If you have a piece of cloth and try to tear it in two it requires quite a bit of effort to tear it straight down the middle.
Now take the same piece of cloth and imagine putting a small cut in it with a pair of scissors. Now, starting at that cut try to tear the cloth. It is much, much easier.
Episiotomy is much like this. Having the soft tissues of your pelvic floor cut by your doctor will weaken them and make a tear even more likely. Women who have third and fourth degrees tears have often had a first or second degree episiotomy.
— “Episiotomy Epidemic,” www.naturalbirthandbabycare.com/episiotomy.html
Raw honey is a great remedy for first-degree [perineal] tears. Honey’s thick consistency forms a barrier defending the wound from outside infections. The moistness allows skin cells to grow without creating a scar, even if a scab has already formed. Meanwhile, the sugars extract dirt and moisture from the wound, which helps prevent bacteria from growing, while the acidity of honey also slows or prevents the growth of many bacteria. An enzyme that bees add to honey reacts with the wound’s fluids and breaks down into hydrogen peroxide, a disinfectant. Honey also acts as an anti-inflammatory and pain killer and prevents bandages from sticking to wounds. Laboratory studies have shown that honey has significant antibacterial qualities. Significant clinical observations have demonstrated the effectiveness of honey as a wound healing agent. Glucose converted into hyaluronic acid at the wound surface forms an extracellular matrix that encourages wound healing. Honey is also considered antimicrobial. — Demetria Clark
Excerpted from “Herbs for Postpartum Perineum Care: Part I,” The Birthkit, Issue 46
Each of my babies left a minor 1st degree tear. The first time it was stitched, but the second and third times I had it left alone and the difference in recover was remarkable! It seemed I was one of those who react negatively to either the suture needle, thread, or analgesia.
Most of the time. minor tears in the perineum heal easily on their own, but there are things you can do to spped your recovery naturally. These include avoiding stairs and keeping your legs together as much as possible for at least a few days, using comfrey ice packs, sitz baths, and apparantly honey as well!
While thoughts of pushing out a baby often bring up fears of tearing, little is recommended by care providers when it comes to comfort post-birth. Thankfully, my midwife sold me on a near-miracle recipe for comfort before my first baby was born.
After you give birth, whether you tear or not, using comfrey ice packs for the first day or two will reduce swelling quickly, heal tears faster, relieve discomfort, and generally get you feeling more normal a lot faster.
The hospital may offer you an ice pack (which cost a few dollars each), but this is not just an ice pack, these are comfrey ice packs. HUGE difference.
I am a big fan of comfrey, so my midwife got me started with a plant of my own and now I have it growing in my backyard. I give away so much of it each year that I have to remind myself to keep enough for my own births! If you know anyone who grows comfrey count yourself blessed, if you don’t have such a friend, you should be able to find some dried comfrey at a local healthfood store, or you can buy seeds and start a plant of your own.
Whatever way you manage to get it, here is how you can make comfrey ice packs to use after giving birth.
You Will Need
- A bunch of fresh comfrey leaves or approximately a cup of dried comfrey
- Cookie trays
- A 2 quart sauce pan
- A package of 18 maxi pads
- A couple ziplock bags
If you are getting comfrey leaves straight from the plant, start by trimming the stems and washing the leaves with water to remove dirt and any bugs you might find. Next, you will need to dry them. I find a cookie tray works well to lay the leaves out on so that you can easily move the tray when you need the work space, but you can also use some tinfoil, or even paper towels. Lay out the leaves individually so the air can get to each one, and once or twice a day flip the leaves over so both sides get light and air. The leaves should dry within a few days, perhaps more or less depending on the climate in your area and the time of year.
Once the leaves are dry enough so you are able to crumble them in your hand, you are ready to prepare the comfrey infusion. Begin by bringing your pot of water to a boil. Turn off the heat, add your dried comfrey (I don’t crumble mine so that it is easier to remove, but I think crumbling it is the correct method), cover, and let steep for about 15 minutes. Strain out the dried comfrey.
Next, remove each individual maxi pad from its wrapper (keeping the sticky part covered with the backing) and cut them each in half width wise (see picture above). Place them on cookie trays and pour the infusion over each of them so they are all soaked. Place tray in freezer for sufficient time to freeze the infusion in the pads, preferrably overnight. Remove the trays from the freezer, put the pads in the ziplock bags, and put the bags back in the freezer. Your comfrey ice packs are now ready to be used.
If you are having your baby in the hospital, place a reminder note in or on your hospital bag to grab the comfrey ice packs from the freezer before you leave in labor. If you forget them, you can have someone bring them to the hospital after baby is born. The freezer/fridge unit reserved for drinks and popcycles for the laboring mom and her family can be used to store the the icepacks until they are needed. If you are having a home birth, just leave them in your freezer. When baby is born, you can use the ice packs right away, placing one inside your hospital-issued, one-size-fits-all underwear. Replace when it is no longer cool, and continue to use for 24-48 hours or as needed. I found that because you are using maxi pads to hold the infusion, you don’t really have to worry about the liquid wetting your pants (or gown) as it melts.
