Patent Publication Number: US-2023157726-A1

Title: Externally Applied Intrapartum Support Device

Description:
PRIORITY DATA 
     This application is a continuation of U.S. application Ser. No. 17/542,012, filed Dec. 3, 2021, now U.S. Pat. No. 11,510,699, which is a continuation application of U.S. application Ser. No. 16/148,732 filed Oct. 1, 2018, now U.S. Pat. No. 11,389,187, which is a continuation of U.S. application Ser. No. 14/817,959 filed Aug. 4, 2015, now U.S. Pat. No. 10,085,770, which claims priority to and the benefit of the filing date of U.S. Provisional Application No. 62/033,038 filed Aug. 4, 2014, titled “Devices for Assisting the Progression of Labor During Childbirth,” and U.S. Provisional Application No. 62/086,634 filed Dec. 2, 2014, titled “Externally Applied Intrapartum Pelvic Floor Support Device,” each of which is incorporated herein by reference in their entireties. 
    
    
     BACKGROUND 
     A typical labor process during childbirth is divided into three stages. The first and second stages are directly involved in the delivery of the child, and the third stage involves the delivery of the placenta. The first stage of labor begins with the onset of rhythmic uterine contractions and ends with complete cervical dilatation. The second stage of labor begins upon complete cervical dilatation and ends after the birth of the child. The third stage of labor extends from the birth of the child to the complete delivery of the placenta. The labor progress, especially through the second stage of labor, is driven by two types of labor forces. The primary force is produced by the involuntary contractions of the mother&#39;s uterus (i.e., uterine muscle contractions). The secondary force is produced by the increase of intra-abdominal pressure created by voluntary contractions of the mother&#39;s abdominal muscles, including pelvic musculatures and diaphragm. These forces act synergistically to increase the intrauterine pressure and aid the expulsion of the child from the uterus. 
     The use of epidurals and pain relieving drugs during the labor and delivery process can desensitize the birthing mother from experiencing the natural body signals needed to push the baby through the birth canal and thereby ultimately delay the progression of childbirth. One indication of this phenomenon is that in recent years, there has been a dramatic increase in the incidence of children born by Cesarean childbirth. This form of child birth significantly increases the cost to the healthcare system when compared to a natural vaginal delivery. In addition, the birthing mother needs significantly more time to recover from a Cesarean operation compared to a natural vaginal child delivery. Systemic analgesic drugs, epidural anesthesia, and the long duration of exhaustive labor all can lead to the weakening of the secondary force, and sequentially to delayed labor duration or even dystocia (arrest of labor). Thus, in some instances, the duration of the second stage of labor is prolonged by ineffective or inadequate pushing by the mother, which can lead to injuries of the pelvic floor, fetal distress, higher rate of infant mortality, neonatal seizures, postpartum hemorrhage, and/or to delivery by Cesarean section. 
     While prior apparatus and methods like those disclosed in U.S. Patent Application Publications 2007/0031466 and U.S. Pat. No. 7,673,633 provide stable support for the soft perianal tissues near the anal orifice, these can be further improved to provide additional benefits for labor management to increase intrauterine pressure (e.g., by strengthening contractions and pushing), thereby decreasing the duration of the second stage of labor and/or decreasing the incidence of Cesarean childbirth. More specifically, there exists a need for devices that permit a healthcare provider to actively and intermittently monitor and guide the labor process to promote more effective fetal descent, thereby decreasing the duration of the second stage of labor and increasing the likelihood of successful vaginal births. 
     The devices and methods described herein overcome one or more deficiencies of the prior art. 
     SUMMARY 
     The present disclosure provides a device for assisting in the progression of labor during childbirth. In one aspect, the device includes a working end with a pressure surface or contact surface configured for spanning the anal orifice and a grip joined to the working end. In one form, the device comprises a V-shaped contact surface coupled to an elongate handle or grip. In a further form, the working end includes an inner surface opposing the contact surface, and the grip is coupled to the opposing inner surface. The grip can be attached to the working end at an adjustable angle by a pivoting assembly, at a fixed angle, or via a detachable connection. 
     In one embodiment, the working end includes compression members extending outwardly from the contact surface. The compression members extend equal lengths from the contact surface or may alternatively each extend a different length from the contact surface. In one aspect, the compression members each include a longer portion and a shorter portion. 
     In another embodiment, the working end comprises a V-shaped or U-shaped contact surface. However, it will be appreciated that the working end can include a flat contact surface. In one form, the working end includes a transparent body and contact surface with the transparent body and/or contact surface including markings. In one aspect, the markings may assist a user in positioning the device on the patient. In another aspect, the markings may assist the user in measuring the tissue distention against the contact surface through changing pressure situations during labor. In a further form of the device, the working end includes a transparent window extending through the contact surface. 
     In a further embodiment of the device, the working end includes a pad coupled to the contact surface. As set forth in the following description, the pad is compliant and may be conformable to the patient&#39;s body. In one aspect, the pad is adjustable to have a desired turgidity or degree of conformability. In another aspect, the pad is inflatable with a variety of fluids to have a desired turgidity or degree of conformability. The pad may be configured to retain its shape after the application of pressure. 
     In yet a further embodiment of a labor assist device, the working end of the device includes a focal protrusion extending outwardly from the contact surface. In one aspect, the focal protrusion is positioned off-center on the contact surface. In another aspect, the focal protrusion may be configured for partial or complete insertion into the anal orifice of the patient. 
     In a further feature, the grip comprises a T-bar handle coupled to the inner surface of the working end. The T-bar handle can include apertures configured to receive a user&#39;s fingers. In an alternative form, the grip comprises a knob-like or tab-like handle. The tab-like handle can include an aperture or depression. In still a further form, the grip comprises a tube-like passageway coupled to the inner surface of the working end. In one aspect, the working end includes a channel that extends from an anterior edge to a posterior edge of the device and aligns with the midline axis of the working end. In yet a further form, the grip comprises a curved support structure or compliant pad coupled to the inner surface of the working end. 
     In another aspect, the device includes a haptic feedback generator. The haptic feedback generator may be responsive to pressure applied to the contact surface. In one form, the haptic feedback generator causes movement of the working end, while in another, the haptic feedback generator causes movement of the grip. 
     In still a further aspect, the device includes a push evaluation system coupled to the grip and including an apparatus configured to measure the extent of displacement of the contact surface from the second position during a push. 
     In a further feature, the present disclosure is directed to a labor assistance system for contact with external perianal tissue of a patient with the system comprising a perianal support member and a grip. In one aspect, the perianal support member includes a contact surface, an inner surface opposing the contact surface, and a rigid compression element. The contact surface may include a continuous compression surface apex extending from the contact surface in a first direction corresponding to a height of the apex. In one form, the contact surface is dimensioned to span across an anal orifice without entering the anal canal for engagement with at least a portion of the external perianal tissue on opposing sides of the anal orifice of the patient. In a further form, the contact surface is oriented to extend from an anterior edge to a posterior edge along a midline axis in a sagittal plane of the patient, and the contact surface anatomically configured to not substantially interfere with the birthing canal of the patient during childbirth. The rigid compression element has a proximal end portion and a distal end portion, with the compression element being operatively joined to the contact surface adjacent the distal end portion and extending therefrom in a second direction to the proximal end portion. In one form, the second direction is generally transverse to the midline axis. The compression element may be configured to transmit compressive force applied adjacent the proximal portion to the contact surface. In one aspect, the grip is coupled to the inner surface between the anterior edge and the posterior edge. The grip can extend from the inner surface in a third direction away from the contact surface. As described in more detail in the following, the grip is shaped and configured for grasping by a user to position and hold the perianal support member against the perianal tissue of the patient. 
     In one embodiment, the present disclosure provides for a labor assistance system for contact with external perianal tissue of a patient, comprising a perianal support member including: a contact surface, an inner surface opposing the contact surface, a compression element, and a grip. In one aspect, the contact surface has a continuous compression surface apex extending from the contact surface in a first direction corresponding to a height of the apex, the contact surface dimensioned to span across an anal orifice without entering the anal canal for engagement with at least a portion of the external perianal tissue on opposing sides of the anal orifice of the patient, the contact surface oriented to extend from an anterior edge to a posterior edge along a midline axis in a sagittal plane of the patient, the contact surface anatomically configured to not substantially interfere with the birthing canal of the patient during childbirth. In one aspect, the compression element has a proximal end portion and a distal end portion, the compression element operatively joined to the contact surface adjacent the distal end portion and extending therefrom in a second direction to the proximal end portion, the second direction generally transverse to the midline axis, the compression element configured to transmit compressive force applied adjacent the proximal portion to the contact surface. In one aspect, the grip is coupled to the inner surface between the anterior edge and the posterior edge and extending from the inner surface in a third direction away from the contact surface, and the grip is shaped and configured for grasping by a user to position and hold the perianal support member against the perianal tissue of the patient. 
     In one aspect, further including at least a second compression element joined to the contact surface. In one aspect, the second compression element extends in a fourth direction substantially transverse to the midline axis and at an angle with respect to the second direction. In one aspect, the angle is between  130  and  30  degrees. In one aspect, the angle is between  100  and  70  degrees. In one aspect, the first compression element, the inner surface, and the second compression element meet to define an access cavity. In one aspect, the grip extends through the access cavity between the first and second compression elements. In one aspect, the grip extends from the inner surface at an oblique angle with respect to the midline axis. In one aspect, the grip extends from the inner surface at a transverse angle with respect to the midline axis. 
     In one aspect, the grip is coupled to the inner surface via a pivot element. In one aspect, the grip extends from the inner surface at a dynamic angle with respect to the midline axis. In one aspect, the pivot element includes a locking feature configured to releasably lock the grip at a fixed angle with respect to the midline axis. In one aspect, the pivot element is spaced a distance apart from the contact surface. In one aspect, the grip extends from the inner surface at a fixed angle with respect to the midline axis. 
     In one aspect, the perianal support member includes a first height extending from the proximal end portion of the compression element to the apex, the grip includes a second height extending from a proximal end to a distal end of the grip, and the first height is less than the second height. In one aspect, the perianal support member includes a first height extending from the proximal end portion of the compression element to the apex, the grip includes a second height extending from a proximal end to a distal end of the grip, and the first height is greater than the second height. 
     In one aspect, the perianal support member includes a curved, convex contact surface and a curved compression element having the same radius of curvature as the contact surface. In one aspect, the perianal support member includes a substantially flat, planar contact surface. 
     In one aspect, the perianal support member includes a pressure element disposed on the contact surface, the pressure element extending from the contact surface in the first direction. In one aspect, the pressure element comprises a protrusion shaped and configured to apply a focal area of increased pressure upon the external perianal tissue of the patient. In one aspect, the pressure element is positioned on the contact surface closer to the anterior edge than the posterior edge. 
     In one aspect, the contact surface includes a visual indicator configured be aligned with a body reference marker to assist the user in positioning the perianal support member against the patient. 
     In one aspect, the anterior edge of the perianal support member includes a concave portion alignable with the vaginal orifice of the patient. 
     In one aspect, the perianal support member includes a compliant pad disposed on the contact surface. In one aspect, the compliant pad includes a treating compound. 
     In one aspect, the grip comprises an elongated shaft terminating in a crossbar configured to form a grasping handle for the user. In one aspect, the grip comprises an elongate shaft terminating at a knob configured to form a grasping handle for the user. In one aspect, the grip comprises an elongate shaft terminating in a tab configured to form a grasping handle for the user. In one aspect, the tab forms an annular ring. In one aspect, the grip comprises a hollow tube coupled to the inner surface and extending parallel to the midline axis. In one aspect, the grip comprises a channel formed within the perianal support member, the channel extending from the anterior edge to the posterior edge of the perianal support member. In one aspect, the grip comprises a curved support structure including an upper surface having substantially the same shape and contour as the inner surface of the perianal support member, the upper surface being in contact with the inner surface. 
     In one aspect, the system further comprises a push evaluation system configured to measure the strength of the patient&#39;s pushes, the push evaluation system including a spring-loaded device coupled to the grip. In one aspect, the spring-loaded device comprises a spring coupled to the grip, a securing member extending from the spring and coupled to an anchor pad, the anchor pad including an adhesive portion configured to adhere to the patient. 
     In one aspect, the grip includes markings spaced relative to the securing member such that the position of the markings relative to the securing member indicates the degree of displacement of the perianal support device during a patient&#39;s push. In one aspect, the perianal support member is formed of a substantially clear material. In one aspect, the perianal support member includes a plurality of measurement markers. In one aspect, the compression element includes a short portion defining a posterior edge and a long portion defining an anterior edge of the perianal support member. 
     In one aspect, at least a portion of the perianal support member is shaped and configured to conform to superficial contours of a pelvic floor and apply pressure against an anococcygeal region of the patient. In one aspect, at least a portion of the perianal support member is sufficiently rigid to apply pressure against an anococcygeal region of the patient. 
     The present disclosure is, at least in part, directed to a method of providing a laboring patient with a focal point against which to push. In one aspect, the method comprises providing a labor assistance system having a perianal support member including a contact surface configured for engaging the pelvic floor area of the patient and a grip coupled to the perianal support member and configured for a user to grasp. The method includes maneuvering the grip to position the contact surface in a first position in contact with skin adjacent the posterior pelvic floor area of the patient. The method also includes applying pressure through the grip to the perianal support member to direct pressure through the contact surface against skin and into the pelvic floor area of the patient, wherein applying pressure includes pushing the grip toward the patient during a uterine contraction and moving the contact surface to a second position. 
     In one aspect, the method includes: providing a labor assistance system having a pelvic floor support member including a contact surface configured for engaging the perianal area of the patient and; maneuvering the pelvic floor support member to position the contact surface in a first position in contact with the perianal area of the patient; and applying pressure to the pelvic floor support member to direct pressure through the contact surface against the perianal area of the patient during a uterine contraction. 
     In one aspect, the method further comprises maintaining the position of the pelvic floor support member against the perianal tissue throughout the duration of a uterine contraction. In one aspect, the method further comprises increasing the pressure applied through the contact surface against the perianal tissue as the uterine contraction gains strength. In one aspect, the method further comprises decreasing the pressure applied through the contact surface against the perianal tissue as the uterine contraction loses strength. In one aspect, the method further comprises observing the strength of a push from the patient by measuring the extent of displacement of the contact surface from the first position to a second position during a push. 
     In one aspect, the method further comprises a labor assistance system including a push evaluation system coupled to the pelvic floor support member and including a spring-loaded device configured to measure the extent of displacement of the contact surface from the first position to the second position during a push. In one aspect, wherein applying pressure to the pelvic floor support member to direct pressure through the contact surface against the perianal area of the patient includes pushing a grip coupled to the pelvic floor support member toward the patient during a uterine contraction. 
     In still a further aspect, the present disclosure is directed to a method of guiding a baby through a birth canal to a vaginal orifice during childbirth. The method includes positioning a labor assistance system in contact with at least a portion of the skin overlying the posterior pelvic floor of the patient prior to delivery of the baby, and the labor assistance system includes a grip extending from a perianal support member having a contact surface configured to engage the perianal tissue. In one aspect, the method includes positioning the contact surface against at least a portion of perianal skin such that the contact surface operates as a sacral extension member and provides external scaffolding to support the anococcygeal region tissue and the posterior pelvic floor as well as to guide the baby through the birth canal extending through the anterior pelvic floor. In another aspect, the method includes directing pressure through the grip toward the contact surface against the perianal tissue in a direction configured to guide the baby toward the vaginal orifice. 
     In one aspect, the method includes: positioning a labor assistance system in contact with at least a portion of the anococcygeal region of the patient prior to delivery of the baby, the labor assistance system including a perianal support member having a contact surface configured to engage the anococcygeal region; positioning the contact surface against at least a portion of anococcygeal region such that the contact surface operates as a sacral extension member and provides external scaffolding to support at least a portion of the posterior pelvic floor to thereby guide the baby toward the birth canal; and directing pressure through the contact surface against the anococcygeal region in a direction configured to guide the baby toward the vaginal orifice. 
     In one aspect, the method further comprises changing the position of the contact surface relative to the perianal tissue as the baby descends through the birth canal. In one aspect, the method further comprises changing the direction of pressure applied through the grip toward the contact surface against the perianal tissue to guide the baby toward the vaginal orifice as the baby descends through the birth canal. In one aspect, directing pressure through the contact surface against the anococcygeal tissue comprises directing pressure through a grip extending from the perianal support member toward the contact surface. 
     In a further embodiment, the present disclosure is directed to a method of monitoring pressure in the pelvic tissues to assess the progression of labor in a patient. The method includes positioning a labor assistance system in contact with at least a portion of the pelvic tissues of the patient prior to delivery of a baby, and the labor assistance system includes a grip extending from a perianal support member having a contact surface configured to engage the pelvic tissue. In one aspect, the method includes positioning the contact surface against at least a portion of pelvic tissue such that pelvic tissue engages the contact surface across a first area. In a further aspect, the method includes observing the spread of the pelvic tissue across a second area of the contact surface as the pressure changes against the contact surface. 
     In one aspect, the method comprises: positioning a labor assistance system in contact with at least a portion of the perianal tissues of the patient prior to delivery of a baby, the labor assistance system including a grip extending from a perianal support member having a contact surface configured to engage the perianal tissue; positioning the contact surface against at least a portion of perianal tissue such that perianal tissue engages the contact surface across a first area; and observing the spread of the perianal tissue across a second area of the contact surface as the pressure changes against the contact surface. In one aspect, the method further comprises comparing the first area to the second area to measure the change in tissue distension as the pressure changes against the contact surface. In one aspect, the method further comprises measuring the first area and the second area by observing the engagement of perianal tissue with the contact surface relative to markings on the perianal support member. 
     The present disclosure also provides a non-invasive device for supporting the pelvic floor during an intrapartum period. In one aspect, the device includes a central support element having a contact surface configured to be held against and extend from an anterior portion posterior to a vaginal opening of a patient to a posterior portion of the patient that is posterior to an anal orifice of the patient. A first support element extends from the central support element in a first lateral direction, the first support element comprising a first concave inner surface to receive a first buttock of the patient and a first convex outer surface. A second support element extends from the central support element in a second lateral direction opposite to the first lateral direction, the second support element comprising a second concave inner surface to receive a second buttock of the patient and a second convex outer surface. The non-invasive intrapartum pelvic floor support device is held against superficial tissue superior to the pelvic floor of the patient to support the pelvic floor during an intrapartum period of the patient. In one aspect, the device comprises a central support element having a contact surface configured to be held against and extend from an anterior portion posterior to a vaginal opening of a patient to a posterior portion of the patient that is posterior to an anal orifice of the patient; a first support element extending from the central support element in a first lateral direction, the first support element comprising a first concave inner surface to receive a first buttock of the patient; and a second support element extending from the central support element in a second lateral direction opposite to the first lateral direction, the second support element comprising a second concave inner surface to receive a second buttock of the patient, wherein the non-invasive intrapartum pelvic floor support device is held against tissue superficial to the pelvic floor of the patient to support the pelvic floor during an intrapartum period of the patient. 
     In one aspect, the non-invasive intrapartum pelvic floor support device is held against the tissue superficial to the pelvic floor with an adhesive between an inner surface of the non-invasive intrapartum pelvic floor support device and skin of the patient. In one aspect, the inner surface comprises the first and second concave inner surfaces. 
     In another embodiment, the non-invasive intrapartum pelvic floor support device includes a central support element having a contact surface configured to be held against and extend from an anterior portion posterior to a vaginal opening of a patient to a posterior portion of the patient that is posterior to an anal orifice of the patient, the central support element comprising a concave inner surface facing the patient and a convex outer surface. A first support element extends from the central support element in a first lateral direction. A second support element extends from the central support element in a second lateral direction opposite to the first lateral direction. The non-invasive intrapartum pelvic floor support device is held against superficial tissue superior to the pelvic floor of the patient to support the pelvic floor during an intrapartum period of the patient. 
     In one aspect, the device comprises a central support element having a contact surface configured to be held against and extend from an anterior portion posterior to a vaginal opening of a patient to a posterior portion of the patient that is posterior to an anal orifice of the patient, the central support element comprising a concave inner surface facing the patient and a convex outer surface; a first support element extending from the central support element in a first lateral direction; and a second support element extending from the central support element in a second lateral direction opposite to the first lateral direction, wherein the non-invasive intrapartum pelvic floor support device is held against tissue superficial to the pelvic floor of the patient to support the pelvic floor during an intrapartum period of the patient. 
     In one aspect, an anterior portion of the first support element and an anterior portion of the second support element extend in an anterior direction beyond an anterior portion of the central support element to define a recess at the central support element to allow access to the vaginal opening. 
     In one aspect, a lateral width of the central support element varies along the contact surface between an anterior portion and a posterior portion of the non-invasive intrapartum pelvic floor support device. 
     In another embodiment, a support system includes the non-invasive intrapartum pelvic floor support device comprising a central support element having a contact surface configured to be held against and extend from an anterior portion posterior to a vaginal opening of a patient to a posterior portion of the patient that is posterior to an anal orifice of the patient along a midline axis in a sagittal plane of the patient. The non-invasive intrapartum pelvic floor support device also includes a first support element extending from the central support element in a first lateral direction and a second support element extending from the central support element in a second lateral direction opposite to the first lateral direction. The support system also includes a perianal support member including a contact surface dimensioned to span across an anal orifice without entering an anal canal for engagement with at least a portion of external perianal tissue on opposing sides of the anal orifice of the patient, the contact surface oriented to extend from an anterior edge to a posterior edge along a midline axis in a sagittal plane of the patient. An inner surface of the perianal support member opposes the contact surface. A compression element of the perianal support member has a proximal end portion and a distal end portion, the compression element operatively joined to the contact surface adjacent the distal end portion and extending therefrom in a second direction to the proximal end portion, the second direction generally transverse to the midline axis, the compression element configured to transmit compressive force applied adjacent the proximal portion to the contact surface. The non-invasive intrapartum pelvic floor support is configured to receive the perianal support member along the midline axis during an intrapartum period of the patient. 
     In one aspect, the support system comprises a non-invasive intrapartum pelvic floor support comprising: a central support element having a contact surface configured to be held against and extend from an anterior portion posterior to a vaginal opening of a patient to a posterior portion of the patient that is posterior to an anal orifice of the patient along a midline axis in a sagittal plane of the patient; a first support element extending from the central support element in a first lateral direction; and a second support element extending from the central support element in a second lateral direction opposite to the first lateral direction; and a perianal support member. In one aspect, the perianal support member includes a contact surface dimensioned to span across an anal orifice without entering an anal canal for engagement with at least a portion of external perianal tissue on opposing sides of the anal orifice of the patient, the contact surface oriented to extend from an anterior edge to a posterior edge along a midline axis in a sagittal plane of the patient; an inner surface opposing the contact surface; and a compression element having a proximal end portion and a distal end portion, the compression element operatively joined to the contact surface adjacent the distal end portion and extending therefrom in a second direction to the proximal end portion, the second direction generally transverse to the midline axis, the compression element configured to transmit compressive force applied adjacent the proximal portion to the contact surface. In one aspect, the non-invasive intrapartum pelvic floor support is configured to receive the perianal support member along the midline axis during an intrapartum period of the patient. 
     In one aspect, the non-invasive intrapartum pelvic floor support further comprises a gap along the central support element and a first part of a locking mechanism, and the perianal support member further comprises a second part of the locking mechanism, the second part being configured to couple with the first part to operatively join the non-invasive intrapartum pelvic floor support and the perianal support member together. 
     In one aspect, the perianal support member further comprises an adjustable strap connected between the compression element of the perianal support member an anchor mechanism, the strap configured to increase or decrease pressure to the external perianal tissue in response to tightening or loosening of the strap. 
