Baby Massage
Baby massage can be a good thing for both parent and child because:
It's a good bonding experience - a good way for you and your baby to get to know each other and to spend a bit of quality time together.
Studies have suggested that physical contact is good for babies, improving their breathing, circulation, digestion and growth.
It provides a good source of sensory and muscle stimulation, which is beneficial to all babies, but may be particularly good for babies with special needs, such as developmental disabilities and Down's syndrome.
Baby massage is even claimed to combat postnatal depression in mothers, according to a BBC News Report on baby massage and post-natal depression.
It relaxes both parent and child.
It's fun for both of you.
Some health professionals feel that you should not carry out massage on newborn babies, or should wait until they have had their first full course of immunisations (at around 3-4 months). Conversely, others feel you should start as soon as possible, as massage can help to provide a smooth transition from the womb to the outside world and that massage is particularly beneficial to premature babies. Massage is also a popular option for coping with colic, a problem normally only encountered in babies under 3-4 months. If you have any concerns about massaging your baby - and especially if your baby is sick - you should consult an appropriate health professional first. In any case: never massage a baby if the baby seems uncomfortable.
Setting Up
You will need:
Some massage oil - Make sure that the oil is suitable to use on a baby. Most massage oils - including those sold as 'baby massage oil' - tend to include a fragrance. Chances are that your baby will end up ingesting some oil, for instance by putting their massaged hands in their mouth, so you really want to make sure it is safe. A simple oil like pure almond or olive oil is best, but if in doubt, ask for advice before buying.
A warm room - Your baby is going to be stripped right down to the skin and therefore needs to be in a warm environment. Also remember that babies are not good at regulating their body temperature and cool down much quicker than adults do. Before you begin, consider getting an extra heater going in the room and close all doors and windows. Watch out for draughts, especially if the baby will be on the floor. Make sure that you are dressed appropriately for the temperature of the room and that your clothing is as comfortable as possible.
A comfortable surface - You need something soft, warm and well-cushioned for the baby to lie on. At the same time the surface needs to be able to cope with accidents - remember, your baby is going to be without a nappy! Something like a thick towel on top of one of those plastic-covered changing mats would be ideal. Have a spare nappy to hand in case of accidents. You also need a safe place to put what is likely to become a rather messy bottle of massage oil. Keep it away from carpets and soft furnishings1.
A chunk of time - Try to pick a time when you will not be disturbed and when you both can relax. For your baby, it should not be too soon after a feed (who wants to be poked with a full tummy?), or so close to a meal that the baby will be hungry and distracted. Equally, don't pick a time when your baby is really tired and just wants a bit of peace, although don't be surprised if they nod off during the massage. After your baby's bathtime might be a good idea, provided they are not too sleepy. Also make sure that you pick a time when you can put aside thoughts and worries about chores or work. Remember that your baby relies on non-verbal communication and will pick up on your mood if you are tense. Relax, so that you are only transmitting good vibes to your child. Try to set aside around half-an-hour at a time for a baby massage.
A good atmosphere - Don't try and watch telly and massage your baby at the same time. This is not an opportunity to catch up on the news, or on your favourite soap opera or quiz show. If you want something on in the background, then play some gentle instrumental music or put on an 'ambient music' video. Dimming the lights, or lighting a candle might also help.
Before You Begin
Make sure you really are comfortable and relaxed and that you have everything to hand. Do a bit of deep slow breathing to make sure you're not tense.
Undress your baby and pop a clean nappy under the baby's bottom (if you decide you don't want to take any risks with accidents!).
Warm up: shake your hands vigorously to loosen them up. If it's your kind of thing you may want to envision energy flowing from your body and down into your hands.
Pour a generous amount of oil on your hands and rub them together, before touching your baby, to warm the oil. This also gives your baby a visual and aural cue that there is a massage on the way.
Some General Rules
Baby massage can be quite different from adult massage, both in terms of strokes and techniques. Baby massage should never be probing, but should also not be so light as to tickle the baby. Of course you need to be most gentle on tiny babies: a standard recommendation is to place your finger on your closed eyelid and press lightly, stopping before it feels uncomfortable. Use this as a gauge for how much strength to use on a new baby. For older babies, be quite firm as babies prefer confident handling. Think about what you would enjoy and then watch your baby for reactions.
