Episiotomy?

[elvenmama]

How about perineal massage? Start at about 32 weeks pg and do it at least every 2 days, if not every day.

[aggfan]

Originally Posted by elvenmama How about perineal massage? Start at about 32 weeks pg and do it at least every 2 days, if not every day.

yeah that. There are two kinds of perineal massage: daily in the weeks before delivery and during the pushing phase. I've read several abstracts (not whole articles) and the advance massage often reduces tearing in first-time moms, doesn't seem to have a huge effect on second-time moms or beyond. But I figure, it might help and can't hurt. I did it with all three of my pregnancies and never had a tear.

I have not read anything about the effectiveness of perineal massage during pushing. I think applying some oil to help can't possibly hurt and supporting the perineum during crowning might help, but I too am unsure about having a provider keep massaging me during labor. It seems very annoying to me.

It's true that the evidence now is soundly against routine episiotomies. They result in more pain in the short term, longer recoveries, and greater chance of long-term problems, including pain during sex and incontinence. I'd shout it from the rooftops that you don't want one.

[mparmywife]

Like the other mamas said, the episiotomies are not good for healing. I know a couple of ladies that still had pain in that site over 6 months PP so unless it's better for the baby I would put in my birth plan not to do it. Make sure you have a birth plan and that the doctor reviews it in a final appointment and bring another couple with you so there is one in the room and one in your record. I had perineal massage with 3/4 babies (2nd pregnancy was stillborn and under a pound) and I never tore with my babies - 7.8, 7.10, 6.6. Stay away from an episiotomy unless medically necessary and make sure to ask for the massage not only in the birth plan but also talk to your doctor about it. It can't hurt and most likely will be better. Good luck!

[JeDeeLenae]

Originally Posted by aggfan yeah that. There are two kinds of perineal massage: daily in the weeks before delivery and during the pushing phase. I've read several abstracts (not whole articles) and the advance massage often reduces tearing in first-time moms, doesn't seem to have a huge effect on second-time moms or beyond. But I figure, it might help and can't hurt. I did it with all three of my pregnancies and never had a tear. I have not read anything about the effectiveness of perineal massage during pushing. I think applying some oil to help can't possibly hurt and supporting the perineum during crowning might help, but I too am unsure about having a provider keep massaging me during labor. It seems very annoying to me. It's true that the evidence now is soundly against routine episiotomies. They result in more pain in the short term, longer recoveries, and greater chance of long-term problems, including pain during sex and incontinence. I'd shout it from the rooftops that you don't want one.

I completely agree with this.

I have had 4 births and tore with the first three. This time around, I started using Evening Primrose Ol at 36 weeks and did perineal massages starting around 38 weeks. My midwife supported my perineum during pushing, but did not massage it. I think that would have annoyed me. I delivered on hands and knees also, with very focused pushing to give myself time. (I can push a baby out in 1 push, but it would make a tear inevitable!)

Using my DS app, please excuse the lack of proofreading.

[corscors]

Thanks everyone for all of the info and opinions! I do have in my birth plan that i do NOT want an episiotomy and that i DO want perineal massage. Im 37 weeks and have done it myself a couple times, i just have no idea if what im doing is right! Ha! As for evening primrose oil (which i have also read about), do you take supplements or use it to rub on the perineum?

[HippieMomof5]

I had an episiotomy over 9 years ago and still feel pain there during sex. I was cut and needed six stitches. I tore along the same line with the next baby and needed four stitches. I didn't tear or need stitches with the last two.

*Sent from my Droid using DS Forum*

[~Cricket~]

Ask for them to slow you down during the pushing stage and gently support the perineum as the baby's head comes down to allow the tissue time to stretch. Directed pushing (push! push! push! push! OK breathe.) is more likely to cause fetal distress, and tearing as it can bring the baby down too fast, rob you and baby of necessary oxygen, and not allow time for things to stretch. Gentle "pant/blow" breathing with pushing (your body is going to do a lot of the work involuntarily anyways) is more likely to be easier on baby, you, and your bottom!

[MaterofJacob]

I did evening primrose oil. The MW said to take 1-2 orally and insert 2 capsules every other night. The capsules dissolved and I had to wear a pantyliner but I had no tearing and an 8lb baby Oh and I started the oil like a week or two before my Due Date. She said it would also help soften the cervix (she was worried about me going overdue since it was my first)

[TrennaII]

I was told that when you tear, the tear always goes with the grain of the muscle fibers, which makes it heal better. A cut tends to go against the grain.

My midwife who had been delivering babies for 20 years said she'd NEVER seen any situation with a vaginal birth where a cut was completely necessary, and felt it was her duty as a midwife to do all she could to protect the mother from even a big tear.

[TrennaII]

Just saw your note on evening primrose oil ...

Be really careful: It helps the cervix to dilate and is used to speed up labor, so it's probably not a good idea until you are in labor or overdue, without asking your birth care person.

Just use olive oil for massage, if you want to do that.