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Monday, June 23, 2008

Stretching For Damage Control? Think again.

My husband came up with a very good point about perineal manipulation during the pushing stage of labor. I was talking about how the doctors and residents, and even some nurses, can't seem to keep their hands out of a woman's vagina while she pushes. They stretch the tissues out, push posteriorly on the perineal muscles, and generally create a very swollen perineal and labial mess. I hate it. My own personal practice is very hands off and have had good results- only one second degree tear, and the rest were either intact, minor first degrees or "skidmarks" not requiring anything but time to heal.

So this is what he said, "Why don't we do that when we have to take a shit? You know, a big shit might come through your anus so maybe we should stretch it out a bit before we go just in case it could do damage." This was the cleaned up version.

Good point.... good point.


The Queen of Everything said...

I little anal lubricant might do some good, too!

Kimberley said...

I really like your comment on not stretching during the pushing phase. Some of the Docs I work with believe that if the baby is not born in four pushes they need a vacuum. Kim

Linz said...

My doctor did this on my last birth (third baby), even after repeatedly telling him not to. He kept telling me it was for my own good, that it would get the baby out sooner, etc. I was too tired to fight it out, and my birth support was oblivious to the fact that the doctor wasn't right to push that on me.

I think it gives doctors a feeling of being useful for the time that a mother is pushing and they aren't doing anything.

Needless to say, next time around will NOT be in a hospital with that doctor.

AtYourCervix said...

Ha! definitely gives some thought to the "perineal stretching".

Anonymous said...

Argh. The last nurse I had during my 6th birth (6th) did two things, she tried to stretch my cervix manually from 9 to 10, and then was pushing her finger toward my anus and running her finger around in there to stretch me. She would keep her finger in between two contractions. I had an OP baby but she didn't know it at the time, and all I could think was that I was flat on my back and the earlier decel was when I was flat on my back. She would keep that finger in there and my contractions seemed to slow up...and it seemed like an eternity that my lower half was open to the world, she was sitting on the foot of the unbroken bed, and she had me in such a compromised position. I did tell her it hurt. She kept doing it. I do not know how many contraction pairs she did this through, but I know I felt very violated. I had conflict with this nurse, but after my initial disputing with her, I gave in and quit feeling guilty for fighting. It's been nine months, and in thinking about it I still get a lump in my throat. I wish I had yelled at her to get her hand OUT of my vagina. I didn't need to be stretched for my 6th born baby. All her work was for nothing, I pushed my baby out in the caul on my left side after the OB finally (five hours later) had asked that they allow me to squat and move because the baby was OP. I had been begging to get up and move around the entire day, and birthed my baby ten minutes after the OB had me moving because baby finally turned. I am so blessed that I didn't end up with a c-section for pushing at 9 cm and swelling (she had me do this against doctor's orders to have me labor down).

Keep your little fingers out of my vagina. I am gong to be so annoying, but if I get another chance to birth and I am in a hospital, I will not allow internal exams unless I feel there may be no progress, and it will take a great deal of trust for me to allow the nurse to do it.


Amy said...

My midwife did some perineal stretching (I think!) and I still had 2nd degree tears. I thought it was a good thing to do, until I read this post. Makes sense.

nadahfmidwife said...

I agree 100%; I have seen the perennial tissues become quite irritated by stretching and friction. I work in a freestanding birth center and see some midwives who still partake in this ritual. It’s been my experience that it does more harm than good.
Keeping fingers in the women’s vagina makes my skin crawl, it has a certain vulgarity to it that makes me want to vomit on the perpetrator.

Hilary said...

I think the same thing applies to a cervical lip. I think "rubbing it out" does more harm than good.

Anonymous said...

i definitely love the warm compresses compared to stretching. hell i didn't even do perineal massage in the month preceding birth, and birthed my second baby 9lbs 5 oz with only two bruises that didn't hurt until 3-4 days after the birth! (my first was 7lbs 10oz and I had two skid marks at the top of my vagina, but that's it...)

As my midwife told me, perineal massage (stretching) during the birth inflames the skin and prevents it from properly stretching to allow baby's head through.

mommasara said...

I'm a birth doula and that has happened at every birth I've seen so far, bar one! I always leave so traumatized!