Birth Presence Doula Care - BLOG

Introducing the La Bassine Maxi Birthing Pool!

10/28/2020

We are excited to offer the La Bassine Maxi as a new option for customers seeking a birth tub for a home waterbirth. The colour and design of this pool are sure to add serenity and comfort to your waterbirth experience.

The La Bassine Maxi Professional comes in a beautiful deep blue shade and features 6 strategically placed handles that are excellent for supporting multiple positions, as well as ease in getting in and out of the pool. The location and height of the 4 internal handles are ideal for supporting you while kneeling, squatting or pushing and are more accessible for smaller women.

Other unique features are the transparent sides that allow just enough light through to give midwives good visibility from outside the pool and a 3'' deep, inflated floor - the deepest birth tub floor on the market!

And if all of that weren't enough, the La Bassine Maxi is made from the thickest (0.60mm) eco-friendly vinyl - making it super-strong and safe for people and the environment.

Want more details? Check out our birth pool rental page.

5 Benefits of Waterbirth for Labor and Delivery

9/22/2015

Contemplating what it would be like to give birth in water?

Many women who've had a waterbirth rave about the benefits of labouring and giving birth in water and would jump at the opportunity to have another one. There are glowing testimonials out there summarizing the positive birthing experiences that many women have had in water. Women considering a waterbirth will be happy to know that, on top of all these positive personal accounts, there is also evidence-based research that supports a number of benefits for women labouring and/or delivering their babies in water. Here are a few for your review!

Evidence-Based Benefits of Waterbirth

1. Waterbirth decreases pain perception during labor

Many women want to have a drug-free birth and one of the main considerations, when deciding to take the natural route, is to determine which tools can be used to manage discomfort or pain in labor. Consequently, some will enlist the help of a doula, TENS machine, Hypnobirthing® techniques, etc. to increase their levels of comfort during labor. One recent study found that women who had water births reported less pain than women who gave birth out of water, including those that had epidurals. Waterbirth has also been shown to reduce the need for pain medication. For women hoping to have a drug-free birth, the evidence is reassuring.

2. Waterbirth decreases the use of episiotomy and the likelihood of severe perineal tears

Most, if not all, expectant women wish to avoid injury to the perineum during childbirth. Some will use preventative measures, such as perineal massage in pregnancy, to reduce the chance of trauma to the perineal area during delivery. Studies show that waterbirth can increase a woman's chance of having an intact perineum during the delivery of her baby. Episiotomies are more detrimental to women than naturally occurring tears and are indicated for use in urgent/emergency circumstances only. Waterbirth decreases the likelihood of being subjected to an episiotomy. Like episiotomies, third and fourth degree tears contribute to a longer postpartum recovery period for the mother; they may also, in certain cases, lead to long-term health complications such as chronic perineal pain and fecal incontinence. Current evidence reveals that the incidence of third and fourth degree tears are lower when birth occurs in water than when it occurs on land.

3. Waterbirth increases the likelihood of a hands-off delivery

Women who are interested in having the most naturally occurring delivery they can, with as little manual intervention as possible, may be excited to learn that waterbirth increases the chances of having a hands-off delivery. A hands-off delivery refers to one that occurs without manual support/facilitation of the baby's head, by the attending clinician, as it emerges. This allows for the delivery to unfold as naturally as possible, without added external intervention. There is evidence to suggest that the majority of women delivering in water will experience a hands-off delivery.

4. Waterbirth is safe for healthy, low-risk pregnancies

Despite the opinion that the practice of giving birth in water has no benefit and is potentially unsafe, a belief still held by some medical care providers, this opinion is not supported by present findings. Midwives are specially trained to assist and monitor low-risk clients desiring a natural birth. Primary healthcare providers attending water births should be comfortable and experienced in supporting birth in water, just as medical practitioners should be at ease and trained to assist in any medical intervention they perform on land. Women should continue to discuss the potential risks associated with any method of birthing with their primary care provider to ensure they are good candidates for their chosen approach. Overall, in low-risk pregnancies, waterbirth has been found to pose no greater risk to the well-being of mother or baby than birth occurring on land. Consequently, these findings indicate that waterbirth should become (if it isn't already) and continue to be an available option for women desiring a natural birth. Research shows that newborns fare just as well as land-born babies, if not better, when birth takes place in water.

