C h i l d b i r t h   P r e p a r a t i o n

• 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) or side-lying positions reduce the strain on the perineum. Lying on your back with feet up in stirrups makes an episiototmy almost inevitable.
• After childbirth, tone up the stretched muscles in the vagina by continuing the pelvic floor (Kegel) exercises that you learned in childbirth preparation classes.

Perineal massage
Directions:
1. Wash your hands.
2. Find a private, comfortable place and sit or lean back in a comfortable    position.
3. Put a lubricant such as KY jelly, cocoa butter, vitamin E oil, or pure vegetable oil on your thumbs and around the perineum. You can also use your body's own natural lubrication.
4. Place your thumbs about 1-1.5" (3-4 cm) inside your vagina. Press downwards and to the sides at the same time. Gently and firmly keep stretching until you feel a slight burning, tingling or stinging sensation.
5. hold the pressure steady at that point with your thumbs for about 2 minutes until the area becomes a little numb and you do not feel the tingling as much.
6. Keep pressing with your thumbs. Slowly and gently massage back and forth over the lower half of your vagina, working the lubricant into the tissues. Keep this up for 3-4 minutes. Remember to avoid the urinary opening.
7. As you massage, pull gently outwards (forwards) on the lower part of the vagina with your thumbs hooked inside. This helps stretch the skin as the baby's head will stretch it during birth.
8. Do this massage once a day, starting around the 34th week of pregnancy. After about a week you should notice an increase in flexibility and stretchiness.