Wanna Get Engaged?

Twice this year I've heard of sections being performed for "failure to progress."  As a birth worker, this term can mean many things, but typically has to do with the OB's definition of "progress", which is practically synonymous with "velocity".  How far has your baby moved in a given time?

It's true some labors are long.  Really long.  And some labors stall- which depending on who you are may or may not be such a bad thing.

Sometimes a uterus is tired and contractions need to stop and mother rest before labor is completed.  Sometimes the baby's head is presenting non-traditionally.  The mother may be dehydrated, have an emotional block, or there may be an issue with the cervix.  And yes- sometimes the baby's head can be "too big."  All of which lead to a prolonged labor and if not changed, a diagnosis of failure to progress. (birthingnaturally)

In the cases I reviewed, exams revealed the baby had not descended and in one case, dilation had "stalled" around 7cm.  In both cases, mothers had an uncontrollable urge to push.  Good?  "Bad"? What's a mother to do?  Well, I may have some answers.  First- a word from our sponsor-  err rather- a blog I admire:

 

Before we ask for help from medicine may I suggest we evaluate what's actually going on in your labor? Did walking around get us quickly from 1 or 2 to 5cm before we got in the shower? Sometimes though it may be less comfortable- going back to what worked before may be the answer.  When did you eat last and how long has it been since you've had a sugar boost?  Are you sure you're fully hydrated?  Mothers in active/cranking labors will rarely eat- and often if they do- their body simply will reject it.  A way around this can be small bites or sips of something energizing.  Drink.  If you can't, seriously consider an IV intervention.

Next to address is getting the baby into the pelvis.  Opening mom's pelvic bowl and making an engraved invitation to baby to fit into the space given.  Doulas- PLEASE carry a needle and hand pump with you to your births.  I can't tell you how many times I've pumped up an under-inflated hospital birth ball.  Mom- have a seat on a firm and appropriately sized birth ball and start rolling your hips in circles (pretend your hula hooping) or figure eights.  Feel your pelvic bowl stretch and visualize your little one moving into the space.

Abdominal lift- mom leans with her back against a wall, feet 6in from the wall and shoulder width apart, knees slightly bent.  During a contraction lift baby/belly with your clasped hands and "place" the baby into your pelvis.  Repeat for ten contractions.

Combine the two above.

As I've never used this third technique, I'll link to it and plug a little bit of Spinningbabies.com - one of the best baby positioning resources evah!  Filled with good research, illustrations and videos, I highly recommend birth professionals have a shortcut link on their smart phones to be accessed on the fly.  Spinning Babies refers to a technique called the "Walcher" method to engage baby.  The idea is to position mom with her hips elevated in such a way to open her pelvis front to back.

 

Lastly, I invite the birth team to try to "turn the page" in labor and consider whether there is pressure from the mothers support team, her doctor, you, or herself even to "get this baby moving."  Have the mom affirm-  "I TRUST MY BODY.  I TRUST THIS BIRTH."  A bold support team may ask for such an affirmation of the mother from the doctor.  This usually goes a long way for mom.   A relaxed and confident mom can open much more easily than one under pressure.

 

Finally to address the case where mom feels the Ferguson's reflex before dilation is complete. Professional opinions do vary.  Take mine with the weight it deserves- and know that I'll never give advice here without a credible resource to support it.  In this case I say consult your OB or midwife and have your doula show them this article from Midwifethinking.  It explains the anatomy and physiology of an engaging baby in the birth canal and how a baby's head in some cases facilitates the completion of dilation.  When faced with a client who experiences the uncontrollable urge to push AND a direction from her nurse or doctor NOT to- I offer the grunt/clenched jaw approach. Essentially I ask the mom to expel the energy of the push upward rather than down at the vagina. Eventually the direction of her energy will turn, but sometimes this is a happy medium between letting her body do it's job and keeping from putting too much pressure on her undilated cervix. Still, it's important for mom to recognize in a case like this, that her body knows better. Better than her nurse, her doctor, her doula, and even her logical sense of what is happening in a given contraction.  

 

In the end- the cases I reviewed ended in healthy babies delivered in less than ideal circumstances. The moms in their own time came to understand the progression of the choices they made for their births and integrated the experiences in a healthy way.   When interviewed regarding their feelings about their labors one mom had a profound reflection.  "Just because I would have done it differently doesn't mean that I did it wrong."   