Comfrey is a magic herb and has lots of good properties to it that are useful for many injuries. My friend Renee posted some information on how to make a comfrey poultice, which she used to aid in the healing of her daughter’s sprained knee. Here is a good website on how to prepare herbs for different uses.
Another of my midwives applied the ice pack to my perineum after my second, precipitous birth left me quite swollen, and was amazed at the immediate effects it had. The swelling was nearly gone by the time she left my house, and I was much more comfortable! I know women’s bodies are created to open easily around the baby and to heal quickly, but I swear by this stuff and I highly recommend that you use it!
And for those who have a cesarean, you can also use it on the incision wound. A friend of mine tried it a week or two after her birth (it was the soonest I could get the comfrey to her), and she applied the comfrey via a poultice and found it gave her quite a bit of relief after a long day. Using comfrey ice packs or poultices after a cesarean section may lead to faster recovery after surgery as well.
When I teach a childbirth class, I prefer to do an all-day event so there is plenty of time for discussion, practicing techniques, and working on emotional aspects of giving birth. When I don’t have time (for example, an evening class), I focus on the most important things I feel will help women to have an easier birth. Here are my top ten for an easier birth:
1) Choose your birth place and birth team very carefully. What should you look for?
- Proven safety, and feeling of safety (do not disregard your intuition about a potential birth place or care provider)
- Low intervention rates, implying more hands-on care and the promotion of normal birth
- Takes the time to listen to your concerns and answer your questions with respect and interest
- Has assisted women having your ideal birth (epidural, natural, water birth, vbac, etc.)
2) Prepare for an easier birth, now!
- Don’t watch A Baby Story! Instead (if you are interested in watching birth videos), watch movies like The Business of Being Born, Orgasmic Birth, Pregnant in America, Water Birth, Special Women, and normal birth videos on YouTube which represent birth as it usually is. TV specials on birth are designed and promoted to offer drama and attract viewers, not to support women preparing for birth.
- Don’t read What to Expect When You’re Expecting. Nearly every woman I have spoke to said this book scared them more than it gave them confidence and reassurance. Instead read books like Ina May’s Guide to Childbirth by Ina May Gaskin and Creating Your Birth Plan by Marsden Wagner. Other good reads can be found on my lending library list.
- Eat well, getting a variety of foods in your diet, focusing especially on protein, green veggies, water, limiting sugar and processed foods, and salting foods to taste.
- Rest up, both for your current health, your energy level during birth, and for the late nights you’ll spend with your baby.
- Exercise. This means pelvic rocking and tilts, kegals, tailor sitting, squats, walking, swimming, and similar activites.
- Practice relaxation and visualization. Both of these are extremely helpful in having a tension free and easier birth. Hypnobabies is helpful for many in this respect.
- Position baby well. The position of your baby prior to labor greatly influences how easy or difficult your birth will be.
3) Have continuous labor support by a birth doula
- Moms supported by birth doulas have fewer complications, fewer interventions, more satisfying births, better bonding experiences with dad and baby, better baby outcomes, and less postpartum depression.
- In one large survey, moms who used doulas rated their support better than everyone else’s – doctors, midwives, nurses, dads, their mothers, sisters, and friends. Yet those present to support mom reported feeling more confident and relaxed themselves when a doula was present to support the mom.
- There are many myths about doulas, read this article to find out what they are and why they are myths.
4) Do not get induced!
- 40% of women are induced for lots of reasons, but it is only medically necessary in 5-10% of cases, for the following reasons: Pregnancy beyond 42 weeks, evidence of placental malfunction, baby small for age, preeclampsia, membranes ruptured beyond 4 days with no labor (less than that if there are signs of infection), true fetal distress confirmed by fetal scalp sampling or a biophysical profile.
- Alternatives to medical induction are waiting it out or using natural methods.
5) Stay home as long as you can
- Staying home until contractions are consistently less than five minutes apart and distracting you from other activities helps to ensure that active labor has begun and you will not be sent home from the hospital for false labor. It also reduces your chances of having interventions used on you that may not be necessary.
- In the meantime, rest, eat well, drink lots of fluid, visualize your birth going well, and carry on with normal life as much as possible.
6) When you get to the birth place, stay active
- Your pelvis is flexible, especially by the end of pregnancy, and staying active helps to ensure freedom of movement of your pelvis so that your baby can move down and be born easier. Staying upright and moving also helps labor to go more quickly and be less painful for you.
- If you are restricted to bed, first make sure it is actually necessary, then ask for help in finding different positions to use in bed to keep baby moving and make labor easier for you.
- Make sure to change positions frequently, drink and eat, and take breaks to rest, using upright positions which keep you fully supported.
7) Avoid uncessary interventions
- Do your homework on all possible interventions and ask questions anytime one is suggested to you!
- Possible interventions which are common include: vaginal exams, electronic fetal monitoring, IV, rupture of membranes, pitocin, episiotomy, epidural or other pain meds, restriction to bed, restriction of food and drink, and cesarean section.
- Interventions used which are not justified carry risks which do outweigh the benefits of using them. Unless there is very good reason (see articles linked above) to use them, you are likely to suffer consequences that could easily have been avoided by not using the interventions.
