Mar 22, 2018
Preparing for Birth
Whether it’s your first pregnancy or your third as your due date approaches you begin to think more and more about what your labour is going to be like and if there is anything you can do to prepare…
AP: Dr. Sarah lea is a family doctor specializing in obstetrics and has specialized training in women’s health. She is also the mother of three children and therefore is a double expert in preparing perineums for delivery!!!
SL: That’s right Alicia/Dr. Power. I just had my third baby in November and the lead up to my delivery was actually the inspiration for this podcast. I have had difficult deliveries in the past so wanted to do everything I could in my power to prepare and make the labour as smooth as possible.
AP: That being said. Let’s dive in. I’m curious what you came across in your research.
SL: Well, the first think I wondered about was how best to prepare the perineum (do we define what this is?) to minimize the risk of tearing and the need for episiotomy (? Define) and stitches following delivery. I know this is on everyone’s mind regardless of whether it’s your first delivery or your third!
AP: For sure…I know a few recommendations out there include perineal massage before labour. What did you find out about that?
SL: Well Alicia, the literature out there shows that for women who had never given birth vaginally before reduced the likelihood of perineal trauma (mostly episiotomy) and ongoing perineal pain. The evidence wasn’t as clear for women who had had previous vaginal deliveries but on review of additional studies, although there is no clear benefit there is definitely no harm In doing so.
AP: That’s fantastic news! So perhaps we should be letting our patients know about the benefits of perineal massage and provide them with some information about how to perform perineal massage.
SL: Absolutely! There are some great resources available and perhaps we could post them on our Show Notes.
AP: So what else did you find? I’ve had some women ask me about shaving in preparation for labour and delivery as a means to reduce risk of infection. Is this something we should be recommending?
SL: Interesting you should ask! This is a common myth and misperception that many women have and believe it or not there are even studies about this! The general consensus from the literature is that there is no benefit to shaving or waxing. It doesn’t decrease the risk of infection, and can actually be associated with multiple side effects including irritation, itching/burning of the vulva.
AP: Now that you mention this I think I recall a colleague in another province saying they actually had a campaign a few years back called ‘Leave the hair down there’. Just like American Apparel did!
SL: You’re right. I’d say if a women gets regular bikini waxes there is no need for her to stop in pregnancy and around the time of delivery but I’d actually recommend against waxing and definitely tell patients if it’s not something they routinely do there is no need for them to get it done!!!
AP: Excellent. So so far, we would recommend perineal massage for preparation but no neeed to shave or wax.
SL: Yout got it! I’ve also had women ask me about enema or ‘bowel prep’ before labor. And this is an understandable question as this is something that was routinely done in the past.
AP: Enema – something I think most people wouldn’t look forward too.
SL: Agreed – and fortunately the evidence agrees too. No need for routine, or even ‘elective’ enema for that matter!
AP: Something I often have patients asking me is what they can do to help deliver on time and avoid going overdue. Some patients ask me about acupuncture. Do you have any thoughts about this?
SL: It just so happens I do! I have actually gone for acupuncture for cervical ripening in two of my previous pregnancies. I also took a look at the literature and it seems that there is a bit of evidence out there that acupuncture done by appropriately trained individuals MAY improve cervical readiness for labour, but the evidence is pretty weak. There hasn’t been a lot of safety data but what has been reported hasn’t show any harm.
AP: So it seems the limited research show so far no harm and possibly some improvement in cervical ripening?
SL: That’s right Alicia. In addition to acupuncture which I often discuss with patients I’ve had people ask me about castor oil.
AP: Ah yes, castor oil I understand it can bring labour on but can also bring on a whole host of undesirable side effects, like your doctor trying not to vomit on your vagina as I you are delivery your baby into a puddle of diarrhea…..
SL: You’re right there Alicia. And interestingly the evidence actually doesn’t show any benefit as there hasn’t been enough studies done but they have found that women reported more negative side effects including nausea and diarrhea. A few things you’d likely not want to experience before going into labour
AP: I’ve had two kids of my own so can definitely agree labour is hard enough without adding some GI upset in there. What about ‘membrane sweeping or as I like to say “The old stretch and sweep”? I think this is something most of us at GROW offer our patients after 38 weeks. Can you comment on how effective this can be?
SL: Absolutely. For those listeners who don’t know, a membrane sweep is when your doctor does a pelvic exam and passes a finger through the cervix and separates the amniotic sac or membranes from the uterus. There have been lots of studies looking into the effectiveness and it’s been show to reduce the duration of pregnancies going post-dates (beyond 41+ weeks), and therefore avoiding induction because you are overdue.
AP: That’s good to know since I know most of us offer this to patients. Did they say how many times it has to be done to be successful? Or if there were any negative side effects?
SL: I’m glad you asked. Membrane sweeping is safe and the most common side effects are bleeding and pain/cramping following the procedure, which you will also experience in early labour. And in terms of how many times, basically you need to do a membrane sweep on 8 patients to send one into spontaneous labour.
AP: I’d say that’s a pretty decent number given how many patients we see and offer this to.
SL: I agree, and it’s such a safe and low risk intervention that I think it’s reasonable to offer to all women as long as they are aware of the likelihood of going into labour and to expect to experience some bleeding and pain following.
AP: That’s what I do regularly in my practice, but good to know I’m following the evidence so I’ll keep it up!
SL: So Alicia, there is a lot more to talk about but I think we’ve covered a few key topics people would want to know about when preparing to push, wouldn’t you agree?
AP: I do! SO let’s review. First things first, we should start recommending perineal massage and will put some resources up on our show notes. Secondly, we’ll tell our patients no need to shave or go for a bikini wax and that doing so may actually increase their risk of infection and that they should ‘keep the hair down there’!
SL: Totally. Thirdly, if people are hoping to avoid going overdue we can offer our patients a membrane sweep at term to try to induce spontaneous labour and avoid women going overdue and we can also chat about using acupuncture and advise that although more studies need to be done there is some evidence of benefit when it comes to cervical ripening but that they should avoid castor oil as a means to induce labour!
AP: Well, this has been educational and informative for me and hopefully for our listeners.
SL: Me too! I really enjoyed doing the research for this and look forward to joining you to chat about another topic soon!
Alicia Power: Great! Keep on growing healthy!
Perineal Massage Info:
Pelvic Physio Victoria, BC: