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What Is the Evidence for Perineal Massage During Pregnancy to Prevent Tearing?

December 18th, 2012 by avatar

By Rebecca Dekker, PhD, RN, APRN of Evidence Based Birth

Do you talk about perineal massage with your students, clients and patients and state that perineal massage during pregnancy will/will not reduce tearing during birth?  today, Rebecca Dekker, of Evidence Based Birth takes a look at the research on perineal massage during pregnancy and provides information on the outcomes for women who practiced this and those who didn’t.  Does the research support what you have been saying? – Sharon Muza, Community Manager

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http://flic.kr/p/5XmJtL

Tearing during childbirth is a common occurrence among women who have a vaginal birth. In studies where the use of episiotomies was restricted, the rate of spontaneous tearing was recorded to be anywhere from 44-79% (Soong and Barnes 2005; Dahlen, Homer et al. 2007). Studies have consistently shown that women are more likely to experience tearing during a first vaginal birth and with forceps and vacuum assistance (Aasheim, Nilsen et al. 2011).

Spontaneous tears can be classified as first, second, third, or fourth degree tears. First degree tears involve only the perineal skin, while second degree tears involve both the skin and the perineal muscle. Third degree tears involve the anal sphincter, while fourth degree tears involve the anal sphincter and tissues. Third and fourth degree tears happen at 0.25% to 2.5% of spontaneous vaginal births (Byrd, Hobbiss et al. 2005; Groutz, Hasson et al. 2011).

Women are more likely to have a third or fourth degree tear if they are giving birth vaginally for the first time, if a baby is in the posterior position or has a heavier birth weight, and if forceps, vacuum, or episiotomy are used (Christianson, Bovbjerg et al. 2003; Groutz, Hasson et al. 2011; Hirayama, Koyanagi et al. 2012).

What is perineal massage?

It is thought that massaging the perineum during pregnancy can increase muscle and tissue elasticity and make it easier for a mother to avoid tearing during a vaginal birth. Typically, women are taught to spend about 10 minutes per day doing perineal massage, starting at about 34-35 weeks of pregnancy. Women are taught to insert 1-2 lubricated fingers about 2 inches into the vagina and apply pressure, first downward for 2 minutes, and then sideways for 2 minutes. The massage can be done by the woman or her partner, and sweet almond oil is sometimes used for lubrication (Labrecque, Eason et al. 1999).

What is the evidence for perineal massage?

In 2006, Beckmann and Garrett combined the results from four randomized, controlled trials that enrolled 2,497 pregnant women. Three of these studies involved only women without a previous vaginal birth (mostly first-time moms). One study enrolled women with and without a previous vaginal birth. All four of the studies were of very good quality.

Beckmann and Garrett found that women who were randomly assigned to do perineal massage had a 10% decrease in the risk of tears that required stitches (aka “perineal trauma”), and a 16% decrease in the risk of episiotomy—but these findings were only true for first-time moms.

It is important for you to understand that this is a 10% reduction in relative risk, and relative risk is different than absolute risk. Let me give you an example. Say you are a first-time mom, and let’s pretend your absolute risk of perineal trauma is 50%. A 10% decrease in relative risk means that your absolute risk decreases by 5% (because .5 X .1 = .05). So for you, doing perineal massage reduces your absolute risk of perineal trauma from 50% to 45%.

*As a side note, all of the numbers I am reporting below are changes in relative risk.

Importantly, for second-time moms who had already had a vaginal birth, prenatal perineal massage did not reduce the risk of perineal trauma (any tearing requiring stitches). However, second-time moms who massaged did report a 32% decrease in the risk of ongoing perineal pain at 3 months post-partum.

Surprisingly, Beckmann and Garrett found that the more frequently women used perineal massage, the less likely they were to see any benefits. Women who massaged an average of 1.5 times per week had a 17% reduced risk of perineal trauma and a 17% reduced risk of episiotomy. Women who massaged between 1.5-3.4 times per week had an 8% reduced risk of perineal trauma.

http://flic.kr/p/8pLkpV

Interestingly, women who massaged > 3.5 times per week experienced NO benefits and had a longer pushing phase of labor by an average of 10 minutes. So basically the finding was: the less frequent the massage, the better off the outcomes. However, this finding was unexpected, and the researchers had a hard time explaining it. I think we should interpret this result with caution, because in the largest clinical trial on perineal massage (included in Beckmann and Garrett’s review), Labrecque et al. (1999) found that the more often women did the massage, the more likely they were to avoid any tears.

