One of the possible complications of childbirth that generates the most fear is perineal trauma , the name given to the tear or episiotomy produced at the moment of delivery. Although the new protocols are trying to re-educate professionals to intervene less and let labor flow smoothly, not everything is in the hands of doctors and women can also do things to avoid these types of situations.
We have spoken with Elena Valiente, a physiotherapist specialized in pelvic floor at the “Duque de Sevilla – Gynecology and Physiotherapy for women” clinic, about what the pregnant woman can do to avoid episiotomies and tears .
Perineal massage … but not only that
On several occasions we have spoken of perineal massage as one of the main resources that we can put into practice to avoid, as far as possible, that tears occur during childbirth.
The objective of perineal massage is to stretch the perineum, soften it and give it elasticity so that at the time of delivery it is more prepared to open. In addition, the massage serves to learn a little about the sensations that will occur during childbirth and become familiar with them, thus helping to relax the area at the peak of delivery.
“The perineal massage helps to improve the vascularity of the vaginal area. The weight that is supported during pregnancy reduces the oxygenation of the vulva, hence its classic bluish appearance in the last stage of pregnancy. This is important to improve it on the face to childbirth, to avoid complications “- advises the physiotherapist.
And that, as the physiotherapist explains, perineal massage is only part of the preparation that the woman must carry out during pregnancy , and which includes, among other aspects:
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Take care of the weight that is gained throughout the pregnancy
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Perform regular Kegel exercises to gain perineal strength
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Be in shape and lead an active life during the nine months of pregnancy, so that we combine both relaxed breathing exercises, stretching and postures such as yoga or Pilates, with cardiovascular exercises
When and how to perform the perineal massage?
Thus, and starting from the basis that perineal massage is just one more help , Elena explains how and when to do it so that it is more effective:
“My recommendation is to start doing them after week 35 , and not before, because I have met women who have started doing them much earlier and when they have reached week 36 they have gotten tired and have stopped. precisely this last stage is the important one “
” Ten minutes a day is enough if it is done well . Therefore, my advice is not to do it yourself, but to ask your partner for help. Because you will only be able to massage yourself with your thumb, so that only the entrance area to the vagina will work. While the couple can reach much deeper planes of the pelvic floor “
In her clinic, Elena explains to couples who want to start with massages how they should perform them, and although we take this opportunity to recall a post by Armando where he explained the perineal massage technique, it is advisable to always consult with a pelvic floor specialist to guide us in its correct execution.
Is rosehip oil effective?
Much is said about rosehip oil as an ally to promote skin elasticity. However, for perineal massages Elena does not recommend it , and instead relies on lubricants similar to vaginal mucus, such as Mucus de Cumlaude gel.
” Perineal massage is annoying , and rosehip oil is absorbed quickly, so there is a tendency to make more friction when massaging, and this causes greater contraction of the perineal muscles and, therefore, greater discomfort “
“It is better to opt for lubricating gels and once we have finished the perineal massage, resort, if you want to a gentle massage with rosehip oil or some other that can be used for this purpose”
Is the use of Epi-No effective?
A few years ago a device called Epi-No came on the market, which is presented as a pelvic floor exerciser to prepare the perineum for childbirth. What this device does is to familiarize the woman with the sensation and pressure that she will feel in the perineum at the moment of delivery, helping her to control her pushing.
However, from the El Parto es Nuestro Association they do not recommend it, and neither does Elena.
“I always work based on scientific evidence, and I am adapting to new studies. At the moment, there is no evidence that Epi-No reduces the risk of episiotomies and tears in childbirth”
“On the other hand, it would be logical to use the Epi-No if the woman is clear that she will not want an epidural in childbirth , but if this is not the case, this device is of no use since the sensation of pressure in the perineum that is feel when using the Epi-No, and that therefore helps you to know how to direct the pushes, disappears the moment the epidural is administered “
At the time of delivery, what can be done to avoid tears and episiotomies?
The physiotherapist insists that the fact of carrying out a correct preparation during pregnancy, combined with perineal massages, helps reduce the risk of episiotomies and tears in childbirth, but unfortunately they do not prevent it.
And there are many other factors that can interfere when labor ends with tears or the need for an episiotomy:
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Macrosomic babies, or with a weight over 4 kilos
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Baby with a large head circumference
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Expulsive very fast, that is, babies that are born in a single push, since the perineum does not have time to gradually dilate
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Instrumental delivery
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A very long labor
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Amount of epidural anesthesia administered
“If the woman gains a large amount of kilos, the final stretch will face it in a heavy and not very active way, and as a result, she will arrive tired and in poor shape at childbirth. Also, if she decides to have an epidural, a greater amount of epidural will be needed. anesthesia (since this is a function of weight), and the higher the dose of anesthesia, the greater the probability of not controlling the push, that the labor is lengthened and that instrumental help is required “
In summary, if you are pregnant and are concerned about the time of delivery, remember that you can do several things to prevent it from ending with perineal trauma. Ask your midwife or a physiotherapist specialized in gynecology and pelvic floor all your questions!
Thanks Elena Valiente
Photos from iStock
In Babies and More Performs a perineal massage to improve delivery conditions, Episiotomy increases the risk of tearing in the next delivery, Percentages of episiotomies in European countries, Curious viral video: a balloon and a ping pong ball to explain what happens in childbirth
