Can Massage Help Start Labor?

Opening to Labor Massage

Wouldn’t it be lovely and oh-so-convenient if there were some magic “labor-starting” buttons that could be pushed on a woman’s body? Alas (or perhaps, thankfully) these do not exist.  We know that massage therapy cannot induce labor directly.  It would also be impossible to determine if, should a woman go into labor shortly after receiving her massage, it was the massage that caused the shift, or if she was “naturally” about to start labor anyway.  

So, then, how might massage be helpful for supporting a woman to OPEN to her labor process?  

1 - The Relaxation Response.  When feeling stressed, fearful, anxious, or unsafe, the sympathetic or “fight/flight” nervous system is activated and adrenaline (amongst other catecholamines) is released into the bloostream.  Dr. Sarah Buckley writes in Gentle Birth, Gentle Mothering, 2005 “...high adrenaline levels in the first stage of labor will inhibit oxytocin release, therefore slowing or even stopping labor. Adrenaline also acts to reduce blood flow to the uterus and placenta...” 1 Supportive, nurturing, deliberate, competent, non-judgmental touch can help diminish or interrupt the sympathetic stimulation and allow a more optimal hormone flow and balance, which could allow labor to unfold.
Oxytocin is the hormone that triggers uterine contractions. It is also considered the “love hormone” of bonding, it increases one’s pain threshold, and reduces anxiety.  Touch can be one of the most helpful ways to increase oxytocin both prenatally and during labor (and after). One study showed that just ten minutes of gentle stroking by a trusted person increased oxytocin production and decreased blood pressure.2

2 - Brain Wave Changes. When someone receives massage, they are more likely to go from producing Beta waves (which are present when we are in an alert, cognitive, linear state of mind) to producing Alpha (creative, intuitive, right brained) and even Theta (attention turning inward, accessing the unconscious) waves.   These waves are also present as a woman begins and deepens into her dance of labor!

3 - Body Balancing.  Prenatal Massage specific to Labor Preparation often includes soft tissue release in the pelvic area, abdomen, and other related areas like the respiratory diaphragm. Melting and softening these myo-fascial structures may create more SPACE for baby to engage in the pelvis, and/or to tuck his chin at a better angle that more directly meets the softening cervix.  Massage and other body balancing approaches (some of which are detailed at spinning babies.com) to the abdominal and uterine muscles/fascia/ligaments can help release any twists in the lower uterine segment that may be keeping baby in a less-than-optimal position.

3 - Energy Flow.  Most labor preparation massage will include the “stimulation” of certain reflexive points/areas in the body that may influence the flow of energy or “Chi” and support any changes in the body that are naturally happening already.   Systems of Western Reflexology orTraditional Chinese Medicine or both, are utilized with the gentle intention of downward energy, cervical dilation, or optimal uterus/ovary functioning.

4 - Visualization.  Using rich and specific imagery can influence the physical body. Your Prenatal Massage Therapist can incorporate visualizations in your massage that may open up deeper layers of the body-mind to respond either to the natural hormones of labor, or to make more effective any synthetic hormones that are used medically to induce or augment labor.

5 - Connection.  Sometimes, the time set aside for a warm, nourishing, deliberate, massage in late pregnancy is one of the few ritual times in our busy lives for a mother and her baby to really connect in a special way. Nurturing touch in a warm, dimly lit environment can also help oxytocin, the hormone of connection, to flow. It may also remind a soon-to-be birthing mother than she and her baby are working together as a team, regardless of when labor actually starts. She can tune into the subtle movements and messages within her own body and from her baby.  Cultivating relationship is the priority, rather than trying to “get baby to come out.”  Another thing to consider: when we are focused on connection, rather than achieving an outcome (like labor starting), then more oxytocin is able to flow, which, then may likely lead to labor starting!

We offer a supportive, sensation-focused, and safe “Opening to Labor” Massage that incorporates some or all of the elements described above.  We look forward to working with you!

References:

1. Buckley, Sarah J. Gentle Birth, Gentle Mothering. One Moon Press, Anstead, Australia. 2005.

2. Wolf, Naomi. Vagina: A New Biography. HarperCollins. New York. 2012. p. 304 (referencing study by Dr. Light at the University of North Carolina's Medical Center in 2005)

The Nature Child Archetype and Her Role in Birth Preparation

Many pregnant mothers- and fathers-to-be spend time thinking about what it will be like to give birth, and what it will be like to be a parent.  In the modern world we spend much time combing through books, blogs or research articles on different medical technology and their risks and benefits and statistics about outcomes ...many of us are really good at cultivating this thinking, analyzing part of ourselves. Especially as this is the type of preparation our culture tends to validate most: “If you prepare enough, if you have all the information, if you read the right books and take the right classes, then you’ll get the birth you want.” But there is probably already a part of you that knows that there is more to childbirth preparation than just "the assimilation of obstetrical information."  

There are other "parts" of ourselves that need time to be heard, seen and developed in order for our birth preparation to be more holistic, more balanced. One of these parts, or "archetypes" is the Nature Child. But all too often she is dismissed in our culture (as real children often are): that she wastes time, she’s messy, what she has to say isn’t important to the Real Adult World.  

This is part of what is missing in Birth In Our Culture, this honoring of the Nature Child side of ourselves, honoring the importance of Wonder and Oneness and Non-Knowing.  For some of us this might be confusing. When we believe that or “Everything I need to know is in the research,” or even that “Everything you need to know is already within you” we close off to a sense of embracing the unknown, the deep mysterious universe, and to staying ever-curious about our experience.   

