Pushing

Click here for an excellent and comprehensive post on pushing.

h/t to Molly for the link

Advertisements

Birth and ear infections

This is anecdotal, and as far as I know, there is no research into this topic. I don’t expect there to be research into it, either, because of the prevailing medical opinion from doctors (who often think the “MD” after their name stands for “minor deity”).

I wonder how many babies and children have ear infections because of their difficult births. Seriously.

When MJ told me the story of her second child’s birth, or rather, what happened afterwards, because of the birth, she said that her son “took a baseball bat to her tailbone on the way out.” Her tailbone was literally broken during the birth, but she didn’t know it until months afterwards. She had had an epidural of course, same as with her first birth. When giving birth to her first child (different hospital, different state, different everything), they wouldn’t top off her epidural when she was pushing because they wanted her to be able to feel what she was doing. With her second, they gave her a second dose, and she said that she thought it was more helpful to her to be numb, because then she wasn’t distracted by the pain, and could concentrate on pushing. While that’s certainly possible, I wonder if it was worth it, all things considered.

One blogger likened pushing with an epidural to getting a shot of lidocaine at the dentist’s office. You move your mouth, or you think you’re moving your mouth, but you’re not really sure, because you can’t totally feel it. You’re doing your best, but you’re still numb so you don’t know if it’s really right. (And considering the number of words I’ve slurred, or the food or liquid I’ve spilled when my mouth was still numb, it’s pretty obvious that many times it does not work just right.) I like this analogy, but have never had an epidural, so don’t know its accuracy from experience.

So my friend was nice and numb, which is what she wanted at the time, but I think she also was in a bad position for birth, and didn’t know it. Had she been able to feel, she probably would have realized she was uncomfortable (or perhaps in a downright painful position), and would have made an adjustment so that she was more comfortable. The fact that the tip of her tailbone broke is evidence to me that she was not in a good position. Of course, having an epidural, she was pretty much sitting on her tailbone in a C-position or lying supine, which makes it difficult for the tailbone to flex outward, which it naturally does when a baby’s head passes it. In her case, I think her position made it impossible for the coccyx to move, so it broke.

She didn’t feel it then, but she sure did over the course of the next several months when she couldn’t sit comfortably except with the donut ring (and sometimes not even then)! So I wonder if it was really even worth it for her. Not that one can travel backwards in time anyway, but if I wonder if I were to go to her when she was pregnant and tell her that if she got an epidural her tailbone would break and she’d be unable to sit comfortably for any length of time for six months after the birth, if she’d still get an epidural. But that’s neither here nor there. What happened happened. Enough background.

This baby had multiple ear infections in his first year of life, and he had no risk factors for it. He was exclusively breastfed (even when he started eating baby cereal for his first solids, his mother mixed breastmilk in it); he did not go to day-care, nor was he around a lot of other little children. His older brother was 3, but he didn’t really go to a lot of friends’ houses and bring back germs, etc. But he still had one infection after another, at an average rate of one infection a month. The pediatrician eventually referred him to an ear nose and throat doctor, who recommended ear tubes. Of course. She actually had the surgery scheduled, when I mentioned chiropractic.

My older sister started getting ear infections as a teenager after being thrown from a horse. She got no help from a medical doctor (the first time he looked in her ears, he said they were too infected and he couldn’t see anything; two weeks of antibiotics later, he looked in her ears and said they were clear so he couldn’t see anything). My mom had trouble with her back (a swing fell underneath her years previously), and was seeing a chiropractor, and mentioned the ear infections to him. Although she had to go frequently for the first few weeks, after that she was just on maintenance visits, and never had another ear infection. This was after having many multiple infections.

So, I mentioned this possible course of treatment to MJ. She was naturally skeptical, but decided that she really needed to exhaust all alternatives before choosing what was possibly an unnecessary surgery for her son. She had plenty of reason to be concerned about the infections — her older son also had many ear infections as a child, and was delayed in speech because of it, and she didn’t want her younger son to be likewise affected. But she decided to give it a try.

When she told the pediatrician and the ENT (she had to cancel the tube surgery), they pooh-poohed it, said it wouldn’t work, she was wasting her time and money, her son (who had an active ear infection at the time) would never get any better without the surgery, etc., etc., etc. A week or two after starting chiropractic adjustments, his ear infection was cleared up (without antibiotics), and he never had another one.

These ear infections started within a few months of his birth. There was nothing physical that happened to him that would account for a messed up neck or back causing an ear infection — he wasn’t crawling, rolling over, falling off of stuff, bumping his head into walls, etc. But one thing he did have was a difficult birth — as evidenced by his breaking his mother’s tailbone on the way out. The chiropractor said that he often saw cases like this, and he said it was many times due to the manipulations doctors do to babies in getting them out — both vaginal and Cesarean births. In fact, he said that oftentimes babies born by C-section are even worse, because doctors will pull these babies out by the head, putting a great deal of stress on the head and neck area, much more than in a vaginal birth, in which mothers are pushing their babies out, rather than having their babies pulled out of them.