     In another embodiment, the non-invasive intrapartum pelvic floor support device includes a flexible anterior support structure having a first rigidity for supporting a pelvic floor of a patient, the flexible anterior support structure extending along a midline axis of the patient from an anterior portion that is posterior to a vaginal opening of the patient to a posterior portion of the patient that is posterior to an anal orifice of the patient, and in a first lateral direction toward a first buttocks of the patient and a second lateral direction toward a second buttocks of the patient. The non-invasive intrapartum pelvic floor support device also includes a first lateral support structure extending from the flexible anterior support structure around a lateral side of the first buttocks, and a second lateral support structure extending from the flexible anterior support structure around a lateral side of the second buttocks, the first and second lateral support structures having a second rigidity that is less than the first rigidity. The first and second lateral support structures are configured to transfer a load from the flexible anterior support structure. 
     In one aspect the device comprises: a flexible anterior support structure having a first rigidity for supporting a pelvic floor of a patient, the flexible anterior support structure extending along a midline axis of the patient from an anterior portion that is posterior to a vaginal opening of the patient to a posterior portion of the patient that is posterior to an anal orifice of the patient, and in a first lateral direction toward a first buttocks of the patient and a second lateral direction toward a second buttocks of the patient; a first lateral support structure extending from the flexible anterior support structure around a lateral side of the first buttocks; and a second lateral support structure extending from the flexible anterior support structure around a lateral side of the second buttocks, the first and second lateral support structures having a second rigidity that is less than the first rigidity, wherein the first and second lateral support structures are configured to transfer a load from the flexible anterior support structure. 
     In one aspect, the flexible anterior support structure comprises a first mesh, the first and second lateral support structures comprise a second mesh, and the first mesh has a higher rigidity than the second mesh. In one aspect, the non-invasive intrapartum pelvic floor support device comprises a material sheet, the flexible anterior support structure comprises a first plurality of ridges along a first portion of the material sheet, and the first and second lateral support structures comprise a second plurality of ridges along a second portion of the material sheet. In one aspect, at least a portion of an interior portion of the non-invasive intrapartum pelvic floor support device facing the patient comprises an adhesive to adhere the between an inner surface of the non-invasive intrapartum pelvic floor support device and skin of the patient to skin of the patient. 
     In another embodiment, the non-invasive intrapartum pelvic floor support device includes a first contact member configured to attach to a lateral portion of a first buttock of a patient near a first crown of the first buttock. A second contact member is configured to attach to a lateral portion of a second buttock of the patient near a second crown of the second buttock. A joining member is configured to join between the first and second contact members and pull the first and second buttocks laterally inward toward each other to support a pelvic floor of the patient. 
     In one aspect, the device comprises: a first contact member configured to attach to a lateral portion of a first buttock of a patient near a first crown of the first buttock; a second contact member configured to attach to a lateral portion of a second buttock of the patient near a second crown of the second buttock; and a joining member configured to join between the first and second contact members and pull the first and second buttocks laterally inward toward each other to support tissue superficial to a pelvic floor of the patient. In one aspect, the joining member comprises a flexible strap attached between the first and second contact members, the first contact member comprises a first adhesive anchor pad configured to releasably adhere to the lateral portion of the first buttock, and the second contact member comprises a second adhesive anchor pad configured to releasably adhere to the lateral portion of the second buttock. In one aspect, the flexible strap comprises an arcuate shape that is concave at an anterior portion and convex at a posterior portion to allow access to a vaginal opening of the patient. In one aspect, the joining member comprises an inflatable support device configured to inflate with a fluid, the inflatable support device comprising the first and second contact members to contact the lateral portions of the first and second buttocks upon at least partial inflation with the fluid. 
     Further aspects, forms, embodiments, objects, features, benefits, and advantages of the present disclosure shall become apparent from the detailed drawings and descriptions provided herein. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1    illustrates a side view of an exemplary labor assistance system applied to a patient with stylized depiction of the patient anatomy according to one embodiment of the present disclosure. 
         FIG.  2 A  illustrates a partial perspective bottom view of the labor assistance system shown in  FIG.  1    applied to a patient during child delivery.  FIGS.  2 B and  2 C  illustrate partial perspective bottom views of an exemplary labor assistance system positioned against a patient during two different pressure situations during child delivery. In addition,  FIG.  2 C  illustrates exemplary securing members according to one embodiment of the present disclosure. 
         FIG.  3    illustrates a perspective view of the labor assistance system shown in  FIG.  1    according to one embodiment of the present disclosure. 
         FIG.  4    illustrates a side view of the labor assistance system shown in  FIG.  1    according to one embodiment of the present disclosure. 
         FIG.  5 A  illustrates a perspective side view of an exemplary labor assistance system according to one embodiment of the present disclosure. 
         FIG.  5 B  illustrates a cutaway side view of the exemplary labor assistance system shown in  FIG.  5 A  according to one embodiment of the present disclosure. 
         FIG.  6    illustrates a perspective view of an exemplary perianal support member according to one embodiment of the present disclosure. 
         FIG.  7    illustrates a perspective view of an exemplary perianal support member according to one embodiment of the present disclosure. 
         FIG.  8    illustrates a perspective view of an exemplary perianal support member according to one embodiment of the present disclosure 
         FIG.  9 A  illustrates a perspective view of an exemplary perianal support member according to one embodiment of the present disclosure. 
         FIG.  9 B  illustrates a perspective view of the exemplary perianal support member shown in  FIG.  9 A  including exemplary securing members according to one embodiment of the present disclosure. 
         FIG.  10    illustrates an exemplary labor assistance system including the perianal support member shown in  FIG.  1    coupled to an exemplary grip according to one embodiment of the present disclosure. 
         FIG.  11    illustrates an exemplary labor assistance system including the perianal support member shown in  FIG.  1    coupled to an exemplary grip according to one embodiment of the present disclosure. 
         FIG.  12    illustrates an exemplary labor assistance system including the perianal support member shown in  FIG.  1    coupled to an exemplary grip according to one embodiment of the present disclosure. 
         FIG.  13    illustrates an exemplary labor assistance system including the perianal support member shown in  FIG.  1    coupled to an exemplary grip according to one embodiment of the present disclosure. 
         FIG.  14    illustrates an exemplary labor assistance system including the perianal support member shown in  FIG.  1    coupled to an exemplary grip according to one embodiment of the present disclosure. 
         FIG.  15    illustrates an exemplary labor assistance system including an exemplary push evaluation system positioned on the patient  10  according to one embodiment of the present disclosure. 
         FIG.  16 A  illustrates a cross-sectional view of a patient in the sagittal plane and the labor assistance system taken along the lines  16 - 16  shown in  FIG.  2   . 
         FIG.  16 B  illustrates a similar cross-sectional view of a patient in the sagittal plane and the exemplary labor assistance system shown in Fig. 9 A. 
         FIG.  17    illustrates a flow chart illustrating a method of utilizing an exemplary labor assistance system according to one aspect of the present disclosure. 
         FIG.  18    illustrates an exemplary childbirth assisting system according to one embodiment of the present disclosure. 
         FIG.  19    illustrates an exemplary abdominal girdle according to one embodiment of the present disclosure. 
         FIG.  20    illustrates an exemplary abdominal girdle according to one embodiment of the present disclosure. 
         FIG.  21    illustrates a cross-sectional view of a patient in the sagittal plane, an exemplary labor assistance system, and an exemplary childbirth assisting system according to one embodiment of the present disclosure. 
         FIG.  22 A  illustrates a perspective view of an exemplary labor assistance system including an exemplary perianal support member according to one embodiment of the present disclosure. 
         FIG.  22 B  illustrates a side view of the exemplary labor assistance system shown in shown in  FIG.  22 A  according to one embodiment of the present disclosure. 
         FIG.  22 C  illustrates a top view of the exemplary labor assistance system shown in  FIG.  22 B  including exemplary securing members according to one embodiment of the present disclosure. 
         FIG.  23    illustrates a partial perspective bottom view of the labor assistance system shown in  FIG.  22 A  applied to a patient during child delivery. 
         FIG.  24    illustrates a cross-sectional view of a patient in the sagittal plane, and includes the labor assistance system shown in  FIG.  22 A  positioned on a patient. 
         FIG.  25    illustrates is a partial cross sectional bottom view and stylized depiction of a patient anatomy. 
         FIG.  26 A  illustrates a bottom view of an exemplary intrapartum anococcygeal support device positioned on a patient according to one embodiment of the present disclosure with stylized depiction of a patient anatomy. 
         FIG.  26 B  illustrates a top view of the exemplary intrapartum anococcygeal support device patient shown in  FIG.  22 A  according to one embodiment of the present disclosure. 
         FIG.  26 C  illustrates a perspective view of the exemplary intrapartum anococcygeal support device patient shown in  FIG.  22 A  according to one embodiment of the present disclosure. 
         FIG.  26 D  illustrates a side view of the exemplary intrapartum anococcygeal support device patient shown in  FIG.  22 A  according to one embodiment of the present disclosure. 
         FIG.  27    illustrates a rear view of the intrapartum anococcygeal support device shown in  FIGS.  26 A- 27 D  positioned on a patient according to an embodiment of the present disclosure. 
         FIG.  28    illustrates a perspective view of an exemplary intrapartum anococcygeal support device positioned on a patient according to one embodiment of the present disclosure. 
         FIG.  29    illustrates a bottom view of the intrapartum anococcygeal support device shown in  FIG.  28    positioned on a patient according to one embodiment of the present disclosure. 
         FIG.  30    illustrates a bottom view of an exemplary intrapartum anococcygeal support device positioned on a patient according to one embodiment of the present disclosure. 
         FIG.  31 A  illustrates an exemplary intrapartum anococcygeal support device and an exemplary perianal support member positioned on a patient according to an embodiment of the present disclosure. 
         FIG.  31 B  illustrates an exemplary locking mechanism for an intrapartum anococcygeal support device and a perianal support member according to an embodiment of the present disclosure 
         FIG.  32 A  illustrates an intrapartum pelvic floor support device positioned on a patient according to an embodiment of the present disclosure. 
         FIG.  32 B  illustrates a partial perspective top view of an intrapartum pelvic floor support device according to an embodiment of the present disclosure. 
         FIG.  32 C  illustrates a side view of an intrapartum pelvic floor support device according to an embodiment of the present disclosure. 
         FIG.  33    illustrates an intrapartum pelvic floor support device according to an embodiment of the present disclosure. 
         FIG.  34 A  illustrates an intrapartum pelvic floor support device according to an embodiment of the present disclosure. 
         FIG.  34 B  illustrates an intrapartum pelvic floor support device according to an embodiment of the present disclosure. 
         FIG.  34 C  illustrates an intrapartum pelvic floor support device according to an embodiment of the present disclosure. 
         FIG.  34 D  illustrates an intrapartum pelvic floor support device according to an embodiment of the present disclosure. 
         FIG.  35    illustrates an intrapartum pelvic floor support device positioned on a patient according to an embodiment of the present disclosure. 
         FIG.  36    illustrates an intrapartum pelvic floor support device positioned on a patient according to an embodiment of the present disclosure. 
         FIG.  37 A  illustrates a bottom view of an intrapartum pelvic floor support device positioned on a patient according to an embodiment of the present disclosure. 
         FIG.  37 B  illustrates a bottom view of an intrapartum pelvic floor support device positioned on a patient according to an embodiment of the present disclosure. 
         FIG.  37 C  illustrates a bottom view of an intrapartum pelvic floor support device positioned on a patient according to an embodiment of the present disclosure. 
         FIG.  37 D  illustrates a perspective view of an intrapartum pelvic floor support device shown in  FIG.  37 C  according to an embodiment of the present disclosure. 
         FIG.  37 E  illustrates a side view of an intrapartum pelvic floor support device shown in  FIG.  37 C  according to an embodiment of the present disclosure. 
         FIG.  38    illustrates an intrapartum pelvic floor support device positioned on a patient according to an embodiment of the present disclosure. 
         FIG.  39    illustrates an intrapartum pelvic floor support device positioned on a patient according to an embodiment of the present disclosure. 
         FIG.  40    illustrates an intrapartum pelvic floor support device according to an embodiment of the present disclosure. 
         FIG.  41    illustrates an intrapartum pelvic floor support device positioned on a patient according to an embodiment of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     For the purposes of promoting an understanding of the principles of the present disclosure, reference will now be made to the embodiments illustrated in the drawings, and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the disclosure is intended. In the following detailed description of the aspects of the invention, numerous specific details are set forth in order to provide a thorough understanding of the disclosed embodiments. However, it will be obvious to one skilled in the art that the embodiments of this disclosure may be practiced without these specific details. In other instances well known methods, procedures, components, and circuits have not been described in detail so as not to unnecessarily obscure aspects of the embodiments of the invention. The following patents and patent applications are incorporated by reference. 
     U.S. Pat. No. 8,123,760, filed Aug. 5, 2005, titled “Method, Apparatus and System for Preventing or Reducing the Severity of Hemorrhoids,” and commonly assigned to the present applicant, is hereby incorporated by reference in its entirety. 
     U.S. patent application Ser. No. 11/743,858, filed August May 3, 2007, issued as U.S. Pat. No. 7,673,633,entitled “Apparatus and Method of Inhibiting Perianal Tissue Damage,” and commonly assigned to the present applicant, is hereby incorporated by reference in its entirety. 
     U.S. patent application Ser. No. 12/106,956, filed August Apr. 21, 2008, and published as Patent Application Publication No. 2008/0202505, entitled “Apparatus and Method of Supporting Patient Tissue,” and commonly assigned to the present applicant, is hereby incorporated by reference in its entirety. 
     U.S. Pat. No. 8,684,954, filed Mar. 15, 2013, entitled “Labor Management Devices for Decreasing the Incidence of Cesarean Childbirth,” and commonly assigned to the present applicant, is hereby incorporated by reference in its entirety. 
     U.S. Pat. No. 5,871,499, filed Apr. 25, 1997, titled “Child Birth Assisting System,” and assigned to Novatrix, Inc., is hereby incorporated by reference in its entirety. 
     Any alterations and further modifications to the described devices, instruments, methods, and any further application of the principles of the present disclosure are fully contemplated as would normally occur to one skilled in the art to which the disclosure relates. In particular, it is fully contemplated that the features, components, and/or steps described with respect to one embodiment may be combined with the features, components, and/or steps described with respect to other embodiments of the present disclosure. In addition, dimensions provided herein are for specific examples and it is contemplated that different sizes, dimensions, and/or ratios may be utilized to implement the concepts of the present disclosure. To avoid needless descriptive repetition, one or more components or actions described in accordance with one illustrative embodiment can be used or omitted as applicable from other illustrative embodiments. For the sake of brevity, the numerous iterations of these combinations will not be described separately. For simplicity, in some instances the same reference numbers are used throughout the drawings to refer to the same or like parts. 
     The present disclosure is directed to systems, devices, and methods for monitoring and assisting the progression of labor during childbirth by providing a qualitative pressure indicator while supporting and/or treating the perianal and anococcygeal tissues of a patient. These labor assistance systems introduce novel elements and methods that may assist the management, progress, and effectiveness of labor along with supporting and/or treating the tissues, muscles, and organs of the pelvic region, including, by way of non-limiting example, the pelvic tissues, muscles, and organs within the anogenital triangle and the anal triangle (e.g., the pelvic diaphragm, the coccygeus muscle and the levator plate), the perianal region, the perineal region, and the anococcygeal region. The embodiments may provide visual and/or tactile feedback to healthcare providers and patients regarding changes in pressure levels due to device application or physiological transformations, such as those that occur with uterine contractions or voluntary contractions during child delivery (including, by way of non-limiting example, changes in uterine, pelvic, rectal, anal, perianal, intrauterine, intrapelvic, intrarectal, and/or intra-anal pressures). Application of pressure in the perianal and anococcygeal regions can be sensed as a tactile sensation by a patient, often even after administration of an epidural and provides a pushing focal point to enhance the effectiveness of contractions. For example, in some instances, the embodiments disclosed herein provide a tactile (and sometimes visual) focal point at the perianal region on which the patient can focus her pushing effort during voluntary muscle contractions. The embodiments described herein provide a qualitative sense to the user and/or the patient of the relative amount of pressure that is being applied to the device by the patient&#39;s tissue and/or the relative amount of pressure that is being applied to the patient by the device. Thus, the devices described herein provide an indication (e.g., a tactile, haptic, and/or visual indication) in real time of the change in pressure relationships between the device and the patient as the patient&#39;s labor progresses. 
     In addition, some embodiments may increase the intensity and/or number of intrauterine contractions, thereby shortening the second stage of labor and decreasing the occurrence of various negative effects of a prolonged labor (e.g., injuries of the pelvic floor, fetal distress, higher rate of infant mortality, neonatal seizures, postpartum hemorrhage, and/or to delivery by Cesarean section). In some instances, the embodiments disclosed herein may apply sufficient pressure to the perianal region to stimulate the patient&#39;s physiologic urge to push (e.g., similar to the Ferguson reflex, which triggers uterine contractions). These effects may result in a shortening of the second stage of labor by enhancing the effectiveness of contractions (e.g., by increasing the intensity and or number of contractions) in advancing the baby down the birth canal. 
     In some instances, the labor assistance systems disclosed herein may be used to support the perianal tissue and/or anococcygeal region of a patient during the second stage of labor, which may reduce the incidence of a number of complications and conditions, including, for example, pelvic floor incompetence or dysfunction (over-stretching of pelvic floor muscles, ligaments and tendons), organ prolapse results from the over stretching, incontinence secondary to pressure and stretching exerted on bladder and bladder neck, over-stretching due to use of forceps in delivery, perineum tears and lacerations due to over stretching, vacuum or forceps use, uncontrolled flexion/extension of the fetal head as it descends, and hemorrhoids. The pelvic floor, sometimes referred to as the pelvic diaphragm, is the inferior border of the pelvic cavity defined between the lower openings of the pelvic girdle. The pelvic floor has two hiatuses (gaps or openings): the anterior urogenital hiatus through which the urethra and vagina pass and the posterior rectal hiatus through which the anal canal passes. The pelvic floor facilitates birth by resisting the descent of the presenting part of the baby (i.e., typically the head of the baby), causing the baby to rotate forward to navigate through the pelvic girdle and exit through the vaginal opening in the anterior urogenital hiatus in the pelvic floor (see, for example,  FIG.  16 A ). In particular, the pelvic floor, the sacrum, and the coccyx provide resistance against the downward descent of the baby (along the longitudinal axis of the baby and toward the posterior rectal hiatus) caused by force of the mother&#39;s uterine contractions. This passive resistance causes the baby&#39;s head to rotate and descend in the direction of least resistance, which is usually in the direction of the midline of the maternal pelvis. 
     In one aspect, an external labor assist device is provided to apply pressure to and push against the skin of the anococcygeal and/or perianal tissues outside the pelvic floor to thereby support the internal pelvic floor tissues in their function of guiding the baby toward the vaginal opening. Support of the posterior pelvic floor by the devices disclosed herein facilitates the progression of the baby through the birth canal toward the vaginal opening by acting as a type of external scaffolding to lengthen the path of passive resistance that turns and guides the baby towards the vaginal opening. In some instances, the pelvic floor and anococcygeal support provided by the devices disclosed herein facilitate the delivery of the baby with fewer uterine and voluntary contractions for the mother, thereby reducing the overall length of the second stage of labor and reducing injury to the mother (e.g., from the distention of pelvic floor and anal tissues that result from force applied by the baby in the direction of the posterior rectal hiatus). 
     In some instances, the embodiments disclosed herein provide external birth canal support devices that may be manually repositioned throughout the labor process to effectively channel the mother&#39;s pushing force along the appropriate axis to guide the child&#39;s head through a desirable exit path from the birth canal. In some instances, the embodiments disclosed herein may cover all or most of the anal orifice, and thereby provide defecation suppression, hemorrhoid development, and/or the advancement of existing hemorrhoids. In some instances, the embodiments disclosed herein enhance the willingness of the patient to push when instructed by lessening the patient&#39;s fear of trauma and/or involuntary defecation as a result of pushing. 
     The labor assistance systems disclosed herein can efficiently, effectively, removably, and safely prevent prolonged duration of labor and dystocia due to various causes, including, without limitation, systemic analgesia, epidural anesthesia, and/or maternal exhaustion, which may avoid a Cesarean section and/or an instrument-assisted delivery. Given that weakening of the secondary labor force has been reported in patients receiving epidural anesthesia, the systems may effectively enable a safer and less painful delivery under anesthesia by preventing weakening of the secondary labor force (e.g., even under anesthesia). Thus, the labor assistance systems disclosed herein may reduce the necessity of Cesarean section deliveries and/or instrument-assisted deliveries by guiding the patient and monitoring (via pressure feedback) the strength and focus of contractions to generate a more effective pushing effect on the baby. By reinforcing the secondary labor force, the labor assistance systems disclosed herein may lower the dosage of oxytocin (or other pharmacological contraction aides) necessary during labor. In some instances, the systems disclosed herein may be used to cooperatively complement the effects of oxytocin during labor. 
     Turning now to  FIG.  1 - 4   , a labor assistance system  100  according to one exemplary embodiment disclosed herein is illustrated.  FIGS.  1  and  2    show the labor assistance system  100  in association with the perianal tissue of a patient  10 , and  FIGS.  3  and  4    show the labor assistance system  100  independent of the patient  10 . 
     In  FIG.  1   , the patient  10  is shown in partial cross section to illustrate a portion of the rectum  54 , anal canal  36 , anal orifice  26 , internal venous plexus  29 , pectinate line  37  (also known as the dentate line), and external venous plexus  28 . The patient&#39;s buttocks  14  and  15  are shown with the crowns of the buttocks  16  and  17 , respectively, laterally adjacent the perianal region  38 . The gluteal cleft  13  ( FIG.  2   ) is between the buttocks  14  and  15 . The buttocks  14  and  15  extend laterally beyond crowns  16  and  17  toward lateral flanks  18  and  19 , respectively. The crowns  16  and  17  of each buttocks  14  and  15  in essence define the midline of each leg and the lateral flanks  18  and  19  are the area lateral of the leg/buttocks midline. The lateral flanks  18  and  19  may include, for example but without limitation, all or a portion of the lateral buttocks, hips, or upper thigh of the patient. 
       FIG.  2    illustrates the patient  10  during a child birthing process. Contractions during labor move a child  12  into the birth canal and ultimately, for a vaginal delivery, through the vaginal opening  11 , as shown in  FIG.  2   . In an alternative birthing process, labor is commenced to move the child  12 , but for a variety of reasons, the delivery does not occur vaginally but instead caesarian delivery is performed through a surgical opening in the mother&#39;s abdomen. During the birthing process, tremendous pressure is exerted (e.g., generated by voluntary and involuntary muscle contractions) in an effort to move the child  12  toward delivery through the vaginal opening  11 . By applying counter pressure with the labor assistance system  100  in the opposite direction to the perianal region  38  and the anal orifice  26  ( FIG.  1   ), a user (e.g., a healthcare practitioner or the patient  10 ) can provide the patient  10  with a tactile, discrete source of resistance against which to push and support pelvic floor tissues to direct forces applied to the baby toward the vaginal opening. 
     In some embodiments, as described further below in relation to  FIG.  15   , the labor assistance systems disclosed herein can provide indicators that detect changes in intrauterine pressure or pelvic tissue distension (e.g., by way of non-limiting example, anal distension, pelvic floor distension, perineal distension), and/or indicate when desired application pressures are achieved. Some exemplary embodiments provide feedback to users regarding changes in relevant pressure levels due to device application or physiological transformations, such as those that occur during muscle contractions during child delivery. The embodiments disclosed herein allow for real-time user adjustment systems and techniques, allowing a patient as well as a doctor to adjust the device for maximum comfort and effectiveness. 
     At least some of the pressure generated during labor is exerted against the tissues of the pelvic floor adjacent the anal orifice  26  in the perianal region  38  ( FIG.  1   ). The result of these forces is that blood vessels near the anus, such as those in the external venous plexus  28 , may bulge or rupture causing hemorrhoids or increasing their severity. Still further, other tissues in the perianal region  38  adjacent the anus may distend outwardly opposite arrow A 4  in  FIG.  1    causing lacerations such as tearing around the vaginal opening  11  or fissures from the anus. In addition to the blood loss, pain, and discomfort, these lacerations can be a location for infections in the mother. The systems, devices, and methods disclosed herein, including the exemplary labor assistance system  100 , are shaped and structured to not only increase the strength and/or number of contractions by providing a tactile and/or visual guide to the mother during the birthing process, but also include features, elements, or structure that support the perianal tissues (tissue forming or supporting the perianal region  38 ) without interfering with the birthing canal or vaginal opening  11 . For example, the exemplary systems, devices, and methods disclosed herein may support the tissue of the pelvic floor to inhibit damage to the tissue near the anal orifice  26 , both internally and externally, to inhibit, for example but without limitation, the formation or advancement of external hemorrhoids, and/or to inhibit the formation or advancement of lacerations of the perianal tissues. 
