The Monthly Doula
A newsletter by Birth a Miracle Services
Volume 1 Issue 8 February 2009
Protecting the Perineum
Mission Statement: My goal is to educate and inform all parents and future parents of their rights and responsibilities of bearing children and of the truth and wonder of birth. My mission is to inspire them to enjoy their pregnancies and to look forward to bringing their children into the world.
Contents:
Letter from the Editor
In the News
Quote of the Month
Benefits of Perineal Massage in Pregnancy
The Sitz Bath: Post-Birth Healing and Comfort for New Moms
Website of the Month
Book of the Month
Online Video of the Month
What is Birth a Miracle Services?
Inspired Birth
Request for Contributions
Subscribing/Unsubscribing
Letter From the Editor
While it may come as a surprise to many women, one in three American women will get an episiotomy while giving birth, and still more tear on their own. Yet it doesn’t have to be this way. More and more midwives and doctors are learning what it takes to protect women’s bodies during childbirth.
This issue will provide you with some great information on what you can do to protect your body during childbirth and to recover more quickly afterwards. While many women choose to focus on pain relief and other important issues in birth, it is vital not to overlook this important aspect, which can have long-term effects on your health.
I hope this information is eye-opening to you, and will set you on the way to making a positive difference to your birth experience.
Enjoy!
Naomi Kilbreth, Certified Doula
Birth a Miracle Services
36 Greenwood Street
West Paris, ME 04289
kilbrethfamily@yahoo.com
www.birthamiracle.wordpress.com
http://www.youtube.com/user/Naomidoula
http://www.facebook.com/pages/West-Paris-ME/Birth-a-Miracle-Services/39346226298
In the News:
Long-term consequences:
http://sexualhealth.e-healthsource.com/index.php?p=news1&id=527729
Epidurals can result in more pain than they save:
http://goliath.ecnext.com/coms2/gi_0199-1221429/Epidurals-and-severe-perineal-tears.html
Does Perineal Massage Prevent Tears?
OB GYN News. Some say that although it may be helpful, other factors like nutrition, warmth of the perineum at birth, and slow birthing of the baby’s head are more attributable to an intact perineum. Check out the full story here: http://www.suite101.com/article.cfm/pregnancy_childbirth/50805Some suggest it does not, including a new study by New research suggests that women who have epidurals in labor are more likely to suffer from third and fourth degree tears. Click here to find out why:
Women who suffer 4th degree tears or episiotomies during birth suffer from more serious long term difficulties than those who have third degree tears or episiotomies. See the full article here:
Quote of the Month:
In a branch of medicine rife with paradoxes, contradictions, inconsistencies, and illogic, episiotomy crowns them all. The major argument for episiotomy is that it protects the perineum from injury, a protection accomplished by slicing through perineal skin, connective tissue, and muscle. Obstetricians presume spontaneous tears do worse damage, but now that researchers have finally done some studies, every one has found that deep tears are almost exclusively extensions of episiotomies. This makes sense, because as anyone who has tried to tear cloth knows, intact material is extremely resistant until you snip it. Then it rips easily.
By preventing overstretching of the pelvic floor muscles, episiotomies are also supposed to prevent pelvic floor relaxation. Pelvic floor relaxation causes sexual dissatisfaction after childbirth, urinary incontinence and uterine prolapse. But older women currently having repair surgery for incontinence and prolapse all had generous episiotomies. In any case, episiotomy is not done until the head is almost ready to be born. By then, the pelvic floor muscles are already fully distended. Nor has anyone every explained how cutting a muscle and stitching it back together preserves its strength.
— Henci Goer, Excerpted from
Obstetric Myths Versus Research Realities: A Guide to the Medical Literature (Bergin & Garvey, 1995)
Benefits of Perineal Massage in Pregnancy
By Naomi Kilbreth
Throughout pregnancy, most women are advised to continue an exercise routine, altering it to fit their new body. Many care providers, however, fail to recognize the power of kegal exercises and perineal massage. Both kegal exercises and perineal massage increase a woman’s ability to relax her pelvic muscles, and brings increased elasticity to the vaginal tissues. Combined, these will increase the mother’s probability of maintaining an intact perineum and its integrity throughout the birth and postpartum period.
This article focuses specifically on how to perform perineal massage. The pregnant woman or her husband can perform this technique. During the later weeks, it may be easier to have the massage given by a person other than the pregnant woman. She should aim for five minutes of massage each day, starting around the 34th week up until the birth.
It would be most appropriate to use a warmed vegetable oil with Vitamin E, or a water-soluble jelly. Do not use baby oil, mineral oil, Vaseline or anything with perfume. Place your thumbs or forefingers about one inch inside the vagina and press downward toward the anus and out to the sides. Hold the stretch and breath, focusing on relaxing the pelvic floor for about two minutes. Please note: this should never hurt! Seek the point of “gentle tension”. After practicing this massage, you should be able to stretch further and wider.
A variation to this technique is to maintain steady pressure while moving the thumbs or forefingers in a slow rhythmic U pattern back and forth over the lower half of the vagina, while gently stretching it outwards as well. This should be practiced for two to four minutes at a time.
Please be aware that, for safety reasons, perineal massage should not be done if the pregnant woman has pelvic varicose veins, active herpes lesions, or any other vaginal infection.
