What to Do when Baby is Breech

Finding out your baby is breech can be an emotional experience.

I know for my friend who just gave birth, the last few months were filled with anxiety and doing everything possible to get baby to turn. As her due date approached, she slowly began to accept that baby may know best for position, even though she continued to work hard to give baby the opportunity to move into a head down position.

For most of us, even if we don’t know why, we know that the best way for baby to be born is head first.

Sticking with the physical aspects of birth, having the head birth first follows the natural curve of the spine and allows the body to follow along smoothly.

However, when baby is feet or bum first, this does not happen.

Since the dawn of cesarean birth, babies who are [known to be] breech for the most part have been scheduled to be born through a cesarean. The medical community feels the pros of a cesarean out way the risks of of a breech vaginal birth, for most moms.

So if you are a woman who really wants to have a vaginal birth, the fear of a cesarean can be very strong.

But how you handle that fear can be even stronger. Having an experienced provider who is open to assisting a breech vaginal birth would be wonderful, unfortunately, that is not always available.

So what can you do?

Fortunately, most babies turn on their own, with 3-4% remaining breech at birth (source). But there are ways to support your body and baby through this process when there are no other medical complications preventing baby from turning.

Inspired by my friends journey I put together my top 6 strategies (in no particular order) to help baby turn into a head down position.

The main focus to all these strategies is to create space in the pelvis. The pelvis is the outlet for birth. There is the upper ring and lower ring made up of two bony sides (or wings I call them), the sacrum, and soft tissue. These rings can expand and shrink depending on posture, muscle and tissue tension, and joint movement. Performing techniques that target softening and expansion of these rings is the goal!

  1. Pelvic Opening Exercises

    Doing stretches that promote widening of the pelvis and gentle mobility of the sacroiliac joints does just that. These exercises involve a lot of stretching the muscles and tissues around the low back, trunk, pelvis and hips.

    An example of one exercise sequence I teach my patients are pelvic tilts, circles & sways.

    These can be done in various positions but there are 3 that I find most effective: hands and knees, a birth ball or standing. They can be performed from small to large movements, slow or fast, and as many as feel comfortable.

    They are great to do throughout pregnancy as well as while in labor.

  2. Spinning Babies

    Spinning Babies was created by Gail Tully as strategies to help optimize babies position. They provide exercises and hands on techniques to create space for baby to “spin” in utero to be in the best position for birth.

    They offer online support and in person care through providers trained with Spinning Babies.

  3. Fascial Release Bodywork

    Sometimes muscles and joints that become tight over years of imbalance may need more than stretching and movement to create space.

    Using a form of manual therapy that targets the fascial system. This system is a network of connective tissue that surrounds and is interwoven into every fiber of the body and provides the support necessary for optimal functioning.

    When the fascial system is dehydrated and restricted it inhibits muscles and joints. Fascial release nourishes these tissues, allowing them to open up and create space. Performing releases around the spine, ribs, pelvis and hips improves babies chance of finding optimal position.

  4. Webster Technique

    This technique is used by Chiropractors to analyze the sacrum for subluxation and provide adjustments accordingly to restore neuro-biomechanical function.

    While this technique does not necessarily create more space, sacral subluxation can cause baby mal-position, due to the imbalanced of space in the pelvis. Bringing the sacral into alignment allows baby to find a better position.

  5. Osteopathic Manipulation

    Osteopathic manipulation are hands on techniques that Doctors of Osteopathy use to balance joints and surrounding tissues. Again, various techniques can be utilized to manipulate the spine, pelvis and sacral joints to target the uterine and cervix ligmants and muscles to bring alignment to the area and remove mechanical interferance to baby’s position.

  6. Acupuncture

    Acupuncture is another technique that can be used to open the pelvis and hips to create space for baby to turn into optimal birth position. Acupuncture points are targeted in the back, arms, hands, legs, and feet to remove restrictions and improve energy flow in the sacrum, surrounding muscles and uterine ligaments.

    Some acupuncturists are also trained to do Moxabustion, a Traditional Chinese Medicine technique where moxa (Chinese herb) is burned over a point in the outer toe. This has been shown to be effective in turning babies for hundreds of years in China and recently validated with randomized controlled-studies.