A beautiful aspect of the Nature Child archetype is that she is not attached to an outcome - she is not so interested in “Can I do this?”, but more interested in “What will happen next?”  More interested in her relationship to the plant, rock, tree, clay, animal, rather than an outcome. She can also be awoken in our natural internal landscape: for example, in a yoga class the other day we were being guided through a forward bend and my thoughts were focusing on the goal of getting my forehead to my shin.  Our wonderful teacher reminded us “Let the prize not be getting your head to your shin, let the prize be the relationship with your body, the relationship with your breath.” 

Below are some specific ideas for awakening your Nature Child archetype. As with any list, please consider these starting points and by no means an exhaustive list of suggestions nor yet another list of things to add to your ever-growing to-do list.  Nature Children don’t make lists!  Just pick one or two that sound appealing, that call to you, and see what happens... So here it is:

Eleven Things you can do to awaken the Nature Child:

sit spot
  1. Spend time in nature.” With trees and plants and in Living Nature.  In Coyote’s Guide to Nature Connection the author Jon Young suggests finding a regular Sit Spot to foster this ancient connection: the same place in a natural or semi-natural space is visited on a regular basis (ideally daily or weekly).  A person can discover that rather than the natural world being just wallpaper, a person is in relationship TO and WITH the natural world. Maybe you start to recognize a certain size and shape of bird that also visits your Sit Spot regularly?  Hear a certain bird call?  Even if you don’t know who the bird is, just listen and notice. Perhaps a certain plant catches your eye?  Even better if it’s one that you don’t know the name of (very young children usually couldn’t care less about names - they just want to explore the texture of the leaves and count them and smell them and does this plant have many friends like her...etc.). Let your curiosity awaken...make a new friend...

 

2. Plant a garden.  Those three words perhaps strike fear in the hearts of many self-proclaimed Black-thumbed peeps. Seeking the assistance of a loving gardening elder is imperative, or just start with a small potted indoor plant that you nurture from seed. Let your hands and fingers relish the nourishing soil.  Maybe rub some on your face (make sure no cat poop is in it though!)  Plant a little flower for your baby and watch it grow as she grows. 

 

3.  Eat wild edible herbs. I love this quote from Stephen Harold Bruhner: “Once we have tasted this wildness, we begin to hunger for a food long denied us, and the more we eat of it the more we will awaken. It is no wonder that we are taught to close off our senses to Nature. Through these channels, the green paws of Nature enter into us, climb over us, search within us, find all our hiding places, burst us open, and blind the intellectual eye with hanging tendrils of green.” Some safe plant friends who don’t have any toxic look-a-likes include:  dandelion (great added to salad), chickweed (great with egg salad!), malva (cheeseweed!), nettle (cook first, though, she bites a bit!), “sourgrass,”  sorrel, violet, miner’s lettuce, wild rosehips, evening primrose seeds, etc.  While there are VERY few herbs that are harmful in small quantity, (spit out if bitter and burning!!) if you are not 100% sure of the identity of any herb, do not consume!! Here’s another great opportunity to connect with herb-savvy elders in your community.

 

4.  Learn about animals and how they birth and care for their young. The Nature Child is fascinated with animals, and relates deeply to them. For example, did you know that elephants make a circle around a laboring elephant to protect and support her?  Or that bonobos actually tend to give birth with other female companions around, and often up in a tree? (rather than on their own as previously thought) And dolphins give birth tail-first to their young?

5.  Observe the Phases of the Moon.  The Moon, whose rhythms and dancing mirror changes in a woman’s body, the roundness of a pregnant belly like the full moon. She waxes and wanes, ebbs and flows, in a circular rather than linear way.  Rather than looking up the phase of the moon on a calendar, try looking up into the sky - notice how she dances with the sun, gets close and then sways away...perhaps chart your moods, dreams, and physical sensations and notice how they might relate to the phase of the moon...

 

6.  Making Music and Singing.  Children sing their way through their days - and you can begin singing to your baby now.  Even if you cannot carry a tune, the sound of your voice vibrating through his whole body can nourish and stimulate.  Also playing an instrument live has a magical vibration: try drums, rattles, shakers.  Rhythmic drumming has been shown to alter brain waves from the more logical every-day beta waves to the more intuitive and meditative alpha and theta waves (that are the same waves produced during labor!)

 

7.  Play with clay. What child doesn’t like to get her hands dirty!  Exploring the simple combination of earth and water to create and get messy at the same time sets free the Nature Child!  Particularly when emphasis is placed on the process of creation rather than “what” is created. An interesting practice to cultivate non-attachment to outcome: after you have sculpted something, smush it back into a clay ball and begin again... 

 

8.  Measure time naturally.  The Nature Child is averse to clocks and calendars. When my daughter was younger and I was headed out while she was in the care of others, she would sometimes ask me when I would be back.  I knew that “4:30pm” was meaningless to her, so I pointed to the sun and said, when the sun starts to hide behind that tree across the street, I will be home.  How delightful to spend an entire day speaking about time in those terms!  “How long will it take to drive there?” “As long as it takes to cook oats.” It’s also helpful to speak in a larger sense of months and seasons passing: “My baby will likely come when the rains begin again, or when a certain flower is in bloom....”  (Note: It is from this magical and symbolic place that we can safely tell young children their Birth Stories as they start to ask questions about their births.)

9.  Belly dancing.  Not just for seduction, belly dancing traditionally was and is used to teach younger women how to move their bodies in labor! Practice a fun, playful, sensual and helpful form of exercise...most communities offer “Bellydancing for Labor” classes.

10.  Get a massage! Awaken the sense of touch with the nurturing, gentle, confident hands of bodyworker near you. Use your hour enveloped in touch as an opportunity to practice mindfulness - bring your awareness fully to where you are being touched.

