Perineal massage

Massage of the perineum (the area between the anus and the vagina) has been shown to reduce the risk of tearing, needing an episiotomy or stitches during a vaginal birth. You can start practicing perineal massage when you’re 34 weeks pregnant – research shows that it is most effective when performed at least twice a week. You can do it yourself or ask your partner to do it for you, as it can be a little difficult to reach if you have a big bump!

To perform the massage, you should:

  • Make sure your hands are clean and your nails are short and filed

  • Use a mirror so you can see what you’re doing

  • Squat, sit or lie down – however you are most comfortable

  • Use a lubricant – vegetable oils (such as olive oil), vitamin E oil or a water-based lubricant such as KY Jelly work well (do not use Vaseline or baby oil)

  • It’s easiest to use your thumbs (if your partner is doing it, they can use their index fingers)

  • Insert thumbs or fingers about 5cm into your vagina (up to the second knuckle)

  • Press downwards towards your perineum/bottom until you feel a tingling sensation

  • Use sweeping, swirling motions to stretch the surrounding tissues

  • Massage the perineum itself between your thumb and forefinger

  • Relax your pelvic floor muscles during the massage

Moxibustion

Moxibustion is a traditional Chinese medicine technique, used to turn babies into the head-down (cephalic) position.

It is a Chinese medicine treatment allied to acupuncture but uses no needles. A dried herb called moxa (mugwort) is tightly rolled into the shape of a cigar. This roll is lit and held above the skin, next to an acupuncture point on the foot called Bladder 67, on the outside of the little toe nail. When lit, the herb smoulders slowly, allowing the heat to permeate into the body. This is believed to affect the flow of qi (energy) and blood flow in the area (British Acupuncture Council 2010).

Research suggests that this technique might be helpful for some women whose babies are not head down. It’s not painful or harmful, and some women may wish to try it before having an external cephalic version (ECV). There’s also some evidence that it might reduce the need for oxytocin and, if combined with acupuncture, may reduce the likelihood of needing a caesarean.

Moxibustion is available at Poole Maternity Hospital for women living in Poole and Bournemouth. Dorset County Hospital will soon be offering moxibustion too.

You may be offered moxibustion if your baby is lying in breech position at 34 weeks, and you have no other complications. If you are eligible, your midwife or obstetrician will refer you.

The appointment for the first treatment usually takes 30 minutes and will be held at Poole Maternity Unit. You will then need to continue with moxibustion at home for 15 minutes every day for seven days – it’s very straightforward and you will be taught how to do this at your appointment.

Although this is generally a safe and gentle procedure, it may not be suitable for you if:

  • Your doctor has said it is not appropriate for you to have an ECV

  • You have had a previous caesarean, or other uterine surgery in the last two years

  • You have a bicornate uterus or fibroids

  • You are having twins or more

  • Your baby is expected to be very large or very small, or is known to have health problems

  • You have a low-lying placenta, placenta praevia or vaginal bleeding

  • You have had any other complications

  • You have diabetes, high blood pressure or any other medical problems

  • You are scheduled to have a caesarean for medical reasons

  • Your baby is transverse or keeps changing position, especially if there is a lot of fluid

If moxibustion does not help your baby to turn to the head down position, you may be offered an ECV.

ECV

External cephalic version (ECV) is a method of turning babies who are breech or transverse into the head-down (cephalic) position. A doctor or specialist midwife will apply pressure to your abdomen with their hands.

Some women find this uncomfortable. This method works for around 50% of women and is generally safe. A small number of babies (approximately 1 in 200) will need to be delivered by emergency caesarean after an ECV, but your baby will be monitored throughout the procedure to ensure they are coping well.

If your baby needs help to turn into the right position, your midwife will refer you to the ECV clinic at Poole, or to have the procedure in the day assessment unit at Dorset County Hospital.

Expressing colostrum

Most mothers start producing colostrum about halfway through pregnancy, and some leak small amounts of colostrum while they are still pregnant.

Some women decide they would like to hand express and freeze colostrum during pregnancy. This is not usually necessary, but it might be recommended if you are diabetic or taking medication for high-blood pressure, or if your baby is likely to be premature.

If you do wish to try hand expressing colostrum, speak to your midwife so that they can advise you. You should wait until you are at least 36 weeks pregnant. If you are leaking before this, you can try to collect some of the colostrum with sterile syringes.

Please don’t worry if you aren’t leaking during pregnancy, or if nothing happens when you try to hand express. This does not mean you will be unable to breastfeed or that you aren’t going to produce colostrum or milk once your baby is born.

Some women are specifically advised not to attempt to express during pregnancy, including:

  • Women with threatened or actual preterm labour

  • Women having twins or more should wait until 36 weeks to try hand expressing

  • Women with a cervical suture, or a shortened (effaced) cervix

This is because of a slight risk of triggering labour in women who are already at risk of preterm labour.

If you experience any contractions while hand expressing during pregnancy, you should stop immediately. If these continue, you should call Labour Line on 0300 3690388.

Find out more about antenatal hand expression

Feeding

It’s a good idea to think in advance about how you want to feed your baby, and to include this in your birth plan. You can discuss your thoughts with your midwife. There’s lots of evidence that breastfeeding has many health benefits for you and your baby, but it is up to you how you would like to feed your baby, and the team will support you whatever you choose.

Read more about feeding your baby.

Sleeping

During your pregnancy, you should think about where your baby is going to sleep. It’s a good idea to set up a safe sleep environment for your baby during late pregnancy, in case your baby is born early.

There are lots of options for sleeping and it can feel a bit overwhelming. It’s really important to do your research and consider what will be both practical for you and safe for your baby.

The following resources will help you to decide what’s best for you and your family: