Perineal massage to prevent episiotomy

When it comes to childbirth, one thing guaranteed to make all women cross their legs is the mention of the word 'episiotomy'. Even men shuffle uncomfortably at the thought of it, thanking their lucky stars (just that once, of course) that they miss out on the wonder of giving birth!

An episiotomy is a surgical cut carried out under local anaesthesia as the baby is born. It is used to widen the birth canal enough so the baby can fit through. The cut is made in a downward and outward (usually to the right) direction so that any extension is not in the direction of the anus. Sometimes an episiotomy is done because it is so clear that a significant tear is going to happen, it can be preferable to ensure it is both controlled and in an appropriate outward direction (as opposed to toward the anus). This is not by any means to say that an episiotomy is always better than a tear - most tears are minor - and we know that a 'liberal' approach to episiotomy as opposed to a 'restrictive' one results in more severe tears overall.

The Cochrane Library is an electronic medical resource full of helpful information for health professionals, and the latest version has something useful for pregnant women too. Research has found that perineal massage from 35 weeks of pregnancy can significantly reduce the need for episiotomy during childbirth. Irrespective of whether an episiotomy was done or not, women who did perineal massage were also 30% less likely to experience perineal pain at 3 months after the birth. The benefits were most likely for women who were experiencing their first birth, probably because the perineum is much more elastic in any case after the first baby has been born.

Don't worry, antenatal perineal massage doesn't require a trained masseuse and can be done in the privacy of your own home. The studies used a sweet almond oil based lubricant although other vegetable oil or water soluble one should be fine. Some women involve their partner.

• Wash hands, and find a relaxing place to do the massage (bathroom, bedroom, where ever you are comfortable)
• Sit in a comfortable position. (A warm bath or warm compresses on the perineum for 10 minutes before massage may help with relaxation.)
• Put the lubricant on the thumbs and perineum.
• Place a thumb just inside of the vagina.
• Press downward towards the rectum and to the sides at the same time until a very slight burning, stinging, or tingling sensation is felt
• Hold the pressure for about 1 minute
• Breathe deeply and slowly and try to consciously relax the muscles.
• Keep pressing down with the thumb and slowly and gently massage back and forth over the sides of the vagina in a 'U' movement for 3 minutes.
• Relax and repeat once.

Many recommend this to be done daily from 35 weeks, but the research suggests that twice a week is preferable.

Comments

[Dr Norman Blumenthal]

There are some problems that can result from an episiotomy such as: more blood loss, higher risk of infection, longer healing time, longer time to resume normal sexual relations, more pain, and for some women it can result in more tearing.