8 ) Don’t push on your back
- Remember your pelvis is flexible
- Pushing on your back is rarely a good thing and unless baby needs extra help being born, carries multiple risks.
- Ask about alternative pushing positions like hands and knees, squatting, sidelying, or standing.
9) Keep your baby with you
- Having your baby put on your chest after birth offers you and your baby multiple health benefits and is great for bonding.
- All routine newborn exams and procedures done immediately after birth can be done on your abdomen or right beside you, unless your baby needs extra help starting to breath.
10) Remember, you were designed to give birth!
- Even if you have had a difficult birth before, or know someone who has, your body was designed perfectly for birth. Sometimes things can make that more difficult, like a less than ideal diet, a pelvic injury, or interventions used in labor which made birth more difficult, but 90+% of women giving birth are able to have normal births if they are healthy and well supported during birth.
- Labor is hard work, it may hurt, and you can do it. That’s the bottom line, everything else you learn is icing on the cake (statement adapted from Birthing From Within).
Most believe that if a woman gives birth vaginally that it was a “natural” birth. Our birth culture has changed so much in the past 100 years that very few women truly have a natural birth.
In order for a birth to be truly natural, the mother must have no interventions. That means no epidural, no pitocin, no IV, no fetal monitor, among other things. Some women benefit from having these interventions, when they or their babies are showing significant signs of stress, but most of the time the risks of using them outweigh the benefits.
There are many interventions which a woman may use during labor and birth, so this post is not an exhaustive review of interventions in childbirth. Rather it is a summary of the most common ones, how they interfere with normal birth, and when they are medically justified.
The Electronic Fetal Monitor (EFM)
If you’ve seen A Baby Story, you’ll recognize the fetal monitor when you are admitted to the hospital in labor. It is a machine by your bedside that uses ultrasound technology to detect your baby’s heart rate via a doppler device held against your abdomen by a strap. Another device detects contractions, and both are printed out on a graph and sent to a central computer at the nurse’s station.
The fetal monitor is used because the baby’s heart rate is a good indicator of overall health and his reaction to the normal stresses of labor. The hope, in making this intervention routine, was to prevent babies from dying in labor or from having long term health issues from being “in distress” for loo long during labor.
The problem with using the electronic fetal monitor on every woman, regardless of risk level, is that research has shown it does not reduce the risk of mortality or mordity of babies, but it does increase the chance of a woman having a cesarean section with it’s associated risks. Research has shown that using a handheld doppler or fetascope, which promotes freedom of movement of the mother and more involved care by the nurse, will detect when a baby needs to be born quickly, without increasing the risk of an unnecessary cesarean.
Times when an EFM are medically indicated: When a woman is on Pitocin, on an Epidural, or other medications, if the handheld doppler picks up a slower or faster than normal fetal heart rate, or if the baby is in a breech position.
Intravenous Fluid (IV)
A good many, if not most, hospitals consider it standard that laboring women recive an IV upon admitance in labor. It is easy to do when getting the admission blood work done, and prepares the way for any medications that might be given to her during labor or birth. If food and drink are restricted during labor, “sugar water” will keep her hydrated and help to provide much needed energy for the hard work ahead.
The problems with IVs are multiple. For one, they do carry risks including fluid overload, swelling/edema, and infection. They also restrict freedom of movement and make it easier for medications to be given, which could be a good or bad thing.
The only times when having an IV is necessary are when the mother is dehydrated and cannot keep down food or drink, or if she gets an epidural, since the fluid can help to counteract the quick drop in blood pressure which is common to epidural-users.
Restriction of Food and Drink
Also common to most hospitals is the restriction to ice chips only, or maybe clear fluids. Why? Because all laboring women are treated as pre-op patients. One in three women have a cesarean setion, so they treat all women as if they might soon be going in for surgery.
Although it makes sense at first glimpse, this too is a routine that should be abandoned. The concern is that if a woman has been eating and she has a cesarean that she could vomit during delivery and then inhale her food, causing a serious complication known as aspiration pneumonia. The problem with treating every woman as if this will happen is that even with without such precautions, very few women will ever inhale their vomit during birth.
For one, it is now known that aspirating vomitus will almost always occur in women who are given general anesthesia, not an epidural, and that it is much more common when the anesthesiologist does not administer the general anesthetic properly.
Already this brings down the chance of contracting aspiration pnuemonia to almost none, but another shocking factor is that inhaling vomit on an empty stomach is much more dangerous to the lungs than inhaling food because of the stomach acids present. And, denying food in labor does not guarantee an empty stomach at the time of surgery anyway.
Restricting food and drink may prevent an extremely small number of women from incurring damage, but to all the other women it only reduces their energy levels, impedes progress of labor (and I believ causes “failure to progress”), and causes dehydration and ketosis. It is therefore recommended by researchers that instead of restricting food and drink that general anesthetic be avoided, and when used that it is given with meticulous care to technique.