 

fire

11.  Sit by a fire. What could be more magical than gazing into the transformative and awe-inspiring power of fire?  Do you have memories of watching the fire as a child?  The child within may visit again when you sit down, wrap a blanket around you and simply watch the flames dance.  Perhaps a friend or elder can tell you an ancient story, a story that was told by fires for thousands of years....

How will you cultivate your Nature Child? Can you hear her whispering to you? “Come out and play....”

 

Red Raspberry Relationship

Disclaimer:  The contents of this article are for informational use only.  I am not a licensed herbalist, merely an interested person who believes that everyone has the right to information about common herbs.  I share my experiences and opinions within, however please consult with your prenatal care provider before ingesting anything you might have concerns about. (Originally composed December 2013.)

A friend and midwife recently shared with me a conversation she’d had with a fellow birthworker.  She was asked, “Are you more about the mothers, or more about the babies?” and her response was, “I’m more interested in their relationship.”  When I was contemplating what information I wanted to share about the commonly recommended herb for pregnancy, Red Raspberry Leaf, this conversation entered my consciousness. I realized that while all of the information I had learned about this herb (benefits, botany, etc.) is important, equally important was to task myself with encouraging a stronger and deeper relationship with the herb herself.  I need to be a “doula” to the relationship between a pregnant woman and this plant, support and nurture it, not merely rattle off some facts about the plant’s scientific constituents and add another item to the long list of things a pregnant woman “should” do.  I want what I share not to become a chore or task undone that creates guilt, but rather an invitation to create more intimacy between a birthing woman and the natural world.

Red Raspberry Plant

Red Raspberry Plant

In this post I will explore the benefits, possible contraindications, and a detailed and illustrated “how-to” of red raspberry leaf tea or brew preparation.  All throughout I will weave in the thread of “relating” to the herb.

As with all relationships, some unhurried, open-hearted get-to-know you time is a great place to start.  Here is a photo of the plant herself growing in my garden.  Wild red raspberry, botanical name Rubus idaeus.   After sitting next to her for a while, with permission, gently touch her feathery leaves, serrated edges, and the only mildly pokey thorns that run down her stem.  (If you can’t find red raspberry growing wild in your area, try sitting with raspberry’s cousin, blackberry (another Rubus species),which is very common and has similar properties – except her thorns are pokey) .The leaves can be harvested whenever they are bright green and full of life. 1

Going through the process at least once of harvesting (only one third of the plant if wild), and then drying helps us not to take for granted the effort, energy, and love that brought perfectly packaged dried herb into our kitchens.  I believe it’s worth it to seek out ethically wildcrafted red raspberry, as locally as possible.

Note: I’ve been sourcing most of my herbs and supplies from Mountain Rose Herbs for over a decade. As of this writing, the cost for bulk dried raspberry leaf, one pound, is $9.  However, the herb originated in Albania- quite a journey.  Other larger herb companies like Frontier, Starwest Botanicals, etc., also source similarly.  Another great place to look is on hand-crafted sites like etsy.com – though more expensive ($20/lb or more), they are for the most part locally and lovingly wild crafted and stored well. And it’s still a deal if you consider that in a package of 20 tea bags (which costs around $5) the total quantity of red raspberry is probably less than a half an ounce!

Raspberry Leaf Dried Herb

Raspberry Leaf Dried Herb

For more information about harvesting, drying, and other herbal preparations, please consult some of the sources listed as references at the end of the article.

Once you are ready to prepare your tea or brew, spend some time handling and smelling the dried herb.  Many herbalists subscribe to the theory of The Doctrine of Signatures.  It’s the idea that plants, fruits, or nuts, have the shape of or remind us of the organ in the body that they benefit.  For example, walnuts look like little brains, so they are helpful for brain function.  To me, dried red raspberry looks and feels like the material a bird would use to build her nest, and a nest is a cozy home for an egg, just like the womb!  Red raspberry has a history with herbalists and midwives of tonifying and nourishing the uterus (and other organs that live in the pelvis – good for men, too!).  Specifically for pregnant women, she may help uterine contractions function more fully and effectively, which may in turn make labors “shorter.” Many women take red raspberry to promote fertility and prevent miscarriage, as well as support general health of the uterus (including the cervix) throughout her life.  Enjoy her fluffy herbness, and smell her softish leaves. Does the smell appeal to you?  Is it interesting? If the smell is offensive, the herb may be contaminated, old and moldy, or just may contain something your body does not want right now.  Tasting the final tea will give you a good indication if it is appropriate or “safe” to drink.  More on this later.

Dried Herb in Jar

Dried Herb in Jar

So, how much herb should be used?  You could take just a teaspoon or tablespoon of the dried plant and steep in a cup of hot water for fifteen minutes or so.  This ritual is calming and nourishing, and the benefits of slowing down and consciously sending loving energy to the womb are worth making just tea.  However, you may want to experiment with creating a dense brew of an ounce or so of dried herb, brewed in about a quart jar for at least four hours or overnight.  This is called an “infusion,” so describedby herbalist Susun Weed.2 Prepared in this way, the infusion is more like a nutrient-dense broth, containing important minerals and vitamins that are often ingredients in prenatal vitamins.  I find that precisely measuring and weighing herb quantities to not be so useful if one considers that there are so many factors (where the plant was grown, neighboring plants, soil health, shady or sunny site, how harvested, etc.) that influence what minerals are present and what quantities. So, when working with whole herbs, I generally estimate filling about one fourth of the container I’m using by volume.  Less if I don’t want something so strong, more if I want a super-dense robust tea flavor.  With practice you will get a feel for the right quantity to use.