Other results: 

There were no differences between women who did prenatal perineal massage and those who did not with regard to:

  • • First degree tears
  • • Second degree tears
  • • Third or fourth degree trauma
  • • Use of forceps or vacuum during delivery
  • • Sexual satisfaction 3 months post-partum
  • • Pain with sexual intercourse 3 months post-partum
  • • Uncontrolled loss of urine or bowel movements 3 months postpartum

Wait, I’m confused. You say that there was a significant decrease in perineal trauma requiring suturing. But there was no difference in 1st, 2nd, 3rd, or 4th degree tears. How can this be?

It’s important for you to understand that perineal trauma is an “umbrella” category that means all types of trauma requiring stitches, including episiotomies. Perineal massage during pregnancy decreased the overall risk of perineal trauma (the umbrella outcome), but the effect was too weak to see any difference with each of the individual outcomes (first degree, second degree, etc.). Also, the researchers think that the overall decrease in perineal trauma may have been due to the decreased episiotomy rate in the perineal massage group.

Why would perineal massage during pregnancy reduce the rate of episiotomies, but not tears?

The researchers guess that the women who were trained in perineal massage were highly motivated to birth with an intact perineum, so maybe they were more likely to refuse an episiotomy. Fewer episiotomies would then mean fewer incidents of trauma requiring stitches.

So what can we learn from the evidence?

During pregnancy, massage of the perineum can reduce the risk of tearing requiring stitches, but this benefit is only seen in moms giving birth vaginally for the first time. It is thought that most of the decreased risk of perineal trauma was due to a decrease in the episiotomy rate. In the largest study included in this review (Labrecque et al., 1999), there was an overall episiotomy rate of 38%. In the U.S., 25% of women have an episiotomy during a vaginal birth (Declercq, Sakala et al. 2007), and rates are even lower for some providers.  It is possible that these research findings might not apply to birth settings where episiotomies are extremely rare.

Second time moms who use perineal massage will not see any decrease in their risk of tearing, but they may reduce their risk of ongoing perineal pain at 3 months postpartum.

So in summary, for first-time moms only:

Perineal massage during pregnancy

Decreased risk of episiotomy

Decreased risk of trauma requiring stitches

If women choose to use perineal massage during pregnancy, there is no consensus on the amount of massage needed to reduce the risk of tearing.

Questions for discussion: Do you recommend prenatal perineal massage to others? Have your thoughts about this intervention changed after reading this article? 

References

Aasheim, V., A. B. Nilsen, et al. (2011). “Perineal techniques during the second stage of labour for reducing perineal trauma.” Cochrane Database Syst Rev(12): CD006672.

Beckmann, M. M. and A. J. Garrett (2006). “Antenatal perineal massage for reducing perineal trauma.” Cochrane Database Syst Rev(1): CD005123.

Byrd, L. M., J. Hobbiss, et al. (2005). “Is it possible to predict or prevent third degree tears?” Colorectal Dis 7(4): 311-318.

Christianson, L. M., V. E. Bovbjerg, et al. (2003). “Risk factors for perineal injury during delivery.” Am J Obstet Gynecol 189(1): 255-260.

Dahlen, H. G., C. S. Homer, et al. (2007). “Perineal outcomes and maternal comfort related to the application of perineal warm packs in the second stage of labor: a randomized controlled trial.” Birth 34(4): 282-290.

Declercq, E. R., C. Sakala, et al. (2007). “Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences: Conducted January-February 2006 for Childbirth Connection by Harris Interactive(R) in partnership with Lamaze International.” J Perinat Educ 16(4): 9-14.

Groutz, A., J. Hasson, et al. (2011). “Third- and fourth-degree perineal tears: prevalence and risk factors in the third millennium.” Am J Obstet Gynecol 204(4): 347 e341-344.

Hirayama, F., A. Koyanagi, et al. (2012). “Prevalence and risk factors for third- and fourth-degree perineal lacerations during vaginal delivery: a multi-country study.” BJOG 119(3): 340-347.

Labrecque, M., E. Eason, et al. (1999). “Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy.” Am J Obstet Gynecol 180(3 Pt 1): 593-600.

Soong, B. and M. Barnes (2005). “Maternal position at midwife-attended birth and perineal trauma: is there an association?” Birth 32(3): 164-169.

About Rebecca Dekker

Rebecca Dekker, PhD, RN, APRN, is an Assistant Professor of Nursing at a research-intensive university and author of www.evidencebasedbirth.com. Rebecca’s vision is to promote evidence-based birth practices among consumers and clinicians worldwide. She publishes summaries of birth evidence using a Question and Answer style.

