The effectiveness of perineal massage.
Perineal massages and other similar techniques are usually applied to pregnant women as they are believed to prevent damage or tears to this area. The perineum is the region between the vagina and anus where some flesh is located. It is a sensitive area during virginal childbirth and damage to this area leads to several complications. Among the complications involved is reduced support by the pelvic floor to the uterus. It means that the uterus is under risk of prolapse and it can affect the success of future pregnancies. Additionally, damage to the perineum can cause discomfort during sex. It can also lead to poor control over one’s bladder and bowels. Perineal massages are believed to assist the perineum to stretch and be more elastic during childbirth. It happens once this tissue relaxes, allowing the vagina to open and letting the baby pass through.
However, the effectiveness of this method is questionable given that most research carried out till today has been on a trial and error basis. Many aspects involved in this practice are questionable and some of the techniques used appear to cause more harm than good. Therefore, this paper will seek to argue that these perineal messages and other similar techniques like perineal stretching cause more harm than good. For the safety and well-being of women close to giving birth, other hands-off techniques are more favourable and effective. Such methods are also discussed in this paper and should be favoured over the traditional perineal massages.
Among the greatest disadvantages posed by perineal massages is its intrusive nature to the pregnant woman. As the woman nears childbirth, vaginal examinations become more frequent and are expected to happen every four hours. Additionally, the midwife will often prod and conduct further observation on an hourly basis. Such practice has negative impacts on the woman as it easily scares and unsettles them. The women are hardly able to relax and concentrate on their labour rhythms. Disruption of this essential rhythms lead to problems during childbirth and even increase the risk of perineum tears. Therefore, it is preferable for the midwife to only provide a strictly hands-off support role. This way, the woman is allowed to naturally calm down and concentrate on her labour rhythm. Hence, the intrusive nature of perineal massages causes more harm than good and should be avoided.
Another disadvantage caused by perineal massages is a risk of infection to the patients. If the midwife massages the perineum to hard or aggressively, complications are likely to follow. This area is usually swollen and filled with blood. Massaging the area strongly will lead to an increase in blood flow to the perineum which already contains a large amount of blood. The result is inflammation to the perineum due to excessive blood circulation. The pain levels will rise even before labour and childbirth and this leads to the unsettling of the woman preparing to give birth. Also, it tends to cause discomfort for the woman and distracts them from concentrating on their breathing and labour rhythms. It can also irritate this area which only means the woman will experience more problems post-childbirth.
During the second stage of labour, the woman’s cervix dilated to allow the child to pass. It is the stage where women’s uterine muscles contract and allow passage of the child via the birth canal. The woman is expected to push the baby out in a moment where they feel immense pressure which is coupled with labour pains. This direct pushing can be greatly affected in case perineal massages are taking place concurrently. It is because the woman attempts to push the child out while the midwife is pushing the perineum in, cause a huge power imbalance. This imbalance leads to confusion on the labouring woman’s part who may likely be able to effectively perceive her labour. Additionally, it may cause negative impacts on labour outcomes and cause intense pains.
Perineal massages should be practised over three to six weeks before childbirth for its effects to be noticed. It is a common belief among many midwives and thus expectant mothers nearing childbirth are usually required to show up for these per massages daily. Thus, it shows that the process is long and tiring to the woman. The woman, who is very close to giving birth, is expected to prepare herself and accommodate time every day to undergo this technique. Needless to say, it is not very comfortable for pregnant women to undergo.
Furthermore, research has shown that these massages do not fully reduce the likelihood of perineum tears occurring during delivery (). They are said to only reduce the severity of such tears, and this only occurs occasionally. Thus, it means that the whole practice can easily not have any of the desired effects on the women and end up being a waste of time which can also cause further risks.
Research has found that the more frequent perineal massages were applied to women, the less effective they were and no benefits were reported (). Studies have found that perineal massages are only effective to some first-time mothers, with others not noting any benefits. Consequently, women who have given vaginal birth before have experienced barely any benefits from the massages and are exposed to more risks. Also, the rate of perineal massage affects the possible benefits, if any. This means that the benefits are more likely to appear if the mothers undergo little massaging as they near childbirth. Still, a considerable amount of risk is incurred hence it is better to avoid it altogether.