Another key element of infusion creation, according to Susun Weed, is that you not add other herbs to your infusion.  This is called “simpling,” and the benefit of working with herbs in this way is that you can build an authentic relationship with just the one herb, without too many other herbs confusing your interpretation. And should you have a unpleasant reaction, if there were eight other herbs in your tea you wouldn’t know which one wasn’t agreeing with you. Most “pregnancy teas” on the market today contain many different herbs, plus they contain red raspberry leaf in such minute quantity that, as mentioned above, the main benefit is probably just the ritual of tea love, rather than much ingestion of nutrition.

Our next step is to place the glass jar somewhat near the pot or other container you plan to boil the water in (more than a quart-size pot).  Any glass jar will do, as long as it isn’t too thin.  I love mason jars because they are the perfect size and they make me feel crafty.  I did have a client who used an empty pickle jar, and aside from her tea smelling slightly like pickles, she still enjoyed her infusion. (:  When I was first making infusions I didn’t put the jar close to the heat source while I was boiling the water and when I poured the boiled water into the jar (especially on a cold day) it would sometimes break the jar, even thicker mason jars.  I’d suggest placing the jar near the heating pot so glass and water heat up together.

Brewing

Brewing

Once the water has been brought to boiling, turn off the heat/flame and pour the water into your jar.  Some people like to mix the herb around with a wooden spoon, but I’ve found just securing the lid and maybe turning the jar upside down once it has cooled a bit helps distribute the herb through the water.

Now we get to observe the magical transformation.  I love to just sit and watch the first few moments when the clear water becomes infused, moment by moment, with the contents that used to reside within the cell walls of the plant.  It feels like the plant is bleeding, giving her body back to the earth, back to me….I feel such gratitude.

Once your water is fully infused (again, at least four hours, up to 12 or so), you are ready to strain out the pulpy herbal material.

If you are using a mason jar, the cooling liquid probably created a vacuum seal (yes, just like canning!) if your water was hot enough.  Simply break the seal, and remove the lid.

 Now, pour the entire contents of the jar through something that will strain the pulp into some container that can hold more than a quart.  You can use a metal strainer over the rim of your new container, but I love using a simple square cloth.  Use untreated, dye-free, 100% natural material (cotton, linen, etc), preferably organic if available.  You can cut up old T-shirts (the older the better – more dye is likely to have been leached out if colored).  I’ve used old unbleached muslin curtains and old tea towels.

 Gather up the edges of the cloth to keep the pulp inside, gently lift the cloth baggie out of the container, and squeeze all of that delicious and nourishing infusion out of the remaining herb.  I love this step so much, particularly for pregnant women, because it reminds us that life is messy, birth is messy, and that’s what makes it so real and full of the power of life.  Feel the infused water drip over your hands and fingers.

To further deepen our connection with this herb, be sure to return the plant material back to the earth.  Sometimes I will sprinkle the pulp around the small but growing red raspberry plant in the garden, or feed it to another meaningful plant or tree, like the pomegranate tree that was nourished by my daughter’s placenta.  You can add it to your compost bin, or if your living arrangements don’t allow it, simply sprinkle beneath any bush or tree near your home.  Don’t be surprised if a new plant relationship emerges from this offering. (:

Depending on how much dried herb you used, you should have three to four cups strained out. Most midwives and/or herbalists recommend drinking about one cup per day, and the infusion will keep for a few days refrigerated.

I love the deep orange-red glow of raspberry leaf infusion.  If I were an infant in the womb, I think this would be the first color I would see when the sun shines on my mother’s belly.  Most women find that this liquid smells and tastes just like black tea, without the caffeine of regular black/green tea!

So, just as we did with the dried herb, inhale, take a small sip, and observe how you feel.  If it’s too strong, you can always dilute it with some water.  Feel free to heat it back up, and/or add a bit of honey or stevia. Generally midwives and other prenatal care providers recommend starting regular consumption at 32 weeks of pregnancy to supposedly “build up” the active ingredient and minerals in your system to support your labor.  But I’ve know women to drink it at 38 weeks who found it enjoyable and claim it affected their labor experience.  Here, we want to be careful of why we are drinking the tea/infusion of this herb.  I believe our labors are as long as they need to be, and will begin when they need to.  If you drink the tea with the attitude that you are supporting your uterus to do what it needs to do to help birth your baby, then I would consider this a healthy uterine-herbal relationship.  If you are forcing down a cup of infusion daily so you can have a shorter labor, then perhaps reconsider what your true motivations are for drinking it.  Where can you surrender more to the process rather than trying to manage your birth?

I like this step of the relationship, too, because it poses a question that only the pregnant (or non-pregnant) woman can answer: “Does my body want to drink this?”  I’ve given hundreds of samples of this infusion to my doula clients, prenatal massage clients, and prenatal massage students, and I’m amazed at how varied their responses are.  Some smile warmly, some ravenously drink their entire glass, some sip it gingerly, a few don’t like it.

But, is it safe?

I think the response to this question is quite complex.  People in our culture are in general terrified of herbs, particularly wild herbs, because we are afraid of being poisoned.  It makes sense since most of grew up with very little knowledge of the plants that grew wild around us.  In fact, there are very few poisonous herbs out there, many of which affect different people in different ways.3  I believe that we are actually afraid of wildness, afraid of the mystery that is inherent in whole plants and feel more comfortable with active ingredients isolated in a lab whose doses are precisely measured and have predictable effects, and someone to blame if the effect is “wrong.” This parallels our fear of birth, the wild unpredictable nature of birth.  Trust your body, your senses.  If it feels wrong, tastes wrong, then don’t drink it!

