The rhombus of Michaelis, also known as the Michaelis-Raute or the quadrilateral of Michaelis, is a rhombus-shaped contour (also referred to as kite-shaped or diamond shaped) that is sometimes visible on the lower human back. It plays a key role in physiological birth.

Your birth partner can compress and massage it during contractions. Your birth partner can use a scarf if their hands get tired during compression and massage. Warm compress can also be used to ease pain.

Another technique that your partner can try is massage of the sacrum bone, using circular movements.

There are certain positions that help to make compression and massage easier. For example, leaning forward on a birth ball or sitting on a chair turned back to front, will make it easier for your birth partner to put steady pressure on your lower back or rub your back and pelvis.

Massage and compression may ease pain and reduce anxiety in the first stage of labour. It may help you to cope with your contractions by making them feel less intense and more manageable.

How to massage

Many women feel contractions strongly in their lower back, so lower back massage may help.

In early labour, your partner can use the flat of their hand to stroke down the side of your spine, from shoulder to bottom. They then use the other hand to stroke down the other side of your spine, maintaining a rhythmic movement, with one hand constantly in contact with you. These long, slow strokes can be very soothing.

Make sure that they are massaging you using the whole of their hand and not just the heel. Their fingers need to be in contact with your body as they try to respond to the tensions they find there.

In advanced labour, your birth partner can use the heel of their hand to press firmly over the base of your spine. They will need to apply quite a lot of pressure to counteract strong contractions so gently leaning in with their body weight is one way to conserve their energy. Or they can use their thumbs to make circles over the dimples in your bottom. Tell them what you find most helpful.