Further studies are have shown that those who undergo perineal massages are more likely to experience perineum pain after birth compared to those who used a hands-off technique (). The studies found out that those who underwent perineal massages are more likely to experience more pain in the perineum as they undertake their daily activities after childbirth. Also, six weeks after childbirth, they are said to be in more pain when compared to those who underwent a hands-off technique. The explanation behind it is that those who underwent a hands-off technique had their perineum region undisturbed during childbirth. It means that the tissues for the hands-off group achieve natural and gradual dilation, allowing it to heal naturally. In contrast, those who had their perineum touched experienced more blood flow to the area and thus it was unable to naturally dilate. Therefore, the hands-off procedure is commendable and should be preferred.
Additionally, women who undergo perineal massages have been found to suffer more mental health issue than those who undergo the hands-off techniques (). The complications involved in the hands-on method leads to more pain and disturbance to the mother. The mothers often suffer anxiety, stress and depression due to their complications. They are also less prone to want to give birth again. These women feel they are not in a position to share their woes as many others do not understand what they are going through. With the addition of painkillers, these mothers probably incur greater expenses while looking for ways to better their mental health. Thus, perineal massages end up being more expensive in the long run due to the multiple complications that arise.
Another disadvantage to perineal massage is that it cannot be performed on those who have certain sexually transmitted illnesses like herpes or vaginal thrush. They will lead to serious complication to the genital areas and treatment of these diseases could be affected. Some women are not aware of their status, especially whether or not they have these sexually transmitted infections. They may be financially stricken and therefore unable to know their status. Such women belong to a vulnerable category who may not be able to deal with the consequences of the perineal massages. Therefore, this method should not be used on those who are not aware of their medical ailments and those who do not have a clean bill of health.
Thus, research proves to us that hands-off techniques are safer and pose a greater advantage to expectant women in the long-run (). Hands-off techniques have shown to lead to less third-degree tears in mothers and allow a healthier environment for the mother to look after her offspring. These third-degree tears will require operation in a different place from the delivery room and requires the mother to be sedated. This procedure requires additional pay that is not included in the delivery fees. Furthermore, even after the procedure is completed, the mother is still not yet fully healed. The mother is then expected to bear the pain for up to three months before the perineum region is comfortable. During this period, controlling the bladder and bowel becomes a significant issue and puts the mother in great pain. In some cases, mothers face persistent issues and can never control their bowels and bladders as they did before childbirth. All these issues can easily be avoided if a hands-off approach is adopted.
During labour, the contractions are known to cause a lot of pain to women. Hence, there arose a need for methods of coping with these contraction pains naturally to facilitate childbirth in the least painful manner possible. Women are encouraged to follow a natural coping mechanism whereby they follow patterns and certain rhythms during the contractions. The rhythms are unique to every woman and require concentration and slow breathing to achieve. Hence, when a woman wishes to achieve this rhythm, she must be able to fully concentrate. If perineal massaging is done during this moment, it is likely to throw her off and make her confused. Thus, a hands-off technique would be perfect in such a scenario as the midwife now plays a role focused on motivating the woman and giving her advice. This is difficult to achieve while using hands-on techniques.
In conclusion, perineal massages cause more harm than good and hands-off techniques should be adopted. For the safety and well-being of expectant women, these perineal massages need to be avoided. They are known to be very intrusive to a woman’s privacy and do not allow her to reach her comfort zone especially during labour. The risk of pain, discomfort and irritation is high while using the hands-on method due to the increased blood flow in the perineum. During labour, perineal massages may cause a power imbalance as the mother attempts to push put while the midwife pushes the perineum in. This imbalance may cause complications during childbirth. Another problem caused by the perineal massages is their longevity to be successful if it is of any benefit. They take a long time, usually done daily for up to six weeks, and their results are not certain. It means that the massages can be administered over a lengthy period and still fail to nurture any useful results. The perennial massages are not always effective in reducing the severity of tears. Research has shown that those who undergo hands-off techniques less likely to suffer from third-degree tears. The hands-on techniques also cause more pain to the mothers and maybe more expensive due to their side effects. These side effects include mental health issues like stress, depression and anxiety.
Studies have found out that the hands-off techniques are safer, cheaper and more effective in the long run. They facilitate relaxation and concentration during labour allowing the mother to achieve the desired rhythms. This also occurs with less pain to the mothers and less likelihood of tears to the perineum tissues. Therefore, it is advisable that midwives adopted the safer, cheaper, less intrusive and less painful method which is the hands-off technique in childbirth.