Recommendations for perineal massage

[beckydv]

First time homebirther here putting together my birth supplies. On the list my MW gave me is oil for perineal massage. So I've got two questions about this.

1) What do you think of perineal massage anyway? I didn't have any with my first two births, and I can't imagine that I'm going to feel comfortable with anyone "massaging" down there while I'm trying to relax and concentrate. But if some oil applied down there makes things more slippery and the baby can slip out easier, that's great. Can anyone shed some light?

2) What kind of oil? The paper suggests vitamin E, olive, or wheat germ oil. Can anyone give a personal recommendation of which of these, or some other? Or does it really not matter?

Thanks!

[georgannemomof6]

Honestly.....

I don't think perineal massage does any good, especially if you've given birth prior. What works really well, is warm compresses, or staying in the water (again, warm!) for as long as you can! Also, there is less chance for tearing if baby emerges slowly enough to allow for stretching!

[pamamidwife]

I don't recommend it. I think it's an old belief system.

I also recommend NOBODY'S hands on you while pushing except for YOU.

[umami_mommy]

but it's fun to do while pregnant! :

[pamamidwife]

Originally Posted by honeybeedreams

but it's fun to do while pregnant! :

lol, yeah, anything that leads to sex has to be beneficial!

[cottonwood]

1) What do you think of perineal massage anyway?

Do a search, there've been many discussions about this!

Personally, I think it's a myth that it can help, and there's no question that it can harm.

I didn't have any with my first two births, and I can't imagine that I'm going to feel comfortable with anyone "massaging" down there while I'm trying to relax and concentrate.

Exactly.

But if some oil applied down there makes things more slippery and the baby can slip out easier, that's great.

The idea of oil getting on the baby's face makes me a little uncomfortable. It's good to have things be slippy, but in a normal hormonal process your body is going to provide for that just like it does during sex. So the key is to create an environment where those hormones can be released optimally. (Nothing distracting, inhibiting, etc.)

[SublimeBirthGirl]

IMO perineal massage is unnecessary at best. Maybe even harmful. I did my own perineal support with my 2nd and I am convinced that's why I didn't tear. I had a tiny skidmark I couldn't even see-it burned when I peed for a day or so. It happened in the place where I really felt I needed support during pushing, and where my support was concentrated. If I hadn't listened to that instinct, or if someone else had been trying to do support/massage from an outsider's POV, I think i'd have torn.

[umami_mommy]

just to be clear, we didn't do any massaging during labor.... (not sure if that is what people are refering to).... but how can it harmful during pregnancy? i don't understand...:

[StacyL]

Recent studies suggest perineal massage actually CONTRIBUTES to tearing.

That said, it was done against my will by my MW at my first birth and it was excruciatingly painful AND unnerving.

I told my MW (different one) for my second birth that I didn't want it AT ALL. I gave birth just fine without it. No pain, and no feeling of being violated.

BTW, I am also in MD. If Evelyn is your MW, she will be totally hands off for that if you want. She respects your wishes. Evelyn is awesome!

[umami_mommy]

Originally Posted by StacyL

Recent studies suggest perineal massage actually CONTRIBUTES to tearing.

i'm trying to be clear here. recent studies show it contributes to tearing DURING LABOR? or when done DURING PREGNANCY???

yes i could see if a woman has not had that part of her body touched for her whole pregnancy that vigorous massaging during labor could be harmful, but what exactly are we talking about here? who did the massaging in the study? when was it done? how big was the study? who did it?

do you have an references?

TIA!

[beckydv]

Thanks everybody for confirming what I thought -- perineal massage is really not for me. I'm not even interested in doing it myself or having DH do it before labor.

Yes, Stacy, I'm with Evelyn. I'm sure she wouldn't force anything on me (and glad to hear you say she's hands off), but after reading about the massage in books and stuff I wondered if I was missing something.

FWIW I did search the boards before posting the question but wasn't able to turn up the info I wanted. I'm not good at searching!

Thanks again!

[cottonwood]

I don't have studies, perhaps others can provide them. As far as I know the only studies that have been done look at tear rates for massage done during birth itself, and there has been no study looking at the reasons for these tear rates. Heck, it seems like nobody is even talking about it theoretically, not published anyway. If anybody has sources I'd like to see them too.

In any case, here's what I think: Perineal massage during pregnancy is fine as long as you're not causing pain. Pain means you're tearing down tissue, and if you do that enough over a long period of time, that tissue is going to start not recovering.