Interestingly, some herbs in the parsley and mint families (common cooking herbs like parsley, basil, sage, thyme, etc.) are emmenagogues (i.e., they bring on menstruation) or are abortifacients (i.e., cause a miscarriage).  And yet, I’ve never heard of a prenatal care provider recommending against their ingestion.  If anything, peppermint and friends can help with nausea of early pregnancy. Perhaps it is because we are culturally very familiar with these food herbs.   However, if one were to concentrate the active properties of basil, for example, into an essential oil and offer to a pregnant woman, the effects would be much stronger.  Many essential oils (which are quite drug-like in their strength) are to be avoided in pregnancy.  Whole herbs, like an infusion of dried raspberry leaf, however, are generally quite safe.  (It’s an interesting comparison that chewing willow bark, which contains salicylic acid, the isolated active ingredient in aspirin, does not upset the stomach, while taking an aspirin tablet often will.  There is something to be said for the protective quality of whole plants).  An herbalist, midwife, and MD lists Red Raspberry Leaf under a table entitled “Herbs Considered Safe in Pregnancy.”4

There are very few studies in the literature that examine the effects of raspberry leaf on labor.  A few show that women who used a tablet of the herb (not the infusion, which some herbalists would argue is much different than a tablet, i.e. capsule) had shorter “pushing” stages of labor, and less complications and interventions overall.5,6   A more recent study states in the abstract: “The efficacy of raspberry leaf is not convincingly documented. The use of raspberry leaf in pregnancy is a traditional herbal therapy and is recommended by some midwives. Due to the lack of evidence for safety and efficacy such recommendations are questionable.”7

According to the scientific model something must have measurable and repeatable results to be considered a valid scientific theory. I’m not against science, but it’s hard to argue with what generations of midwives and healers, women with deep relationships to plants, have been taught sometimes by the plants themselves. One herbalist writes, “….it’s rare for a Gypsy woman to go through pregnancy without drinking daily raspberry from time of conception and gives birth with the ease of the ‘wild vixen.’” 8 The world of herbs, like birth, is often hard to study.  Herbs, like pregnant women, are vibrant living individuals.  They are subjects, and not easily amenable to being an “object” of a study. It may also be that since red raspberry leaf is not available everywhere, often imported from other continents to where it is consumed, certain elements are missing in the relationship.  Consuming a tablet or capsule, again, is much different than an infusion in how it is received by the body.  I read one article where women were advised to take raspberry leaf in capsule form rather than the tea form if they didn’t like the taste.  I would argue that taste is an important part of the relationship!

There is also much controversy and differing opinions about who should NOT take raspberry leaf regularly.  Some women are told not to take it during the first trimester because it may overexcite the uterus and cause a miscarriage.  Some are told to drink it in the first trimester because it will strengthen the uterus and prevent miscarriage.  Some are told to avoid it if they are at risk for preterm labor, or had a previous cesarean birth, pregnant with twins, have preeclampsia or other complications where stimulating the uterus might result in preterm labor.  Again, some are told it will help these conditions.  It reminds me of the general recommended contraindications for prenatal massage to the abdomen.  A nurturing massage therapist’s deliberate and gentle hands on your belly would never cause a miscarriage or preterm labor, (in fact, it may help you relax enough to prevent both situations), but because a miscarriage is more likely to happen in the first trimester, or preterm labor to happen with certain conditions, belly rubs are often avoided to prevent an association with the possibly undesired outcome.  It comes down to practitioners’, perhaps justifiably, fears of being sued or blamed.  Perhaps the same is true of red raspberry leaf.

I hope this article provided some herbal food-for-thought, and that you might consider making a new plant friend on your birth journey.

References:

  1. Edwards, Gail Faith. Opening our Hearts to the Wild Herbs.  Woodstock, NY Ash Tree Publishing. 2000.
  2. Weed, Susun.  Wise Woman Herbal for the Childbearing Year. Woodstock, NY Ash Tree Publishing. 1986.
  3. Thayer, Samuel.  “Into the Wild and Other Poisonous Plant Fables” (article from foragersharvest.com)
  4. Romm, Aviva. Mothering Magazine. “Herbs for Pregnancy”. Jan-Feb 2008.
  5. Parsons M, Simpson M, Ponton T. 1999. Raspberry leaf and its effect on labour: safety and efficacy.Aust Coll Midwives Inc J 12(3):20-5
  6. Simpson M, Parsons M, Greenwood J, et al. 2001. Raspberry leaf in pregnancy: its safety and efficacy in labor. J Midwifery Women’s Health 46(2):51-9
  7. Holst L, Haavik S, Nordeng H. 2009. Raspberry leaf – should it be recommended to pregnant women? Complement Ther Clin Pract 15(4):204-8
  8. Parvati-Baker, Jeannine.  Hygeia: A Woman’s Herbal. North Atlantic Books.  1978.

Gathering Berries for Birth

bear eating berries

The omnivorous black bear spends considerable time sifting through dense foliage hunting for delicious berries, usually in the last few months leading up to hibernation, if she lives in a more northern climate.  She stores these sugary bits as fat on her body, in the hopes that they will sustain her during the cold dark time she will spend in a cave, learning to see in the dark. 

So it is with us. 

berry picking.jpg

I recently spent time gathering blueberries with my family in northern Idaho. As I squatted close to the ground and reached for the plumpest clusters in the understory that were protected from the summer sun, I slipped into a meditative and focused state: moving efficiently, strategizing the next branch to explore, enjoying the plunking of several berries at once into my filling bucket (much like in the book, Blueberries for Sal!), feeling that delightful abundant sensation of collecting-for-later. (Though of course many berries found their way directly to my belly.)

