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REMINDER: are you doing your perineal massage?

post #1 of 22
Thread Starter 
JUST as important as kegels? Yes, yes, yes. I will start tonight......ugh. i am 34 weeks today and a good time to start.

anyone else!?



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Low-tech, at-home preparation in the last month before childbirth could help pregnant mothers avoid one of the more common surgeries performed on women in the United States, a new review suggests.

The review looked at studies in which women used a massage technique in the last four or five weeks of pregnancy to train the lower genital tract for childbirth. During perineal massage a women kneads the tissue below the vagina to prepare the tissue to expand more easily during birth.

There was a 15 percent reduction in episiotomies among the women who practiced perineal massage the review found, based on results from three trials, including data from 2,434 women.

The findings appear in the most recent issue of The Cochrane Library, publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Lead reviewer Dr. Michael Beckmann and his colleagues also discovered an added benefit: Three months after birth, women who had practiced massage were less likely to report perineal pain -- whether or not they had an episiotomy.

Those positive results were most clear for mothers having their first vaginal birth. But Beckmann said the statistical trend of the research suggests that the benefits would also hold true for the other, smaller sub-groups of women in the study -- given larger sample sizes, more time and research.

An episiotomy is performed in up to 35 percent of vaginal births in the United States each year, affecting as many as 1 million women. But Beckmann said the number of episiotomies performed around the world is dropping following a general shift toward reserving the surgical procedure for emergencies.

A May 2005 article in the Journal of the American Medical Association cast doubt on many of the rationales offered for routine episiotomy. That evidence review found episiotomy does not reduce pain or improve healing in the short term, or prevent incontinence or impaired sexual function in the long term - when compared with natural tears.

Many expectant mothers have heard about Kegel exercises to strengthen the pelvic-floor muscles before birth, but perineal massage isn't as well-known or recommended as often.

"It's not standard in obstetrics, but there is interest in this area," said Beckmann, an obstetrician with the QE2 Jubilee Hospital in Queensland, Australia.

"It's amazing the number of women who are fearful about cuts and tears and afraid of an episiotomy," said Sally Avenson, a certified nurse midwife in western Washington state.

As more women demand greater control and involvement in their childbirth plan, Avenson said, preventing an episiotomy -- or the spontaneous tears that can occur at childbirth -- has gained mainstream attention, and become a goal for all providers who care for pregnant women.

Perineal massage is now common in some corners of maternal health care, Beckmann said, so "it's nice to see there's some evidence behind it." He now says expecting women should be provided information on perineal massage and its likely benefits.

In the three reviewed studies, women practiced perineal massage for as little a four minutes three to four times a week, and as much as 10 minutes daily, beginning in week 34 of their pregnancy.

Pregnant women may not hear about perineal massage from their obstetrician, but midwives have recommended the practice for years. Avenson, a lecturer with the University of Washington's department of Family and Child Nursing, said it is difficult to separate the effect of perineal massage alone. But she includes the technique in her discussions about "perineal management."

"It goes along with a plan for exercise and nutrition. You can't isolate the perineum from health," she said.

"It's not anything where I guarantee you won't tear, but it is something you have power to do," said Avenson, who's led her own midwifery practice for 25 years.
post #2 of 22
I can't decide if I am going to do it this time or not. I did last time and my midwife did during pushing and I just had a small tear, but she doesn't recommend it anymore. She feels that it causes less damage to the perineum if we just let it stretch naturally. Any thoughts on this?
post #3 of 22
Thread Starter 
everything i hear/read says that it works if you do it in ADVANCE, not during birth -- that u actually should NOT do it during birth. (warm compresses are great tho)

also that it helps first time moms get used to relaxing during that stretching sensation.....

and finally that infusing oil down there does make it more pliable....

dunno. i am gonna go for it....ugh. i think i will just do it before my shower...keep a bottle of olive oil in the bathroom.

deb
post #4 of 22
I'm doing it to practice relaxation during the snesation and also to make the muscles more pliable.
post #5 of 22
Nope.

I use to do Kegals. I tore each and every birth. So this time I am not and see what happens.
post #6 of 22
Thread Starter 
no, these are different than kegels!

you actually stretch the muscle/skin with your fingers....weird, i know.
post #7 of 22
OK, I just tried this.....it reeeeeally hurt. Is that supposed to happen? I wasn't being rough or anything, it's just that having 2 thumbs in there is very sore. Ummm, yeah, baby's head is gonna be a bit bigger than 2 thumbs...
Also (way TMI), I found this rather messy....it's all a bit gooey there (except when I need it to be for getting it on..grrr)
post #8 of 22
Quote:
Originally Posted by beatee View Post
Also (way TMI), I found this rather messy....it's all a bit gooey there (except when I need it to be for getting it on..grrr)


Though I thought I read around here somewhere that that is an alternative to massage if you find it more appealing
post #9 of 22
Nope, not gonna either. Never have and have never torn, worst was skidmarks with a 9 lb 13 oz, nothing with the other 2. I think this one will be more on the lines of #4 (8 lbs 13 oz) and he just kinda slipped right out. The way has been paved .
post #10 of 22
I will do this at 34 weeks. I did it last time and I think it can't hurt. I had a small tear with a 9lb 1oz baby- 11 min pushing stage- first timer. Not bad at all.
And it's true, if anything it helps with giving you a sense of what will be doing what down there and how to relax through the discomfort.
Plus, I want DP to feel that baby's head, so he can do that when he does the massage.
We do some massage during 2nd stage and lots of counter pressure. I took hypnobirthing as well last time and truthfully, I did not like it. It was not for me and involved too much dogma. I think it is inappropriate to say that doing that during 2nd stage is counter productive....but it's just generalizing and most childbirthing corps generalize, it's hard not to when approaching such a broad audience....anyway....just my rant. Not to be offensive, just my experience.
It's funny some couples when we tell them about the massage are like "Ooh we'll do that for foreplay" Ummm....it's not sexy...not even a little! And they come back just like "It is NOT good foreplay!!"
post #11 of 22
Thread Starter 
ha ha well i tried it myself last night, argh, my arm is too short or my belly is too big? i couldnt exactly manage this. it was pretty comical.

