Thoughts on perineal massage during pushing?

smilelari · April 2011

When I delivered LO, there was definitely a nurse trying to stretch the perineal area while I was pushing. I didn't really give it a second thought, but I was just reading this blog entry:

https://prepforbirth.com/2009/08/25/new-episiotomy/

And now I'm not so sure this is a good practice and might put something about it in my birth plan.

Thoughts?

ckolak:-) · April 2011

I know there wasn't time with DD. I think maybe just support/ warm compresses rather than massage would be better.

ncbelle · April 2011

I'm no expert but it seems like there's a difference in massage and forcing dilation in the way that's described in that link.

With my first, the midwife did do a bit of perineal massage as I was getting ready to push - but not for very long if I recall (I pushed for 45 minutes and she wasn't doing it the whole time). I had a tiny not even first degree tear with two stiches.

This time I didn't have it done but I only pushed 3 times. No tearing. Both kids had 95th percentile heads and this one was 10 pounds - so I must be very elastic or something ;-)

If I trusted that my practitioner knew what she was doing in terms of being gentle and not forcing things, I probably wouldn't say no. But I might need to read more since this is the first I've heard about it possibly being bad.

CaseBride · April 2011

It's certainly a big debate... After all the reading I've done, I'm of the camp "hands off the perineum!!" - i.e. the less the better. Doing a water birth also usually reduces tearing... Don't know if that is an option for you.

For example, this link (scroll down a bit) from a midwives mailing list, says "The longer I practice midwifery, the less I do to (or for) the perineum, and the lower my laceration rates get."

https://gentlebirth.org/archives/perinealProtection.html#Technique

hilwithonelary · April 2011

I haven't done much research on it, but I will tell you that I had a nurse try it when I was pushing. She didn't warn me, but all of a sudden I felt a very different pain from what I had been feeling. I yelled out "What is that?" She told me that she was helping stretch me. I yelled back at her to stop.

I did get a 2nd degree tear, but I think that was because I pushed in between contractions. DH says he saw it happen. With my second to last push, I got his head part way out. The doctor and nurses were all yelling at me to keep pushing. I was kind of panicked and confused, so I pushed reaaally hard even though I wasn't having a contraction. DS came all the way out, but DH said that was when I tore.

SageBeginnings · May 2011

My thoughts and research are summed up here. I'm not a huge fan. I have seen more moms swell from 'massage' during pushing than from the actual birth itself. I also see more small tears than intact perineums the more hands-on the provider is... both to baby and to the perineum.

humynone · May 2011

My doc did a quick ring around the edge in between contractions near the end of pushing. It definitely did not feel good...I wonder if this was the "massaging/stretching" he was attempting? It was over quickly...but I still had a second degree tear and fair amount of swelling later. I had asked not to be cut (so I'd still prefer a tear to that, and it was a REALLY fast labor...pushing all of 45min, so there wasn't much time for my body to stretch naturally anyways I wouldn't think).

vflipo · May 2011

I was massaged the whole 2.5 hours of pushing... and I still tore something fierce. I have little faith in this practice. However, my sister had a much larger baby (DD was 6lb11oz, my nephew was 8.5 lbs) and didn't tear at all. So who knows.

Blackvelvet · May 2011

I choose to start pushing at 8 I want NOT willing to wait. The MW streched me and used some oil I pushed a few times less then 19 min no damage was done I must strech well

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