I came across this video on YouTube. I encourage all expectant moms to take 3 minutes and 3 seconds out of their day to watch it.
What I think is really scary about this video is how much truth is revealed about the practices of birth in our society. The video demonstrates the many ways a mother is pressured and frightened into accepting a variety of different interventions that may or may not be necessary, but have become commonplace in today’s births. The message seems to be clear: If the mother doesn’t accept these interventions, she is doing something wrong and it will hurt her baby. I have heard, on occasion, nurses and doctors saying, “We need to have full-time external fetal monitoring to make sure your baby is ok.” When in fact, there is evidence supporting the contrary, that full time EFM can lead to unnecessary cesarean birth. Or statements like “If you don’t take your epidural now, you may not be able to get it later.” Or “You can’t push your baby out, there is not enough room, your baby is too big”. All of these statements - that were probably not made with malicious intent - diminish a woman’s confidence that she is capable of birthing her own child without a cascade of interventions.
Hopefully at some point this trend will change, and birth will become an opportunity for a woman to feel supported and empowered by her choices - not scared.
The cervix is opened by the baby’s head pushing against it with each contraction. You can visualize this action by picturing the cervix as a turtle neck sweater through which the head is slowly emerging. Ideally, to push the cervix open most effectively, the baby’s chin is flexed, and the smallest part of the baby’s head (the occiput) presents first. However, sometimes the baby’s occiput is facing backwards or is posterior, so it does not emerge first.
Posterior Position
• Occiput Posterior (OP)
• Right Occiput Posterior (ROP)
• Left Occiput Posterior (LOP)
The baby presenting in a posterior position can lead to a host of issues. For one, dilation and progression usually take longer, and some women get “stuck” at a certain point in dilation. The mother may experience intense back pain, since the baby’s skull is pressed up against her sacrum. She may also experience the urge to urinate during each contraction, because the baby’s forehead is pushed up against her bladder.
At times it is it difficult to rotate a baby out of the posterior position, especially if the baby has entangled itself in the cord. There are yoga poses that are encouraged and discouraged during the last trimester to help the baby move into the ideal birthing position.
Specific yoga poses to omit from the 3rd trimester practice are:
• Legs up the wall
• Supta Baddha Konasana (at the end of class)
• Supported bridge for a long period of time
It is advisable to do any “belly down” pose like child’s pose, cat/cow, body circles and a brief downward facing dog. (Please exclude downward dog if the baby was once in a breech position and has finally turned head down.) I also encourage women to sit on a birth (exercise) ball or sit upright or leaning forward in chairs. If the mother has access to a pool, swimming is a fantastic activity for the last trimester since the mother is belly down for a prolonged period of time, and immersing the body in water can help reduce swelling.
During the last trimester I encourage the mothers to spend as little time on their backs as they can. This includes asking them to check in with the way they recline at home as well as in the yoga studio. It is so easy (and desirable!) to come home and drop back into the couch or comfy chair. They should avoid doing so, however, since it creates a hammock-like shape for the back and invites the baby to settle into a spine-to-back position.
Another reason that the baby may present posteriorly is that the mother’s uterine ligaments and pelvic floor muscles are tight and somewhat twisted, preventing her baby from settling into a good position. Luckily, many poses we do in prenatal yoga encourage the pelvic and uterine ligaments to gently open and relax. Exercises that relax and tone the pelvic floor muscles are also included in class.
Specific asanas for preparing the pelvis for labor and delivery:
If the baby is malpositioned and the mother is aware of what side the baby is laying on, she can help correct this by arranging her body to encourage the baby to shift during savasana or while asleep. If the baby is OP, the mother should use “pure side lying” as opposed to semi-prone. The mother should lie on the side towards which the occiput is already facing, with the baby’s back toward the bed.
If the mother would prefer to rest in a semi-prone position, she needs to lie on the side in which the baby’s occiput and back are facing towards the ceiling. For example, if the baby is ROP, the mother would be on her left side in a semi-prone position and on her right side for “pure side lying”.
Breech Position
• Breech
o Footling breech
o Frank breech
o Complete breech
o Kneeling breech
Another issue some mothers face is the baby being in a breech position. This could mean the baby is standing straight up in the womb (footling breech), presenting butt first (frank breech), sitting cross- legged in the womb (complete breech) or the baby is kneeling inside (kneeling breech). Either way, very few doctors will deliver a breech baby vaginally. If a mother finds out her baby is breech, she is often anxious to help turn the baby around. Luckily, there are some yoga poses that can assist with this.
Poses to help turn a breech baby:
• Prolonged inversion like downward dog
• “Butt up” child’s pose
• Supported bridge pose
• Right angle handstand at the wall ***advanced practitioners only
• AVOID squatting, as it opens the outlet of the pelvis and invites the baby to wedge itself deeper down.
Beyond these specific yoga poses, acupuncture has been known to help. Also, you can try placing ice at the fundus since the baby will likely move away from the cold. Or, place music or light down at the pelvic opening since babies will go toward sound and light.
In general, mothers should be mindful of the baby’s position as she nears her due date and tailor her practice accordingly. Yoga can have a powerful effect on these last few weeks and days of pregnancy!
Labor is probably not the time you will be requesting a huge steak dinner, but it is a good idea to continue to nourish your body. Not eating during labor may reduce your energy, increase your fatigue and decrease your ability to deal with stress during labor. Can you imagine laboring for 15 hours and then pushing your baby out having only ingested ice chips the whole time?
Hospitals began restricting food and fluids about 50 years ago, when women often gave birth under general anesthesia without their airway protected. The doctors were concerned that the women would vomit and aspirate while under the anesthesia. Even though it is extremely rare that general anesthesia would be used in a labor and delivery situation, this old protocol is still enforced in many hospitals.
A recent review of the research on this topic found that there is no evidence that restricting food and fluids in normal labor is beneficial. Recent research shows that eating and drinking are safe in normal labor. Based on the best evidence available, food and fluid should not be routinely restricted in labor.
Moreover, women who ate rated their overall labor experience as significantly better than that of women who were only allowed to drink water, according to a study presented in poster form at the annual meeting of the Society for Gynecologic Investigation“.
A while back, I was reading Midwifery Today and found a short article about “The Midwife’s Pitocin”. This one midwife recommends that her clients make a bowl of oatmeal, honey and nuts during labor and graze on it when they desire. If you break down the ingredients, you will find the perfect balance of complex carbohydrates, protein and natural sugar. Imagine that you are about to run a marathon - you would surely fuel your body with healthy supportive food! I have been recommending this concoction to my doula clients. It seems to have given them some lasting stamina.
The oatmeal will probably not be welcome at the hospital, but you can try to get some in your body before you head in. If you are birthing at a birthing center or at home, you can continue to eat when you like. So what can you do if you are birthing at a hospital? First check in with your hospital and care provider and see what their guidelines are. Recently some hospitals have begun to allow clear fluids, broths and juices for low risk women. If you are restricted to ice chips, bring along a sports drink that has electrolytes and some sugar and mix that in with your ice chips. But be sure to try to avoid the overly sugary drinks as they may cause nausea.
Some women are concerned that eating during labor will cause them to vomit. But according to the same study referenced earlier, “Vomiting was not more common among women allowed to eat light foods, 18% of whom vomited once and 17% of whom vomited more than once, compared with 17% and 17% of women in the water-only cohort.” In fact, vomiting is a sign of transition and can actually help push the baby deeper down into the birth canal.
Here is a list of “light eating” that may be appealing to the laboring mom. Please note you are more likely to have a desire for food in early labor. Don’t force yourself to eat anything you don’t want to.