I got to thinking about birth and the ways in which we prepare. Pam England, author of Birthing From Within, describes one of the archetypes that is often quite present during preparation for any major rite of passage: The Gatherer.  This is the part of our selves, our psyche, that wanders gently through the forests of our minds and worlds collecting.  Collecting what we think we might need for our journey.  Different than a Huntress who stalks her prey, (stalks her own mind for patterns of thought and beliefs that may or may no longer serve her highest Self), the Gatherer does not stalk, but shifts her attention to the next shiny thing, the next plump berry that draws her attention. She may be picking at the same bush for most of her pregnancy, never realizing there is a whole field of sun-ripened wild huckleberries over the next hill.  However, gathering is still an important task of prenatal preparation, and much of what we gather will sustain us in one way or another during the Journey of Transformation.

Many women and their partners gather articles and stories about evidence-based birth practices. We gather stories from our friends and relatives about what is a good birth and what is a bad birth. We put them in our baskets, fill our unconscious bucket with things that help us feel full and heavy and prepared. Especially if what we gather looks a lot like what we have gathered already: ...my mother had a difficult birth, so of course since my pelvis measures small I will have a difficult birth as well… or... I must have a gentle birth and breathe my baby into the world - I will only listen to positive birth stories from now on and watch beautiful birth videos...

berry bucket

When I had a pretty full bucket I added a lovely flower.

How did I know to add the flower?  I was drawn to it. The flower called me. 

And that is how it is when we prepare for birth. We listen to what we are drawn to, honor our heart's calling, pack it up, make it pretty (like our perfectly packed birth bag), and then we let it go.  We surrender to the fact that maybe our birth bag will get left at home on the way to the hospital, or kicked over and the contents spilled, or thrown up on, or never even opened.  But that doesn't mean we don't pack it up with awareness.

What are you collecting in your bucket or basket as you prepare for an upcoming birth? What do you gather as a parent?  What do you gather as a birth worker?  

gathering

Perineal Massage: Touching the Sacred Gateway

Originally posted by JAMIE on MARCH 17, 2013

Perineal Massage

Touching the Sacred Gateway

One of the most common fears surrounding the birth process for pregnant women is that the tissues of her perineal area (particularly between the vagina/vaginal opening and the rectum/anus) will “tear.”  It has become a more common recommendation that a pregnant woman, with or without her partner, begin about a month before her estimated due date to “massage” or manually stretch the tissues of her perineum to prevent perineal lacerations and other trauma during birth. Is this a safe practice? Is it even beneficial? As a prenatal massage therapist I took a special interest in this topic. I would love to share with you what I’ve learned!

In this post we will explore some of the energetic and physical anatomy of the perineum, the goals and possible benefits and risks of the practice, what the studies appear to demonstrate, and a how-to discussion of massage approaches to the area. Please note that the contents of this article are for informational use only and should not replace the advice of your Prenatal Care Provider.

Perineal Anatomy

“I am the floor. I am the ground.  I am the base of your pleasure.  I am the foundation of your well-being.  I am the road that rises to meet you….I am rich.  I am well supplied.  I have nerve endings in abundance.  I throb with blood.  I am a treasure.  I am the setting of the jewels. I am flexible.  I stretch and bounce back.  I thrive on action.  Stir me.  Pulse me…I am the mystical figure eight.  I am infinity…the endless loop.” 1

-Susun Weed

Let’s discuss the energetic, emotional, and physical anatomy of this amazing area.

Root Chakra

Root Chakra

In the Indian system of mind-body medicine, Ayurveda, the perineum is also known as the “Root Chakra” (a chakra is translated as a “wheel of energy”) which is the first of seven chakras that move up the torso and head.  The Root Chakra is our energetic connection to the earth, and it is this grounded energy that helps spiral our babies through our perineums and down to the earth.  The color of this chakra is blood red, seen physically with powerful menstrual and birth blood that figuratively (and sometimes literally) feeds and fertilizes the earth.

Practitioners of yoga also engage bandhas, or locks, at some or all of the three major diaphragms of the body to direct life-force energy.  These are the vocal, respiratory, and perineal diaphragms.  The perineal lock, or “mula bandha,” directs energy upward through the body which essentially elevates the muscles of the perineum.2

In Traditional Chinese Medicine, the perineum is the first acupuncture point of the Ren meridian, aka Ren-1 or Conception Vessel -1.  It is precisely at the midpoint between the posterior labial commissure and the anus in females, and is considered the most yin (or feminine) point in the human torso.  It is used to treat many urogenital disorders, including pelvic organ prolapse, as well as to bring someone back to consciousness!

The perineum is also known as “Down There.” When I lived in a French-speaking country in central Africa I learned the term en-bas la-bas, which translates literally as “down there over there” – twice removed apparently!  These cultural linguistic preferences show that talking about, let alone deliberately massaging, the perineum can feel awkward and foreign. Many women have also been victims of physical and sexual abuse which may intensify her trepidation to connect with this area of her body. This psycho-emotional component is very important to consider before we make a physical recommendation to “just massage your perineum a few times a week starting week 34 or 35 of pregnancy.” We’ll talk about this more when we discuss the goals of Perineal Massage.

The word perineum from the Greek means “around or near that which empties out,” much like the wordperinatal means “around or near birth. “ When defining the perineum’s location, many western practitioners simply mean the skin between the anus and the genitals as a specific physical external area, but some would consider the perineum anything below the peritoneum of the abdominal cavity, with many internal physical layers of muscle and fascia (connective tissue). (Tears and other perineal trauma from the birth process can occur more superficially to the skin and mucosa, or if the laceration is more severe, to the layers of connective tissue and muscle.)

Most anatomical diagrams still show the perineal muscles as a sling or hammock holding the pelvic organs inside the body.  However, recent findings from MRI photos show that the deeper muscles of the lower pelvic region are in fact a diaphragm, matching the shape of the respiratory diaphragm, meaning rounded at the top. “At resting tone, the pelvic floor is convex superiorly rather than inferiorly, and …. it is shaped like a dome, and not a basin.”3 This feels very significant to me, because it implies that the perineal muscles are more active and poised, rather than just hanging there like a hammock.

