Keeping the perineum intact during birth... - Mothering Forums

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#1 of 21 Old 03-21-2011, 11:27 PM - Thread Starter
 
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I would really like to educate my doctor on ways to help keep my perineum intact during birth. I had an episiotomy with my first child and would really like to avoid that this time around. I have read that once you tear or have an episiotomy, the scar tissue in that area makes you more prone to tear again. Any ideas?


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#2 of 21 Old 03-22-2011, 06:22 AM
 
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My midwife told me that from 28 weeks on, my husband should massage my perineum with olive oil every day and that that would help prevent tears. I don't know what the doctor can do specifically, but I know that I have heard that once the baby starts to crown, you should slow down pushing, let your body push naturally and your doctor can support your perineum (With a hot wash cloth if possible) to help prevent tears. 

 

I am sure you will get much more advice on here, just wanted to share what I could. 

 

Cerise

 

 


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#3 of 21 Old 03-22-2011, 06:30 AM
 
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I second Ceriserenee.  Our childbirth class mentioned gently applying a warm compress to your perineum while crowning.  You don't want to press too hard, and you don't want the doctor to do any stretching of the perineum at that point - both can cause tearing (the former can press it too thin, the latter can force it to stretch more than needed - and it's amazing how often you'll see doctors do this).  Your partner could take care of this too, if you prefer / have a partner with you.  Directed pushing can cause tearing, as can lying on your back.  So if you can, you may want to try other positions (squatting, hands and knees...) when you reach the pushing stage.


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#4 of 21 Old 03-22-2011, 09:49 AM
 
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Adding that I had an episiotomy w/ my first (3rd degree - birth was vacuum assisted) and it was terrible. With number 2, I told the doc there was no way in hell I was getting an epi again. I tore a little but compared to the epi, it was a piece of cake to recover from.

 

To this day, I firmly believe that the only reason I ended up w/ that intervention with my first was because of AROM and a posterior baby. Awesome suggestion, doc....


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#5 of 21 Old 03-22-2011, 10:52 AM - Thread Starter
 
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Yeah I was in the pushing stage for 3 hours with my first. The nurse kept telling me to lay back down, even though I complained that it hurt to lay on my back. My doctor had me squat on the bed and do tug of war with a towel with him to get the pushing stage to progress. Once I started to crown the nurse had me lay down on my back. Everyone was screaming at me to push harder every time that I had a contraction. My body only took over and pushed like three times and I think those were the only pushes that showed any progress because every time I would have the natural urge to push everyone would be like "yeah! that's it, keep doing that!" It's like ummm I'm not even doing that, my body is. So I am kind of nervous about the pushing stage this time around. I don't want everyone in my face yelling, and I guess I am kind of confused now...am I supposed to push on every contraction? Or just when my body gets that intense pushing urge? My doctor knew that I did not want an epi unless it was medically necessary, but in the throes of child labor he said I was starting to tear where he would do an episiotomy anyway and was it okay if he did one. I just said yes without thinking and it seemed like my baby just shot out of me after he did it. That made me feel that my body was inadequate, since she came out so fast after he did that. I wish I knew what it was like to birth without having had that done.

 

Anyways...thanks for the suggestions ladies. I will definitely start the olive oil today and let my husband know about the hot compress during the pushing stage.

 

xo

 


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#6 of 21 Old 03-22-2011, 11:01 AM
 
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If it's possible, I would suggest you maybe work with a doula this time around? I discovered during labor with my first that I was not able to be the advocate for myself I thought I would be (to put it mildly, I was in labor land!).

 

I pushed for about 3 hours with my first, with the doc yelling at me - I just didn't respond well to that at all. I switched docs with my second, and hubby and I were also much stricter with what we "allowed" the doc to suggest at any time (for example, I said no yelling, no AROM - don't even ask). Number two was so much better/easier. I still pushed for about an hour, but compared to my first birth, it was very, very healing.


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#7 of 21 Old 03-22-2011, 11:35 AM
 
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There are two things about childbirth that scare me: epi's and that I might need an emergency C-section (Not that I'm at risk, just that the possibility exists). I have hired a doula and I am going to be incredibly clear about the fact that I would rather tear than be cut. I know it might sound weird, cause the whole thing about them is that it prevents tearing supposedly, but everything I've looked into says that that's not necessarily the case, especially if you are doing everything everyone above mentioned. I had emergency (unmedicated) perenial surgery for an abcess last year, and I never want anyone going near that part of my body with a scalpel ever again.

As for perinial massage, I have read some mixed things about it, and based on our comfort level (me and my husband) we're not doing it. I know that one risk factor for tearing can actually be yeast (I have had vaginal tearing due to bad yeast infections in the past, so it can happen without childbirth as well) so I am going to keep an eye on that and hope that slow pushing and lots of support during labor do their job :)


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#8 of 21 Old 03-22-2011, 01:31 PM
 
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I also tore somewhat severely with my first born, not really through any fault of the doctor as she encouraged very slow pushing with the head and shoulders appeared. Am also concerned about this happening again as recovery was really a breeze apart from the tear/resulting stitches. Two things I recently read might help in addition to perineal massage and compresses... thought they were interesting to note:

 

- Ina May Gaskin (the famous midwife) has supposedly observed that most women who smile during expulsion do not suffer from perineal rupture, presumably because smiling relaxes the pelvic floor muscles. May be worth a try.... I know I wasn't smiling the first time round after 2.5 hours of pushing shy.gif

- Pulling the baby up toward yourself during delivery (like you might if you were birthing the baby all alone) may reduce stress on the perineal area. If the person delivering mimics this action, pulling the baby up towards the mother's abdomen as they come out, it might help. I guess you can't beat nature!