     As shown in  FIGS.  1  and  2   , the labor assistance system  100  includes a perianal support member  102  having an external pressure surface or contact surface  104  and a grip  106 . The contact surface  104  includes a continuous compression surface apex  105  dimensioned to span across an anal orifice for engagement with at least a portion of the external perianal tissue on opposing sides of the anal orifice of the patient. The contact surface  104  is anatomically configured to not enter the anal canal. For example, the contact surface  104  in the pictured embodiment comprises a convex, curved surface having a radius of curvature sized to substantially prevent the apex from entering the anal canal of the patient. The contact surface, and in particular the compression surface apex  105 , is oriented to extend along a first direction in a sagittal plane of the patient when the system  100  is positioned within the gluteal cleft  13 . As shown in  FIG.  2   , the contact surface  104  extends along a midline axis  108  extending longitudinally between a posterior edge  110  and an anterior edge  112  of the perianal support member. The grip  106  is configured to assist a user in holding the perianal support member  102  in pressurized engagement with the perianal tissue in the perianal region  38 . In the pictured embodiment, the grip  106  is configured as a handle. 
       FIG.  3    shows a perspective view of the labor assistance system  100  independent of the patient  10 , and  FIG.  4    shows a side view of the labor assistance system  100  independent of the patient  10 . The perianal support member  102  includes a pair of compression elements  116 ,  124  extending laterally from the contact surface  104 . In the pictured embodiment, the compression elements  116 ,  124  are formed as flanges extending laterally from the contact surface  104 . The first compression element  116  has a distal end portion  118  adjacent the contact surface  104  and an opposing proximal end portion  120 . The opposing second compression element  124  has a distal end portion  126  adjacent the contact surface  104  and an opposing proximal end portion  128 . The perianal support member  102  includes an outer surface  130  and an opposing inner surface  132  defining an access cavity  136 . 
     In the pictured embodiment, the grip  106  extends from an area of the inner surface  132  located opposite the contact surface  104  (e.g., an internal contact surface  143 ). The grip  106  extends from the internal contact surface  143  in a direction away from the contact surface  104 . In the pictured embodiment, the grip is spaced substantially equidistant from the anterior edge  112  and the posterior edge  110 . In other embodiments, the grip  106  may be spaced closer to the anterior edge  112  or the posterior edge  110 . In other embodiments, as described below with reference to  FIGS.  10 - 14   , the grip  106  may be formed in a variety of other shapes and coupled to the inner surface  132  in a variety of different ways. In the pictured embodiment, the grip  106  extends from the inner surface  132  at a constant angle relative to the midline axis  108  along an axis  134 , which lies substantially perpendicular to the midline axis  108 . It can be understood that the contact surface  104  is configured to be positioned at the gluteal cleft of the patient  10  with the midline axis  108  lying along the sagittal plane. In other embodiments, as shown in  FIG.  5 A , the grip  106  may be coupled to the inner surface  132  at a dynamic angle. In other embodiments, the coupling angle may be a non-perpendicular angle with respect to the midline axis  108 . 
     As shown in  FIG.  4   , the perianal support member  102  includes a height H 1  extending from an apex of the contact surface  104  to the distal tip of the compression members (e.g., a distal tip  128   a  of the compression member  124 ). The height H 1  may range from 1 cm to 10 cm. The grip  106  includes a height H 2  extending from a distal end  137   a  (at the inner surface  132 ) to a proximal end  137   b . The height H 2  may range from 3 cm to 30 cm. Although the height H 2  of the grip  106  is greater than the height H 1  of the perianal support member  102 , in other embodiments, the height H 2  may be less than the height H 1  (e.g., as shown in  FIGS.  13  and  14   ). Although not limited to specific dimensions, the grip  106  includes a diameter Dg that may range from approximately 1 cm to 8 cm. As shown in  FIG.  2   , the grip  106  includes a cross-sectional area CA 1  that may range from approximately 3 cm 2  to 25 cm 2 . As shown in  FIG.  3   , the contact surface  104  includes a cross-sectional area CA 2 . In the pictured embodiment, the cross-sectional area CA 1  of the grip  106  is substantially smaller than the cross-sectional area CA 2  of the contact surface  104  (indicated in part by the dotted area shown in  FIG.  3   ). In the illustrated embodiment of  FIGS.  2  and  3   , the ratio of CA 2 :CA 1  is greater than 5:1. In other embodiments, the ratio of the cross-sectional areas CA 2 :CA 1  may be larger (e.g., the ratio CA 2 :CA 1  may be 1 or greater than 1). For example, in the embodiment described below with respect to  FIG.  13   , the cross-sectional area CA 2  of the grip (e.g., the grip  460 ) may be substantially similar to the surface area CA 1  of the contact surface  465 . Other dimensions are contemplated, and the above dimensions are supplied for exemplary purposes only. 
     The first compression element  116  and the second compression element  124  meet at a first angle α 1  to form the access cavity  136 . In one embodiment angle α 1 , is between 140 degrees and 30 degrees. In the illustrated embodiment, angle α 1  is approximately 80 degrees. In the example shown the first and second compression elements  116 ,  124  are integral with and define a portion of the perianal support member  102 . The distal end portion  118  of the compression element  116  transitions into the contact surface  104 . In a similar manner, the distal end  126  of the compression element  124  transitions into the contact surface  104 . The compression element  116  comprises an elongated, planar exterior side wall  138  extending from the distal end  118  to the proximal end  120 . The compression element  118  comprises an elongated, planar exterior side wall  139  extending from the distal end  126  to the proximal end  128 . The compression member  116  extends generally along an axis  140 , which is substantially transverse to the midline axis  108 . The compression element  124  extends generally along an axis  142 , which is substantially transverse to the midline axis  108 . As shown in  FIG.  4   , the compression element  116  extends at an oblique angle α 2  with respect to the axis  134  (e.g., the sagittal plane extending through the midline axis  108 ), and the compression element  118  extends at an oblique angle α 3  with respect to the axis  134 . It will be appreciated that in the illustrated embodiment, compression element  124  extends at an oblique angle α 3  substantially equal to the oblique angle α 2  at which compression element  116  extends with respect to axis  134 . In some embodiments, the oblique angles α 2  and α 3  are each within the range of about 5 to 25 degrees. In other embodiments, the oblique angles α 2  and α 3  are each within the range of about 10 to 20 degrees, and in yet other embodiments, are with a range of about 15 to 20 degrees. 
     Referring back to  FIG.  1   , each compression element  116 ,  124  has a length L, and the maximum lateral distance of the access cavity  136  is defined by the distance D 1  extending between the distal end portions  120 ,  128 . In one embodiment, L is greater than 4 cm in length. In a preferred aspect, L is approximately 8 cm. In one embodiment, the maximum lateral distance D 1  of the access cavity  136  is greater than 4 cm. In the illustrated embodiment of  FIG.  1   , the maximum lateral distance is approximately 10 cm. 
     The perianal support member  102  of the labor assistance system  100  has the internal contact surface  143  defined along the midline  108  opposing the contact surface  104 . It will be understood that a health care provider may apply pressure to the contact surface  143  to move the perianal support member  102  into the operative position shown in  FIGS.  1  and  2    and/or apply additional pressure to apply pressure to (and, in some instances, compress) at least some perianal and/or perineal tissue. The first compression element  116  includes an interior wall  144   a  while the second compression element  124  has an opposing interior wall  144   b  generally facing the interior wall  144   a . The interior walls  144   a ,  144   b , along with the internal contact surface  143  define the access cavity  136  within the labor assistance system  100 . As shown in  FIGS.  3  and  4   , the configuration of the perianal support member  102  as described above results in a generally wedge shaped device. Still further, with the inclusion of the access cavity  136 , the perianal support member  102  has a substantially V-shaped configuration with the contact surface  104  defined at the apex of the V and the compression elements  116 ,  124  forming the legs of the V. In other embodiments, as described below with reference to  FIG.  8   , the perianal support member may lack an access cavity altogether. 
       FIGS.  2 B and  2 C  illustrate partial perspective bottom views of the labor assistance system  100  positioned against a patient during two different pressure situations during child delivery. In some embodiments, the perianal support member  102  is formed of an opaque material. In other embodiments, the perianal support member  102  is formed of an optically clear material that enables the user to see through the compression elements  116 ,  124  and/or the contact surface  104 . For example, in the pictured embodiment, the perianal support member  102  is formed of a clear, transparent, translucent, or semi-translucent material. The material composition of the perianal support member  102  allows the user to visually observe and/or measure the changes in tissue distension (e.g., secondary to pressure changes against the perianal support member  102 ) occurring on the contact surface  104  and the exterior side walls  138 ,  139  of the compression elements  116 ,  124 , respectively, shown in  FIG.  4   . The clear, transparent, translucent, or semi-translucent material of the perianal support member  102  allows the user to view the changes in tissue distension through the perianal support member  102  without removing the perianal support member  102  from the patient  10 . 
     In the pictured example,  FIG.  2 B  illustrates an area  51  that represents the initial tissue spread against the perianal support member  102  upon an initial placement of the labor assistance system  100  on the patient  10 .  FIG.  2 C  illustrates an area S 2  that represents the subsequent tissue spread against the perianal support member  102  during different pressure conditions (e.g., as might occur during voluntary or involuntary contractions, while the patient  10  pushes, and/or while the user applies more pressure to the perianal support member  102  through the grip  106 ). The user may observe the changes in tissue spread or tissue distension to evaluate the changes in pressure associated with the progress of labor. If the tissue spread is not adequate or is excessive, this may indicate that the mother&#39;s labor or labor efforts (e.g., voluntary contractions) are not progressing appropriately. 
     In some embodiments, as shown in  FIGS.  2 B and  2 C , the perianal support member  102  includes markings  144  designed to indicate measurements, a ruler, or a scale that assist the user in making precise measurements and comparisons of tissue distention through different pressure conditions throughout the labor process. The markings  144  may comprise any variety of indicators (e.g., shapes, lines, colors) designed to convey measurement data. The markings  144  may extend across the perianal support member from one compression element to the other, as shown, or may extend along the contact surface along the midline axis  108  (e.g., as shown in  FIG.  22 A ). The markings  144  may be positioned across only a portion of the perianal support member  102 , or may be positioned across the entirety of the perianal support member  102 . In some embodiments, the markings  144  may be on the contact surface  104  and the exterior side walls  138 ,  139  of the compression elements  116 ,  124 , respectively, and in other embodiments, the markings  144  may be on the inner surface  132 . 
     In some embodiments, the perianal support member  102  may lack predefined markings for measurements, such as the markings  144  in  FIGS.  2 B and  2 C . In such embodiments, the user may manually mark the perianal support member  102  (e.g., on the inner surface  132 ) to mark the relevant or desired margins of the area S 1  and the area S 2 , and then quantitatively (by measuring the difference in areas as indicated by the hashed area in  FIG.  2 C ) or qualitatively (by visually observing the marked areas) compare the different degrees of tissue distension to evaluate the progress of labor and/or the effectiveness of the pushing effort of the patient  10 . The user may use a marker or a grease pencil, by way of non-limiting example, to permanently or temporarily mark the perianal support member  102 . 
     In the embodiment shown in  FIGS.  3  and  4   , the labor assistance system includes a pad  145  positioned on the contact surface  104 . In some embodiments, the pad  145  has a width W 1  that is substantially equivalent to a width W 2  of the contact surface  104 , and in other embodiments, as shown in  FIG.  3   , the pad  145  has a width W 1  less than the width W 2  of the contact surface  104 . The anterior to posterior width W 2  of the contact surface  104  between the anterior edge  112  and the posterior edge  110  is approximately 5 cm in the illustrated embodiment. This midline width W 2  can be adjusted in some embodiments depending on the amount and extent of perianal tissue that needs to be supported. In the embodiment shown the pad  145  extends along the contact surface  104  and extends at least partially along the outer surface  130  of the perianal support member  102 , covering at least a portion of the first compression element  116  and the second compression element  124 . The pad  145  may be disposed and arranged as an interfacing structure disposed between the contact surface  104  of the perianal support member  102  and the patient&#39;s perianal tissue  38  (shown in  FIG.  1   ) when the labor assistance system  100  is positioned in contact with the patient  10 . 
     In some embodiments, the pad  145  comprises an anatomically conformable structure. In some embodiments, the pad  145  comprises a compliant pad. In some instances, the pad  145  may be formed of a compliant material such as, by way of non-limiting example, polyurethane, silicon, rubber, foam, or cotton. Such materials may enable the pad  145  to conform to the patient&#39;s anatomy as the labor assistance system  100  is positioned in contact with the patient  10 . In some embodiments, the pad  145  is formed of a material that retains its shape (e.g., a complementary shape to the patient&#39;s tissue surface) upon removal of the pad  145  from the patient&#39;s tissue. For example, in some embodiments, the pad is formed of a clay or clay-like polymer that has a high degree of conformability when pushed against the patient, but retained that “conformed” shape upon removal of the pad  145  from the patient. In some embodiments, the pad  145  is a sterile gauze pad. In other embodiments, the pad  145  includes an internal cushioning structure, such as polyurethane, silicon, rubber, foam, cotton, etc., with a non-abrasive skin contact surface. 
     In other instances, the pad  145  comprises a hollow, inflatable structure that may be selectively inflated with various amounts of fluids (e.g., by way of non-limiting example, air, liquid, gels). In some embodiments, the pad  145  may be adjusted by the user to exhibit different degrees of conformability. For example, in some embodiments, the pad  145  may be inflated through a tube  146  that may be attached to the pad  145  from a fluid source  147 . In some embodiments, the tube  146  is a detachable tube that may be removed or disengaged from the pad  145  and/or the fluid source  147 . In some embodiments, the fluid source  147  comprises a pump-like structure which may be electronically or manually operated to increase or decrease the amount of fluid within the pad  145 . In some embodiments, the fluid source  147  includes a control feature  148  that allows the user to control the fluid ingress and/or egress from the pad  145 . In some instances, increasing the amount of fluid within the pad  145  will increase the turgidity and lessen the degree of conformability of the pad  145 . If the user fills the pad  145  with fluid, the pad  145  may hold its shape and stop conforming to the patient&#39;s tissue contours. If, however, the pad  145  is incompletely filled with fluid, the pad  145  may retain a high degree of conformability and assume a complementary shape to the contours of the patient&#39;s tissue as the labor assistance system  100  is positioned in contact with the patient  10 . 
     In some instances, the pad  145  is opaque. In other instances, the pad  145  may be clear or translucent, thereby allowing the user to visually observe changes in tissue distension through the pad (i.e., by observing changes in the area of tissue contact against the pad  145  over time). The pad  145  may be adhered to the perianal support member  102  across the majority of the contact surface  104 . 
     In one embodiment, the pad  145  is die cut from  1776  and  1772  stock materials from 3M. In another embodiment, pad  145  is an absorbent material adapted to absorb bodily fluids. It will be appreciated that the pad  145  may make placement and application of the labor assistance system  100  more comfortable for the patient. In addition, the surface of the pad  145  is configured to frictionally engage the patient&#39;s perianal tissue to inhibit movement between the labor assistance system  100 , particularly the contact surface  104  and the patient. 
     In still a further aspect, the pad  145  includes a treating compound. The treating compound can be disposed within the pad  145 , applied on the surface, or a combination of both. Treating compounds useful for combination with pad  145  include, but without limitation to other compounds, antibacterial compounds, antibiotic compounds, sclerants, antimicrobial compounds, anti-inflammatory compounds, anti-fungal agents, anti-itching agents, humicants, moisture absorbing agents, gas absorbing agents, buffering agents for pH control, drying agents and the like and coagulants. 
     In yet a further embodiment, the pad  145  is not fixed to the perianal support member  102  but is instead positioned on the patient in advance of positioning the perianal support member  102  or is loosely held to the perianal support member  102  as it is applied to the body. In this embodiment, the pressure applied via the grip  106  on the perianal support member  102  can maintain the position of the pad  145  relative to the patient&#39;s body and in particular the anal orifice  26  (shown in  FIG.  1   ). 
     Returning to the embodiment shown in  FIGS.  2 B and  2 C , the labor assistance system includes two securing members  149   a  that terminate in anchor pads  149   b . The anchor pads  640  are shaped and configured to be removably attached to the buttocks  14 ,  15  (e.g., within the gluteal cleft  13 ) of the patient  10 . The securing system is substantially the same as described in U.S. Pat. No. 7,673,633, entitled “Apparatus and Method of Inhibiting Perianal Tissue Damage,” which is hereby incorporated by reference in its entirety. In some embodiments, the anchor pads  149   b  may be adhesively attached to the patient  10 . In the pictured example, each securing member  149   a  is fixedly coupled to one of the compression elements  116 ,  124  and one of the anchor pads  149   b . In some examples, the securing members  149   a  include a first half of a releasable fastening system coupled to the compression elements, such as a hook and loop system or a releasable adhesive system. In the illustrated embodiment, the anchor pads  149   b  have a generally rectangular shape that is shorter in length and wider than elongated securing members  149   a . The shape of the anchor pad is shown for illustration purposes and may take any form that is suitable for fixing to a patient or inanimate object, as well as joining to the elongated fixation member. Each anchor pad  149   b  includes a first surface having an adhesive surface (substantially similar to the adhesive surface  642  described in more detail with relation to  FIG.  15   ) adapted for joining to the patient&#39;s skin or some inanimate object. The opposing surface (substantially similar to the adhesive surface  644  described in more detail with relation to  FIG.  15   ) includes the second half of the fastening system, which couples to the securing member  149   a . In some embodiments, at least a portion of a surface of the first surface includes an adhesive coating that can fix the securing member to another object. In one embodiment, the adhesive coating is adapted for releasably adhering to a patient&#39;s skin. 
       FIG.  5 A  shows a side view of an exemplary labor assistance system  100 ′ according to one embodiment of the present disclosure, and  FIG.  5 B  shows cutaway side view of the labor assistance system  100 ′. The labor assistance system  100 ′ is substantially similar to the labor assistance system  100  except for the differences described herein. For example, the labor assistance system  100 ′ includes a grip  106 ′ movably coupled to an inner surface  132 ′ of a perianal support member  102 ′ at a pivot element  150 . The pivot element  150  may comprise any of a variety of coupling elements configured to permit the grip  106 ′ to move with respect to a midline axis  108 ′ of a contact surface  104 ′ of the perianal support member  102 ′. For example, the pivot element  150  may comprise, without limitation, a hinge, a rotatable ball-and-socket joint, a knuckle joint, a pin joint, and a screw joint. As shown in  FIG.  5 B , the pivot element  150  may be spaced by a distance or gap G 1  from the contact surface  104 ′ of the perianal support member  102 ′. In the pictured embodiment, the grip  106 ′ is shown positioned at a non-perpendicular angle with respect to the midline axis  108 ′. A longitudinal axis  134 ′ of the grip  106 ′ intersects the midline axis  108 ′ to form an acute angle a 4  and, as shown in  FIG.  5 B , an obtuse angle a 5 . In some embodiments, the pivot element  150  couples the grip  106 ′ to the perianal support member  102 ′ at the dynamic angle a 4  which changes in response to the actions of the user holding the grip  106 ′ and/or the movements of the patient  10 . As shown in  FIG.  5 B , in some embodiments, the pivot element  150  couples the grip  106 ′ the perianal support member  102 ′ in a manner that allows the grip  106 ′ to be repositioned anywhere within the  180 ° degree arc indicated by angles a 4  and a 5 . In other embodiments, the pivot element  150  includes a locking feature  152  that enables the user to temporarily and reversibly lock or fix the angle a 4 . The locking feature  152  may be positioned on the grip  106 ′ and/or the perianal support member  102 ′. The locking feature  152  may include any variety of locking means shaped and configured to temporarily lock the grip  106 ′ in at a fixed angle a 4  relative to the midline axis  108 ′. For example, by way of non-limiting example, the locking feature  152  may comprise a protrusion on the grip  106 ′ configured to mate with a depression on the inner surface  132 ′. In the pictured embodiment, the grip  106 ′ is coupled to the inner surface  132 ′ at a position closer to an anterior edge  112 ′ than a posterior edge  110 ′ of the perianal support member  102 ′. In other embodiments, the pivot element  150  (and the grip  106 ′) may be spaced closer to the posterior edge  110 ′. 
       FIGS.  6  -  9    illustrate different embodiments of a perianal support member according to various embodiments of the present disclosure. The perianal support members described herein may be combined or coupled with any of the grips described in this disclosure to form various labor assistance systems. For purposes of illustration, the grip  106  is shown in dotted lines coupled to the exemplary perianal support members shown in  FIGS.  6 - 9   . The grips may be coupled to the exemplary perianal support members via a pivot element (e.g., the pivot element  150  described above). In other embodiments, the grips may be attached to the exemplary perianal support members in a fixed relationship. 
     The grips extend from the perianal support member and are configured and arranged to permit the patient to adjust the relative position and orientation of the labor assistance system. The adjustment may include modifying the pressure applied by the perianal support member on the perianal tissue or may include adjusting the physical location of the perianal support member on the patient. Accordingly, during contractions or during pushing, the user can apply additional pressure on the perianal and/or perineal tissue if desired. Therefore, the user has some level of control of the pressure on the perianal and/or perineal tissue. 
     When additional pressure loading is desired, the user may press on the grip in the general direction of the patient&#39;s head so that the perianal support member applies additional loading onto the perianal tissue. In some embodiments, the user may monitor the push strength of the patient, the force, duration, and strength of intrauterine contractions, and/or other markers of the progression of labor described herein, and may adjust the labor assistance system using the grip to maintain the applied pressure against the patient in a desired pressure range. The grip allows a user to quickly and easily adjust the relative position and orientation of the perianal support member on the perianal tissue and to increase or decrease the pressure on the perianal tissue. In particular, the user may adjust the position or the pressure applied by the perianal support member by manipulating the grip relative to patient. 
       FIG.  6    illustrates a perspective view of an exemplary perianal support member  160  according to one embodiment of the present disclosure. The perianal support member  160  is substantially similar to the perianal support member  102  except for the differences described herein. Unlike the perianal support member  102 , which has a V-shaped side profile, the perianal support member  160  has a generally U-shaped side profile. The perianal support member  160  includes a curved or rounded contact surface  162  and an opposing inner surface  164 . A grip (e.g., the grip  106  discussed above) may be coupled to and extend from the inner surface  164 . The perianal support member  160  includes compression elements  166  and  168  that flank the contact surface  162  and have substantially the same radius of curvature as the contact surface  162 . In some embodiments, the compression elements  166 ,  168  are integral extensions of the contact surface  162 . In other embodiments, the compression elements  166 ,  168  are coupled to the contact surface  162 . The compression elements  166 ,  168  may extend equal distances from the contact surface  162 , as shown in  FIG.  6   , or they may extend unequal or different distances from the contact surface  162 . For example, in some embodiments, the compression element  166  may include a length L 1  that is less than or greater than a length L 2  of the compression element  168 . 
       FIG.  7    illustrates a perspective view of an exemplary perianal support member  170  according to one embodiment of the present disclosure. The perianal support member  170  is substantially similar to the perianal support member  102  except for the differences described herein. Unlike the perianal support member  102 , which has a V-shaped side profile, the perianal support member  170  has a trapezoidal side profile. The perianal support member  170  includes a flat contact surface  172  and an opposing inner surface  174 . A grip (e.g., the grip  106  discussed above) may be coupled to and extend from the inner surface  174 . The perianal support member  170  includes compression elements  176  and  177  that flank the contact surface  172 . The compression elements  176 ,  177  include inner surfaces  178 ,  179 , respectively. In some embodiments, the compression elements  176 ,  177  are integral extensions of the contact surface  172 . In other embodiments, the compression elements  176 ,  177  are coupled to the contact surface  172 . The compression elements  176 ,  177  may extend equal distances from the contact surface  172 , as shown in  FIG.  7   , or they may extend unequal or different distances from the contact surface  172 . For example, in some embodiments, the compression element  176  may include a length L 3  that is less than or greater than the length L 4  of the compression element  177 . 