Pelvic Gateway versus Pelvic Bowl

Pelvic Gateway versus Pelvic Bowl

Likewise, there is controversy around the orientation of the standing female pelvis.  The conventional medical model is of a passive pelvic floor that hangs between a horizontal coccyx and pubic bone.  A growing minority of professionals perceive that women actually have an active pelvic gateway oriented more toward the back of her body whose main function is to complete elimination rather than keep the pelvic organs from falling out.4

 

Whether it be dome or bowl, tilted back or straight under, the female perineum is beautifully designed to meet, stretch, allow, open, and surrender to a flexible and moldable emerging infant.  Some of the muscles that play an important role in this dance of tissue and energy are shown in the line drawing here.

Muscles of Perineal Area - "pelvic floor muscles

Muscles of Perineal Area - "pelvic floor muscles

The body landmarks of the perineal muscles include the pubic bone (which is where the two sides of pelvis meet in front), the coccyx (or tailbone), and the two ischial tuberosities (or the bones you can feel through your glute muscles, especially when seated upright).  These round bony knobs merge with the pubic bones, forming a “V”, though it’s more of an upside down “U” in this drawing.  There are many layers and muscles that act in this area. I’ve chosen to show a few, highlighting the pubococcygeal1 (or PC) or sometimes known as the bulbospongious and anal sphincter muscles.5  Notice the fascinating and functional figure eight shape.

Potential Goals of Perineal Massage

More pliable tissue or more scar tissue?

The primary goal of perineal massage is to reduce the chance of tearing during birth.  How might this work? It is thought that the stretching massage action will soften the muscles, connective tissue, and skin of the area, and pliable tissue is less likely to tear.  This is the same rationale behind how massage on other areas of the body might work – one would think it would apply to any area of the body with connective tissue.  Also, most recommend perineal massage be performed to the edge of comfort until a burning or numbing sensation has occurred. This may help some women become more familiar with the sensation of a baby’s head crowning so that when she feels this in labor she is less likely to panic and tense up (or panic and push really hard and fast) rather than relax into it- which also my cause tearing.  Some birth professionals even say the perineal massage will reduce the burning sensation during labor itself, sometimes referred to as the “ring of fire.”

These are two of the possible benefits of prenatal perineal massage.  However, it is also possible that if the massage is performed too aggressively (i.e., the burning sensation – which is how most recommend to do it!) there can be damage to the perineal mucosa/tissue.  There would then be scar tissue from the damage, which would create a less pliable perineum if the scar tissue did not resolve before labor!  Also, I’ve been practicing massage for over a decade, and any technique that causes burning or numbness in any area of my client’s body is promptly stopped or altered.   So this recommendation gives me pause.

The most commonly cited study that seems to have led to the blanket recommendation of perineal massage was done by Labrecque et al in 1999.6  It showed reduced incidence of perineal trauma in first-time mothers only (actually slightly more trauma for second-time or more moms) who performed the perineal massage.  However, “perineal trauma” also included episiotomies (the surgical cut to the perineum that was formerly routine in this country, though still done today), so it’s hard to say if it was practitioner preference or the massage actually made the tissue so pliable there was no need for the episiotomy.  Subject compliance is also difficult to control for: maybe the women actually did or did not perform the techniques as directed or as often as requested.

Perineal Awareness and Empowerment

A third benefit of massaging the perineum is bringing more consciousness and awareness to an area of the body whose messages many of us, at best, ignore.  The vagina and perineum store possible physical and emotional traumain their tissues, and doing some kind of internal physical touch may help to resolve or integrate those areas back into wholeness so they are less likely to hold the woman back during labor.  A woman who is relaxed and surrendering to the process will have more responsive tissues and may be less likely to tear.  (There is also the possibility of reactivating or even reinforcing trauma with aggressive perineal massage, so if you have any known previous abuse you might choose to seek professional guidance.  Again, please discuss these concerns with your Prenatal Care Provider before proceeding.)

A woman (with or without her partner) who has explored how her own body feels, moves, and responds to touch may feel more in control and more likely to take an active role in making decisions about her body, her baby, and her birth.  This may indirectly affect her chances of tearing because of interventions she may choose to forego or healthy practices she may choose to undertake.  Birth is also a sexual experience.  Midwives are fond of saying “The same energy that got the baby in will get the baby out.”  If her perineal massage becomes more of an exploration of her sexuality, rather than some chore she has to do to keep her from tearing, she may find enjoyment in the practice and self-realization that could help her through labor.  Also it is the hormones and changes in blood flow of labor that actually cause the engorgement and opening of the whole perineal area, something again more related to whole-body-mind response rather than just some tissue that needs to be stretched out.

A final important psychological element to the perineal massage debate is to consider what this recommendation may be telling some of our pregnant women subconsciously.  Perhaps she hears “my body is not good enough, it will not open enough on its own so this massage needs to be done since my body can’t do it.”  If you find yourself as a pregnant woman having this kind of attitude, please reconsider why and for whom you are performing perineal massage.  Anything we choose to do during pregnancy may not always be comfortable, either physically or emotionally, but it should empower us, and never make us feel like our bodies are “not good enough.”

How to Massage Your Perineum

So, then, should I do perineal massage or not?

As with all choices in pregnancy, I strongly believe you should do what feels right for you.  If perineal massage is not something that sounds appealing, or you try it and hate it, then I’d suggest doing something else entirely (how about belly dancing, prenatal yoga, or just walking barefoot in the sand?), or changing your approach.  Maybe you feel less awkward in the shower, perhaps it feels more like a sacred practice if you light a candle, or you would prefer your partner do it?  I think we should change what we call it.  How about Sacred Gateway Exploration.  Try and make it feel right for you.

