A sitz bath is just a bowl or basin big enough to sit your bum in. Sea salt can be lovely, also a drop or two of tea tree oil or lavender oil (not too much or it might sting) - these are natural anti-septics and lavender has analgesic properties.
Healing herbs can also be great. They reduce swelling, promote tissue healing and relieve pain. You can also dip soft cloths or even those cotton wool cleansing pads in the herbal liquid, put them in a ziploc bag and cool them in the freezer, then apply them cold to swollen areas - this is great for haemorrhoids!
Another method that speeds healing and relieves discomfort is using a perineal cleansing bottle - easiest to do while seated on the toilet. You can fill it with warm herbal liquid, or warm water & sea salt, and add a drop of your essentail oil too if you want. This is just great during those first few days when weeing feels 'stingy'.
You can also use active Manuka honey on tender healing tissues. Smear it on a pad and apply it gently - yes it's sticky but if you wear for an hour or so and then step into a warm herbal bath it's a pretty nice healing regime.
I have even heard of people using nori - dried seaweed sheets - to help heal minor tears. I haven't tried that myself but why not.
On my blog I have a study about reducing perineal damage that showed that the kneeling position was associated with less tearing. I notice that a lot of women giving birth in pools choose a variation of the kneeling position.
I just remember, "it's designed to tear, and it's designed to heal". And there is research that demonstrates that tears do heal better than episiotomies. I've also been told it's better to tear lettuce than cut it for salad, it tears along the cell boundaries - I'm sure it's a similar principle with skin cells.
I do think that freedom of movement in labour, commencing pushing when your body compels you and the urge is overwhelming - not when they 'tell' you you are '10cm' - own choice of postion during pushing with particular consideration to being OFF THE BED, and undirected pushing, following your body's urges as the foetal ejection reflex is triggered, are all pretty significant right up there with the right of consent/refusal of episiotomy. 'Breathing your baby out' can happen when such bodily autonomy exists, but women's birth experiences are all so varied. As a general rule the only advice or encouragement I give when a woman is pushing is 'listen to your body' and 'you're doing fine' (and that's the truth!) But I have seen situations where the expulsion urge is very strong (a fantastic thing, it means her body rocks and is working great!) and the midwife has noticed the skin is getting a little white wear it is stretching - and has suggested the mother pant and quit pushing if she possibly can - and on several occasions this back-pedalling has prevented a tea while the skin had a change to oxygenate and stretch. Sometimes a change of position can help at this point - like getting off a birth stool onto hands and knees, or changing from squatting to side-lying. Sometimes those intense open-pelvis, gravity-positive positions are helpful for getting the baby round the J-curve and under the pubic bone and well onto the peri - and then you don't need it, you can choose another position once you're just off crowning, to ease baby's head out nice and slow.
And placing your hand on your peri, feeling the gradual progress of your baby's head emerging, can be quite helpful for some women, it helps them know 'where they're at'.
Another trick is reducing all the forces at play.
There's:
1. gravity
2. the expulsive force of the uterine contractions
3. volitional pushing/bearing down efforts
4. the foetal ejection reflex
Even if you needed them ALL during most of second stage, to bring baby right down, you *might* not need them all at the point of crowning. To ease bub out gently, perhaps you could employ just 2 or 3 of these forces, eg:
- give a gentle volitional push in between contractions, and see what happens
- reduce gravity by kneeling or side-lying, or head-down/bum up
- try puffing, through 'horse-lips' for a contraction, instead of bearing down (this can be wonderful for letting everything stretch up beautifully!)
But I think you really need to be totally free to choose the right positions for you, and be free of well-meaning people telling you what to do, in order to tune into your body enough to know what you need at that time. And there certainly is a way you can ask for this in your birth plan, if you think this approach is for you.
Also just watch those shoulders. Sometimes we all do a lovely job easing that head out so gentle - and then the shoulders shoot out and nick a tear. Gently does it!
Amazingly, during water births, the attendants usually can't see a darn thing, and the mother manages just fine, and I don't think I can remember a waterbirth in which the mother needed stitches later.
I attended the labour of a friend last year, but was not able to stay for the whole birth (my baby was only 6 months old, and it was a 60 hour primip labour!) But she told me about it later - how she was pushing well in a supported squat, but the midwife saw she was about to tear, and assisted her into another position, and she birthed that wee bub (slightly asynclitic) with no tearing - I thought, what a great job that mum and midwife did. The midwife thought she would have torn right to a 3rd degree tear if they hadn't acted swiftly in that moment.
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