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Recommendations for perineal massage - Page 2  

post #21 of 36
Regarding prenatal perineal massage (bold mine):

Quote:
Beckmann MM, Garrett AJ. Cochrane Database Syst Rev. 2006

BACKGROUND: Perineal trauma following vaginal birth can be associated with significant short- and long-term morbidity. Antenatal perineal massage has been proposed as one method of decreasing the incidence of perineal trauma. OBJECTIVES: To assess the effect of antenatal perineal massage on the incidence of perineal trauma at birth and subsequent morbidity. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 January 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2005), PubMed (1966 to January 2005), EMBASE (1980 to January 2005) and reference lists of relevant articles. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials evaluating any described method of antenatal perineal massage undertaken for at least the last four weeks of pregnancy. DATA COLLECTION AND ANALYSIS: Both review authors independently applied the selection criteria, extracted data from the included studies and assessed study quality. We contacted study authors for additional information. MAIN RESULTS: Three trials (2434 women) comparing digital perineal massage with control were included. All were of good quality. Antenatal perineal massage was associated with an overall reduction in the incidence of trauma requiring suturing (three trials, 2417 women, relative risk (RR) 0.91 (95% confidence interval (CI) 0.86 to 0.96), number needed to treat (NNT) 16 (10 to 39)). This reduction was statistically significant for women without previous vaginal birth only (three trials, 1925 women, RR 0.90 (95% CI 0.84 to 0.96), NNT 14 (9 to 35)). Women who practised perineal massage were less likely to have an episiotomy (three trials, 2417 women, RR 0.85 (95% CI 0.75 to 0.97), NNT 23 (13 to 111)). Again this reduction was statistically significant for women without previous vaginal birth only (three trials, 1925 women, RR 0.85 (95% CI 0.74 to 0.97), NNT 20 (11 to 110)). No differences were seen in the incidence of 1st or 2nd degree perineal tears or 3rd/4th degree perineal trauma. Only women who have previously birthed vaginally reported a statistically significant reduction in the incidence of pain at three months postpartum (one trial, 376 women, RR 0.68 (95% CI 0.50 to 0.91) NNT 13 (7 to 60)). No significant differences were observed in the incidence of instrumental deliveries, sexual satisfaction, or incontinence of urine, faeces or flatus for any women who practised perineal massage compared with those who did not massage. AUTHORS' CONCLUSIONS: Antenatal perineal massage reduces the likelihood of perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain and is generally well accepted by women. As such, women should be made aware of the likely benefit of perineal massage and provided with information on how to massage.
The fact that prenatal perineal massage prevents not tearing but episiotomy seems a little odd, don't you think? Considering that episiotomy is unnecessary in unhindered birth, this suggests to me that it is not the natural body itself that has a need for a managed priming of the perineal area, but that it is the birth attendant's psychological need.

Quote:
Originally Posted by pretty pixels
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.
No one was saying that prenatal perineal massage will hurt as long as it, well, doesn't hurt. The references to it "hurting" were to perineal massage during birth causing harm in the sense that a) if done aggressively enough it will break down tissue and b) for most women to have hands on her genitals that are not her own or her lover's will create tension in the tissues and interfere with hormone release.
post #22 of 36
that does seem like an odd conclusion and i'm not sure how the study is skewed becuase of the whole cutting thing.

really, before i would consider the results of any of these studies, i'd love to know more about the group, the control, the expections of the researches and where they were done... (which is hard to get fully from an abstract) and it's really hard to extrapolate from a hospital based study to a homebirth. KWIM?
post #23 of 36
Perineal Massage Doesn't Reduce Tear Rate

Quote:
Stretching and massaging the perineum during the second stage of labor does not reduce the rate of perineal tears and does not change postpartum urinary, fecal, or sexual outcomes, a recent study suggests.
Thoughts On Perineal Massage


Quote:
First, I'd like to offer a currently unpopular view regarding perineal massage. For some women, this attempt to stretch the skin is uncomfortable and may actually hurt...

My first homebirth ended with a two-hour marathon of forced pushing, with the midwife doing gentle but firm perineal massage. I did not tear but had a nasty "skid mark," which for days was quite painful when urinating. That wasn't the worst of it, however. My perineum was so sore I could hardly walk; it hurt even while lying still. My great suspicion is that the perineal massage, if not in itself damaging, at the very least made necessary some things that were.