I invite you to an informational consult call to learn more about how I can help your baby find optimal position as a maternal pelvic health physical therapist!

When Labor Fails to Progress

So you're in the middle of labor, things have been progressing nicely and all of a sudden your midwife, OB or nurse say labor has stalled.

Well, what the heck happened?

This happened to a patient of mine recently.

She was having some complications at the end of her pregnancy with severe Braxton Hicks, so her OBs decided it was time to induce her.

She went over her plan with her OB and doula to make sure they were all on the same page in terms of how high the Pitocen would be for the strength of the contractions because she knew they would be stronger than her current contractions and she really wanted to avoid having an epidural.

So, she was laboring at the hospital and things seemed to be progressing until a new OB came on shift.  As my patient puts it "she wanted to kick it up a notch."  So she increased the Pitocen dose, which made the contractions incredible painful and constant.  So my patient had no break.

She said, "we're getting the baby out now."

My patient voiced her concern and asked to reduce back to the original rate. Her feelings were dismissed by everyone in the room based on the new OBs advice.

Her labor slowed and she was in so much pain, she needed an epidural.

So now she was no longer progressing and she had to have more of a medicated delivery than she had planned.

Now, my patient has chronic sacroiliac dysfunction from a traumatic fall years ago, which we had worked really hard to get under control.  She has a hard time relaxing because she is a high energy person and she tends to forget to breath in intense situations.

All of these things are recipe for a harder delivery before adding in the fact she now did not feel comfortable with the OB who would potentially be delivering her baby.

Her body decided to stop her labor.

Our bodies have a protective mechanism - fight, flight, freeze.

When you are presented with a situation that is threatening or may be harmful your primal brain does a quick assessment without you even consciously being aware.

Your body will them respond by either fighting the threat, fleeing from the threat or freezing until the threat is gone.

In all of these situations our bodies produce more cortizal and endorphins which are stress hormones.  During birth, these hormones will slow progression.  In my patients case, her body froze and completely stopped progression.

Fight, Flight, Freeze

For many who are put into this situation where they do not feel comfortable either with the amount of activity in the room, a person in the room, a procedure that is being suggested or performed, will respond in this way.

The medical community calls this "failure to progress."

Some births truly fail to progress because of pelvic structure or babies position.

However, for many moms it's because they subconsciously do not feel comfortable in the situation they are in. So until they do feel comfortable the body will not thaw.

 

This is precisely what happened with my patient. Once the OB she did not feel comfortable with, went off shift, her body went back into dilating and she was able to birth her baby boy within an hour.

This can be an amazing tool of our body when allowed to work itself out.  But only when someone recognizes it as such, can you give the mom space to open up and birth.

Working with your body, not against it allows you have a much smoother labor, delivery and recovery.  You just need to know how!!

If you're interested in learning ways to assist the body in working through distractions and uncomfortable situations during birth contact me!

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 I'm Doing to Prepare for Birth

At 39 weeks pregnant with my second the realization that my birth is fast approaching comes in waves.

I am still in awe to the fact that I'm pregnant and will be doing this birth thing again.

I reflect on my birth experience with my daughter. How it was text book until the midwives needed to cut the umbilical cord before her body was born. Then she needed to be resuscitated and brought to the hospital to make sure she was okay.

My plans for delayed cord clamping and peaceful bonding experience were dashed.

I didn't have the same daily or exercise routine this time around. During my first pregnancy I worked 40 hours a week in an outpatient hospital setting as the women's health physical therapist. I had a solid exercise routine running several times a week,  and doing my yoga and Pilates to keep connected to my core, maintain my balance and flexibility.

This time around I am running around with a 3 year old, building a local business while creating an online presence with my signature program to reach moms beyond the Seacoast and helping with a house renovation to be ready for new baby.

So what am I doing now to prepare for my second birth?

Physically

Practicing my squats

Squats are a great way to open up the pelvis and work on hip flexibility.

In a squat position the sitz bones, those bone structures we sit widen, opening up the lower ring of the pelvis and relaxing the pelvic floor.

By adding flexion (forward bend) or extension (back bend) of the spine it will open or close the upper and lower rings of the pelvis. This works the tissues connected to the pelvis and sacrum getting them ready to move and expand during birth.

You can do a squat with or without support.