     In an alternative form, a compliant pad  173  (shown in dash) is added to the contact surface  172 . It is joined to the surface  172  by adhesive or any suitable joining technique. In one method, the pad  173  may be a separate component that is positioned on the patient before the support member  170  is positioned in a supporting fashion on the patient. In some embodiments, the pad  173  comprises an anatomically conformable structure. In some embodiments, the pad  173  comprises a compliant pad. In some instances, the pad  173  may be formed of a compliant material such as, by way of non-limiting example, polyurethane, silicon, rubber, foam, or cotton. Such materials may enable the pad  173  to conform to the patient&#39;s anatomy as the labor assistance system  170  is positioned in contact with the patient  10 . In some embodiments, the pad  173  is formed of a material that retains its shape (e.g., a complementary shape to the patient&#39;s tissue surface) upon removal of the pad  173  from the patient&#39;s tissue. For example, in some embodiments, the pad is formed of a clay or clay-like polymer that has a high degree of conformability when pushed against the patient, but retained that “conformed” shape upon removal of the pad  173  from the patient. In some embodiments, the pad  173  is a sterile gauze pad. In other embodiments, the pad  173  includes an internal cushioning structure, such as polyurethane, silicon, rubber, foam, cotton, etc., with a non-abrasive skin contact surface. 
     In other instances, the pad  173  comprises a hollow, inflatable structure that may be selectively inflated with various amounts of fluids (e.g., by way of non-limiting example, air, liquid, gels). In some embodiments, the pad  173  may be adjusted by the user to exhibit different degrees of conformability. For example, in some embodiments as described above with respect to  FIG.  3   , the pad  173  may be inflated through a tube that may be attached to the pad  173  from a fluid source. In some instances, increasing the amount of fluid within the pad  173  will increase the turgidity and lessen the degree of conformability of the pad  173 . If the user fills the pad  173  with fluid, the pad  173  may hold its shape and stop conforming to the patient&#39;s tissue contours. If, however, the pad  173  is incompletely filled with fluid, the pad  173  may retain a high degree of conformability and assume a complementary shape to the contours of the patient&#39;s tissue as the labor assistance system  170  is positioned in contact with the patient. 
       FIG.  8    illustrates a perspective view of an exemplary perianal support member  180  according to one embodiment of the present disclosure. The perianal support member  180  is substantially similar to the perianal support member  102  except for the differences described herein. Unlike the perianal support member  102 , which has a V-shaped, concave side profile, the perianal support member  180  has a curved, dome-like, solid side profile. The perianal support member  180  is shaped and configured as a solid shape having an arcuate contact surface  182 . The perianal support member  180  includes the curved or rounded contact surface  182  and an opposing inner surface  184 . The inner surface  184  forms a substantially flat, planar surface. Thus, the perianal support member  180  lacks an access cavity (e.g., the access cavity  136  shown in  FIG.  3   ). In other embodiments, the inner surface  184  may be slightly convex or slightly concave. A grip (e.g., the grip  106  discussed above) may be coupled to and extend from the inner surface  184 . The perianal support member  180  includes compression elements  186 ,  188  that form integral or continuous extensions of the contact surface  182 . 
     Fig. 9 A illustrates a perspective view of an exemplary perianal support member  190  according to one embodiment of the present disclosure. The perianal support member  190  is substantially similar to the perianal support member  102  except for the differences described herein. For example, the perianal support member  190  includes a contact surface  192  extending along a midline axis  193  from a posterior edge  194  to an anterior edge  195 . An opposing inner surface  196  defines an access cavity  197 . A grip (e.g., the grip  106  discussed above) may be coupled to and extend from the inner surface  196 . The perianal support member  190  includes compression elements  198  and  199  that flank the contact surface  192 . In some embodiments, the compression elements  198 ,  199  are integral extensions of the contact surface  192 . In other embodiments, the compression elements  198 ,  199  are coupled to the contact surface  192 . The compression elements  198 ,  199  may extend equal distances from the contact surface  192 , as shown in Fig. 9 A, or they may extend unequal or different distances from the contact surface  192 . For example, in some embodiments, the compression element  198  may include a length L 5  that is less than or greater than a length L 6  of the compression element  199 . 
     The perianal support member  190  includes a focusing pressure element or focal protrusion  200  disposed on the contact surface  192 . In the pictured embodiment, the focusing pressure element  200  comprises a raised protrusion extending outwardly from the contact surface  192  away from the compression elements  198 ,  199  and having a curved shape. In other embodiments, the focusing pressure element  200  may comprise any structure shaped and configured to apply a focal area of increased pressure upon the perianal region  38  or perineal region of the patient  10  (shown in  FIG.  1   ). For example, without limitation, the focusing pressure element  200  may comprise a textured area (e.g., having a different texture than the remainder of the contact surface  192 ), a protrusion having a polygonal shape, or a plurality of protrusions or ridges. In the pictured embodiment, the focusing pressure element  200  is spaced farther from the posterior edge  194  than the anterior edge  195 . This configuration enables the user to position the perianal support member  190  against the patient  10  such that the focusing pressure element  200  abuts the perineal region between the anal orifice  26  and the vaginal opening  11  (shown in  FIGS.  1  and  2   ) without obstructing the vaginal opening  11 . In other embodiments, the focusing pressure element  200  may be spaced equidistant from the anterior edge  195  and the posterior edge  194 , or may be positioned closer to the posterior edge  194  than the anterior edge  195 . In the pictured embodiment, the focusing pressure element  200  includes a length L 7  along the axis  193  that is less than a length L 8  of the contact surface  192 . In other embodiments, the length L 7  of the focusing pressure element  200  may comprise any fraction of the length L 8  of the contact surface  192 . For example, the length L 7  may comprise one-fourth, one-third, or one-half the length L 8  of the contact surface. 
     In some embodiments, the perianal support member  190  may include a pressure sensor  202  on the contact surface  192 . In the pictured embodiment, the pressure sensor  202  is positioned on the focusing pressure element  200 . In other embodiments, the pressure sensor  202  may be found on another part of the contact surface  192 . In some embodiments, the pressure sensor  202  may protrude outward from the contact surface  192  and may be configured to extend completely or partially into the patient&#39;s anal canal. In other embodiments, the pressure sensor  202  may be configured for external placement against the pelvic tissues (e.g., perianal tissue) of the patient  10 . The pressure sensor  202  may be includes on any of the perianal support member embodiments described herein. 
     In some embodiments, the perianal support member  190  may include a haptic feedback generator  203 , which may be positioned on the inner surface  196  as shown in the pictured embodiment or, on the contact surface  192 , or on the grip  106 . In some embodiments, the haptic feedback generator  203  may be positioned on the focusing pressure element  200 . In other embodiments, the haptic feedback generator  203  may be found on another part of the contact surface  192 . In some embodiments, the haptic feedback generator  203  may be configured to provide haptic feedback to the user and/or the patient  10  via any type of suitable tactile feedback (e.g., by way of non-limiting example, vibrations, forces, or motions) through the perianal support member  190  and/or the grip  106 . In some embodiments, the haptic feedback generator  203  may be connected to the pressure sensor  202  (either wirelessly or through a wired connection) to provide varying degrees of haptic feedback depending upon the amount of pressure registered by the pressure sensor  202 . For example, in one instance, the haptic feedback generator  203  may provide increasing (e.g., stronger or faster) vibrations through the perianal support member  190  when a pressure increase is sensed by the pressure sensor  202 . The haptic feedback generator  203  may be included on any of the labor assistance system embodiments described herein. 
     In use, the user (e.g., the health care provider, the patient, or another) can position the perianal support member  190  against the patient&#39;s perianal region  38  or perineal region to apply increased pressure to the focal area in contact with the focusing pressure element  200 . In some embodiments, this focused application of increased pressure (relative to the surrounding tissues) stimulates a nerve or bundle of nerves to enhance the pushing reflex in the patient  10  (e.g., similar to the Ferguson reflex). For example, a user may push the grip  106  at the appropriate angle to transfer sufficient pressure through the focusing pressure element  200  against a focal area of the perianal or perineal region of the patient  10  to stimulate the patient&#39;s urge to push the child out of the birth canal. In other instances, the focal application of pressure through the pressure element  200  against the perianal or perineal region of the patient  10  may assist in guiding the child&#39;s head and body along an optimal route through the vaginal canal. 
     Fig. 9 A shows a visual indicator or marker  205  that can assist a user in properly positioning the perianal support member  190  on the patient  10 . In this example, the marker  205  is an elongated shape formed on the contact surface  192  of the perianal support member  190  that extends onto the compression elements  198 ,  199 . In other embodiments, the marker  205  may have any of a variety of shapes or patterns, including, without limitation, oblong, round, ovoid, target-shaped, or striped. In some embodiments, the marker  205  may comprise a window (e.g., either an open cut-out from the perianal support member  190  or a solid window formed of a suitably clear material) that allows the user to see through the perianal support member  190  during and after placement of the perianal support member  190  on the patient  10 . In other embodiments having a clear or translucent contact surface  192 , where the user may visually observe the spread of tissue contacting the contact surface  192  through the member  190 , the marker  205  may comprise a manually drawn marking on the contact surface  192  or the inner surface  196  that marks a particular anatomic reference structure, point, margin, or distance for the user. In some embodiments, the user may mark the a first location on the inner surface  196  to indicate the initial margin of tissue contacting the contact surface  192  after the initial placement of the perianal support member  190  on the patient  10 , and then mark a second location on the inner surface  196  to indicate the spreading margin of tissue contacting the contact surface  192  after the change in pressure relationships between the contact surface  192  and the patient  10 . The user can measure the distance between the first and second markings to evaluate the extent of tissue distension and pressure changes and analyze the progress of labor. 
     In use, the user can align the marker  205  with a body reference marker, such as the anus or anal orifice  26  (shown in  FIG.  1   ). This may help ensure that the perianal support member  190  is properly located to apply focal pressure through the focusing pressure element  200  in the correct area (e.g., to stimulate the pushing reflex and/or give the patient a physical focal point to direct the pushing effort), to properly shape the exit portion of the vaginal canal to facilitate the baby&#39;s egress from the birth canal, and/or to support or treat perianal tissue while maintaining suitable spacing from the vaginal opening. 
     The other embodiments of perianal support members described herein (e.g., perianal support members lacking the focusing pressure element  200 ) may also include a marker  205 . Application of the perianal support member  190  on the patient  10  is described further below in relation to  FIG.  16 B . 
       FIG.  9 B  illustrates a perspective view of the exemplary perianal support member shown in  FIG.  9 A  including two securing members  210   a ,  210   b  that terminate in anchor pads  212   a ,  212   b . The anchor pads  212   a ,  212   b  are shaped and configured to be removably attached to the buttocks  14 ,  15  (e.g., within the gluteal cleft  13 ) of the patient  10  (in a similar fashion as shown in  FIG.  2 C ). In some embodiments, the anchor pads  212   a ,  212   b  may be adhesively attached to the patient  10 . In the pictured example, the securing members  210   a ,  210   b  are fixedly coupled to the compression elements  198 ,  199  and the anchor pads  212   a ,  212   b , respectively. In some examples, the securing members  210   a ,  210   b  include a first half of a releasable fastening system coupled to the compression elements  198 ,  199 , such as a hook and loop system or a releasable adhesive system. In the illustrated embodiment, the anchor pads  212   a ,  212   b  have a generally rectangular shape that is shorter in length and wider than elongated securing members  210   a ,  210   b . The shape of the anchor pads  212   a ,  212   b  is shown for illustration purposes and may take any form that is suitable for fixing to a patient or inanimate object, as well as joining to the elongated fixation member. Each anchor pad  212   a ,  212   b  includes a first surface  214   a ,  214   b  having an adhesive surface (substantially similar to the adhesive surface  642  described in more detail with relation to  FIG.  15   ) adapted for joining to the patient&#39;s skin or some inanimate object. 
     The opposing surface  216 a,  216 b (substantially similar to the surface  644  described in more detail with relation to  FIG.  15   ) includes the second half of the fastening system, which couples to the securing member  210   a ,  210   b , respectively. In some embodiments, at least a portion of a surface of the first surface  214   a ,  214   b  includes an adhesive coating that can fix the securing member to another object. In one embodiment, the adhesive coating is adapted for releasably adhering to a patient&#39;s skin. 
     In addition to including different types of perianal support members, as described above, various embodiments of the labor assistance systems may include different types of grips. In this regard,  FIGS.  10 - 12    illustrate the perianal support member  102  coupled to a variety of different exemplary grips, and  FIGS.  13  and  14    illustrate a perianal support member  455  coupled to a variety of different exemplary grips. The different types of grips are meant to be illustrative only, and are in no way limiting. Other types of grips are contemplated. In addition, it should be understood that each of the different perianal support members and grips described herein can be combined in any of a variety of combinations to create labor assistance systems having different configurations and pressure-application characteristics. 
       FIG.  10    illustrates an exemplary labor assistance system  300  including the perianal support member  102  coupled to an exemplary grip  305 . The grip  300  is substantially similar to the grip  106  described above except for the differences described herein. The grip  300  is shaped as a “T-bar” including a shaft  310  and a bar  315 . The bar  315  extending from an end  316  to an end  317 , and is attached to the shaft  310  at a midpoint  318  to form two sections  320   a  and  320   b  on either side of the shaft  310 . In the pictured embodiment, the section  320   a  has approximately a same length L 9  as a length L 10  of the section  320   b . In other embodiments, the bar  315  may be positioned such that the sections  320   a ,  320   b  are not of equal lengths. In some embodiments, bar  315  may be attached to the shaft  310  to form an “L-bar” shape (e.g., with the shaft  310  meeting the bar  315  at one end  316  or  317  instead of the midpoint  318 ). In the pictured embodiment, the bar  315  is disposed substantially perpendicular to the shaft  310 . In other embodiments, the bar  315  may be disposed at an oblique angle with respect to the shaft  310 . The bar  315  forms a handle for the user to hold while positioning and maintaining the labor assistance system  300  against the patient  10 . For example, in some instances, the user may wrap his or her fingers around the sections  320   a ,  320   b  to obtain a secure grasp of the grip  305 . 
     In some embodiments, the bar  315  (and/or the shaft) may include grip-enhancing features that enhance the graspability of the grip  305  such as, by way of non-limiting example, through holes  325  that enable a portion of the user&#39;s hand or fingers to extend therethrough. In other embodiments, the bar  315  (and/or the shaft  310 ) may include grip-enhancing features such as, by way of non-limiting example, indentations or protrusions that allow a portion of the user&#39;s hand or fingers to conform to or rest within. In other embodiments, the bar  315  (and/or the shaft  310 ) may be coated with polyurethane or other friction enhancing material to allow the patient to comfortably grip the grip  305  and provide pressure. Such grip-enhancing features may be found in any of the variety of grips described herein. 
       FIG.  11    illustrates an exemplary labor assistance system  350  including the perianal support member  102  coupled to an exemplary grip  355 . The grip  355  is substantially similar to the grip  106  described above except for the differences described herein. The grip  355  includes an inner shaft  360  received within a hollow cylindrical portion of outer shaft  362  such that the inner shaft can telescope within the outer shaft. A spring  367  is positioned within the hollow cylindrical portion of the outer shaft and is compressed between inner shaft end  361  and outer shaft shoulder  364 . The outer shaft  362  terminates in a knob  365 . The knob  365  forms a graspable portion for the user to hold while positioning and maintaining the labor assistance system  350  against the patient  10 . For example, in some instances, the user may wrap his or her hand around the knob  365  to obtain a secure grasp of the grip  355  while positioning and maintaining the labor assistance system  350  in pressurized engagement with the patient  10 . In some instances, the knob  365  may be shaped and sized to comfortably fit in an average user&#39;s palm. The spring has a stiffness that maintains the amount of force the user can apply to the patient even at multiple knob position along the directions of arrow T. For example, if the user applies significant force to knob, the force will overcome the spring force and the knob will move in the direction of arrow T toward the patient. If the user&#39;s hand moves slightly away from the patient, the spring will move the knob away from the patient in the direction of arrow T and maintain substantially constant pressure on the patient even if the user&#39;s hand moves in and out in the directions of arrow T. 
       FIG.  12    illustrates an exemplary labor assistance system  400  including the perianal support member  102  coupled to an exemplary grip  405 . The grip  405  is substantially similar to the grip  106  described above except for the differences described herein. The grip  405  includes a shaft  405  that terminates in a tab  410  having a central portion  415  and a raised rim  420 . The tab  410  forms a graspable portion for the user to hold while positioning and maintaining the labor assistance system  400  against the patient  10 . For example, in some instances, the user may wrap his or her fingers around the tab  410  to obtain a secure grasp of the grip  405  while positioning and maintaining the labor assistance system  400  in pressurized engagement with the patient  10 . In some embodiments, the tab  410  forms an annular ring and the central portion  415  forms an aperture through which a user may pass one or more fingers. In other embodiments, instead of an aperture, the central portion  415  forms a central depression encircled by the raised rim  420 . 
       FIG.  13    illustrates an exemplary labor assistance system  450  including the exemplary perianal support member  455  coupled to an exemplary grip  460 . The perianal support member  455  is substantially similar to the perianal support member  102  described above except for the differences described herein. In particular, the perianal support member  455  includes a more rounded contact surface  465  and internal contact surface  470  than the contact surface  104  and internal contact surface  143  of the perianal support member  102 . The grip  460  comprises an elongate, hollow tube that is coupled to the internal contact surface  470 . In some embodiments, the grip  460  may extend the entire length L 10  of the internal contact surface  470 , which extends from an anterior edge  472  to a posterior edge  474 . In other embodiments, the grip  460  may extend only partially along the length L 10 . For example, in some embodiments, the grip  460  may not extend to the anterior edge  472  and/or the posterior edge  474 . In the pictured embodiment, the grip  460  forms a hollow cylinder having a passageway  475 , through which the user may extend one or more fingers. Although the pictured embodiment shows the grip  460  having a circular side profile (e.g., the circular side profile of a cylindrical tube) the grip  460  may form a tube having any of a variety of side profile shapes. The grip  460  extends along the midline axis  108 . In use, a user may slide one or more fingers through the passageway  475  and apply pressure towards the contact surface  465  to position and maintain the labor assistance system  400  against the patient  10 . For example, in some instances, the user may push his or her fingers in the direction of the arrow Al within the passageway  475  to maintain the labor assistance system  400  in pressurized engagement with the patient  10 . In some embodiments, the grip  460  may form a tunnel or channel  480  through the perianal support member  455  through which a user may pass one or more fingers (instead of comprising a separate tubular element as shown in  FIG.  13   ). In such embodiments, the perianal support member  455  may be thicker than shown in  FIG.  13    (e.g., with a greater distance between the contact surface  465  and the internal contact surface  470 ). 
       FIG.  14    illustrates an exemplary labor assistance system  500  including the exemplary perianal support member  455  coupled to an exemplary grip  510 . The perianal support member  455  includes an inner surface  505  disposed opposite an outer surface  508 , which extends across the perianal support member  455  to include the contact surface  465 . The grip  510  comprises a curved support structure or compliant pad that is coupled to the inner surface  505 . In some embodiments, the grip  510  substantially mimics the shape and contour of the perianal support member  455 . For example, in the pictured embodiment, the grip  510  forms a curved, wedge-shaped structure including an upper surface  515  that has the same curvature and contour as the inner surface  505  of the perianal support member  455 . In some embodiments, the grip  510  may extend the entire length L 10  of the internal contact surface  470 , which extends from the anterior edge  472  to the posterior edge  474 . In other embodiments, the grip  510  may extend only partially along the length L 10 . For example, in some embodiments, the grip  510  may not extend to the anterior edge  472  and/or the posterior edge  474 . Although the pictured embodiment shows the grip  510  having a side profile that substantially mimics the side profile of the perianal support member  455  (e.g., a wedge or curving V-shaped side profile), the grip  510  may have any of a variety of side profile shapes provided that the upper surface  515  is configured to contact the inner surface  505  of the perianal support member  455 . 
     In use, a user may press one or more fingers against a lower surface  520  of the grip  510  and apply pressure towards the contact surface  465  to position and maintain the labor assistance system  400  against the patient  10 . For example, in some instances, the user may push his or her fingers in the direction of the arrow A 2  to maintain the labor assistance system  400  in pressurized engagement with the patient  10 . In some embodiments, the grip  510  comprises a pad of compliant material that conforms or molds to the pressure applied by the user&#39;s fingers. In other embodiments, the grip  510  comprises a pad of non-compliant material. In some embodiments, the grip  510  may form an integral extension of the perianal support member  455  (instead of comprising a separate element as shown in  FIG.  14   ). In some embodiments, the grip  510  can provide additional structural support for the perianal support member  455  as the user pushes the contact surface  465  against the patient  10 . In some embodiments, the grip  510  can help the perianal support member  455  better conform to the patient  10 , particularly when the contact surface  465  includes a conformable material. In some embodiments, the labor assistance system  500  also includes a handle-like grip (e.g., the grip  106 ) coupled to the grip  510 . 
     In some embodiments, contact surface  465  includes a conformable material. Details of the types of materials and certain properties that may form contact surface  465  are described in detail with respect to the embodiment of  FIG.  7   . In at least one aspect, contact layer  465  comprises a material that deforms under compressive force of 1-10 pounds of pressure applied to the grip, and more preferably deforms at loads of 3-7 pounds of pressure applied to the grip. These same properties may be experienced with use of pad  173  described with respect to  FIG.  7   . 
       FIG.  15    illustrates an exemplary labor assistance system  600  positioned within the gluteal cleft  13  of the patient  10 . In particular,  FIG.  15    shows the labor assistance system  600 , including a perianal support member  605  and a grip  610 , and a push evaluation system  615 . In some embodiments, the push evaluation system  615  is integrally formed with components of the labor assistance system  600  discussed above. That is, in some embodiments, the push evaluation system  615  is a part of the labor assistance system  600 . In other embodiments, the push evaluation system  615  is associated with the support system  100  in a manner enabling the push evaluation system  615  to monitor or detect the pressure on the labor assistance system  600  or on the patient. The perianal support member  605  is substantially similar to the perianal support member  102  except for the differences described herein. For example, the perianal support member  605  is sized and shaped to fit within the gluteal cleft  13  of the patient  10 . In particular, in the pictured embodiment, compression members  620   a ,  620   b  are shaped and sized to extend within the gluteal cleft  13  without extending past the gluteal cleft  13 . The grip  610  may be substantially similar to the grip  106  except for the differences described herein. For example, the grip  610  in the pictured embodiment is coupled to the push evaluation system  615 . The grip  610  includes a series of markings  612 . The markings  612  may be used to indicate the amount of anal displacement, the amount of displacement of the perianal support member  605 , and/or the amount of force or pressure applied to the perianal support member  605 . 
     The push evaluation system  615  is shaped and configured to measure and convey the extent of the pushing force applied by the patient  10  on a contact surface  625  of the perianal support member  605 . The push evaluation system  615  may be configured and arranged to detect changes in pressure, stress, or strain, either directly or indirectly, that may be indicative of the amount of force being applied on the labor assistance system  600  by the patient  10 . The push evaluation system  615  may be associated and configured with other components of the labor assistance system  600 , such as the perianal support member  602  or the grip  610 . For example, the push evaluation system  615  in the pictured embodiment is coupled to the grip  610 . For example, the push evaluation system  615  may directly measure pressure or force upon the perianal support member  605  using pressure sensors, or may indirectly measure pushing force by detecting and conveying changes in the shape, structure, or arrangement of various components or elements making up the labor assistance system  600 . 