For your Perineal Massage you might include the following:

Perineal Massage

Perineal Massage

  1. Create a safe environment where you won’t be interrupted.
  2. Wash hands thoroughly, trim fingernails.
  3. Use some kind of safe lubricant (coconut oil is a good choice) if desired, with a towel under her bottom to catch dripping oil.
  4. Place one or both hands over the vulva and perineum and honor your baby’s gateway into this world.
  5. Insert one or two fingers (or thumbs if that feels best) into your vagina up to one or two knuckles, whatever feels comfortable.
  6. Apply downward pressure (toward your anus) for a few minutes.  Perhaps slide back and forth.  Note any sensation.
  7. Apply pressure to one side and then the other for several minutes.  Note sensations.
  8. Stop when you feel you’ve had enough.
  9. Place your hand over your vulva and perineum and send your gratitude again.

Notice I omitted the “apply pressure until you feel a burning sensation to ensure you are getting a good stretch” as this may possibly be creating microtears and damaging the tissue.  But you may choose to do this.


There is also a wonderful tantric healing practice called Yoni Mapping.8 Rather than using the word vagina (which means “sheath”) the ancient practice of tantra yoga, also from India, describes the uterus, vagina, and vulva all as the yoni – a more sacred and spiritual term.  You could essentially follow the steps listed above, but instead of just stretching the tissue from side-to-side and starting at the bottom, you create a clock around the entire vaginal opening and you start just below the pubic bone.  Also, the Giver might use his/her more sensitive finger pads rather than thumbs.

Yoni Mapping

Yoni Mapping

Just below the pubic bone is 12 o’clock. (6 o’clock would be straight down toward the anus). Then you move to 1 o’clock and hold, noting anything that you feel physically or emotionally.  Allow a lengthy pause between holds to help her enter a more meditative state. Proceed around the entire “clock” until you’ve returned to 12 o’clock again.  This is a great practice to do with a partner who can respectfully note how you respond at the different “times” on a clock and go back there if you need them to.  It also allows the woman to relax more and passively experience, rather than being both the Giver and the Receiver.


The massage should not be performed if

  • the woman has an active vaginal infection.
  • her membranes have ruptured (water broke).
  • she is at risk for preterm labor, or is on bed-rest for a high risk condition.
  • her partner cannot remain present or respectful.
  • it doesn’t feel right to her.

Please consult with your Provider should you have concerns.

Perineal Massage and Massage Therapists

In most jurisdictions it is illegal for massage therapists to perform any intra-anal or intra-vaginal manual technique. We can certainly give you how-to information about different techniques and approaches. It is within our scope of practice to massage the muscles of the pelvic floor as they attach the various areas of the pelvis and sacrum.  Also, there are tantric healers in some communities who can support you in learning some of these techniques.

Other Ways to Possibly Prevent Tearing

Most Prenatal Care Providers, especially those practicing within the midwifery model, would recommend good nutrition and adequate hydration to keep all the tissues of the body healthy and pliable.  There is also the practice of being patient and slowing down during Pushing to allow the perineum adequate time to stretch as baby’s head emerges (crowns).  Of course physical activity keeps all of our muscles and connective tissue healthy!  (Did I mention yoga, dancing, walking?)

Other practices that a pregnant woman might find helpful have conflicting professional perspectives.  One can practice squatting during pregnancy, which has numerous benefits and may help keep the pelvic floor functioning optimally, but some say to avoid squatting during the last few weeks of pregnancy, as it may drive a less-than-optimally positioned baby further into the pelvis.  Also, there is some debate amongst birth professionals as to whether or not a woman should practice pelvic clenches, (aka kegeling) to “strengthen” the pelvic floor muscles.  I look forward to exploring these topics with you in future posts!

I think it’s important when we choose to devote our time to any prevention tactic or intervention that we ask ourselves why. Are we trying to control too much?  Are we trying to bury rather than face our fears? How would we deal with a tear should it happen?  How can we make tearing a sacred experience?  Perhaps, tearing was just the thing to slow us down after the birth of our child so we could learn to ask for help  more.  Maybe the tear kept us in bed with our baby long enough to get the breastfeeding relationship going.  Maybe observing how the yoni heals so miraculously after tearing teaches us the power, beauty, and dynamic nature of the body.  Whether or not a pregnant woman chooses to massage her perineum before birth, I hope she honors her beliefs, her body, and her self.



References

1 Weed, Susun.  Down There: Sexual and Reproductive Health the Wise Woman Way.  Ash Tree Publishing. 2011. pgs 3-5.

2 Kaminoff, Leslie and Matthews, Amy.  Yoga Anatomy, 2nd Edition.  The Breathe Trust. 2012. p. 17

3 Goldstein, Irwin. Women’s Sexual Function and Dysfunction: Study Diagnosis and Treatment. Taylor and Francis, US, 2006. p. 142

4 Kent, Christine. Saving the Whole Woman. Bridegworks, Inc. Albuquerque, NM. 2006.

5 Calais-Germain, Blandine. The Female Pelvis: Anatomy and Exercises. Eastland Press,  Seattle, WA, 2003.

6 Labrecque, M., Eason, E., Marcouz, S., Lemieux, F., Pinault, J., Feldman, P. and Laperriere, L., “Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy,” American Journal of Obstetrics and Gynecology 180, 3 (March 1999): 593. 

7 Stager, Leslie.  Nurturing Massage for Pregnancy. Lippicott Williams & Wilkins, 2010. pgs 138-140.

8 Devi, Kamala, and Dez Nichols, Baba.  Sacred Sexual Healing. Zendow Press. 2008.  p. 204-205.