5. Waterbirth has a high satisfaction rate

Over 70% of women who had water births, according to one study, would choose waterbirth again; this compares to less than 10% of those who would elect to give birth again, in the same manner, after giving birth on land. Some of the words women have used to describe birthing in water and their overall birth experiences are relaxing, fulfilling, liberating, calming, and soothing. There is, however, one aspect of waterbirth that many women collectively praise and that is given to the sanctuary it seems to provide when the new mother receives her baby upon delivery. For a considerable number of women, the most memorable detail of their waterbirth was being left undisturbed to meet and bond with their new arrival in that shortly-lived, once in a lifetime moment.

Resources

The evidence on waterbirth

General information on waterbirth

Science and safety of waterbirth

Debating which birth tub to have for your own waterbirth? Check out our post on the Birth Pool In A Box.

5 Reasons to Rent the Birth Pool In A Box for your Waterbirth

9/13/2015

The Birth Pool In A Box

You may have already decided that your ideal birth will be at home and in water. Your first thought may be that your bathtub will serve as a suitable space to labor in and deliver your little bundle, but I assure you that there are far more comfortable options out there than that hard, difficult to get out of porcelain tub. Wouldn't you much rather relax in a flexible and comfortable, yet sturdy, pool with lots of handles for support and a built in seat? Doesn't that sound great? If you agree, you'll be excited to know that you can have this amazing pool for your own waterbirth! What is the name of this amazing device? It's the one and only Birth Pool In A Box, of course! Here's why you'll want to rent your very own:

1. It's inflatable

Space is often a major consideration for many expectant couples planning a home waterbirth. The Birth Pool In A Box is an inflatable birth tub, which means it won't take up unnecessary space while it is not in use. Compared to other non-inflatable birth tubs, the Birth Pool In A Box is light-weight and easy to set up in your room of choice. On top of that, it takes little time to inflate, line, and fill.

2. It's Affordable

Preparing for a new baby isn't cheap! I'm sure you've already discovered this for yourself. Every little thing adds up eventually and can get a little overwhelming at times. You'll be happy to know that you can rent the Birth Pool In A Box at a reasonable price with everything you'll need to set up and use the tub and still have some spare change left over to buy that really cute bunny sleeper you spotted the other day.

3. Did I mention how comfortable it is?

The Birth Pool In A Box features six handles, a comfy built-in seat, and a safe, soft floor. It even has a built-in cup holder to encourage you to stay well hydrated throughout labor. Unlike your typical bathtub, the Birth Pool In A Box has an adjustable upper wall chamber that can be adjusted for ease in getting in and out of the tub. Don't be fooled by the fact that the Birth Pool In A Box is an inflatable tub. Just because it may be more space effective than other non-inflatable pools, it is surprisingly spacious. Feel free to invite your partner into the pool with you as it has been specifically designed to accommodate both you and your other half. You can't do that in a hospital bed.

4. It has a great shape and so do you!

If you compare the Birth Pool In A Box to other inflatables, you'll notice that our pool is uniquely egg-shaped. Not only does this shape tend to fit better in birthing spaces, it also provides the choice to labor on either end. Some women prefer labouring at the narrower end, while others opt for the wider one.

Every woman is shaped differently and the Birth Pool In A Box is wonderful for moms of all shapes and sizes. The upper wall chamber is adjustable, so shorter women - like myself - can easily custom reduce the height of the pool to make it easier for us to get in and out. For taller women, the length of the pool allows for greater extension of the legs so you won't feel like a sardine in a tin. Other pools are round in shape and do not allow for optimal flexibility. The Birth Pool In A Box, even with its more elongated shape, is able to allow for a considerable depth to make sure moms are well immersed.

5. It's safe

Ultimately, it is up to you and your midwife to decide if a home waterbirth is suitable and safe for you and your pre-born baby. But, if you have the green light to go ahead with planning your dream waterbirth, the Birth Pool In A Box is sure to meet your approval. This pool is made from strong eco-vinyl, which is phthalate free and safe for people and the environment. All pools feature a white, fully visible anti-slip floor. You can be sure that our hospital grade pools have been made with high quality materials and are safe for you and your baby. The Birth Pool In A Box continues to rank as the #1 inflatable birth tub on the market and is the only birthing tub wholeheartedly recommended by Barbara Harper, RN and president of Waterbirth International.