     In the pictured embodiment, the push evaluation system  615  comprises a spring-loaded device including a spring  630  having two securing members  149   a  that terminate in anchor pads  149   b . The anchor pads  149   b  are shaped and configured to be removably attached to the buttocks  14 ,  15  (e.g., within the gluteal cleft  13 ) of the patient  10 . In some embodiments, the anchor pads  149   b  may be adhesively attached to the patient  10 . In the pictured example, the securing members  149   a  are fixedly coupled to the spring  630  and the anchor pads  149   b . In some examples, the securing members  149   a  include a first half of a releasable fastening system coupled to the spring  630 , such as a hook and loop system or a releasable adhesive system. In the illustrated embodiment, the anchor pads  149   b  have a generally square shape that is shorter in length and wider than elongated securing members  149   a . The shape of the anchor pad is shown for illustration purposes and may take any form that is suitable for fixing to a patient or inanimate object, as well as joining to the elongated fixation member. Each anchor pad  149   b  includes a first surface  642  having an adhesive surface adapted for joining to the patient&#39;s skin or some inanimate object. The opposing surface  644  includes the second half of the fastening system, which couples to the securing member  149   a . In some embodiments, at least a portion of a surface of the first surface  642  includes an adhesive coating that can fix the securing member to another object. In one embodiment, the adhesive coating is adapted for releasably adhering to a patient&#39;s skin. 
     The push evaluation system  615  is configured to monitor uterine contractions and pushing by the patient by reflecting the force and/or pressure applied on the perianal support member  605  by the anal orifice  26  and the perianal tissue  38 . That is, during contractions, the push evaluation system  615  described herein may be configured to detect a change in pushing force and pressure that occurs due to muscle displacement or distention of the perianal tissue (e.g., caused by the contractions and pushing effort of the patient  10 ). During labor, the contractions of the uterus, along with movement of the baby&#39;s head as a result of the uterine muscles, physically displace the perianal tissue. When the perianal tissue is supported by the perianal support members described herein, the result is less perianal tissue displacement and an increase in net pressure and force against the contact surface  625  of the perianal support member  605 . These increases in pressure against the contact surface  625  can be detected using the push evaluation system  615 . In particular, as the pushing force increases toward the labor assistance system  600 , the perianal support member  605  will move in the direction of the force as indicated by the arrow A 3 . As the perianal support member  605  moves a distance D 1  from a first position  645  to a second position  650  in response to the displacement of the perianal tissue, the grip  610  can slide within the spring  630  in the direction of the arrow A 3  from a third position  655  to a fourth position  660 . Although the movement of the grip  610  may compress the spring  630 , the securing members  149   a  and the anchor pads  149   b  remain substantially fixed in place relative to the patient  10 . The greater the pushing force and/or effort of the patient  10 , the greater the distance D 1  the perianal support member  605  will shift away from the line  645 . 
     This distance D 1  and pushing force may be reflected by the markings  612  on the grip  610  relative to the securing members  149   a . For example, in one embodiment, when the contact surface  625  of the perianal support member  605  is positioned relative to the anal orifice  26  at the first position  645 , the marking  612 c may be level with or adjacent to the securing member  149   a . As the patient pushes, the perianal support member  605  may shift downward by the distance D 1  until the contact surface  625  is positioned at the second position  650 , simultaneously shifting the grip  610  the distance D 1  from the line  655  to the line  660 . When the grip  610  is positioned at the line  660 , the marking  612   a  may be level with or adjacent to the securing member  149   a , indicating the change in force and/or pressure applied to by the patient&#39;s pushing upon the perianal support member  605 . Accordingly, in addition to measuring the pushing force and pressure statically upon application of the labor assistance system  600 , the push evaluation system  615  may be used to monitor dynamic force and pressure by detecting changes in force and pressure on the labor assistance system  600  resulting from uterine contractions ad maternal pushing. 
     In addition, by monitoring the changes in pressure on the perianal tissue by the perianal support member  605  that occur during a push, the pressure detection systems may be able to provide a pressure indication of the strength of a push. Accordingly, during the birthing process, the patient and/or the healthcare provider may observe the system  615  to determine the strength of a push. The position of the markings  612  on the grip  610  relative to the securing members  149   a  may suggest whether or not the patient is effectively pushing the baby toward the vaginal opening during a contraction. Moreover, if the grip  610  compresses the spring  630  to the extent that the position of the markings  612  relative to the securing members  149   a  can no longer change, the user may be alerted to a pushing effort by the patient  10  in an unsafe force or pressure range. This may indicate that pressure on the perianal tissue should be reduced, and the user may instruct the patient  10  to halt pushing and/or remove the labor assistance system  600  from contact with the patient  10 . Therefore, this condition alerts the user and patient  10  to either cease the pushing contractions and/or to reposition or remove the labor assistance system  600 . As such, the push evaluation system  615  may provide positive user feedback on dynamic pressure changes indicative of the success or lack thereof of pushing associated with contractions. It&#39;s worth noting that the labor assistance system  600  may be retained in position on the patient  10  both during the static support phase and the dynamic support phase of the birthing process. 
     The push evaluation systems disclosed herein may enable a health care provider of the patient to apply the labor assistance system with at least a proper amount of pressure to provide therapeutic support to the patient during childbirth. Accordingly, by evaluating the strength and effectiveness of the patient&#39;s pushing and adjusting the position and pressure application of the labor assistance system accordingly, utilizing the systems disclosed herein may reduce the incidence of a number of complications, including for example and without limitation, pelvic floor incompetence or dysfunction, organ prolapse, incontinence secondary to pressure and stretching exerted on bladder and bladder neck, over stretching, perineum tears and lacerations, forceps use, and hemorrhoids. 
     Returning now to  FIGS.  1  and  2   , in use the user (e.g., the patient  10 , a health care provider, or another) positions the patient  10  to expose the perianal region  38 . During the child birthing process, the patient  10  may be positioned in stirrups attached to a delivery table (not shown). The labor assistance system  100  is then moved adjacent the gluteal cleft  13  between the buttocks  14  and  15 . The support system  100  is positioned such that the midline axis  108  of the perianal support member  102  is substantially aligned with the patient&#39;s midline within the sagittal plane. Referring to  FIG.  1   , the perianal support member  102  is advanced in the direction of arrow A 4  toward the anal orifice  26  (generally within the sagittal plane toward the head of the patient  10 ) to bring the contact surface  104  into contact with the perianal tissues  38 . Continued advancement of the perianal support member  102  toward the anal orifice  26  applies pressure through the contact surface  104  and the compression members to the perianal tissues. The user may hold the grip  106  to position the perianal support member  102  within the gluteal cleft  13  and to advance the perianal support member  102  against the perianal tissues  38 . In one aspect, the healthcare provider may place at least one finger within the access cavity  136  and preferably against the inner surface  132  to further advance the device against the anal orifice  26 . 
     The user may utilize the pressure feedback (e.g., tactile or haptic feedback) associated with the labor assistance system  100 , the push evaluation system  615 , and/or an intrauterine contraction monitor to sense whether the patient  10  is or should be actively pushing. In one aspect, the labor assistance system  100  is initially positioned to be spaced from or only in touching engagement with the patient  10  without creating pressure when the patient  10  is not experiencing a contraction. As a contraction occurs or the patient  10  pushes, the perianal tissues  38  will tend to protrude thereby engaging the system  100  with a pressure that can be felt by the mother through tactile or haptic feedback and/or sensed by the push evaluation system  615 . With continued pressure applied by the user to the grip  106  and/or the inner surface  132  of the labor assistance system  100 , the patient  10  can feel increasing tactile pressure from the perianal support member  102  against which to focus her pushing effort and direct the force of her pushing. 
     The extent of tissue deformation surrounding the anal orifice  26  when the labor assistance system  100  is applied is a function of the patient anatomy, the amount of pushing force exerted by the patient  10 , and the amount of compressive force applied in the direction of arrow A 4  through the grip  106  during application of the system  100 . As shown in  FIG.  1   , the maximum extent of perianal tissue engagement inwardly on the patient  10  in the sagittal plane is shown by the line  645 . In one aspect, it is contemplated that pressure applied in the direction of arrow A 4  moves the anal orifice  26  inwardly 1 cm to 3 cm. The compression elements  116 ,  124  exert tension forces generally in the direction of arrows A 5  and A 6 , respectively. The compression elements  116 ,  124  are substantially rigid members capable of transmitting compressive forces to the perianal support member  102  and the perianal tissues  38 . The compressive forces A 5  and A 6  are transmitted by substantially rigid compression elements  116 ,  124  and ultimately to the contact surface  104  to apply support and/or pressure to the perianal tissues in the direction of arrow A 4 . It will be appreciated that the lateral components of compressive forces applied in A 5  and A 6  help to maintain the position of the perianal support member  102  as well as tending to maintain the access cavity  136  in an open position. It will be understood that while compression elements  116 ,  124  are sufficiently rigid to transmit compressive force toward the contact surface  104 , in one embodiment they are flexible, at least laterally, to bow or bend in response to forces applied by the buttocks  16 ,  17 . 
     As shown in  FIG.  1   , a distance D 2  between the anal orifice  26  and the buttocks crown  16  is less than a distance D 3  between a distal end  670  of the compression member  116  and the anal orifice  26 . Thus, tension applied to the grip  106  is transferred through the substantially rigid compression elements  116 ,  124  to exert a compressive force on the contact surface  104  in the direction of arrow A 4 . In other embodiments, the distance D 3  may be greater than the distance D 4  (e.g., as shown in  FIG.  15   ). It will be appreciated that with the illustrated embodiment, the user may maneuver the grip  106  to reposition the perianal support member  102  and adjust the compressive force applied through the grip  106  to the contact surface  104  by decreasing or increasing the force applied through the grip  106  in the direction A 4  toward the patient  10 . 
     The extent of tissue deformation surrounding the anal orifice  26  is a function of the patient anatomy and of the amount of compressive force applied during application of the labor assistance system  100 . In one aspect, the health care provider makes initial contact with anal orifice  26  and then applies pressure in the sagittal plane (generally toward the patient&#39;s head) to advance the device 1 cm to 3 cm. This advancement of the device approximately 1 cm to 3 cm compresses the perianal tissue and thereby supports the tissue to inhibit distention as the patient  10  pushes during the birthing process. It will be appreciated that with the illustrated embodiment, the user may reposition the device and adjust the compressive force applied through the grip  106  and the compression members  116 ,  124  to the contact surface  104  by adjusting his or her grasp on the grip  106  to adjust the strength and directionality of force and/or pressure applied through the contact surface  104 . 
     In an alternative approach, the contact surface  104  is positioned in engagement with the anal orifice  26  with little if any compressive force applied to deform the perianal tissue  38 . The perianal support member  102  is then manually maintained in position using the grip  106  as described above. With this technique, the labor assistance system  100  will resist movement of the device in a direction generally away from the patient&#39;s head and will thereby support the perianal tissue to maintain its position. In a further feature, the push evaluation system  615  may indicate outward pressure on the perianal tissue to provide feedback to the patient  10  and/or other users on successful pushing during contractions. 
     Still referring to  FIGS.  1  and  2   , with the system  100  in position, a user may position one or both hands within the access cavity  136  extending into the gluteal clef  13 . In this manner, the hands may be below the lowest portion of the vaginal opening  11  as the head of the baby  12  passes out of the vagina. Thus, the hand within the access cavity  136  is positionable less than 1 cm from the mother&#39;s vaginal opening or perineum so the healthcare provider may support the head of the baby as is it is being born. As shown in  FIG.  2   , the position of the anterior edge  112  of the perianal support member  102  also allows access to the tissue immediately posterior to the vaginal opening  11  in the event an obstetric maneuver, such as an episiotomy, manual manipulation of the fetus, etc., is necessary. In some instances, the anterior edge  112  of the perianal support member  102  may be curved or concave to allow better access to the vaginal opening  11  while the labor assistance system  100  remains in position against the perianal tissues. Further, as discussed above, in some instances, the perianal support member  102  can be quickly repositioned or removed, an obstetric maneuver can be performed, the perianal support member  102  is repositioned in a supporting position adjacent the anus, and its position can be maintained by manually handling the grip  106 . 
     Additionally, in the illustrated embodiments, the perianal support member  102  of the labor assistance systems is sized and positioned with respect to patient  10  to allow for the passage of a child through the birthing canal during childbirth. The labor assistance system  100  is positioned on the patient  10  such that the perianal support member  102  does not extend along the patient midline  108  in the gluteal cleft  13  with the potential for interference with the birthing process, but instead extends substantially laterally from the patient&#39;s midline (e.g., the compressive members  116 ,  124  extend laterally from the midline axis  108 ). It is contemplated that the perianal support member  102  may be placed to support more or less of the external perineum region located between the anal orifice  26  and the vaginal opening  11  depending on the user&#39;s judgment and the progress of the child birthing process. Still further, it is contemplated that an exemplary labor assistance device having an elongated anterior to posterior width W 2  (as shown in  FIG.  3   ) may be positioned to support at least a portion of the perianal tissue and the vaginal tissue during the labor process. In some embodiments, the anterior edge  112  of the perianal support member may be curved toward the posterior edge  110  (e.g., having a concave profile) to allow for greater access to the vaginal opening  11  and provide ample room for the baby  12  to crown. It is anticipated that the system  100  will be repositioned posteriorly away from the vaginal opening prior to delivery of the child through the vaginal opening. 
       FIGS.  16 A and  16 B  illustrate cross-sectional views of a patient  10  in the sagittal plane taken along the lines  16 - 16  shown in  FIG.  2   .  FIG.  16 A  illustrates the perianal support member  102  positioned against the patient  10 , and  FIG.  16 B  illustrates the perianal support member  190  (described above in relation to Fig. 9 A) positioned against the patient  10 . In  FIG.  16 A , the labor assistance system  100  is shown held by a user U and positioned against the perianal region  38  of the patient  10 . In other instances, the labor assistance system  100  may be secured to the patient  10  by means of securing members and anchor pads, as described above in relation to  FIGS.  2 B and  2 C . For example, the perianal support member  102  may be secured to the patient  10  in a manner to apply pressure to the perianal and/or anococcygeal regions by securing members substantially similar to the securing members  149   a  and anchor pads substantially similar to the anchor pads  149   b  described above in relation to  FIGS.  2 B and  2 C . Such securing members and anchor pads are not shown in  FIG.  16 A  due to the difficulty of illustrating such an embodiment in the depicted view. 
     In  FIG.  16 A , the perianal support member  102  is positioned with the contact surface  104  in contact with the anal orifice  26 . In one instance, the user U holds the grip  106  to position the perianal support member  102  against the perianal region  38  at an angle and with sufficient pressure to assist in shortening the second stage of labor. As shown in  FIG.  16   , uterine contractions and the patient&#39;s pushing force may act in the direction of an arrow A 7 , directing the baby  12  downwards but not necessarily toward the vaginal opening  11 . The baby  12  is shown in a downward position with a baby&#39;s head  700  contacting the cervix  705 . As the baby  12  progresses through the birth canal, the mother&#39;s anatomy assists in guiding the baby  12  along an optimal path toward the vaginal opening  11 . For example, a sacrum  710 , and, in particular, a coccyx  715 , can provide an internal brace or scaffolding to provide counter pressure in the direction of an arrow A 8  that can guide and/or shift the exit trajectory of the baby  12  toward the vaginal opening  11  in the direction of arrow All as the patient  10  pushes the baby  12  in the direction of the arrow A 7 . 
     Similarly, in some instances, the labor assistance system  100  may be used as an external guide or brace that provides counter pressure along the contact surface  104  to help guide the baby  12  along a desired path through the birth canal and toward the vaginal opening  11 . In particular, the labor assistance system  100  can act as a sacral extension member or anococcygeal support member configured to provide counter pressure in the anococcygeal region (i.e., the region between the anus and the coccyx of the patient  10 ) in the direction of an arrow A 9  against the pushing forces acting in the direction of the arrow A 7 . The contact surface  104  of the labor assistance system  100  can act as a relatively firm and selectively yielding external scaffolding that prevents the patient&#39;s pushing force from driving the baby&#39;s head  700  in a direction away from the ideal exit path towards the vaginal opening  11 . For example, the patient&#39;s pushing force may direct the baby&#39;s head  700  towards the posterior of the patient  10  (e.g., towards the posterior rectal hiatus or rectum  36 ) instead of more anteriorly towards the vaginal opening  11 . The sacrum  710  provides a natural guide or internal scaffold that assists in redirecting the baby&#39;s head  700  towards the vaginal opening  11 . Like the sacrum  710 , the labor assistance device  100  can act as a physical guide or external scaffold against the anococcygeal region that assists in redirecting the baby&#39;s head  700  towards the vaginal opening  11 , especially once the baby&#39;s head  11  has descended past the sacral promontory  715 . Unlike the sacrum  710 , however, which is relatively stationary within the patient  10 , the labor assistance system  100  can act as a dynamic guide to assist the baby&#39;s exit from the birth canal. In particular, as labor progresses and the baby&#39;s head  700  descends through the birth canal, the user may adjust the direction and strength of the counter pressure applied through the labor assistance system  100  against the anococcygeal and perianal regions by changing the strength and directionality of his or her grasp on the grip  106 . Thus, the user may change the angle A 9  as the angle A 7  changes with the progression of labor to best guide the baby&#39;s head  700  through the birth canal. 
     In  FIG.  16 B , the perianal support member  190  is shown positioned against the perianal region  38  of the patient  10 . In particular, the perianal support member  190  is positioned with the contact surface  192  in contact with the anal orifice  26 , and the focusing pressure element  200  positioned against the perineum between the anal orifice  26  and the vaginal orifice  11 . In one instance, the user U holds the grip  106  to position the contact surface  192  and the focusing pressure element  200  against the perianal region  38  (e.g., against a nerve or nerve bundle or nerve plexus  725  that may stimulate the patient&#39;s urge to push) at an angle and with sufficient pressure to assist in shortening the second stage of labor. In some embodiments, the user U may observe the position of the marker  205  in relation to the patient&#39;s anatomy (e.g., the anal orifice  26 ) to appropriately position the focusing pressure element  200  against the patient  10 . 
     In embodiments having a clear or translucent contact surface  192  (or  102 ), the user U may observe, mark (on the inner surface  196  or  132 ), and/or measure the extent of tissue distention against the contact surface  192  or  102  upon initial placement of the device, and then observe, mark (on the inner surface  196  or  132 ), and/or measure the extent of tissue distention against the contact surface  192  or  102  after the change of pressure on the contact surface due to the voluntary or involuntary contractions of labor. The difference between the two measurements or the distance between the two markings may suggest the extent of the pressure changes occurring in the labor process and may serve as an indication of the progress of labor. 
     As shown in  FIG.  16 B , the application of counter pressure in the direction of arrow A 10  through the contact surface  192  and/or the focusing pressure element  200  may augment or spur the patient&#39;s pushing force and aid the descent of the baby  12  in the direction of arrow All toward the vaginal opening  11 . As labor progresses and the baby&#39;s head  700  descends through the birth canal, the user U may adjust the direction and strength of the counter pressure applied through perianal support member  190  and/or the focusing pressure element  200  by changing the strength and directionality of his or her grasp on the grip  106 . Thus, the user U may change the angle A 10  as the angle All changes with the progression of labor to best guide the baby&#39;s head  700  through the birth canal. 
     In use, the user can position the patient  10  to expose the perianal region and vaginal opening  11 . Referring now to  FIG.  17   , there is a shown a flow chart illustrating a method of utilizing a labor assistance system according to one aspect of the present disclosure to manage a mother&#39;s labor process to reduce the duration of second stage labor and increase the incidence of a vaginal delivery without increasing tissue damage to the mother. In general terms, the method includes applying a tactile or haptic feedback device (e.g., the labor assistance system  100 ) in engagement with the perianal tissue and monitoring the progression of labor during the second stage. 
     With respect to  FIG.  17   , in some instances, the method begins at step  800  by determining whether the expecting mother has previously delivered a child by a vaginal delivery. If the answer to this inquiry is yes, then at step  802 , the progress of labor is monitored to determine if labor is progressing as desired at step  804 . In one instance, the progression of labor can include the amount of movement of the child toward the vaginal opening over a given a period of time. In another instance, the progression of labor can include shortening or thinning of the cervix, the amount of cervical dilation, assessment of fetal position and/or descent (e.g., via digital assessment inside the vagina, via manual palpation of the abdomen, via visual observation, or via imaging), and the amount of movement of the child toward the vaginal opening in comparison to the number of contractions or successful pushes the mother has experienced. The determination of the progression of labor may be made by a healthcare provider monitoring the patient or by an electronic monitoring system receiving one or more inputs indicative of labor progression such as the strength and/or number of contractions, effective pushes, and movement of the child within the mother and/or overall time of labor. As long as labor is progressing as desired, the method continues with monitoring the progress of labor. 
     If labor is not progressing as desired in step  804 , then the method progresses to the application of a tactile feedback device (TFD) in a first tactile position at step  806  which could include devices similar to any of the labor assistance system embodiments described above or any other device configured and applied to provide perianal tactile sensation to the patient. In some embodiments, the TFD may also supply haptic feedback to the user that is indicative of the extent of pressure applied on the TFD. A first tactile position can include applying a TFD in a pressure inducing and tissue compression engagement at a first pressure threshold, engagement with the perianal tissue without pressure inducement or tissue compression, or positioning adjacent the perianal tissue sufficiently close such that during a push by the mother, the protrusion of soft perianal tissue will engage the TFD to provide a tactile sensation to the mother. In some instances, the user may position the TFD in the first tactile position to contact the patient  10  only when the patient  10  is experiencing a contraction, as observed by the user or indicated by the electronic monitoring system. Once the TFD is positioned in the desired first tactile position, the method includes the step at  812  of maintaining the TFD in contact against the mother in the first position. 
     During initialization of the method in step  800 , if it is determined that the mother has not previously had a successful vaginal delivery or has previously undergone a Cesarean section child delivery procedure, the method continues to step  810  where a TFD is applied in a first tactile position to provide perianal tactile sensation to the mother. Of course, use of the methods and devices described above can be applied to all patients; however, it may be desirable in some situations to limit use of the labor management devices and techniques to those patients mostly likely to benefit from the added attention and treatment. In some instances, the method omits the steps  800 - 806  and commences at step  810  with the application of the TFD against the patient  10  during the second stage of labor. As described above, a first tactile position can include applying the TFD in a pressure inducing and tissue compression engagement at a first pressure threshold, engagement with the perianal tissue without pressure inducement or tissue compression, or positioning adjacent, but spaced from, the perianal tissue in a sufficiently close arrangement such that during a push by the mother, the protrusion of soft perianal tissue will engage the TFD to provide a tactile sensation to the mother. Once the TFD is positioned in the desired first tactile position, the method includes the step at  812  of maintaining the TFD to the mother in the first position in any suitable manner, including the techniques disclosed herein of a user grasping the grip  106  and applying pressure through the perianal support member  102  against the patient  10 . 
     After the TFD is positioned, the method of using the TFD to manage a mother&#39;s labor continues at step  814  by monitoring the progress of labor. In one instance, the progression of labor can include shortening or thinning of the cervix, the amount of cervical dilation, and/or the amount of movement of the child toward the vaginal opening over a given a period of time. In another instance, the progression of labor can include the amount of movement of the child toward the vaginal opening in comparison to the number of contractions or successful pushes the mother has experienced. In some instances, the TFD may include a counting component to track the number of successful pushing episodes experienced by the device. In some instances, as described above, the TFD may include a haptic feedback component to monitor the pressure applied against the device (e.g., the contact surface) by the patient. As described above, the determination of the progression of labor may be made by a healthcare provider monitoring the patient or by an electronic monitoring system receiving one or more inputs indicative of labor progression such as the number of contractions, effective pushes, and movement of the child within the mother and/or overall time of labor. As long as labor is progressing as desired in step  816 , the method continues with monitoring the progress of labor in step  814 . 
