I have searched around the internet a bit and tried to find some evidence for and against the technique of breathing a baby out at the end of the second stage rather than coached, or active pushing but I did not have much luck. I have to be honest, I did not do an in depth search but I would have thought that even a quick search would have brought up a bit more than what I found. I searched in Google and Google Scholar two search phrases (reducing perineal tears through breathing baby out during the second stage and Reducing perineal trauma through controlled head delivery in the second stage)
What I found was my old internet midwife friend, Ronnie Falco, her site is great and always gives me food for thought. She has loads of evidence on her site relating to many issues concerning child birth. Her site is full of studies and evidence, unfortunately I think the majority of her evidence is past the 5 year rule of “useability”, if you were planning to use if for a dissertation or the like. But that does not discredit the information she has made available. http://www.gentlebirth.org/archives/perinealProtection.html
I also found a small bit of supporting information from a site called’ Birthing by the Heart, but this site is more commercial and there is no mention of where it gets its evidence from. http://www.birthingbyheart.com/self-care/perineal-tears/
From Google Scholar I found a few older studies on the use of different techniques such as a warm compress applied to the perineum during this stage, perineal massage with oil used at this stage and non touch technique appear to have little effect on perineum trauma. None of these studies looked into the use of breathing control to reduce perineal trauma.
Since working with my colleagues I have found many of their techniques amazingly effective and surprisingly common sensible. I have often asked myself why I was not taught more of these techniques during my training. One of these techniques is breathing babies out, or to be more correct singing babies out at the end of the second stage. We support and encourage all of our ladies to do this and our incidence of perineal trauma is fantastically low, and many of our women are nullparous (first time mothers) as well.
I first witnessed my colleague do this while I was doing my elective placement with them in my final year of university. We had a client who was having her first baby, she was in her mid thirties and had planned a home birth with the team. Her birth sent me on an amazing journey and helped me to redetermine that I would go directly into independent midwifery after graduation. Her labour was so natural, so powerful and in the end her birth touched my heart deeply. As babies head began to crown, she became frightened and started to fight against her urges to open and allow baby out. I had seen this before many times and I had seen many midwives reassure the frightened women with encouraging words and instructions like telling her to blow or give small pushes to try to control the heads delivery and reduce trauma. I would also do these things, as I had experienced them as being a great help to the mother. I had also witnessed and practiced myself, gently putting my gloved hand just at the top of the crowning head, to help ‘slow’ the delivery.
But instead of using any of these techniques, my colleague just began to sing. It was something I had never seen before. She spoke no words only to gently say the woman’s name, then she took a deep breath opened her mouth wide and sang AHHHHH. Within seconds we were all joining in. The fear and restraint that had over taken our lady had gone and as she opened her mouth and sang ahhh, her baby was born. He was 3.5 kilos and had his hand on his face as he made his way out to our joyous chorus and his mother was intact. It was beautiful.
Now I use this technique with all of the woman I deliver with my team and its an amazingly effective tool. We always tell our women, when you open your mouth you open your vagina. I have read this in Ina May Gaskins books and know it to be true somehow. But when you vocalize in a positive manner, like singing, your fear disappears and you don’t just open, you seem to allow every cell in your perineal area to allow the passage of the baby no matter what size. I have witnessed this with women having their first babies and others having second and third babies. But what I find most interesting with these women is that most of our multiparous women come to us after sections or assisted deliveries for ‘large’ babies. Yet with us they are able to deliver even larger babies and with little to no perineal damage.
I can only assume that it is our technique of encouraging our women to sing their babies out rather than using any other technique. Of course I am sure that the relationship that we build with the majority of them is supportive of their trust in us so that they will listen and take our direction when the time comes and the work we encourage them to do in our 12 week long antenatal courses. But in the end I have seen clients who have booked with us late and attended no courses, sing their babies out gently and beautifully with the same results.
Singing babies out, maybe give it a try at your next birth and see the results.
The Barcelona Midwife 