Childbirth Education, Evidence Based Medicine, Guest Posts, Research , , , , , , , ,

  1. December 18th, 2012 at 09:34 | #1

    I read research many years ago that was similar to these recent findings so never focused on prior perineal massage but focused in my classes more on position of pushing. I assigned an out of classroom task. The mothers were to lie on their backs and reach around and assess the tautness of their perineum (or partners could do it). Then get on side, sit, hands and knees and also assess tautness of perineum in each position. Then they could choose what position worked best for their perineum. We all know which positions are best but this way the mothers discovered what was best for THEM.

  2. December 18th, 2012 at 11:33 | #2

    For my first birth, I had an unconsented episiotomy. For my 2nd, I agreed to an episiotomy because there was a great deal of meconium in the fluid when my membranes ruptured, spontaneously, during pushing and the CNM attending the birth strongly recommended it, to decrease the risk of meconium aspiration. My third baby, I had a 2nd degree tear. When I was pregnant with my 4th, I did a fair amount of research to determine how I could decrease my risk of tearing. I discovered both perineal massage AND the fact that one can birth a baby with almost no pushing. (In my first three births, I pushed like a robot-woman, HARD, both when I had the urge and when I didn’t; I was just very motivated to get the baby OUT… So I had to learn how to push NOT as hard, and to push more judiciously.) It worked, for both births #4 & #5 — no tearing, no sutures. I teach birthing classes and I tell my students that there has always been conflicting evidence regarding the efficacy of perineal massage, and that, frankly, I think my own improved result was from learning to push more gently, rather than from the massage. But, as the combination worked for me, that’s what I will likely continue to do with this, my 6th (and very likely last) baby, as well.

  3. December 18th, 2012 at 11:46 | #3

    Thanks for posting (and explaining!) the actual numbers. I tell my students, “can’t hurt, might help” with regards to perinial massage. In other words, because the benefits are slim, and the massage is uncomfortable, if they don’t want to do it, they shouldn’t worry about it.

  4. December 18th, 2012 at 13:15 | #4

    @Deena Blumenfeld RYT, RPYT, LCCE
    Deena, that is a great summary of the evidence!!

  5. December 18th, 2012 at 18:04 | #5

    Great post and very interesting reading. I give very similar advice in my classes. I give them a little handout which they can read at home and mention that they can do perinial massage at home by themselves, or have their partner do it for them – but mention always that if it is something they are not comfortable about doing, they shouldn’t stress about it. I also recommend that they pack a bottle of pure almond oil with them to take to the hospital and give to the midwife to use on the perinium when the baby is crowning to help soften the skin. Out of interest, did any of these studies mention the Epi-No or compare its effectiveness vs perinial massage.

  6. December 18th, 2012 at 20:59 | #6

    Great article! I encourage women to as it can’t hurt. In my first birth I had an unconsented episiotomy and was really upset by it later. During the moment I just did whatever the doctor told me to because she said the baby was coming fast — well, now having studied to be a Doula, there are ways to slow a baby down (side lying, etc) and spontaneous pushing would have reduced the speed of her exit — as well as my ability to stretch more naturally. As a doula I coached a woman to do that exact thing (she feared a second episiotomy) and she not only was blessed with a sub doctor (a doc on call) who had only done 3 episiotomies in 6 years. . .but she spontaneously pushed the baby out with a surface tear. The momma was thrilled and her recovery time was a day or so!!

    I personally feel it can’t hurt. Spontaneous pushing as well as different positions are also very helpful in reducing tearing and need for episiotomies. Thanks Dr. Rebecca!

  7. December 19th, 2012 at 06:40 | #7

    Deena Blumenfeld RYT, RPYT, LCCE :
    Thanks for posting (and explaining!) the actual numbers. I tell my students, “can’t hurt, might help” with regards to perinial massage. In other words, because the benefits are slim, and the massage is uncomfortable, if they don’t want to do it, they shouldn’t worry about it.

    Actually an intact perineum will decrease the chance of meconium aspiration because the desired effect is the fetal heimlich maneuver which causes the mucous to be expelled by the intact pereneum pressing on the babies chest. It has this “squeegy” affect. Pressing on the babies body and squeezes the mucous out. Carolyn Gall AAHCC

  8. avatar
    Avery
    December 19th, 2012 at 07:00 | #8

    Thanks for this timely post! I’m 36 weeks pregnant at the moment and was wondering whether I should feel bad that I haven’t been doing perineal massage. Given that the evidence at the moment suggests the benefits are slim I’m going to give myself a pass on this one and not feel guilty. The Beckman and Garrett finding about decreased frequency leading to increased effect is rather interesting though. Sounds like a good starting point for another study.

