Different techniques have been used for a long time to avoid perineal tears that occur during childbirth. One of these strategies, quite aggressive, is the episiotomy, which for a long time has been considered a lesser evil, since it was argued that with a "rajita" provoked a great tear was avoided.
The problem with episiotomy is that practically all the women who were going to give birth were practicedWhen the tear did not affect such a high percentage and, what is worse, many times the episiotomy was greater than the possible tear and its healing was also more complicated.
Given this evidence it has become necessary to know what other techniques can be carried out to try to avoid tears during childbirth. We'll see now what professionals can do at the time of expulsion to prevent trauma to the perineum (or to minimize them) and we will explain what scientific evidence there is about it.
Perineal massage
He perineal massage It is a technique that is performed during the expulsion, in which the perineum is touched and massaged with the intention of making it more elastic and warming the area a little.
Studies in this regard, comparing women who underwent perineal massage during childbirth with women who were not done, show that there are no significant differences in intact perineal rates, in tears of different degrees or episiotomies, nor are there differences in vaginal pain at 3 days, 10 days and 3 months.
It is not recommended to do something during childbirth that does not seem to have any effect, so perineal massage is not recommended. If some mothers ask about the perineal massage that is recommended during pregnancy, precisely to prepare the perineum, say that, in the absence of evidence, each mother does what she considers best.
I personally see it positive and would even add to the rosehip massage, which probably helps the skin to have a greater degree of elasticity. If you do not opt for this solution, making love is usually a good perineal exercise, they say (but I have no evidence that either of them works for anything).
Apply hot compresses during labor to avoid tears
The theory says that things, when they are a little hot, work better (not all, of course). If we think of our body, the muscles work better when they are a little "hot" and the immune system, for example, also works better when it is hot (what we commonly call "fever"). Well, it is believed that applying hot compresses on the perineum will help prevent trauma and the reality is that it seems that something does help.
Although there are studies that show no difference between applying or not hot compresses, there are some that show that with its application the risk of third and fourth degree lacerations is reduced (the most severe), but not perineal suture rates. That is, it seems that women tear the same, but there is a tendency to suffer smaller tears if hot compresses are applied.
In addition, it has been seen that with compresses the pain decreases during childbirth and in the first 3 days after giving birth, and can also reduce the risk of urinary incontinence in the first 3 months postpartum.
Active protection of the perineum controlling head output
One of the most used and known techniques when giving birth, by professionals, is to try to protect the perineum, simply holding it a little when the head is coming out and controlling that moment a little so that the baby Do not leave too hard and injure the perineum.
This technique has had many detractors to date who believe that the ideal is not to touch the area or the baby's head and simply have your hands ready in case you need to intervene.
Comparing a group of women whose perineum is protected and controlling the baby's exit with another who does not do this, it is observed that the former have less pain ten days after delivery and have more episiotomies. The overall perineal trauma rate is similar in the two groups, so it is understood that more tears occur in the second group.
Another study shows that manually protect the perineum and control the output of the baby's head decreases the number of anal sphincter tears, so the recommendation in this regard is to perform this maneuver, also asking the woman not to push.
Application of local anesthetic in the perione area
Another of the possible interventions that professionals can carry out to try to avoid pain and trauma in the perineal area is that of apply local anesthesia spray. Studies that exist in this regard say that the application of spray lidocaine does not reduce perineal pain, so it is not recommended to use it.
Concluding
Ultimately, of the four most common maneuvers that are performed to try to avoid episiotomies or tears and to take care of the perineum of women as much as possible, two of them could help: the use of hot packs during the second stage of labor and protect the perineal area manually, controlling the baby's head output.
On the other hand, the use of anesthetic sprays and perineal massage at the time of giving birth do not seem to do anything, so given this evidence, it is better not to do these techniques.
