For those who didn't tear - what position did you birth in?

[Julie Doula]

All three times I was on my knees. The first and third time I did not tear. Little tear with the second birth, due to it being pretty fast and I forgot to 'back pedal' (she was born in a hurry in a shopping mall.)

Some women just have lovely stretchy vaginas. All vaginas are designed to stretch, are tough, strong, stretchy and tensile, and heal beautifully from minor tears. Yay, the vagina!

Here's my thoughts on supporting optimal wellbeing for the birthing vagina and the lovely perineum:

* Grab a copy of My Pelvic Flaw and learn all about really good pelvic floor exercises.

* Consider perineal massage and gentle vaginal exploration. I don't believe you need to stretch or condition your tissues. They're naturally designed to stretch! But, gentle massage and exploration might be good for a mumma to get in touch with her body and *discover* just how awesome, strong and stretchy it is. That was my experience, anyway.

* Use a birth pool & give birth in water! The gold star standard for perineal care.

* Listen to your body and ban 'Directed Pushing'.

* Gravity, uterine contractions, the foetal ejection reflex, and volitional pushing are 4 different forces that are involved in the expulsion of the baby. You rarely need all 4 forces happening at once! In an uncoached, un-coerced birth, the FER is really strong. When the mother just goes with it, she rarely needs to push and strain.

* Wait until the urge to push is absolutely overwhelming, Like, don't start pushing because you've been *told* you're fully. Don't start pushing as soon as you first start feeling pushy. Welcome and celebrate when you first start feeling that unmistakeable pushy feeling. But if you can, keep breathing through the pushiness until it's just so overwhelming that you can't hold off any longer. Blow out forcefully if you have to. I watched one first timer mama do this in a strong rhythm - puff-puff BLOW! Puff-puff-BLOW! The rhythm really helped her stay in control and resist that urge. Then - just go with it! Mischief can be caused by *telling* a woman to 'push', or if you're an impatient mama and you give into that litle demon whispering in your ear that if you push heaps now you can get this over. Tell that imp to shut up and go away. Heaving and shoving and pushing too hard too soon could be counterproductive and set you back. Keep breathing ... be patient ... trust your body ... kinda boycott the pushing thing for a while ... eventually it will be so full on, it will be undeniably the real thing. Wait till you're "11 cm dilated" before starting to push.

* Get gravity on your side and make sure you have the freedom, and the motivation, to follow what your body is compelling you to do. Some women really do like to push on their backs or on their sides. But make sure you're not doing that because of the subconscious influence of The Bed, the staff, or the media!

* Check out this study that associated the kneeling position with less perineal damage. Worth taking into consideration.

* Consider using only one or two of the 4 forces. Such as, gravity and the FER, but not pushing. Or, pushing gently between contractions rather than during contractions. That's when you're trying to ease bub's head out really gently. (I nailed this with birth #3). Or, eliminate the gravity factor if it's coming too fast, by kneeling into a knee-chest possie, or lying down in the birth pool or on your side, for example. You may not need to use all the 4 forces all at once, especially if the birth is progressing well and the baby's head is advancing. Some women find kneeling, then dropping their head down into a knee chest, helpful to slow down a fast second stage to a manageable sped.

* When you can feel that burning ring of fire, you're as good as done. That burning is your signal to BACK-PEDAL. In most cases, strenuous pushing efforts are no longer needed. It's time to stop pushing, and just b-r-e-a-t-h-e your baby out. Don't be tempted to just rocket that wee bub across the room. It's better to gently ease your bub out over the length of a couple of contractions than give into the urge to 'just get it out' (through gritted teeth)!

* Watch the shoulders! Congrats, you just birthed the head - awesome! Now, gently does it with the shoulders. Unless the shoulders are sticky and there are concerns about possible dytocia, there's NO RUSH! Sometimes large heads are born with no tear, then little shoulders cause a rip because of too much rush.

*Reach down and feel inside your vagina, and touch your baby's head. You can feel just how close your baby is. As the head starts to emerge, a little more each contraction, reach down and feel whenever you want to, if it helps you connect with how your body is stretching & how you're progressing. This tactile approach helps some women know 'where they're at'. Other women would rather shut their eyes and do it all by feel. But hey, your fingers belong there more than anyone else's fingers.

* Watch that second birth! If you had a long arduous first time labour, you might not realise how much quicker your next birth could be - especially if bub #2 comes along within about 3 yrs of the first.