     If labor is not progressing as desired in step  816 , then the method progresses to modifying the position of the TFD at step  818  to move the TFD to a second tactile position on the mother to thereby increase the tactile sensation and/or to change the degree of haptic feedback for the mother, which may improve her ability to effectively push the baby towards the vaginal opening by supplying a tactile focus point against which to push and/or by providing an external scaffolding or sacral extension member that supports the anococcygeal region tissues (including, for example, the posterior pelvic floor tissues) to guide the baby&#39;s head through the birth canal towards the vaginal opening. Similarly, the monitoring of the labor process also takes into account the administration of sensory numbing medications administered to the mother at step  820 . As will be appreciated, the application of numbing medications, including spinal epidurals, orally administered pain relievers and intravenously injected pain relievers, may significantly reduce the mother&#39;s ability to feel pain along with tactile sensation in the perianal tissues. As a result, the method of managing the labor process advances to step  818  to increase the amount of tactile sensation applied to the perianal tissues. In some instances, the user may coordinate this repositioning of the TBD to apply more tactile sensation and/or to change the degree of haptic feedback against the mother with the mother&#39;s contractions. Thus, the user may gradually increase the pressure applied by the TBD in sync with the increase in intrauterine pressure due to contractions. In other instances, the user may decrease the pressure applied by the TBD in sync with the increase in intrauterine pressure due to contractions, particularly if labor is progressing as desired 
     In one aspect, in order to increase tactile sensation at step  818 , the TFD is moved to a second tissue engaging position where the amount of pressure applied to the perianal tissue is increased compared to the first tactile position. In an exemplary embodiment, the TFD includes a pressure indication mechanism that provides feedback to the individual moving the device about how pressure is being applied, or if the pressure is increasing from the first position, as the TFD is moved to the second position against the perianal tissues. In another exemplary embodiment, the TFD includes a push evaluation system (e.g., the push evaluation system  615  shown in  FIG.  15   ) that provides feedback to the individual moving the device about the strength, directionality, and/or effectiveness of the mother&#39;s pushing effort. In an alternative form, the healthcare provider applies inward (toward the anus) movement of the TFD while receiving feedback from the mother concerning her ability to sense the increased tactile sensation. Once the mother indicates a desired level of tactile sensation, the healthcare provider (or the patient in patient manipulated embodiments) maintains the device in the second position at step  822 . 
     As will be appreciated, the process of monitoring labor in step  814  and increasing the tactile sensation (or managing the labor process to decrease the tactile sensation if the mother experiences excessive pain or is pushing too hard) can be repeated multiple times throughout the labor process to manage a balance between causing pain/injury to the mother and provides the mother with a tactile sensation to push against to generate more effective pushes with increased movement of the child into and through the birth canal. More specifically, at step  830 , tissue adjacent the TFD is monitored to avoid applying too high a pressure on the tissue for too long of a time period. Thus, in step  832  if it is determined that the current position of the TFD may cause tissue injury (e.g., to either the mother or the baby), then in step  834  the TFD device can be moved to reduce the pressure on the perianal tissue or increase spacing from the vaginal orifice. In one embodiment, the TFD includes a mechanism for alerting the user to an over pressure situation and this mechanism can provide feedback on the force exerted on the perianal tissue. 
     In embodiments employing pressure detecting systems, uterine contraction monitors, or push evaluation systems (e.g., in the grip  106 ) to determine whether a suitable pressure is being applied to the device and/or whether the patient&#39;s pushing force is sufficient, the user may visually observe the grip or may be able to identify by tactile feedback when a suitable pressure is applied by and/or to the labor assistance system  100 . If more pressure is desired as indicated by the pressure detecting systems, the push evaluation systems, the uterine contraction monitors, and/or observation, then the user may provide additional pressure through the labor assistance system  100 . In embodiments having device adjustment elements (e.g., such as a sufficiently long grip  106 ) that may be manipulated by the patient, the patient may adjust the pressure applied by the system  100  based on self-assessment or feedback from the various monitoring systems or healthcare professionals. 
     In some instances, the labor assistance systems described herein that are configured to apply an upward pressure in the pelvic regions may be used in combination with a child birth assisting system that is configured to apply downward pressure in the abdominal region. For example, in some instances, a labor assistance system may be positioned against the patient&#39;s perianal region in combination with a child birth assisting system positioned around the patient&#39;s abdomen (e.g., above the uterus). Both systems may be arranged and configured to work in concert to decrease the duration of the second stage of labor by assisting the patient&#39;s efforts to push the baby through the birth canal. 
       FIG.  18    illustrates an exemplary childbirth assisting system according to one embodiment of the present disclosure. In the pictured embodiment, the child birth assisting system comprises an expandable pneumatic girdle as described in U.S. Pat. No. 5,871,499, filed Apr. 25, 1997, titled “Child Birth Assisting System,” which is incorporated by reference in its entirety. As shown in  FIG.  18   , a childbirth assisting system  900  includes an automatically synchronized expandable pneumatic girdle  902  configured to externally augment the secondary force of labor (e.g., the forces produced by the increase of intra-abdominal pressure through voluntary contractions of the abdominal muscles and diaphragm, as opposed to the primary force of labor produced by the increase of intrauterine pressure produced by involuntary contractions of the uterus).  FIG.  18    is a block diagram of the childbirth assisting system  900  including a patient  10 , the abdominal girdle  902 , a controller  904 , and a uterine contraction monitor  906 . 
       FIG.  18    illustrates a closed loop system using patient response and rule-based decision making methods to achieve operator specified responses. The device is a pneumatic closed loop system which is composed of the abdominal girdle  902  and the controller  904 . The controller  904  possesses five main functions: (1) Receiving the uterine activity data from the uterine contraction monitor  906  and detecting the onset and offset of contractions; (2) Synchronizing the girdle pressure with the contraction, increasing the girdle pressure at the onset of contraction and decreasing it at the offset of contraction; (3) Adjusting the girdle pressure automatically to obtain the intrauterine pressure at a preset level; (4) Displaying information, including girdle pressure; and (5) Setting an alarm or alert system for abnormal situations. The uterine contraction activity can be monitored either externally (e.g., using an external tocodynamometer) or internally (e.g., using an intrauterine catheter) by the uterine contraction monitor  906 . In alternate embodiments, the system may operate on an open loop principle which comprises a modification of functions 2 and 3 listed above. In the open loop system, the application and release of girdle pressure need not rely on intrauterine pressure. Instead, application of pressure to the girdle will be triggered by detection of contraction pressure by the external toco sensor only, and only after a pre-determined threshold pressure is attained and held for a specified period of time. 
       FIG.  19    illustrates the abdominal girdle  902  according to one embodiment of the present disclosure. The girdle  902  is formed of two basic components: the belt  910  and the bladder  912 . The design of the belt requires two considerations. The inner lining must be soft and comfortable to the mother while the outer lining must have high tensile strength so that it can be tightly secured around the mother to keep the bladder inflation pressure downward against the abdomen. The belt  910  may be formed from polyvinyl chloride (PVC) or an elastomer-coated fabric, such as polyurethane-coated nylon. For the patient&#39;s comfort, the interior lining of the belt which comes in contact with the skin should be a soft fabric, such as the loop material of a hook-and-loop fastener, velour, woven fabric such as cotton or nylon, netting, or a combination of materials including a laminate. The choice of materials will depend on the integration of the bladder. For example, the belt could serve as the reinforced lining to the bladder, or it could be part of the bladder. An elastomer coating on outer layer of the belt may be added to prevent the fabric from stretching, or the outer surface may be non-stretch cotton fabric or surgical tape. In one version illustrated in  FIG.  5 A , the belt is originally formed in two layers  914  and  916  so that the bladder  912  may be inserted between the layers. (Layer  914  represents the outer PVC layer and layer  916  represents the inner fabric-lined layer.) The layers may be sealed together after the bladder is inserted to firmly retain the bladder at a fixed position within the belt. The sealing welds  918  are indicated as dashed lines. Alternatively, the bladder  912  may be floating, sealed to only one of the two layers of the belt, or unattached to either layer and simply retained between the two layers once they have been sealed together. Selection of belt configuration may be made based upon pressure transfer efficiency, with the floating bladder version having demonstrated improved pressure transfer in prototypes of the invention. The choice of material of which the belt is made will depend upon whether the bladder is attached or floating. 
       FIG.  20    illustrates another exemplary abdominal girdle  920  in which the inner and outer layers  914 ′ and  916 ′ are sealed together without placing the bladder  912 ′ between the layers. The bladder  912 ′ is held directly against the mother&#39;s abdomen, with the inward force of the belt  910 ′ providing means for maintaining the bladder  912 ′ in the proper location. 
       FIG.  21    illustrates a cross-sectional view of a patient  10  in the sagittal plane, and includes the childbirth assistance system  900  as well as the labor assistance system  100  positioned on the patient. In the pictured embodiment, the patient&#39;s labor is managed using both the childbirth assistance system  900  as well as the labor assistance system  100 . For example, in a closed loop system, once the controller  904  detects the onset of contraction, the girdle pressure is increased at the pre-set rate until the desired or preset intrauterine pressure is obtained. Once the intrauterine pressure reaches the preset pressure, the girdle pressure will be maintained to obtain a constant intrauterine pressure. The offset of contraction can be detected when the girdle pressure increases sharply, and the girdle pressure will be released upon detection of the offset of contraction. In some embodiments, the user may apply increased pressure to the perianal tissues through the labor assistance system  100  in the direction of arrow A 9  as the girdle pressure increases in the direction of arrows A 12 , and may decrease the application of pressure to the perianal tissues through the labor assistance system  100  as the girdle pressure decreases. Thus, the childbirth assistance system  900  and the labor assistance system  100  may work in concert to increase the intrauterine pressure and aid the baby&#39;s progression through the birth canal. Whereas the childbirth assistance system  900  works from “above” the uterus, increasing external pressure on the abdomen to force uterine contents (e.g., the baby) downward toward the vaginal orifice, the labor assistance system  100  may operate from “below” the uterus by providing the patient with a tactile, pressure-responsive focal point for pushing against and/or providing a sacral extension member. The labor assistance system  100  may also direct the added pressure on the uterus and the baby in the direction of arrow All toward the lower pressure area of the vaginal opening  11 . 
       FIG.  22 A  illustrates a perspective view of an exemplary labor assistance system  950  including a perianal support member  960  according to one embodiment of the present disclosure.  FIG.  22 B  illustrates a side view of the exemplary labor assistance system shown in shown in  FIG.  22 A  according to one embodiment of the present disclosure.  FIG.  22 C  illustrates a top view of the exemplary labor assistance system shown in  FIG.  22 B  including exemplary securing members according to one embodiment of the present disclosure.  FIG.  23    illustrates a partial perspective bottom view of the labor assistance system  950  shown in  FIG.  22 C  applied to a patient  10  during child delivery.  FIG.  24    illustrates a cross-sectional view of the patient  10  in the sagittal plane, and includes the labor assistance system  950  positioned on the patient  10 . 
     The perianal support member  960  is substantially similar to the perianal support member  102  except for the differences described herein. For example, the perianal support member  960  includes a contact surface  962  extending along a midline axis  964  from an anterior edge  974  to a posterior edge  976 . In the pictured embodiment, the contact surface  962  is slightly curved (e.g., concave) as shown in  FIGS.  22 A and  22 B . As best shown in  FIG.  22 B , the contact surface  962  of the perianal support member  960  includes areas having different radii of curvature. For example, in the pictured embodiment, a posterior region  978  of the contact surface  962  adjacent the posterior edge  976  has a smaller radius of curvature RC 1  than the radius of curvature RC 2  of an anterior region  980  adjacent to the anterior edge  974 . In other embodiments, the contact surface  962  may be substantially straight, as shown with respect to the contact surface  102  shown in  FIG.  3   ). An opposing inner surface  966  defines an access cavity  968 . A grip (e.g., the grip  106  discussed above) may be coupled to and extend from the inner surface  966 . The perianal support member  960  includes compression elements  970  and  972  that flank the contact surface  192 . In some embodiments, the compression elements  970 ,  972  are integral extensions of the contact surface  962 . In other embodiments, the compression elements  970 ,  972  are coupled to the contact surface  962 . The compression elements  970 ,  972  may extend equal distances from the contact surface  962 , as shown in  FIG.  22 A , or they may extend unequal or different distances from the contact surface  192 . 
     The compression elements  970 ,  972  meet the contact surface  962  to form a saddle-shaped structure. Each compression element  970 ,  972  is shaped and configured to include a short portion  970   a  (shown in  FIG.  22 C ),  972   a , and a long portion  970   b ,  972   b . As best shown in  FIG.  22 C , the long portions  970   b ,  972   b  form the anterior edge  974  and the short portions  970   a ,  972   a  form the posterior edge  976  of the perianal support member  102 . This configuration enables the narrower or shorter portion of the perianal support member  960  (i.e., the shorter portions  972   a ,  970   a , and the contact surface  962  adjacent those portions) to be positioned more easily within the gluteal cleft, as shown in  FIGS.  23  and  24   . 
     In some embodiments, the perianal support member  960  is bendable along the axis  964 . In the pictured embodiment, the perianal support member  960  includes markings  144   b , which are substantially similar to the markings  144  described above in relation to  FIGS.  2 B and  2 C . In some embodiments, the markings  144   b  comprise cutouts in the contact surface  962  that facilitate the bending of the perianal support member  960 . For example, with reference to  FIGS.  23  and  24   , which illustrate the perianal support member  960  positioned against the patient  10 , the contact surface  962  of the perianal support member  960  may be bent into a slightly concave shape upon application of pressure to the contact surface  962  (e.g., through the handle  106 ). 
     As described above,  FIG.  22 C  illustrates a top view of the labor assistance system  950  including two securing members  982   a ,  982   b  that terminate in anchor pads  984   a ,  984   b . The anchor pads  984   a ,  984   b  are shaped and configured to be removably attached to the buttocks  14 ,  15  (e.g., within the gluteal cleft  13 ) of the patient  10  (in a similar fashion as shown in  FIG.  2 C ). In some embodiments, the anchor pads  984   a ,  984   b  may be adhesively attached to the patient  10 . In the pictured example, the securing members  982   a ,  982   b  are fixedly coupled to the compression elements  972 ,  970  and the anchor pads  984   a ,  984   b , respectively. In some examples, the securing members  982   a ,  982   b  include a first half of a releasable fastening system coupled to the compression elements  972 ,  970 , such as a hook and loop system or a releasable adhesive system. In the illustrated embodiment, the anchor pads  984   a ,  984   b  have a generally rectangular shape that is shorter in length and wider than elongated securing members  982   a ,  982   b . The shape of the anchor pads  984   a ,  984   b  is shown for illustration purposes and may take any form that is suitable for fixing to a patient or inanimate object, as well as joining to the elongated fixation member. Each anchor pad  984   a ,  984   b , as shown in  FIG.  22 C , includes a first side  986 a,  986 b, respectively, and an opposite second side  988   a ,  988   b , respectively (shown in phantom in  FIG.  22 C ). A portion of each anchor pad  984   a ,  984   b  includes at least a portion of the opposite second side  988   a ,  988   b  having an adhesive surface (which, in some embodiments, may be substantially similar to the adhesive surface  642  described in more detail with relation to  FIG.  15   ) adapted for joining to the patient&#39;s skin or some inanimate object. The opposing first side  986 a,  986 b (which, in some embodiments, may be substantially similar to the surface  644  described in more detail with relation to  FIG.  15   ) includes the second half of the fastening system, which couples to the securing member  982   a ,  982   b , respectively. In some embodiments, at least a portion of a surface of the anchor pads, whether the first sides  986 a,  986 b or the opposing second sides  988   a ,  988   b , includes an adhesive coating that can fix the securing member to another object. In one embodiment, the adhesive coating is adapted for releasably adhering to a patient&#39;s skin. 
     Labor assistance systems as described herein may be applied to patients for a variety of reasons including, alone or in combination, any of the following: a) shortening the second stage labor by providing a push focal point to enhance the effectiveness of contractions in advancing the baby down the birth canal, b) reducing the necessity of Cesarean section births by encouraging and monitoring, via pressure feedback, the effectiveness of contractions to generate a pushing effect on the baby to move it toward the vaginal opening as sensed by pressure exerted on the perianal tissue, c) assisting the baby&#39;s progression through the vaginal canal by providing an external scaffolding using an anococcygeal support device or sacral extension member, d) covering all or most of the anal orifice and thereby providing defecation control, e) suppressing hemorrhoid development and/or advancement of existing hemorrhoids, f) supporting internal and external tissues to inhibit damage such as anal sphincter damage and lacerations, and g) delivering post-delivery therapeutic treatments, such cooling treatments, for example. 
     In one embodiment, the labor assistance system  100  (and/or the labor assistance system  950 ) is formed of biocompatible material suitable for contact with human tissue. Moreover, in one embodiment, the system is provided sterile in a package for single use application on a patient, although reusable devices according to the present teachings are also disclosed in the present description. In the single use type of embodiment, the system is cost effectively manufactured such that it is discarded after use. For example, the system  100  is formed by of a substantially rigid polycarbonate material. In one aspect, the system  100  is injection molded to substantially its final form (e.g., V-shaped form with the grip  106 ). In some embodiments is contemplated that grip  106  may be riveted, snapped or otherwise fixedly attached to the contact surface  104  and compression elements. Still further, in a different embodiment, the grip  106  is passed through a channel or other opening associated with the compression elements to removably join the grip  106  to the perianal support member  102 . 
     It is contemplated that in other embodiments, the perianal support member  102  and the grip  106  are formed by compression molding, transfer molding, reactive injection molding, extrusion, blow molding, casting, heat-forming, machining, deforming a sheet, bonding, joining or combinations thereof. In other embodiments, suitable materials for the perianal support member  102  and the grip  106  include polymers, metals, ceramics or combinations thereof. The materials can be or include alone or in combination: hard solids, soft solids, tacky solids, viscous fluid, porous material, woven fabric, braided constructions, or non-woven mesh. Examples of polymers include polyethylene, polyester, Nylon, Teflon, polypropylene, polycarbonate, acrylic, PVC, styrene, PEEK, etc. Examples of ceramics include alumina, zirconia, carbon, carbon fibers, graphites, etc. Examples of suitable metals include titanium, stainless steel, cobalt-chrome, etc. 
     It is contemplated that in some embodiments, the perianal support member  102  and grip  106  can be sterilized by known techniques such as ethylene oxide gas, gas plasma, electron-beam radiation or gamma radiation. Such materials are available from various suppliers such as 3M. In a similar manner, the securing members or anchor pads may be formed of hook and loop fastening systems available from 3M. Adhesive fixation systems may be adhesive a Rayon woven tape on a liner (1538L from 3M). The tape may include liners to prevent premature tape adhesion. In one embodiment, for example, the liners include a cut between the midline end of the anchor pad and the lateral end. During initial placement, the system is pushed against the anus with a firsthand. The opposite hand spreads the buttocks away from the device while the first hand pushes the perianal support member to get further compressive penetration in the gluteal cleft. The hands are switched and the steps are repeated on the opposite buttocks. 
     After positioning the system, the liners adjacent the anchor pads are sequentially removed and adhered to the medial portion of the buttocks for provisional positioning of the device. Once the device is provisionally positioned, the first lateral liner is removed and with pressure applied to the device, the lateral tape segment is adhered to the patient in a final supporting position to supply compressive force to the device. This step is repeated on the opposite side for final fixation. 
     The present invention also contemplates a kit that includes one or more of the components described above provided in a package. In one embodiment, the kit includes at least a sterilized labor assistance system. In another aspect, the kit includes a push evaluation system (including securing members and anchor pads) as described above. In still another aspect, the kit includes a childbirth assisting system as described above. In yet another aspect, the kit includes removable grip. In some embodiments, the push evaluation system may be preassembled with the labor assistance system as shown in  FIG.  15    or may be provided unassembled. In the unassembled kit, a health care provider can remove the perianal support member, grip, and push evaluation system from the packaging and assemble the labor assistance system with or without connection to the childbirth assisting system. In still a further embodiment, the kit includes a treating compound to apply to the patient. In one such embodiment, the treating compound is provided in a separate package. In an alternative embodiment, the treating compound is applied to or incorporated into the labor assistance system on the contact surface of the perianal support member. 
     In addition to perianal support during labor, devices and methods disclosed herein provide support to the pelvic floor during an intrapartum period, for example during stage II labor. The pelvic floor, sometimes referred to as the pelvic diaphragm, includes the inferior border of the pelvic cavity defined between the lower opening of the pelvic girdle. The pelvic floor has two openings: the anterior urogenital opening through which the urethra and vagina pass and the posterior rectal opening through which the anal canal passes. The pelvic floor, the sacrum, and the coccyx cooperate to facilitate birth by resisting the downward descent of the presenting part of the baby, and thereby helps the baby to rotate forward to navigate through the pelvic girdle and exit the vaginal opening. 
     According to embodiments of the present disclosure, an intrapartum pelvic floor support device provides support to one or more muscles of the pelvic floor to assist in preventing birth-related traumas to the pelvic floor, such as pelvic floor incompetence or dysfunction (over-stretching of pelvic floor muscles, ligaments and tendons), organ prolapse resulting from the over stretching, and incontinence secondary to pressure and stretching exerted on the bladder and bladder neck. In one aspect, the intrapartum pelvic floor support device or anococcygeal support device is provided to apply pressure to the skin extending from the perianal region to the coccyx that overlies the pelvic floor to thereby push against and support the internal pelvic floor tissues. Support of the anococcygeal region may increase or lengthen the scaffolding provided by the anatomical pelvic tissues (including, for example, the pelvic floor musculature, the sacrum, and the coccyx) by lengthening or increasing the area of counterpressure applied to the presenting part of the baby as it descends in the direction of the posterior rectal hiatus, thereby encouraging the baby to turn in the direction of the anterior urogenital hiatus (i.e., the vaginal opening). Support of the posterior pelvic floor by the devices disclosed herein may also assist in reducing injury to the mother from pelvic floor distension that can result from force applied by the baby during labor. 
       FIG.  25    illustrates a partial cross sectional bottom view and stylized depiction of a patient  10 &#39;s anatomy. In  FIG.  25   , the patient  10  is shown in partial cross section to illustrate a portion of various muscles of the pelvic floor. Muscles of the pelvic floor include the bulbocavernosus muscles  80 , the ischiocavernosus muscles  82  near the vaginal opening  11 , the transverse perineal muscles  84 , the external anal sphincter muscle  86  near the anal orifice  90 , and the levator ani muscle  88 . As illustrated in  FIG.  25   , the muscles of the pelvic floor are deeper within the patient  10  than the skin tissues or, in other words, the skin above the pelvic floor is superficial (or superior with respect to the outside of the body) to the muscles of the pelvic floor listed above. In addition, the muscles of the pelvic floor are superficial (or superior with respect to the outside of the body) to the pelvic bones. Also illustrated in  FIG.  25    are the gluteus maximus muscles  89 . 
       FIGS.  26 A- 31 A  illustrate an intrapartum pelvic floor support device or anococcygeal support device  1000  positioned on a patient  10  according to various embodiments of the present disclosure.  FIG.  26 A  illustrates a bottom view of the exemplary intrapartum anococcygeal support device patient shown in  FIG.  26 A  according to one embodiment of the present disclosure.  FIG.  26 B  illustrates a top view of the exemplary intrapartum anococcygeal support device patient shown in  FIG.  22 A  according to one embodiment of the present disclosure.  FIG.  26 C  illustrates a perspective view of the exemplary intrapartum anococcygeal support device patient shown in  FIG.  22 A  according to one embodiment of the present disclosure.  FIG.  26 D  illustrates a side view of the exemplary intrapartum anococcygeal support device patient shown in  FIG.  22 A  according to one embodiment of the present disclosure. In some instances, the anococcygeal support device  1000  provides a physical or tactile sensation against the patient&#39;s skin that acts as a focal point against which the patient can direct her pushing effort during labor. In some instances, the anococcygeal support device  1000  may, for example by covering the anal orifice  70 , increase the patient&#39;s willingness to push. In some instances, the anococcygeal support device  1000  supports the pelvic floor tissues and acts in concert with the pelvic floor tissues to turn the baby in the correct direction toward the vaginal orifice  11 . 
