Showing posts with label perineal care. Show all posts
Showing posts with label perineal care. Show all posts

Friday, March 18, 2011

You want to stick that WHERE?!?

Some things you wouldn't believe were true, except they are.

Like the story of my birth. My mom had a straightforward unmedicated delivery of my older sister in Washington state with a supportive nurse who coached her through the process. When she was pregnant with me and living in Rochester, MN (home of the Mayo Clinic), she assumed that the next birth would be much the same.

So she was astonished when she found herself upside down during my birth. Literally. Her doctor had a theory that giving birth upside-down would prevent hemorrhoids. He hung my mother by her ankles from the ceiling, with only her shoulder blades touching the bed. Without her permission. She was screaming to be let down, to no avail. I made my entrance into the world in a rather unconventional fashion.

To top it off, she has never had hemorrhoids with any of her five children, no matter what position she gave birth in.

But that was a generation ago, you're thinking. Surely we're more enlightened now.

Remember the BirthTrack?




Oh yeah. Well, but...

How about the Hem-Avert Perianal Stablizer Device? This FDA-approved medical device, which one commenter on At Your Cervix described as "something that belongs in the S&M section of a sex store, not in L&D," is supposed to prevent hemorrhoids due to childbirth.

Looks really comfortable!

Then there's the Materna medical device that is supposed to prevent tears by stretching the vagina for 1-2 hours before the baby is born.
Yes, that's right: instead of feeling the "ring of fire" for just a few minutes as your baby's head is emerging, you get to enjoy hours of that pleasant sensation!

Please hop on over and complete the survey about the Materna. Here's an excerpt from page 3:

It is has been shown [argh! bad grammar!] that 8 out of 10 women will have some degree of tearing during childbirth. These tears can range from from small vaginal tears, to tears that extend from the vagina all the way through the anus. Additionally, there can be invisible damage to your pelvic muscles which can lead to consequences later in life. Short term consequences include infection, extended pain, and longer recovery times. Long-term consequences may include pelvic organ prolapse, loss of urinary and fecal control, and potential sexual dysfunction.

Materna has developed a device that may be able to decrease some of the pelvic damage and the resulting complications that can arise as a result of childbirth. The device is a semi-automated mechanical vaginal dilator similar in design to a standard obstetrician’s speculum.

The soft, blue portion is inserted into the vagina after you arrive at the hospital or birthing center in labor, and will require 1-2 hours of dilation time before delivery. A medical provider will control the expansion of the device, which will gradually stretch the vaginal tissue during labor. The device can be easily removed at any time, and will pose no harm to the baby.

By dilating the vagina over 1-2 hours instead of the rapid dilation which normally occurs during childbirth, perhaps some of the pelvic damage can be prevented. The idea is similar to an athlete stretching muscles before a workout to increase flexibility and prevent injury. The device will be removed before you deliver, and should never come in contact with your baby.
Both Navelgazing Midwife and Dou-la-la have comment on the Materna. Go read their posts for a good laugh.

Then finally, there's the Cervo-Check. It's a prototype device that goes inside the vagina to detect early signs of pre-term labor.

L&D nurse & student nurse-midwife blogger At Your Cervix commented:
1. Painful and huge
2. You want to stick that where???
3. Will in fact irritate the cervix more. Hello - manual stimulation to the cervix/a device touching the cervix is going to trigger more prostaglandin release --& contractions!
Seriously, my bottom hurts just thinking about all these devices. Clips on my cervix, inflatable dildo in my vagina, plastic V pushing against my rectum...SIGN ME UP!

Not. 
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Sunday, February 27, 2011

Supporting your own perineum

A blog reader recently asked a question about supporting your own perineum:
Reading the post regarding birth plans, I came across the part where you say "I catch my own babies and support my own perineum" and it confused me a little bit.  I am not a mother, never given birth.  I have witnessed a few births but I still have the question... What do you mean when you say you support your own perineum?  Can you explain to me exactly how you support it?  If this is too personal of a question, sorry!  I am just unfamiliar with this and would like to know what it is for future knowledge.  My husband and I are trying for our first and I have to say that I am scared of the birthing process.  Mainly because I am scared that I would tear.  So you mentioning this peaked my interest.
First, I should clarify that what I do is provide gentle counter-pressure against the baby's head wherever I feel too much burning/stinging, rather than touch or support the actual perineum.

Let me quote from Dio's birth story to illustrate:
The baby’s head descended rapidly. When I felt it hit my perineum, I slapped my right hand down to support my tissues while maintaining a death grip on Eric’s arm with my left hand. As I was doing this, this passage from Gloria Lemay’s article Midwife’s Guide to an Intact Perineum flashed through my mind: "The next distinct feeling is a burning, pins-and-needles feeling at the opening of the vagina. Many women describe this as a 'ring of fire' all around the vaginal opening. It is instinctive to slap your hand down on the now-bulging vulva and try to control where the baby’s head is starting to emerge. This instinct should be followed. It seems to really help to have your own hands there."
...With each contraction, the head emerged more and more. I applied counterpressure to the head, varying the pressure between the front and back depending on where I felt more pressure and stinging. As much as crowning, and pushing in general, was wild and crazy and painful, it was amazingly cool to once again support my baby’s head as it emerged out of my body. There’s nothing like feeling your baby’s head come out, bit by bit, into the palm of your hand. Every woman deserves that experience.
Providing your own counter-pressure or perineal support isn't a fancy technique; it's a matter of following your body's cues. You cup your hand over the baby's head once it starts crowning and apply counter-pressure wherever it feels best to do so. Sometimes it will be in back towards the perineum; other times in front near the urethra/clitoris.

During Zari's birth, she seemed to take forever to be born. On the other hand, during Dio's birth I was doing everything I could to slow the pushing stage down. So the counter-pressure was especially useful for Dio's much faster pushing stage (20 minutes versus 2 hours).

If you want to do your own perineal support/counter-pressure, make sure those attending the birth know this and are prepared for it. Every provider has their own habitual practices--some routinely massage and stretch the perineum, others provide counter-pressure, others keep their hands off entirely. Be very clear that you want no one touching you or the baby as it is crowning and that you will be putting your hands on the baby's head instead.

It also helps to be in the right birth position so you can easily reach the baby's head. Variations on a low kneel or crouch work especially well.
"frog squat" from Sage Beginnings

A low kneel from Laura Shanley's Bornfree site

Sitting on the toilet also works; I did this while Zari's head crowned and emerged, then went down to a half-kneel/half-squat on the floor for the birth of her body.

I'd love links to photos or videos of women doing their own perineal support/counter-pressure!
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Wednesday, July 16, 2008

4th degree tears and forced cesareans

I think I've linked to the At Your Cervix blog before, but I wanted to mention it again. She is a L&D nurse and recently met a woman who, after two 4th degree lacerations (thanks, most likely, to her episiotomies), was coerced into having a cesarean section. Read more about it here. I have heard of women threatened with court-ordered cesareans for other reasons, but never because of a history of 4th degree tears.
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Saturday, February 23, 2008

The perineum

The topic for today is perineums (perinea?). Let's start by reading Sara Wickham's classic articles Perineal pampering - before, during and after birth and Is prevention always the best cure?

There's a great visual example of an upright birth with no one messing around with the perineum from Sage Femme. (It begins after the 3rd or 4th slide and is definitely not work appropriate. Unless, of course, you are a midwife, doula, or childbirth educator!)

So, let's talk perineums!

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