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O parto normal no Brasil não é nada normal. Cheio de intervenções e procedimentos que são uma verdadeira violência contra as mulheres. Este tipo de parto deixa marcas, não só no períneo, mas principalmente na psique feminina, perpetuando o terrível imaginário sobre a prática do parto “normal”.
A verdade é que existem poucos médicos que verdadeiramente sabem deixar a mulher se conduzir a um parto natural, sem as intervenções e a terrível prática da episiotomia.
Segundo a médica Ginecologista, Obstetra e Parteira, Melânia Amorim, a episiotomia consiste numa incisão do períneo (parte de pele, músculos etc. entre a vagina e o ânus) para ampliar o canal de parto e sua prática foi historicamente introduzida no século XVIII por uma parteira irlandesa para ajudar o desprendimento do bebê em partos difíceis.” Embora não tenha ganhado popularidade no século XIX, o procedimento tornou-se disseminado no século XX em diversos países, sobretudo nos Estados Unidos da América e países latino-americanos, entre eles o Brasil. Foi nesta época em que a percepção do nascimento como um processo normal requerendo o mínimo de intervenção foi substituído pelo conceito do parto como um processo patológico, requerendo manipulações médicas para prevenir lesões em mãe e bebês”, afirma a médica em seu artigo (clique aqui para ler na íntegra).
Daí por diante a episiotomia se difundiu e obstetras famosos de meados de 1920 sugeriam que a incisão perineal, juntamente com o fórceps fossem utilizados em todos os partos de mulheres que estivessem parindo pela primeira vez (primípiras). O objetivo de tal recomendação visava reduzir a probabilidade de lacerações perineais graves e o risco de trauma fetal.
Sabemos que o dominó de intervenções é o grande vilão das lacerações graves no parto normal. Afinal, uma posição de cócoras aumenta em 30% a abertura do canal vaginal; não fazer força na hora do expulsivo (ato impossível quando a mulher está anestesiada) e a massagem do períneo ajudam a reduzir o risco das lesões mais graves.
Melânia diz que alguns autores mencionam que a prática da episiotomia aumentou consideravelmente a partir da década de 1950 porque muitos médicos acreditavam que sua realização reduzia significativamente o período expulsivo, o que lhes permitia atender rapidamente a grande demanda de partos hospitalares.
A laceração é um rompimento orgânico dos músculos perineais para permitir a passagem do bebê. Por respeitar o desenho natural do tecido a recuperação do mesmo é muito mais rápida e os traumas infinitamente menores se comparados com uma episiotomia.
A adoção de posições que facilitem a abertura vaginal, a ausência de manobras e procedimentos médicos ajudam a reduzir o risco de lacerações que acontecem em primeiro grau (envolve a fúrcula, a pele perineal e a membrana mucosa vaginal), segundo grau (envolve a fáscia e o músculo do corpo perineal), terceiro e quarto graus, ( que envolve o esfíncter anal e a mucosa retal, respectivamente) estas últimas bem mais raras em partos naturais.
Em minhas conversas neste mundo mamífero vejo relatos de mulheres que disseram que suas episios demoraram bem mais para cicatrizar (comparado com as mulheres que tiveram laceração) e as dores durante as relações sexuais continuaram, mesmo tendo passado mais de 3 meses.
Se mesmo uma laceração de grau mais elevado é melhor que uma episiotomia, porque os obstetras continuam usando como rotina?
Bem, a resposta imediata que me vem é que é muito mais fácil costurar a linha reta da episio do que as curvas de uma laceração. Outro ponto que em um evento sobre períneo íntegro, em um dos Hospitais com as maiores taxas de cesárea e práticas médicas ultrapassada, é que uma mudança de comportamento leva anos para ser disseminada no meio médico.
A discussão, na verdade, ganha uma esfera mais ampla. No país com uma das maiores taxas de cesariana do mundo , conseguir um parto normal é uma raridade e pode ser muito traumático, nos moldes intervencionistas. Eu não vejo outro caminho senão lutar por um parto natural humanizado, negando a episiotomia, os velhos conhecimentos médicos e buscando um caminho natural.