I think there's often a misunderstanding, also, of what perineal massage is for. It's often thought that it increases tissue flexibility but in reality stretching tissue does not make it more stretchy, it just makes it stretched out.

Perineal massage during pregnancy can serve a valid purpose in simply getting the mother used to sensations in and around that area, if she's not already. Not that a bit of massage comes even close to the sensations of birth, but there are women who never touch themselves and are tense even when their lovers touch them, so it's a starting point. It can help also in bringing to light infection or an imbalance of bacteria -- if there's pain or burning with even a light touch, for instance. It's never a bad thing to help yourself be more aware of what is going on in and around your vagina.

Someone also mentioned doing perineal support during birth. I'm skeptical about it but at least it does not have the potential to harm that massage does. I still recommend that the mother herself do it. She will intuitively have a better sense of where it needs to be done, she will not hurt herself, and her own hands aren't going to make her tense up like an attendant's would.

[MommytoTwo]

My MW recommends olive oil. I, like you, cant imagine feeling like I want someone massaging that area. I also read that if you are pretty sexually active during pregnancy (though it didnt say exactly how often) that its not really necessary. Anyone know if thats true?


OK I just read the thread and it seems most people feel its unneccessary... thats good 'cause I am not interested. lol

[Peppamint]

Personally- I like MY hands down there while baby is crowning and no one else. OTOH, a HB'ing friend of mine likes to have perineal support (we use the same midwife).

At my first birth, a hospital/OB managed birth, the OB did perineal "massage" and it was excruciatingly painful. She hadn't recommended perineal massage in pg. After all that she still said I'd tear and cut an episiotomy.

BTW- at birth #2 and #3, both WB @ home, I did not have any perineal massage . #2 came down reallllly fast and I only had a small skidmark that I couldn't feel the next day (no stitches). #3 had her hand/arm by her face and I had no tears at all.

[Ymoja]

Hi Guys,

This is an interesting discussions...I would like to hear more. Though honestly my experince with it was quite different. My husband did the massages during pregnancy and I would always verbalize when it would be uncomfortable.

My midwife and I through her encouragement developed a relationship that allowed me to be comfortable with her massaging me during birthing. She also used a brew of papaya leaves (which is a meat softener) to dab my perinium while gently massaging.

The head was the hardest part so with each contraction as the baby started to crown she would help brace my perinium as I pushed. It really help to me.

I am pregnant again, due december 23rd and i started the massages again.

Good luck guys and please post sources that discourage it because I would like to see what information is out there.

Blessings

[StacyL]

I wll try to find the studies I've read and post them here. I would imagine it is harmful to have done massage while pregnant, as well as during labor, but I don't remember if the studies made that distinction.

Evelyn did tell me that the hormones of pg and bf'ing make your tissues down there more susceptible to tearing.

[umami_mommy]

Originally Posted by StacyL

I would imagine it is harmful to have done massage while pregnant, as well as during labor, but I don't remember if the studies made that distinction.

how would it be harmful during pregnancy? just wondering what your imagination would be.

and i would imagine if the study didn't make a distinction of pregnancy versus labor, it wouldn't be much of a study.

[prettypixels]

I am birthing with Evelyn, and her list of homebirth supplies includes olive oil for perineal massage. I mean, it says that right on the list! I will have to ask her thoughts on it... I really don't get how it can *hurt*, my husband does my perineal massage every week or so and if it doesn't feel good we stop. It seems like massaging oil there should help with elasticity in the long run... at least I know that is the idea behind it, certainly not to harm!

Also love to hear about studies/info saying otherwise...

[umami_mommy]

i just did a pub med search for perineal massage (17 citations) and all the studies i read said that perineal massage during pregnancy was helpful for preventing tears, esp, in first births and for preventing 2nd and 3rd degree tears. massage during labor did not effect outcomes. i did not see anything that said it was harmful. these are of course studies done during hospital births.

some of the studies cited were still in the pilot stage.

[kathan12904]

A midwife recommended to me that I do it, not necessarily for the actual stretching that it would help with, but because it will increase your awareness and understanding of your vaginal space as you prepare yourself for the sensations of labor. If you've already birthed vaginally, this might not be something you need to do, but since I am an HBACer, she thought this would help me understand better the sensations that would be occuring during actual birth. Stretching or massage that is painful would never be advisable, but making sure the tissue there is well moisturized with an oil of your own choosing will keep it in the best shape it can be in for birth.