On the trunk, always massage from your left to right (that's from your baby's right to left). This follows the direction of flow in the digestive system, so that you are working with the baby's organs - not against them. Use your 'main' hand - that is your writing hand - for the major part of the strokes.
Standard Strokes
These are the strokes mentioned in the massage routine suggestions. They can be used on many different parts of the body.
Open Book (Used on Chest, Back and Forehead)
Place your hands together palm to palm, in a 'praying' gesture, with your fingertips pointing towards the baby's head, your thumbs uppermost. Now imagine that your hands are a closed book, and your thumbs are the spine. Place your little fingers - they are the edges of the pages - against the baby's skin and 'open' the book by spreading your hands, until your thumbs - still touching each other - reach the baby's flesh. Separate your hands and continue to move them outward across your baby in one smooth motion.
Milking (Used on Arms and Legs)
Starting at the top of the limb and squeezing gently, move your hand down to the wrist or ankle. Imagine that you are milking a cow, or squeezing the filling out of a sausage. As one hand reaches the wrist or ankle, start at the top with the other hand so that there is a continuous stroking effect.
Rolling (Used on Arms and Legs)
This is a classic massage stroke - you have probably seen it, even if you've never done it. Place your non-writing hand under the limb and your main hand above. Roll the limb between the hands - you'll probably find you do this by moving your main hand rapidly and your other hand hardly moves at all. Then move gradually down the limb.
A Sample Massage
You may wish to practice first on a doll or teddy bear, so that you can relax and handle your baby confidently.
Different babies enjoy different things, so feel free to adapt the order of these sections, or miss out the parts of a routine your baby doesn't enjoy.
To start with, try doing each major stroke five times - strokes on the hands and feet tend to be repeated five times anyway - one for each digit.
Place the baby on their back, feet towards you.
Chest and Stomach
Open book on the baby's chest, spreading out around the baby's ribcage and under the arms.
Open book again on the baby's chest, but this time going up to the collar bone, shoulders and tops of arms.
Stroking neck - place your hand diagonally on the centre of your baby's chest, so that your fingertips point to one shoulder. Push your hand up and over the shoulder so that your fingers go under the chin and into the crease against your baby's neck. Do the same with the other hand on the opposite shoulder.
Arched window - place two fingers of your main hand at the very top of your baby's right thigh, and run them up, under the curve of the ribcage, and down to the same point on the left side. You should have drawn the shape of an arched window, or an upside down 'U'.
Scooping in the sand - now place the side of your curved hand in the arch under the ribcage, and bring it down towards the groin, as if you were scooping a hole in sand. Do this five times with each hand and then again with your main hand, holding the baby's legs up with the other.
Sunrise and sunset - hold your hand so that the palm is above, but not touching, the baby's groin and the upper half of all the fingers is resting on the point at the very top of the baby's right thigh so that your hand is diagonal to the baby's body. Turn your wrist and sweep your hand around until your fingertips touch the same point on the left thigh, keeping your palm in roughly the same place, just twisting on the spot. Your fingertips should then have drawn a low, round arch. As one hand reaches the end of this arch, start the other off on the same path, so that one hand follows the other, over and over.
Walking your fingers - starting at the baby's right side, walk your fingers in a horizontal line just above the belly button, then slide back.
Thumb bird - place your thumbs together and stretch your palms out, as if you were miming a bird. Place your thumbs on the centre of the baby's stomach and wrap your hands around the waist. The tips of your thumbs should come up just above the belly button. Then separate your thumbs, stroking across the stomach and round the baby's sides.
Arms and Hands
Milk the arm, making sure you get into all the creases, especially behind the elbow.
Roll the arm.
Stroke the back of the hand, starting at the wrist and going down over the top of each finger in turn.
Do the same on the palm of the hand. As you reach the tip of each finger, give it a little roll between your fingers.
Draw small circles around the knobbly wrist bone.
Armpit - raise your baby's arm above their head and flat onto the towel. If your baby stiffens their arm, try jiggling it gently from the elbow until they relax. With your other hand stroke down the inside of the upper arm and into the cavity of the armpit, and off. Make sure this one touch is firm so that it does not tickle.
Movements: holding it by the wrist, take one arm down to the baby's side, then up and across to the opposite collarbone, in the style of a Roman salute. Make sure you return the arm to the baby's side afterwards and do this five times with each hand. Now take a wrist in one hand and the opposite foot in the other. Bring the two together, meeting somewhere over the baby's belly button, making sure that you return both limbs to the ground between movements and repeat five times with each side.