  9. December 19th, 2012 at 07:31 | #9

    Perineal massage during labor does not increase the chances of an intact perineum or reduce the likelihood of pain, dyspareunia, or urinary and fecal problems, an Australian research team reports. A study from the University of South Australia randomized 1340 pregnant women to receive either perineal massage and stretching of the perineum during the second stage of labor, or supportive measures only. The researchers found that the rates of intact perineum, first- and second-degree tears, and episiotomies were similar between the groups. The massage group did have fewer third-degree tears, but the study did not have sufficient power to measure this rare outcome. Postpartum pain, dyspareunia, resumption of sexual intercourse, and urinary and fecal incontinence and urgency also did not differ between the groups. “Although perineal massage in labor did not increase the likelihood of an intact perineum, our trial does provide good evidence of lack of harm that in itself may be of value,” the investigators point out. In view of the current findings, they suggest that “midwives follow their usual practice while taking into account the preferences of individual women.”
    - BMJ 2001; 322:1277-1280

  10. avatar
    Jacqueline (Jackie) Levine
    December 19th, 2012 at 10:03 | #10

    I’m guessing that as we read Rebecca Dekker’s article and analysis of the massage study, many of us thought about other important variables that have direct bearing on what happens to the perineum during birth. I wonder how the facts of ante partum perineal massage can be studied in isolation… separated from any connection to position during labor and pushing for instance, or who was attending (OB or midwife), whether the mother had analgesia, whether pushing was directed by those attendants or was “physiological” and length of second stage. From what we know about how emotion affects birth, the birth venue itself might have some bearing on outcomes. All those, and some that I have not thought of, no doubt, have consequences for the perineum. But, no matter; I too teach the technique with the caveat that it may or may not be of use, since it has been referred-to, even in passing, in much of the choldbirth literature.

    Here are two studies that might be of interest:
    Warm Compress During Labor Prevents Trauma Emma Hitt, PhD
    “The use of warm compresses on the perineum during the second stage of labor is associated with a decreased incidence of perineal trauma, according to the findings of a new systematic review. Vigdis Aasheim, MD, from the Department of Postgraduate Studies at Bergen University College in Norway, and colleagues published their findings online December 7 and in the December issue of the Cochrane Database of Systematic Reviews Cochrane Database Syst Rev. Published online December 7, 2011. “
    “….The researchers found a significant effect for the use of warm compresses compared with “hands-off” or no warm compress on the incidence of third- and fourth-degree tears. The risk was reduced by 52% (risk ratio [RR], 0.48; 95% confidence interval [CI], 0.28 – 0.84; 2 studies including 1525 women). They also found a reduction in third- and fourth-degree tears with massage of the perineum vs hands-off, with a risk reduction of 48% (RR, 0.52; 95% CI, 0.29 – 0.94; 2 studies including 2147 women).

    And this one:
    Lateral Deliveries Less Damaging to the Perineum – Jenni Laidman
    June 7, 2012 — In a single-hospital study, mothers who delivered infants in the lateral position were less likely to suffer damage to the perineum than those who delivered lying on their backs, largely because of a decrease in the number of episiotomies used in lateral deliveries, according to a study published online May 17 and in the June print issue of Birth. The study was a retrospective analysis of the records from 557 births of infants with a gestation of 37 to 42 weeks in an Antwerp, Belgium, hospital from November 2008 to November 2009.Inge Myevis, MSc, BaM, lecturer in midwifery, Artesis University College, Antwerp, and colleagues found episiotomies and perineal lacerations occurred in 27.9% of lateral deliveries compared with 45.9% of lithotomy deliveries (P < .001).” “The study found that perineal damage, including episiotomy, was more likely in deliveries performed by physicians than in deliveries performed by a midwife (OR, 2.92; 95% CI, 1.79 – 4.78; P < .001).”

  11. avatar
    Missie
    December 19th, 2012 at 11:09 | #11

    foreplay. just foreplay. dont make it a chore for couples.

