Perineal massage

iris427

When did you start doing perineal massage and how often did you do them?

Does anyone else find this to be painful? I can't stand the way it feels but I don't know if I'm just tensing up or if it's because of my interstitial cystitis (or both). Since I got pregnant, I have felt very tight and any kind of penetration has been painful; did anyone else have that problem? I am doing kegels to try and strengthen my pelvic muscles.

I really want to avoid damage to the perineum as much as possible, especially because I already have issues with sex being painful because of my bladder. I'm hoping that the water birth will help too. (If anyone has other suggestions too, let me know!)

RedCatWaves

Here's my theory:

I don't think it's necessary to do perineal massage prior to birth. There is NO way you're going to be able to stretch the perineum the way a baby's head is going to stretch it. And, even if you could, you'd be stretched out like an old sock from that sort of abuse.

I understand wanting to preserve the perineum...I had those same concerns...but perineal massage ain't gonna help. The things that will help are:

• Good nutrition
• Birthing upright
• Birthing in water
• No forced pushing, listen to your body and push when you feel the need to push, not when someone wants you to push
• Avoid an epidural, so you can feel the perineum and respond to it
• breathing through the delivery of the shoulders...or at least try not to shoot baby to the moon
• KEGELS...do them now, and after delivery

Even if you tear, it's not the end of the world. An upright birthing position will usually only result in very minimal tearing.

marielle448

Agreed. I never did the perineal massage but my MW did use pressure during the pushing and I have heard benefits of using oil/warm compresses during pushing. But as far as benefits of doing it before I've heard mostly it doesn't. I had minimal tearing with both boys (about a 1 stitch tear that I was told could be stitched or left to heal as is). But that may be because once my babies' heads are out I shoot them to the moon.

They were both blessed with my huge noggin.

iris427

RedCatWaves wrote: »

Here's my theory:

I don't think it's necessary to do perineal massage prior to birth. There is NO way you're going to be able to stretch the perineum the way a baby's head is going to stretch it. And, even if you could, you'd be stretched out like an old sock from that sort of abuse.

I understand wanting to preserve the perineum...I had those same concerns...but perineal massage ain't gonna help. The things that will help are:

• Good nutrition
• Birthing upright
• Birthing in water
• No forced pushing, listen to your body and push when you feel the need to push, not when someone wants you to push
• Avoid an epidural, so you can feel the perineum and respond to it
• breathing through the delivery of the shoulders...or at least try not to shoot baby to the moon
• KEGELS...do them now, and after delivery

Even if you tear, it's not the end of the world. An upright birthing position will usually only result in very minimal tearing.

My doctor said the same thing about perineal massage that you said. But I have also seen studies that found that it did help. I find it so uncomfortable though, so if they aren't going to help much, I don't want to do them! But if they will, I will try to suffer through it.

I'm not very concerned with minor tears because I know those will usually heal fine. I'm more concerned with making sure I do what I can to avoid more serious perineal damage. Your list is pretty much what I was thinking.

Does a lot of tearing happen during the delivery of the shoulders? I have heard to breathe through the delivery of the head and try to keep it from coming out slowly; is it the same for the shoulders?

Amneris

I had second degree tearing and almost an hour of stitching and I had no epidural, birthed upright, etc. etc. (didn't birth in water, but laboured there.) I heard that tearing is very common in first-time mamas, and between that and being naturally "small" it's not really a surprise that I did. Perineal massage is not something I could imagine doing - it SOUNDS painful and yes, during pregnancy I was very sensitive in that area. Everyone talks about tearing like it is a huge tragedy but unless you are talking third or fourth degree tears that damage the rectum or whatever RCW is right, it's not that big of a deal. They stitch you up, it is sore as heck for a few days but it's not like you wouldn't be sore without tears after a vaginal birth, and then you slowly get back to normal and within a couple of months, you are just like you were before (at least I am.)

PixieCurl

I didn't do perineal massage during pregnancy, but my doctor did do some massage (with oil I think?) in between pushes. I tore a little bit but not too badly.

realistic

I didn't tear at all and I had no episiotomy. I didn't do perineal massages but I did kegels all the time throughout my pregnancy. My midwive also used a warm compress on my perineum and didn't rush me while I was pushing.

webjockey

Maybe I'm a wuss, but getting stiched up with/o anesthesia is no joke. I didn't do the massage thing either, but I think my tearing had alot to do with me pushing forcefully (basically wanting it over with immediately) than taking my time. This time around, I'm focusing on deep breathing, and pain management techniques. I think that may help me slow down and not be in so much of a rush.

Brown_Eyed_Girl

I planned to do perineal massage, but then DH went out of town for the last 2 1/2 weeks, and it was almost impossible for me to do myself. The couple times we did do it, the massage was somewhat painful.