An unsupported squat works more on the endurance of the leg muscles and your stamina.

A supported squat works more on the flexibility of your hips and pelvis. As you get closer to your due date, this is the way to go.

Being supported by sitting on a variety of seats can help you gradually increase flexibility and comfort.

The height of the seat and the amount of hip flexion (bend) will depend on your comfort. Sitting on a chair or ball and working to a lower seat like an ottoman or mediation pillow will bring your hips into more flexion and a deeper squat.

Then leaning forward or back onto a cushioned chair or ball will change the sensation of relaxation in your pelvic floor. Experimenting now is a great way to prep your body.

This is what I do when I play with my daughter on the floor or fold laundry or just sit to practice my breathing.

Getting on my birth ball

I love sitting on my birth ball to rock, roll and shake my pelvis. My body create a muscle memory for controlling the movement of the ball while I loosen tight muscles, ease muscle aches, bring awareness to my core and help babe get into a good birth position.

Simply sitting on the ball and rocking your pelvis back and forth, side to side and in a circle. Paying attention to the sensations in the pelvis, hips and spine for ease of movement so you can then use this as a guide for where you need to do more stretches.

Massage

 This includes two forms of massage.

Going and getting a whole body massage.

And perineum massage.

A whole body massage is a great way to reduce muscle tension, stimulate stress relieving hormones, and reduce swelling.

Perineum massage is a great way to connect with your pelvic floor.  You're physically touching the area that babe will be birthed. Then doing the massage, which is more of a stretch gets you to start to feel the "burn" that happens during birth.

The goal of perineum massage is to work on your tolerance of the 'burn' not necessarily to stretch out your muscles. When you can work through this sensation without fear and with a deeper relaxation you improve your chances of being able to do so during birth.

The benefits of perineum massage is reducing risk of tearing and other medical intervention that may result in urinary incontinence and vaginal pain.

Getting down on the floor

Getting down on the floor to stretch on hands and knees is a go to position for me. This was the position my body chose for my first birth and it provides a lot of relief for back discomfort and feeling of abdominal fullness. 

When on hands and knees I do cat/cow stretch, I shift my weight from side to side and front to back, I roll my hips in circles and figure eights.

You can work through your hips, your pelvis, your spine all the way up to your head when on hands and knees. It is such a versatile position to move your body in through out pregnancy but especially as you near birth.

Mentally

Practicing my mind-body connection through breath

Breathing is a very powerful tool to use for birth.

It can help with pain relief, progression, relaxation, and so much more.

Practicing a variety of breathing methods prior to birth (I'm talking many months before) allows your body to create a muscle memory which can be used when you are in the middle of labor and delivery when your mental capacity to make decisions (which is on purpose) is diminished.

I'm practicing my connection with pelvic floor relaxation on inhale through exhale, prolonging my breathe cycle to see how long I can breath, short breathes and a variety of nose/mouth breathing.

Imagery of the birth

Imagining how your birth will go can help you mentally prepare for birth.

Picturing baby descending throw the birth canal. Your pelvis widening, your pelvic floor relaxing and opening. Baby's head emerging followed by his body.

By using this imagery again you are creating a conscious connection to process of birth that you're body can unconsciously call upon during labor and delivery.

I practice this when I'm doing my breathing or just before bed.

Organizing my birth space

Since I'm planning a home birth, mentally preparing for birth also means making sure the space I'm birthing in is ready.

I don't want to caught laboring and feeling uncomfortable or annoyed that something is not in place or ready.

Making sure our lovely new soaking tub is cleaned, the speaker for our music is in the bathroom, the essential oils and diffuser or spray bottle is easily accessible.

Having my birth kit handy and all the extras like towels and baby's blanket.

This is my version of getting my hospital bag ready.

Emotionally

Positive affirmations

Being in a positive mindset reduces fear and stress hormones that may impact labor and delivery.

So saying positive affirmations is a great way to get into this mindset.

This could be as simple as:

"My body is made to birth a baby"
"My pelvis is just the right size for baby"

Really believing what you are saying and repeating is frequently is very important.

Pretending to be an animal with my daughter

Since we are planning on having a home birth, my daughter will be in the house when I'm laboring and when her little brother or sister is born.