  12. December 19th, 2012 at 13:20 | #12

    @Jacqueline (Jackie) Levine
    Great comments, everyone! I agree, it is so hard to look at one technique (perineal massage) in isolation. However, if I had written in depth about the evidence for every single one of the techniques used to try and prevent tearing– well, it would have been a book, not a blog article! I think many of you have raised a good point, though… it is hard to talk about this one intervention in isolation. Unfortunately, although the studies on prenatal perineal massage were of pretty good quality, they didn’t give us a complete picture of other methods that may or may not have been used (such as spontaneous pushing, different pushing positions, massage during labor).

    I really think the take away point is that prenatal perineal massage “might” lower your risk of tearing a little bit, but only if you are a first-time mom. If you have a second-time mom sitting through one of your childbirth classes, you can pretty confidently tell them to skip prenatal perineal massage (unless they REALLY want to do it), since research has shown it does not really have any effect compared to control group in women who have already had a vaginal birth. At least, that is what systematic research evidence has shown us.

  13. avatar
    Holly Hule, RNC, RYT, RPYT
    December 20th, 2012 at 12:42 | #13

    I also agree – it cannot be evaluated in isolation. This question came up in my childbirth class last night. The truth is that HEALTHY TISSUE will stretch and also heal better! Was nutritional status and overall health considered in the study? Directed vs. non-directed pushing… etc. I basically told this mom same as above, but stressing the importance of overall health, nutrition, hydration, stress reduction – anything that has already been proven to increase healthy tissues in any part of the body will help reduce tearing of the tissue and also decrease perineal pain after delivery.

  14. December 21st, 2012 at 13:10 | #14

    @Carolyn Gall AAHCC
    Thank you for that, Carolyn!! I had never heard that, but it makes complete sense.

  15. avatar
    Jacqueline (Jackie) Levine
    December 22nd, 2012 at 07:36 | #15

    @Rebecca Dekker, PhD, RN, APRN
    I surely didn’t mean to imply that the article was incomplete in its scope or lacking thoroughness…not at all. What I meant was wonderment at the study itself, the very doing of a study about one disconnected facet of a multi-faceted situation without any mention of the other facets, or any caveat that other factors might have bearing on results. Perineal massage just seems a concern with a very minor impact when all is said and done. In the dozen or so years I’ve been teaching and doing births, I haven’t even heard of any OB who makes his pregnant mothers aware of it or who recommends it or teaches it. In every vaginal birth, the baby crosses the perineum…so all the factors mentioned in comments to this site must come to bear on the fate of that perineum. Again, I’m just amazed at the lack of mention that factors during the birth itself have their impact on a mother’s bottom along with ante partum massage or its lack! The article itself is a fine thing, as evidenced by all the comments it has so far provoked! So thank you for it.

  16. December 25th, 2012 at 05:37 | #16

    I liked the summary of research, however I feel a point missing. This probably comes from the fact that I teach HypnoBirthing the Mongan method, so I look on everything related childbirth education from the “what do we suggest here?” point of view. Suggestions themselves have a demonstrated effect… (Think about tv ads. ;) If it wouldn’t work, corporations certainly wouldn’t pay for them…)
    So I’m sure that when we teach women to have perineal massage to improve outcome, we tell them (simplified) “your body on its own wouldn’t be good enough”, you HAVE TO do something to avoid catastrophe. So while the practice of massaging might help, part of these women will act on their reinforced belief: my body does not work good enough to let a baby easily out! The other part will think: my body works because I helped it to…

    I believe that when I teach perineal massage I do it differently. (And I’m not the only one with this approach!) I start with explaining that just like their little fingers or feet, also their perineums work completely OK, healthy, according to design (let a baby out as needed). Maybe not 100% of people have a healthy little finger or foot, but most of us do, and don’t expect a catastrophe or whole lives… which – at the same time – does not exclude the option to love them a little bit and care for them in times of bigger demand. (Like using a very good walking shoe when going to hike 20-30km, or massaging gently when sore, etc…)
    So they don’t do the p. massage to improve something but rather to LEARN about their own body (where are those muscle rings at all? how tight or loose are they? what does relax them mean?), to TEACH it something new (maybe??), and to caress themselves with the loving touch and maybe a luxurious oil to improve cooperation, harmony in the body, or between body&mind… Where the message is: my body IS healthy, WORKS FINE, and I discover these wonders again&again every day… and also during birth!
    A last remark: in my country, but also in the HypnoBirthing course – we seem all to define perineal massage somewhat differently… and I loved that you gave a definition to realize this tiny but important detail! It could be also interesting to wonder about those slight changes if they may have different results?? Eg. inserting finger only 1 inch deep. Not pressing on one point, but rather massaging in a U shape, or increasing stretching intensity over weeks… Not using almond oil but rather wheat germ oil, or tutsan oil, or a Stadelman aromatherapy mixture, etc. Point of massage being stretching or just associating pressure&relaxing the muscle. Etc.

