Fiddling with the perineum
Swollen perineum
The caregiver - Hands on or off?
There was a recent study done in the UK evaluating the traditional 'hands on the head' of the baby by the caregiver as the baby is being born, with a 'hands poised' position and no actual contact with the baby's head. The outcomes were very similar as far as tearing goes, the episiotomy rate was significantly less in the hands poised group, but that the women's perception of perineal pain in the days following was a little higher if the head was not controlled.
Fiddling with the perineum
Some caregivers massage or stretch up the perineum in the last 20 minutes to half an hour of the second stage for first time mothers. Usually from the time when the baby's head can first be seen to when their head actually emerges. It has been suggested that 'fiddling with the perineum' as it were, for long periods of time can make the tissues swell and then be less able to stretch effectively.
Swollen perineum
If the perineum is swollen, it is less able to thin out and stretch adequately and more likely to tear. This can be the case if the woman is pushing for a long period of time, especially in a squatting or birth stool position, if the caregiver or support people are manipulating or massaging the perineum excessively or if local anaesthetic is injected into the perineum 'just in case' an
episiotomy is needed.
Updated June 2008