Newbie nurse with a ? about perineal massage.

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I've heard about the pros/cons of perineal massage while a woman is pushing. My preceptor told me it's a good idea to do it to help stretch the tissue (especially in primes) and prevent tears. One of the midwives I work with said never do perineal massage, it causes swelling and leads to more tears, swelling etc. What are your thoughts on this?? Both make sense to me. My instructor in nursing school (with 25 years experience) also said not to do perineal massage.

Thanks for any input, I'm loving my job so far and feel very blessed to have been given this opportunity!!

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Specializes in geriatrics, L&D, newborns.

I have to admit that i am unfamiliar with perineal massage and I have never seen anybody do it.

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I've never done it on anyone. I'll put my fingers in the vag for the mom to feel where to push but I don't do the sweeping massage. I've heard in a class not to do it. Do a lit search and let us know what the research says.

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Specializes in Community, OB, Nursery.

Some midwives encourage women to do perineal massage on themselves in the last few weeks (36 and after) to stretch out the tissue in prep for labor. Especially primips.

During labor, though, you have to be really careful about how you do it, because overdoing (too much, too fast) it CAN cause edema & more problems. (Same reason you don't constantly suction a trach.)

I've also seen midwives use intermittent hot packs on the perineum instead of massage. It relaxes and allows for stretching without the edema. I've heard a lot say they like this better than the massage.

ETA - Having said all that, allowing women to birth in the position of their choice, allowing the baby to descend at his/her own rate, and gently supporting the perineum as the head is delivered are, IMHO, the best ways to keep the perineum from tearing.

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Specializes in Community, OB, Nursery.

Article on perineal massage during pregnancy (does not discuss during labor):

http://209.85.207.104/search?q=cache:aVHym8jzYxEJ:www.acnm.org/siteFiles/news/sharewithwomen50_1.pdf+%22perineal+massage%22&hl=en&ct=clnk&cd=9&gl=us

From Journal of Midwifery & Women's Health, 2005.

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As I understand it, perineal massage during pregnancy is effective at preventing traums, but during delivery it is either not beneficial or potentially harmful. I once watched an OB "iron" my doula clients perineum roughly throughout 2nd stage- I can't imagine that it was helpful.

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Specializes in Emergency Midwifery.

No haven't seen it done but have personally experienced the warm/hot pads which I felt were nice. Nearly worked to - if I hadn't pushed too hard at the shoulders I don't think I would have torn at all.

Nicky.

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Specializes in ob; nicu.

Warm packs work nicely to prevent edema and also offers a comfort measure, Our little mommies also appreciate it. Not a big fan of massage.

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Specializes in NICU, High-Risk L&D, IBCLC.

I've also seen midwives use intermittent hot packs on the perineum instead of massage. It relaxes and allows for stretching without the edema. I've heard a lot say they like this better than the massage.

ETA - Having said all that, allowing women to birth in the position of their choice, allowing the baby to descend at his/her own rate, and gently supporting the perineum as the head is delivered are, IMHO, the best ways to keep the perineum from tearing.

Completely agree. Midwives at my facility do this as well, and it works very well. Position changes also work wonders.....I recently had a primip that just wasn't bringing baby down with pushing in the "traditional" position and she asked to push on hands and knees. Fifteen minutes later she was crowning and only ended up with a small first degree tear. Works for me!

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As a midwife for a good number of years I have always left womans perineums well alone allowing slow desent of the head to do all the stretching that is needed -I have noticed since being in the US IMO- women are checked way to often even antenatally and all that sweeping of the perineum drives me crazy

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Has anyone here HAD perineal massage performed on them during labor??? I have, and it HURT SO BAD. It made me clench up and want to back off of labor. I would actually stop pushing every time the nurse did it. I finally had to tell her (a couple of times, last time wasn't very nice about it) to keep her d*** fingers out of my lady parts. I've seen so many moms clench up and/or experience edema from the perineal massage.

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Specializes in Community, OB, Nursery.
Has anyone here HAD perineal massage performed on them during labor??? I have, and it HURT SO BAD.

My OB did it while I was pushing, and I agree with you. It burned like the devil. looking back, I wish I'd asked her to stop & just let me stretch as the head was delivering.

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