Sunday, February 27, 2011

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!


  1. Yes, this is what I did! I was in a deep squat in the pool. As my son's head started to crown, I could feel the tissue streeeeeeeeetching, and one hand instinctively went down to press on the part of my perineum where I could feel the strain, while the other cradled his head. I did have a little tear but it was on the side of my labia towards the back end. Didn't even need stitches.

  2. This is great -- I have actually been concerned about this myself! Next time, I would really like to catch my own baby, but was afraid that I would tear with no one there to support my perineum. I tore terribly last time, but that was the fault of "purple pushing" and an impatient doctor. Tearing is considered "normal," but I really think we should be able to birth babies without damaging ourselves.

    I am SO looking forward to your next birth story. Sending you lots of prayers and good thoughts. :)

  3. Wanted to add that no one was fiddling with my perinuem during the birth but me...the midwives did try doing a little perineal massage during pushing while I was out of the pool, but I found that to be too distracting so I told them to stop. It was very, very empowering to be the only one touching myself or my baby as he was born!

  4. This was a most unexpected instinct for me. I was reclining/side-lying due to fatigue and had both hands supporting my perineum - one on either side of my daughter's head. I had planned a home birth and transferred to the hospital, where the MD did all she could to support all we needed and wanted. Still, her training kept her from a hands-off approach and her touch was the most distracting (and subsequently painful) thing I experienced. I would agree that feeling/controlling her head was one of the most powerful moments for me. I grieved when Gemma's head grew too big to fill my palm the day of her birth.

  5. Thank you so much for explaining more about this. I thought I wanted perineal massage to help me not tear, but then it HURT! After that birth, I found your blog and remember reading Dio's birth story and being very interested in this. I love the idea of catching my own baby, but have a hard time visualizing it because I've never seen it. I pushed out my son semi-seated in the bed (got there for a vaginal exam and then did not want to move) and I grabbed him once he was out to about the hips and pulled him up, which was awesome, but next time I'd really like to try birthing upright and catching or helping to catch my own baby--I think a "kneeling captain morgan" position would be really comfortable for me.

  6. I have not once had this instinct for any of my five babies, I actually tend to arch my back and head looking backwards. I hoped I would experience this in my last birth in the water but still I did not.
    but I 100% support women following their instinct if this is one they happen to have.

  7. I think the whole idea of "supporting the perineum" is a bit misleading - since it's the perineum's job to support the pelvic floor muscles. There can be NO hands on the perineum - and surely many women instinctively apply pressure up by the clitoris and not towards the rectum - and that is the message I want to convey.

    Kind of like midwifing yourself - we get caught up in what a midwife DOES and think we should be doing THAT to ourselves, when in essence, it is about instinctive freedom instead of DOING.

  8. salemmidwife--totally agreed! I hoped that my clarification at the beginning made that clear. And I don't think you *have* to do anything at all when the baby is coming out, mother or birth attendant. It's funny how most women think that someone has to be "doing something down there" as the baby is crowning. Probably because hardly anyone ever has a baby without "something" being done--but honestly, babies will just come out!

    I guess the most important message is to give yourself the freedom to do whatever you want. And to ask your birth attendants to keep their hands off *unless you specifically ask them to do something* (and of course, unless there's a rare emergency situation such as a shoulder dystocia).

  9. I had a completely unmedicated birth, tore and did not feel a thing. No "ring of fire," I didn't feel any pain as I tore and I didn't feel the head crown either. The only thing I felt was when my son's body came out, it felt sort of like a snake slithering out. I know I am in the minority from birth stories I have read online, but I think I just had so many endorphins running through my system that everything seemed to be pretty much numbed.

    1. Love your story. I am about to give birth in weeks and i am nervous, but i have to trust my self and believe in God that we are strong and built to be able to birth a child. I just have to trust my body and believe in God's powers that my child can come out without any drugs or the help of anyone. Adrenaline, endorphins, hormones all of those chemicals are triggers for a better delivery and it's all natural

  10. I HOPE I get to do this at my birth. It's at the hospital complete with doctor roulette. I'm feeling really peaceful about giving birth at the the hospital, so now I've got hope for wonderful opportunities like feeling my baby being born into my hands instead of just feeling angry and scared about the possible 'bad' scenarios. It's nice to have hope.

  11. I actually have a picture of this exact thing from my daughters hospital birth. I'd be happy to share, let me edit out the other people. =)

  12. Please do share it--we'd love to see, especially one in a hospital!

  13. I've sent a couple picture attachments to your gmail for this blog.

  14. Thank you so much for this post! I think the topic is very important and not talked about enough. With my first, I had MWs applying warm compresses with oil on my perineum and I ended up tearing up and to the side. I felt like I couldn't touch myself b/c someone else already was.

    I read Dio's birth story shortly before my homebirth baby was born. The part about every woman deserving to feel her baby descend into the palm of her hand really resonated with me. It actually came into my head for a split second as I was pushing.

    My hands were already there...they automatically went there without a thought. I felt the water bag burst in my hand like a fire-hose. I needed most of the support on the side and up front. Pushing was less than 3 minutes and it was a complete fetal ejection reflex. At one point, I put both of my arms on the side of the pool for support and when I watch the video back, I see that my hand goes back to support my perineum and the look on my face turns from tense to calm when I do so. It really connected me with my baby and made me feel at peace during a really intense moment. After his head came out, my body automatically went from kneeling to all fours but I still had to support myself, my hand wouldn't move. Any who, I really felt that providing my own support when and where that I needed it made a huge difference. Baby had a 15" head with a nuchal arm and was a decent size (9lb5oz) and I didn't tear at all. There was virtually no recovery at all. But even if I had torn, just being present and connected through touch was totally amazing and so important to me. I can share a video but you can't actually see my perineum -

  15. I had an accidental home birth with my third child, and am now a month away from my due date for my fourth. What you described is what happened naturally. I was 8 days past my due date, and had been dialated to 4 cm on my due date. I had about 5 strong contractions about 10 minutes apart. I took a bath during this time, got dressed to go to the hospital, and then went to the bathroom. I had diareah, like I have had with each labor. After I cleaned myself up and was about to leave the bathroom, I had one more massive contraction, and the water burst out and his head crowned. I yelled for my husband. I instictually pushed on my pernium where it hurt. My husband helped my out of the restroom. I put one foot up on the bedframe, and while I was holding myself, another contraction came and his head was out. My husband helped me undress and with the next contraction was the rest of him. Standing was sooooo much better than laying for recovery. Really, I didn't do any pushing, it was just the contractions and gravity that pushed him out. We will see if this one comes fast at home or not - but I am not really afraid of it anymore. Everything happened quickly and smoothly.


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