So to get her prepared for the noises I may make, we are making noises for fun.

Growling, moaning, roaring, puffing, grunting.

Even though each birth is unique and your body is different from mine, your birth prep will look differently from mine, but may include some of what I practice.

You have to chose what is right for you!

If you want to learn more on how to prepare your pelvis for birth check out my Prepare Your Pelvis for Birth Package!

Happy birthing!

Preparing for Birth

During pregnancy our bodies go on this journey of incredible change that prepares us physically for growing another human being and ultimately leading us to birth.

Our body institutionally knows how to birth, but that may not make it any easier on us to actually birth because there are factors that are within our control and outside of our control that play a role in birth as well.

Birthing is a very physical activity that even the fittest woman may not be prepared for.

It takes a great deal of inner awareness to let go of the tensions in our body while using a dynamic stability and stamina to maintain postures that promote the baby’s descent into the pelvis and through the vagina.

Wouldn’t it be nice to influence the factors that we have control over, before you are in labor?

These factors may be your ability to relax the pelvic floor, your awareness of pelvic positioning and hip flexibility. All within your control prior to labor but never really mentioned in your prenatal visits or well meaning friends and family when they tell you stories of their birth experiences.

Regardless of your birth method choice having a better sense of your body prior to birth will help you recover and figure out your new body after birth.

You can do this through therapeutic maternal specialist training. Not typically mentioned or suggested at your prenatal visits, you are expected to know everything there is to know about how to birth…or your told to go to a childbirth class, which is great but will not give you the same level of body awareness as one on one training. Childbirth classes are so important for providing information about different methods of childbirth, certain medical interventions and varying pain management skills.  But they do not go over postures, positions, stretches and birth recovery that is so paramount for the health of our bodies.

Your physical health affects your mental & general health…who hasn’t heard “a happy wife a happy life.” Well this goes for moms too (because you don’t have to be a wife to be a mom).  If we don’t take the time to really invest in our bodies during pregnancy to reduce the effects these changes have that can cause serious long term problems (incontinence, prolapse, pelvic pain, to name a few), then we are only giving part of ourselves to our loved ones.

If you agree with me, spread the word.  We need to create a new culture surrounding the maternal care system when it comes to moms health.  Other countries have been doing this for decades, why not the US. So let’s start right here in the Seacoast. (especially if you had a C-section...if you think about it, you just went through major surgery...any other major surgery, i.e. total joint replacement, heart surgery, etc...you'd automatically be sent to rehab...not so for moms).

The best part, you don’t need to go to your OB to get a referral in NH, ie. this can be your choice. We rely very heavily on the medical expertise of doctors, which is absolutely needed, but when truths and education is inadvertently omitted from conversations, we need to listen to our inner voice.  So bring it up at your next visit or just contact a highly trained maternal physical therapy specialist in your area….ME!

And to be honest…we’re not all created equal.  We all bring different modalities and thinking to the table. For me I’m a nontraditional PT. Yes, I have the same doctorate training as many of my colleagues and I did some of the same post-graduate training in pelvic floor rehab as others in my area, ultimately receiving my Certification as a Women’s Health Clinical Specialist.

What I also bring to the table is my years of experience working with woman from across the spectrum, so I know the devastating outcomes that can happen if we leave our bodies to their own devices or *gasp* improper fitness training.

Oh, and did I mention I have additional training in manual myofascial release therapy which is a powerful tool for helping muscles come back “on line” from not being able to work for us then add to the mix Pilates exercises.  But I’ll tell you, I’m a non-traditional Pilates trainer.  I believe, as do my instructors that it is less about performing specific classical exercises and more about how the body performs movement while using the inner body (core).

Every day I’m amazed at how this combination of training really serves the expecting and new moms so well.

So let’s circle back around, our body goes through tremendous changes during pregnancy, to the point that our structure will never be the same, no matter how many crunches you do (please, please don’t do crunches).

But there are ways you can reduce these affects on the body by improving your awareness of your inner body through specialist care.

The main thing that matters is you are taken care of, now and in the future, so you can continue the activities you love, explore new activities, give the most you can to your loved ones without the fear of causing harm to your body.

Take care of yourself today

And stay tuned for more on "What Your NOT Told About Birth"...

