Perineum Support at the time of Birth

I have been thinking about perineal support a lot lately, yes these are the things that run through my brain. I have a close connection with the varying levels of perineal pain that my clients experience in the postpartum. I see time and time again how much more pain women experience if they were given an episiotomy as apposed to natural tearing or an intact perineum. I am proud to say that in my 7 year career as a midwife I only performed 3 episiotomies, all of which were due to emergencies and every time with the consent of my client.

When interviewing new clients, I will ask them of their fears or concerns about birth. Many women voice being afraid of episiotomies. I validate these fears, no one wants to be cut on the perineum at birth. Perineal tissue for the most part is able to stretch and if it does need to tear it will take a gentle route, much more gentle then the scissors choose.

I write this blog with a slightly heavy heart, because I would like to say that Israel is forward thinking that there are not many episiotomies being done here and that a woman’s consent is always taken.

“Ensuring that women are involved in the decision-making process in the event that an episiotomy might be needed is also critical. Performing an episiotomy—or any other intervention—without a woman’s informed consent is a violation of her right to respectful maternity care. Addressing the non-evidence-based use of episiotomy is key to improving maternal health and women’s birthing experiences worldwide.” For further information please visit this link

Non-evidence based use of episiotomy is still very common unfortunately. I understand that episiotomies can be a life saving procedures at times, if used within an evidence based way. “Research has shown that natural tears typically are less severe (although this is perhaps not surprising since an episiotomy is designed for when natural tearing will cause significant risk or trauma). Slow delivery of the head in between contractions will result in the least perineal damage. “ For further information please visit this link

Of course when I am in an Israeli birth room with my client in the capacity of their Doula, I will never interfere with their doctor or midwife needing to do an episiotomy in a true emergency. What I will do is to try to prevent them in situations where there is not an emergency. I will advocate for my client to have a chance to birth her baby without being cut. I celebrate those moments for my clients when an episiotomy is prevented and their perineum stretches beautifully or if it did tear it only was minimal and healed easily. It brings me joy when the women I support are able to recover in the postpartum a little more easily with less perineal pain. Some may call me a anti-episiotomy vigilante, so be it, if I can help promote trust in women’s bodies to birth their babies then I will take that title for the cause of no more unnecessary episiotomies.

I wish for all women freedom of movement for their vaginal birth, that they can choose the position that is comfortable to them and not because it is convenient to their practitioner. That they are given warm compresses, and oil is used and that their perineum is supported in a way that promotes an intacted perineum. That there is a trust and communication between them and their care provider to slow down the birth of the head of the baby. That women feel safe to birth with dignity, power and that their voice is always heard through consent.

Birth is powerful … let it empower you!

I have been fascinated by this quote lately, “Birth is powerful … let it empower you.” It resonates with me on so many levels. As a mother who gave birth two times, as a Midwife, a Birth Doula and childbirth educator.

As a mother it reminds me of how powerful my body is and was when I gave birth to my baby’s. How I could not have thought my way through birth even if I tried and how I had to give into the power of birth to birth.

As a Midwife I had the joy of witnessing the power of birth hundreds of times. Women would ask me “how will I know when I am in active labor?” My usual response to that question was it may not be you knowing your are in active labor but someone else, because you will have gone into a more inward state at that point. In essence you will have given into the power of birth, and allowed your analytical brain to slow down, allowing your brain to go into a more instinctual mode, more inward. I saw time and time again when women were in the moment in labor, allowing their bodies to produce endorphins a natural pain reducing hormone, their bodies knew what to do and they birthed empowered.

As a Birth Doula and Childbirth Educator I am always looking for phrases to help inspire women to believe in their bodies ability to give birth. “Birth is powerful … let it empower you” has such a simple beauty to it. In it I hear, that sometimes women just need to give into labor and birth. That they can breath and feel safely surrounded by their trusted birth support people, that that team is watching out for them, protecting them. Giving them the space to give into birth, to be empowered by it.

My hope is that we as a birth society will give women ‘quiet birth space’ to give into the power of their bodies ability to give birth and be empowered through birth.