  17. avatar
    sara r.
    December 29th, 2012 at 15:12 | #17

    Holly Hule, RNC, RYT, RPYT :
    I also agree – it cannot be evaluated in isolation. This question came up in my childbirth class last night. The truth is that HEALTHY TISSUE will stretch and also heal better! Was nutritional status and overall health considered in the study? Directed vs. non-directed pushing… etc. I basically told this mom same as above, but stressing the importance of overall health, nutrition, hydration, stress reduction – anything that has already been proven to increase healthy tissues in any part of the body will help reduce tearing of the tissue and also decrease perineal pain after delivery.

    yes yes! I tell women to eat lots of healthy fats (butter, coconut oil, cheese, etc..) as this will help your tissues to be more elastic. Vegetable oils actually have the opposite effect and a diet high in processed foods and vegetable oils is bound to produce skin that is more prone to tearing.
    Anecdotally, my second was born precipitously with his hand up by his face with NO tearing in the least. My midwife was quite surprised when she checked me out. I told her it was the butter :)

    Oh, and someone tell me how perineal massage is different from sex…really?

  18. January 4th, 2013 at 16:20 | #18

    Great question Sara! Some years ago I heard a very special midwife saying that sex was the best thing we could do to prepare perineum for birth. For me, make sense, it’s like instinct “technique” ;)

    I would like to see studys comparing tears and episiotomy and no tears with Valsalva and Kristller maneuvre.
    Rebecca you don’t mention these maneuvres in your article for any reason? Don’t you think they can have hugh impact in perineal trauma?

  19. January 4th, 2013 at 20:50 | #19

    In my own births and years as a midwife, physiologic birth almost always wins out for a healthy body after birth and a quick recovery. The mama should be feeling her own body and her own baby as he emerges; there is something so magical and so perfect about this connection. In most situations, women that choose to birth this way (with no forced pushing, direction, or anyone else’s hands) will not tear or only have a minor tear. I believe this is the secret to not tearing and believe that nothing preparatory needs to be done (other than supreme nutrition and believing that the female body is made to birth!)

  20. January 6th, 2013 at 00:43 | #20

    hi since I found in my own midwifery eperince its very helpful,if all women after 36 weeks can start prenia massage,
    during labor too I m very interested to continue by almond oil as well

  21. avatar
    Lillian Alice
    January 6th, 2013 at 16:24 | #21

    One benefit that I did not see raised is that doing the p.massage can give a woman a moment to experience what the opening of her vagina can feel like and that she can learn how to relax, not tighten, and breathe through the sensation. That when they feel the baby’s head coming through that they can then breathe and relax and allow that stretching.

  22. February 25th, 2013 at 12:02 | #22

    Years ago when I home birthed 4 children, one of my midwives recommended using copper ointment and I found it did help to prevent tears and allow easier crowning and passage of the baby along with relaxed breathing. Copper is said to have warming and muscle relaxing properties and is sometimes used for arthritis, either in a cream form or worn as a bracelet.

  23. avatar
    Karen
    August 23rd, 2013 at 10:56 | #23

    I provide information on perineal massage to my classes, but make it clear that it’s not a magic formula for an intact perineum and that other factors are more important – nutrition, pushing position, spontaneous pushing, etc. What I would like to see is more research on the aggressive massage often performed by caregivers *during* pushing. Nurses in my area are taught to “iron it out” and in every birth I’ve been to where a caregiver stretched the mom’s perineum while she was pushing, the mom ended up with a severe tear – 2nd degree all the way through 4th degree tears. Yeouch. I can’t help but think that the massage had something to do with the tears, as all women in my area are made to use stirrups and most end up doing directed pushing, but the “ironed out” women seem to have severe tears more often than those with a more hands-off caregiver. By the time baby’s head and shoulder gets to the perineum, it’s swollen, red, and irritated from being stretched so aggressively, no wonder they tear so badly. :(

  1. December 18th, 2012 at 09:16 | #1
  2. January 6th, 2013 at 15:20 | #2
  3. January 19th, 2013 at 17:08 | #3
  4. September 19th, 2013 at 09:11 | #4
  5. February 7th, 2014 at 02:28 | #5
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