Legs and Feet
Start with the left leg - milk the leg, making sure you get into all the creases, especially behind the knee, then roll the leg.
Squeeze and twist the leg, in the style of a 'Chinese burn2' - but gently and with plenty of oil! Work your way down the leg.
Stroke the top of the foot, going down over the top of each toe in turn.
Do the same on the base of the foot, starting at the heel. As you reach each toe, give it a little roll between your fingers - this can be quite difficult if your fingers are slippery! If your baby has their toes curled over, try putting your thumb at the base of the toes and pushing gently and repeatedly, until they relax.
Use your thumb to press in all over the base of the foot.
Draw small circles around the ankle bone on the outside of the leg.
Then switch to the right leg and do the same.
Place the palm of each hand at the top of a thigh, with the side of your index finger in the crease between thigh and stomach. Stroke inwards down the side of the groin. Note that this is as close as you should ever get to the genital area in baby massage.
Place one hand under each buttock and massage it, then bring your hand out along the underneath of the leg and down to the feet, pulling ever so gently. Give a little shake and then let go when you get to the feet. Try saying 'round and round and round we go - and all the way out and down to your toes!'
Movements: lift one ankle and bend the knee so that the back of the heel of that foot touches the inside of the knee of the other leg - as if your baby was hopping. Repeat five times with each foot and then alternate left and right feet. Finally, cross legs to knees left over right and right over left, and repeat five times.
The Back
Turn your baby until they lie on their front. Some babies love this, while some hate it - it may depend on their age and upper body strength. If your baby won't lie happily on their front, try holding them to your chest with their head lying on, or over, your shoulder or, if they are old enough, sitting up, perhaps in the crook of your leg to hold them steady.
Use the open book technique, down below their arms onto their ribs, and up over their shoulders.
Lay both palms perpendicular to the baby's spine and move your hands back and forth, working your way gradually down to the small of the back.
Use the tips of two fingers to draw small circles all over the back, working roughly from top to bottom. Try to draw the circles by shifting the skin, rather than moving your fingers over the skin.
Use the tip of all the fingers on one hand to come down the spine, and in a curve from the outer edge of the shoulders and down the spine. If your baby is lying down you can continue these strokes over the bottom and down the legs.
Face and Head
This is perhaps the section that most babies like least. If your baby doesn't want it, simply miss it out. If you baby likes it, try inserting it earlier on into the massage, when the baby is still lying on its back.
Most of the following strokes use the tips of the first two fingers of each hand, working symmetrically on both sides of the face at the same time.
Use the open book technique on the forehead, but just using the upper half of your fingers.
Use your thumbs to stretch the forehead gently, pulling outwards from the centre.
Draw the tips of your forefingers down the jawbone from the front of the ear until your fingers meet on the chin.
Draw small circles on the skin above the hinge of the jaw in front of the ears.
Stroke from the bridge of the nose, down the sides of the nose and across the cheekbones.
Stroke from the bridge of the nose along the eyebrows.
Run the pads of your thumbs gently down from the centre of the eyebrow and over the eyelid, closing the eyes in the process. Some parents even swear by this as a way of encouraging sleep!
Stroke the top lip, finishing in an upward stroke, making the shape of a smile.
Do the same with the lower lip.
Run a fingertip around the inside of the curve of the ear, top to bottom, and then without breaking contact, round the outside of the back of the ear, again top to bottom.
Run the flat of all your fingers from the temples, up and round the side of the head, down behind the ears and along the jawbone, so that your hands meet at the tip of the chin.
Finding Out More About Baby Massage
Only so much of massage that can be learnt from a written description. If you would like to learn more, you may wish to attend a baby massage course. You could ask your midwife, health visitor, medical centre or maternity hospital for details of local teachers or courses - some of which may be free. If you are in the UK, you could check with your local branch of the The National Childbirth Trust or you could contact your national chapter of The International Association of Infant Massage. If you cannot find a course that suits, then there are a number of baby massage videos available.
When is My Child too Old for Baby Massage?
Some babies go off massage when they start to crawl and just get too wriggly - don't worry if this is the case - you're not doing anything wrong. You may find that your child is willing to start again when he or she is a little older, and by then you may find that they are old enough to respond and tell you which strokes they like best. This Researcher's massage teacher said that the best time to quit is when they are old enough to give a massage to you.
