Does perineal massage, uhh, help?

[PipPipPip]

I'm pregnant with my first child and have been hearing about "perineal massage".

Has anyone out there done it, and believe it helped with their birth? Or any midwives who really believe it makes a difference?

I'll do it if it genuinely helps in labour. But if not, it sounds like a bit too, ahem, fiddly to bother with!!

(Ps. if you don't know what this term means, have a google. It saves me the embarrassment of explaining it! haha)

By the time it's been time to do it, ive never been able to reach it. IYSWIM.

With dc1 and 2 I was on a bed, once semi-recumbent and once on my side (side vastly better than recumbent BTW). Once I pushed freely, once I pushed but did my best to pant through crowning. Both times I tore.

With dc3 OTOH I was upright, in water, did not push at all, and did not tear. Im sure this was not because of the water as I was only in the pool for about 15mins before dc3 was born. I'm sure it was a combination of being upright, relaxed, and not actively pushing.

Sounds like a pain in the arse. Sorry.

And a tear is not?

We dutifully did it with our first, as instructed by our NCT teacher. DH had to do it (you really can't do it yourself) and I hated it but he made me!

I still tore and needed stitches when DS was born but who can say whether it would have been worse if we'd not done the massage. I imagine there are lots of other factors involved to do with positioning, baby's size, what state your muscles are already in etc. so I doubt it can make that much difference.

I haven't tried it yet, but my other half is looking forward to lending a hand.

i did it, you need to use almond oil as it aids elasticity, i did not tear. I was nt ver big during pg and managed to do it my self

My silhas qualifyed as a mw this year and she did a case study on this and said yes it definately does work or at least help. I've been doing it from about 34 weeks,but i only spend 1 min doing it just rubbing the oil in, not really sure how to massarge it properly.

NCT antenatal teachers are really keen on this. None of my antenatal lot did it, though! I kept on putting it off. If I'd have been able to do it myself, I might have, but it was a matter of DH and I being free to do it at the same time in the evening (ie. awake).

My MW this time is v sceptical of it and says a good, calm and supported birth generally won't need it to have been massaged and stretched first. Happy to go with her!

Pinkyp - I think it's only thought to work if you really stretch the perineum so that it, um, sort of hurts. The idea is not just to make it all soft from the oil but to stretch the skin.

I'm with your mw on this, Reshape. I can't help wondering whether the reason the study appeared to show benefits from perineal massage is that the sort of people who will do it are the sort who will also be more likely to labour in a more placid, relaxed, way, Following their own instincts and wishes, and notnecessarily giving over control to the HCPs around them.

There's a good patient information summary available here - www.oxfordradcliffe.nhs.uk/forpatients/patientinfoleaflets/maternityleaflets.aspx

The evidence on this looks quite good, and is not limited to case studies. There's been a review of four trials, looking at around 2,500 women - it concluded that, certainly with first babies, "perineal massage, undertaken by the woman or her partner (for as little as once or twice a week from 35 weeks), reduced the likelihood of perineal trauma (mainly episiotomies) and ongoing perineal pain."

As they were controlled trials, the impact of the type of women who will do it should hopefully have come out in the wash.

www2.cochrane.org/reviews/en/ab005123.html

I am 26 weeks now and will start doing it today. The evidence is good, and it can't do any harm but could bring big benefits (just not tearing sounds to me like a great thing). It kind of makes good sense too, as muscles stretch easier if you use them for that gradually, be it plates on your lips or big earings.

I think you are not meant to do it until 36 weeks knittakid

Hi yellowflowers MW said any time after 25 weeks is alright... and i plan to start really gently...

I can only tell you this. None of my ladies have wanted anyone anywhere near their perineum whilst in labour. But if it works for you then fabulous.

I tried it but basically couldn't reach and just didn't feel happy with my DH doing it.

So I bought an Epi-no and after using every day for maybe 4 weeks, I had nothing more than a nick and popped my DD out after 20 mins (2nd stage) even though I was on an epidural. Obviously I can't say if this would've happened if I hadn't used the Epi-no but I'm convinced enough to use it again this time. It's only 10 minutes a day and doesn't hurt.

Here's the link: www.epi-no.co.uk/

I won't describe it here as I don't want to put you off. It's not glamourous but then neither is trying to massage yourself!

Wow, the Epi-no sounds bizarre but fascinating.

Were you able to, uh, operate it while being super pregnant? Could you reach etc?

I am a DH and got involved in this.

However I am the only bloke I met would did; i.e the Dads to be we met through pre-natal, hypnobirthing and post-natal groups seemed to either have no clue or scoffed at the idea.

If DH is not keen that I heard a useful tip for you is to reach from behind!

Agree with several coments - a pre-stretch warm-up surely must be beneficial!

Epi-No looks v interesting... But £90??? I will have to have a think about it, as I think I am too big to reach also...

Yes, expensive but if it saved me from tearing, I was going to pay for it.

You can operate it however big you get, there was no problem there. It is very bizarre to use but again, I'd do bizarre to save weeks of walking like a cowgirl. You have a pump in your hand to pump up the balloon thing, which you should be able to reach to insert. The problem with the massaging was sustaining the stretch. I can reach to touch but I couldn't then hold it for long without serious breathlessness. Not of the positive kind.

You can also use it afterwards to tighten up your pelvic floor. I'm useless at remembering to do my exercises otherwise.

Buckingbronco, good for you, you're a nice DH. My DH offered too but I just couldn't. Not a prude, we have had plenty fun conceiving but it somehow just crossed a line of privacy for me.

Another vote here for the epi-no - so much easier to reach and way more efficient than perineal massage imo. Also gives you confidence that you won't tear, which probably helps relax when it comes to the real thing.

Sancerre, have you had your baby yet? If so, do you think that Epi-no helped? Or are you still preggers?

Thanks everyone for input!

PS. I noticed that there are quite a few threads about Epi-no scattered throughout Mumsnet. If you want to do further reading, search for Epi-no on the top right-hand corner.

Can someone explain to me why it's hard to reach?

I tried this for the first time last night and am not sure if I am reaching the right bit having heard how difficult it is. I am almost 37 weeks and still able to reach 'the area'.

I'm sure you're doing it right, probably just more flexible than me. I can reach as far as the area (ie the vagina!) but I can't hold the stretch long enough to carry out the massage and certainly can't start moving my fingers around.

But I also can't put my socks on my left foot . Probably depends on arm length and how your belly is shaped.

I did it twice a day using almond oil throughout both my previous pregnancies and had 2nd degree tears both times, sorry! Didn't have any trouble reaching the area either though, I was told to do it by putting my fingers inside my vagina and gently stretching/massaging the perinium with the oil... I'm now pregnant with baby number 3 and haven't bothered this time as didn't seem to work for me, who knows I might have a worse tear this time though !!

I did it with both pregnancies religiously, and had no tearing with either. I will deinitely do it again this time too!!!