Ina May Gaskin, the renowned midwife, coined the phrase “The Sphincter Law” in her book, Ina May’s Guide to Childbirth. Her theory is based on the idea that the body has sphincters, and these sphincters can be shy and can NOT be forcefully opened. Think back to a time when your bladder was shy. For example, if there was a long line behind you for the bathroom and you when it was your turn, you suddenly couldn’t go. At some point or another we have all encountered this law. Mine was in India with a “foot tread” toilet - the experience still haunts me.
Anyway- I digress. The cervix is a sphincter and can refuse to open under pressure or seize up when feeling uncomfortable or embarrassed. This is why it is important to choose who YOU want supporting you during your labor and delivery. Labor is a primal and private affair. It’s not too different from the act of getting pregnant, and would you really want onlookers present for that event? In all seriousness, when recruiting your labor support team, think about who you can feel most open with. Who are you comfortable being vulnerable in front of? Those are the special people that should be invited into this private ceremony. Nobody you invite in should be there because you feel obligated to have them there, including hospital staff (You can request not to have student doctors and nurses present and limit the amount of extraneous people coming in and out of your room). Distractions will only prohibit you from opening up and doing the job you need to do.
Once you have chosen your team, it is important to discuss your wishes regarding you foresee your birth. I also recommend having an honest conversation with them about any fears and concerns you may have surrounding your birth. This way, your support circle will be armed with support and comfort should these issues appear.
Here are a few ideas to discuss with your posse.
When do you want to get to the hospital or birth center? Many of the doctors and midwives I work with instruct the mother to labor at home for a period of time. If the mother is planning on not taking pain medication, most care providers suggest staying home until active labor.
What are your desires for pain medication? Are you planning on foregoing it? Are you waiting to reach a certain dilation before receiving it? Do you want it immediately upon arriving at the hospital?
What pain coping techniques do you want to try? Massage and counterpressure, visualizations, movement, shower or tub, hot or cold pack, aromatherapy?
Do you have a code word for letting your support team know that you have REALLY changed your plans for your birth and you are ready to take a different direction?
What interventions are you comfortable accepting and which ones would you like to avoid? If you are low risk and it is not hospital protocol, you may want to have intermittent fetal monitoring instead of full time. Perhaps you can have just a hep lock (a portal for an IV drip) instead of continuous intervenous fluids. Are you going to try natural methods for augmenting labor if necessary or do you prefer pitocin?
Would you like their support for immediate skin to skin contact or help with breastfeeding?
I also think it is beneficial those that are planning to be present attend a childbirth education class or read about the birth experience. Labor and delivery rarely unfolds the way it does in the movies and on TV, and a more realistic understanding will leave less room for surprises. (For those that want to read up on the subject, I really like The Birth Partner by Penny Simkins.)
The team should know that birth happens on it’s own schedule- which for many first time mothers is on average 16 – 20 hours. After the initial excitement that labor is underway, the longevity of the situation can test some people’s patience. Be prepared to camp out for a while and do not pressure the mother to move things along faster than she desires. (I personally estimate that once I am called into a birth, that I will be gone for at least a 24 hour period.)
Know what birth looks like. Or specifically, unmedicated birth. As I mentioned before, birth is primal and the daily demeanor of the person that you are used to seeing is quite different than an unmedicated laboring woman. This is particularly helpful in deciding when to head to the hospital or birth center. I often get a call from the expectant father that labor has progressed and they are heading into the hospital immediately. I then ask to speak to the mother to listen to her during her contraction. Most of the time, the mother is just starting to turn the corner into active labor, and her behavior begins to change. This shift can be scary and overwhelming for those that are not expecting such a dramatic change.
It can also be hard for someone to see a loved one in pain. Remember, in terms of labor- the pain has a purpose! Contraction pains help to open the cervix and expel the baby from the mom’s body. It is just as nature intended, but that does not mean it is easy to watch.
Now that you have some guidelines for how to pick your support group, and how they can assist your labor and delivery, you can move forward knowing you are in good and caring hands. This confidence will allow you to focus on you and your baby, rather than on hospital staff and their protocols.