Also, the discomfort of having the midwife's hands constantly on my perineum was a mental, and therefore physical, hindrance to the labor;

My second homebirth was handled quite differently: no one but me touched my perineum. The physical and emotional freedom and level of comfort this allowed me had a very favorable result: there was absolutely zero trauma to my perineal area, and I felt fully recovered only hours after the birth.
Perineum Massage

Quote:
Since the 1980s, there has been increased interest for pregnant women to use perineal massage to help minimise or prevent tearing. At present, an overall assessment of the research indicates that women having their first baby can lessen their chances of requiring stitches if they do regular perineal massage in last few weeks of pregnancy, but that it will not necessarily prevent tearing.

Some caregivers believe it is best to avoid massaging the perineal area in the event of possibly traumatising or bruising the area.
This one references several studies...

http://www.btinternet.com/~wellmothe...oncallcott.htm

Here's another:

http://www.midwiferytoday.com/enews/enews0237.asp


Quote:
Q: Is perineal massage necessary? Does it help or hinder tearing? I have been trained to do perineal massage and it seems to me that all it does is make the tissues edematous. I'm beginning to think that hot compresses and oil as well as positioning may be enough.
-Karen

A: In my experience as a mother I found perineal massage to be unpleasant and intrusive, both prenatally and during birth. That was a signal to me as a midwife: If something is unpleasant, maybe it's not really a great idea. Over the years as a midwife I was able, with my Amish clients, to back way off on everything without fears of litigation, etc. and what I saw in most every case is the least you do, the better the process works. So perineal massage was the first to go. I never in my entire practice had to sew more than three women, and one of those was the birth of a baby that came before I got there. In the hospital I now work in, they do vigorous massage and it looks savage and the moms don't appreciate it. I say, trust the process. Perineums can birth.
-Elizabeth von der Ahe
post #24 of 36
I don't know the pros and cons. I really didn't do more than skim a few of the responses.

Our experience with it was only with our latest baby (#5) and it was the first time my wife didn't tear. AT ALL.

She also said that it was easier to guage how hard to push and even when she was pushing when she didn't realize it, because she was pushing against something.

We used extra virgin olive oil. (Pardon me if I find that slightly amusing.)

(I really need my wife to get on here to talk about her experiences...)
post #25 of 36
Stacy, thank you for the links... I am too sleepy right now but I'm going to come back to read them.

It *would* be nice to be able to evaluate issues related to prenatal massage WITHOUT assuming it is some aggressive nurse or midwife insisting it be done, and WITHOUT assuming that the alternative (hospital births) is an episiotomy... know what I mean? Seems those two huuuuuge factors can definitely affect things. I also wonder about just using pressure and oil during crowning, vs. actual MASSAGE during crowning, how those two things are different.

Anyways as long as we have fun with it we'll prolly do it! But I'm worried that my yoni will smell like salad with the EVOO! !

Stacy, I'll post again after I have time to read those links tomorrow. Thank you again!
post #26 of 36
Well, I did peri massage during preg (on myself, no less!) and massage during labor. Never hurt. Actually the oil felt really good during labor and, like pp said re:his wife, it was nice pushing against a little resistance.
I never felt violated/bothered, etc. and if I told my mw to stop, she would have.
I also didn't even tear a tiny bit as opposed to the tear I had in my first birth, but that is more due to the slow, natural pushing I think.
I figure it may not have helped a ton, but it certainly didn't hurt.

This time I don't want mw (same one) to be there with me as much. It is my 3rd birth, 2nd homebirth, and I want to be left alone more. I don't have the fear of the unknown this time either. So I may not have any of that this time. :
post #27 of 36
Quote:
Originally Posted by prettypixels View Post
I also wonder about just using pressure and oil during crowning, vs. actual MASSAGE during crowning, how those two things are different.
Okay. So what benefits do you think pressure might confer?
post #28 of 36
Well, Bella says it felt good pushing against the resistance...

Although I would think it would be to support the perineum and help prevent tearing... referring to compression/pressure/oil only, not massage.

I try so hard to keep myself open to whatever is going to happen... I'm really blessed to have a midwife who I know will go with the flow of what I'm comfortable with while I'm birthing, vs. forcing me to adhere to *her* idea of what my birth should be. Including stepping back and leaving me alone if I tell her to. So either way (if I want her help/support during, if I don't), I feel set. I just think this is an interesting discussion!

I'm also planning a waterbirth and I've heard/read the water in the tub can also help prevent tearing via putting gentle pressure on the whole area.
post #29 of 36
Jumping in to this discussion really quick....

I think that the part that I like the least about prenatal and in-labor perineal massage is the message it confers....that somehow our perineums are not naturally designed to birth our babies without extensive trauma (tears that require repair, etc). Just as we don't need to "prepare" our nipples for breastfeeding, I don't believe that we need to be intentionally oiling up and stretching our perineums so they will stretch "better".