The handout the midwife gave me about it also said that the massage could help you learn to practice relaxing those muscles when you feel burning, like you should do when the baby crowns. The crowning part of delivery is such a blur to me, that I couldn't say if it helped me with that or not. I know the midwife had me alternate pushing and breathing as she crowned (I pushed on my own the rest of the time), but I couldn't even tell you if I actually followed her instructions.

In the end, I tore a little, but not enough to need stitches. I pushed on hands and knees and finished side lying. The midwife did some massage while I was pushing, but I don't know if she used counter pressure. Lydia did "shoot out" once her head was born, so that could have contributed to the tear. But honestly, I was really happy with the outcome.

SweetPickles

We did it, for probably the last 6-7 weeks. It was horribly uncomfortable and a bit painful at first, but in my experience, it got a lot better the longer we did it. The way I figured it, it might not prevent tearing, but it couldn't hurt anything to do it. Though, since I ended up in an emergency c-section situation, turns out all that discomfort was all for nothing anyway!

ETA: You asked how often we did the massage. I can't remember exactly, but I think we were pretty good about doing it on almost a daily basis.

geeky

I did it pretty much daily for the first pregnancy, from 36 weeks on, and had a tiny tear that took 3 stitches. Did not do it with #2 because my husband got sick, and did not tear at all.
I agree with RCW. Push when you feel like it, go easy once you feel the ring of fire and you should be OK. Even if you do tear, it is really unlikely to be a serious one if you follow her tips.

Amneris

webjockey wrote: »

Maybe I'm a wuss, but getting stiched up with/o anesthesia is no joke. I didn't do the massage thing either, but I think my tearing had alot to do with me pushing forcefully (basically wanting it over with immediately) than taking my time. This time around, I'm focusing on deep breathing, and pain management techniques. I think that may help me slow down and not be in so much of a rush.

Tell me about it - I had that too! But thankfully it does not last TOO long....

RedCatWaves

iris427 wrote: »

RedCatWaves wrote: »

Here's my theory:

I don't think it's necessary to do perineal massage prior to birth. There is NO way you're going to be able to stretch the perineum the way a baby's head is going to stretch it. And, even if you could, you'd be stretched out like an old sock from that sort of abuse.

I understand wanting to preserve the perineum...I had those same concerns...but perineal massage ain't gonna help. The things that will help are:

• Good nutrition
• Birthing upright
• Birthing in water
• No forced pushing, listen to your body and push when you feel the need to push, not when someone wants you to push
• Avoid an epidural, so you can feel the perineum and respond to it
• breathing through the delivery of the shoulders...or at least try not to shoot baby to the moon
• KEGELS...do them now, and after delivery

Even if you tear, it's not the end of the world. An upright birthing position will usually only result in very minimal tearing.

My doctor said the same thing about perineal massage that you said. But I have also seen studies that found that it did help. I find it so uncomfortable though, so if they aren't going to help much, I don't want to do them! But if they will, I will try to suffer through it.

I'm not very concerned with minor tears because I know those will usually heal fine. I'm more concerned with making sure I do what I can to avoid more serious perineal damage. Your list is pretty much what I was thinking.

Does a lot of tearing happen during the delivery of the shoulders? I have heard to breathe through the delivery of the head and try to keep it from coming out slowly; is it the same for the shoulders?

When you look at studies, you have to remember what they're comparing it to. If you compare lithotomy position births where some moms had perineal massage, and some didn't, I'm sure the massaged perineums had fewer tears. But I don't think anyone has compared perineal massage with waterbirth or other types of non-lithotomy position births.

Sometimes those sneaky shoulders can cause a rip at the end, right after you think you're safe because the head is out, usually from explosive pushing, or over-ambitious care providers trying to "manage" the shoulders.

By birthing upright, I mean on your feet...squatting, semi-squatting, or standing. Hands and knees is fine too. Sitting upright in bed doesn't count as upright. That's still lithotomy position and is the worst position for tearing. Think of how women birthed back before medical care. Do you think ANY of them willingly chose lithotomy?

I didn't tear with my VBAC baby, and he was my first vaginal birth, and he was 9 pounds with a 15 inch head (that's big). I credit the water and being upright. Even if she wanted to, the midwife couldn't get at my perineum to "manage" it in any way during the birth, because I was squatting. Perineums don't need managing. Babies don't need much managing. They come out best when left mostly alone.

Kaia

I started at 35 weeks meaning to do it everyday. Yeah, didn't happen. We did it maybe 10 times total. I didn't find it painful, but it wasn't particularly pleasant either. It did give me a chance to practice my relaxation and breathing which was good.

The nurse massaged and lubricated my perineum during delivery and I tore anyway. But Dylan was pretty huge, so that may be why.

mayim

we never got around to it.

i did do a lot of kegels and belly dance type hip roll exercises and lots of yoga during my pregnancy.

breathe through the crowning, my midwives and doula really helped me with that (i can't remember which one, but they were there supporting me through it).

i don't remember if someone did a compress for me while she was crowning.

i didn't tear.

