I’ve been through childbirth 8 time – and after the first couple of babies, I started looking into how to handle the ring of fire during a natural birth with as little pain as possible! I discovered some techniques that helped me push out babies with far less pain – including a 10lb 10oz baby boy.
Using perineal massage and conditioning during pregnancy can reduce or prevent the “ring of fire” during your baby’s birth. During the birth itself use position changes and breathing to slow pushing down and prevent pain. You should avoid holding your breath and coaching pushing, if possible, because these often make the ring of fire much worse.
Worried about the pain of childbirth? Click here to read my natural pain relief techniques for earlier in labor, too!
What Causes the Ring of Fire During Labor
(Plus How to Deal With It)
Labor is a complex process that doctors and midwives divide into roughly three stages:
The “ring of fire” sensation happens during the crowning portion of the pushing phase of a vaginal birth. At this point your baby is almost born – his or her head is just inside the entrance to the birth canal (the vaginal opening).
The burning, stinging sensation happens because your skin begins to stretch to let the baby’s head out. The area surrounding the birth canal is called your perineum, and this tissue stretches too.
(NOTE: Want 3 Simple Steps for a Smooth, Gentle Pushing Stage? These techniques helped me birth 8 babies (including a 10lb, 10oz baby boy) gently with NO tearing. Get the steps here.)
“Crowning” traditionally meant when the baby’s head applied enough pressure to create an opening the size of an old British crown (coin) – and sometimes stinging sensations start at that point.
Your body continues to open until the skin stretches around your baby’s head like a crown on a queen – this is what most people consider “crowning” today.
This is the point at which many women feel burning and stinging. You may feel another stinging sensation when your baby’s shoulders are born, but then it’s usually over (the placenta doesn’t generally sting or hurt).
Traditionally, an episiotomy is done because the skin is so stretched that a woman cannot feel the scissors cut the skin.
We know today, however, that an episiotomy is not recommended – and there’s a lot you can do to ease the ring of fire and prevent tears during birth.
It’s Possible to Have NO Ring of Fire!
As with handling transition there are steps to take during pregnancy to prepare for pushing – doing these can mean no ring of fire, like I discovered with some of my births.
Here’s a clip from my 6th baby’s birth – pushing him out was so gentle and painless that nobody else realized he was being born:
Before your baby’s birth you can:
Here are some steps to take during pushing:
Remember, the ring of fire occurs right before your baby is born – so you are almost there! It may last for a few contractions, but these techniques will help you get through it – and to having your baby in your arms!
(NOTE: Want a Perfect Birth Plan Template? Use this template and step-by-step videos to write a birth plan that gets your birth team on your side for a beautiful birth experience! Get the birth plan kit here.)
3 Strategies to Use Before Labor to Prevent the Ring of Fire
There are three strategies to use during pregnancy to help prevent or lessen the “ring of fire” experience while pushing your baby out. I’ll talk about two in this section and devote a full section to the third.
Let’s start out with two simple strategies that work. I covered these in the post on handling transition during a natural birth, so they’ll feel familiar if you already started on those tips!
Condition Yourself to Relax
First, condition yourself to relax your whole pelvic area. This is my #1 tip and it’s what helped me birth my baby with no pain during pushing (see the video above). Every time you go to the bathroom, practice relaxing your pelvic area.
You can do it with #1, since you’re probably in the bathroom all the time. But also practice with #2 (even if you’re dealing with some pregnancy constipation).
The pressure of your baby coming down feels a lot like needing a bowel movement, so conditioning yourself to relax against that pressure pays off.
Using a Cue Word
I like to use a cue word – “soften” is a good word, or “peace” (“peace” is the cue word I learned in Hypnobabies) Take some time to relax your whole body and slow your breathing, then feel your pelvic tissues soften, too.
You can start by clenching everything down there up – this helps you figure out exactly which muscles to release and keep soft during bathroom trips.
Say your cue word and then work on releasing your muscles from your forehead down, but focus most especially on you pelvic area.
Do this every time you go to the bathroom and your body becomes conditioned to it.
Talk with your birth partner about it, too. You won’t talk much when you’re in the most intense parts of birthing your baby.
