Sunday, October 5, 2008

Massage Your Way Through Childbirth

We all know that childbirth causes muscle stretching, lacerations, and pain. Studies show that women (and their partners) who massage the muscular area below the vagina (the perineum), experience less tears and need for episiotomy during childbirth. In addition, ice massage can help relieve labor pain, and can be easily learned by your partner.

Physicians often make cuts (episiotomy) when it appears that too much stretching during childbirth will result in injury. Minor tears happen but rarely cause long-term problems.

According to Michael M. Beckmann, MD, and Andrea J. Garrett of the QE2 Jubilee Hospital in Queensland, Australia, "Perineal massage during the last month of pregnancy undertaken by the woman or her partner for as little as once or twice a week reduced the likelihood of perineal trauma (mainly episiotomies) and ongoing perineal pain." The study was published online January 2006 in The Cochrane Database of Systematic Reviews.

In January, 2007 the Cochrane database again searched for information about the benefits of perineal massage before childbirth, concluding, “Antenatal perineal massage reduces the likelihood of perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain and is generally well accepted by women. As such, women should be made aware of the likely benefit of perineal massage and provided with information on how to massage.” It was found that women who practiced perineal massage experienced 15% fewer episiotomies. Both partners can be involved to make childbirth less traumatic, facilitating quicker recovery and maternal activity.

How is Perineal Massage Performed?

Begin the practice at 34 weeks gestation. Either the woman or her partner can provide the massage. The instructions provided by one of the studies are as follows:
"Woman or partner performed daily 5- to 10-minute perineal massage from 34 weeks [of pregnancy]. One or two fingers are introduced 5 centimeters [about 2 inches] into the vagina, applying alternating downward and sideward pressure using sweet almond oil."

Massage devices have not been studied, so their usefulness is unknown. To date, manual massage is recommended. According to speculation, perineal massage should work not only for first-time delivery, but for subsequent pregnancies as well. The women studied were experiencing their first pregnancy.

Ice Massage for Labor Pain

Ice massage of the web between the thumb and forefinger, referred to as Ll4, or Hoku, and has been found to help the pain of labor and delivery. Researchers studied twenty women who were being admitted to the labor and delivery unit at Humana Hospital, Dade City, FL, in 1992. Ice massage to the Hoku meridian was performed for thirty minutes during each contraction.

Pain reduction was found to be significant. The ice massage was carried out on either hand, depending on what activities were being performed by the recipient at the onset of contractions.

Of note, though the exact meridian, or massage point is on the inside of the thumb, the skin may be fragile and sensitive to cold. To facilitate pain reduction, and reduce the potential for skin damage, massage was performed by snugly placing a bag on the web between the thumb and forefinger, filled with crushed ice. The web space is thicker, and less prone to trauma. (1)

The technique can easily be taught to family members – a consideration for anyone who is expecting. The end result, as perceived by the massage recipients? – pain became one of discomfort versus distress.

Adding the benefits of each of these massage suggestions during childbirth can contribute to a healthier, happier experience. It involves both partners, and possibly avoids the administration of potentially harmful medications, and the need for episiotomy.


Ice Massage for the Reduction of Labor Pain
Massage Cuts Need for Episiotomies

(1)10/20/09 Addendum:
According to Bette Waters, when massaging the hand,

"If you approach the area from the top of the hand you will be massaging tissue that can be fragile to friction and cold. You approach the site from the inside of the palm where the ice and friction is applied to the tissue made of different skin cells, the massage can be done intermittently for several hours with no harm to the skin. In the research paper a graphic demonstrating this technique appears".

Bette Waters is a Certified Nurse-Midwife, and author of Massage During Pregnancy., and author of the above referenced article from Medscape - Ice Massage for the Reduction of Labor Pain. ◦