1 However, this Researcher has discovered, by happy chance, that spilled sweet almond oil removes watermarks from coffee tables, brings up teak a treat and puts a lovely shine on wooden doorknobs.
2 'Chinese burn' is one name given to the painful playground trick of gripping someone's bare arm tightly with both hands touching each other, then rotating the hands in opposite directions
Source : http://www.bbc.co.uk/dna/h2g2/A880670
Showing posts with label massage. Show all posts
Showing posts with label massage. Show all posts
Sunday, May 9, 2010
Thursday, May 6, 2010
How to avoid an episiotomy
Perineum Massage
Starting around 34 weeks, you could try massaging your perineum (the area around your vagina). Daily perineal massage may increase the area's stretching ability, leading to less need for an episiotomy and fewer natural tears (lacerations).
Try this technique yourself, with clean hands and trimmed nails, or have your partner do it for you. If you're going solo, have a large mirror handy so you can see what you're doing and to help familiarize yourself with your perineal area.
• Sit in a semi-reclined position in a warm, comfortable area, spreading your legs apart. Lubricate your fingers, thumbs, and perineal area with vitamin E oil (from punctured vitamin E capsules), pure vegetable oil, or personal lubricant. Don't use baby oil, mineral oil, or petroleum jelly.
• Place your thumbs about 1 to 1 1/2 inches (to or just past your first knuckle) inside your vagina and spread your legs. Press down toward the rectum and toward the sides at the same time. Gently and firmly continue stretching until you feel a slight burn or tingling.
• Hold this stretch for about two minutes — until the tingling starts to subside.
• Now slowly and gently massage the lower part of the vagina back and forth, hooking your thumbs onto the sides of your vagina and gently pulling the tissue forward, as your baby's head will do during delivery. Keep this up for three to four minutes.
• Finally, massage the tissue between the thumb and forefinger back and forth for about a minute.
• Be gentle because a vigorous touch could cause bruising or swelling. During the massage, avoid pressure on the urethra (urinary opening) as this can lead to irritation or infection.
Of course, perineal massage isn't for everyone and it may not help in every case. The most important thing you can do is to choose a midwife or doctor who's experienced and comfortable delivering babies without doing episiotomies. In general, midwives tend to perform this surgery less often than physicians. Regardless of the type of practitioner you choose, discuss your wishes and expectations with that person before the birth.
Relaxation and Lubrication
The number one way to prevent an episiotomy is relaxation. Pick up a book on focused breathing or relaxation during delivery (hypnobirthing is great for this!). Also, check with your OB to see which oils are allowed during labor - extra lubrication can also reduce the likelihood of a tear.
Practice Positions
Preparing for birth by squatting is a time honored and common sense practice that helps stretch all the areas that will be affected during childbirth. It is a natural and helpful posture to use in addition to walking during labor anddelivery.
BirthBall
Sitting on a birthing ball while you are in early to mid labor help stretch out the area. Making it easier for baby to come through.
Kegel Exercises
My OB for my first child did not believe in doing episiotomies. She recommended doing kegel exercises, to strenghten the muscles, and stretching exercises. She would give instructions every month on different exercises to help with delivery. I followed every one, and when it came to the delivery, I didn't even tear a little bit, nothing. She helped guide the baby out with ease. My son was a big baby and his head was huge for a newborn of his size, I barely just got him out, but still no rips. Afterwards I was walking and back to normal within a few hours. I couldn't even tell that i just popped a child out. With this child I'm carrying now, I have a new OB but I clearly stated that i refused to have one done because I still do my exercises regularly...oh and the bonus of these exercises is they also help with increasing your orgasms and make sex feel much more intense.
Perineal Massage
In a study, researchers asked women to massage themselves every day and found 24% of first time mothers did not tear, while only 15% of those who did not do the perineal massage did not. Perineal stretching seems to help both psychologically as well as physically. Most women (85%) who preformed the massage would recommend it to other pregnant women!
To perform a perineal massage, a woman or her partner places one or two fingers about an inch to an inch and a half into the vagina. Use almond oil, K-Y jelly, pure vitamin E oil, wheat germ oil or other lubrication. Gently stretch the lower part of your vagina, gently stretching the perineum, until you feel a slight burning or stinging sensation for several minutes. Concentrate on relaxing the tissues through the stretch. Then, gently, massage your lower vagina with your thumbs for several more minutes, avoiding the urinary opening.
