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Discussion Starter · #1 ·
please forgive me if this is TMI,but I can't find the info anywhere!

Is a doula allowed to massage the perineum during labour so that it doesn't tear? Does a doula touch you anywhere near that area?

I read in a friends midwife book years ago that if this is done it avoids tears and feels good,the same with holding a nice warm cloth to the area. I'm pretty sure I'll be able to have a doula,not sure if I'll have a midwife or not. I really haven't figured out much yet.
 

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I don't know of any doulas who have actually done the perineal massage for their clients. But your care provider should be able to do it. And while I know it's debated as to whether it's actually effective prenatally, you can gently massaging the area yourself before labor. When choosing your care provider, whether you have an OB or a midwife, ask them if they do perineal massage. If they think don't or don't know what you are talking about, remember you can always keep searching for the right provider.
 

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I personally wouldn't do it for any of my clients. I feel like it is out of the scope of a doula to do it especially since it is debated as to wether it can help or hurt (and when done incorrectly it can increase the risk of tearing).
 

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Depending on your doula's training, (I have done a few different trainings, so I am not positive which one it came from) massaging the perineum would not be within a doula's scope of practice, or may be against a code of ethics depending on who you ask. However, I have been known to do so depending on alot of factors (discussion and consent with the mom/couple, openness of the care provider or depending on if the care provider is doing it herself, etc.) and I have also held compresses to the perineum as well. For me this was after a midwife assistant training and with a close relationship with the midwives attending.

I would talk to your care provider and find out if she already does so, and if not then maybe ask your doula? Just know that some OB's and midwives would not feel comfortable with a doula doing so.
 

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Discussion Starter · #5 ·
Thanks for all the answers. I don't have a doula yet,but am very close to meeting with one to see if we'd be a good match. I'd love a list of questions to ask her if you don't mind. I can also ask them to the OB I'll be seeing March 12.
 

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I don't think I would, but I would atleast provide a crock pot and some message oil in case that client would like to have it done by her care provider.
 

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I occasionally do warm compresses on the perineum after checking with the client that it feels good (it doesn't always). Also, some L & D nurses get hugely territorial about "their space", so if I get a vibe that the nurse has an issue with me being in her space, I won't do it.

The only time I did active perineal massage (for a hospital birth) was at the request of a nurse who was stepping out to get the OB. The mom was pushing, but the baby was nowhere near crowning when the nurse stepped out. I wound up with a baby head in my hand after one push. Thankfully, the mom never freaked that no one else was there, and I kept my cool, as did the OB and nurse when they came back in a second later. The dad never realized what had happened until I told him.

I think I'll skip the perineal massage in the future...
 

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I wouldn't do it, but if a client asks would find out if their partner was interested in doing it and would also ask them to consult with their midwife or ob to see if they regularly do it.
 

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The only time as a doula I've put my hand IN the vagina is when I had a friend and client who VBAC'd, had days of prodromal labor, and was exhausted by the time she was in transition decide to get an epidural, and then the epidural was WAY too strong and she couldn't feel to push. The doc tried putting pressure on the perineal floor, which really DID help her to find the "spot" to push into. He had another woman in labor in a room nearby and had to go catch, and we're familliar with each other and work well together. The nurse on this woman's case wasn't very eager to help ANYBODY do ANYTHING, so the OB asked me to step over and do the pressure. I was happy to for her, and it helped her make significant progress.

I prolly wouldn't do perineal massage during labor for somebody because it's my understanding that it can cause swollen tissues and thus increase the risk of tears.

However, I am MORE than happy to hold a warm compress on a woman's perineum if she has requested it, is comfortable with my doing it (or has asked me to), and other people in the room are doing other things.

I'm sorry but "scope of practice" to me is providing physical support. If this form of physical support means that the woman's tissues are softer and more supple and less likely to tear, how is that out of my scope of practice as a doula? I am not trying to catch a baby, and for goodness' sake, there are VERY few times that a woman is in any kind of advanced stage of pushing that hospital staff or midwives are not in the room. That kind of thing just reminds me how glad I am that I trained through the group I trained through.