Breaking the “Water Bag”
Also known as “artificial rupture of membranes”, this is a common procedure for caregivers who wish to induce or speed up labor. A thick plastic hook that appears like a knitting needle is inserted through the woman’s cervix and tears a hole into the membranes surrounding the baby.
Normally the bag of waters breaks on it’s own late in labor, often when the mother is pushing. It acts as a barrier to germs and cushions both the baby’s head from the pressure of contractions, and the mother’s pelvis from the baby’s head.
For a long time doctors have believed that breaking the water will speed up the labor, and while that is possible and does sometimes happen, most of the time it does not significantly speed up labor. Instead it presents several risks, including longer labor, infection, cesarean section, more painful labor, fetal distress, umbilical cord prolapse, and fetal bleeding from the membranes, cervix, or placenta. If the baby is not positioned well, removing the cushion of the intact bag of water can make it difficult if not impossible for him to turn into a better position for birth.
For these reason, most women should allow their bag of waters to rupture spontaneously, unless there is need to delivery the baby quickly and birth is imminent, or there is no better option available to speed up labor when it is medically justified.
Restriction to bed for labor and birth
Even though women are usually allowed to get out of bed, using multiple interventions, not specifically being encouraged to get out of bed, and seeing women on TV stay in bed during labor, leads most women to believe that it is just what they are supposed to do. Yet this is rarely the case.
As I wrote in my second post on normal birth characteristics, being out of bed during labor offers multiple benefits and has no risks. Being out of bed encourages women to move and this often will make her more comfortable, speed up labor, and keep the baby happy.
Sometimes a woman will be asked to remain in bed, for instance to monitor the baby’s heart rate. A handheld doppler can be used in an out-of-bed position, but being in bed may be more convenient for the mother when she needs a rest.
Pushing and delivering on her back is usually the worst position a woman can be in. I’ll talk more about that in the fifth post on normal birth characteristics.
There are several drugs that can be used to prepare a woman’s cervix for induction, and to cause contractions. Pitocin can be used both to start and speed up labor. It is a fluid given by IV that is a synthetic version of the hormone Oxytocin. Oxytocin is released in a woman’s body when she has sex, when she gives birth, and when she breastfeeds. It is known as the “love hormone”, and its presence is absolutely essential for labor to start and bring about the birth of a baby.
Coincidentally, using Pitocin is not at all like injecting Oxytocin into a woman’s veins. Because her body has no control over the amount or content, Pitocin is well-known for causing sudden and intensely painful contractions compared to the body’s own version. It is almost unheard of for a woman to give birth without pain medication when she has been given this drug. Read Normal Birth Characteristic #1 for more risks of using Pitocin.
Induction is questionable when used for macrosomia, gestational diabetes, too little or too much amniotic fluid, and “failure to progress”. Reasons scientifically proven to be appropriate for induction or augmentation with Pitocin include pregnancy beyond 42 weeks, placental malfunction, baby small for gestational age, preeclampsia, membranes ruptured for longer than 48 hours, and baby showing signs of distress.
Every woman experiences labor differently, and no woman should be judged if she accepts pain medication during labor, but every woman having a baby needs to know the risks of having pain medication, and their alternatives.
Epidural anesthesia is the most common form of pain relief used in labor. It is an anesthetic given through a catheter inserted in the spine which numbs everything lower than the ribcage. Women with a low-dose epidural may be able to have limited mobility, but most women remain in bed after receiving one. The epidural is a precious gift to a woman who can benefit from it, but again, for most women, the risks outweigh the benefits.
Once the epidural is placed, the mother’s labor becomes a medical event, if it was not one already. An IV, continuous fetal monitor, and restriction to bed are required, and many women also require Pitocin and a urinary catheter as a direct result of the epidural. Urinary retention, long term severe back pain, infection, fever, newborn spinal taps, forceps and vacuum deliveries, cesarean section, temporary paralysis, and even maternal death are significantly more common among women who use epidurals, although some of these risks are still very low.
On the other hand, there are a few situations in which the use of an epidural offers greater benefits and outweighs the risks. These are when the labor is induced or augmented, during a cesarean section, extreme pain (if other methods are not helping anymore), or if the labor has lasted days not hours and the mother is exhausted.
Alternatives include the use of a doula (known to increase the pain threshold), movement, counter pressure, hot and cold applications, immersion in water, touch and massage, and prayer.
Although episiotomy has been proven to be an out-of-date procedure, it is still performed anywhere between 20 and 80% of the time in hospitals. An episiotomy is an incision made on the perineum, the skin and muscle between the vagina and anus, usually extending half way between the two, intended to widen the vaginal outlet.
This is done for four reasons: to speed the delivery of the baby, to prevent tears which are more difficult to stitch back up than episiotomies, to prevent significant damage to the pelvic floor or to the baby’s head, and to prevent tearing to the anus.
Not only have all of these widely held beliefs been scientifically refuted, but it has been proven that episiotomies cause more short and long term pain and damage than tears. Not to mention that getting an episiotomy guarantees these difficulties while attempting to protect the perineum through compresses and guiding the baby’s head may prevent tears and avoid all perineal damage and significant pain. The only times when episiotomy is medically justified is when the perineum is scarred or has a defect, preventing it from softening, and it is possibly beneficial when forceps are used.