What You Were Not Told About Birth: Part 4

As we all know birth does not always happen vaginally.  Many babies are born through mom's belly.

Moms who have a cesarean have many of the similar factors to consider as moms who birth vaginally.  These factors are centered around all moms were pregnant before birthing and the pregnancy itself alters our body.

However, moms who birth through cesarean have the added factor of an abdominal surgery.

Let's consider the two paths moms may on before a cesarean.

The first path is mom is laboring and pushing, but for what ever reason baby is not progressing or another medical complication occurs and for the best interest of mom and baby a cesarean is performed.

The second path is mom is scheduled for a cesarean and does not labor and push.

Each of these paths have it's own implications on the mom's body.

In the first path, the pelvis is primed for a vaginal birth, the tissues and muscles of the pelvis are stretching and widening, the uterus is contracting.  Mom may have been laboring naturally, induced or with pain medication. She may have tried multiple positions to help baby out and may have pushed for hours. For some baby is in an asymmetrical position or breech which puts strain on moms tissues where we don't want the extra strain. Baby may have been pushing into and stuck on the pubic bone.

Whatever the scenario, when mom has labored and pushed before a cesarean her pelvis has gone through a partial vaginal birth.  This means that she is at risk of long term pelvic floor dysfunction, similar but not as high of a risk to those who delivered vaginally.

A reminder of these problems are incontinence, pelvic pain, and prolapse, which Part 3 goes over in more depth.

In the second path, moms body has started prepping for a vaginal birth, but typically a cesarean is scheduled at least a week or 2 before the due date.  This is to reduce the chances of mom going into labor.

For these moms, they have the least risk of pelvic floor dysfunction.  This is a no judgement zone and I believe cesareans are absolutely needed when medically necessary, but don't let the reduced risk of pelvic floor dysfunction lull you into a false sense of security.

Cesareans are a major abdominal surgery.

Without getting into the medical component of a cesarean, which you can read more about the that in my blog post Vaginal vs Cesarean, I'm going to cover how an abdominal surgery alters the body.

Unlike cesareans of the past, the abdominal muscles should no longer be cut, however they spread and separated from the connective tissue.  So after 9 months of being stretched out they are further stretched and traumatized, regardless of how gentle the OBs are.

Especially during an emergency cesarean, OBs want to get baby out fast, so moms tissues may be bruised and have extra micro trauma that has to heal.

If you think of any other major surgery, most of us don't assume the person will bounce right back from it.  Usually there is a recovery time and rehab, sometimes A LOT of it.

When your abdominal muscles are retracted and organs are shifted some more to remove baby, the fascia and connective tissue that is interwoven through the abdomen down into the pelvic floor is involved. This means that even though baby was not born vaginally, there is still a risk of pelvic floor dysfunction, because of the interplay of tissue.

What are the major implications though of the incision?

A cesarean incision is a scar. A scar is an interruption in the normal tissue fiber, which is weaker and sometimes unpredictable.  The scar for a cesarean is multi-layered and can vary from mom to mom based on the OBs technique and how mom heals.

Some moms heal beautifully without complication and others may have extra scar tissue, infection or added complications that prolong the healing process.

In turn, a scar may visually looked healed but tactically be numb, bumpy, tight or painful.

There are two major implications that result from the scar.

  1. Pelvic weakness, mainly the abdomen.
  2. Pain, mainly abdominal or pelvic.

Let's take a look at each these more closely.

When any muscle is traumatized by injury or insult, such as a surgery it is weakened at a micro level.  Plus nerves are also involved causing numbness and reduced sensation in the abdomen. Combine this with weakened and stretched out abdominal muscle from pregnancy, moms with a cesarean are at a higher risk of longer lasting abdominal weakness and a harder time tuning into the Abs.

This is perpetuated by the fact that most OBs don't want mom to perform any form of exercise for 8 weeks to make sure the incision is healed, which is fair enough. However, with the guidance and expertise of a maternal pelvic health specialist there are safe exercises that can help with healing.

Abdominal weakness can lead to

  • back pain
  • constipation
  • prolapse
  • poor posture

But as I stated before the fascia that is woven through the abdomen reaches into the pelvic floor, which can result in some pelvic floor dysfunction as well and as we all know (now, from reading the series) it's not all about Kegels for pelvic floor dysfunction. So we want functional Abs too!

