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Perineal Health
The following herbs and essential oils can be used topically to help speed recovery
to the perineum following bruising, stretching, and possibly stitching following
birth:
Comfrey - Cell proliferant, vulnerary
Yarrow - Astringent, antiseptic
Rosemary - Astringent, antiseptic
Goldenseal - Antimicrobial, astringent
Witch hazel - Anti-inflammatory, vulnerary, astringent
Thyme - Antimicrobial, antispasmodic
Lavender - Antispasmodic, antimicrobial
Calendula - Anti-inflammatory, antimicrobial
Myrrh - Antimicrobial, astringent
Tea tree Essential Oil - Antiseptic, antimicrobial
Lavender Essential Oil - Antimicrobial, antispasmodic
Aloe vera - Vulnerary, antibacterial, analgesic
Make an Infusion
Bring 2 cups water to a boil; remove from heat and allow to cool slightly. Pour
over two heaping teaspoons of the desired combination of herbs and cover tightly.
Allow the mixture to steep for at least 1/2 hour (overnight is best), then strain
well. Keep refrigerated for up to 3 days.
Method:
- Spritz bottle: Put the undiluted mixture into a clean glass spray bottle and
keep next to the toilet. Spray as needed, especially after urination.
- Sitz bath: Soak the perineal area in a basin of water with the full 2 cups
of tea added to an additional 6-10 cups of clean water. Use cold water if there
is inflammation or swelling. Once that has subsided, experiment with warmer water
until comfortable.
- Regular Bath: Add the full 2 cups of tea to bath water.
- Peri Bottle: This is a plastic squirt bottle (a water bottle with a pop-up
top works) that can be used to irrigate the perineal area. Greatly reduces stinging
if used during urination. With clean water, dilute the tea by half and fill the
bottle.
- Compress: Soak a clean cloth in the cooled mixture and apply to the sore area.
Try freezing the cloth ahead of time for a cold compress.
For essential oils recommended above:
- Sitz baths: Add up to 5 drops
- Spray bottle: add 10-15 drops
- Peri bottle: Add 5 drops per 500 ml
Caution: Many essential
oils, if used undiluted, can cause serious damage to tissues. Be sure to use only
those that have been recommended by a professional for undiluted use. Both lavender
and tea tree oils are safe when used as directed in this article.
- Stacelynn Caughlan, ClN, CH, The Birthkit No. 30
====
THE BIRTHKIT, Midwifery
Today's between-issues newsletter, is full of helpful articles, commentary, stories,
herbal lore, and art.
====
Perineal Exercise
Vaginal muscle awareness and control are essential for avoiding vaginal/perineal
tears. If the expectant mother can learn the difference between contracted and
relaxed states of her vagina and perineum, she will be able to create either at
will. Encourage her to do some exploring; have her place her fingers inside and
contract her muscles around them in order to learn which motions work for her.
My favorite exercise is the classic "elevator." In this exercise,
the pelvic floor muscles are pulled up like an elevator ascending to the first
floor, second floor, third floor, fourth floor, fifth floor, then are held for
30 seconds and let down slowly to the fourth floor, third floor, second floor,
first floor and finally to the basement--the place from which we give birth.
Yet another exercise that imparts control of the internal muscle most likely
to tear at birth (the bulbocavernosus) is a quick, snapping movement lower down
in the vagina, near the introitus.
- Elizabeth Davis, Heart & Hands, Celestial Arts 1997
====
Place the birthing woman's hand on her baby's head while it is emerging. The
woman feels her baby crowning past the "ring of fire" and will slow
down her pushing so she can birth without tearing.
- Midwifery Today Issue
No. 33
Prenatally, a well-balanced diet of enough proteins, fresh fruits, and vegetables
and very little refined foods is critical to the integrity of the perineal muscles
and tissues. Well-hydrated and oxygenated tissues promote elasticity and quick
healing. Women should drink a minimum of 8 glasses of filtered water a day. Adequate
fat intake is also important for skin suppleness and elasticity. Supplemental
alfalfa tablets contain vitamins A, B-12, D, calcium and phosphorus. Vitamin E
(200-400 IU) taken daily with foods or drink containing fat will help absorption.
Daily intake of vitamin C (1000-2000 mg) will help circulation and tissue elasticity.
Red raspberry tea is wonderful for relaxing and helping the entire pubococcygeal
area to be supple, especially toward the end of pregnancy.
Greater oxygenation of tissues is not only accomplished by diet, but also with
exercise by increasing circulation. Walking, squatting, duck walking, pelvic rocks,
tailor sitting, kegels, and swimming all are useful exercises.
- Renee Stein, Midwifery
Today Issue 33
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TEAR PREVENTION and
Alternatives to Suturing: Midwifery Today conference audiotape; teacher is
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Midwifery Today's Online Forum
I am about to attend my first birth as a doula to a good friend. It is her first
baby, and while her husband is there, he will not be able to touch her. I would
appreciate any advice you might be able to give.
- Jennifer
To share your thoughts and experience, go to Midwifery
Today's Forums.
Question of the Week
Q:
- What is the longest you have waited for a placenta after the birth of the
baby? What was the outcome?
- While I was at the conference in NY the midwife covering for me attended
one of my women. She was dilated fully at 5 am and had no urge to push. Six hours
later, after trying several things, including AROM, they transported to the hospital
and the woman was given Pitocin and an epidural - she was sectioned four hours
later for failure to progress. Heart tones were fine all through and mother,
although tired, did not want to be sectioned. The mother now believes that if
they had simply waited, not broken her water, and trusted, the baby would have
been born vaginally. What is the longest you have seen from full dilation to
the beginning of pushing - or to the birth of a baby? What were the outcomes?