It does bear repeating that there are no guarantees in birth.  Our tools help overcome some of the challenges that labor can bring- but always remember that there is a divine component to this process.  It is something beyond any human control.  It is something that requires surrender and trust.  It is the essence and the joy of birth.

Additional Resources:

http://www.birthingnaturally.net/birth/progress/slow.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595201/

http://www.webmd.com/baby/guide/prolonged-labor-causes-treatments

http://walkingwithdancers.blogspot.com/2012/05/helping-baby-engage-at-end-of-pregnancy.html

http://www.mumsnet.com/pregnancy/labour-and-birth/transition-and-second-stage

http://www.cafemom.com/group/14077/forums/read/15857916/pushing_when_not_fully_dilated

Dad I Have A Message or You

Dear Dad-

There is So so much I want to tell you while mom is not around.  I want to tell you that this birth is a memory for you too.  I want you to know that what you think and feel and need in this birth is important too- and that what your feeling about this birth and this baby has tremendous power. Please use it wisely.

I remember a birth several years ago where mom had a prodromal labor.  Prodromal labors can be tricky in that they can indicate either a labor that WANTS to start but cant, or a labor that is getting ready to begin.  regardless of the reality, it can be very discouraging for mom.  Often she may feel conflicted emotionally- not knowing quite what to do with her frustration.  She's tired, but can't rest because contractions keep her awake but moving slowly. After some time (and the doula's methods to start things going have proven ineffective) there's not a whole lot anyone can do but truck along with mom for this chapter of the birth story-  oh-  and try to keep a perspective on it all.

Dad- you're up.

Because you know better than the doula how mom copes with frustration.  Doulas know how moms cope with exhaustion, but dad- you've been here before- when you were lost together on that road trip and she was mad that you wouldn't stop for directions.  Or the time you forgot her birthday.

Oh, that's just me? ;)

Dad- you have the words.  You really do. You have the words to help her remember that this is actually going to be great. That she's doing this for all THREE of you. And you can begin thanking her for her hard work right now.

This dad (one of my favorites) and I had mom sitting on a low stool and leaning into him for each contraction.  mom switched it up and preferred to move with each one and instead came to rest leaning on him.  dad- welcomed his wife to rest with tender arms around her and came close to her ear.  He whispered.

She reached up and embraced him, and they held each other there for the next six minutes.

Throughout the labor they came back to this place; a private space where only he could reach her.  I wish I could tell you what magic things he said- but I wasn't there.  I'm sure it went something like this:

"I know i'm supposed to say your amazing but really you are beyond what words I can find."

"I am so grateful you are doing this for our son!"

"I know it sounds crazy but you look so beautiful right now- I'm reminded of when I first saw you *remember?*"

"I'm really proud of you."

 

Dad-  Trust me I know when she needs to go to that place.  But I trust that you know what to say when she gets there.

The "Why" of Birthmark Doula

It always amazes me how quickly time flies.  I can think things like "just five years ago..."  not realizing that SO MUCH has changed in that time.  For instance, "just five years ago"  I hadn't heard of Facebook and only thought I knew what a doula was.  Just five years ago my husband and I were dreaming about possibly expanding our family.  Just five years ago I was a process engineer for a major manufacturing company.  The core of who I am and what I love has changed so drastically in "just five years."  My circle of friends and influencers has changed... as has my circle of influence.

Which is the reason for these key thoughts on birth.

As time has marched forward I now find myself answering questions about birth almost as frequently as I ask them.  I've noticed that my research isn't as straightforward as it used to be. I look at specialized topics now where the available knowledge is evidenced based rather than empirical. I now dig to answer questions like:  WHERE the body of research a given topic comes from. I now think about WHY there is (relatively) scant data on a given topic and how to ethically add to the information that is available.

I've come to a first name basis with practitioners.  I've taught a class or two.  I've seen women empowered by what I have shared with them.  And I want to share with as many people as I can as a doula and childbirth educator now. Here I offer a repository and in a way a catalog for the research I've done along with conclusions regarding the information available.  I hope that some of what I share ends up being wrong.  Yes, you read that right.  I hope that some of what I publish here is eventually outdated because someone thought to question HOW or WHY obstetrics and pediatrics are what they are today.  I hope to gain for myself, from a dissenting opinion that drives me to search further for a picture of what the best standard of care for women should be.

Through these key thoughts I hope you come to a determination on how I can help you have your best birth. You may determine that I'm not the best doula for you.  In that case I sincerely hope I help form your idea of what your ideal doula should be.  And if I can help you find her, I will!