Re: [ozmidwifery] intact peri

[suzi and brett]

Hi Paivi,    Heres some bits from a lit review i did:   There is no evidence to support perineal massage in birth to assist intact peri -     Stamp, G., Kruzins, G. & Crowther, C. 2001, ‘Perineal massage in labour and prevention of perineal trauma: randomised controlled trial’, British Medical Journal , vol. 322, no. 7297, pp. 1277-1280.   Renfrew, M., Hannah, W., Albers, L. & Floyd, B. 1998  ‘Practices that minimize trauma to the genital tract in childbirth: a systematic review of the literature’, Birth, vol. 25, no. 3, pp. 143-160.   I have seen in hospital perineums become very swollen after much streaching and pulling by midwives - who are trying to encourage thining but it seems to do the opposite  - turned me off touching very early in my still early career and prompted me to check the research around the practice.     But antenatal massage is supported by recent large RCT ( Labrecque) and some other smaller studies   Labrecque, M., Eason, E., Marcoux, S., Lemieux, F.,  Pinault, J.,  Feldman, P. &  Laperriere, L. 1999, ‘Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy’,  American Journal of Obstetrics and Gynaecology, [Online], vol. 180, no.3,  pp. 593-600, Available: Ovid/[EMAIL PROTECTED] [11 March 2004].     So don't throw the baby out with the bath water!  (not sure how that translates in Finish) - not all peri massage is useless.       In 1998, Renfrew et al. conducted a systematic review of the literature to help define the knowledge on reduction of genital tract trauma. They concluded that antenatal perineal massage along with maternal position and method of pushing, ‘warranted further study’ (Renfrew et al. 1998, p. 143). Similarly a retrospective descriptive study (Davidson, Jacoby & Brown, 2000) looked at 13 variables associated with the rates of perineal lacerations (n=368). These included maternal position in labour, maternal age, parity, length of second stage and perineal massage. They found that the only factors that individually affected the extent of trauma were parity and antenatal perineal massage.   Renfrew, M., Hannah, W., Albers, L. & Floyd, B. 1998  ‘Practices that minimize trauma to the genital tract in childbirth: a systematic review of the literature’, Birth, vol. 25, no. 3, pp. 143-160.   Davidson, K., Jacoby, S. & Brown, M. 2000,  ‘Prenatal perineal massage: preventing lacerations during delivery’, Journal of Obstetric, Gynecologic, and Neonatal Nursing [Online], vol. 29, no. 5, pp 474-479. Available: Ovid/[EMAIL PROTECTED] [11 March 2004].       I know this only answers some of your question but it may help...suzi   PS. i know there maybe no studies to support it & maybe not purist hands off  - but i have found in both practice and on myself in labour - a warm wet pad compress around the anal area (but so peri is still visible)  is supportive and gives great comfort to those with haemorrhoids  -  i talk to women and if they like it i do it.