On the other hand the scar can cause pain. When a scar is formed the body arbitrarily adds connective tissue to the area.  Then over time the body comes back and straightens it up to match the force vectors in the tissue.

Some bodies aren't as efficient at this process or are overly efficient, meaning they don't straighten it up very well leaving nodules or bumps or extra scar tissue is created and may adhere to surrounding organs or tissues.

This disorganization or adhesions can result in pain receptors saying something is wrong, thus abdominal or pelvic pain.

For many moms this is most noticeable with activity, bowel movements, a full bladder, sex, and menses (once they start).

Long term implications if not addressed as be increased severity of symptoms, "sudden" start of symptoms that may seem out of the blue but stemming from the cesarean or complications in later births.

So as you can see there are risks for all forms of birth and we as women need to research, ask questions and feel in control of the decisions we make regarding birth.

Knowing that you are not alone, there are people who can support you through your birth and your healing after birth. There are treatments for these complications and ways to help reduce these risks. All it takes is reaching out.

We'd love to hear your birth experience. Comment below.

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.

 

 

 

 

Vaginal Birth versus Cesarean

To continue the What They Don't Tell You Series we need to talk about the differences between birth methods so we can understand what happens to our bodies during each.

Most of us know the two ways babies are birthed: vaginal and cesarean.

You may be thinking, "well of course I know the difference" and if you've experienced both then you have a leg up on the rest of us.

However, most of us don't really know the physical differences each has on our body.

Let me help clear that up.

A vaginal delivery is just that, the baby is birthed through a small hole in the pelvic floor, aka the vagina.

A cesarean delivery, the baby is birthed through an incision made in the abdomen and uterus.

Now, let's look a little closer at each.

VAGINAL DELIVERY

A vaginal delivery may be natural with no medical intervention or have medical intervention.

A natural delivery means the woman's body went into labor on it's own, chose or was unable to use medication for pain relief, and did not need any equipment or intervention to remove the baby from the vagina.

Medical interventions during a vaginal delivery may include: induction (which may include membrane sweeping if not consented), pain relief medication, IV, fetal monitoring, forceps, episiotomy, and vacuum.

Without getting extremely technical what our bodies need to be able to do for a vaginal delivery is the following:

  • Open and expand the upper pelvic rim and SI joints
  • Use the power of the uterine contracts to help the baby descend into the vaginal canal
  • Open and expand the lower pelvic rim and coccyx
  • Relax the pelvic floor

This process may be affected by the position of baby, pregnancy complications (preeclampsia, placenta position, etc), pain management, medical interventions, distractions or actions that may slow moms progress.

This is where I can get super detailed about what happens to the body, especially to the pelvic floor, but that is for future posts.

Ultimately, our body will either be able to pass the baby through the vagina or the decision will be made that a cesarean is required.

CESAREAN

There are two ways a cesarean is the birth method... an emergency after pushing is not successful or the life of baby or mom is at risk and a scheduled cesarean.

Before an emergency cesarean the mom's body goes through the same processes as a vaginal delivery and may even have other medical interventions performed prior to the cesarean.  She may even push for hours, which can  affect the pelvic floor almost as much as a vaginal delivery.

For those who have a scheduled cesarean, the mom knows exactly when she will be birthing the baby.  A cesarean is scheduled for many reasons, a few of these are pregnancy complications like placenta privea, baby's position, being "over due" and for some a previous cesarean.

This is what happens to the body during a cesarean:

  • A catheter is placed so you can pee
  • The mom is given a spinal block or epidural to numb the lower half of the body. In some emergency situations general anesthesia is given.
  • Horizontal incisions are made just above the pubic bone - cutting through skin, fat, and fascia.
    • The muscles are not actually cut, however the the fascia that connects them are and then separated to pull the muscles apart.
  • The uterus is then cut and the baby is eased out
  • The uterus is massaged to help the placenta release
  • The incisions are stitched or stapled back up layer by layer
  • Then you are in recovery - where you catheter is eventually removed

 

So what really happens to the body during a cesarean beyond the steps of getting the baby out. Again, this is the topic of another post.... so stay tuned.