     As illustrated in  FIG.  26 A , the anococcygeal support device  1000  may be positioned over one or more muscles of the pelvic floor, for example at least a portion of bulbocaervnosus muscles  80 , at least a portion of the ischiocavernosus muscles  82 , at least a portion of the transverse perineal muscles  84 , at least a portion of the external anal sphincter muscle  86 , and at least a portion of the levator ani muscles  88  during labor. As illustrated, the anococcygeal support device  1000  extends over substantially all of the levator ani muscles  88 , the transverse perineal muscles  84 , and the external anal sphincter  86 . 
     In the embodiment shown in  FIGS.  26 A- 26 D , the anococcygeal support device  1000  includes first and second compression elements  1001  and  1002  that extend laterally away from a central compression element  1003 . As shown best in  FIGS.  26 B and  26 C , the central compression element  1003  extends longitudinally along the center of the anococcygeal support device  1000  from an anterior portion to a posterior portion. In some embodiments, the anococcygeal support device  1000  is relatively flexible to conform to the contours of the patient&#39;s anatomy while retaining the rigidity necessary to apply force to the anococcygeal and/or perianal region. 
     In one embodiment, as shown best in  FIG.  26 C , the anococcygeal support device  1000  may be contoured in multiple directions to at least partially anatomically conform to the patient  10 . For example, the central compression element  1003  may be formed to fit in the gluteal cleft  13 . The first compression element  1001  has an inner surface  1004  and an outer surface  1005 . The inner surface  1004  of the anococcygeal support device  1000  is the surface that faces and comes into contact with skin of the buttocks  14  of the patient  10  (and, in embodiments, has an adhesive  1006  to adhere to the skin, as shown in  FIG.  26 C ). The inner surface  1004  is partially concave so that it may receive the buttock  14  in a manner that is anatomically conforming, as illustrated in  FIG.  27   . In the pictured embodiment, the anococcygeal support device  1000  includes ribs  1003   a  that extend from the inner surface  1004  toward the central compression element  1003 . The spines  1003   a  may be shaped as any of a variety of structures that are configured to provide structural support to the central compression element  1003 . The ribs  1003   a  convey a force from the inner surface  1004  to the central compression element  1003 . The adhesive coating  1006  As best shown in  FIG.  26 C , the outer surface  1005  is the surface that faces away from the patient  10  and is convex so that the outer surface  1005  follows the profile established by the concavity of the inner surface. In similar manner, the second compression element  1002  has inner and outer surfaces that conform to a curvature of the buttock  15  toward its crown, such as is illustrated in  FIG.  27   . In some embodiments, as shown in  FIG.  26 C , at least a portion of the inner surface  1004  includes an adhesive coating  1006  that can fix the compression element  1001  to another object. In one embodiment, the adhesive coating  1006  is adapted for releasably adhering to a patient&#39;s skin. In the pictured embodiment, the adhesive coating  1006  is covered by a removable tape  1007  that acts to preserve the tackiness of the adhesive coating  1006  prior to the user removing the tape  1007  and affixing the anococcygeal support device  1000  to another object, including, for example, the skin of the patient. In some embodiments, the adhesive coating  1006  overlies a pad-like structure that may be similar to the anchor pads described above with relation to  FIGS.  2 B and  2 C , for example, The ribs  1003   a  convey a force from portion of the inners surface adjacent the adhesive coating  1006  to the central compression element  1003 .  FIG.  27    illustrates a perspective view of the intrapartum anococcygeal support device  1000  positioned on the patient  10 . The side view in  FIG.  27    looks from the posterior of the patient  10  towards the anterior of the patient  10  that is not visible in  FIG.  27   . As can be seen in  FIG.  27   , the first and second compression elements  1001 ,  1002  of the intrapartum anococcygeal support device  1000  include concave inner surfaces (e.g., inner surface  1004 ) that follow the contour of the buttocks  14 ,  15 . This results in the central compression element  1003  extending into the gluteal cleft  13 . 
     In addition to the contour, the relative rigidity of the intrapartum anococcygeal support device  1000  may vary along different portions of the device. For example, the intrapartum anococcygeal support device  1000  may have increased rigidity in the area of the central compression element  1003 , e.g. focused at an area at and/or near the anal sphincter  86  with flexibility increasing closer to the perineum of the patient  10  and as the first and second compression elements  1001 ,  1002  extend laterally away from the central compression element  1003 . In one example, such as shown in  FIG.  28   , the variation in rigidity is accomplished by thinning the material as it extends from the central compression element  1003  such that the center material is thicker than the lateral material found at the edges of the first and second compression elements  1001 ,  1002 . Further, the configuration of the central compression element  1003  may be designed so as to provide different levels of pressure to the tissue it comes in contact with. In one example, the central compression element  1003  may have a ridge that fits within the gluteal cleft  13  and approximately uniformly comes into contact with the pelvic floor tissue extending from the intrapartum anococcygeal support device  1000 &#39;s anterior portion to its posterior portion. The ridge may have a uniform height to apply uniform pressure along the cleft, or alternatively may have an increase or decrease in height in one or more areas to provide more or less pressure, respectively, at those points. In an alternative embodiment, the central compression element  1003  may have two parallel ridges and a small valley therebetween that runs along the length from the anterior to posterior portions of the patient  10 , for example similar to that illustrated in  FIG.  34 B . 
     There are multiple ways in which the intrapartum anococcygeal support device  1000  may be held in place against the patient  10 . According to an embodiment, a pair of extending securing members  2010  and  2020  may be attached to top surfaces of the first and second compression elements  1001 ,  1002  and configured to assist in holding the intrapartum anococcygeal support device  1000  in pressurized engagement with the tissue superficial to the pelvic floor (e.g., the patient  10 &#39;s skin over the muscles of the pelvic floor) such as in the areas shown in  FIGS.  26 A- 31 A . The securing members may be the first half of a releasable fastening system with adhesive pads  2012  and  2022  attached to the patient, such as a hook and loop system or a releasable adhesive system, similar to the manner described above with relation to  FIGS.  2 B,  2 C,  9 B,  15 ,  22 C,  23 , and  26 B- 26 D . A securing member  2020  may be attached to the first compression element  1001  at a periphery of the first compression element  1001  and be joined to pad  2022 . In a similar manner, the second securing member  2010  may be attached to the second compression element  1002  at a periphery of the second compression element  1002  and be joined to pad  2012 . In some embodiment, the securing members may be elongated, flexible strips of a material. The securing members may extend outwardly and laterally away from the central compression element  1003 . 
     The securing members may be part of a releasable fastening system as described above with respect to other embodiments. In an example, the securing members may be attached to respective anchor pads, for example adhered to skin of patient  10  superficial or superior to the gluteus maximus muscles  89 . Each anchor pad may have a generally square shape that is shorter and wider than the securing members. The anchor pads may take any form that is suitable for fixing to a patient or inanimate object. The anchor pads may include a first adhesive surface adapted for joining to the patient&#39;s skin or some inanimate object. The opposing surface of each anchor pad may include the second half of the releasable fastening system. Instead of using the hook and loop fastener arrangement discussed above, at least a portion of surfaces of the securing members may have an adhesive coating adapted for joining to a fixed object. The securing members may be fixed to an inner surface of the first and second compression elements. At least a portion of a surface of the securing members may include an adhesive coating that can fix the securing member to another object. 
     In one embodiment, the adhesive coating is adapted for releasably adhering to a patient&#39;s skin. In another embodiment, the adhesive is adapted for joining to an inanimate object (e.g., a table or an instrument) or to itself. In this manner, the securing member can fix the position of the intrapartum anococcygeal support device  1000  relative to the operating table or other fixture near the patient  10 . In some embodiments, the securing members are formed of flexible tape. Further, while they have been described separately, in one embodiment, the securing members are formed by a continuous piece of material joined at or near the central compression element  1003 . 
     In an alternative embodiment, the securing members may be attached to one or more raised surfaces at the top surfaces of the first and second compression elements  1001 ,  1002 . The raised surfaces may be, for example, raised pegs that elevate the areas to which the securing members are attached. With the areas raised, the securing members may clear the crowns of the buttocks  14 ,  15  to reach the locations of the anchor pads without interference from the crowns of the buttocks  14 ,  15 . 
     With the intrapartum anococcygeal support device  1000  secured, it is capable of applying support and pressure to one or more tissues of the pelvic floor during the intrapartum period. As illustrated, the intrapartum anococcygeal support device  1000  may provide this support and/or pressure without interfering with the birthing canal or vaginal opening  11 . The contoured inner surfaces of the compression elements  1003 ,  1001 , and  1002  contact the skin overlying the above-identified tissues. In this manner, the intrapartum anococcygeal support device  1000  may non-invasively reduce and/or inhibit pelvic floor trauma. The intrapartum anococcygeal support device  1000  is non-invasive because it is applied to the exterior of the patient  10  and is not implanted into the patient  10 . Moreover, the illustrated embodiments are not inserted into any cavity, such as the anal orifice  90  or the vaginal opening  11 . 
       FIG.  28    illustrates a perspective view of an exemplary intrapartum anococcygeal support device  1000 ′ looking from the anterior portion of the patient  10  towards the posterior portion of the patient  10 .  FIG.  29    illustrates a bottom view of the intrapartum anococcygeal support device  1000 ′ positioned on the patient  10 . For simplicity of discussion, only those aspects of  FIGS.  28  and  29    that vary from the discussion above with respect to  FIGS.  26 A- 27    will be addressed. The support device  1000 ′ is substantially similar to the support device  1000  described above with the exception of the differences described below. The central compression element  1003 ′ has an interior surface  1004 ′. The interior surface  1004 ′ of the central compression element  1003 ′ is partially convex and partially concave (as are the inner surfaces of the first and second compression elements  1001 ′,  1002 ′ to varying degrees) so as to follow the anatomical curvature along the patient  10 &#39;s midline axis in the sagittal plane as the device  1000 ′ extends from the base of the vaginal opening  11  toward the anal orifice  90  (not shown in  FIG.  27   ), curving upward beyond the anal orifice  90  in the posterior direction, e.g. curving upward toward the patient  10 &#39;s coccyx (not shown in  FIG.  27   ). 
       FIGS.  28  and  29    illustrate the intrapartum pelvic floor support device  1000  according to an alternative embodiment. The intrapartum anococcygeal support device  1000 ′ in  FIG.  28    further includes a gap  1008  that extends along a portion of the central compression element  1003 . As shown, in the pictured embodiment, the gap  1008  is rectangular in shape. Above the gap  1008 , an anterior portion  1009  of the intrapartum anococcygeal support device  1000 ′ extends between or bridges between the first and second compression elements  1001 ′,  1002 ′. The gap  1008  may allow for defecation or other desired access to the perianal region during the intrapartum period. As such, although depicted as rectangular in shape in the embodiment shown in  FIG.  28   , the gap  1008  may alternatively be of any shape that is sufficient to expose the perianal region while still otherwise generally maintaining pelvic floor support as discussed above. 
     According to embodiments of the present disclosure, the intrapartum anococcygeal support device  1000  may be used in cooperation with other devices, such as the perianal support member  102 . The gap  1008  may be sized and shaped specifically so that it may receive the perianal support member  102 , for example as illustrated in  FIG.  31 A . As shown, an external pressure surface or contact surface  104  of the perianal support member  102  fits within the gap  1008 , for example with sufficient precision that there is only a small distance between the inside walls of the gap  1008  and the surfaces of the perianal support member  102  so as to avoid pinching of patient tissue. Edges of the inside walls of the gap  1008  may have a radius shape to further avoid pinching. The perianal support member  102  may utilize its own securing members according to one or more of the examples described above. Alternatively, the intrapartum anococcygeal support device  1000  may not include any securing members and instead rely upon the perianal support member  102  utilizing its own securing members to thereby keep the intrapartum anococcygeal support device  1000  in place as well. 
       FIG.  30    illustrates the intrapartum anococcygeal support device  1000  according to an alternative embodiment to that discussed above with respect to  FIGS.  28  and  29   . In the pictured embodiment, the intrapartum anococcygeal support device  1000 ″ is substantially similar to the anococcygeal support member  1000 ′ described above, except for the following differences. In  FIG.  30   , instead of a gap  1008 , the intrapartum anococcygeal support device  1000 ″ includes a recess  1008 ′. The recess  1008 ′ interrupts the first and second compression elements  1001 ″,  1002 ″ from connecting each other in an anterior portion of the intrapartum anococcygeal support device  1000  (e.g., near the vaginal opening  11 ). 
     In some embodiments, the intrapartum anococcygeal support device  1000  of  FIG.  26 A  may be used alone, without cooperation with a perianal support member  102 . In alternative embodiments, the recess  1008  of the intrapartum anococcygeal support device  1000 ′ may be sized and shaped so that it may receive the perianal support member  102 , for example so that a posterior end of the perianal support member  102  is adjacent to and in contact with a posterior end of the recess  1008 . In an embodiment, the posterior end of the recess  1008 ′ may include one or more locking mechanisms according to one or more of the examples given below with respect to  FIG.  28    that couple the intrapartum anococcygeal support device  1000 ′ and the perianal support member  102  together while applied to the patient  10 . 
     In some embodiments, the perianal support member  102  may be held in place with respect to the intrapartum anococcygeal support device  1000  by reliance on one or more securing members alone. Alternatively, as shown in  FIG.  31 A , the intrapartum anococcygeal support device  1000  may include one or more locking mechanisms  1010  that are designed to lock the perianal support member  102  into place when applied into the gap  1008 . 
       FIG.  31 B  illustrates the exemplary locking mechanism  1010  shown in  FIG.  31 A  in closer detail according to one embodiment of the present disclosure. In  FIG.  31 B , a female member  1011  may include a blocking member  1011   a  and a tab  1011   b . In an embodiment, the female member  1011  may be integrated or attached with a surface of the intrapartum anococcygeal support device  1000  near the gap  1008 . A male member  1011   c  attached to the perianal support member  102  may include a finger  1011   d  that, when inserted into the female member  1011 , will be caught at the blocking member  1011   a  to operatively couple the perianal support member  102  and the intrapartum anococcygeal support device  1000  together. As will be recognized, in other embodiments, the female locking member  1011  may alternatively be included with the perianal support member  102  and the male member  1005  with the intrapartum anococcygeal support device  1000 . Exemplary locking mechanisms such as that illustrated in  FIG.  31 B  are further discussed in U.S. Pat. Nos. 4,946,404 and 5,577,779, both of which are incorporated by reference herein in their entireties. 
     In another alternative embodiment, the intrapartum anococcygeal support device  1000  may include a first part of a ratchet locking mechanism and the perianal support member  102  may include a second part of the ratchet locking mechanism. For example, the intrapartum anococcygeal support device  1000  may include a finger that engages teeth in one direction, and the perianal support member  102  a corresponding gear or rack that has teeth to engage the finger. The finger may be spring loaded so that the position of the perianal support member  102  may be shifted to increase or decrease pressure applied by the perianal support member  102  as compared to the intrapartum anococcygeal support device  1000 . 
       FIG.  32 A  illustrates an intrapartum pelvic floor or anococcygeal support device  1012  positioned on a patient  10  according to an embodiment of the present disclosure. The intrapartum pelvic floor support device  1012  includes first and second compression elements  1013 ,  1015  that extend laterally from a midline  1014 . The first and second compression elements  1013 ,  1015  have smaller lateral extensions from the midline  1014  at the anterior portion of the intrapartum pelvic floor support device  1012  than at the posterior portion of the device  1012 , which becomes larger towards the posterior of the patient  10 . As a result, the intrapartum pelvic floor support device  1012  may engage the tissue superficial or superior to the levator ani muscles  88  of the pelvic floor. This may be beneficial because the levator ani muscles  88  often endure trauma during vaginal childbirth, and the counterpressure applied by the intrapartum pelvic floor support device  1012  during delivery may help to minimize such trauma by, for example, resisting tissue distention and tearing. 
     In some embodiments, the intrapartum pelvic floor support device  1012  is contoured in lateral and posterior directions from the midline  1014 . For example,  FIG.  32 B  illustrates a partial perspective view of the intrapartum pelvic floor support device  1012 . As illustrated in  FIG.  32 B , the first compression element  1013  has a concave inner surface  1013 A as the first compression element  1013  extends laterally away from the gluteal cleft  13  that enables a contour of buttock  15  to fit within it. The second compression element  1015  has a concave inner surface  1015 A as the second compression element  1015  extends laterally away from the gluteal cleft  13  that enables a contour of buttock  14  to fit within it. 
     As further illustrated in  FIG.  32 C , which illustrates a side view of the intrapartum pelvic floor support device  1012 , the intrapartum pelvic floor support device  1012  may curve in the posterior direction upward toward the coccyx. This is illustrated by the (concave) curved surface  1017  in  FIG.  32 C . As illustrated in  FIG.  32 C , the narrower side (the left side in the pictured embodiment) of the intrapartum pelvic floor support device  1012  is located near the vaginal opening  11  while the wider side (the right side in the pictured embodiment) is located near the coccyx of the patient  10 . 
     In an embodiment, the midline  1014  may be a ridge that fits within the gluteal cleft  13  and approximately uniformly comes into contact with the pelvic floor tissue extending from the intrapartum pelvic floor support device  1012 &#39;s anterior portion to its posterior portion. This ridge may have a uniform height configured to apply uniform pressure along the cleft. In an alternative embodiment, the midline  1014  may have a void or recess  1016  at or near the anal orifice  90 , as shown in  FIGS.  32 A- 32 C , in order to prevent or reduce the pressure applied to the perianal tissue at or near the anal orifice  90 . As a result, less pressure may be applied to the tissues at the anal orifice  90  than other contact areas of the pelvic floor. In another alternative embodiment, the midline  1014  may be convex at or near the anal orifice  90  in order to provide increased pressure to tissues at or near the anal orifice  90 . As a result, greater pressure may be applied to the tissue at the anal orifice  90  than other contact areas of the pelvic floor. In another alternative embodiment, the midline  1014  may have two parallel ridges and a small valley therebetween that runs along the length from the anterior to posterior portions of the patient  10 , for example similar to that illustrated in  FIG.  34 B  as discussed in more detail below. 
     In some embodiments, the intrapartum pelvic floor support device  1012  may be held in place against the patient  10  according to one or more of the embodiments discussed above with respect to the device of  FIG.  26 A . 
       FIG.  33    illustrates an intrapartum pelvic floor or anococcygeal support device  1018  according to an embodiment of the present disclosure. The intrapartum pelvic floor support device  1018  includes first and second compression elements  1020  and  1022 , as well as a midline  1021 . The first compression elements  1020 ,  1022  may each have a concave inner surface to allow a buttock&#39;s contour to fit within it at least partially. As illustrated in  FIG.  33   , a posterior portion  1024  of the intrapartum pelvic floor support device  1018  is curved upward to follow the contour of the gluteal cleft  13  of a patient  10 , and represents the portion of the intrapartum pelvic floor support device  1018  which would be placed at the posterior of the patient  10  toward the coccyx. This curvature may be similar in principle to that discussed above with respect to  FIG.  32 C  and the curved surface  1017 . The anterior portion  1026  follows the contour of the gluteal cleft  13  and extends toward the vaginal opening  11 . The intrapartum pelvic floor support device  1018  provides pelvic floor support by medially compressing tissue that it comes in contact with. 
     The intrapartum pelvic floor support device  1018  may be held in place against a patient  10  according to one or more of the embodiments discussed above with respect to the device of  FIG.  26 A . The intrapartum pelvic floor support device  1018  may be preformed, for example by an injection molding process, according to a pre-defined contour. The pre-defined contour may represent a composite profile of different body types, for example. Alternatively, the intrapartum pelvic floor support device  1018  may have one of multiple pre-defined contours, each of which providing a different contour resulting in more or less pressure at particular areas of the intrapartum pelvic floor support device  1018  than the other contours. 
       FIG.  34 A  illustrates an intrapartum pelvic floor support device  1028  according to an embodiment of the present disclosure. The intrapartum pelvic floor support device  1028  includes first and second compression elements  1030 ,  1032  and central compression element  1034 . The intrapartum pelvic floor support device  1028  has a shape analogous to the perianal support member  102 , but differs in that the intrapartum pelvic floor support device  1028  has a different width to height ratio. For example, the central compression element  1034  is significantly wider (e.g., defined along the frontal plane, transverse to the sagittal plane) than the perianal support member  102 &#39;s contact surface  104 . In an embodiment, the central compression element  1034  has a width sufficiently wide to laterally engage tissue superficial to at least a portion of the transverse perineal muscles  84  of a patient  10  when applied. 
     The central compression element  1034  may be contoured to follow the curve of the gluteal cleft  13  of a patient  10 , for example curving upward toward the coccyx at a posterior end of the intrapartum pelvic floor support device  1028  (e.g., an end of the device that is situated at a proximal end of a patient  10 ). In an embodiment, the intrapartum pelvic floor support device  1028  may also include a flare at an anterior portion (e.g., an end of the device that is situated at an anterior end of a patient  10 ). This flare may be v-shaped so as to extend towards opposite sides of a vaginal opening  11  of a patient  10 . By flaring towards opposite sides of the vaginal opening  11 , the intrapartum pelvic floor support device  1028  may additionally provide pelvic floor support to at least a portion of the ischiocavernosus muscles  82 . 
     The intrapartum pelvic floor support device  1028  may be held in place against the patient  10  according to one or more of the embodiments discussed above with respect to the device of  FIG.  26 A , as well as discussed above with respect to  FIGS.  1 - 3   . 
       FIG.  34 B  illustrates an alternative embodiment of the intrapartum pelvic floor support device  1028 . As illustrated in  FIG.  34 B , instead of a relatively flat surface as in  FIG.  34 A , the central compression element  1034  has a concave inner surface, described elsewhere as a small valley, resulting in two ridges that may engage tissue superficial or superior to lateral muscles of the pelvic floor, such as the levator ani muscles  88 , the transverse perineal muscles  84 , and the ischiocavernosus muscles  82  to name a few examples. 
       FIG.  34 C  illustrates an alternative embodiment of the intrapartum pelvic floor support device  1028 . In  FIG.  34 C , the lateral width of the central compression element  1034  varies along the length of the intrapartum pelvic floor support device  1028 , resembling a dumbbell shape as an example. For example, the anterior portion of the intrapartum pelvic floor support device  1028  that is placed near the vaginal opening  11  (the portion of the device in  FIG.  34 C  facing the top of the page) may have a first width that is relatively large in order to support the pelvic floor muscles in that region. As the central compression element  1034  continues down along midline axis of the patient  10 , a middle portion of the intrapartum pelvic floor support device  1028  may have a second width that is relatively small in order to support the pelvic floor muscles in the region while allowing for the anatomical contours of the region at and posterior to the anal orifice  90 , which cause the gluteal cleft  13  to be narrower in that region. The posterior portion of the intrapartum pelvic floor support device  1028 , which is placed posterior to the anal orifice  90 , may resume a width that is larger than the second width. In an embodiment, the posterior portion may have the first width as well, or alternatively may have a smaller or larger width than the first width while still remaining greater than the second width. 
       FIG.  34 D  illustrates an alternative embodiment of the intrapartum pelvic floor support device  1028 . In  FIG.  34 D , the lateral width of the central compression element  1034  varies along the length of the intrapartum pelvic floor support device  1028 , resembling a V-shape as an example. For example, the anterior portion of the intrapartum pelvic floor support device  1028  that is placed near the vaginal opening  11  (the portion of the device in  FIG.  34 D  facing the top of the page) may have a first width that is relatively large in order to support the pelvic floor muscles in that region. As the central compression element  1034  continues down along midline axis of the patient  10 , the width of the central compression element  1034  gradually decreases towards a common point at the posterior portion of the device. As a result, a width of the anterior portion of the central compression element  1034  is greater than a width of the posterior portion of the central compression element  1034 . 
