Supporting your own perineum

A blog reader recently asked a question about supporting your own perineum:

Reading the post regarding birth plans, I came across the part where you say "I catch my own babies and support my own perineum" and it confused me a little bit.  I am not a mother, never given birth.  I have witnessed a few births but I still have the question... What do you mean when you say you support your own perineum?  Can you explain to me exactly how you support it?  If this is too personal of a question, sorry!  I am just unfamiliar with this and would like to know what it is for future knowledge.  My husband and I are trying for our first and I have to say that I am scared of the birthing process.  Mainly because I am scared that I would tear.  So you mentioning this peaked my interest.

First, I should clarify that what I do is provide gentle counter-pressure against the baby's head wherever I feel too much burning/stinging, rather than touch or support the actual perineum.

Let me quote from Dio's birth story to illustrate:

The baby’s head descended rapidly. When I felt it hit my perineum, I slapped my right hand down to support my tissues while maintaining a death grip on Eric’s arm with my left hand. As I was doing this, this passage from Gloria Lemay’s article Midwife’s Guide to an Intact Perineum flashed through my mind: "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."

...With each contraction, the head emerged more and more. I applied counterpressure to the head, varying the pressure between the front and back depending on where I felt more pressure and stinging. As much as crowning, and pushing in general, was wild and crazy and painful, it was amazingly cool to once again support my baby’s head as it emerged out of my body. There’s nothing like feeling your baby’s head come out, bit by bit, into the palm of your hand. Every woman deserves that experience.

Providing your own counter-pressure or perineal support isn't a fancy technique; it's a matter of following your body's cues. You cup your hand over the baby's head once it starts crowning and apply counter-pressure wherever it feels best to do so. Sometimes it will be in back towards the perineum; other times in front near the urethra/clitoris.

During Zari's birth, she seemed to take forever to be born. On the other hand, during Dio's birth I was doing everything I could to slow the pushing stage down. So the counter-pressure was especially useful for Dio's much faster pushing stage (20 minutes versus 2 hours).

If you want to do your own perineal support/counter-pressure, make sure those attending the birth know this and are prepared for it. Every provider has their own habitual practices--some routinely massage and stretch the perineum, others provide counter-pressure, others keep their hands off entirely. Be very clear that you want no one touching you or the baby as it is crowning and that you will be putting your hands on the baby's head instead.

It also helps to be in the right birth position so you can easily reach the baby's head. Variations on a low kneel or crouch work especially well.

"frog squat" from Sage Beginnings

A low kneel from Laura Shanley's Bornfree site

Sitting on the toilet also works; I did this while Zari's head crowned and emerged, then went down to a half-kneel/half-squat on the floor for the birth of her body.

I'd love links to photos or videos of women doing their own perineal support/counter-pressure!
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