Episiotomy is associated with an increased risk of tears extending to the perineum, hemorrhage, infection, painful urination, and long-term sexual problems.
One in three American women have cesarean sections, a major abdominal surgery to remove the baby from the uterus when it is believed to be a better option than giving birth vaginally.
A few women prefer surgery to vaginal birth, for various reasons, but most women who have one experience some amount of dissappointment over not giving birth “naturally”. A few experience significant stress or depression after the birth.
Cesareans are much safer than they once were, hence they are used more frequently. Reasons include being past 40 weeks, estimating the baby to be too large for the mother’s pelvis, a breech presentation, twin pregnancy, fibroids, diabetes, obesity, “failure to progress”, preventing perineal trauma, previous cesarean section, and elective cesarean.
None of the reasons above should be considered automatic and standard indications for cesarean section. Many women in these situations would have perfectly normal births if they were supported by caregivers experienced with these conditions, and the risks of having a cesarean outweigh the benefits in all of them.
Conditions that usually or always require a cesarean include a fetal heart rate too fast or too slow, placenta covering the cervical opening, placenta detaching from the uterus, baby lying sideways that won’t turn, cord coming through the cervix first, hyperstimulated uterus, uterine rupture, preeclampsia, active herpes lesions, and HIV positive status.
You may find yourself in the position of having to consent to a procedure, but it is always good to ask questions first. Make sure you know why you are having the intervention, whether it is truly medically justified, and if/what the alternatives are. If you have reason to believe that one or more of these will be used (like if your doctor tell you at a prenatal that it is routine at their hospital), ask for second opinions, research your options, and consider finding a new caregiver and/or birth place if it would make you feel more comfortable. And if in the end you still require the intervention, you will have the reassurance that it was probably necessary.
Creating Your Birth Plan by Marsden Wagner, M.D., M.S.
A Guide to Effective Care in Pregnancy and Childbirth by Enkin, Keirse, and Renfrew
Pushed by Jennifer Block
Today’s primary resource for learning about childbirth is to watch Birth Day or A Baby Story on TLC. Once in a while you will see a “natural” childbirth on one of these shows, but for the most part they are made out to be emergencies with women writhing in pain, lying on their backs, and their doctors have to come in and rescue their babies. Now, the next time you see an episode where the mother is sitting in a chair, walking around, or kneeling in the tub, see if you can tell the difference in the way these labors seem to go. Although the mothers are obviously working hard, in some amount of pain, and anxious for the labor to be over with, most of the time the active mother’s babies are happier, there are less emergencies, and the delivery itself usually requires less active management on the part of the doctor. And this is no coincidence.
“Women who walk, sit, kneel or otherwise avoid lying in bed during early labor can shorten the first stage of labor by about an hour,” according to a new Cochrane evidence review. Women who labored out of bed during the early stages were also 17 percent less likely to seek pain relief through epidural analgesia, the review found. Women who have a baby in the posterior position (what frequently causes “back labor”) have nearly a 90% chance of turning their babies in labor if they remain upright and moving during much of their labor. Shortened labor, less pain, and better positioning of babies are just a few of the benefits of remaining active during labor. Here are some others: increased comfort to the mother, as well as distraction and an enhanced sense of control. It can also help to relieve the sense of being overwhelmed. Other benefits include reduced likelihood of tearing (if in an upright position while pushing), less fetal distress, and a reduced incidence of low maternal blood pressure (this can happen if mom is lying on her back or even semi-sitting).
Why does being active keep things normal? Pelvic bones are not inflexible. They are actually made of a few bones held together by flexible cartilage. When the mother remains upright and active, her bones are constantly moving and adjusting. This means that her baby, who needs to move it’s head quite a bit to rotate down and through the pelvis, is getting help from his/her mother to be able to mold and flex his head and neck to be born. Being active not only makes this process easier, but faster. With direct pressure from the baby’s head on the mother’s cervix, she will also dilate and soften her cervix easier than if she were only lying down or sitting in bed.
As for the pain, it is not usually completely removed by being upright, but a woman’s pain threshold can be increased this way, and pain from certain positions (like being on her back) can be removed. Lying on one’s back in labor really is the most painful position for a couple different reasons. One, when her uterus contracts it tilts forward, so if she is lying on her back her uterus has to tilt up and forward and the harder it has to work to remain efficient, the more pain it causes the woman. Second, lying or sitting ontop of a surface prevents the mother’s pelvic bones from moving, and constricts the space within the pelvis, both actions make it more difficult for the baby to mold and descend through the pelvis (often this situation mimics a case of “baby too big for pelvis” when really the mother just needs to get out of bed). This of course is not only difficult for the baby, but more painful for the mother.
