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

Conscious Grandmothering Bibliography

Blair, Pamela, D, The Next Fifty Years: A Guide for Women at Mid-Life And Beyond, Hampton Roads, 2005

Bolen, Jean Shinoda, Urgent Message from the Mother, Conari Press, 2005

Bolen, Jean Shinoda, Crones Don’t Whine, Red Wheel,Weiser, 2003

Carson, Lillian, The Essential Grandparent, Health Communications, Inc, 1996

Davis, Elizabeth and Leonard, Carol, The Women’s Wheel of Life: Thirteen Archetypes of Woman at Her Fullest Power, Viking Adult, 1996

Elgin, Suzette Haden, Grandmother Principles, Abbeville Press,1998

Ellison, Sharon, Taking the War Out of Words, Bay Tree, 1998

Giovanni, Nikki Ed, Grand Mothers: Poems, Reminiscences, and Short Stories About the Keepers Of Our Traditions, Henry Holt and Co. 1994

Grandmothers Against The War, Love, Grandma, Lulu. Com, 2007

High, Linda O, The Hip Grandma’s Handbook, Falls Media, 2007

Kitzinger, Sheila, Becoming A Grandmother: A Life Transition, Fireside, 1997

Kornhaber, Arthur, The Grandparent Solution, Jossey-Bass, 2004

Lara, Adair, The Granny Diaries, Chronicle Books, 2008

Levine, Suzanne Brau, Inventing the Rest of Our Lives, Plume, 2005

Martin, William, The Parents Tao Te Ching, Marlowe & Co, 1999

Northrup, Christiane, The Wisdom of Menopause, Bantam Books, 2001

Rosenberg, Marshall B., Non-Violent Communication, Puddle Dancer Press, 2003

Remen, Rachel Naomi, My Grandfather’s Blessings, Riverhead Trade, 2001

Ryan, MJ, Attitudes of Gratitude, Conari Press, 1999

SageWoman, No. 74 whole issue is on “The Queen“.

Scheaffer, Carol, Grandmothers Counsel The World, Trumpeter Books,  2006

Stone, Douglas et al, Difficult Conversations, Penguin, 1999

Walker, Alice, We Are the Ones We Have Been Waiting For: Inner Light in a Time of Darkness, The New Press, 2006

Wasserman, Selma, The Long Distance Grandmother, Hartley & Marks, 1988

Wilder, Barbara, Embracing Your Power Woman, Wild Ox Press, 2005

Willcox, Bradley, J. et al The Okinawa Program, Three Rivers Press, 2001

Conscious Woman Online

Image of the InternetJoin Internet Marketing Expert Laureen Hudson in an ongoing series for those looking to bring traffic to their sites, get their name out, enhance their online presence, and understand the goings-on in cyberspace.

Each session is approximately 60 minutes in length.

Cost: $7.50 per session.

Certificate of Completion: $7.50 (completion of post-session questionnaire required).

Continuing Education Units are available for some professional groups. To view a listing of CEU opportunities, click here.

A Guided Tour to Online Communities
What’s the internet?  What are online communities? Why do we care?

Fundamental human behavior does not change over time; we are the same human beings, with the same basic needs, that we have always been. We want to come together, to share human experience. But because we’re scattered, isolated, and no longer in supportive extended-family groups, the Internet has become our tribe.

In this session, Laureen Hudson covers the basics, and gives you a firm grounding in the realities of the internet; what it is, what it isn’t, where it came from, where it’s going, and the needs it serves. She then moves on to online communities, explaining why they exist, some of the controversies with them and advantages to them. We then take a tour around the major offerings such as Blogs, Internet Groups (yahoo, google, etc.), Facebook, LinkedIn, Twitter, Tribe, Discussion Forums , and discuss why you might or might not want to participate – all with an eye towards advocacy and building your business base.


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Creating An Online Presence
What is identity? What is reputation? How do you use them in creating your presence?

Now that you know what online communities are, let’s explore the fundamentals of social networking. It’s not enough to just have accounts everywhere; you need to have a voice that is unique to you, that gives value to your readers. The way you present yourself online can serve as a sterling reference or as a shocking warning, depending on how you do it.  Let go beyond old school marketing and give some real thought to how you want to represent yourself, using your voice and authenticity as currency.

Once you have your identity set up, the next step is audience.  Setting up a profile isn’t enough – you need to engage commitment and participation.  Who needs to hear what you have to say? How can you make sure they’re hearing you?  In this session, Laureen demonstrates how this is all connected, how to identify yourself online, and how to build an audience through traffic, feed readers, trackback etiquette, search, signature files and blog carnivals.