To recap...a vaginal delivery requires a full stretch of the pelvic floor to birth the baby & a cesarean is major abdominal surgery.

Regardless of the birth method your body just went through intense changes during pregnancy which affect the structure of the pelvis, spine and soft tissues in the abdomen and pelvis...not to mention other joints like our feet and shoulders. Which means your body has already undergone changes that have nothing to do with birth method and can affect long term health and fitness.

To be continued...

What You Were Not Told About Birth: Part 1

So I can't tell you how many times I have been chatting with a client and she says

Why didn't they [meaning her OB or midwife] tell me that?

And I can never really give a good answer, because I don't know why providers don't inform expecting moms what may or will happen to her body after birth.

To me, this should be common practice, so that moms can make the best decisions while preparing for birth and recovery. If we are unaware of what to expect how can we prepare?

This creates more of a reactionary mindset, which is typically more defensive.  Rather than a proactive mindset, which is typically more offensive.

So I've decided to delve into the issues that aren't brought up. The changes, birth injuries and short and long term problems that arise from pregnancy and birth.

To begin, I want to talk about a podcast I listened to this morning on the way to work.  It was called Risky Birth-ness from The Longest Shortest Time.

It was brought to my attention by a past client, who thought I'd enjoy the topic, being about the risks of vaginal births.

In the episode the host, Hillary interviews Kiera Butler who wrote What the Expect: Why aren't we talking about the surprising number of women injured by childbirth?  for the magazine Mother Jones.

[You may subscribe to the magazine for free here]

After downloading the podcast I couldn't wait to listen to it!!

I am such an advocate for women who experience childbirth injuries so I was excited to hear what Kiera had to say.

So I was shocked to feel less than satisfied by the conversation. Which you can listen to here.

Hillary and Kiera spoke some specific birth traumas that can occur from vaginal birth and how the prevalence of birth traumas are on the rise.  How Doctors are required by law to inform women the risks of  C-section but aren't required to discuss the risks of vaginal birth.

They also discussed certain interventions that may occur during vaginal birth, such as epidural, vacuum, episiotomy, and how the risks of these interventions are not addressed. And how vaginal birth can leads to short term and long term injury. Kiera went into a little more detail around these, stating short term injury is tearing or episiotomy and long term can be prolapse and stress incontinence. [I will go into more detail to these later].

But to me, this episode sounds almost like an anti-vaginal birth discussion until the very end.  I do not believe that was the intent; however I feel there was information lacking about the comparison in risks between C-section and vaginal, not just stating there are risks with C-section as well because it is major surgery.

Here's my insight on the risks of vaginal birth - 

Vaginal birth is the most natural way to deliver; however there are circumstances that can reduce a woman's ability to birth vaginally, so in those cases C-section is necessary.

Just because vaginal birth is the most natural doesn't mean there are no risks to your body.

There needs to be more education upfront about how to birth, including positioning, respecting the bodies innate pushing reflex. This includes the providers involved doing every effort to use these practices rather than the default lying on the back and telling moms to push.

Providers need to have more training on the muscular on the pelvis or to at least have it become standard practice to have expecting moms see a physical therapist trained in pelvic floor and prenatal care.  This gives expecting moms the best opportunity to bring awareness to the proper muscles that are the most involved or injured during birth, regardless of method.

Even though the risk of stress incontinence and prolapse is twice as likely for those women who have vaginal births compared to C-section and may lead to surgery in the long run. These are still risks of C-section in addition to other complications like abdominal pain, back pain, painful sex...

Medical interventions should be the last resort based on an individual basis, because there are other risks that are involved, such as epidural migraines, lack of body awareness to feel a natural push (which can lead to tearing), trauma to infant from vacuum or forceps, etc.

Hospitals and birthing centers need to be more open about it being the woman's decision for birth method and the experience she is looking for. Meaning she should not feel pressured or shamed into either method, but treated with respect.

Care does not end after birth. There needs to be more education around recovery, what to expect, what could happen and how to be proactive. I like how Kiera brought up recovery in France includes PT! [I have to listen to the podcast about pelvic floor PT].

And never, I mean never, tell a mom "At least you have a healthy baby" when she expresses a discontent with the birth experience because it diminishes her feelings.