To rent your Birth Pool In A Box today, click here!

More information on the benefits of water birth.

Postpartum Recipe: Quick & Easy Black Bean and Corn Quesadilla

2/25/2015

Need a snack in a hurry? This tasty recipe works great as an appetizer or a satisfying snack any time of the day. Small tortillas make this dish the perfect handheld snack when breastfeeding or multi-tasking. Family and postpartum approved!

Ingredients (per serving):

* 2 small whole wheat flour tortillas
* 1/4 - 1/2 cup of cheddar cheese (grated or thinly sliced)
* 1-2 tsp canned black beans (rinsed and drained)
* 1-2 tsp green or red onion (thinly sliced or chopped)
* 1-2 tsp canned or fresh corn kernels (drained/removed from cob)
* 1 tsp cilantro (optional)
* 1-2 tsp homemade or store-bought salsa (optional)

Directions:

1. Heat medium non-stick skillet at medium heat
2. Place 1 tortilla flat on skillet
3. Sprinkle grated or thinly sliced cheese on top of tortilla in skillet, ensuring an even spread
4. Sprinkle beans, corn, onions and cilantro (if using) evenly over the layer of cheese
If using salsa: First coat the beans, corn, onions and cilantro with salsa in a bowl. Then, spread the mixture evenly over the cheese
5. Place 2nd tortilla on top of the first one with the filling to create the sandwich
6. Flip the quesadilla when golden brown on the first side. Remove the quesadilla from skillet when other side is golden brown. Transfer to a plate, slice into small triangles with a pizza slicer/sharp knife and serve.

Serving Tip: Serve with marinara, salsa, or guacamole as a dip

Practical Tip: Freeze your tortillas for added convenience. They freeze wonderfully and make putting this dish together, at any time, a snap!

Choosing a Birth Doula: A Brief Guide To Finding Your Best Match

1/28/2015

Looking for a birth doula and wondering how to get started? You'll find all kinds of checklists online that you could use to help you in your search; however, assembly line checklists don't tend to address the unique needs of the individual doing the searching.

In order to give the search for a doula the best shot, it's important for the prospective client to focus on what is important to her. Let's take a look at some essential aspects of selecting a doula.

1. Do you like the doula?

This question may seem a bit silly, but some women don't place the same weight on their level of connection with the doulas they are interviewing as they do on the quality of the doulas' testimonials and level of experience.

Many clients find their doulas via word-of-mouth, which is a great way to begin the search, but a friend's positive experience with a particular doula does not guarantee that you will have the same experience with that doula.

After each interview, make sure to ask yourself questions like these: Did I connect with the doula? Was I comfortable with her personality/manner? Did she seem caring? Was she sensitive to any concerns I may have expressed? Did she seem compassionate?

If you answer "no" to any of the above questions, you may wish to interview with others. If you don't find a suitable match at first, do not be discouraged. For every woman who values and wants a doula, there is a doula out there looking to serve someone just like her.

2. Do you feel that the doula respects your 'birth vision'?

This element is as important as the first. The interview is an ideal time for sharing a brief description of your birth plan/wishes with the doula. Listen carefully to her responses. Does she seem supportive? Is she excited for you? Is she enthusiastic about attending a home birth, for example, if you're planning for one?

3. How well did the doula engage with your partner?

Did the doula ask for your partner's input during the interview? Did she ask him if he had any questions for her? It's important for your partner to feel comfortable with the doula too!

4. Did you like the doula's answers to your questions?

The questions you ask the doulas you meet should depend on what's important to you. You can use standard questionnaires as a guide, but don't feel obligated to strictly adhere to them. You may very well wish to ask questions about her experiences, special certifications/qualifications and interests; address the areas that matter to you. It's important that you are comfortable with the answers.

5. Can you afford the doula?

Fee can be an important consideration for families. If you believe you've found the doula of your dreams, but are not sure how you'll manage to pay the bill, you may be surprised to find out that many doulas are happy to set up a payment plan to make paying their fees more manageable. It never hurts to ask!

Feel free to incorporate the questions above into your selection process if you're looking for a few points of focus that'll give you a good foundation for finding a great match!

