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COPYRIGHT 2003 Midwifery Today, Inc.
Attending women in labour who give birth with intact perineums is something that midwives take great pride in. There have been many theories, tips and tricks for midwives to help women birth without injuring their perineums. Many of these practices have little basis in research and tend more to reflect regional and cultural trends. In fact, one large study from England comparing the effect of midwives taking a hands-on or hands-off approach at the point of birth showed no significant difference in rates of perineal tears (McCandlish, et al, 1998).
However, despite the lack of hard evidence, I still think it is important that we discuss and share our own experiences in limiting perineal damage. I often think there is a danger in "throwing out the baby with the bath water," so to speak, if we limit ourselves to considering conventional research only.
Preparation in Pregnancy
For me, limiting perineal damage starts in pregnancy and is related to nutrition, optimal foetal positioning and perineal massage.
The effects of nutrition on soft tissue are well documented; well-nourished women with an adequate vitamin C intake are more likely to have healthy tissue, which is, as a result, more supple.
Discussing with women ways that they can encourage their babies to rotate into an anterior position can help to reduce the rate of malpositions, particularly occipito-posterior positions (OP). Women giving birth to malpositioned babies are more likely to sustain perineal damage due to the wider diameters of the babies'...
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