Intact Perineum ~insight from a midwife
~insight from the dear Gloria Lemay~
An intact perineum is the goal of every birthing woman. Advising a
woman to do perineal massage in pregnancy implies a lack of confidence
that her tissues have been designed perfectly to give birth to her
infant. The intact perineum begins long before the day of the birth.
Sharing what the feeling of a baby's head stretching the tissues will
be like and warning the mother about the pitfalls in pushing will go a
long way to having a smooth passage for both baby and mother. The
woman will be receptive to conversations in prenatal visits about the
realities of the birth process. Here is the information I convey for
the second stage:
1. When you begin to feel like pushing it will be a bowel
movement-like feeling. We will not rush this part. You will tune into
your body and do the least bearing down possible. This will allow your
body to suffuse hormones to your perineum and make it very stretchy by
the time the baby's head is there.
2. The feeling will increase until it feels like you are splitting in
two and it's more than you can stand. This is normal, and no one has
ever split in two, so you won't be the first. Because you have been
educated that this is normal, you will relax and find this an
interesting and weird experience. You may have the thought, "(My
midwife) told me it would be like this, and she was so right. I guess
this has been going on since the beginning of humankind."
3. The next distinct feeling is a burning, pins-and-needles feeling at
the opening of the vagina. Many women describe this as a "ring of
fire." It is instinctive to slap your hand down on the now-bulging
vulva and try to control where the baby's head is starting to emerge.
This instinct should be followed. It seems to really help to have your
own hands there. Sometimes women like to have very hot cloths applied
to their perineum at this point. If you like or dislike the feeling,
4. Most women like pushing more than dilating. When you're pushing,
you feel like you're getting somewhere and that there really is a goal
for your efforts.
5. This is a time of great concentration and focus. Extraneous
conversation will not be allowed in the room. Once you begin feeling
the ring of fire, there is no need for hurry. You will be guided to
push as you feel like until the baby is crowning. All that will be
touching your tissues is the hot cloth and your own hands. It is
important for the practitioner to keep her hands off because the
blood-filled tissues can be easily bruised and weakened, which can
lead to tearing.
6. The point of full crowning is very intense and requires extreme
focus on the burning. It is a safe, healthy feeling but unlike
anything you have felt before.... Panting and rising above the pushing
urge will help you focus, and you will have less discomfort in the
7. You will be offered plain water throughout this phase because
hydration seems to be important when pushing. You can take the water
or leave it.
8. Once the head is fully born, you will feel a great sense of relief.
You will keep focused for the next sensation, which will bring the
baby's shoulders out and the baby's whole body will quickly emerge
after that with very little effort on your part. The baby will go up
onto your bare skin immediately, and it is the most ecstatic feeling
in the world. Your perineum may feel somewhat hot and tender in the
first hour after birth. The remedy that helps the most is to apply
very hot, wet cloths. This is in keeping with the Chinese medicine
theory that cold should never be applied to new mothers or babies.
Women report they feel instantly more comfortable when heat is
applied, and any swelling diminishes rapidly.
I also like to twist a diagonally folded bath towel into a very tight
roll and coil that into a ring for the woman to sit on when
-Gloria Lemay, "Midwife's Guide to an Intact Perineum," Midwifery
Today Issue 59