that eased the "ring of fire" and gave me the confidence to really push her out. My midwife did *ask* before doing it and I said yes. I'm glad I did.
Y'know how in movies about The Olden Days, when a woman was in labor, there were frantic cries to "boil some water!"

I once read somewhere that the reason for boiling water was to create warm compresses for the perineum to facilitate birth.....and I've been searching for a "heck yeah! that's true" to support this theory that I have not heard of/read of anywhere since I first read it.

When I've spoken to others about it, they admit they thought the boiling water was to sterilze the equipment, which I also used to think. (What equipment!?! But that's our current modern techno-mindset, assuming people who thought damp air could cause swamp flu or that excessive bathing is unhealthy would be sterilizing the nonexistant forceps/episiotomy scissors on the prairie.)

.....rambling....I hope I'm not too OT here....... "warm compresses on/off" that's in line with hands on/off, right?!
post #71 of 87
Quote:
Originally Posted by tinyshoes
Y'know how in movies about The Olden Days, when a woman was in labor, there were frantic cries to "boil some water!"

I once read somewhere that the reason for boiling water was to create warm compresses for the perineum to facilitate birth.....and I've been searching for a "heck yeah! that's true" to support this theory that I have not heard of/read of anywhere since I first read it.

When I've spoken to others about it, they admit they thought the boiling water was to sterilze the equipment, which I also used to think. (What equipment!?! But that's our current modern techno-mindset, assuming people who thought damp air could cause swamp flu or that excessive bathing is unhealthy would be sterilizing the nonexistant forceps/episiotomy scissors on the prairie.)

.....rambling....I hope I'm not too OT here....... "warm compresses on/off" that's in line with hands on/off, right?!
Where I work when the baby is about to crown the CNM has me got water "as hot as you can, so hot it hurts to touch it" and they use that for the compresses. I always wondered if it would hurt, it burns my hand as I bring it over yet they slap it right on the perineum. Who knows.

Yeah, you're right though, the old saying boil some water- there weren't "tools" back then, so what would they be sterilizing? Hmm.
post #72 of 87
Depends on how far back - they might have boiled the string they used to tie the cord and the razor for cutting it.

Boiling water also helps keep the house (most houses had 1, maybe 2 rooms) warm and humid for the birth, which is a common ritual in a LOT of pre-industrial cultures (hmm....).

And then of course there's the "busy work" factor. (Oh, to be able to send the OB and L&D nurses out to boil a hundred gallons of water... )
post #73 of 87
Quote:
Originally Posted by milkydoula
I was at my sister's prenatal appt (i am her doula) with the midwife i am considering using and the midwife suggested that she do prenatal perineal massage. She said that it would help her be able to relax the muscles when there was a lot of pressure from the babies head pushing on it and to train the muscles to relax under pressure.
So you train yourself to relax at manipulating your tissues -- your body is not going to recognize the birth experience as the same sort of thing, so it's not going to react the same way. You can get to where you can be completely relaxed in a relaxing environment with nothing in particular happening to your body, in complete privacy with only your own hands on yourself. That is not going to hold for intercourse or rape. It's not necessarily going to hold for someone besides yourself touching your genitals, or for a baby's head coming through when you're having contractions. The way behaviorism works, if that's what she's after, it requires some degree of specificity. Certain conditions must be present for the learned automatic response to set in.

She's trying to solve the wrong "problem" anyway. The body's tissues don't have to be trained to relax -- they already know how to, and will, given the right conditions. Just like with sex. If a woman is fully aroused, that is, if the body's hormonal process is facilitated and undisturbed and the woman is healthy, the vulval tissues are not going to be traumatized during sex. Even assuming that a woman can train herself to relax while her vulva is being handled, it's going to be superfluous unless she's expecting to not have a normal sexual experience.

I'll leave you to make the parallel with birth.

