PREGNANCY

Optimal fetal positioning
The theory here is that our sedentary lifestyles, including slouching on the couch and riding in cars, allow gravity to encourage the heaviest part of the baby — the spine — to roll to the back of the mother’s body. Optimal fetal positioning (OFP) is a concept developed by New Zealand midwife Jean Sutton, which may help get baby into the best position — facing the mother’s back — before labour begins.

If the back of a baby’s head is turned to press against the mother’s tailbone, the mother experiences intense back pain in labour and often a slower labour as well. Sometimes these posterior babies require assistance with forceps or vacuum extraction to be born. Connie Banack’s first baby was posterior and was delivered by Caesarean — part of the reason she’s an advocate of the technique.

“Spend time every day sitting upright with a slightly forward lean, or kneel on the floor while leaning forward into the couch,” suggests Banack, a childbirth educator and mother of four. One study found that being on hands and knees 10 minutes twice a day from 37 weeks’ gestation to the onset of labour did not reduce the number of babies still in a posterior position at birth. Advocates of OFP argue that women should start earlier (34 weeks) and spend longer (30 minutes twice a day) in a forward position.

Kegels
“Do your Kegels!” admonishes Skylar Hill-Jackson, director of Baby and Me Fitness in Toronto. “Pelvic floor exercises help many women avoid medical interventions.” She explains that the weight of the uterus creates continuous and increasing stress on the pelvic floor muscles, the hammock of muscles that support the uterus. Strengthening these muscles, by squeezing the walls of the vagina tightly together and holding for a count of as much as 20, may make pushing more efficient and prevent poor bladder control and hemorrhoids.

Perineal massage — does it help?
Perineal massage gently stretches the tissue at the opening of the vagina. While studies are not conclusive about the value of perineal massage, some research suggests it reduces a woman’s chance of tearing when she pushes her baby into the world.

Registered massage therapist Paula Jaspar is an advocate. She argues that the perineum is made of muscle (it’s the hammock of muscles that support your growing uterus in pregnancy) and muscles need time to learn to be supple. Jaspar advises her clients to begin massaging the perineum as early as 12 weeks of pregnancy.

She explains how: Imagine the face of a clock at the opening of your vagina. The 12 points to the clitoris, the six to the anus. The area to be massaged is the lower half of the vagina, from three o’clock to nine o’clock. Women can do the massage themselves. Lubricate your thumb with olive oil. Place one thumb into the vagina to the first knuckle. Stretch the tissue at three o’clock, then four and all around the bottom of the clock, continuing to nine o’clock.

Just how far should you stretch? Jaspar says you’ll know, but describes the sensation as burning.

Another benefit of perineal massage is that it helps women learn to consciously relax the perineum, allowing for an easier passage of the baby. Massage increases the circulation of the perineal tissues, speeding healing after the birth.

Originally published in Today's Parent Pregnancy & Birth, Winter 2005