In addition, oils can also be massaged into the perineum daily to help avoid episiotomy.
During Birth - Breathing
Focus on your throat while giving birth. The throat has a connection to the vagina. As you breathe deeply, try to open and relax the throat. As you relax, imagine all the oxygen getting to the cells of the vaginal walls… nourishing them with rich oxygen and making them more resilient and stretchy.
During Birth - Perineal support, compresses and oils
Olive oil or mineral oil gives a slippery quality to the perineum. It feels like hands move more easily over the skin without dragging or causing irritation. Use verbal imagery when applying the oil. "I'm going to put some oil down here now to help the baby slide out." Women find it a relaxing and reassuring image and it seems to help them believe in their ability to deliver intact.
Warm compresses at the perineum feel great and encourage relaxation of tissues. Do not use hot compresses, as temperatures that are too warm can bring excess blood flow and cause swelling.
Castor oil packs for the perineum can help relieve prenatal pain around the perineal region as well as make your tissues supple and help prevent tearing when you give birth. Castor oil has healing and restorative properties so the relief builds up over time and the heat increases blood flow to the area, relieves pain, improves circulation and relieves venous congestion. You have to use cold pressed castor oil. Soak an old washcloth or a flannel in the oil, wring it out and put it right on your perineum. Then cover that with something waterproof and put a heating pad of some sort on (electric, microwave, hot water bottle, it won't matter.) Cover the compress because the castor oil will stain and also to avoid shock if you use an electric heating pad. Leave it as long as you can but at least 30 minutes. You can't do it too much, and it can only help not hurt.
Additional practices to avoid:
Starting around 34 weeks, you could try massaging your perineum (the area around your vagina). Daily perineal massage may increase the area's stretching ability, leading to less need for an episiotomy and fewer natural tears (lacerations).
Try this technique yourself, with clean hands and trimmed nails, or have your partner do it for you. If you're going solo, have a large mirror handy so you can see what you're doing and to help familiarize yourself with your perineal area.
• Sit in a semi-reclined position in a warm, comfortable area, spreading your legs apart. Lubricate your fingers, thumbs, and perineal area with vitamin E oil (from punctured vitamin E capsules), pure vegetable oil, or personal lubricant. Don't use baby oil, mineral oil, or petroleum jelly.
• Place your thumbs about 1 to 1 1/2 inches (to or just past your first knuckle) inside your vagina and spread your legs. Press down toward the rectum and toward the sides at the same time. Gently and firmly continue stretching until you feel a slight burn or tingling.
• Hold this stretch for about two minutes — until the tingling starts to subside.
• Now slowly and gently massage the lower part of the vagina back and forth, hooking your thumbs onto the sides of your vagina and gently pulling the tissue forward, as your baby's head will do during delivery. Keep this up for three to four minutes.
• Finally, massage the tissue between the thumb and forefinger back and forth for about a minute.
• Be gentle because a vigorous touch could cause bruising or swelling. During the massage, avoid pressure on the urethra (urinary opening) as this can lead to irritation or infection.
Of course, perineal massage isn't for everyone and it may not help in every case. The most important thing you can do is to choose a midwife or doctor who's experienced and comfortable delivering babies without doing episiotomies. In general, midwives tend to perform this surgery less often than physicians. Regardless of the type of practitioner you choose, discuss your wishes and expectations with that person before the birth.
Relaxation and Lubrication
The number one way to prevent an episiotomy is relaxation. Pick up a book on focused breathing or relaxation during delivery (hypnobirthing is great for this!). Also, check with your OB to see which oils are allowed during labor - extra lubrication can also reduce the likelihood of a tear.
Practice Positions
Preparing for birth by squatting is a time honored and common sense practice that helps stretch all the areas that will be affected during childbirth. It is a natural and helpful posture to use in addition to walking during labor anddelivery.
BirthBall
Sitting on a birthing ball while you are in early to mid labor help stretch out the area. Making it easier for baby to come through.
Kegel Exercises
My OB for my first child did not believe in doing episiotomies. She recommended doing kegel exercises, to strenghten the muscles, and stretching exercises. She would give instructions every month on different exercises to help with delivery. I followed every one, and when it came to the delivery, I didn't even tear a little bit, nothing. She helped guide the baby out with ease. My son was a big baby and his head was huge for a newborn of his size, I barely just got him out, but still no rips. Afterwards I was walking and back to normal within a few hours. I couldn't even tell that i just popped a child out. With this child I'm carrying now, I have a new OB but I clearly stated that i refused to have one done because I still do my exercises regularly...oh and the bonus of these exercises is they also help with increasing your orgasms and make sex feel much more intense.
