Avoiding an epidural is also necessary to preventing perineal damage. An epidural prevents the mother from assuming optimal positions during delivery. She is denied the natural sensations of an urge to push, and has to rely on external sources to tell her when it is appropriate, instead of listening to the wisdom of her body. Good Management of Delivery At a typical home or birth center birth, a skilled midwife will deliver the baby in such a way as to minimize trauma to the mother's perineum. She helps the mother assume an upright position, encourages her to soak in warm water, and eases the infant gently into the world, one shoulder at a time.
Many midwives use hot compresses and olive oil to further ease the transition.
They let the mother know that she can trust her body to help the baby out in his own sweet time, as long as there is no fetal distress. If you make it through delivery without lacerations, you may be amazed at how normal you feel. Most women can comfortably get up and walk around the very first day after an unmedicated, intact birth. The perineum will still be sore, but you may not even need pain medication. Eisenberg, Arlene et al.