- Nancy Wainer
(Editor's Note: Please be as succinct and as helpful as possible when answering
Nancy's question--avoid lengthy birth stories--E-News can't accommodate them!)
====
Send your responses to:
Question of the Week Responses
Q: Has anyone had experience with pertussis contracted
during pregnancy? I have searched all the textbooks I have, many from the local
medical library, and the Internet with no significant results. My common sense
tells me it could cause PROM, fetal and maternal hypoxia, and very possibly preterm
labor. Any information?
- Susan Padilla
A: I have only worked with one case of pertussis during pregnancy. The
mother was very uncomfortable with coughing frequently and excess mucous production.
Often she would cough continuously to the point of vomiting. This put a lot of
stress on abdominal muscles. However, she did carry to term and had no problems
with delivery. The baby was healthy and has done well in spite of mom's discomfort
during pregnancy.
- Judy
====
More about breastfeeding challenges as the result of large breasts and flat
nipples (Issue 3:40):
In the case of an uninterested baby combined with nipples that are hard to latch
onto, I recommend that moms pump their milk to keep up with milk production and
to avoid engorgement (which makes nipples even flatter). The pumping can also
help draw out the nipple. Then, with a person holding a container with the milk
below breast level and a narrow tube (#8) leading out of the container, put the
baby to the breast -- as best as possible get the baby on the nipple. Slide the
end of the tube into baby's mouth so that it's entering over the top of the mom's
nipple. Let baby suck on tube/mother's nipple. Usually babies are pretty good
at drawing milk through the tube. It seems to be the reward of milk that eventually
stimulates the uninterested baby. They get used to the flow of milk and soon the
tube can be discarded (within a few days to a week). It might be necessary to
finger feed with the tube for a few minutes before the feed to get the baby accustomed
to the reward of milk for sucking, but don't get in the habit of only finger feeding.
To help baby get on flat nipples, show the mom how to compress her breast to
make a "ledge" which the baby can latch onto. With the reward of milk,
baby will soon become an expert at attaching to this ledge. If baby fusses, remove
him/her from the breast. Don't force the issue--take a short break, wait for fussing
to end, then try again. You don't want to set up being close to the breasts as
a negative thing. Eventually, even with very flat nipples, babies figure out their
own individual latch for their own mother.
Make sure the pumping is done with a high-quality electric double pump. Anything
less is quite inefficient and mom may get the impression she isn't capable of
producing good quantities of milk.
- Terra Reindl, Kelowna
Switchboard
Know a strong woman? Helping empower one? If you haven't already done so, please
forward this issue of Midwifery Today E-News to one or two of your friends or
business associates. Thanks so much!
~*~*~*~*
Regarding a question about counseling couples about infertility (Issue 3:40):
Whenever someone asks me about infertility problems, the first thing I look for
is possible low thyroid. In our part of the USA, thyroid problems are rampant.
I have found that low thyroid is one of the most frequent causes of infertility
as well as frequent repeated miscarriages. I ask them about a list of symptoms:
feeling tired all the time, feeling cold, dry skin, brittle hair, chocolate cravings,
fuzzy thinking, sometimes weight gain or inability to lose weight after a previous
pregnancy, history of postpartum depression, any menstrual irregularities. If
they answer yes to a majority of the questions, they are probably low thyroid.
If you are unsure, have them chart their basal body temperature (same time every
morning before rising) and coordinate it with their menstrual cycle. Low thyroid
will actually cause a low basal body temperature. I give these women natural food
products from Standard Process, Thytrophin PMG and Iodomere. It is amazing how
quickly their body can heal itself and they often become pregnant. If they wish
to go to a physician, make sure they do the complete thyroid panel work-up not
just the initial thyroid level, or they will miss it. The conventional medical
treatment would be to put them on thyroid. This works but does not really help
the thyroid to heal.
- Judy
====
I learned of the RAMP technique in midwifery school but have never seen it done
and I don't know anyone who has used it. It involves making a "ramp"
with your dominant hand to slide the baby under the pubic bone. The hand is stiff
with the fingers angled up toward the umbilicus. This supposedly prevents the
baby's anterior shoulder from becoming lodged against the bone and allows it to
slide down the hand into the birth canal. This is done if a shoulder dystocia
is anticipated, and we all know this is very difficult to predict. Personally,
I cannot imagine doing this even in anticipation of a large baby. Perhaps others
have tried it and can comment.
- Kathleen Mulkern, CNM
====
In response to a question about tubal ligation (Issue 3:40): I would suggest
to your sister to check the possibility of vasectomy for her partner. I would
not choose BTL because women who have had this done [may] have early onset of
menopause. Doctors forget to say so. My last pregnancy was while I was using the
pill, so after the baby was born I got an IUD. Again I became pregnant. I decided
to have an abortion and BTL, which seemed to me the only way not to become pregnant
again. Vasectomy was out of the question because my partner was against it ("One
never knows"). Today, with sperm banks, that problem is easily solved. Seven
years after the BTL I found myself in the middle of menopause. Since than I have
to use hormone replacement therapy (HRT) because life became very unpleasant without
estrogen. Today I am 50 and have been using HRT for over 10 years, which puts
me at a higher risk for breast cancer. I thought 20 years ago that I had no other
options, but today you have and I do hope you will check all the possibilities
before acting.
- Nellie Kahania Herman
====
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will be considered for inclusion. Letters sent to ANY OTHER email addresses will
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