       FIG.  35    illustrates an intrapartum pelvic floor support device  1036  positioned on a patient  10  according to an embodiment of the present disclosure. The intrapartum pelvic floor support device  1036  includes anchor pads  1038 ,  1040  on lateral sides of buttocks  14 ,  15  respectively, for example near the crowns of the buttocks  14 ,  15  on skin superficial or superior to the gluteus maximus muscles  89 . The anchor pads  1038 ,  1040  may be attached to the skin of the patient  10  by way of an adhesive, as discussed with respect to other embodiments above. For example, the adhesive may be a skin-friendly, rubber based adhesive. 
     The intrapartum pelvic floor support device  1036  also includes a tissue retention strap  1042  that is releasably connected laterally to each anchor pad  1038 ,  1040 . The tissue retention strap  1042  may be constructed of a flexible material. Further, the tissue retention strap  1042  may be formed of inner and outer portions, where the outer portion is formed of a polyurethane material and the inner portion is formed of a nylon material. The tissue retention strap  1042  may have sufficient elasticity that it stretches before the anchor pads  1038 ,  1040  begin detaching from the patient  10 &#39;s skin at the buttocks  14 ,  15 . As shown, the tissue retention strap  1042  extends laterally from buttock  14  to buttock  15 . In an embodiment, the tissue retention strap  1042  extends laterally between the buttocks  14 ,  15  over the anal orifice  90 , while still allowing access to the vaginal opening  11 . The length of the tissue retention strap  1042  is sufficient to extend from the anchor pad  1038  to the anchor pad  1040 , while a width of the tissue retention strap  1042  is less than the length. In an alternative embodiment, the tissue retention strap  1042 , anchor pad  1038 , and anchor pad  1040  may be integrally formed together, for example from the same material. The intrapartum pelvic floor support device  1036  may have a shape as illustrated in  FIG.  35   , or alternatively may have a dumbbell shape such as illustrated in  FIG.  34 C  with the narrow portion extending over the pelvic floor region and the wide portions serving as the anchor pads. In this alternative embodiment, the intrapartum pelvic floor support device  1036  may be applied to patient  10  by adhering one anchor region (e.g., corresponding to where anchor pad  1038  was) to a lateral side of a buttock, e.g. buttock  14 , pulling the strap portion of the intrapartum pelvic floor support device  1036  toward the other buttock&#39;s lateral side to a desired tautness while also pressing the tissue of the buttock  15  toward the buttock  14 , and adhering the second anchor region to a lateral side of the second buttock  15 . 
     In place, the tissue retention strap  1042  is connected to each of the anchor pads  1038 ,  1040  with sufficient tension that it pulls the buttocks  14 ,  15  toward each other. The tissue retention strap  1042  may be connected to the anchor pads  1040 ,  1042  with adhesive, hook and loop system, or other type of fastener. The pulling of the buttocks  14 ,  15  toward each other results in compression of the pelvic floor muscles and prevention of movement therefrom, providing pelvic floor support. 
       FIG.  36    illustrates an intrapartum pelvic floor support device  1044  positioned on a patient  10  according to an embodiment of the present disclosure. In an embodiment, the intrapartum pelvic floor support device  1044  is a variant of the intrapartum pelvic floor support device  1036  discussed above with respect to  FIG.  35    and operates to similar results. The intrapartum pelvic floor support device  1044  includes anchor pads  1046 ,  1048  and curved component  1050 . The curved component  1050  is connected to the anchor pad  1046  by way of tissue retention strap  1045  and to the anchor pad  1048  by way of tissue retention strap  1047 . The curved component  1050  has an arcuate shape that curves away from the vaginal opening  11  (e.g., a boomerang shape with ends pointing up toward the anterior of the patient  10  and a central portion extending down toward the posterior of the patient  10 ). The arcuate shape of the curved component  1050  provides greater access to the pelvic area of the patient  10  during childbirth. Although illustrated as extending posterior to the anal orifice  90 , the curved component  1050  may be located across different regions over the pelvic floor area that leaves the central portion posterior to the vaginal opening  11 , for example such that the central portion extends over the anal orifice  90 . 
     In an embodiment, the curved component  1050  is composed of a relatively solid component, such as a type of plastic or metal. The tissue retention straps  1045 ,  1047  may be composed of one or more materials as discussed above with respect to the tissue retention strap  1042  of  FIG.  35    above. The intrapartum pelvic floor support device  1044  provides pelvic floor support by pulling the buttocks  14 ,  15  together to compress tissues of the pelvic floor. For example, proximal ends of the tissue retention straps  1045 ,  1047  (e.g., proximal to the midline of the patient  10 ) may be releasably or permanently connected to lateral ends of the curved component  1050  as illustrated in  FIG.  36   . The distal ends of the tissue retention straps  1045 ,  1047  may be pulled to a desired tightness and releasably connected to the respective anchor pads  1046 ,  1048 . The amount of pressure applied to tissues of the pelvic floor may be varied based upon the level of tightness achieved by placement of one or both of the tissue retention straps  1045 ,  1047 . 
     In an alternative embodiment not shown in  FIG.  36   , the curved component  1050  and tissue retention straps  1045 ,  1047  may be replaced by a single tissue retention strap that has a laterally pre-contoured shape that also results in an arcuate shape to provide increased access to the pelvic area. In such an embodiment, the single tissue retention strap may be composed of a material with sufficient firmness to retain its arcuate shape in the anterior-posterior direction under stress while still retaining sufficient flexibility in the lateral direction to prevent tearing or breaking of the strap. This may be accomplished, for example, by a plastic mesh with sufficient flexibility in the lateral direction and firmness in the anterior-posterior direction. In another alternative embodiment, the curved component  1050 , tissue retention straps  1045 ,  1047 , anchor pad  1046 , and anchor pad  1048  may be integrally formed together, for example from the same material. In this alternative embodiment, the intrapartum pelvic floor support device  1044  may be applied to patient  10  by adhering one anchor region (e.g., corresponding to where anchor pad  1046  was) to a lateral side of a buttock, e.g. buttock  14 , pulling the strap portion of the intrapartum pelvic floor support device  1044  toward the other buttock&#39;s lateral side to a desired tautness while also pressing the tissue of the buttock  15  toward the buttock  14 , and adhering the second anchor region to a lateral side of the second buttock  15 . 
       FIG.  37 A  illustrates an intrapartum pelvic floor or anococcygeal support device  1052  positioned on a patient  10  according to an embodiment of the present disclosure. The intrapartum pelvic floor support device  1052  includes a contoured support  1054  and straps  1056 ,  1058 . In an embodiment, the contoured support  1054  is an inflatable contoured support, for example using some form of fluid such as air or liquid as the inflation medium. Where the contoured support  1054  is inflatable, it may be partially inflatable (e.g., a portion of the contoured support  1054  comes pre-inflated or is composed of a more solid material around which the rest of the contoured support  1054  is inflated) or substantially fully inflatable (e.g., the contoured support  1054  has substantially no fluid within it prior to first use). The contoured support  1054  may be contoured to the general shape of the buttocks  14 ,  15  as well as the gluteal cleft  13  therebetween at a posterior area of the patient  10 . 
     In the pictured embodiment, the contoured support  1054  is held in place against the patient  10  by way of the straps  1056 ,  1058 , which are placed laterally to the crowns of the buttocks  14 ,  15 . The contoured support  1054  may be connected to the straps  1056 ,  1058  with an adhesive or hook and loop system, as described with respect to other embodiments above. Alternatively, the straps  1056 ,  1058  may be releasably inserted through slots in the contoured support  1054 . As another alternative, the straps  1054 ,  1056  may be permanently connected to the contoured support  1054 , e.g., formed with the contoured support  1054 . As will be recognized, where adhesives are used, the straps  1056 ,  1058  may alternatively be anchor pads as described in other previous embodiments. Each of straps  1056 ,  1058  may be releasably connectable. For example, each strap  1056 ,  1058  may have a hook and loop system that enables the circumferential size of the straps to be larger or smaller while closed to accommodate varying leg sizes. In an alternative embodiment, the straps  1056 ,  1058  may use a buckle to be adaptively sized to the particular size of a given patient  10 . In another alternative embodiment, the straps  1056 ,  1058  may use a ratchet-type system with a spring-loaded finger on a receiving end of the straps and corresponding teeth on an inserting end of the straps so that the straps may adaptively sized to the given size of a given patient  10 . The straps  1056 ,  1058  may be attached to the patient  10  at the thighs of the patient  10 , for example close to the pelvic region as illustrated in  FIG.  37 A . 
     After application to a patient  10 , the intrapartum pelvic floor support device  1052  may be inflated as much as desired to provide pelvic floor support. The intrapartum pelvic floor support device  1052  provides pelvic floor and/or anococcygeal support by cradling the buttocks  14 ,  15  and laterally compressing the tissue between the buttocks, including the pelvic floor muscles, together. The compression may prevent one or more pelvic floor muscles from trauma such as may result from overstretching, tissue distension, or other strain during childbirth. After the initial placement and inflation on the patient  10 , the contoured support  1054  may be further inflated or deflated to increase or decrease, respectively, the amount of compression on one or more tissues associated with the pelvic floor. 
       FIGS.  37 B and  37 C  illustrate alternative embodiments of the intrapartum pelvic floor support device  1052 . As illustrated in  FIG.  37 B , instead of the contoured support  1054  extending across only a posterior portion or outer buttock region of the patient  10 , the contoured support  1054 ′ of the intrapartum pelvic floor support device  1052 ′ also includes a support structure  1053  that extends from the lateral flanks  18 ,  19  inward toward the gluteal cleft  13 , covering the anal orifice  90  and tissues superior to the pelvic floor (e.g., the skin overlying the pelvic floor). The support structure  1053  may also be inflatable according to one or more of the embodiments discussed above with respect to  FIG.  37 A . The inner surface of the support structure  1053  may be concave to approximately follow the contour of the buttocks  14 ,  15 , and the gluteal cleft  13 . The material of the support structure  1053  may be pre-formed with the concave structure. In addition or in the alternative, the inner material may also be more flexible than the outer material of the contoured support  1054  such that, when inflated, the material of the inner surface of the support structure  1053  may adapt in shape to accommodate the contours of the buttocks  14 ,  15 , and the gluteal cleft. 
       FIGS.  37 C- 37 E  illustrate another alternative embodiment to that of  FIGS.  37 A and  37 B .  FIG.  37 C  illustrates a bottom view of an intrapartum pelvic floor support device  1053 ″,  FIG.  37 D  illustrates a perspective view of an intrapartum pelvic floor support device  1053 ″, and  FIG.  37 E  illustrates a side view of an intrapartum pelvic floor support device  1053 ″. As illustrated in  37 C, the intrapartum pelvic floor support device  1052 ″ includes a support structure  1053 ″. Unlike the support structure  1053  depicted in  FIG.  37 B , however, the support structure  1053 ″ includes a recess  1055  that exposes the anal orifice  90 . 
       FIG.  38    illustrates an intrapartum pelvic floor support device  1060  positioned on a patient  10  according to an embodiment of the present disclosure. The intrapartum pelvic floor support device  1060  includes a support base  1061  and lateral supports  1062 ,  1064 . In an embodiment, the lateral supports  1062 ,  1064  are physically joined to the support base  1061 , for example by way of one or more connectors or adhesive. In another embodiment, the lateral supports  1062 ,  1064  are formed with the support base  1061  together, for example by injection molding. The intrapartum pelvic floor support device  1060  may be placed at a posterior region of the patient  10 , as shown in  FIG.  38   , for example near the coccyx. 
     The support base  1061  may be composed of a polymer, a metal, or other firm material capable of providing an opposing lateral force to that exerted on the lateral supports  1062 ,  1064  when applied during the intrapartum period. The intrapartum pelvic floor support device  1060  may be attached to a patient bed for additional lateral support. Alternatively, the intrapartum pelvic floor support device  1060  may be incorporated into a platform that the patient  10  lies on, such as on a bed or some other underlying support. In another alternative embodiment, the intrapartum pelvic floor support device  1060  may be made to resemble a pillow that the patient  10  lies on. 
     The lateral supports  1062 ,  1064  may be releasably connected to the support base  1061  in order to enable repositioning of the intrapartum pelvic floor support device  1060  to provide more or less support to the patient  10 &#39;s pelvic floor as desired. As one example, the lateral supports  1062 ,  1064  may be attached to a track that is placed within a groove in the surface of the support base  1061  that faces/contacts the patient  10 . The lateral supports  1062 ,  1064  may be able to slide along this track in a reciprocal fashion, e.g. applying sliding pressure to the lateral support  1062  to move it laterally towards the gluteal cleft  13  of the patient  10  causes a corresponding lateral move of the lateral support  1064  close to the gluteal cleft  13 , and vice versa. In this embodiment, once the lateral supports  1062 ,  1064  have been moved to a desired position, they may be locked by any suitable locking mechanism as will be recognized by those skilled in the relevant art(s). As another example, the support base  1061  may include a plurality of holes or pegs spaced along its upper surface. Each of the lateral supports  1062 ,  1064  may have corresponding pegs or holes, respectively, to releasably join with the support base  1061  at different lengths from one another. 
     The support base  1061  operates together with the lateral supports  1062 ,  1064  in order to provide pressure laterally to the buttocks  14 ,  15 , for example at locations extending from near the crowns of the buttocks  14 ,  15  toward the flanks  18 ,  19 . In an embodiment, the lateral supports  1062 ,  1064  may extend from the crowns of the patient  10 &#39;s hips where the reference numbers  18  and  19  point to near the crowns of the buttocks  14 ,  15 . The lateral supports  1062 ,  1064  may alternatively extend from near the crowns of the buttocks  14 ,  15  toward a location midway between the patient  10 &#39;s crowns of the hips. This applies lateral pressure to compress the buttocks  14 ,  15  together, resulting in pressure being applied to one or more tissues of the pelvic floor, thereby supporting the pelvic floor during the intrapartum period. 
       FIG.  39    illustrates an intrapartum pelvic floor support device  1066  positioned on a patient  10  according to an embodiment of the present disclosure. The intrapartum pelvic floor support device  1066  includes a support device  1068 , anchor pads  1069 ,  1070 , and retention straps  1072 ,  1074 . The support device  1068  may be connected to the anchor pads  1069 ,  1070  via the retention straps  1072 ,  1074  respectively. The anchor pads  1069 ,  1070  may be attached to the skin of the patient  10  laterally near the crowns of the buttocks  14 ,  15  by way of an adhesive, such as discussed with respect to other embodiments above. For example, the adhesive may be a skin-friendly, rubber based adhesive. The retention straps  1072 ,  1074  may connect with one or both of the support device  1068  and the anchor pads  1069 ,  1070  with an adhesive or hook and loop system, as described with respect to other embodiments above to name just a few examples. Where the retention straps  1072 ,  1074  connect with just one of either the anchor pads or the support device, the retention straps may be formed with the other. For example, in an embodiment the retention straps  1072 ,  1074  may be formed as part of the anchor pads  1069 ,  1070  as regions not adhered to the skin of the patient  10 . In such an embodiment, the retention straps  1072 ,  1074  are releasably connected with the support device  1068  while being an integral part of the anchor pads  1069 ,  1070 . In another alternative embodiment, the support device  1068 , retention straps  1072 ,  1074 , anchor pad  1069 , and anchor pad  1070  may be integrally formed together, for example from the same material. In this alternative embodiment, the intrapartum pelvic floor support device  1066  may be applied to patient  10  by adhering one anchor region (e.g., corresponding to where anchor pad  1069  was) to a lateral side of a buttock, e.g. buttock  14 , pulling the support device  1068  of the intrapartum pelvic floor support device  1066  toward the other buttock&#39;s lateral side to a desired tautness while also pressing the tissue of the buttock  15  toward the buttock  14 , and adhering the second anchor region to a lateral side of the second buttock  15 . 
     The support device  1068  may be contoured to the anatomy of the patient  10 . For example, the central portion of the support device  1068  may contour to the gluteal cleft  13  of the patient  10  and include concave inner surfaces extending out laterally in order to receive the buttocks  14 ,  15  and generally fit their contour. The support device  1068  may extend out in the anterior direction as well, with side edges of the support device  1068  extending beyond the beginning of the vaginal opening  11  while the central portion of the support device  1068  extends in the anterior direction to stop before the vaginal opening  11 , thereby covering at least a portion of the perineum as illustrated in  FIG.  39   . In an embodiment, the support device  1068  may have varying levels of rigidity throughout the device. For example, the central portion of the support device  1068  may be rigid and become less rigid as the support device  1068  extends out laterally from the central portion. This may result in the lateral components of the support device  1068  being more complaint to contour to the shape of the patient  10 &#39;s buttocks  14 ,  15  when applied to the patient  10 . For example, the support device  1068  may have increased rigidity at the central portion, e.g. focused at an area at and/or near the anal sphincter  86  with increased flexibility closer to the perineum of the patient  10  and as the support device  1068  extends laterally away from the central portion. 
     Further, the configuration of the central portion may be designed so as to provide different levels of pressure to the tissue it comes in contact with. In one example, the central portion of the support device  1068  may have a ridge that fits within the gluteal cleft  13  and approximately uniformly comes into contact with the pelvic floor tissue extending from the support device  1068 &#39;s anterior portion to its posterior portion. The ridge may have a uniform height to apply uniform pressure along the cleft, or alternatively may have an increase or decrease in height in one or more areas to provide more or less pressure, respectively, at those points. In an alternative embodiment, the central portion may have two parallel ridges and a small valley therebetween that runs along the length from the anterior to posterior portions of the patient  10 , such as discussed above with respect to  FIG.  34 B . 
     In an alternative embodiment, the lateral components of the support device  1068 , and/or the placement/size of the anchor pads  1069 ,  1070  are large enough that lateral edges of the support device  1068  may releasably attach directly to the anchor pads  1069 ,  1070 . In this embodiment, there is little need for the retention straps  1072 ,  1074  and may be omitted. The lateral edges may releasably attach using a hook and loop system or adhesive, to name some examples. 
     In place, the support device  1068  may cover several muscles of the pelvic floor, for example at least a portion of the bulbocaervnosus muscles  80 , at least a portion of the ischiocavernosus muscles  82 , the transverse perineal muscles  84 , the external anal sphincter muscle  86 , and the levator ani muscle  88 , thereby providing pelvic floor support. As illustrated, the intrapartum pelvic floor support device  1066  may provide this support and/or pressure without interfering with the birthing canal or vaginal opening  11 . In this manner, the intrapartum pelvic floor support device  1066  may non-invasively reduce and/or inhibit pelvic floor trauma. 
       FIGS.  40  and  41    illustrate an intrapartum pelvic floor support device  1076  according to an embodiment of the present disclosure. The intrapartum pelvic floor support device  1076  includes thin sheet  1078 , anterior mesh  1080 , optional hole  1082 , lateral support meshes  1084  and  1086 , and central support mesh  1088 . The thin sheet  1078  may be a thin film of plastic that is flexible enough to conform to the anatomy of the patient  10 . In an embodiment, the thin sheet  1078  may be composed of a medical grade plastic. The thin sheet  1078  may have adhesive throughout its top side in order to adhere to the skin of the patient  10 . The thin sheet  1078  may extend from an anterior portion  1090  that reaches the perineum area adjacent to the vaginal opening  11  in a posterior direction to the posterior portion  1091  that may curve around the coccyx and extend upward the back of the patient  10 , for example near or at the S 3  or S 4  vertebrae. Further, the thin film  1078  extends between lateral support meshes  1086  and  1084 . 
     The intrapartum pelvic floor support device  1076 &#39;s anterior mesh  1080  is sized and shaped so as to cover and support the pelvic floor of the patient  10 . As shown in  FIGS.  40  and  41   , the anterior mesh  1080  covers the tissues of the perineum and extends in the posterior direction over the anus and onward, curving upward with the curve of the gluteal cleft  13 . The anterior mesh  1080  may include, for example, an interwoven network of fibers or rods that are flexible in one direction but more rigid in another. The anterior mesh  1080  is connected to the lateral support meshes  1084 ,  1086  as well as the central support mesh  1088 . The anterior mesh  1080  transfers the load applied to it from the tissues of the pelvic floor to the lateral support meshes  1084 ,  1086  and the central support mesh  1088 . In an embodiment, the anterior mesh  1080 , lateral support meshes  1084 ,  1086  and central support mesh  1088  are thicker than the thin sheet  1078  in order to provide support to the pelvic floor. In an embodiment, the stiffness of the anterior mesh  1080  may be three to four times stiffer than that of the lateral support meshes  1084 ,  1086  and the central support mesh  1088 . As shown in  FIGS.  40 - 41   , the anterior support mesh  1080  may have an optional hole  1082  that lies generally over the region of the anal orifice  90 . The optional hole  1082  may be, for example, a section of the anterior support mesh  1080  that has a circular perforation. As a result, if desired the perforated area of the anterior mesh  1080  may be removed before or after the intrapartum pelvic floor support device  1076  has been applied to the patient  10 . 
     Adhesive may have been applied previously to the entirety of the side of the intrapartum pelvic floor support device  1076  that is attached to the patient  10 . Alternatively, adhesive may be applied to the intrapartum pelvic floor support device  1076  or to the patient  10  immediately prior to the intrapartum pelvic floor support device  1076  being temporarily attached to the patient  10 . Where the intrapartum pelvic floor support device  1076  has adhesive previously applied, the intrapartum pelvic floor support device  1076  may include three separate sheets of backing on the side that has the adhesive. In order to apply the intrapartum pelvic floor support device  1076  to the patient  10 , a person may first remove the backing (or apply adhesive in alternative embodiments) and then either have the patient  10  sit on the intrapartum pelvic floor support device  1076  on the exposed adhesive side, or apply to the patient  10  while the patient  10  is in a sitting/squatting/reclined position. This may include manually assisting the portion of the device including the anterior support mesh  1080  and/or the central support mesh  1088  to adequately match the contour of the patient  10 , such as entering the gluteal cleft  13  and following the contour of the buttocks  14 ,  15 . The intrapartum pelvic floor support device  1076  is positioned on the patient  10  so that the anterior mesh  1080  of the anterior portion  1090  is located near the vaginal opening  11  and extending from there in posterior and lateral directions. 
     In an alternative embodiment, instead of the thin sheet  1078  and the meshes  1080 ,  1084 ,  1086 , and  1088 , the intrapartum pelvic floor support device  1076  may be composed of a single device, such as one that has been injection molded. In this embodiment, the intrapartum pelvic floor support device  1076  may include ribbing with a variety of different strengths throughout the surface of the device. For example, there may be ribbing throughout but the ribbing where the anterior support mesh  1080  would otherwise be is thicker and/or otherwise stronger than other regions where the  FIGS.  40 ,  41    do not show any mesh. In another alternative embodiment, the thin sheet  1078  is not included. In this embodiment, the adhesive would be applied to the sides of the meshes  1080 ,  1084 ,  1086 , and  1088  that face and attach to the patient  10 . 
     In an embodiment, the intrapartum pelvic floor support device  1076  may also include one or more sensors designed to detect stretching of the intrapartum pelvic floor support device  1076 . This stretching may be correlated to a condition of one or more muscles of the pelvic floor. Further, the different rods or fibers of the meshes  1080 ,  1084 ,  1086 , and  1088  may be color fibers that change colors based on the level of stretching they undergo. This color change may be correlated to an amount of stretching the underlying muscles have undergone, a level of stress the muscles of the pelvic floor may have experienced, or feedback to indicate whether more or less strain should be applied during childbirth without causing pelvic floor trauma. 
     The foregoing outlines features of several embodiments so that those skilled in the art may better understand the aspects of the present disclosure. Those skilled in the art should appreciate that they may readily use the present disclosure as a basis for designing or modifying other processes and structures for carrying out the same purposes and/or achieving the same advantages of the embodiments introduced herein. Those skilled in the art should also realize that such equivalent constructions do not depart from the spirit and scope of the present disclosure, and that they may make various changes, substitutions and alterations herein without departing from the spirit and scope of the present disclosure. Furthermore, although elements of the described embodiments may be described or claimed in the singular, the plural is contemplated unless limitation to the singular is explicitly stated. Additionally, all or a portion of any aspect and/or embodiment may be utilized with all or a portion of any other aspect and/or embodiment.