natural birth

Rhythmic Movement for Birth Pain Control

Birth is a life changing event that many women have a desire-fear relationship with.

The idea of knowingly putting yourself through pain can be daunting. Even with modern pain medication, which you may want to avoid.

So your pregnant and want to try for a natural birth or at least wait as long as possible before getting pain medication (if at all).

What are some strategies to cope with the pain of birth?

The first pains that are felt during birth are the result of uterine contractions. These contractions pull the cervical muscle up and out of the way to allow baby to descend. The widening of the cervix  pulls on the surrounding muscles and ligaments. These pelvic floor tissues are packed with nerves wit pressure and pain receptors and are the source of the strong sensations during contractions. The tighter or tense these tissues the more intense the pain response.

In early labor contractions and sensations are less intense and infrequent.

As labor progresses, the sensations intensify, lengthen and become more frequent. This is how you know your body is priming for full delivery. However it also becomes more challenging to cope.

The second set of pains is the stretch of the pelvic floor tissue as baby’s head is delivered.

Some call this the “ring of fire” because it feels like a burning sensation as the tissue stretches. Again, being more intense if the pelvic floor muscles are tense or tight.

Other pains that may be felt are back pain, especially if baby is posterior occiput breech, meaning face up. Others may experience vaginal or rectal pain in the form of pressure.

Most pain during labor and delivery is absolutely normal and healthy. But there are ways to influence and cope with the pain naturally.

Many people think of breathing strategies to cope with pain. I can't agree more. But there are other strategies that help your body work through the aches and pains during labor.

One strategy is to MOVE!

There are many ways to move during labor ... walking, sitting on the birth ball, yoga poses ...but one of the most influential movement is rhythmic.

Rhythmic movement targets the autonomic nervous system, which controls how you FEEL pain.

When you are in labor your body triggers your sympathetic nervous system due to the stress your body is under, which controls your fight, flight or freeze mechanism, which sharpens your senses, including pain.

Even though your autonomic nervous system is not under our direct conscious control you can influence it by targeting your parasympathetic nervous system, which suppresses the sensation of pain.

Rhythmic movement relaxes your muscles and taps into this system. Helping you take the edge off of labor pains.

During my second birth, I found my body automatically moving in a rhythmic way when the contractions became more intense.

What are rhythmic movements?

A movement that recurs repetitively to a certain pattern.

This could be rocking, shaking, bouncing, swaying.

In early labor I used my birth ball by rocking my pelvis, bouncing, and swaying my hips with wide legs.

When labor progressed and I was "resting" on my side in bed, every time there was a contraction my body (but mostly my pelvis) would rock back and forth. This movement was soothing and allowed me to stay calm and work with the pain rather than stiffen against it.

There is no one correct way to move. You can practice throughout your pregnancy to create muscle memory and a mind-body connection that your body can call upon when you are in labor. Then you're body will move in it's own unique way.

Rhythmic movement allows you to take charge of your labor and work with the pain.

FEEL how your body wants to move and let your body move freely...creating your birth dance!

 

What You Were Not Told About Birth: Part 3

Once the swelling and inflammation has gone down. Tearing or incisions have closed and superficially healed. The tissue has to continue going through a healing process which includes relearning how to function.

To better understand the long term effects we need to understand the roles of the pelvic floor.

The pelvic floor has four main functions...

  • To keep pee and poop in
  • To let pee and poop out
  • Sexual
  • Structural

These functions are influenced by the flexibility, contractility and coordination of the muscles and tissues of the pelvic floor. But they are also influenced by what is happening above and below the pelvis, daily movement patterns, and your habits.

A vaginal delivery not only stretches the pelvic tissues of the pelvic floor, but also widens our hips and pelvic joints changing how the forces travel through the body.

The pelvic muscles and tissues are attached to and support these joints. Your pelvic joints are affected by positioning, external forces from people pulling on your legs, or your inability to feel how hard your pushing from an epidural. So if your pelvic joints are injured the tissues that are attached to them can also be injured or guard to protect.