It absolutely breaks my heart to know that many women are not given the chance to get out of bed during labor. Last January, I attended Lisa’s birth as her labor support doula. I stopped by the hospital while she was in early labor, and then headed home until she needed me. At sometime between 2 and 3am, she called and said things had been slow to progress. She was on pitocin (the synthetic form of oxytocin) and was having a hard time with the contractions. I asked her if she was moving around to deal with the intensity of the contractions, and she explained that the nurses didn’t want her out of bed. I asked “Why, was the baby’s heart rate decelerating when she got up?” She said no. I encouraged her to get out of bed and I assured her that I would be there soon.
It turns out that Lisa had not been out of bed since I had left around 6pm the night before! She was medicated only by pitocin, so her legs were not compromised by an epidural. Once Lisa was able to move (the nurse would only allow her to move on the bed) we got her onto all fours. She rocked and swayed, which alleviated pressure from her back and hips. She was immediately more comfortable and capable of dealing with the contractions. By simply getting off the back, which puts pressure on nerve endings, a laboring mother may experience less pain.
This scenario is becoming too common. There is no doubt that movement during labor is not only more comfortable for the mother, but also promotes maximum effectiveness of the uterus, and helps the baby shift into the optimal birthing position. Research shows that restricting movement during labor is NOT in the woman’s best interest. In 2003, a study in Nursing Research states, “A laboring woman’s lower back pain is worse when she is lying down.” Another study from The New England Journal of Medicine found that women who walked during labor did not have shorter labors; however, the women in the study were so satisfied with the walking that 99% of them stated that they would like to walk again during future labors. (Facts from “Care Practice Papers” from the Lamaze Institute for Normal Birth) WHO (the World Health Organization) also encourages freedom of movement and discourages the supine position during labor.
Although I am stressing the importance of moving during labor, there are valid reasons why some mothers are restricted to the bed: If the mother has severe pregnancy induced hypertension, if certain positions creates decelerations in the baby’s heart rate, or if the mother takes an epidural. Even with the popular “walking epidural” you are likely NOT getting out of bed.
The downsides to restricted movement are:
*The contractions are often perceived as more difficult when lying down.
* Gravity is our friend! When the uterus contracts, it is pulling the cervix open at the same time as pushing the baby’s head against the cervix. You can think of the cervix/baby relationship like a turtle neck sweater. As the baby’s head pushes against the cervix, it opens like a head emerging from a turtle neck. Why not use the natural force of gravity to add more pressure to the cervix, helping it stretch open?
Also in terms of using gravity to help labor progress, it is important not get get stuck in one position. The baby is still able to shift and move inside. The position of the baby can determine how labor moves. Remember that the heaviest parts of the baby are the back and the occiput (the back of the head). If the mother is on one side or her back for a prolonged period of time, the baby is likely to shift in that direction. As mentioned above, it is the baby’s head that pushes the cervix open. If the baby is either posterior (towards the mother’s back) or transverse (towards mother’s side) there will likely be less direct pressure being applied to the cervix with the optimal part of the baby’s head. In this instance, gravity may not be working with the mother, but against her. A recent study showed “Restricting women’s movement may result in worse birth outcomes and may decrease women’s satisfaction with their birth experiences”
*Pelvic bones do move! The pelvis is not a solid, fused structure. The two pelvic halves (the innominate bones aka- the hip bones) and the sacrum make up the bony structure of the pelvis. Mobility does exist here, and especially during labor when the body is brimming with relaxin- the hormone that soften tendons and ligaments. This movement provides opportunities for the baby to shift and move into the optimal birthing position.
As an example of what pelvic movements can do, one of my doula clients, Angela, named her labor movement “The Baby Hula.” She stood with gently bent knees and swayed her hips around as she breathed and moaned, helping her body open as it needed to. For Angela, her “Baby Hula” helped put her in a zone that allowed her to shift internally, and listen to what her body and baby needed. I have bared witness to many mothers who found their own instinctual maternal dance.
