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perineal massage

Does anyone have information about whether there are different outcomes for perineal massage during a second pregnancy as opposed to the first?
I have a client you did perineal massage leading up to her first birth. She still had some bad tearing and ended up with stitches - he was a big boy. She's about 3 weeks out from her second child's due date and asked if perineal massage would still benefit her?
I don't see how it could hurt, but are the benefits different after one vaginal birth? Will the fact that she had stitches factor in?
I'd appreciate any thoughts and/or references!

Replies to This Discussion

Permalink Reply by leslie stager on December 5, 2009 at 8:16pm

There is actually quite a bit of research nowadays... that show that PRENATAL perineal massage shows some benefit for certain women. Here is a piece from my article about Perineal massage... but Also, a big factor is size of baby, and position of delivery...
"A Canadian study in 1999 with 1527 women determined that 24.3% of first time mothers who did daily perineal massage for 10 minutes beginning the 35th week of pregnancy until birth, had intact or unsutured perineums after delivery, as compared to 15% of the women who did not do perineal massage. The more consistently women did the massage, the less likely they were to have lacerations. Another study determined that primiparas, and multiparas who had an episiotomy in their first delivery, benefited from prenatal perineal massage. Women who had previous vaginal deliveries and who did prenatal perineal massage in a subsequent pregnancy did not have any obvious difference in laceration rates from those multiparous women who did not do perineal massage.
Another study asked 861 first-time mothers to do kegel exercises for the last two months of pregnancy, and at least 4 minutes of perineal massage 3-4 times per week during the last 6 weeks of pregnancy. This resulted in a 6.1% reduction in 2nd degree or greater lacerations and episiotomies. For women over 30 years old, 12.1% had a reduction in tears.
Perineal massage during the 2nd stage of labor is not so effective according to several trials. In one, outcomes were essentially the same for women who received massage in the 2nd stage of delivery and those who did not. The researchers did note, however, that the control group with no massage had the only 4th degree tear, and had more 3rd degree tears than the massage group. In addition, the mean duration of the 2nd stage was11 minutes shorter in the massage group .
The home-birth study, however, found that second-stage perineal massage and the use of lubricants were actually associated with trauma . "

Permalink Reply by Nicola Hogan on December 13, 2009 at 11:24pm

From my own personal experience, I found perineal massage to be hugely beneficial for the birth of my second child.

I used perineal massage for my first pregnancy, however, only in the last couple of weeks. I birthed naturally, drug free and had second degree tearing, which healed remarkably quickly.

For my second pregnancy, I began perineal massage early in the third trimester and practiced daily in the shower. My second baby was bigger than my first, the labor was shorter, harder and faster in that the baby was born within 3 hours and he did all the pushing. I did not tear. The scar tissue from the first labor tear is still intact.

I also used a lot more creative visualization when I did perineal massage for my second pregnancy. I would imagine it softening and becoming more pliable and see myself easily opening to allow this baby an easy passage.