Perineal massage

The intention is also to attempt to: eliminate the need for an episiotomy during an instrument (forceps and vacuum extraction) delivery; to prevent blood loss (risk of Sheehan's syndrome) and tearing of the perineum during birth and in this way avoid infection (cellulitis and necrotising fasciitis of the pelvic floor muscles), helping to keep antibiotics working into the future.

The Oxford Radcliffe NHS Trust Document "Antenatal Perineal Massage" 2011 describes the use of the pregnant mother's thumbs being placed just inside the birth canal, whilst she stands with one foot supported on the toilet.

[1][2] She pulls backwards towards her spine, whilst relaxing her pelvic floor, progressively increasing the pressure under her finger tips until this starts to feel uncomfortable.

[5] The German obstetrician Mr Welheim Horkel, when visiting a medical mission in the mid-1980s, learned that African tribes used gourds of increasing sizes to stretch the perineum, to avoid tearing during childbirth.

Antenatal perineal massage reduced the second stage of labor duration (p = 0.005) and anal incontinence (p = 0.003) with significant improvement in baby's Apgar scores at 1 and 5 minutes (p = 0.01 and p = 0.02).

[7] Perineal massage by minimising blood loss during birth, decreases the risk of Sheehan's syndrome - the stroke of 'the hormone control centre' on the under surface of the brain, called the pituitary.

Finger tip 'Antenatal Perineal Massage' or 'Birth Canal Widening' to 10 cm diameter, affords mothers worldwide, irrespective of income, the opportunity to shorten the critical last 30 minutes of labour[8] and improve APGAR score of baby at birth.