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Create Your Blog
Social Networking sites like Facebook are the parking lots in the driver’s ed of online communities. Once you’ve figured out how to operate there, you’re ready to start venturing out on your own, and you do that by blogging. This session focuses on blogging platforms (e.g., Blogger, WordPress, Typepad) pros, cons and tips, what belongs in the right and left columns, how to write a good post (length, voice, referencing), and how to track “good” once you get there (through Google Analytics, Feedburner, etc.).


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Search!
One of the most misunderstood aspects of the internet, search functionality is far from constant; it’s an ever-changing panoply of theory, algorithm, and magic. But rather than spend our time brushing up on our applied mathematics skills, this session focuses on terminology and how to use that to explore the really meaty bits of search, including SEO, metatagging, and web gardening. We use a case study to explore how all this really works, and then finish with an examination of strategies for following your own growth in the search rankings.

At the end of this session, you’ll understand how search engines work , web gardening, mighty metatagging, pinging services, search engine optimization, how to keep up with this stuff and more.  A case study will be featured on Dr. Amy, and how we shoot ourselves in the collective feet by visiting and commenting on her website.


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Drugs: Black Box Warnings and Product Inserts

This is a work in progress.  If you are interested in helping with this project, an offshoot of our Conscious Activism program with Jim Turner, please email us at info@consciouswoman.org.

Drugs Used for Labor Induction

Click here to review the product insert for Cytotec/Misoprostol. 

Click here to review the product insert for Pitocin/Oxytocin Injuection, USP (Synthetic). 

Click here to review the product insert for Cervidil/Dinoprostone.

{pullquote}We have two online courses that discuss Labor Induction.  Sarah J. Buckley, M.D.’s Gentle Birth: The Science and the Wisdom includes a session entitled “The Impact of Interventions” and Gloria Lemay’s Essentials of Maternal-Infant Care includes a workshop entitled “Induction of Birth”.{endpullquote}

Online Resources

(In development)

Click here to read an article (adobe pdf) published in the International Journal of Obstetrics and Gynecology, entitled Routine Induction of Labor at 41 Weeks: Nonsensus Consensus.

Click here to view tips for 10-Month Mamas.

Click here to view Ina May Gaskin’s collection of articles on Cytotec (among other things).  

Postdate Pregnancies: Personal Accounts

 “I have given birth to seven children. My first five were born in the hospital- one was a c-section; my other four were induced. Most were induced for postdates.With my sixth child I simply could not go back to the hospital to give birth again. All those inductions, and the cesarean, hurt me very deeply in ways; especially in how I had no confidence in my body to do its most basic female act- giving birth.

This self-doubt stayed with me for the pregnancy of my sixth child… but my midwife was very strong for me, and spoke with me about how many women actually do not give birth by the medical rule book; that just as all babies and children mature at different rates when outside the womb, so they do inside it. I struggled to believe her.

I was worried about my placenta deteriorating- not being able to nourish my baby. She said in over 700 births she had never seen a “bad” placenta because of postdates… she spoke of how she herself gave birth at 43 and 1/2 weeks to a beautiful, healthy baby at home.

Then, at 44 weeks pregnant, I gave birth in my own home to a big, beautiful healthy baby- then pushed out a big, healthy beautiful placenta afterwards.

Then I gave birth to my 7th child at home at 46 weeks pregnant; he weighed 12.6 pounds. My longest pregnancies produced my healthiest children, and smoothest births….”

– Leilah McCracken

                  
 

Restoration: Treating Adhesions

Trauma to the abdomen and/or pelvic regions – the core of our balance and power – is a major contributor to a variety of subsequent health issues. Following cesarean surgery, episiotomies and/or instrumental deliveries, women may experience any number health problems, including back problems of any kind (which in the long run may become slipped or herniated discs); headaches, sinus problems and breathing difficulties; heartburn and heart problems; increase in blood pressure; gallstones; pinched nerves (anywhere); teeth and jaw problems; pelvic rotations; bowel and/or bladder problems; sexual dysfunction; joint problems and more. Adhesions (scar tissue) contract the entire body into itself. The ramifications can be very serious and are entirely preventable through proper treatment.

Join us in a fascinating and unique presentation by Tanya Tarail, a physical therapist of more than 20 years who practices CranioSacral Therapy, Visceral Manipulation and Urogenital Manipulation. Tanya has worked extensively with women following birth trauma; her specialty is scar tissue and trauma from any cause.

Tanya treats cesarean and episiotomy scars literally from the inside out. In addition to her physical therapy work, Tanya integrates Somato Emotional Release into her sessions, with an in-depth understanding that the emotional content of the trauma (how a woman feels about the birth, the scars, the after-effects such as sexual dysfunction, bowel/bladder changes, abdominal and pelvic weakness, etc.) can all be released along with the tension of the scar tissue.