These changes can have lasting affects on the structure of your pelvic bowl and may alter the strength-tension relationship in the muscles supporting the joints and organs, most importantly the pelvic floor. The body needs to compensate by shifting your posture or you may unconsciously alter how you perform a task.

This results in changing forces within our trunk and pelvis.

When this occurs the functions listed above can be altered resulting in

  • Urine or fecal leakage
  • Urine or fecal urgency
  • Pelvic pain - front or back
  • Back pain - anywhere in the back
  • Painful sex
  • Reduced sexual arousal
  • Constipation, etc.
  • Prolapse

The longer the body compensates, guards, moves in less than desirable patterns the more the tissues will tighten, weaken and become imbalanced.

Resulting in:

  • That pesky twinge with sex now being a sharp chronic pain with sex.
  • No leakage with coughing or sneezing to every time you have a cold you have to wear a pad.
  • Once your baby starts to grow and get heavier your back aches or you can't bend over to lift the babe up because it hurts your pelvis so much.
  • Whenever you lift your leg to go up the stairs or get dressed you have pain in the front of the pelvis.

Really the list can go on and on.

The contractility and flexibility of the pelvic floor muscles in particular are most influenced by a vaginal birth and just like the short term risks, medical intervention can result in more dysfunction.

For example, an episiotomy rips more resulting in a fourth degree tear. This means the laceration affects all the muscles and tissue between the vagina and rectum, including a large junction point of pelvic floor muscles and ligaments. When this happens not only is the scar going to be bigger, which may cause increased adhesions and reduced flexibility and guarding in the tissues and muscles, but also weakness in the anal sphincter.  Resulting in increased risk of uncontrollable gas loss or fecal incontinence. On top of pelvic pain, prolapse and urine incontinence.

These issue will not be helped with just Kegels, ladies!

On a more global scale, the length of pushing during birth, regardless of medical intervention can increase the risk of pelvic floor dysfunction.

As I mentioned in Part 2, a short labor may not allow the time for the tissues of the pelvic floor to relax and stretch to expand for baby.  On the other hand a long labor and pushing can overstretch the tissues.

Not being able to relax may cause tearing, resulting in scarring. Leading to pain or inability to contract or relax the pelvic floor muscles.

Either of these can mean muscle guarding, muscle weakness, muscle spasm - which can all lead to incontinence and pain.

Over stretching the tissues also means increased risk of prolapse. What this means is your pelvic tissues are unable to support your pelvic organs and either your bladder drops into the vaginal canal, cervix or uterus drop into the vaginal canal or the rectum drops into the vaginal canal.

Prolapse is highly influenced by the support you are able to provide to the pelvis through muscular, fascial tensioning and proper pressures. This is really where the weakness of the core, pregnancy posture and any other trauma that occurs to the pelvis from vaginal delivery is be highlighted as a problem.

Another injury that is rarely spoken of is nerve damage. This can be caused by:

  • The amount of force placed into the pelvis during pushing
  • The position of the baby
  • The position of mom
  • Any external forces on mom (think partner holding onto one leg and nurse holding on the other leg while moms on her back)
  • Medicalization such as epidural so mom can't feel how hard she's pushing, or instruments.

It takes a long time for nerves to heal and if the surrounding tissues have also been injured, posture is altered, pelvic congestion or there are imbalances in tissues causing tension or guarding squeezing the nerve it'll take even longer.

The nerves that run through the pelvis not only control the pelvic organs and tissues but also the legs!

Ever wonder why it's hard to lift your leg or why your foot is numb after birth?

To recap:

Long term effects of a vaginal birth on pelvic health are:

  • Incontinence
  • Pain
  • Prolapse

These are influenced by:

  • Scarring (tearing, episiotomy)
  • Injury from vacuum, forceps
  • Length of labor and pushing
  • Ability to relax the pelvic floor during birth
  • Awareness and health of the pelvis prior to pregnancy
  • Nerve damage
  • Any other pelvic injury during birth

The good news is all of these are treatable in some way, with care from a pelvic health PT!