Although most women will need some encouragement from a knowledgeable person (such as a doula) during labor on choosing helpful positions, they also tend to adopt positions or movements that will help them without being told how to do them. For instance, hands and knees is a very common position that laboring women will try without suggestion, simply because it feels right. And the positions that “feel right” are probably the best ones for them to use. In this case, pain directs women to choose positions that not only feel better but are also beneficial for the progress of labor and the health of her baby. If good progress is not being made, changing positions, or trying different movements, every 20 or 30 minutes may help to get things moving again. I very strongly recommend that if you can’t buy any other books about childbirth, that you pick up these three books: Ina May’s Guide to Childbirth by Ina May Gaskin, The Labor Progress Handbook by Penny Simpkin, and The Birth Partnerby Penny Simpkin. Ina May’s Guide will give you some great ideas on creating an environment that encourages freedom of movement and great progress in labor, and the other two have wonderful drawings of positions that you can try during normal labor and during any complications that might arise. Here is a website with a few good examples of positions you can try in labor.
So happens if you choose not to get out of bed, or if you are restricted to bed by your risk level, complications, or pain medications? It is more difficult to get the benefits of movement when you are restricted to bed, so it is helpful if you can stay out of bed as much as possible. Frequent trips to go pee in the bathroom are a help if you are given no other excuse to get up. Sometimes it is better for you or the baby if you do stay in bed, although realistically this doesn’t happen very often. If your doctor or midwife asks that you stay in bed, first ask why they are saying this. Then, ask how strict this rule is, since there might be leeway. For example, if you are supposed to get frequent heart rate monitoring, you may still be able to get off the monitor and out of bed for 20 minutes every hour. If you must stay in bed, like if you have a high-dose epidural, ask the nurse to help you switch positions every half hour or so to encourage good progress. You can sit up, lie on each side, try the exaggerated side position, hands and knees, and others. The Penny Simpkin books I mentioned above all have very good drawings describing these positions and how they can help you to dilate more quickly, or to help move the baby if he/she is not positioned well.
What you can do to ensure freedom of movement in labor:
1. Exercise during pregnancy to build your stamina for labor. Brisk walking and the breast stroke while swimming are two of the best and safest exercises you can use.
2. During early labor, REST as much as you can, drink water to quench your thirst, and eat carbohydrate and calcium rich foods.
3. During active labor, take a sip of water after EVERY contractions, and try to eat nourishing food to keep up your body’s energy. Sometimes labor slows down just because a woman isn’t hydrated, she’s too tired, or she hasn’t eaten all day. If you are well nourished with food and drink and labor still slows down, consider taking a rest before going for a walk. Don’t be afraid to give your body a break during labor. If you and your baby are tolerating labor well, there is no reason to rush the birth.
4. Talk to your doctor or midwife about staying upright and active during labor. Ask them in what situations you would have to stay in bed, and ideas of how you can stay active even if complications arise (eg. rocking in rocking chair, sitting on a birth ball, or sway-dancing with a partner next to the bed so you can stay on the fetal monitor).
5. Read books and visit websites (preferably with a person who will attend your birth) to get ideas of positions you can try. If you can, bring one of these books (like the ones I mentioned above) to your birth place so that if you forget them you can look up some fresh ideas.
6. Hire a doula. She can remind and help you to keep up your energy, to encourage you and reassure you that what you are experiencing is normal and that you are doing a good job, and physically support you in different positions so that you don’t get tired too quickly.
7. Don’t worry about trying to find the “right” position. Just do what comes naturally, do what feels good, and chances are you will be doing just what you should be doing. Stay out of bed unless you are tired and need a rest. Even when you are in bed you could still adopt a hands and knees position, or get on your knees and rest on the back of the bed (when the head of it is raised). There are so many options, so pick your favorites, use one of them for a while, then try another one.
Here is a University of Toronto study that shows what happens when the hospital bed is no longer the “focal point of labor”.
When a woman pushes her baby out, she is given one of two options for how to breath while she is pushing. One is called the Valsalva maneuver and the other is called spontaneous pushing. The kind you usually see when watching A Baby Story or A Birth Story or any movie that has a birth in it would be the Valsalva maneuver: taking a deep breath, holding it while pushing until the count of ten, and then quickly repeating the process, usually three times during each contraction. Midwives are more often known for allowing spontaneous pushing, where the mother only pushes when she feels the urge to, and for the length of time that she feels like pushing, where she would then take a few breaths and push again when she had the urge.
Here is what Varney’s Midwifery has to say on the scientific study of using the Valsalva maneuver (also known as “purple pushing”) for giving birth:
There is evidence of potential detriments in the Valsalva maneuver, closed glottis sustained pushing efforts. Detrimental effects include decreased oxygenated blood to the placenta resulting in fetal hypoxia, a higher incidence of perineal trauma (lacerations, episiotomies), maternal exhaustion, and potential for cystocele and urinary stress incontinence and for uterine prolapse from stretching of the cardinal ligaments.
And for spontaneous, open glottis pushing:
Studies have shown that there is no change in arterial umbilical cord blood pH [a sign of fetal distress] and that the second stage of labor is either the same length or shorter. No detrimental effects have been shown, and the detrimental effects of the Valsalva maneuver type of breathing and pushing are avoided.