*FAILURE TO PROGRESS!!! The result of inadequate contractions and slow progress often leads to artificial labor augmentation, such as the implementation of pitocin, or the rupturing of membranes in an attempt to move labor along more quickly. Sometimes, the pitocin is successful in creating strong enough contractions that the uterus continues to push the baby downward, and dilates the cervix to 10 cm. That is where the saying “Pit her to 10!” or “Pit to distress” comes from. Should the mother reach 10cm, then she will have the opportunity to push. However, if the baby is still in a bit of an odd position, pushing it out the birth canal can still be challenging. Usually when pitocin is introduced into labor, the epidural is needed. So now we have a mother who has been restricted of movement and who is numb from waist down, which will only add to her challenge of getting the baby out.
If the cervix does not dilate to 10cm then the labor is declared a “Failure to progress” and the mother will undergo a cesarean birth. Which is currently how 1/3 of American babies are being born and 44% of these cesareans are a result of labor induction.
I can not promise that if you move throughout your labor you are GUARANTEED an ideal labor. However, research does show that freedom of movement has been more satisfying for women, and may lower the need for pain medication and resulted in fewer cesarean surgeries. Why not give it a try: close your eyes, crank up the music and let your body HULA your baby out!
Please take a moment to watch this video and read the article about the alarming upward trend in C-sections for first time mothers.
Ripple effect seen from rising C-sections in first-time moms
One in three first-time moms are now delivering their babies by
Caesarean section, according to a new study.
This has a tremendous ripple effect because most of these moms are
likely to have repeat C-sections, says lead study author Dr. Jun
Zhang. “C-section in first-time mothers is increasing and VBAC
(vaginal birth after C-section) is decreasing.”
Zhang is a labor and delivery expert at the Eunice Kennedy Shriver
National Institute of Child Health and Human Development, which funded
the research. He says his study, published in the American Journal of
Obstetrics & Gynecology, also found that 44 percent of women who
attempted vaginal delivery were induced, and in this group the
C-section rate was twice as high as women who were not induced.
More research is needed to determine whether inducing a pregnancy
leads to complications, which then make a C-section necessary, Zhang
says.
Zhang also says the study suggests that doctors may not be patient
enough. Researchers found that with first time moms attempting
natural delivery, the decision to deliver the baby by C-section was
made before the recommended three hours of “second stage of labor”
(when moms are pushing) or before the moms were at least 6 centimeters
dilated, both short of the recommended guidelines set by the American
College of Obstetricians and Gynecologists.
Zhang and his co-authors analyzed electronic medical records from more
than 200,000 births at 19 hospitals across the United States.
In March, the Centers for Disease Control and Prevention released data
that shows that 32 percent of babies in the United States are
delivered by C-section, which is the highest rate ever recorded and 53
percent higher than the rate in 1996. Some pregnancy complications
that could make a C-section more likely include the age of the mother,
the mother’s weight and twin or multiple pregnancies.
Zhang says scheduled repeat C-sections now contribute to almost a
third of all Caesarean deliveries. He says only one in six women even
attempted natural delivery after having a C-section in a previous
pregnancy. “Prelabor Caesarean delivery due to a previous uterine
scar (from previous C-section) was the most common reason for
Caesarean section,” the study said. According to an NIH panel of
experts on vaginal birth after Caesarean, the risk of uterine rupture
is a common reason for doctors to suggest a repeat C-section, even
though that risk is lower than 1 percent.
Carol Hogue, a maternal and fetal health expert at Emory University
in Atlanta, Georgia, was on the NIH panel. She strongly believes
that moms-to-be need to be better educated before they have their
baby. “C-section itself is not a benign thing,” says Hogue. While many
people may no longer view Caesareans as a major operation, she says
women need to remember that there are risks
for a mother because it is still major surgery, which can include
complications with anesthesia and scarring. ‘The process of labor
helps the baby survive,” Hogue adds.
Just last month, ACOG reaffirmed its guidelines that VBAC is a viable
option and urged physicians to counsel women who have had one or two
previous C-sections to consider delivering their baby naturally.
The study concludes that if fewer women were induced, if better
guidelines for the timing of Caesareans existed and if women were
better educated about their ability to deliver a baby after a surgical
birth, it could help lower the number of C-sections in this country.