Nutrition
Good nutrition and hydration are very important for tissue health and elasticity. "Good nutrition is vital to your body's work in preparing the perineum for stretching during birth. Hormonal changes during pregnancy cause the tissues of your cervix and perineum to become extremely thick and elastic. Crucial to this process is an adequate intake of protein, vitamin E, and short-chain fatty acids, which consist of two types of 'good' fat, Omega-3 and Omega-6. Short-chain fatty acids are found in nuts and seeds, cold-pressed oils, all types of beans, and fish such as salmon and tuna" "Avoiding an Episiotomy", Nancy Griffin, Mothering Magazine, # 75, summer 1995, (p 60).
Vitamin E can be especially helpful (at least 1,000 mg per day). Food sources include: Wheat germ oil, wheat germ, sunflower seeds, almonds, pecans, safflower oil, peanuts, corn oil, soybean oil, and lobster.
Vitamin C is also very beneficial for tissue health, cellular integrity, elasticity and regeneration.
Bioflavanoids. These are the compounds that make oranges orange, blueberries blue, and cherries red. These crystalline compounds give foods their bright colors and great taste. More than 4,000 flavonoids are known. While sometimes-called vitamin P, they are not truly vitamins. The medicinal effects of many foods and herbs are due to their flavonoid content. The most well known flavonoids are PCOs (proanthocyanidins), quercetin, citrus bioflavanoids, and green tea polyphenols. Some foods rich in flavonoids are blueberries, cherries, citrus fruits, pears, grapes, cabbage, legumes, plums, and onions.
During Birth -- Positioning
Recommended positions:
Avoid unnecessary pushing. This is commonly encouraged by impatient care providers and involves pushing before the mom feels an urge to push or before the head is reasonably low and is mostly rotated into the optimal orientation for birth. This is best avoided altogether.
True pushing occurs when the mom feels an uncontrollable urge to push because the baby's head is putting pressure on the nerves of the pelvic floor. This almost certainly means the head is low and rotated into birth position. This takes however long it takes for the mom to get the hang of it and to push the baby out. If the mom's instinctive pushing efforts are moving the baby, it doesn't make sense to mess with it.
Be wary of olympic-style "purple pushing" (the Valsalva maneuver), where the mom is encouraged to hold her breath and use all the muscles in her body, may occasionally be helpful; but it also can impede venous return and cause the swelling mentioned above.
Stop pushing when the head has been pushed through the pelvis and is beginning to stretch the perineum. Once the head is through the pelvis, it's just the delicate perineal tissues that are holding the baby in, and this is where a woman's perineum is either protected through careful coaching and hand maneuvers or allowed to tear through ignorance or a rush to get the baby out.
Ideally, the care provider is maintaining a good connection with the birthing woman. By letting her know through words, tone and manner that this is the time to stop pushing and simply to breathe the baby out, i.e. avoid putting any voluntary efforts behind the uterus, which is "pushing" all on its own. "There is a time to push, and a time simply to breathe". Prolonging the unnecessary phase of pushing may contribute to tearing, but prolonging the very end of pushing is likely to reduce tears, rather than cause them.
"When your baby's head no longer disappears back inside you after a contraction, it is about to slip out. At this point, not pushing can allow you to stretch without tearing. You may feel pressure, heat or burning. This too shall pass!"
To help women in second stage stop pushing when we are attempting intrauterine resuscitation (or waiting for the MD). Instead of telling her to "Stop pushing!" over and over, rock her hips side to side and tell her to "Rock your baby." The motion of the hips keeps the abdominal muscles from coming fully into play for a push effort and prevents an all out bearing down. Besides it is much nicer to say gently "Rock your baby." than commanding "Don't push, don't push." We want to have S L O W crowning and head birthing, supporting the tissues as the baby is born. It is important to ease shoulders through slowly, arms close to the chest.
Preventative: Exercises and Tissue Health
A good foundation in prenatal exercise is helpful. It is beneficial for circulation, which keeps tissues supple.