Your birth partner should know your cue word and strategies to help you. They can (calmly) remind you of your cue word and encourage you during pushing.
Need more tips for your birth partner? Click here for my podcast episode on getting your birth partner ready to help during labor!
Breathing (the right way) Really is Key for the Ring of Fire
Second, work on breathing. Like with relaxation, conditioning is key here. Practice breathing in through your nose and out through your mouth.
A great tip for practicing to is to hold ice cubes in your hands while you practice. Or, have your partner hold them behind your ear. It is REALLY difficult to keep your body soft and relaxed and keep your breath calm when someone does this!
It’s also a fun way to “practice” keeping calm in a tense situation. This tip is from Pam England’s book Birthing From Within, a classic pregnancy read.
Breathing in through your nose and out through your mouth while keeping your jaw open and relaxed directly affects your pelvic muscles – it helps keep them soft and open, making it easier for your baby to come through.
Practice this breathing anytime you feel winded or short of breath. It’s also good to notice how you breathe when you’re calm and relaxed, stressed or angry, excited, etc.
Awareness of your breath helps you use it when you need to handle the ring of fire during natural birth!
Additional Pregnancy Tips
Evidence also suggests that an excellent pregnancy diet helps reduce perineal trauma – as does having an active sex life during pregnancy (Dieb et al., 2019)!
(NOTE:Want Labor Pain Techniques that REALLY Work? Get these 11 mom-tested techniques for handling contractions from start to finish Get the mom-tested natural labor techniques here.)
The Evidence for Perineal Massage
The perineal tissues are the tissues (skin) surrounding the opening of the birth canal (the vagina). “The perineum” is the area of skin between the opening of the birth canal and the anus, and it’s where the pressure of the baby’s head will center.
All tissues surround the opening of the birth canal stretch for the baby, however, so perineal massage techniques tend to work with the perineum and the skin on the sides of the birth canal.
Evidence suggests that perineal massage makes a difference during birth, especially for first-time moms (Beckmann & Stock, 2013).
Doing it during pregnancy reduces tearing and helps with pelvic healing after birth – it’s something you can start in the third trimester. It can also help reduce the “ring of fire” effect while birthing your baby.
Some mamas feel timid about doing perineal massage because it involves touching the perineum and even just inside the birth canal. This can feel really intense, and even scary for women who may have a history of abuse.
Recent research in Japan showed that understanding perineal massage and having the encouragement of a midwife or childbirth educator can help women overcome shyness and use perineal massage (TAKEUCHI & HORIUCHI, 2014).
If you are a survivor of sexual abuse, talk to your doctor or midwife about getting support to prepare for birth – it can make a huge difference to have that support during a natural birth experience.
Based on research, 1-2 times a week is optimal for perineal massage.
How to do Perineal Massage
This handout from the NHS gives detailed, step-by-step instructions for perineal massage. This brochure from the Auckland District Health Board has color illustrations that may be helpful.
I used Birthing Better’s form of perineal massage – called the “Internal Work” to help prepare for my babies. Birthing Better has an mp3 track that guides you through the Internal Work, which was much easier for me to use than trying to use a handout!
The Internal Work is part of the collection of techniques to make labor and delivery smoother – for me they really paid off, as you saw in the video of Corwin’s birth above! Click here to read about the Internal work and cue words helped during Corwin’s birth.
The Pros and Cons of Perineal Support
Many midwives (or your delivery nurse) use perineal support of some type. They either put their hands or warm compresses over the skin of the perineum to provide support as the baby’s head is crowning and being born.
The evidence on these techniques is mixed. There appears to be some evidence that perineal warm packs reduce more severe tears of level 3 and 4 (the different degrees are on a scale of 1 to 4, with 4 being the most severe tear) (Aasheim et al., 2017).
But support and/or a warm perineal pack don’t stop smaller tears, including second degree tears.
In fact, some evidence supports that perineal massage may increase the risk of tearing in mamas who are having a second or later baby.
An Australian study showed no help or harm for first-time mothers, but all other mamas had an increase in tearing and injury to the perineum when the healthcare provider gave perineal support (Lee et al., 2018).
