Second Stage Positions

With Pelvis upright

  • Baby's angle of descent is easiest  when down and out
  • Uterus can exert maximum force making bearing down more efficient and shortening the second stage. Perineum expands evenly
  • Reduces risk of tearing.
  • Baby at birth is in optimal condition 
  • Less need for painkillers or interventions thus reducing risk of side effects.
  • Mother feels proud, empowered and satisfied

Read  a great article on  the evidence behind birthing upright.

When the Pelvis is horizontal ie. lying on back

  • Baby's angle of descent is more difficult - up hill
  • Bearing down force made less efficient, prolonging second stage
  • Perineum cannot expand evenly
  • Baby's head presses directly on me perineum and risk of tearing increases
  • Baby at birth may be compromised when birth is passive
  • Greater need for painkillers or interventions with possible side effects.

Here is a good video explaining the use of different positions in hospital births

Perineal massage - internal vaginal massage

by Suzanne Swan

Massage of the perineum is a technique which slowly and gently stretches the skin and tissues around the vagina and rectum. This internal work investigates the internal muscles and soft tissue of the perineum. You can massage the tissues both outside and inside the perineum regularly in the last eight weeks of pregnancy. Doing this work can have a profoundly positive affect on the ability of these muscles and surrounding tissues to relax and open.  Perineal massage helps reduce both the risk of tearing during birth and the need for an episiotomy.

The position in which you give birth can affect the likelihood of perineal tearing and the need for an episiotomy. Upright positions (sitting, squatting, kneeling), leaning forward positions (all fours) or side-lying positions reduce the strain on the perineum. Lying on your back with feet up in stirrups makes an episiotomy almost inevitable.

CAUTIONS: Avoid the urinary opening to prevent urinary tract infections. Do not do perineal massage if you have active herpes lesions, as you could spread the herpes infection to other areas.

General Hints:

  • The first few times it's helpful to use a mirror to find the vagina and perineum and see what they look like.
  • If you feel tense, take a warm bath or use warm compresses on your perineum for 5 to 10 minutes.
  • If you have had an episiotomy with a previous birth, concentrate part of your massage on that area. Scar tissue isn't as stretchy as the rest of your skin and needs extra attention.

Directions for you or your partner:

  • Wash your hands
  • Find a private, comfortable place to sit or lean back in a comfortable position.
  • Put a lubricant such as Vitamin E oil (pricked capsule), wheat germ oil. Rosehip Oil or pure vegetable oil on your thumbs and around the perineum (the tissue just below the opening of the birth canal). You can also use your body's own natural lubrication.  Take hold of the outside of the perineum and massage the opening between your thumb and fingers.
  • Next, place you thumbs (partners may use their index or middle finger to massage) about 3-4cm inside your vagina. Press downwards and to the sides at the same time. Gently and firmly massage and knead. You work the internal muscles of the perineum, the muscles on either side of the rectum and either side of the tailbone.
  • Slowly and gently massage back and forth over the lower half of your vagina, working the lubricant into the tissues. Keep this up for 2-4 minutes. Remember to avoid the urinary opening.
  • As you massage, pull gently outwards (forwards) on the lower part of the vagina with your thumbs (partners finger/s) hooked inside. Be gentle and give lots of feedback.  Stop and breathe.  This helps stretch the skin as the baby's head will stretch it during birth.
  • When you work inside your vagina you are working on the deep muscles by stretching and massaging them so that they can relax more easily. At birth, the baby presses on the rectum because it is in the middle.  When you tense up the muscles that would prevent a bowel movement you are tensing the muscles on both sides of the rectum.  By working before hand, you can become familiar with the sensations, and learn to relax these muscles. Do this massage once a day, starting around the 32nd week of pregnancy. After about a week you should notice an increase in flexibility and stretchiness.