Kegel exercises for tissue health and elasticity. A Kegel is the name of a pelvic floor exercise, named after Dr. Kegel who discovered the exercise. These muscles are attached to the pelvic bone and act like a hammock, supporting your pelvic organs. To try and isolate these muscles, try stopping and starting the flow of urine. Once you have located the muscles simply tighten and relax the muscle over and over, about 200 times a day. These are basic Kegels. There are many variations on Kegels: elevator Kegels (Where you tighten slowly, in increments going in and out, like an elevator stopping on several floors.), you can hold the muscle tightened for five seconds, you can bulge the muscles out at the end, and many other variations.
Sexual activity, especially orgasms, help increase blood flow to the area thereby enriching the health and stretching ability of the tissues.
Good nutrition and hydration are very important for tissue health and elasticity. "Good nutrition is vital to your body's work in preparing the perineum for stretching during birth. Hormonal changes during pregnancy cause the tissues of your cervix and perineum to become extremely thick and elastic. Crucial to this process is an adequate intake of protein, vitamin E, and short-chain fatty acids, which consist of two types of 'good' fat, Omega-3 and Omega-6. Short-chain fatty acids are found in nuts and seeds, cold-pressed oils, all types of beans, and fish such as salmon and tuna" "Avoiding an Episiotomy", Nancy Griffin, Mothering Magazine, # 75, summer 1995, (p 60).
Vitamin E can be especially helpful (at least 1,000 mg per day). Food sources include: Wheat germ oil, wheat germ, sunflower seeds, almonds, pecans, safflower oil, peanuts, corn oil, soybean oil, and lobster.
Vitamin C is also very beneficial for tissue health, cellular integrity, elasticity and regeneration.
Bioflavanoids. These are the compounds that make oranges orange, blueberries blue, and cherries red. These crystalline compounds give foods their bright colors and great taste. More than 4,000 flavonoids are known. While sometimes-called vitamin P, they are not truly vitamins. The medicinal effects of many foods and herbs are due to their flavonoid content. The most well known flavonoids are PCOs (proanthocyanidins), quercetin, citrus bioflavanoids, and green tea polyphenols. Some foods rich in flavonoids are blueberries, cherries, citrus fruits, pears, grapes, cabbage, legumes, plums, and onions.
During Birth -- Positioning
Recommended positions:
- Water birth encourages "good mechanics" A mom can float into a very natural relaxed position. She can push as she feels a need to. She may be more relaxed -- no one is flexing the head or has their fingers in her vagina. The warm water soothes and takes away the sting of crowning, so she is more able to slowly birth the head (some women push like gangbusters just to get the crowning over with!). There are very few tears in water births.
- Squatting (can be done with a birthing bar or directly on the bed with support from labor partners) helps reduce tearing. It shortens the length of the vaginal canal and increases the diameter.
- Lying on left side Most women do better if they lie on their left side to avoid tearing.
- Any back lying position, including semi-sitting
- Widely flexed legs -- lithotomy position or any back lying.
- Coached pushing -- Standard American births, we coach to PUSH HARD until full crowning -- then tell the mom to slow down. This is TOO LATE!
- Rushing the shoulders -- standard in the US.
Avoid unnecessary pushing. This is commonly encouraged by impatient care providers and involves pushing before the mom feels an urge to push or before the head is reasonably low and is mostly rotated into the optimal orientation for birth. This is best avoided altogether.
True pushing occurs when the mom feels an uncontrollable urge to push because the baby's head is putting pressure on the nerves of the pelvic floor. This almost certainly means the head is low and rotated into birth position. This takes however long it takes for the mom to get the hang of it and to push the baby out. If the mom's instinctive pushing efforts are moving the baby, it doesn't make sense to mess with it.
Be wary of olympic-style "purple pushing" (the Valsalva maneuver), where the mom is encouraged to hold her breath and use all the muscles in her body, may occasionally be helpful; but it also can impede venous return and cause the swelling mentioned above.
Stop pushing when the head has been pushed through the pelvis and is beginning to stretch the perineum. Once the head is through the pelvis, it's just the delicate perineal tissues that are holding the baby in, and this is where a woman's perineum is either protected through careful coaching and hand maneuvers or allowed to tear through ignorance or a rush to get the baby out.