In most cases, a woman experiences what is called the Ferguson’s reflex, where she feels an overwhelming desire to push. It may not occur as soon as she reaches 10cm, but it will occur. Reasons it may not happen include having an epidural and being in a supine position (lying on her back during labor). Even if a woman doesn’t experience Ferguson’s reflex, she can be encouraged to push in a more natural manner that will help to avoid the potential side effects of the Valsalva maneuver. Talk to your care provider about his/her usual method of encouraging a woman to push, and if you are not satisfied, consider interviewing other care providers in your area about their methods.
The Monthly Doula
A newsletter by Birth a Miracle Services
Volume 1 Issue 8 February 2009
Protecting the Perineum
Mission Statement: My goal is to educate and inform all parents and future parents of their rights and responsibilities of bearing children and of the truth and wonder of birth. My mission is to inspire them to enjoy their pregnancies and to look forward to bringing their children into the world.
Letter from the Editor
In the News
Quote of the Month
Benefits of Perineal Massage in Pregnancy
The Sitz Bath: Post-Birth Healing and Comfort for New Moms
Website of the Month
Book of the Month
Online Video of the Month
What is Birth a Miracle Services?
Request for Contributions
Letter From the Editor
While it may come as a surprise to many women, one in three American women will get an episiotomy while giving birth, and still more tear on their own. Yet it doesn’t have to be this way. More and more midwives and doctors are learning what it takes to protect women’s bodies during childbirth.
This issue will provide you with some great information on what you can do to protect your body during childbirth and to recover more quickly afterwards. While many women choose to focus on pain relief and other important issues in birth, it is vital not to overlook this important aspect, which can have long-term effects on your health.
I hope this information is eye-opening to you, and will set you on the way to making a positive difference to your birth experience.
Naomi Kilbreth, Certified Doula
Birth a Miracle Services
36 Greenwood Street
West Paris, ME 04289
In the News:
Epidurals can result in more pain than they save:
Does Perineal Massage Prevent Tears?
OB GYN News. Some say that although it may be helpful, other factors like nutrition, warmth of the perineum at birth, and slow birthing of the baby’s head are more attributable to an intact perineum. Check out the full story here: http://www.suite101.com/article.cfm/pregnancy_childbirth/50805Some suggest it does not, including a new study by New research suggests that women who have epidurals in labor are more likely to suffer from third and fourth degree tears. Click here to find out why:
Women who suffer 4th degree tears or episiotomies during birth suffer from more serious long term difficulties than those who have third degree tears or episiotomies. See the full article here:
Quote of the Month:
In a branch of medicine rife with paradoxes, contradictions, inconsistencies, and illogic, episiotomy crowns them all. The major argument for episiotomy is that it protects the perineum from injury, a protection accomplished by slicing through perineal skin, connective tissue, and muscle. Obstetricians presume spontaneous tears do worse damage, but now that researchers have finally done some studies, every one has found that deep tears are almost exclusively extensions of episiotomies. This makes sense, because as anyone who has tried to tear cloth knows, intact material is extremely resistant until you snip it. Then it rips easily.
By preventing overstretching of the pelvic floor muscles, episiotomies are also supposed to prevent pelvic floor relaxation. Pelvic floor relaxation causes sexual dissatisfaction after childbirth, urinary incontinence and uterine prolapse. But older women currently having repair surgery for incontinence and prolapse all had generous episiotomies. In any case, episiotomy is not done until the head is almost ready to be born. By then, the pelvic floor muscles are already fully distended. Nor has anyone every explained how cutting a muscle and stitching it back together preserves its strength.
— Henci Goer, Excerpted from
Obstetric Myths Versus Research Realities: A Guide to the Medical Literature (Bergin & Garvey, 1995)
Benefits of Perineal Massage in Pregnancy
By Naomi Kilbreth
Throughout pregnancy, most women are advised to continue an exercise routine, altering it to fit their new body. Many care providers, however, fail to recognize the power of kegal exercises and perineal massage. Both kegal exercises and perineal massage increase a woman’s ability to relax her pelvic muscles, and brings increased elasticity to the vaginal tissues. Combined, these will increase the mother’s probability of maintaining an intact perineum and its integrity throughout the birth and postpartum period.
This article focuses specifically on how to perform perineal massage. The pregnant woman or her husband can perform this technique. During the later weeks, it may be easier to have the massage given by a person other than the pregnant woman. She should aim for five minutes of massage each day, starting around the 34th week up until the birth.
It would be most appropriate to use a warmed vegetable oil with Vitamin E, or a water-soluble jelly. Do not use baby oil, mineral oil, Vaseline or anything with perfume. Place your thumbs or forefingers about one inch inside the vagina and press downward toward the anus and out to the sides. Hold the stretch and breath, focusing on relaxing the pelvic floor for about two minutes. Please note: this should never hurt! Seek the point of “gentle tension”. After practicing this massage, you should be able to stretch further and wider.
A variation to this technique is to maintain steady pressure while moving the thumbs or forefingers in a slow rhythmic U pattern back and forth over the lower half of the vagina, while gently stretching it outwards as well. This should be practiced for two to four minutes at a time.
Please be aware that, for safety reasons, perineal massage should not be done if the pregnant woman has pelvic varicose veins, active herpes lesions, or any other vaginal infection.