This is one of my favorite articles about this.

I'm not saying women shouldn't do prenatal perineal massage if that is what they want to do, but I just hope they aren't doing it with the misbelief that they will tear if they don't do it.

post #30 of 36
Quote:
Originally Posted by Lennon View Post
I think that the part that I like the least about prenatal and in-labor perineal massage is the message it confers....that somehow our perineums are not naturally designed to birth our babies without extensive trauma (tears that require repair, etc). Just as we don't need to "prepare" our nipples for breastfeeding, I don't believe that we need to be intentionally oiling up and stretching our perineums so they will stretch "better".

:
post #31 of 36
Quote:
Originally Posted by Lennon View Post
Jumping in to this discussion really quick....

I think that the part that I like the least about prenatal and in-labor perineal massage is the message it confers....that somehow our perineums are not naturally designed to birth our babies without extensive trauma (tears that require repair, etc). Just as we don't need to "prepare" our nipples for breastfeeding, I don't believe that we need to be intentionally oiling up and stretching our perineums so they will stretch "better".

This is one of my favorite articles about this.

I'm not saying women shouldn't do prenatal perineal massage if that is what they want to do, but I just hope they aren't doing it with the misbelief that they will tear if they don't do it.

Well said.
post #32 of 36
Quote:
Originally Posted by prettypixels View Post
Well, Bella says it felt good pushing against the resistance...
If it feels good, it is good.

Quote:
Although I would think it would be to support the perineum and help prevent tearing... referring to compression/pressure/oil only, not massage.
How does counterpressure prevent tearing? Can you explain the mechanics of this to me?

Quote:
I'm also planning a waterbirth and I've heard/read the water in the tub can also help prevent tearing via putting gentle pressure on the whole area.
One way water can "prevent" tearing is simply by removing a source of tension, i.e. others' eyes and hands on the mother's genitals. Another way is that the tissues are moist and warm in the water -- cold, dry skin is less supple and hurts more with friction.
post #33 of 36
Quote:
Originally Posted by fourlittlebirds View Post
If it feels good, it is good.

How does counterpressure prevent tearing? Can you explain the mechanics of this to me?

One way water can "prevent" tearing is simply by removing a source of tension, i.e. others' eyes and hands on the mother's genitals. Another way is that the tissues are moist and warm in the water -- cold, dry skin is less supple and hurts more with friction.
No, fourlittlebirds, clearly you know more about this than me. I just thought it was an interesting discussion and the first I've seen about anything negative related to perineal massage!

I will say that I'm not generally a shy retiring lil' flower, but I do wonder how I'll be during my birthing time. It will be interesting. But I really am blessed to have a MW who doesn't insist on having her hand up my wazoo for the duration (I have not had a single VE during my pregnancy except for our first visit for testing purposes, swab etc), will back off and leave me and husband alone as long as I'm doing fine and don't need her, etc... but can also manage an emergency situation, which is important to me. No way would I personally feel safe birthing without her (or someone similar) there... and if she can enable me to birth at home instead of in a (blech) hospital, that is all good stuff!

Actually I'm kinda wishing I could reach my own cervix and see if anything is *going on* there, though I know bacteria can be an issue. I'm getting curiouser and curiouser!
post #34 of 36
pp, don't let your curiosity get the better of you! It better to let sleeping dogs lie, or cervixes, as the case may be.

I didn't have a single VE with Evelyn either. In fact, she barely made it to my birth because it went pretty fast. I spent the last half hour before she arrived panting through my body's involuntary pushes, trying to 'hold him in!' She got there and tried to do a check and got a half a fingertip in and said, "His head is right there!" and he was born about 20 minutes later.
post #35 of 36
Quote:
Originally Posted by fourlittlebirds View Post
How does counterpressure prevent tearing? Can you explain the mechanics of this to me?
My wife told me that she can't really tell how hard she's pushing except by the feedback she's receiving from our midwife (or the doctor, when we had a doctor at the house with the delivery of the first two homebirths).

However, by having the pressure, "something to push against", she could better guage how hard she was pushing because she could feel the resistance. She said it was easier to guage how hard she pushed that way.

(And I thought I should mention that our midwife is exceptionally accomodating and would have stopped anything my wife didn't appreciate. She was there to assist my wife have a baby, not to tell her how it was going to be.)
post #36 of 36
Quote:
the first I've seen about anything negative related to perineal massage!
And I've never seen much of anything positive (with the exceptions if the woman feels the need to do it once she has the information about the practice or would like to get more familiar touching her body)

Interesting how perceptions differ
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