The reduction of risk and prevention of perineal tears when supporting birth is a core part of skilled midwifery practice. We know that perineal damage can have both short and long term impacts around discomfort, pain and sexual functioning and a Cochrane review considered the evidence behind perineal techniques for reducing perineal trauma in the second stage of labour.
However there is more to midwifery practice than randomised controlled trials, and empirical evidence is part of midwifery history – wisdom and techniques passed down from mentor to student; midwife to midwife. So after sharing the open access article Margaret Jowitt wrote about the OASI Care Bundle:First Do No Harm, we asked our followers on Facebook what tips they might have for helping to prevent perineal tears. We had a great response and here’s a curated selection of anonymised responses from our midwifery community.
Perineal massage from 36 weeks
Avoiding induction unless absolutely clinically necessary
A calm environment with a real sense of safety
Birthing at home
Trusting relationship with the midwife – continuity of carer
Explaining the sensations that may be felt
Adopting the position that they feel comfortable in
Upright leaning forward
Birth in water
The Second Stage
Slow birth of the head, slow nudging of the head,
Breathing through those first feelings of pushing until the body takes over. Baby descends slowly allowing tissues plenty of time to stretch.
Not coached/purple pushing
Following their own instincts, placing a hand on the baby’s head
Giving a low deep ‘hum’ focused down into the bottom rather than breathing /pushing
A relaxed mouth and jaw
Watching for and gently controlling any nuchal arms present by using your hands to support the baby to maintain it’s tightly curled shape as it’s emerging, and then unfold after leaving the tissues
Warm compress on the perineum
Once almost crowning, closing the legs during contraction to improve blood flow to perineum.
Let the woman lead.
The following article is on Research Gate – it’s free to join and lots of really great open access research to explore.
But please feel free to add your thoughts in the comments below!