Guide to an Intact Perineum

Midwife’s Guide to an
Intact Perineum *
by Gloria Lemay

An intact perineum is the goal of every birthing woman. We love to have whole, healthy female genitalia. Many people consider the health of the vagina/perineum to be a matter of chance, luck or being at the mercy of the circumstances of the forces that prevail at the time of the birth.

Folklore abounds about doing perineal massage prenatally. No other species of mammal does this. 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 open and receptive to conversations in prenatal visits about the realities of the birth process. Here, in point form, is the information I convey for the second stage (pushing):

1. When you begin to feel like pushing it will be a bowel-movement-like feeling in your bum. We will not rush this part. You will tune in to 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 stretching it.

2. The feeling in your bum 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, “Gloria 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” all around the vaginal opening. 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 face cloths applied to their perineum at this point. If you like the feeling of this, say so, and if you don’t, say so. We will do whatever you feel like.

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 for you. Extraneous conversation will not be allowed in the room. Everyone will be silent and respectful in between sensations while you regather your focus. 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 (the biggest part of the back top of the head is visible). All that will be touching your tissues is the hot face cloth and your own hands. It is important for the practitioner to keep their hands off because the blood-filled tissues can be easily bruised and weakened by poking, external fingers. This can lead to tearing. We will use a plastic mirror and a flashlight to see what’s happening so we can guide you. We won’t touch you or the baby.

6. This 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. You may hear a devil woman inside your head who will say to you, “All you have to do is give one almighty push here and it will all be over-who cares if you tear . . . just give it hell and get that forehead off your butt!” This devil woman is not your friend. Thank her for sharing and then have your higher self say, “Just hang in there. It’s OK. Panting and rising above the pushing urge will help me stay together, and I will have less discomfort in the long run.” Your practitioner will be giving only positive commands at this point, and she will be keeping them as simple as possible to maintain your focus.

Typically the birth attendant’s instructions are “Okay, Linda, easy . . . easy . . . easy . . . pant . . . pant with me . . . Hah . . . Hah . . . Hah . . . Hah . . . Hah . . . Hah. Good, that one’s over. You’re stretching beautifully; there’s lots of space for your baby. This baby’s the perfect size to come through.”

7. You will be offered plain water with a bendable straw throughout this phase because hydration seems to be important when pushing, and you can take the water or leave it, as you wish.

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 to have that slippery, crawling, amazing little baby with you on the outside of your body. Your perineum may feel somewhat hot and tender in the first hour after birth, and believe it or not, the remedy that helps the most is to apply very hot, wet face cloths. This is in keeping with the Chinese medicine theory that cold should never be applied to new mothers or babies. Women report that they feel instantly more comfortable when heat is applied, and any swelling diminishes rapidly.

9. When you push your placenta out, the feeling will be like that of a large, soft tampon just plopping out. It is a good feeling to complete the entire process of birth with the emergence of the placenta.

When a new mother has an intact perineum, she recuperates faster and easier from birth. I 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 breastfeeding. Lovemaking can resume whenever the couple is ready; it feels good to use a little olive or almond oil as a lubricant the first few times.

Gloria Lemay is a Private Birth Attendant in Vancouver, British Columbia, Canada.

* Originally published in Midwifery Today Magazine

A Father and Son Dialogue / Intactivism / Circumcision in Israel

A bit of humor, courtesy of my husband, Jacob:

Father:
“Son, what do you think about being circumcised?”

Son:

Father:
“OK, we won’t do it to you.”

Son:

Thank you for your wonderful and supportive congratulatory messages!

I have received so many fabulous congratulatory notes and emails on the announcement of Gabriel’s birth. I had debated whether or not to make a public announcement of our decision to leave our son intact, and am so glad I did.   The response has been fabulous.  I’d like to share some excerpts of just a few of the many wonderful emails I received following that announcement:

“As the mother of two intact Jewish boys who also blazed a trail in their family, I applaud you for that…”

“I let my son be circumcised 40 years ago but wouldn’t do that today. My daughter and husband listened to the new evidence and their boys are intact.”

“…As a Jewish mother who also did not circumcise her son, I am thrilled for you and your precious angel, that he, indeed, your whole family, remains intact, un-traumatized and whole.”

“A big thank you for letting us know that Gabriel will remain intact, it really helps others who are in a similar situation to know they are not alone. I am supporting a Jewish couple birthing in a few weeks time who are very conflicted on this and at the moment they are planning to circumcise due to the pressure from family, even though they are not entirely happy with their decision. I will let them know about you!”

“And I have to tell you how happy it makes me to hear about yet another Jewish non-circumcising family. What a blessing for your little one.”

“I am so happy about your decision to keep your boy intact.  You guys have guts (and lots of smarts too, obviously).”

“I remember the conversation with my dad when I decided our son would remain “intact.”  It was wonderful and supportive.  I do recall one funny thing he said, “Just don’t tell your mother.”  Ha! As though she wouldn’t notice…”

“..kudos on the natural and honoring birth Raquel… and the decision to let the little guy remain as God designed him.  We know that can bring up a lot of issues with family.”

Actually, my family has been supportive of our decision to leave Gabriel intact.  My mother and stepfather participated in our Intact Boy series; Gillian Longley’s two lectures were enough to make them seriously think about circumcision for the first time.  By the end of Gillian’s first lecture, The Foreskin, their attitude of “circumcision is really no big deal” turned to “Harvey wants his [foreskin] back!” (which came through in the Q&A box, making a few of us chuckle).

Circumcision in Israel – Impressions

After attending The Intact Boy series, my mom has become more vocal herself about this issue! She was in Israel at the time of Gabriel’s birth, and after proudly announcing that she is a grandmother (again), people would ask if she was going back home early for the bris.  Although my mother spared my 95 year-old great aunt the news, she was quite open with others.

Her cousin’s response: “Lots of people here aren’t doing that anymore.”

A few months ago I met a delightful Israeli woman at the local public library, who told me that she and most of her friends back home in Israel did not circumcise their sons.  When I mentioned this to my mother, she informed me that for a few years now, she has received birth announcements from Israeli friends who – instead of announcing the day and time of the bris for all to come witness and “celebrate” – made a notation on the birth announcement that the bris will be “among the family members only”.

Did they actually perform the bris?  Who knows?  But the privacy announcement is encouraging.  The Israeli departure from the public exhibition of the Brit Milah is an important first step in the abandonment of this outdated and barbaric tradition.

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