Each birth experience is different because each woman is different, so every women should have the opportunity to be able to make an informed decision about that experience, without feeling pressured by society, medical community, friends, family or other moms. The only way we can make informed decisions is by being educated by those who have the information.  If birth trauma is not discussed, normalized or dismissed, then woman won't know to ask. So providers need to be the first to bring it up. Especially since, pregnancy books don't talk about birth trauma.

After listening to this podcast I was worried I was over reacting, but was pleasantly reassured by other's comments that I was not the only one who felt that this episode left me wanting more.  As one woman pointed out in the comments - there was nothing said about vaginal injuries being linked to the birth environment, including medical professionals you've never met, machines, IV, other sounds, etc, which may affect the moms mindset around birth. As I mentioned in another post, when a mom feels uncomfortable with a situation during labor the body responses by slowing or stalling progression. This can lead to intervention and possible injury.  So I'm glad someone brought this up in the comments.  That yes, there can be birth trauma and injury but what percentage of this trauma was caused by or within less than desirable environments.

I know I may stir up some conversation about this topic and I'd love to hear from you.  Tell me about your birth experiences. That is the only way we can learn from each other and figure out the best way to educate other woman about the birthing process.

Look for part 2 of this series as I get more in depth with some of the issues brought up in the podcast like stress incontinence, pain, prolapse and more.

Empowerment in Birth

I listened to the podcast The Birth Hour, on my way home from work the other day, and the mom was talking about her home birth and all the work she did to prepare for it.

At the end something she said really struck a cord in me. She described when she was asked about her birth experience, she would tell them that it was fast and there weren’t too many complications and they would say she was “lucky” and it must have been “easy.”

After a while she started to feel dis-empowered around her birth and that she hadn’t done all the work to really prepare for it. So she stopped telling people about her birth.

This really hit home for me because I feel the same way about my birth.

I did not have a home birth but I birthed at a birthing center. I stayed home as long as possible and I was only at the center for about 3 hours before my daughter was born. Everything was really smooth, a good length from beginning to end, there were no medical interventions and technically there were no complications with the birth.

There were complications at the end, with my daughter not breathing because the umbilical cord was wrapped tightly around her neck and she needed to be resuscitated and we did end up going to the hospital to make sure she was okay. But all in all the actual labor and birth portion was smooth and uneventful.

Even though I can’t really remember people saying I was lucky or I wish I had a birth like that, there were times when people asked about my pregnancy or birth, it did feel like I was almost “out shining them” if they didn’t have a pregnancy or birth like mine.

So I stopped telling my birth experience to most people and felt ashamed, if I didn’t go into the problem areas that I had.

I’m really glad that this mom brought up her feelings around this, because I could tell she had a hard time trying to explain why she had the feelings she did, because it’s such a tender topic.

So many of us, do really prepare, do research, take care of our bodies and eat healthy and really dig deep to strive for the pregnancy, birth and postpartum experiences that we want and still it may not happen for us, for so many reasons that are out of our control.

But for the vast majority of us, we are not as prepared as we can be. Not because of lack of trying, but for lack of knowledge.

We are bombarded by images, videos, stories of birth that are fear based and do not empower moms.

We are told “that’s normal”, “you’re pregnant” or “well you just had a baby.” As if what we are experiencing can just be waved away and we have to live with it.

This sets us up to believe that there is nothing to be done to really prepare for pregnancy, birth and postpartum other than having our routine prenatal visits, going to a birthing class and having our 1 postpartum visit.

So really, we are left to our own devices to know what to do, we have little support along the way.

I hear too many times, “I wish I’d known…”

Just the knowing part can help empower moms to question what really is normal or if there is anything more than can be done. Or feeling comfortable with the birth experience they had without questioning, comparing or regretting.

So as my take away, I really want you to understand that no matter how you birthed, you shouldn’t feel ashamed, you should still feel empowered. But know that those who may have had a “smoother” sounding experience than you may not feel they are lucky. And those who may have had medical interventions or a “harder” birth may feel they were absolutely necessary or welcomed. So I feel the best thing to do is to listen and embrace and hold space for any mom who is daring enough to share her story, to honor the powerful mom she is.

And for those who may want a different birth experience or may want to work towards a different birth experience or postpartum recovery, there are people out there to help, all you need to do is ask.