RE: [ozmidwifery] intact peri

[Mary Murphy]

Not so clear cut.  On the whole it means not directed, as many of the women I care for are on their knees in a water tub and I can’t see their perineum. I talk about this during their pregnancy and try to remind them to “go gently”.  I find that women who are free to move their body as they choose (water is great for this) are able to be in touch with what they need to do.  Does this mean hundreds of intact perineums?  No.  It means that sometimes there is a tear and sometimes not.  A hard question to get the right answer.  MM   A little off-topic – when you don’t do directed pushing you do not tell a woman when to push, but do you tell her when not to push? Or another way to put it – does directed pushing only include telling a woman when to push, or telling her when not to push as well?   Vedrana   From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Mary Murphy Sent: Monday, October 02, 2006 4:59 AM To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] intact peri   Hi Paivi, I cannot give you statistics of homebirth as I do not have immediate access to them. I will see if we have any stats on our service that I can access.  Just in general, the main way to protect the perineum is not to tell the woman to push, but to allow her to use her natural open glottis pushing, an keep hands off.  At home we do not do directed pushing.  I cannot speak for birth centres, but their philosophy is much the same.  Each midwife does different things, but it is not usual to use compresses or perineal massage during birth.  Is that what you have found Jan?  I wouldn’t put too much weight on the Bastian research as not all of us completed her surveys.  I personally have done 3 episiotomies in 24 yrs, but would do one if I thought necessary.  Hospital midwives will have to answer the one about epidurals.  MM   From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Päivi Sent: Monday, 2 October 2006 4:54 AM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] intact peri   Hi all,   I am writing an article on episiotomy. I need to know what is the % of intact perineum among homemidwifes or birth centres? This is when the mother is having a natural birth.   Does this change if the mother has an epidural and is having the baby in a hospital? What I mean is that how much can the hospital midwife do to save the perineum if the mother has opted for epidural? Is it still mainly to do with the skills of the midwife? Or is it a harder job with a medicated mom?   Do you all practise hot compresses, perineal massage with oil (during birth) / perineal support?   What is the % of intact peri in a waterbirth?   Many questions... Thank you for any ideas or comments.   Päivi