“I fell into a burnin’ ring of fire
I went down, down, down
And the flames went higher
And it burns, burns, burns
The ring of fire, the ring of fire” —-Johnny Cash
Ah, the dreaded “ring of fire.”
Pregnant women shudder at the mere thought of the commonly described moment as the baby’s head is crowning. Couldn’t we paint a more loving picture of the moment directly before a mother meets the child she has been growing in her belly for 9 months (let’s face it, 10)?
Yes, this moment can be intense.
What exactly causes this sensation? Well, it’s basically the extreme stretch of the perineal region, that tender area between the vagina and rectum, that is often described as a burning, ripping, tearing sensation.
Now hold onto your purse, let me explain further.
It’s actually the same sensation you feel when stretching the super tight hamstring muscles at the back of the thigh, but it isn’t nearly as frightening since that sensation is spread out over a much larger area. Given the tiny area of the perineum and the fact that it is loaded with nerve endings, means a stretch there can be much more intense.
But it can also be your baby’s gift to you. How so?
Well, the baby’s head often rests on this tender region during crowning, allowing your perineal muscles to slowly stretch around your baby’s head, unfolding like the petals of a rose. In fact, a thoughtful birth worker will often ask you to try NOT to push for a contraction or two during this time to allow your body and baby to work together. If you can breathe through this intensity and relax into the sensation of stretching, you may be able to protect this area from unnecessary damage.
I’m a big fan of perineal massage in the final weeks of pregnancy for several reasons. A muscle deserves the chance to be stretched prior to the big “event”. I wouldn’t dream of stretching my hamstrings for the very first time at mile 22 of the marathon. I would expose them to a stretch and train them to be flexible in the weeks leading up to the big day.
Likewise, the pelvic floor deserves the same opportunity to experience lengthening and stretching. The best way to do this is to prop yourself up in bed with your knees bent and feet flat, allowing your legs to relax open, resting on pillows if necessary. Reach around and grab your butt cheeks with your fingers, allowing your thumbs to remain free. Make sure your hands are washed and your nails are trimmed. Gently insert your thumbs into your vagina just about an inch. Now gently pull the tissue downwards at an angle towards your heels.
Do you know how women describe the feeling of self-perineal massage? Burning, ripping, tearing. Sound familiar? But these sensations give way to total numbness and relaxation after 1 or 2 minutes.
At this point, it can be beneficial to perform a “U” shaped massage from either side straight down towards the bottom of the vaginal opening. If it’s too difficult for you to assume this position, ask your partner to assist by stretching one side at a time or try another position like in the shower or while you are sitting on the toilet. This stretch can be done a couple of times a week starting around 34 weeks pregnant. That way, when you experience the sensation of crowning during delivery you will be able to see that moment for what it is.
A moment of extreme stretching that you have prepared for and are not scared of. You can live in that space and breath into the sensation of stretching, accepting the gift your baby is
giving you…..a chance to work together and an opportunity for your perineum to unfold gently as you slide your baby out.
Are there other things you can do to protect your perineum and minimize tearing?
I’m so glad you asked. There are certain birth positions that are more protective of the pelvic floor than others. For example, birthing in the side-lying position has been shown to cause the least amount of pelvic floor injury and this is a position that can be assumed by a woman even if she’s had an epidural. Being on all 4’s is also a fairly safe position for your pelvic floor.
Surprisingly, the squat position (while great in short bouts to help the baby descend into the pelvis) can lead to more pelvic floor injury, hemorrhoids, and tearing if assumed for long stretches of time and especially while pushing for long periods of time.