Rachel Reed covers more information on perineal support and episiotomy in her detailed blog post Perineal Protectors.
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Click here for details on MamaBaby Birthing, my complete online birthing course. Used by thousands of birthing families, you’ll be completely prepared for a beautiful, safe, and confident birth experience.
Bringing Your Own Baby Up
Here’s a personal thought that comes from having 8 babies, the last 5 of whom I birthed and brought up to my chest in my own hands – with no tearing (I didn’t tear with any of my babies).
I feel that part of natural birth is being able to fully experience what’s happening, and I reached down and instinctively felt my baby’s heads as they were being born.
Having an attendant’s hands down there would have gotten in the way. Having my hand there gave me a connection to my baby and helped me push at the right rate for my baby and myself. It is one of my favorite ways to handle the ring of fire during a natural birth!!!
I’ve talked with many women at this point, and many find they reach down to support their own perineum and make that first touch connection with their baby – to me, this is natural, and powerful <3
Your hands can be the ones to feel as baby crowns and is born!
Want more info on this? Check out my podcast on the best positions to catch your own baby!
Birthing Positions to Handle the Ring of Fire
Birthing positions are important when you want to handle the ring of fire during natural birth because some of the positions actually increase the chance of tearing and intensity of the ring of fire.
Consider different positions to ease the pressure an intensity.
AVOID these positions:
Are you surprised I just recommended against a squat? Many women think it’s the “natural” way to give birth, but it puts immense pressure on the perineum and causes skin to stretch.
If you’ve grown up in a culture where squatting is the norm and you do it all the time, your skin is likely used to it and more supple. But it’s not the best position for most women to birth in.
Positions that put pressure on your lower back can slow the birthing process, make pain management more difficult, and increase the intense burning sensation during baby crowning.
Choose positions that give you more flexibility.
If you need to slow pushing down, side-lying is a good option (discussed below).
Here are positions that reduce tearing and help you handle the ring of fire during a natural birth:
Side-lying is a great position because you’re able to fully relax between contractions. Your partner or a birth attendant can hold your leg up at a comfortable angle while you push.
This a good position for mother-directed, slower pushing and to relieve pressure on your tissues, which helps you handle the ring of fire during a natural birth.
Hands-and-knees is often an instinctive position and works well for birth attendants, too. Attendants get a very clear view of the birth, but like side-lying, there’s much less pressure on the perineum.
You also have a lot of flexibility to move your body with the contractions, which helps some mamas. A disadvantage of this position is that it’s often difficult to use your own hands to touch your baby’s head or guide your baby out.
A semi-squat or semi-kneeling position is a great way to birth your baby. It’s a more upright position that gives you a lot of control. Because one knee is down, there’s a lot less pressure on your perineum and you can easily adjust to help slow things down.
This position is how I’ve birthed my last 5 babies.
Kneeling is a variation of the above that works well – both knees are down and you can more easily control pressure and tension on your perineum by adjusting how far apart your knees are.
The right position for you may be different than another woman. While you can’t practice for your baby crowning during pregnancy, you can try these different positions and see how they feel to your body. Notice tension and relaxation in your perineal tissue. Which position feels good?
While it’s especially important to do this during your first pregnancy, I recommend testing different positions even if this isn’t your first baby. Many women don’t realize they can give birth in different positions! And you’ll feel more comfortable with your body and moving into those positions if you’ve tried them before.
Looking for more information on birth positions? Click here for my detailed labor and birth position guide.
Final Tips for Handling the Ring of Fire During a Natural Birth
I’m a firm believer in the work you do during pregnancy to prepare yourself to relax and breathe through the intensity of pushing. Here are a couple more tips:
Mother-Directed Pushing: Don’t go with coached pushing. Sometimes first-time mamas need a little help understanding how to push. Your midwife or doctor can place one or two fingers on your perineum and tell you “push to here” – which generally helps immediately increase the effectiveness of pushing.
You can push when your body pushes (your uterus is going to push down regardless of what you do to help it!). You don’t have to push with your breath held – coached pushing can lead to more pain and lower umbilical cord oxygen levels for babies (Vaziri et al., 2016).