I generally start a patient (if willing) on the table and have her share her story. I can get a lot of information by laying my hands on her as she shares with me. I can get a sense of where to begin unraveling the story that she has caught in her body and how her body reacts to it. This is generally done with a gentle touch. Many times a woman can’t handle having her scar touched at all. Sometimes I can talk with her until we work through it, many times I use alternate areas of the body to begin to loosen the scar. The scars that cause problems generally have adhesions/scar tissue attached to underlying or adjacent tissues such as the pelvic or abdominal organs, the spine and of course the surrounding soft tissues. As I loosen the adhesions, the scar begins to soften. Many times in the first session she will let me work on the scar, sometimes it can take 2-3 sessions. Many times I start with the epidural point of entry to take the pull out of the spine, then take the pull out of the pelvis and finally the scar. Other times I start at the respiratory diaphragm and work my way down. Every woman is different. I feel it’s important to work with a woman where she is and go from there. ~ Tanya Tarail

This remarkable healer can identify what kind of birth a woman has had simply by the way she walks and carries her child. She can explain physiologically why women have breastfeeding difficulties and any number of conditions after cesarean surgery and/or instrumental deliveries. This program is not to be missed! It will benefit women on their healing journey and enlighten all practitioners who strive to assist them.

Of all the modalities I utilized in my healing quest, Tanya’s work was by far the most effective. For two and a half years after the cesarean surgery, every bowel movement felt like the worst of my labor contractions. Intercourse was so painful that my husband was unable to insert more than the tip of his penis into my vagina. This of course put a strain on my marriage, affected my ability to work and to be a parent, and was a major contributor to an extended state of PPD and PTSD that I experienced. Just a few treatments with Tanya restored my body to its pre-delivery state and enabled me to live without pain for the first time in years. Her work paved the way for all the extraordinary things and people that have come into my life since. ~ Raquel Lazar-Paley, Executive Director, Conscious Woman, Inc.

This program is 90 minutes in length.

Cost: $7.50

Certificate of Completion: $7.50 (completion of post-session questionnaire required).

Continuing Education Units are available for some professional groups. To view a listing of CEU opportunities, click here.


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Online Presentations (Videos and Selected Resources)

Here are a few short video segments from some of our online presentations. For those whose browsers could not support the media files during the live presentations, those who wish to see these again, and for the curious among you as well! 

What Would Mammals Do? with Diane Wiessinger

Headstand nursing (from U-Tube)
Gorilla expressed milk snack (from U-Tube)
Chimpanzee holding baby and placenta (from U-Tube)
Human newborn crawling to breast – mother does nothing (from U-Tube)

Would you like to purchase related DVDs?
Birth in the Squatting Position, a 10-minute classic video of squatting births in the 1970s, has been reissued as a DVD by the Bradley Method of Childbirth® (1-800-4-A-BIRTH),  and is available through Cascade Health Care Productions

Baby-led Breastfeeding – The Mother-Baby Dance is a fabulous new DVD by Christina Smillie, MD, IBCLC.  Mother after mother is shown following her baby’s lead to comfortable, simple breastfeeding.  It is available at Geddes Productions.

Freedom of Expression: Supporting Breastfeeding Moms in the Workplace with Cate Colburn-Smith

Videos:
Log rolling ad.  
Mechanical bull ad

Ad Campaign:
National Breastfeeding Campaign
      *  This article was based on the latest data from the CDC (Aug 2007) about breastfeeding rates and exclusivity. 
      *  Note that the CDC conducts their breastfeeding rate research in phone surveys that are primarily about national immunization participation.
Washington Post article: Health and Human Services (HHS) Toned Down Breast-feeding Ads” (Aug ’07)
A direct link to the graphics for the ads that never saw the light of day. 

Other Resources:
American Academy of Pediatrics policy on breastfeeding

Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries
     * This is the study that quantified the risk factors for various diseases for breastfed babies vs. formula fed babies, and for breastfeeding mothers.

Study that revealed more say formula is as good as breastmilk

Article about “Moms Too Quick to Reach for Baby Bottle”

CDC site on breastfeeding.

Breastfeeding Promotion Act (Federal)

MomsRising.org statement of support for breastfeeding moms (for Breastfeeding Promotion Act).

50 state summary of breastfeeding laws.

CDC Lactation Support Program Toolkit:  (includes info for documenting workplace lactation policy) 

The National Women’s Health Information Center web site, June 2005.   

La Leche League web site.

kellymom  Breastfeeding and Parenting website. 

Childbirth “Humor”

Monty Python Birth Scene (from YouTube)

The Obstetrician Song (mp3)

Sexual Abuse History/Childbearing Women