My midwife made a great example of how these exercises help to keep a perineum intact during birth. She would show us a rubber seal from a canning jar and pull and stretch it to show how immovable it really was. She compared this to a vagina that was not exercised. Then she showed us a rubber band elastic and pulled and stretched it in order to show us how much it could be stretched without broken. She compared the rubber band to a vagina that had been exercised through kegals and perineal massage.
I highly recommend perineal massage, for the safety of a woman’s body, and for the increased comfort she wills surely feel while getting to know her baby.
2009 © Associated Content, All rights reserved.
The Sitz Bath: Post-Birth Healing and Comfort for New Moms
After a vaginal birth, a woman is likely to have sore vaginal tissues. This may be aggravated by a swollen perineum, “skid marks”, a tear, an episiotomy, and/or hemorrhoids. One of the most helpful ways to assist in healing and lend comfort at the same time, is using a sitz bath.
A sitz bath is a plastic bowl that fits over the toilet seat. If you are unable to get one from your hospital, they may be found at most pharmacies and are carried by some midwifery suppliers. A gravity-fed tube runs water into the bowl and bubbles around the opening of the vagina. Alternatives to a buying a sitz bath are using a large, shallow basin or the bathtub to soak in.
Soaking in the sitz bath has multiple benefits. Warm water relaxes and soothes the sore tissues, keeps the area clean and prevents infection, and helps with circulation. Cool water may prevent or treat perineal swelling, but some practitioners caution the use of cool water on a newly postpartum woman.
To benefit the most, you may begin sitzing 24 hours after birth, when you can be up and about more comfortably. Sit on the bath for 10-20 minutes, 1-3 times a day or as needed, until the soreness is relieved. Most practitioners recommend use of the sitz bath for at least one week after birth.
Although water itself is healing, making an herbal tea to put into the sitz bath may help the vaginal tissues to heal faster. Here are a few recipes that you can try. Most of these herbs can be found at your local health food store, but may also be found from midwifery suppliers. The basic combination is to put 2 handfuls (or 2oz) of herbs in a cooking pot with 2 quarts of water. Cover and bring to a boil, then let simmer for 15-20 minutes. Strain the tea very well and then add 2 tablespoons of salt to the tea, dissolving well. Allow it to cool slightly, and then poor into the sitz bath. The water should be on the hotter side, but not uncomfortable.
Recipes:
#1
¼ cup lavender infusion to 1 cup water
Add a drop of tea tree oil or patchouli oil
#2
2oz of these mixed herbs:
rosemary, sage and garlic
2 TBSP sea salt
#3
2oz of these mixed herbs:
yarrow, calendula, lavender and rose petals
2 TBSP sea salt
#4
½ oz uva ursi leaves
½ oz yerba mansa root
½ oz marshmallow root
½ oz calendula blossoms
2 TBSP sea salt
#5
½ oz yarrow aerial parts
½ oz witch hazel bark
1 oz comfrey leaf or root
3-4 cloves garlic
2 TBSP sea salt
#6 (steep this recipe for as long as possible, even over night)
½ oz yarrow
½ oz mullein leaves
½ oz sage
½ oz plantain leaves
½ oz calendula flowers
1 oz comfrey leaves
½ cup sea salt
Other appropriate herbs that you can steep for the sitz bath, include goldenseal and oak bark.
After you are done, dab the area dry and allow to air out before dressing. To clean the sitz bath, simply rinse and towel dry, there is no need for any cleaning solution.
To aid healing, add 3-4 grams of vitamin C with bioflavinoids, 25,000 IU of vitmain A, 400 IU of vitmin E in the form of tocopherols, anti-inflammatory omega-3 fatty acids (fish or flax oil) and 1 gram of protein per ½ lb of body weight.1
Sources:
1 – “The Art of the Sitz Bath” by Adrienne Leeds Midwifery Today Spring 2003
2009 © Associated Content, All rights reserved.
Website of the Month:
http://www.withwoman.co.uk/contents/info/perineal.html
Book of the Month:
Birth Crisis
by Sheila Kitzinger
Online Video of the Month
http://www.youtube.com/watch?v=Q0C2gxlcJOI&feature=related
What is Birth a Miracle Services?
Birth a Miracle Services is the name of the birth doula and childbirth education service that I started in 2002.
A birth doula is a person who offers informational, physical, emotional, spousal, and advocacy support to women through pregnancy, birth, and the early postpartum period. I also offer traditional childbirth preparation classes, birth art classes, and childbirth counseling.
All of this is available to women within an hour of my home in West Paris, Maine for a sliding scale fee. Single, teen, and low-income moms can receive my birth doula support for free.
For more information visit my blog:
http://birthamiracle.wordpress.com/
Inspired Birth
I am proud to announce the birth of my first book, Inspired Birth: A Fresh Perspective for Christian Maternity Care Providers. It is an inspirational guide for all Christians who attend women in childbirth, with fresh ideas on how to meet the emotional and physical needs of childbearing women while addressing current challenges to American maternity care. This book is still in the editing process and is not currently available for purchase, but if you know any Christians who are doctors, nurses, midwives, or doulas, please let them know that this book is on the way!
Request for Contributions
Next month’s topic is inducing labor. If you have anything you would like to contribute, such as an experience with induction that you’d like to share, please email your thoughts with the subject line “Monthly Doula” to Kilbrethfamily@yahoo.com . Thank you!
Subscribing/Unsubscribing
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To view previous issues of The Monthly Doula, click this link:
http://birthamiracle.wordpress.com/category/the-monthly-doula/
Excellent article and site. Godspeed.
By: mommyghee on February 18, 2009
at 6:14 pm