PERINEAL STRETCHING PERINEAL MASSAGE

IS there evidence to support Perineal Massage – Stretching? Cochrane Review 2013 supports and recommends perineal stretching – perineal massage for women to do in the last weeks or pregnancy to reduce trauma to the pelvic floor and perineum,. There is no evidence to show it prevents severe tearing but you need to remember that severe tears are relatively rare and when they do occur it is generally because of a quick or rushed delivery. This 2013 review supports a number of previous studies.

Other aspects to consider are: Many women feel it is helpful in giving themselves time to connect with this part of their body in a way that is neither sexual nor associated to going to the toilet - usually the only times that any attention at all is given to the perineum. Many women have acknowledged the benefit of creating a body memory,or becoming familiar with the sensation of the perineum stretching and burning, as a useful exercise to help them deal with the pushing stage of their labour.

Our thoughts...We believe there can be emotional and physical benefits from perineal massage- stretching. If you wish to practise perineal massage you can lay down a body memory that reduces your fear and helps you relax into the stretching sensation, and may assist through the pushing stage of labour

PERINEAL MASSAGE STRETCHING METHOD There is no evidence to show that Epi no is superior to manual techniques. You and your healthcare providers should explore both methods and decide which will work best for you and your partner. Considerations:  I can easily reach my perineum  Cost is a concerns  My partner is able to assist me with stretching  Can assist with Pelvic Floor Muscle training Post partum  I have been an elite gymnast, trampolinist, horseback rider, figure skaters, dancer, or synchronized swimmer  I have had persistent pelvic pain  I have had previous pelvic injury

WHEN SHOULD I BEGIN? Start at 3-5 weeks before your due date. Daily is best but at least everyother day .

HOW MUCH TIME WILL PERINEAL STRETCHING _ MASSAGE TAKE? 10 minutes:

WHAT PREPARATION IS REQUIRED? Wash your hands well, and keep your fingernails short.

Use a good lubricant such as , oil, or good water solube lubricant such as sliquid. on your hands or Epi no. DO NTO USE baby oil, , or

Location will depend on method but ensure you can relax and are comfortable. !/2 sitting may use pillows to support back or use bathtub lined with blankets. . Laying on side use bolster or rolled pillows ( duct taped) in pillowcase to support upper leg

. A) Side ly Reach behind and use index or middle finger just inside of vagina Practice your Pelvic floor contraction- feel tightening then relax and full relaxation ( full relaxation may cause a bladder urge). Pull fingers down toward anus and toward upper sitting bone . Hold each stretch for 1 minute at limit of stretch burning pain-. You may find it helpful to contract pelvic floor then perform stretch after full relaxation. Repeat 2-3 times for each direction. Finish with scooping from bottom of vagina towards sitting bone. You will need to change from to other side to stretch other side.

B) Place your thumbs just inside your vagina (see figure). Press down (toward the anus) and to the sides until you feel a slight burning, stretching sensation. Hold that position for 1 minute. With your thumbs, slowly massage the lower part of the vagina using a “U” shaped movement. Concentraten relaxing your muscles. This is a good time to practice slow, deep breathing techniques.

C) Partners: If your partner is doing the perineal massage, follow the same basic instructions, above. However, yourpartner should use his or her index fingers to do the massage . The same side-to-side,U- shaped, downward pressure method should be used. Good communication is important— be sure to tell yourpartner if you have too much pain or burning!

EPI NO FOLLOW INSTRUCTIONS IN PACKAGE Insert the lubricated EPI-NO balloon 2/3rds into the vagina. Gently contract and relax your muscles against the balloon, which provides resistance. Slowly inflate the EPI-NO balloon to the point of stretching and comfort. Each day you will inflate and stretch more. There is no risk to your baby. After the stretching phase relax your pelvic floor muscles and allow the inflated EPI·NO balloon to gently expel itself from the vagina. This will familiarise you with the sensation of delivering the baby’s head. TIPS The balloon often slips out of the vagina: The best idea to avoid this is Roll up a folded towel, so that it forms a 12 cm (3inch) diameter-roll and put between your thighs. If you now start pumping up the epi-no it will stay in the vagina very comfortably. Releasing the thighs little by little, the balloon will glide out softly. Best training: Start by inflating the balloon only enough to make it stiff enough to insert. Insert it 3/4 of the way, and do not blow it up more. Practice a few pelvic floor contractions and releases and watch the needle of the manometer. You want to know that you raise the needle when you contract your muscles and are able to completely relax your pelvic floor when you relax the muscles, and see the needle back to starting point. This is important because you want to build muscles memory that relaxes your pelvic floor while the head is crowning. After a few minutes of this, you pull out the balloon a little so that only half (1/2) is inside. Begin to inflate the balloon, (now you are not looking at the manometer as it does not play a part in the stretching exercises) and you inflate until you reach a low level of discomfort. You should not have pain, just a feeling of maximum stretching. Now you either hold it with your other hand or lay on your side and legs are bent and you hold it in with your upper foot or calf of leg. Try to stay like that for 5 minutes. You must hold it in because the balloon wants to jump out and you invest effort in keeping it in. If you feel comfortable your partner can assist you by holding the balloon. Repeat the stretching if the balloon jumped out. After ten minutes you stop holding it in, and. allow the inflated EPI-NO balloon to gently expel itself from the vagina by either relaxing your pelvic floor muscles or by gently pushing it out. This will familiarize you with the sensation of delivering the baby's head.Then you measure how big the diameter is by putting it against the graph template in the instructions booklet. …