Quote:
I have a history of sexual abuse and have issues with tensing those muscles anyways (sex took a lot of getting used to and relaxation on my part). Would perineal massage help in this case? I would love some input
Does it have more to do with issues of power and trust and inhibition at having others touch you, or with the sensation of being touched in itself? Can you masturbate? In other words, can you touch yourself without tensing up? When you are in a warm bath in private, say? If not, then yes, it would probably be very helpful to allow yourself to feel good things in your vagina, so your body has other associations with it beside sexual assault. (Although it sounds like you've already been doing that to some extent.) I don't know, though, how stretching and rubbing the skin is relevant to this, unless it makes you feel good!

(Directions for perineal massage are often qualified with, "if it doesn't hurt, it's not doing you any good." As pertains to a normal bodily function, this is just plain wrong. But especially for someone with sexual abuse issues, it's an especially irresponsible thing to suggest.)

If you are fine with certain types of touch, then I would say that what you really need to do is disassociate the working of your body in birth with the sexual abuse. They have nothing to do with each other, one is coming from the inside with your desire and consent, the other from the outside without it. And then set up the birth so as to allow you to remain in a place where those associations will not come up, where you are respected, where you feel completely in control, where you don't feel inhibited.
post #74 of 87
Quote:
Originally Posted by tinyshoes
Furthermore, the concept of perineal massage is just another "women's bodies are broken" message, but this time it is in disguise....."perineal massage" is a suggestion bandied about by the earthy-birth community, especially with CNMs and "crunchy" MDs.
<nodding head>
post #75 of 87
Quote:
Originally Posted by Brisen
Ah, I see. Did you find it uncomfortable being checked with the fetoscope? I've only ever had a doppler used to hear in the past, this is my first time declining the doppler. I have a friend who UC'd her last pg, and brought a borrowed fetoscope over to my place to see if I could hear the heartbeat. I totally failed. But, I'm not at all trained on it.
Ah yes, the constant checking (with the doppler in my case). HIGHLY annoying especially when contractions are one on top of another...hmmm will have to talk to my midwife about that. I did not enjoy that. I thought they were just trying to keep the student midwife busy, lol...I know it's a "required by law" thing but who knows...maybe I can get out of it.
post #76 of 87
Quote:
Originally Posted by fourlittlebirds
<nodding head>
I agree too. For a long time I've had that feeling <shudder> when women recommend perineal massage. In my DDC and here, when it's been brought up I've just been unable to recommend it for some reason.

This thread has been very enlightening to me... it's nice to explore the feelings I have about it and to have everyone back those up with sound reasoning. Great thread Pama!
post #77 of 87
Quote:
Originally Posted by Momof3Girlz
I know it's a "required by law" thing but who knows...maybe I can get out of it.
I think it is just a College regulation... It seems to me now that midwives who like the regulations don't present them as something you can decline.
post #78 of 87
Quote:
Originally Posted by tinyshoes
Y'know how in movies about The Olden Days, when a woman was in labor, there were frantic cries to "boil some water!"

I once read somewhere that the reason for boiling water was to create warm compresses for the perineum to facilitate birth.....and I've been searching for a "heck yeah! that's true" to support this theory that I have not heard of/read of anywhere since I first read it.

When I've spoken to others about it, they admit they thought the boiling water was to sterilze the equipment, which I also used to think. (What equipment!?! But that's our current modern techno-mindset, assuming people who thought damp air could cause swamp flu or that excessive bathing is unhealthy would be sterilizing the nonexistant forceps/episiotomy scissors on the prairie.)

.....rambling....I hope I'm not too OT here....... "warm compresses on/off" that's in line with hands on/off, right?!
I'm OT here, but I always just thought boiling water was something to keep the menfolk busy and from being underfoot.
post #79 of 87
Wow, what a great article! The more I read about perineal massage I just don't think it's for me. A month or so ago I was thinking about getting strarted with prenatal perineal massage but no, the whole thought of it just skeeves me out now, and I just find more and more evidence that for care providers to be totally hands off is the best way to let a woman birth. Makes sense to me. Thanks for the article pamamidwife and to all you lovely posters for your experiences and insights. This has been quite an enlightening thread!
post #80 of 87
I thought boiling water was to get a warm bath ready to clean up the baby and mama after birth.
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