The Fetal Ejection Reflex is something you may hear talked about – when the body pushes the baby out on its own. This is highly likely during a natural birth where hormonal flow hasn’t been interrupted. But sometimes first-time mamas still have to push to help the baby out – just push on your own terms.
Consider Water Birth: Water offers a gentle counter-pressure on the soft tissues as the baby descends. It also supports all of your weight and your baby’s weight, reducing fatigue and helping you better control the rate of pushing.
Water birth is very safe for your baby and offers many benefits during both labor and pushing (Bailey et al., 2019; Carlsson & Ulfsdottir, 2020; Clews et al., 2019; Neiman et al., 2020).
What does the ring of fire feel like during birth? The ring of fire actually feels like a major stretching sensation with a lot of stinging and burning. It generally eases between contractions, but it’s sometimes intense at the peak of contractions.
When does the ring of fire begin during birth? There are three stages of labor and the ring of fire happens during the second stage, when you’re pushing your baby out. You won’t feel it during early labor.
How long does the ring of fire last? The ring of fire starts when the baby’s head reaches crowning and it usually ends after the shoulders are born. It can last from 1-5 contractions, or 2-20 minutes or so. It’s usually not continuous during that time, because it eases between contractions.
How do you stop the ring of fire in childbirth? I’ve covered a number of techniques to use during pregnancy, but the best way to stop the ring of fire during vaginal delivery is to change positions. This can be hard during pushing – but try to move to your side, hands and knees, or kneeling to reduce the pressure, provide pain relief, and birth your baby gently.
Gentle birth is the best way to handle the ring of fire during a natural birth – you can do it, mama <3
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Aasheim, V., Nilsen, A. B. V., Reinar, L. M., & Lukasse, M. (2017). Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd006672.pub3
Bailey, J. M., Zielinski, R. E., Emeis, C. L., & Kane Low, L. (2019). A retrospective comparison of waterbirth outcomes in two United States hospital settings. Birth, 98–104. https://doi.org/10.1111/birt.12473
Beckmann, M. M., & Stock, O. M. (2013). Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd005123.pub3
Carlsson, T., & Ulfsdottir, H. (2020). Waterbirth in low‐risk pregnancy: An exploration of women’s experiences. Journal of Advanced Nursing, 1221–1231. https://doi.org/10.1111/jan.14336
Clews, C., Church, S., & Ekberg, M. (2019). Women and waterbirth: A systematic meta-synthesis of qualitative studies. Women and Birth. https://doi.org/10.1016/j.wombi.2019.11.007
Dieb, A. S., Shoab, A. Y., Nabil, H., Gabr, A., Abdallah, A. A., Shaban, M. M., & Attia, A. H. (2019). Perineal massage and training reduce perineal trauma in pregnant women older than 35 years: a randomized controlled trial. International Urogynecology Journal, 613–619. https://doi.org/10.1007/s00192-019-03937-6
Lee, N., Firmin, M., Gao, Y., & Kildea, S. (2018). Perineal injury associated with hands on/hands poised and directed/undirected pushing: A retrospective cross-sectional study of non-operative vaginal births, 2011–2016. International Journal of Nursing Studies, 11–17. https://doi.org/10.1016/j.ijnurstu.2018.04.002
Neiman, E., Austin, E., Tan, A., Anderson, C. M., & Chipps, E. (2020). Outcomes of Waterbirth in a US Hospital‐Based Midwifery Practice: A Retrospective Cohort Study of Water Immersion During Labor and Birth. Journal of Midwifery & Women’s Health, 216–223. https://doi.org/10.1111/jmwh.13033
TAKEUCHI, S., & HORIUCHI, S. (2014). Why don’t pregnant women practice antenatal perineal massage?: Journal of Japan Academy of Midwifery, 173–182. https://doi.org/10.3418/jjam.28.173
Vaziri, F., Arzhe, A., Asadi, N., Pourahmad, S., & Moshfeghy, Z. (2016). Spontaneous Pushing in Lateral Position versus Valsalva Maneuver During Second Stage of Labor on Maternal and Fetal Outcomes: A Randomized Clinical Trial. Iranian Red Crescent Medical Journal. https://doi.org/10.5812/ircmj.29279