i already hate it, i need to figure out another way. i also cant see demanding DH to do this for me every night....its just NOT attractive.

maybe just getting the oil in the general area is enough? (tell me it is)

((also i agree on hypnobirthing, its not perfect, so much of it is very vague, and it ended up stressing me out.....but i def. came away with a different view of birth which is awesome (i used to be scared and clueless...) i think the book is pretty great. the breathing and relaxing stuff can only come in handy too))

d.
post #12 of 22
Quote:
Originally Posted by tofutti View Post
ha ha well i tried it myself last night, argh, my arm is too short or my belly is too big? i couldnt exactly manage this. it was pretty comical.

i already hate it, i need to figure out another way. i also cant see demanding DH to do this for me every night....its just NOT attractive.

.
This is my problem too. I can't really get access to do the massage! I am too big around or too short-limbed to massage for more than...10 seconds and honestly I don't see the beenfit of that Any suggestions?
post #13 of 22
Thread Starter 
i am thinking after the shower, leg up on the sink great visual there, i know.

i am so not looking forward to this.

maybe tonight
post #14 of 22
Ummm.... I'm thinking I'm going to have my husband do it... : :
M.
post #15 of 22
I actually do not believe in it. Pamamidwife here wrote a wonderful article a couple years back on it and it made a lot of sense to me.

We tried it with our first but...eh, I have waterbirths - I trust the skin will stretch as much as it needs to anyways!
post #16 of 22
I had DH do it the first time but it turned out not to be as much fun as I thought it would be So I'm doing it myself now. Although not as often as was recommended. I think a couple times a week is enough since we are still having sex
post #17 of 22
We've only done it a couple of times. (DH does it for me.) It has been uncomfortable both times, not exactly painful, but not pleasant either. I am 37 weeks along, 1cm dilated and 50% effaced, so I guess we'd better get a move on!
post #18 of 22
Thread Starter 
i am glad to hear it!!

we can have an non scientific ddc experiment.

i am surprised that i have been keeping up with it ... just about 60 seconds a day, right after my shower, but i think its helping......its at least helping visualization of the birth.....
post #19 of 22
I don't worry about actually streching the muscles or making the tissue more pliable, but I do find that doing it once in a while to practice relaxation and to show myself that it's not scary and it's no reason to panic are good things.

Quote:
Originally Posted by tofutti View Post

i already hate it, i need to figure out another way.

d.
Ok, I can't remember what it was called, but there was this company that made either an inflatable "gourd" that you put in your introitus and you pump it up with a little hand pump to do the strech.
Anyone know what I'm talking about?
post #20 of 22
Quote:
Originally Posted by Synchro246 View Post

Ok, I can't remember what it was called, but there was this company that made either an inflatable "gourd" that you put in your introitus and you pump it up with a little hand pump to do the strech.
Anyone know what I'm talking about?
I don't remember it being called Epi-no (I thought it had Delphi in the name)
but here's something
http://www.andhravilas.com/article.asp?id=19781
Quote:
Informed mothers are learning more about this subject and taking the time to speak with their obstetricians about it, well in advance of their scheduled birthing date. They are adopting a strategy that includes special exercises using a device called EPI·NO. The EPI·NO is a soft balloon-like device that is inserted into the vaginal opening and gently filled with air to a specific pressure.

As the balloon is inflated the tissues are gently stretched. The pressure is then maintained for a period of time so that the tissues can adjust to the new opening. Daily the amount of air is increased slightly so that the vaginal opening is gently prepared to receive the baby's head. The end result is that the tissues are not only better prepared for the birthing process, but - because the tissues are not suddenly and violently stretched - the tissues more readily return to their prior state.

The philosophy is not new. In fact, there exists an age-old African custom by which an expectant mother gently inserts a calabash or gourd into the vaginal opening, to manually stretch the pelvic floor muscles and the perineal tissues. This process is still in use today in many parts of Africa. Modern science provides us with knowledge and materials that perform a similar function, but in a safer and more sterile way.

Unlike the calabash or gourd, the EPI·NO can be used not only to prepare the pelvic floor muscles and perineal tissues for birth, it can also be used to regenerate the tissues through post-partum exercises. Approximately three to six weeks following childbirth (ask your OB/GYN when to begin), a mother can begin once again to use the EPI·NO.

By clenching the pelvic floor muscles - a process known as a "kegel exercise" - the new mother will see the pressure on the EPI·NO gauge rise. This is called "bio feedback" and helps to inform you that your pelvic muscle exercises are being done correctly and to track your progress as muscle strength returns. Expectant mothers can experience mild to severe anxiety as childbirth approaches. Using EPI·NO a few weeks in advance of childbirth can help to reduce this anxiety.

Clinical studies have shown that using EPI·NO will:

Reduce the incidence of elective episiotomy
Reduce the incidence of perineal tissue tearing
Increase APGAR scores (measuring the overall health condition of the newborn baby)
Decrease the need for certain drugs during childbirth
Reduce anxiety for the mother

ETA: It was DELPHINE, and apparently EPI no
http://www.birthinternational.com/pr...pdf/EPI-NO.pdf

The things you get when you goodsearch "perineum gourd". . .


ETA again:
http://epi-no.com.au/content.cfm?Enc...76281631272020
Holy vagina! These things are 'spensive!
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