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Childbirth

Share experiences and get support around labour, birth and recovery.

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Original poster

Perineal massage and episiotomies/tearing

35 replies

sazzybee · 26/01/2007 23:50

Before I go and cut off all my nails, does perineal massage really work to avoid tearing?

And what's the rate of episiotomies nowadays? I can't find any data on it except that it's ridiculously high. If I'm very firm about not wanting one will they listen to me?

Thanks

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sallystrawberry · 26/01/2007 23:52

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Fireflyfairy2 · 26/01/2007 23:52

I had two with both births. The second one didn't take as long to heal as the first. The mW told me that with a cut she could control it, but a tear could be much worse. But it's late & I can't remember much....

mears · 26/01/2007 23:56

sazzybee - in my experience midwives avoid episiotomies if at all possible. The rate of episiotomies has really dropped over rthe years. You have the right to refuse on altogether. They are usually only done if it looks as though you might have a large tear, the baby's heart rate is slow and baby is needing delivered. They are usually needed with forceps deliveries to make more room, and sometimes with ventouse.
Perineal massage can help, more because of getting used to a stretching sensation. I think the main thing to help is slow delivery of the head by practicing breathing techniques and not delivering propped up in a sitting position on a bed. Better to on your side or on your hands and knees. Better still in a pool

Original poster

sazzybee · 27/01/2007 00:04

Thanks - that's very reassuring.

I thought they'd pretty much stopped doing them but then I read some stat somewhere which said they were still very common and the last woman I know to have a VB had one.

I'm hoping to give birth in a pool. But I'd like to be prepared for that not to be a possibility (not least because there's only one pool at the hospital I'm booked into).

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prettybird · 27/01/2007 00:13

I had an episiotomy 6 years ago - but only 'cos I needed mid cavity forceps. I (and dh ) had worked really hard at the perineal massage too!

Best laid plans etc.

I do think that f I hadn't been exhausted and it had looked like ds would have come out with aid, that they would have respected my birth plan to avoid an episitomy.

As it was I tore too!

Peridot30 · 27/01/2007 00:20

I had an episiotomy yrs ago ds was stuck and needed forceps. With dd only 3yrs ago i tore very badly (3rd degree tear) as she came out waving. MIdwife said after that she came out too fast and if had been slower would have had another episiotomy.

AitchTwoOh · 27/01/2007 00:24

i did perineal massage on the grounds that, sharp nails aside, it couldn't do any harm. i didn't do it very religiously (not on my knees, arf arf) but i know it made a difference. not necessarily in the stretching dept, although who knows?

but i learned that when i thought i was relaxing my perineum (in the way that midwives tell you to when they're tying to get the baby in position to come out without tearing) i was actually tensing up. who knew?

so i learned that to relax that area when i wanted to, which is something that has never come in handy again but i only had a teeny half a centimetre tear that healed naturally.

good luck with your birth, hope you get the pool. (i didn't )

Gemmitygem · 27/01/2007 06:28

sazzy, I would really go for the perineal massage. it's not pleasant, you have to stretch it (sorry for TMI) loads, but it worked for me, no tears at all with DS born in Oct..

AitchTwoOh · 27/01/2007 10:52

gemmity, it's not unpleasant either... just a weird feeling wouldn't you say?

Gemmitygem · 27/01/2007 11:45

hmm, dunno, might have been pleasant in some kind of sexual context but not in context of thinking 'oh god, a massive bony head is coming out of here, how can I simulate that!

in Africa apparently they use some kind of baby shaped gourd to practise on. yikes!

Original poster

sazzybee · 27/01/2007 11:57

I like the idea of a gourd. Do you think a butternut squash would work as a substitute?

Looks like that's the end of my nails then - I was so proud of them too but this is more important.

Thanks aitchtwooh for the bit about learning to relax your perineum - it's a really good point and one I hadn't considered.

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Gemmitygem · 27/01/2007 16:43

at squash idea!

seriously though, I was very paranoid about tearing, and another major factor is position you give birth in, and if at all possible to not give birth lying on your back. I had to really insist on this point, asked for kneeling and compromised with lying on my side, which actually worked a treat...

