Tuesday, September 21, 2010

Perineal Massage, Episiotomy, Perineal Support...

This link is to a story lied further down my rambling post and the purpose of this post. Please check it out.

When I had my first baby I was so unprepared in so many areas. I remember reading about episiotomy and thinking I did NOT want that.
So, there I was in labor, and in the overseas hospital I was at, they did a partial shave, which I thought odd, then all of the sudden I noticed the OB coming at me with a large pair of scissors! I remember screaming -in my head- STOP! No! Don't cut me! and more specifically, "Can you just give me a minute! I'm in the middle of a contraction!"

Being the 'good little patient', I said nothing, and the cut was made. Granted, I didn't particularly feel it at the time (he did what is called a pressure episiotomy - when the pressure of the baby's head is there during crowning, the tissues have a sense of numbing, and so you don't actually feel the episiotomy, and you don't need to have a local anesthetic, until they stitch you up). After the birth however I had very bad swelling, pain and tenderness. I learned that they had done a Mediolateral episiotomy, which in fact do cause more swelling and pain than a midline episiotomy. Mediolateral Episiotomy is common in Europe, where the cut is made at an angle into the labia, rather than straight down into the perineum. The theory is that if the mediolateral cut tears further, it will not end up in the anal sphincter, like a midline episiotomy can have a tendency to do.

With my second baby, I did not have an episiotomy, and would have been fine, if I'd been allowed to listen to my own body as I pushed. However, this Dr. -a tall man- tilted the bed, up and back, so that I was literally pushing up hill, and then I was being yelled at, with counting and pushing, and counting. I had a minor labial skidmark/tear, probably only because of the small size of that baby... but I had a lot of bruising and postpartum pain from the way the birth was 'managed'.

The most helpful things that I personally have had that helped to stretch the perineum, was the use of Warm compresses during pushing with two of my babies. The moist warmth helped soften and stretch the tissues and helped me to feel my body to be able to push slowly and ease the head out, and caused less stress and trauma to the tissues of the perineum. The other thing that was a helpful thing as well was having waterbirths. My level of postpartum discomfort/pain from birth was dramatically different and lessened after the use of warmth and moisture.

As a labor doula I have witnessed many births where the OB or even the nurses employed the use of 'perineal massage, or more often I've heard it called 'Ironing out' the Perineum. I have watched as this very vigorous, intense 'massage' is done during the pushing stage of labor. I have watched the tissues swell and subsequently tear during the birth of the baby's head or shoulders, and in one case, before the head was even crowned, just due to the ironing out of the tissues. Some Dr's have commented when I have had clients/patients ask about this procedure/process that the Dr. had for a period of time stopped performing this 'perineal massage' and reported that they had an increased incidence of perineal tearing, so they had gone back to the massage/ironing out of the perineal tissues during pushing. What I have have witnessed is that nearly EVERY single mother that has had this done, has torn and needed stitches after the birth.

**********************************************************************************The link tells detail about what this is like. http://prepforbirth.com/2009/08/25/new-episiotomy/

There are directions for perineal massage, it is to be done prenatally, and can potentially help the tissues stretch during birth. http://www.childbirth.org/articles/massage.html
Then at the birth the mother can massage and help ease the tissues as the baby is born. Some people swear by it. I tried it for one birth, where my caregiver performed the massage, NOPE, that was not for me! However during my waterbirth, I instinctively reached down and eased the tissues around my baby' head. No tearing or cutting and no need for stitches.

I have witnessed a few hosp births without a mother tearing, one even that the Dr. was pushing very hard to perform an episiotomy, "because the mother was going to tear horribly", and the mother refused the cut and birthed her baby, amazingly, over an intact perineum! I have only witnessed one or two episiotomies. I have seen many a mother however birth in an out of hospital environment, and when she is supported, births in an upright or hands and knees position, listens to her body, pushes when she feels the need, not because she is being yelled at to push to a count of ten... mother after mother birth their babies, over intact perineums! The average is 8 lbs or over. I've seen mothers birth 10 and even one 12 pound baby, without even a skid mark, let alone a tear! Yes, I've seen a few tears at OOH births as well, but the way the birth is watched, supported and guided is so different from the managed way of birth in hosp. it wasn't for lack of trying, and few OOH have been as severe as the one's that I believe are caused by the way of birth and perineal massage/ironing, that is used.

I love to have a warm pot of water filled with a bag of healing herbs that I can put cloths into and then use for perineal support. I think it helps the mother.

I have desired to start a dialog about this practice of the 'new episiotomy',for a long time. I'm glad that someone has written about this. Lets get more dialog going, and try to let birth be a more gentle process, no matter your location.

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