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RENTAL OFFER

10/16/2014

As a thank you to those choosing Birth Presence Doula Care for their TENS and birth tub needs, we are now offering $15 off the TENS when both the TENS and a birth tub is rented. We are happy to be offering this discount on a permanent basis. We currently have TENS and birth tub availability for October, November and December 2014 due dates. Contact us today to reserve either or both of these fantastic devices.

Remember, when you choose Birth Presence Doula Care for birth doula support, you will have the option to use the TENS (including all necessary components) for FREE!

All birth clients of Birth presence, wishing to use a birth tub for a home water birth, save $40 on their birth tub rental.

A big thank you to all our valued customers! :)

Elle TENS Special - ON NOW!

6/20/2014

This summer (June, July, August), we are promoting our Elle TENS rentals!

If you're planning on a natural birth or you would like to go natural for as long as possible, the Elle TENS machine may be an ideal addition to your birth plan. This little machine is small, but powerful and is SO easy to use. It's easy to hold and operate for ultimate comfort and convenience. All clients are entitled to a 24-hour trial period in which to test the device to ensure that it is right for them.

Your 4-week rental will include everything you need to operate the unit, including one set of 4 self-adhesive electrode pads and 2 sets of batteries. If you are still waiting to give birth by the end of the rental period, simply let us know and we will gladly let you keep the machine until you deliver!

So here's the deal: Every TENS client that refers 1 friend to our services (either rental or doula) will receive 50% OFF her TENS rental. Each TENS client that refers 2 or more friends to any one of our services will receive her TENS rental for ONLY $5!

We have a limited amount of units so be sure to reserve yours today to avoid disappointment!

Contact us:
Birth Presence Doula Care
Tel: (416) 315-9937
Email: info@torontobirth.com

Reservations are required in order to take advantage of these offers. Validity of offers are based on product availability. Please contact us for full details.

The Beauty of One-Handed Snacks

5/30/2014

We know it's important to have a well-balanced and nutritious diet during pregnancy AND when breastfeeding. We want our babies to be healthy and we know that overall breast milk quality is reflected in part by the quality of what we, ourselves, put into OUR bodies.

Breast milk is ALL your newborn baby needs to be well-nourished for the first six months of life and, in the case of breastfeeding, keeping the food source (mama) healthy is key in producing the best of the best.

The postpartum period can be a busy if not hectic time. Sleep deprivation, adjustment to new needs and establishing new routines can take up a lot of energy, patience and time. As a result, we tend to sleep when baby sleeps, take a shower when we have an extra pair of hands around and, if we're lucky, we'll be able to sneak in brushing our teeth before we go out.

Unfortunately, with all this going on, many new mamas forget to eat! And they don't remember until they get hungry, a situation which is a much greater issue for a breastfeeding and possibly sleep-deprived mother than one who is neither. Breastfeeding takes energy and nutrients from our bodies to support this essential, life-sustaining function.

Some new mothers find that if they don't replenish themselves with the appropriate amounts of food and fluids throughout the day, they will feel extra tired or weak after a feeding session with their babies. This is not normal or something you should get accustomed to. Keeping not only well hydrated and nourished in between feedings, but also DURING feedings, can help reduce or eliminate this unwanted effect. Accessible snacks can solve this dilemma; this is the beauty of 'one-handed' snacks!

Convenience is the main benefit of one-handed snacks. With hand to mouth ease, it's difficult to make an excuse for not having them around when breastfeeding. Have these snacks readily available on a bedside/night table or regular living room couch side table. You can even have them sitting next to you on the couch in a bowl or on a plate - it's ok, I won't tell. ;) This way you can easily reach over and access these energy boosting morsels. Set up minimal-effort snacking stations in your favourite breastfeeding spots throughout your home.

These are the 3 requirements for smart one-handed snacks:

#1. Mom only requires one hand, hence 'one-handed', to access snack - practicality first!

#2. Must be healthy - no potato chips!

#3. Little or no prep time

#4. Must create little or no mess

Now for some examples:

Foods

*Grapes/raisins

*Cherry/grape tomatoes

*Cubes of hard cheese

*Orange segments

*Banana chips (dried banana slices)

*Shelled (without shell) nuts (e.g., almonds, cashews)

*Dried apricots

*Dried cranberries/cherries

*Trail Mix (with easy to pick up pieces)

*Snap peas

*Blueberries

*Ants on a log (celery filled with peanut butter and topped with raisins)

*Bite-sized granola pieces

*Hard boiled eggs (Remove the yolks for less mess)

*Unsalted/butterless popcorn

*Mini/party sandwiches (fill with your favourite spread of tuna salad, cream cheese, etc.)