I have had a couple of times where I was holding compresses while staff were getting things ready where the head popped down to the perineum very quickly...once last summer the nurse walked out to grab something, the doc was across the hall talking to some residents, and the mother had been pushing for quite some time (but then the doc had just given her a sacral adjustment and ran out to talk to the residents...apparently the adjustment WORKED. WELL.). I realized all of a sudden that the mother was making progress and called for the nurse. When she ran in, there was a finger's width of head. Next push palm's worth. Next push, same ctx, crown. She couldnt' find the call button, yelled out the door, then hit the emergency button on the wall... but she wasn't gloved and neither was the doc. By the time the doc had one glove on the head was out and was restituting.
I caught the top half of the baby, but handed the baby over to the doc to hand up...there just wasn't time to do anything else. And I didn't do anything but catch because the only other option was the baby hitting the floor.

Mom would have been pushing whether she'd asked me to hold compresses on her bottom or not...so had I been at her head, we may have had a baby before ANYBODY could get down there to catch! Is that out of my scope as a doula? Perhaps...but it's not like I said, "Hey--shhhhhh, let's just say I'm putting compresses on your perineum and then push till the babycomes out--I can catch, that's no big deal!" Uh, no. Acting as a doula, I do not WANT that level of responsibility! But to be penalized because it's out of scope?

Meh. Birth with a good birth team is a fluid thing. People do things to help one another out. If the nurses are getting stuff together for immediate post partum am I just supposed to say, "sorry, Chica, it's outside of my scope and the nurses are busy. Guess you're gonna have to suffer" Um, I'm not that kind of doula. I'm there to help the Mama and I'll do that if I have the capability.

Sorry. Off soapbox.
 

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By "allowed to" I assume you mean, will the hospital permit it.
I have been at births in two area hospitals. In one, a doula would never be permitted to touch the perineum, and the staff would be horrified at the idea. In the second, not only is it left up to the labouring woman and her doula, but the nurses will fetch gloves, hot compresses, etc as needed.
(I agree with PP's about the questionable benefits of perineal massage in labour, but that is a different question.)
 

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Discussion Starter · #11 ·
I think by allowed I meant is it something they can do as a doula. Like I know they can not deliver a baby like a midwife can and I know that a doula is not the person to ask to do my housecleaning or make me dinner during our visits at home. I hadn't gotten to the part where she may or may not be allowed to certain things at the hospital. The hospital that it looks like I'll be birthing at is a birth center and is "baby friendly" they said. Midwives are welcome there at this place. So they might be more open to my doula doing the things that would make me feel safer and more comfortable. When I meet the doula I can ask what she's comfortable with as well. I wouldn't want want her to rub my bottom parts if she's not comfortable. I actually don't know how comfortable I am with the idea,but I think in that moment if I know she can offer me something to make me feel better I may not care so much. lol

I'm going to Google and find out more about the massage and compresses and see what other things can be done and I'm sure the doula that I meet with have lots of ideas for me as well.
 

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Yes she can. Some doulas do VE's, fundal palpitation, some even use fetoscopes or dopplers. Should she? Well thats up to you and her.

As a doula I'm of the opinion we are emotional support only, meaning nothing clinical. Even as a future midwife, I think VE's, perinium support (doing when not asked by mom or birth attendant), listening to hear tones REALLY blures the lines of a doula stepping into the role of a monitrice stepping into the midwife role.

I also dont think the birth attendant needs to support the perinium most of the time if mom is free to birth in any position she chooses and pushes when and how she wants. Water is the best support for a perinium


Quote:

Originally Posted by missmich View Post
I think by allowed I meant is it something they can do as a doula. Like I know they can not deliver a baby like a midwife can and I know that a doula is not the person to ask to do my housecleaning or make me dinner during our visits at home. I hadn't gotten to the part where she may or may not be allowed to certain things at the hospital. The hospital that it looks like I'll be birthing at is a birth center and is "baby friendly" they said. Midwives are welcome there at this place. So they might be more open to my doula doing the things that would make me feel safer and more comfortable. When I meet the doula I can ask what she's comfortable with as well. I wouldn't want want her to rub my bottom parts if she's not comfortable. I actually don't know how comfortable I am with the idea,but I think in that moment if I know she can offer me something to make me feel better I may not care so much. lol

I'm going to Google and find out more about the massage and compresses and see what other things can be done and I'm sure the doula that I meet with have lots of ideas for me as well.
 
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