Hi Jan (and others)
Our local public hospital includes perineal massage in childbirth education classes.
In my independent practice I discuss perineal tearing with women (they are all worried about it). I provide information/instruction about perineal massage but to be honest most women do not do this. During birth I use a totally hands off approach, however to avoid tearing I:
-do not use directed pushing - women instinctively protect themselves and their babies (including slowing things down as the head crowns)
-I suggest a position change as the head crowns if the woman is in a squat as this position increases tearing.
- I do not check for cord or use traction to pull the baby out unless absolutely necessary. This may mean waiting for a few contractions.
Basically I avoid 'doing' or 'telling' unless necessary. I am aware of a study that a study found warm packs reduced the likelihood of primips sustaining 3rd and 4th degree tears (Dhalen & Homer, 2007). I have shared this with my primips but none were keen for me to try it. I guess there is such a small chance of a 3rd or 4th degree tear that fiddling about would be pointless in most cases. This is a very interesting topic.
Rachel
--- On Tue, 23/9/08, Deborah Caine <[log in to unmask]> wrote:
> From: Deborah Caine <[log in to unmask]>
> Subject: Re: Virtual Global Discussi on Forum on Changing Practice with Evidence - "Active Manag ement of the Third Stage of Labor"
> To: [log in to unmask]
> Date: Tuesday, 23 September, 2008, 10:44 PM
> Thanks for that direction on massage as I have seen few
> descriptions of the
> process and would like to suggest it at antenatal classes.
>
> Deborah
>
>
> STACY SHEER writes:
>
> > Hi Jan,
> > As a traditional homebirth midwife in the US, we also
> rely heavily on
> > perineal massage prenatally and during
> labor(sometimes) to preserve vaginal
> > integrity. I am a firm believer. I recommend clients
> do perineal massage
> > with a good oil at least 2 times per day for 20 mins
> during the third
> > trimester. Good luck to you-Stacy
> >
> > On Tue, Sep 23, 2008 at 5:20 AM, wheeler
> <[log in to unmask]> wrote:
> >
> >> Thank you for information Briley - much
> appreciated!
> >>
> >> Jan
> >>
> >> ----- Original Message -----
> >> *From:* Briley, Annette
> <[log in to unmask]>
> >> *To:* [log in to unmask]
> >> *Sent:* Tuesday, September 23, 2008 5:30 PM
> >> *Subject:* Re: [GANM (Global Alliance for Nursing
> and Mi dwif ery):
> >> Announcement] Virtual Global Discussi on Forum on
> Changing Practice with
> >> Evidence - "Active Manag ement of the Third
> Stage of Labor"
> >>
> >> You need to talk to Prof Debra Bick
> ([log in to unmask]) she has done
> >> lots of work on perineal trauma including the
> PEARL study, and if she can't
> >> help you she will probably know someone who can!
> >>
> >>
> >>
> >>
> >>
> >> Annette
> >>
> >> Annette Briley
> >>
> >> Consultant Midwife/Clinical Trial Manager
> >>
> >> Maternal and Fetal Research Unit
> >>
> >> 10th Floor North Wing
> >>
> >> St Thomas' Hospital
> >>
> >> LONDON SE1 7EH
> >>
> >> tel: 020 7188 3641
> >>
> >> fax: 020 7620 1227
> >>
> >> mob: 07710 348443
> >> ------------------------------
> >>
> >> *From:* A forum for discussion on midwifery and
> reproductive health
> >> research.
> [mailto:[log in to unmask]] *On Behalf Of *
> >> wheeler
> >> *Sent:* 23 September 2008 00:42
> >> *To:* [log in to unmask]
> >> *Subject:* Re: [GANM (Global Alliance for Nursing
> and Mi dwif ery):
> >> Announcement] Virtual Global Discussi on Forum on
> Changing Practice with
> >> Evidence � "Active Manag ement of the Third
> Stage of Labor"
> >>
> >>
> >>
> >>
> >>
> >> Hello Everyone,
> >>
> >>
> >>
> >> My name is Jan Wheeler - I am a Midwife working in
> Australia and am
> >> currently enrolled in a Doctor of Midwifery
> programme at the University of
> >> Technology, Sydney.
> >>
> >>
> >>
> >> I am hoping some of you might be able to help me
> with a question I have? * I
> >> am trying to find evidence of women being provided
> with antenatal
> >> information on how to minimise perineal trauma
> during pregnancy, labour and
> >> birth.* * *Are any of you aware of this practice
> occurring anywhere - as a
> >> preventative measure?
> >>
> >>
> >>
> >> Thank you for your time - I am hoping to get a
> positive response from some
> >> of you because I haven't found any evidence of
> this practice up to now.
> >>
> >>
> >>
> >> Regards,
> >>
> >>
> >>
> >> Jan
> >>
> >>
> >>
> >>
> >> --
> >>
> >>
|