(she was little though, so that helped too).

m

iris427

RedCatWaves wrote: »

iris427 wrote: »

RedCatWaves wrote: »

Here's my theory:

I don't think it's necessary to do perineal massage prior to birth. There is NO way you're going to be able to stretch the perineum the way a baby's head is going to stretch it. And, even if you could, you'd be stretched out like an old sock from that sort of abuse.

I understand wanting to preserve the perineum...I had those same concerns...but perineal massage ain't gonna help. The things that will help are:

• Good nutrition
• Birthing upright
• Birthing in water
• No forced pushing, listen to your body and push when you feel the need to push, not when someone wants you to push
• Avoid an epidural, so you can feel the perineum and respond to it
• breathing through the delivery of the shoulders...or at least try not to shoot baby to the moon
• KEGELS...do them now, and after delivery

Even if you tear, it's not the end of the world. An upright birthing position will usually only result in very minimal tearing.

My doctor said the same thing about perineal massage that you said. But I have also seen studies that found that it did help. I find it so uncomfortable though, so if they aren't going to help much, I don't want to do them! But if they will, I will try to suffer through it.

I'm not very concerned with minor tears because I know those will usually heal fine. I'm more concerned with making sure I do what I can to avoid more serious perineal damage. Your list is pretty much what I was thinking.

Does a lot of tearing happen during the delivery of the shoulders? I have heard to breathe through the delivery of the head and try to keep it from coming out slowly; is it the same for the shoulders?

When you look at studies, you have to remember what they're comparing it to. If you compare lithotomy position births where some moms had perineal massage, and some didn't, I'm sure the massaged perineums had fewer tears. But I don't think anyone has compared perineal massage with waterbirth or other types of non-lithotomy position births.

Sometimes those sneaky shoulders can cause a rip at the end, right after you think you're safe because the head is out, usually from explosive pushing, or over-ambitious care providers trying to "manage" the shoulders.

By birthing upright, I mean on your feet...squatting, semi-squatting, or standing. Hands and knees is fine too. Sitting upright in bed doesn't count as upright. That's still lithotomy position and is the worst position for tearing. Think of how women birthed back before medical care. Do you think ANY of them willingly chose lithotomy?

I didn't tear with my VBAC baby, and he was my first vaginal birth, and he was 9 pounds with a 15 inch head (that's big). I credit the water and being upright. Even if she wanted to, the midwife couldn't get at my perineum to "manage" it in any way during the birth, because I was squatting. Perineums don't need managing. Babies don't need much managing. They come out best when left mostly alone.

Good points, thanks.

Yeah, the lithotomy position is not appealing to me. I can't imagine trying to push a baby out in that position. I'm hoping to squat or something in the tub so, yeah, it doesn't seem like anyone would have much access to my perineum.

With your water birth, did you do anything to make sure the head and shoulders came out slowly? Just breathing through it? Did you use your hand to support the perineum or anything like that?

RedCatWaves

With your water birth, did you do anything to make sure the head and shoulders came out slowly? Just breathing through it? Did you use your hand to support the perineum or anything like that?

No, there wasn't time, nor did I have any presence of mind. At all. Although I pushed for about 30 minutes, I didn't make any progress til the final push, when the baby came all the way down the birth canal to crowning in one big push. I felt him come all the way down and almost out, and it was insane. I couldn't stop or slow it down. I just wanted him OUT! I didn't hold anything but the sides of the tub, where I was gripping on for dear life. At crowning, the perineum was burning bad...the "ring of fire" is real. It burned so bad that I didn't want to push, but I couldn't stand to stay like that either, so I pushed again and his head popped out. Sweet relief! But I still felt a lot of pressure and wanted it to stop.

The midwife was able to get the nuchal cord unwrapped once (it was wrapped twice but the second one was too tight to slip over his head) while I was yelling get-him-out-get-him-out-get-him-out-get-him-out. I remember her saying calmly (oh, she was so calm) that she couldn't get him out, that I had to do it, so I pushed once more and out he flew.

The midwife was catching blind (since I was squatting and in water and she was leaning over the tub half backwards), so she wasn't able to do any perineal support or managing. All she did was hold his head so that his body tumbled forward while she kept the head close to my body because he had the second tight nuchal cord. It's a little tumble maneuver that midwives like to do (OB's usually cut the cord at the perineum if they can't slip it off). Then she brought him up very quickly and thumped him on my chest. I remember the THUMP. It was shocking. I looked down and I had a baby on my chest.

The actual birth only took a few seconds...it took me longer to write this out than the actual event took. I really do think the water and position were key. That baby was big and I didn't tear at all.







You can see his little blue necklace...that was his second nuchal cord.