The sooner you are able to speak up and seek care the better.

The more women who do speak up about it and find out that these effects are not normal results of childbirth the women who will be able to live a fuller life!!

What You Were Not Told About Birth: Part 2

So now that we know the physical differences between a vaginal birth and a cesarean we can delve deeper into what these differences mean.

Part 2 of What You Were Not Told About Birth is going to be all about how a vaginal delivery affects your short term pelvic health.

As I described in the Vaginal vs Cesarean blog post, during a vaginal delivery the baby descends into the vaginal canal, pressing on the cervix for dilation then on the pelvic floor to stretch and improve pliability of the tissue before actually birthing through the vagina (technically the introitus, which is the medical term for the opening of the vagina, if you wanted to know).

Most of us take a birth prep class learning the different medical interventions during delivery to help the mom cope with pain and help the baby out. But most of us don't learn how these interventions can affect our long term pelvic health (which is Part 3)

So sit back, get comfortable, because here we go....

A natural vaginal delivery is one that uses no medical intervention. For most moms this is the goal and if you want to know more about why, here's a great article to read.

However, having a natural delivery doesn't mean you won't experience birth injury or complications.  This is not meant to scare you away from a natural delivery, because comparing all birth methods women with a non-instrument delivery have 30% less birth injury than instrument delivery. These findings do not include epidural side effects or injuries, which you can read more about here, but may increase the risk of instrumental delivery thus birth injury.

To get down and dirty, having a natural delivery, has the least amount of external variables that have risks and benefits. The more variables you add in the higher the risk of birth injury.

Immediately after a natural vaginal delivery your pelvic tissues are swollen, inflamed and sore.

Even if no major birth injury occurred during delivery, there are still micro injuries that happen as a result of the stretching of the tissue.

This micro trauma is influenced by the health of your pelvic tissues, the length of labor, your positioning during birth, and the amount of pushing you do.

Just like any trauma or injury to your body there are reactions within the tissue that cause inflammation and a cascade of pain mechanisms.  This is all totally normal! The larger the injury or trauma the more severe the swelling, inflammation, tissue dysfunction and potential pain.

How does this influence your short term pelvic health?

  • Peeing and pooping can burn, be sore or painful.
    • You may not be able to hold your pee or poop.
    • Or you may not be able to let your pee or poop out.
  • The area will be sore or painful to touch.
  • It can be uncomfortable to sit down.
  • Altered sensations.
  • Weakness in surrounding areas.
  • You may not recognize your vagina.
  • You won't even want to consider sex.

This dysfunction escalates when there is tearing, instrumental or medical intervention.

  • Epidural headache
  • Pelvic joint pain - Sacroiliac joint or pubic symphysis
  • Coccyx pain
  • Nerve damage

The degree of tearing, episiotomy and any injury from forceps or vacuum assist delivery means the more tissue involved, more scar tissue developed, the longer the body heals.

For many women these short term affects gradually go away and don't seem to alter the quality of life.

However, these changes in the tissue last a lifetime and if not addressed can cause long term problems.

The simplest and most effective way to address these short term affects is by being informed about the risks, knowing your options, understanding your body and how your lifestyle can influence how your body will respond to labor and delivery, and preparing your body for birth with appropriate exercises and birth skill practice.

Of course there are other management tools for swelling, inflammation and pain, like soaking a menstrual pad in witch hazel and freezing it to wear, using witch hazel wipes for toileting, sitting on a backward Boppy, diluting honey and gently massaging into the healed scar (once the stitches are gone).

I understand that even being proactive, things can happen that are not within your control like if baby suddenly changes position, contractions are coming fast and furious making your labor super short and your body doesn't have as much time to prepare for pushing, or your life and your baby's life are threatened and an emergency cesarean is required.

Just know having prepared your body for the changes that occur with birth, even if the birth does not go as planned can make a world of difference in the long run.