El masaje perineal, una técnica fisioterápica para prevenir el trauma perineal en el parto

por | Oct 23, 2017 | parto | 9.235 Comentarios

Algunas matronas masajean el periné de la madre en el segundo estadio del embarazo para ayudar a aumentar el estiramiento de la piel y los músculos y de este modo prevenir los desgarros y la episiotomía. Las abuelas, en algunas culturas del Este de Europa, también animaban a sus hijas y sus nueras a practicar esta simple  técnica de estiramiento durante el embarazo. La idea de que es posible preparar el periné para el nacimiento, puede llevarse a cabo durante las clases de preparación al parto; con el objetivo de parir con un periné intacto.

Esta técnica puede ser usada por las propias mujeres, recostándose  en una posición confortable, o poniéndose de cuclillas. Otra alternativa, que algunas mujeres prefieren, es que sus parejas les apliquen el masaje. Se puede usar un aceite natural (oliva, germen de trigo, girasol, etc.). Ambos dedos índice o pulgares, o los dedos índice y medio de una mano, se introducen unos 5 cm en la vagina.  Se realiza una “U” rítmica o movimiento de tipo deslizamiento hacia arriba y a lo largo de los lados de la vagina, ejerciendo poca presión, estirando el periné de lado a lado. Se mantiene un estiramiento de los lados de la vagina durante unos segundos y gradualmente se va aumentando a 30-40 segundos. Esto puede preparar a la mujer para la sensación que va  a tener cuando la cabeza de su bebé empiece a coronar. Conforme la elasticidad vaya mejorando, se sugiere que se usen tres o cuatro dedos. Como alternativa, puede realizarse un movimiento de “amasar” entre el dedo índice y el pulgar. Si la mujer contrae el periné durante una sesión de masaje perineal se dará cuenta de lo difícil que será para sus tejidos estirarse si ella mantiene la tensión mientras la cabeza de su bebé está coronando. Esto refuerza la idea de la necesidad de relajar el periné durante el parto.

Mantle et al. (2004) referencian  un artículo de Avery & Van Arsdale (1987), en el que  dos matronas americanas evaluaron los efectos del Masaje perineal (o Masaje de suelo pélvico) en 55 mujeres (29 experimentales y 26 controles). El Masaje perineal empezó a realizarse 6 semanas antes de la fecha del parto. En el grupo experimental, en el 52% de los casos, su periné estaba intacto o presentaba un primer grado de desgarro tras el parto; al 48% se les realizó  episiotomía o padecieron segundo grado de desgarro, tercer o cuarto grado de desgarro, o ambos. En el grupo control, tras el alumbramiento, el 24% obtuvo un periné intacto o primer grado de desgarro, y al 76% se les realizó la episiotomía o sufrieron un desgarro de segundo grado, tercer o cuarto grado de desgarro, o ambos. Cuando se examinó la tasa de episiotomía, vieron que en el grupo experimental se realizaron aproximadamente la mitad de episiotomías que en el grupo control. Los desgarros de tercer y cuarto grado sólo sucedían cuando la episiotomía se llevaba a cabo.

Algunas mujeres comunicaron que se sintieron incómodas e interrumpieron el masaje; también manifestaron que se requería tiempo para llevarlo a cabo, aunque el tiempo que se recomendó fue de 5 a 10 minutos al día. Sin embargo, otras participantes del estudio se dieron cuenta del gran aumento de elasticidad a las 2-3 semanas de practicar el masaje perineal y manifestaron que la elasticidad de la musculatura perineal se mantuvo tiempo hasta el día del parto.

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