 

Found this info at website: http://www.gentlebirth.org/archives/perinealProtection.html#SelfProtection, there might be some more useful tips there as well.

 

Good luck to us all!

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#9 of 21 Old 03-22-2011, 02:06 PM
 
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I read about perineal massage somewhere & it seemed like a good idea.  Does anyone know if there's a specific method?  What I read also suggested olive oil but that's all I know.  I'd rather use organic canola oil because it's less smelly...  I'm also going to ask my mw about technique when I see her tomorrow.


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#10 of 21 Old 03-23-2011, 10:16 AM
 
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Quote:
Originally Posted by lyndie View Post

I read about perineal massage somewhere & it seemed like a good idea.  Does anyone know if there's a specific method?  What I read also suggested olive oil but that's all I know.  I'd rather use organic canola oil because it's less smelly...  I'm also going to ask my mw about technique when I see her tomorrow.


my bradley instructor shared this with us...

 

Prenatal Perineal Massage

 

Doing perineal massage regularly can increase your chances of delivering your baby without an episiotomy (surgical incision to widen the vaginal opening) or a tear. It stretches your perineum, resulting in less tissue resistance to the baby. Doing perineal massage helps you identify your perineal muscles, and helps you learn to relax them in response to pressure.

 

  • Massage daily for about 10 minutes, starting 6 weeks before your due date.
  • If possible, get the assistance of your partner, as perineal massage can be difficult to do alone.
  • Use wheat germ, sesame, almond, Vitamin E, olive oil, K-Y Jelly or Astroglide. Do not use mineral oil (eg. vegetable oil) – it strips your tissues of oil soluble vitamins – the vitamins that keep your tissues pliable.
  • Make yourself comfortable, lying in a semi-sitting position against some pillows. Pour some oil onto your fingers and massage it into the perineum. Partners: The perineum is the wall of tissue between the bottom of the vagina and the anus (see diagram). sorry the diagram didn't copy.
  • Put your oiled index and middle fingers about 2” into the vagina and press downward toward the rectum. Use firm, steady pressure, but BE GENTLE.  Then slide your fingers from side to side in a rhythmic ‘U’ or sling-type motion. Use enough pressure that the tissue just begins to sting.
  • Mom: Consciously try to relax your perineum. Be sure to let your partner know when your tissue is burning. This massage should not be painful. In the beginning the tissues will be tight, but with time and massage there should be a greater stretch and relaxation.
  • Doing it yourself: It may be helpful to squat or sit on a toilet. Use your thumbs, as this may be easier than your fingers.
  • Do not massage if you have a yeast or other vaginal infection – it will aggravate the problem.

 

 


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#11 of 21 Old 03-23-2011, 09:49 PM
 
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Im doing the internal work from the Pink Kit.. or actually, I guess it is more accurate that DH is doing it and Im focusing on relaxing.  LOL

 

If you think perineal massage is an odd sensation, the internal work is pretty crazy.  Basically, DH is massaging my muscles from the inside including mobilizing the tail bone :)

 

Totally worth it though.  It has made me so much more aware of the muscles and is super reassuring as dh is able to make those tissues more elastic and I can feel my ability to create more space there.

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#12 of 21 Old 03-23-2011, 11:01 PM
 
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I might be going TMI here, but my midwife told me tonight that I should not be doing perineal massage at all because I have herpes and it can possible instigate an outbreak. Which makes so much sense I can't believe I didn't think about it. I know it's not something people really talk about in public, but I think it's pretty important to think about.

 

The other thing we talked about was my intensely traumatic perineal surgery last year and she brought up that it might trigger bad stuff for me in labor, so I am thinking of looking into hypnobabies or something else to give myself a way out if my body starts freaking out due to sensations in that area. I guess it can be similar to people dealing with abuse trauma while in childbirth too, and honestly the way it was handled was insanely abusive, so it fits. That might be a topic for a diff thread though.


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#13 of 21 Old 03-24-2011, 08:28 AM
 
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I had an episiotomy with my first and it was so unnecessary. I think the doc actually probably got a tad bit of money for having done it, who knows? 
 

It was horrible to recover from. Took me a year to be pain free. With my second, the doc and nurses didn't like it but I was hands and knees pushing involuntarily and it was amazing! If they hadn't forced me onto my back at the end, it was almost perfect. I didn't end up tearing at all. 

 

So, anyway, I think you should request no directed pushing and choice of pushing position. 

 

 

(forgot to include, my first was 7lb 14oz and my second was 8 and a half lbs.)

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#14 of 21 Old 03-24-2011, 09:48 AM
 
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yep, i had an episiotomy with haye and it took me nearly a year to recover too. sex? pshhh. yeah right. i would have died...honestly it was that painful. i will avoid another one at all costs!
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#15 of 21 Old 03-24-2011, 04:50 PM
 
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I did not tear with my first child, but she was all of 6 lbs. I pushed her out very slowly and with a lot of control. With my second, he was 8 lbs. I was not pushing, but he was just flying out of me. I ended up with a 2nd degree. It was so much harder to recover from that than with my first. I think that it had more to do with the way he came out more than anything. I have talked to my midwife about it and she has strict instructions to coach me during crowning so that I can hopefully birth this baby a little more slowly than my last.

 

 


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#16 of 21 Old 03-24-2011, 10:12 PM
 
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thank you, sam!  no veg oil for me then,  we'll probably go with almond.


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#17 of 21 Old 03-24-2011, 10:15 PM
 
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Quote:
Originally Posted by MamaChef View Post

Im doing the internal work from the Pink Kit.. 


I just googled that to try to get a sense of what it is, but I'm tired eyesroll.gif  Is it like a home-study birth prep course?

 


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#18 of 21 Old 03-25-2011, 10:03 AM
 
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Quote:
Originally Posted by lyndie View Post

 


I just googled that to try to get a sense of what it is, but I'm tired eyesroll.gif  Is it like a home-study birth prep course?

 

Yup.  http://thepinkkit.com/  I found the program as a doula after DD was born.  Im just so impressed with it and I think at this point Ive done 90% of the childbirth prep programs.  I had only used some of the positioning stuff before with clients.. but now that Im in the program as a birthing woman, it's just so great in ways I hadnt previously realized.

 

The internal work is something you can do by yourself or with a partner.  I prefer to do it with my husband.  It's more comfortable and his fingers are longer.  It's been such a learning experience for us both and has really developed trust, teamwork and comfort.  I hate internal exams, but dont mind this process with my husband.  They also teach you how to check dilation, but we wont even go there for a few more weeks.  Im really excited that hubby will be able to assist me with this.  I'd like to be checked in labor because I do believe if you stall out for awhile it's time to change things up, but hate being checked.  Since hubby and I have been working on this area I feel like it will make it all so much more easy.  Plus, the work really helped me to distinguish what muscles are what and how from the outside of my body I can tense things that seriously effect the inside.. or like, Ive been a hypnotherapist for awhile and I thought I was really great at relaxation, and I am with the muscles and tissues of the outside of my body.. but it is amazing how tight that still leaves the inside.  When my attention was drawn to those areas I could really release them.. or sometimes I need DH to do some deeper massage to help them let go.  

 

Basically it's locating your internal pelvic muscles and massaging and stretching them to help create more space in your mid pelvis and perineal area.
 

 

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#19 of 21 Old 04-01-2011, 05:47 PM
 
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I just finished re-reading Spiritual Midwifery and Ina May mentioned at some point that scar tissue is stretchier than it's often given credit for.  Something to keep in mind as a visual when you are pushing baby out ;)

 

Just adding to the support for not having directed pushing.  With my first, the doctor's main direction was to lower my vocalizations (I was getting tense, I think!) and to just sit on the contraction until I felt it peak and the urge to push was irresistable.  I had specifically requested not be coached so I was happy that they followed my request and let me go with the urge.  I got the occasional "yes, more pushes like that" when I did a big push, but I basically just ignored them - they are so used to coaching I think it's hard to completely not do it :P  Baby was 9lbs 5 ounces and I had a minor tear, just enough to require one stitch.  No warm compresses or anything like that, which was too bad cause I had those with baby #2 and wow, they were really soothing.  With baby #2 the pushing was even less directed - I wasn't encouraged to push with each contraction, I just did what I felt like doing.  The only real direction was not to push when the baby was crowning.  The midwives also applied olive oil to my perineum, I found that helped things feel less tight and burny and easier to relax into it.  I had a little skid mark with baby #2, no stitches.

 

I've never done perineal massage and don't plan to this time.  I am sure it's helpful, but I am the type that's lucky to remember to take prenatal vitamins (on a good day) and to use my suppositories before my GBS swab (which reminds me, gotta buy those!!)...remembering and making time for that every day seems like a big effort. I'm lazy, I know :P  Anyway, just thought I'd throw that out there for people not doing it....maybe if I'd done it each time, I wouldn't have had any tears, small or otherwise, but the amount of tearing I did have was minimal and didn't cause me any problems or pain.

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#20 of 21 Old 04-04-2011, 09:17 PM
 
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Originally Posted by bluepetals View Post

I had a little skid mark with baby #2, no stitches.


what's that?  I've read it a few times but never know what mommas are talking about...


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#21 of 21 Old 04-05-2011, 09:53 AM
 
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Quote:
Originally Posted by lyndie View Post

 


what's that?  I've read it a few times but never know what mommas are talking about...


Someone correct me if I'm wrong, but I think they mean when you get stretched enough to leave a few small "cuts" but nothing that needs to be stitched. 


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