*Grilled cheese bites (So good! Make a regular sandwich and slice into small, bite-sized pieces.)

*Veggies and healthy homemade dip (e.g., yoghurt-based, humus)

Fluids

*Milk

*Smoothies (frozen fruit and a blender makes these a flash to make)

*Soy milk

*Almond milk

*Coconut water

*Fresh veggie/fruit juices (Juicers are great for this)

Tip: Avoid warm beverages and soups to eliminate the risk of dangerous spills.

There are many other options out there. Be creative with your snack choices and select the ingredients you enjoy!

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Dangers Lurking Beyond the Scope

5/1/2014

Please excuse the creepy sounding title. It's not meant to scare you off from reading on, I assure you, and it isn't about the dangers of stethoscopes either.

I really wanted to write a post to address the very real repercussions that can result from non-clinical professionals operating outside their scope of practice. This issue came to my special attention when I recently read an article written by a mother who had a very negative experience with her birth doula. It not only shocked me, but really spoke to me of the importance of remaining within our role in the busy world of birth.

As doulas, no matter who our certifying organizations may be, our role is to support our clients in their birth choices. We are there to provide continuous emotional, practical and informational assistance during the birthing process. On an emotional level, we deliver encouragement, reassurance and compassion. We also offer practical support by employing a number of possible comfort measures throughout labour. But how about informationally? How do we respond when our clients come to us for information and possibly advice?

I have come to learn that information and advice are two very different things. Where information is data, the 'stuff' that people essentially use to help them make decisions, advice often involves the implication that the people providing it have some sort of knowledge/training that would allow them to give sound guidance in a specific area of expertise. Despite obvious differences, information and advice are both important elements to distinguish between when it comes to the doula's professional scope.

I am always providing information to my clients and tons of it! Most people crave information when it comes to making decisions about childbirth and the first few weeks of their babies' lives. And that's great! It's a very important time in both a baby's life and those of his/her parents. Information is so valuable, but it has to be reliable.

Finding accurate information isn't always easy. Lots of sources and publication entities, websites and independent articles, on the internet for example, are not reviewed or monitored for accuracy. As a doula, it's fantastic to be able to recommend websites or individual articles that I know have been researched and documented by the appropriate sources. I feel that this is one of the things that most doulas tend to do amazingly well.

As doulas, a major part of our role is to foster maximum self-determination on the part of the parents we work with. We help parents to make informed decisions by providing them with reliable, evidence-based data. It is not our role to tell them what to do or to make choices for them. I was introduced to this important aspect of our support structure by my postpartum doula trainer. It's a very important role that fosters confidence in expectant women and their partners and I love it!

But then we get to the issue of advice. I've often been asked by clients for advice in some capacity or another and this is where I have to tread carefully.

Occasionally, I have been asked what I think about certain methods of induction that are medicinal in nature, such as the use of castor oil. As a doula, under these circumstances, I am within my scope to provide evidence-based information (if requested to do so) on this topic and similar ones, but would never suggest that a client use such methods without first consulting with her primary care provider. I am not a healthcare provider and, consequently, I am neither in a legal nor ethical position to assess whether this is an appropriate or safe measure for any pregnant woman to take. Furthermore, I'm not prepared to bear the legal and emotional responsibility from offering service to clients outside my scope.

Now, for something else that goes beyond providing unauthorized advice, it's time to address contradictory advice. I'm not talking about contradictory advice given by different practitioners to the same patient. I'm referring to doulas or other non-clinical professionals providing advice that contradicts specific instructions or recommendations given by a member of a client's clinical team. I, for one, automatically assumed that this was a given before I even attended my training. This is one of the reasons why I was taken by such surprise when I read the aforementioned article about one mother's traumatic birth experience. In her article, she expressed numerous encounters with her doula where she (the doula) was giving her advice that she knew was against the instructions provided by the mom's care provider.

Granted, it's true that sometimes a pregnant woman will question the advice given by her care provider. The only way a doula can become involved in the potential resolution of this dilemma is to support the client in advocating for herself and helping her to acquire that valuable evidence-based information. This course of action does not venture outside the doula's scope as it supports the mom in her birth choices and encourages her to advocate for herself and her baby.

