I am interested to know what you know/think about this. I have been under the impression that all NCB folks are advocates for PM, but I am now reading a midwife's blog, and she has concluded that is does more harm than good, which was surprising to me. She seems to be specifically addressing PM during labor/pushing, but she may mean all PM, I am still reading. I would like to avoid tearing this time (duh, lol) so I am wondering if doing things differently may help. My DD was born with a nuchal arm, so perhaps it was inevitable, but I do think I can probably get into a "better" pushing position this time, and perhaps do more or no PM to see if that makes a difference, besides feel more confident about my own pushing instincts, and rely less on being coached on when to push...
I don't understand how it can be harmful. That has me a little perplexed. I personally didn't do it with DS1 and tore pretty bad as well as got an episiotmy and with DS2 we did it and used prim rose oil and I only had an episiotomy with him. BUT DS1 was vacuumed out and DS2 was very forcefully pushed out by momma because I was NOT letting my dr use the vacuum again. I think the dr pulling DS1 out with the vacuum was what made me tear so bad. I don't really think it hurts to try the PM and really can't understand how it could be harmful. All it does is soften those tissues so they stretch easier.
(Warning, this post is of a sensitive nature, and can be graphic, and I think painful to read for people who have gone through certain birth experiences)
In the post, she seems to differentiate between what she calls aggressive perineal stretching and perineal massage or support. I didn't notice that distinction when first reading through it, and then subsequent comments, but in going to back to reread to answer your question, it's clear she is making a distinction.
She posts these links to underscore her standing of the terms she used:
aggressive perineal stretching: http://www.mothering.com/community/f...rineal-massage
perineal massage: http://www.ehow.com/about_4620472_pe...-massages.html
perineal support: http://www.gentlebirth.org/archives/...rotection.html
In searching her site for more info about her views on this, I have mostly found brief statements without much info, and a few comments from her and her readers in the comments sections, but nothing where she clearly sets out her beliefs with data, etc. However, the gist I have been getting by reading through those is she is pretty much all for no touching of the perineum by the attendant(s) during birth at all, so perhaps in labor she sees all perineal support as aggressive? Kind of confusing to me, which is why I'd love some input from you all.
We did some perineal stretching in the pushing stage. My midwife isn't the aggressive type, but I can't say for sure if it was too much or not. At my midwife's direction, I was panting and blowing through about 3 contractions to try to slow the head popping out a bit, and most of my concentration was on getting through them without bearing down, not on what my midwife was doing.
The more I have been thinking about it today while reading, the more emotional I am getting about NOT WANTING TO TEAR again.
Are we talking about prenatal perineal massage or just perineal stretching/ironing during the 2nd stage?
If we're talking prenatal perineal massage, I think the reasoning behind NOT doing it is that there's no good evidence to suggest that it decreases the risk/degree of tearing. Vigorous perineal stretching/ironing during the 2nd stage I do believe has been shown to cause harm and can be unpleasant for the mama. I could be recalling this wrong though.
For my last baby I decided to go with a mw and one of the things we discussed at length was my desire not to tear this time. She encouraged prenatal perineal massage (which I tried a couple times but found it awkward and uncomfortable, so didn't really do it).
But, mostly we talked about easing the baby's head out (as opposed to the freight train-like pushing technique that comes naturally to me ). Using warm compresses, supporting the perineum, etc. And, what I think made the most difference, pushing position. This time I pushing kneeling and leaning forward. The other thing was that she coached me through pushing (I know not everyone likes that), but I needed to be told to STOP pushing, slow down, and let the baby come out gently.
Anyways, it made all the difference. I did need 2 stitches were my old scar started to split, which kind of sucked. But, I was sooooo happy and proud of myself for being able to do that and the recovery was much better.
About the actual post... lol
I think prenatal massage is fine. Because it is done by the mother (or her partner), it is unlikely to be too aggressive, which is where I think the damage/harm could occur. Not to say I'm convinced it is helpful, but I don't think it is bad.
I'll be honest, I don't like massage during pushing. I find it too invasive and when I watch some doctors do it, it looks painful to me. I haven't got evidence to back up whether it helps prevent tears, but it is way too hands on for my taste.
I didn't do any sort of prenatal massage with DD. My MW did some stretching of the perineum during second stage, but I didn't feel it because I had an epidural. She also supported my perineum during crowing. I had 3 small 1st degree tears--two labial and 1 vaginal/perineal.
With DS, I did a little bit of very gentle "test stretching" of my own perineum in pregnancy. I just did it enough to feel the stinging sensation so that I could get used to it (and crowning felt just like it to me, execpt WAY bigger), not enough to actually make the opening any larger. The "massage" my dr. did during 2nd stage with DS was VERY painful for me. I understand why it feels like violation for some women, and I do NOT want it again. I didn't tear with DS, but my MW with DD told me she thought I wouldn't tear at all the next time I gave birth, because I have very elastic skin.
I have heard that some women, when left to themselves, will instinctively put their hand on their vulva as the baby is emerging. See this blog post: http://rixarixa.blogspot.com/2011/02...-perineum.html. I really would prefer to have my provider's hands out of my vagina as much as possible this time.