Ideally, the care provider is maintaining a good connection with the birthing woman. By letting her know through words, tone and manner that this is the time to stop pushing and simply to breathe the baby out, i.e. avoid putting any voluntary efforts behind the uterus, which is "pushing" all on its own. "There is a time to push, and a time simply to breathe". Prolonging the unnecessary phase of pushing may contribute to tearing, but prolonging the very end of pushing is likely to reduce tears, rather than cause them.
"When your baby's head no longer disappears back inside you after a contraction, it is about to slip out. At this point, not pushing can allow you to stretch without tearing. You may feel pressure, heat or burning. This too shall pass!"
To help women in second stage stop pushing when we are attempting intrauterine resuscitation (or waiting for the MD). Instead of telling her to "Stop pushing!" over and over, rock her hips side to side and tell her to "Rock your baby." The motion of the hips keeps the abdominal muscles from coming fully into play for a push effort and prevents an all out bearing down. Besides it is much nicer to say gently "Rock your baby." than commanding "Don't push, don't push." We want to have S L O W crowning and head birthing, supporting the tissues as the baby is born. It is important to ease shoulders through slowly, arms close to the chest.
Preventative: Exercises and Tissue Health
A good foundation in prenatal exercise is helpful. It is beneficial for circulation, which keeps tissues supple.
Kegel exercises for tissue health and elasticity. A Kegel is the name of a pelvic floor exercise, named after Dr. Kegel who discovered the exercise. These muscles are attached to the pelvic bone and act like a hammock, supporting your pelvic organs. To try and isolate these muscles, try stopping and starting the flow of urine. Once you have located the muscles simply tighten and relax the muscle over and over, about 200 times a day. These are basic Kegels. There are many variations on Kegels: elevator Kegels (Where you tighten slowly, in increments going in and out, like an elevator stopping on several floors.), you can hold the muscle tightened for five seconds, you can bulge the muscles out at the end, and many other variations.
Sexual activity, especially orgasms, help increase blood flow to the area thereby enriching the health and stretching ability of the tissues.
Perineal Massage
In a study, researchers asked women to massage themselves every day and found 24% of first time mothers did not tear, while only 15% of those who did not do the perineal massage did not. Perineal stretching seems to help both psychologically as well as physically. Most women (85%) who preformed the massage would recommend it to other pregnant women!
To perform a perineal massage, a woman or her partner places one or two fingers about an inch to an inch and a half into the vagina. Use almond oil, K-Y jelly, pure vitamin E oil, wheat germ oil or other lubrication. Gently stretch the lower part of your vagina, gently stretching the perineum, until you feel a slight burning or stinging sensation for several minutes. Concentrate on relaxing the tissues through the stretch. Then, gently, massage your lower vagina with your thumbs for several more minutes, avoiding the urinary opening.
In addition, oils can also be massaged into the perineum daily to help avoid episiotomy.
During Birth - Breathing
Focus on your throat while giving birth. The throat has a connection to the vagina. As you breathe deeply, try to open and relax the throat. As you relax, imagine all the oxygen getting to the cells of the vaginal walls… nourishing them with rich oxygen and making them more resilient and stretchy.
During Birth - Perineal support, compresses and oils
Olive oil or mineral oil gives a slippery quality to the perineum. It feels like hands move more easily over the skin without dragging or causing irritation. Use verbal imagery when applying the oil. "I'm going to put some oil down here now to help the baby slide out." Women find it a relaxing and reassuring image and it seems to help them believe in their ability to deliver intact.
Warm compresses at the perineum feel great and encourage relaxation of tissues. Do not use hot compresses, as temperatures that are too warm can bring excess blood flow and cause swelling.
Castor oil packs for the perineum can help relieve prenatal pain around the perineal region as well as make your tissues supple and help prevent tearing when you give birth. Castor oil has healing and restorative properties so the relief builds up over time and the heat increases blood flow to the area, relieves pain, improves circulation and relieves venous congestion. You have to use cold pressed castor oil. Soak an old washcloth or a flannel in the oil, wring it out and put it right on your perineum. Then cover that with something waterproof and put a heating pad of some sort on (electric, microwave, hot water bottle, it won't matter.) Cover the compress because the castor oil will stain and also to avoid shock if you use an electric heating pad. Leave it as long as you can but at least 30 minutes. You can't do it too much, and it can only help not hurt.
Additional practices to avoid:
- Multiple vaginal exams -- irritating the tissues.
- IODINE SOLUTIONS ARE IRRITATING AND MAY BE DAMAGING. Toss out your betadine!
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