Doulas have to be very conscious of their agenda when it comes to caring for their clients and that should always be to support them in their individual birth choices. If we cannot do this, we should not take these prospective clients on. We are not obligated to support pregnancy, birth, or postpartum related choices that we are not comfortable with and we may occasionally find ourselves in this position. However, this never gives us the go ahead to offer unauthorized advice.

I will not provide doula support at an unassisted birth, due to the professional risks involved. I am not prohibited from attending these births; however, I am not prepared to be accountable for the potential consequences that may result from working in this type of environment. As a doula, it is wise to avoid putting yourself in a situation where you may struggle to provide the support your client needs. You just need to figure out the degree to which this limits you in your career and whether or not being a doula still feels right for you. Being respectful of the role of a client's clinical support team is not an option and it is never our place to create a wedge between a client and her clinician.

The bottom line is that moms and babies are precious and so are the doulas that support them. I feel it's always important to acknowledge when someone speaks out about a doula that provides assessment or tasks that lie outside her role or professional purpose. It's important because it shows people that these unfortunate incidences are concerning to most of us doulas and that we are also genuinely affected by them as a professional community.

Many doulas are trained through professional organizations, such as myself, and have a certain set of guidelines that we are expected to adhere to. We know that these guidelines are in place to protect our clients, to protect us as individual doulas and to protect our professional identity as a whole.

I sincerely appreciate that this mom took the time to share her story with the world. She has indicated that even after her experience, she values the genuine role that doulas have and is confident that she would hire another one for her next pregnancy.

The good news is that for every not so great childbirth professional, there are many others that will meet or exceed your expectations.

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Perineal Massage: Why Has It Become So Necessary?

3/26/2014

Dear expectant mom,

I’m sorry to have to tell you this, but your perineum may not stretch properly on its own during the pushing stage of childbirth so, if you want to have a fighting chance at keeping it intact, you better get your vegetable oil out of the kitchen cupboard and get to work (and I’m not referring to cooking)!

At face value, perineal massage seems like a sensible proactive measure to prevent perineal tearing during delivery. And don’t get me wrong, I have introduced the idea to my own clients, and it appears that it can work wonders. The real issue lies with why it has become so necessary in our society. Weren’t our bodies designed to give birth without injury? If the answer were no, we’d have to assume that tearing during childbirth is normal. Thankfully, that is not the case.

Is perineal tearing common? Definitely. Is it normal? No! So why do so many women tear during delivery? Well, first of all, there are different factors that can affect our perineums’ ability to stretch; however, there is something to be said about the effects of relaxation on a woman’s body during labour. Relaxation not only helps labouring women to cope better with contractions, but also allows the pelvis to open up, making way for the descending baby. Deep breathing, frequent movement, visualization, and continuous emotional support are all essential in promoting and maintaining relaxation and tension release.

Although there may be other factors involved, a woman’s ability to relax depends heavily on her personal circumstances during pregnancy, how she generally views birth and the treatment she receives during labour. With regard to how society regards birth, often a major influence on how women of childbearing age view birth, let’s focus on the epidemic of fear.

We’re so often concerned – no, terrified – that something bad is going to happen during childbirth so we automatically decide that a hospital birth attended by doctors is the only reasonable path to take. And I’m not talking about women with high risk pregnancies. I’m talking about healthy women that are terrified of birth. We’re often conditioned to accept that birth will be painful. Many of us will hear this from the people we trust, such as our own mothers and close friends. We’re not taught how to manage and work with this intensity, which as early on as possible we’re conditioned to perceive as pain; instead, we’re taught to eliminate it. I’m referring of course to the general, overwhelming message of fear that affects so many childbearing women in our society. This, essentially, is what too many of us are thinking: “Medical interventions are normal and I expect that I will need them.”

I am totally in support of a woman’s choices with regard to where, how, and with whom she gives birth; however, this just simply doesn’t warrant the dismissal of the underlying reasons for choices made due to fear and we have to start acknowledging them. After all, who the heck wants to have a fearful birth? Our well-meaning friends and relatives who tell us to get an epidural as early on in labour as possible are trying to spare us from the pain they genuinely believe we are bound to have – a perfect example of how these deeply imbedded beliefs fuel the lack of trust in the labouring body. And the result is that women are scared from the get-go. How can any part of their bodies, let alone the pelvic floor muscles and the perineum, relax during a tense and fearful labour?