My midwife made a great example of how these exercises help to keep a perineum intact during birth. She would show us a rubber seal from a canning jar and pull and stretch it to show how immovable it really was. She compared this to a vagina that was not exercised. Then she showed us a rubber band elastic and pulled and stretched it in order to show us how much it could be stretched without broken. She compared the rubber band to a vagina that had been exercised through kegals and perineal massage.
I highly recommend perineal massage, for the safety of a woman’s body, and for the increased comfort she wills surely feel while getting to know her baby.
2009 © Associated Content, All rights reserved.
The Sitz Bath: Post-Birth Healing and Comfort for New Moms
After a vaginal birth, a woman is likely to have sore vaginal tissues. This may be aggravated by a swollen perineum, “skid marks”, a tear, an episiotomy, and/or hemorrhoids. One of the most helpful ways to assist in healing and lend comfort at the same time, is using a sitz bath.
A sitz bath is a plastic bowl that fits over the toilet seat. If you are unable to get one from your hospital, they may be found at most pharmacies and are carried by some midwifery suppliers. A gravity-fed tube runs water into the bowl and bubbles around the opening of the vagina. Alternatives to a buying a sitz bath are using a large, shallow basin or the bathtub to soak in.
Soaking in the sitz bath has multiple benefits. Warm water relaxes and soothes the sore tissues, keeps the area clean and prevents infection, and helps with circulation. Cool water may prevent or treat perineal swelling, but some practitioners caution the use of cool water on a newly postpartum woman.
To benefit the most, you may begin sitzing 24 hours after birth, when you can be up and about more comfortably. Sit on the bath for 10-20 minutes, 1-3 times a day or as needed, until the soreness is relieved. Most practitioners recommend use of the sitz bath for at least one week after birth.
Although water itself is healing, making an herbal tea to put into the sitz bath may help the vaginal tissues to heal faster. Here are a few recipes that you can try. Most of these herbs can be found at your local health food store, but may also be found from midwifery suppliers. The basic combination is to put 2 handfuls (or 2oz) of herbs in a cooking pot with 2 quarts of water. Cover and bring to a boil, then let simmer for 15-20 minutes. Strain the tea very well and then add 2 tablespoons of salt to the tea, dissolving well. Allow it to cool slightly, and then poor into the sitz bath. The water should be on the hotter side, but not uncomfortable.
¼ cup lavender infusion to 1 cup water
Add a drop of tea tree oil or patchouli oil
2oz of these mixed herbs:
rosemary, sage and garlic
2 TBSP sea salt
2oz of these mixed herbs:
yarrow, calendula, lavender and rose petals
2 TBSP sea salt
½ oz uva ursi leaves
½ oz yerba mansa root
½ oz marshmallow root
½ oz calendula blossoms
2 TBSP sea salt
½ oz yarrow aerial parts
½ oz witch hazel bark
1 oz comfrey leaf or root
3-4 cloves garlic
2 TBSP sea salt
#6 (steep this recipe for as long as possible, even over night)
½ oz yarrow
½ oz mullein leaves
½ oz sage
½ oz plantain leaves
½ oz calendula flowers
1 oz comfrey leaves
½ cup sea salt
Other appropriate herbs that you can steep for the sitz bath, include goldenseal and oak bark.
After you are done, dab the area dry and allow to air out before dressing. To clean the sitz bath, simply rinse and towel dry, there is no need for any cleaning solution.
To aid healing, add 3-4 grams of vitamin C with bioflavinoids, 25,000 IU of vitmain A, 400 IU of vitmin E in the form of tocopherols, anti-inflammatory omega-3 fatty acids (fish or flax oil) and 1 gram of protein per ½ lb of body weight.1
1 – “The Art of the Sitz Bath” by Adrienne Leeds Midwifery Today Spring 2003
2009 © Associated Content, All rights reserved.
Website of the Month:
Book of the Month:
by Sheila Kitzinger
Online Video of the Month
What is Birth a Miracle Services?
Birth a Miracle Services is the name of the birth doula and childbirth education service that I started in 2002.
A birth doula is a person who offers informational, physical, emotional, spousal, and advocacy support to women through pregnancy, birth, and the early postpartum period. I also offer traditional childbirth preparation classes, birth art classes, and childbirth counseling.
All of this is available to women within an hour of my home in West Paris, Maine for a sliding scale fee. Single, teen, and low-income moms can receive my birth doula support for free.
For more information visit my blog:
I am proud to announce the birth of my first book, Inspired Birth: A Fresh Perspective for Christian Maternity Care Providers. It is an inspirational guide for all Christians who attend women in childbirth, with fresh ideas on how to meet the emotional and physical needs of childbearing women while addressing current challenges to American maternity care. This book is still in the editing process and is not currently available for purchase, but if you know any Christians who are doctors, nurses, midwives, or doulas, please let them know that this book is on the way!
Request for Contributions
Next month’s topic is inducing labor. If you have anything you would like to contribute, such as an experience with induction that you’d like to share, please email your thoughts with the subject line “Monthly Doula” to Kilbrethfamily@yahoo.com . Thank you!
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