PrettyCandles · 27/01/2007 16:51

I birthed one at 8lb10oz on my back and had a 2nd degree tear, another at 9lb3oz on my side and also had a 2nd deg tear. My third was 11lb, I birhted him on my knees in the birthing pool and just tore the surface skin of the perineum a little bit, didn't need any stitching. I hadn't done any perineal massage (couldn't reach!) and had only been in the water about 10min before the second stage began, so I doubt that the water had softened anything. I put the lack of damage down to not having pushed him out, but having breathed and groaned (and shouted) through contractions, allowing gravity and my body to do all the work. Admittedly this was my third birth, so the 2nd stage only lasted a few minutes. I don't know whether a first-timer's body would be as co-operative.

divamumdiva · 27/01/2007 17:01

i used some oil when pg and had no tears outside, but pretty bad tears inside. i supoose its worth using. will do next time,too. i rather have cut next time, if things are bad, because tears may get dangerious.

grouchyoscar · 27/01/2007 17:15

Sazzybee I would say do it. I feel it does work.

My Best mate advised me to do it as she said she'd heard it help to make the skin 'stretchy' so as I was certain I didn't want my fundament slicing I massaged as advised.

DS was 8lbs 5. I had him on my back and I got away with 'labial grazes'. My MW said she could have put a stitch in but I declined (didn't fancy that either tbh.) I was absolutly fine.

I would advise that at the 2nd stage of labour, just before delivery, that you listen to and work with your midwife. They will help to get the shoulders out if you don't need an episiotomy. Hope that makes sense.

So get yer nails chopped, get some grapeseed oil and start massaging!

AitchTwoOh · 27/01/2007 20:02

grouchyoscar, i had labial grazes too... man, that first wee hurts, doesn't it? my midwife said it 'looked like a skint knee down there'. also gave birth on back, for one reason and another. i've only done it once but i didn't think it was so bad...

suis · 28/01/2007 01:38

I had my first go at perineal massage this eve. However... I simply couldn't reach... DP changed the subject at the suggestion of helping, but I was told to use my thumbs and there is just no way, what with this big bumpy thing in the way. Am I doing something wrong ?

trixymalixy · 28/01/2007 01:59

I was very insistent that I didn't want an episiotomy as I was in labour.

The midwife said it had been years since she had seen one done.

As i was pushing the babies heart rate dropped and she said she was going to have to cut me. I said no and we agreed that if he wasn't out in 2 more pushes then she would do it.

He was born with the next push so i did avoid being cut. I did have a second degree tear as he came out quickly, but I had always said I would rather tear than be cut.

So I think they do try to accomodate your wishes as much as possible.

I didn't do any massage, but wish i had, it can't hurt to try it.

grouchyoscar · 28/01/2007 10:53

Suis...I was told that you massage the bit between your fanjo and bum hole (sorry if tmi but you can't avoid the venacular really.) I assume the 'bumps' are the sphincter muscles that stop everything dropping out (ok tmi again)

Some people get that bit pierced....yikes!!!

Maybe I didn't do it right tho as i didn't do any major leauge stretching tho (?????)

Oh and Aitch, the first wee is agony as is the first poo I thought all my insides were exiting.

Original poster

sazzybee · 28/01/2007 12:31

I can reach (just!)if I squat with my hips tipped forward. Or you could try putting one foot up on the bed or loo or something. I have to put my arms round the bump rather than in front.

I got instructions on how to do it by googling perineal massage.

Labial grazing?! Is the baby coated in sandpaper or something? The more I read about birth, the less keen on it I get . Still - this baby's coming out somehow

OP posts:

grouchyoscar · 28/01/2007 13:17

Sazzy

Try lying on yor side in bed and putting your hand round from yor bum.

Sorry if TMI

lulumama · 28/01/2007 13:26

hoe to do perineal massage

Rumpel · 28/01/2007 13:59

I used calendual oil and used to sit on the edge of the bed with feet against the wall - depends where your bed is I suppose. I think they only give youan epi' if you need vontouse or forceps now. I tore a little bit - needed a few stitches but I healed up fairly well. I eneded up having to go to theatre to have my placenta removed manually, as the umbilicol cord snapped. They didn't stitch me up until after that - scar feel slightly keloid but not too bad. Main thing was I was stretchy enough to push baby's head out without needing epi'.

I would do it anyway - good luck!

Rumpel · 28/01/2007 14:00

Sorry for errors - am v tired as LO seems to be teething!

Original poster

sazzybee · 28/01/2007 14:01

Thanks for the tips all

lulumama - those are the instructions I'm following.

I'm just waiting for someone to ask me what's happened to my lovely long nails now

Shall I tell? ;)

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