A tense body paired with labour is a poor match – plain and simple. Tension inhibits the natural progression of labour and can act as a major source of resistance, making it more difficult for baby to move downward through the pelvis. It’s time for your baby to enter the world and you’re, unconsciously, keeping her in! Yes, this really does happen! Fear and tension have been known to stall natural labour or, in some cases, stop it completely.

Tension affects delivery in the same way. When the baby’s head is emerging, the perineal tissue is more likely to stretch effectively, and not rupture, if it is completely relaxed. You’re literally holding your baby in, if you are squeezing and pulling the tissues inward, especially if you’re on your back.

Fear can easily lead to anxiety and sometimes panic. Intensifying contractions can become quickly overwhelming for a woman who perceives them as painful and frightening. Many of these women will end up with an epidural, especially after the introduction of Pitocin. Yes, some women do have a lower pain threshold than others, but pain tolerance is not exclusively dependent on fear. Pain thresholds exist, but general fear surrounding birth doesn’t have to.

After an epidural, it’s a given that you lack normal sensation. You can’t feel your contractions, you can’t move around, and your perineum is pretty much numb. If a labouring woman can’t feel her contractions, how will she know when to push? If she has chosen to employ minimal pushing, how is she going to get that baby to move all the way down toward the vaginal opening when she is lying flat on her back with an epidural?

A woman is more likely to encounter perineal tears if she has an epidural. In North America, hospital staff will often coach a woman through the process of ‘purple pushing’ when an epidural has been administered, and sometimes when it has not. This type of pushing boils down to pushing as hard as one can with each contraction until the doctor arrives for the actual delivery. Not only does this process exhaust the woman, but it doesn’t allow her perineum the kind of time it requires to stretch slowly enough to allow baby’s head to pass through, leaving the tissues unscathed. If the baby’s head appears to be stuck, which is not unusual when mom is lying flat on her back, an episiotomy or instrumental delivery may be ‘required’ to facilitate delivery of the head. If taken, this step can result in complications to mom and/or baby.

When so many women are having epidurals, what other choice do many birth professionals, like myself, have other than to recommend something like perineal massage? It’s just a fact that if you’re not labouring naturally, you cannot fully tune in to what your body is telling you to do, including when to push and when not to push. We have to keep teaching women to listen to their bodies and to trust in their natural ability to birth their babies.

The title of this article pertains to perineal massage and why it has become so necessary in our society; however, the roots of this issue delve so much deeper into the powerful culture of fear surrounding birth. In many areas, we are successfully managing to re-teach and re-connect women to the joy and satisfaction of labouring naturally and labouring naturally for longer through doula support and programs such as HypnoBirthing® education. We must not underestimate the value of women labouring naturally for longer, even if they do end up with an epidural. The longer they can go before pain medication, the longer baby will have to move downward with the aid of gravity and the benefit of cues from his mom’s naturally labouring body. Hopefully, ACOG’s revision of when active labour begins (from 4cm to 6cm), will play a role in allowing women to labour for longer in hospitals without interventions.

Gloria Lemay, in a 2008 blog article, had this to say about perineal massage:

“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.”

To a certain extent, I do agree with this statement; the intro to this post demonstrates this point well, and was intended to portray this attitude, but the fact still remains that not all women choose to have a natural labour and others plan for a natural one, but end up with some form of analgesic-induced intervention – namely an epidural. How else can we help these women, especially first-time mothers, to prepare for an intact perineum other than to suggest perineal massage during the last 6 weeks of pregnancy? For this reason, I continue to mention the prospect of perineal massage to clients concerned about perineal tearing and episiotomies, but only as an add-on to learning to relax the pelvic floor muscles. The use of perineal massage doesn't guarantee an intact perineum, but research has certainly indicated that it can reduce the likelihood of an episiotomy and the extent of damage to the perineum, especially with regard to first-time deliveries.

No woman should be made to feel bad about her birthing choices and if childbirth professionals can step out and encourage a change in the way society looks at and feels about birth, we can help to eradicate the fear surrounding birth and encourage expectant mothers to make the best decisions for their babies and themselves.

Please review the sources below for more information on the effectiveness of antenatal perineal massage:

Canadian study
Cochrane summary
Examination of the evidence

Photo link