Mulheres que fazem a massagem perineal têm grande redução no risco de lacerações. A técnica é usada para ajudar no alongamento/flexibilidade e preparar a pele do períneo para o parto. Essa massagem não vai apenas preparar o tecido do seu corpo, mas vai também é um uma fonte de conhecimento sobre as sensações do parto e como controlar esses poderosos músculos. Durante o expulsivo, o períneo deve se manter relaxado.
- Encontre um lugar onde se possa sentar e estar sozinha, ou com seu parceiro, ininterruptamente.
- Tente ver seu períneo com ajuda de um espelho, note como ele é. Nem sempre será necessário um espelho para essa tarefa!
- Pode usar compressas com toalhas mornas no períneo por 10 minutos, ou tomar um banho morno (de banheira, assento, ou chuveiro, em último caso), caso precise relaxar.
- Lave as suas mãos e peça ao seu companheiro para fazê-lo também, caso ele a ajude nas massagens.
- Lubrifique seus dedos polegares e o períneo. Você pode usar muitos tipos de lubrificantes: Gel Lubrificante Íntimo (encontrado nos hipermercados e farmácias), KY Gel®, óleo de vitamina E, óleo vegetal puro (óleo de semente de uva é uma boa indicação!), etc. Para quem tem candidíase recomendo óleo de coco com uma gota de melaleuca TeaThree.
- Coloque seus dedos polegares um pouco dentro de sua vagina, empurre-os para baixo e pressione para os lados. Deve sentir um leve estiramento, formigamento, ou uma leve queimação, mas nada que seja dolorido. Mantenha esse movimento por 2 minutos ou até que região fique levemente adormecida.
- Se sofreu uma episiotomia ou lacerações prévias, preste especial atenção ao tecido de cicatrização que, geralmente, não é tão elástico e é onde a massagem deve ser feita mais intensamente, com cuidado.
- Massageie em volta e por dentro da região mais externa da vagina e seus tecidos, onde ela se abre, e mantenha sempre a lubrificação.
Use seus polegares para puxar um pouco os tecidos, forçando-os a abrirem-se, imagine como seria se a cabeça do seu bebé estivesse
- fazendo esse movimento na hora do parto.
Se seu parceiro estiver fazendo a massagem, pode ser muito útil que ele use os polegares. A sensação pode ser mais bem percebida por você, mas não deixe de guiá-lo com suas sensações para que ele saiba qual a pressão que deve utilizar. Nesta massagem, quando ela está sendo feita pelas primeiras vezes, é comum que seja possível usar somente um dedo, até que a musculatura seja trabalhada e possa ser estendida.
Cuidados:
1. Evite mexer no ou abrir o orifício da uretra (logo acima da vagina) para evitar infecções urinárias.
2. Não faça massagens no períneo se você tiver lesões ativas de herpes (isso pode causar o aumento da área das lesões).
3. Pode começar essas massagens em torno da 34a semana de gravidez. Se já passou da 34a semana e ainda não começou, não desista! A massagem pode trazer-lhe benefícios ainda assim. Pode fazê-la pelo menos uma vez por dia.
4. Lembre-se que a massagem sozinha não vai proteger seu períneo, mas ela é parte de um grande esquema. Escolher uma posição vertical para parir (de cócoras, de joelhos, sentada etc.) favorece a distribuição de pressão no períneo. Se escolher parir deitada de lado, isso também reduz muito a pressão no períneo. Deitada de costas, totalmente na horizontal, é a posição para parir em que há mais chances de se provocar lacerações e necessidade de episiotomia.
Você passou por uma episio? Como foi a experiência? Teve laceração no parto? De qual grau e a que atribui? Teve um parto sem laceração? O que garantiu o sucesso. Sua experiência pode ajudar outras mulheres a optarem por um parto natural.
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