Episode 49: Perineal Massage While Pushing?Sep 15, 2022
[00:00:00] Did you know that sometimes during the pushing stage of labor, your obstetrician or your midwife may offer some perineal massage as you're pushing your baby out? Maybe you experienced this when you have already had a baby and you kind of wondered why and what the purpose was, or maybe you didn't even notice.
Today, we're talking about perineal massage. I'm Cara Lee Kiggins. I'm a certified birth doula and a childbirth educator. And we're going to talk about perineal massage, particularly through the pushing stage of labor. Let's get started.
First off what's the perineum. The perineum is a triangle shaped patch of skin between your vagina and your anus. So as the baby is emerging from your vagina, if this is the vagina, and this is the baby's head is the baby is emerging. It's the patch of skin under here. . And [00:01:00] what we're talking about here is perineal stretching and perineal massage, which is where the obstetrician or the midwife will take their hands usually and some sort of warm compass and some sort of a lubricating oil. And we'll, and remember, this is when the baby's head is emerging. So the baby's like right here, or maybe right back here, and they'll gently, the point is they should be gently massage right here to en encourage gentle stretching of the perineum.
And the goal with this is to prevent tearing. So a lot of people are really scared of tearing. Tearing is something we can talk about in another video. Generally, the folks who have a tear, it's a minor tear, either doesn't require stitches, or maybe just a few stitches, but in the grand scheme of things, with the power and the energy of labor that stage the tearing doesn't tend to be the part that folks find as awful as maybe they were afraid of. I can't, you know, everybody's experience is so different, but I do wanna mention that.
So the goal of perineal massage, generally, is to prevent or lessen the degree of a tear that happens in the perineum as the baby's [00:02:00] head emerges. And not everybody tears and most people who do tear, it's either gonna not require stitches or just be a first or second degree, which is pretty minor. There's also third and fourth degree, which is a little bit more major and would require some more repair.
Another time that people may talk about perennial massage is through pregnancy. So some people for a while it was advised to practice perennial massage in pregnancy with your partner or yourself to gently encourage those tissues to stretch through pregnancy. There's not a lot of data on that, and that may or may not be helpful for you.
The one thing that may be helpful with perineal massage during pregnancy is that it may help you become used to the sensation of releasing tension in your pelvis and in that space in response to pressure.
But we're not talking about that in this video pregnancy perineal massage is a different issue. What we're talking about is perineal massage during pushing for this video. And the reason this came up recently, Is that I was telling a story on TikTok and you know, there's never enough nuance on social [00:03:00] media, but where I had unfortunately witnessed some obstetric violence. I witnessed a really, really aggressive perineal massage that was painful.
The obstetrician was asked to stop by my client, the birthing person, the obstetrician was asked to stop by her husband and the OB did not stop and it was awful. And years later, I'm still talking about it because it was honestly traumatizing to witness.
What that obstetrician was doing is not what's considered the standard perennial massage standard perennial massage is where they will very, very gently in, like I said, in addition to some lubricating oil and some warm compresses, applying warm compresses. They'll gently massage. The perineum inviting the baby to come through inviting some gentle, gentle stretching to prevent tearing. So let's look at some of the data about the tearing.
Interestingly Evidence Based Birth, just a few months ago, published a new podcast where they had, and their research assistants had looked at the evidence for perineal massage during the pushing stage of labor for [00:04:00] preventing tears. So the American College of Obstetricians and Gynecologists formally mentions that perineal massage may help prevent tears and they base it on a meta analysis of a couple studies and Evidence Based Birth specifically and this is nerd alert. Um, I love this evidence stuff, but evidence-based birth specifically looked into these studies separately, not just as a meta-analysis and looked at the quality of the studies and their findings. And they found that two of the studies that were the best quality studies didn't really find a difference perineal massage and no perineal massage in terms of tear rates. The two studies that found the highest. Positive benefit for perineal massage were studies done in practices with really high episiotomy rates. So also we're not talking too much about epitomy here, but episiotomy is an approach to preventing- it was thought to prevent tears, but it actually makes tears worse where they would surgically cut with scissors, the perineum rather than inviting stretching and letting it tear on its own.
So a has now been proven to not have the positive benefit on [00:05:00] preventing tears that people once thought that it did, but in this practice, this OB practice where this study took place, the episiotomy rate rate was super high. So they assigned people to either have perineal massage or not have perineal massage in this study.
And the ones who didn't have perineal massage probably had an episiotomy but the study doesn't look at this. So the, the study may not conclude that perineal massage was beneficial, but that the perineal massage gave the OB something to do with their hands, besides an episiotomy to help that baby emerge. And so the point of this is please go listen to the Evidence Based Birth podcast.
They do an excellent job of really diving into the data better than I am right now. And the point of this is though is that the data is not that strong on the benefits of perineal massage.
and what none of these studies look at is what perennial massage feels like for the person experiencing it. So perineal massage for many OB practices, most of their patients have an epidural and even some midwives work in practices where most of the patients have an [00:06:00] epidural. Perineal massage with somebody with an epidural can be helpful in combination with, sometimes an OB or midwife will place their fingers, just, just at the base of the, of the vagina to say, "push into this point".
So if somebody's having a hard time finding those muscles for pushing, especially if they have an epidural, which makes it harder to find those muscles to push. That can be a really helpful point. They'll say, "push my fingers out". And it's really a way for that birthing person to focus their energy. And it can be helpful.
Also, when you have an epidural, you're not necessarily feeling your perineum in the same way that somebody who doesn't have an epidural. So a lot of OBs that are generally used to working with people with epidurals and most of the births, I attend people don't necessarily have an epidural.
That feels very, very different for somebody who doesn't have an epidural.
None of these studies look at the fact that it's uncomfortable and it also feels sometimes violating. And of course, every OBs gonna say, yes, yes, yes.
I get patient consent for everything I do. But anybody who's been in a birth room in a really busy hospital or really busy practice knows that sometimes a lot of things are done [00:07:00] automatically without checking. and this is just the virtue of the American medical system and the way that things tend to work.
This instance that I've been talking about on TikTok, the person didn't that OB didn't have consent, the OB was being incredibly aggressive. It was incredibly painful for the birthing person and was not listening. When being asked to stop. That is not what is recommended and it is not the way most obstetricians intend to do their work and not the way most do their work. So I wanna be clear about that, but that's the reason that this has been coming up a lot is I was telling that story cuz years later, I'm still thinking about it still bothers me. So that's that on perennial massage during the pushing stage of labor, it's rather common. It's, there's mixed data on the benefits, but the intent is to help prevent tearing. And if it is done, it should be done very, very gently with warm compresses and with full consent from the person giving birth.
And for some, it can be helpful. And for some, they prefer a more hands off approach, and that should be your choice as a [00:08:00] birthing person. Because again, your body autonomy, your bodily autonomy, your body, your birth, your baby should be your choice. Thank you for listening and I will see you next week.
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