Makes sense to me!

Add to FacebookAdd to NewsvineAdd to DiggAdd to Del.icio.usAdd to StumbleuponAdd to RedditAdd to BlinklistAdd to TwitterAdd to TechnoratiAdd to Furl

Some great articles

I hope you have The Unnecessarean blog on your blog roll or Google Reader or however you keep up with blogs you like to read. She’s had some really great stuff in recent days, and rather than just link to every article I like, you might as well just add her so you can read it when I do. 🙂

But the most recent one, on shoulder dystocia, in addition to being well-written and well-thought-out, has several great links. Including this one, which is so good, I just have to link to it myself!

It’s a birth story written by a doctor of a woman whose last two children both had shoulder dystocia, and what she (the doctor) learned between those births that made a difference. (Both babies were fine, but the births got understandably tense after the distinctive “turtling” of the heads indicating shoulder dystocia was remarked.) Apparently, the doctor discovered that natural birth advocates had picked apart the first baby’s birth story for the doctor not using the Gaskin maneuver (turning the mom to hands-and-knees) to resolve the shoulder dystocia, and she had replayed the baby’s birth in her head thousands of times and learned more about the Gaskin maneuver after that birth, and decided to use it the next time SD was apparent. Very cool story.

Update: I decided to read more of this doctor’s blog (having read a post from it some months ago — I’m pretty sure I recognized the name and design, anyway — I think it’s the kind of thing I’ll like, so added to my Google Reader), and the post immediately after the post I linked to indicated that apparently this doctor had been “Tuteured”! Not only did she link to the comment thread (I didn’t click, but I recognized the URL), but one of the comments she quoted was easily identifiable as coming from the keyboard of none other than Dr. Amy. If she didn’t write “Rural Doc…gives the impression of not knowing what she is doing sometimes,” then I’d be very much surprised. (I would say “I’d eat my hat”, but there is just a small chance that one of her comrades wrote it, and I don’t like the taste of velvet or straw — I have two hats, one black velvet and one cream-colored straw, and neither one looks particularly delectable, just on the off-chance that Suzanne or somebody else wrote such an arrogant, condescending sentence.) Knowing that she’s drawn the ire of Dr. Amy makes me like “Rural Doc” better than just about anything else could do. 🙂 So when you go to the blog, make sure you read the “next entry” as well.

How is this possible??

In researching another topic, I came across this article:

Dystocia rate constant despite risk factors: parity, c-section, birth weight studied.

Here is an excerpt:

Shoulder dystocia appears to occur at a constant rate, despite increased cesarean sections and variations in other risk factors, Dr. Michael Lucas reported at the annual meeting of the Society for Gynecologic Investigation.

“It seems counterintuitive,” said Dr. Lucas of the University of Texas, Houston, in an interview. “There’s this notion that if we manipulate the risk factors we should see a lower rate of shoulder dystocia, but that does not appear to be the case.”

His study of more than 12,650 births in two Houston hospitals showed a similar rate of shoulder dystocia, despite differences in the risk factors of parity, birth weight, cesarean delivery, and operative vaginal delivery between the two hospital populations. The findings could have implications in the defense of shoulder dystocia cases.

“The argument has always been that there are risk factors for shoulder dystocia, which the physician should have acted on,” he said. “Our data suggest this is not true. It may at least be argued that we can take a population with a much different rate of risk factors and have virtually the same rate of shoulder dystocia. This is important clinically, because it supports the notion that our options and our ability to avoid trauma with this complication are limited.”

Shoulder dystocia happened in only about 1% of all cases in this study. For it to be roughly the same, despite wide variations of “known” risk factors is… interesting to say the least. Maybe it’s time for doctors to start looking at other causes and other forces. Like, iatrogenic shoulder dystocia — shoulders getting caught because the mother is lying on her back, with pressure on her coccyx making it unable to naturally move backwards as the baby moves past it, as well as her not being able to be in a squatting position, which widens the pelvic outlet by a couple of centimeters (without episiotomy). Maybe the baby having to fight against gravity (actually pointing upwards to get past the fixed tailbone) has something to do with it. Maybe the baby not being able to shift and rotate naturally because the mom is not allowed to position herself in such a way as to allow the baby’s shoulders to come free, has something to do with it.

Nah! Can’t be! There’s gotta be some other reason. Like, maybe they were born in a full moon. Or a new moon. Or the moms were wearing green socks. Or had sips of water instead of just ice chips. No — I’ve got it! — it’s because the moms were born under an unlucky sign. Doctors should have to take astrology and determine if women are at a cosmic disadvantage before allowing them to give birth. Maybe it’s karma — she did something bad in a past life, so now she’s getting paid back… or maybe the baby did something bad and his having shoulder dystocia is paying him back for being bad in a past life.

I don’t know what it is, but it’s gotta be something! Because cutting women open for no other reason than that they appear to have one risk factor for shoulder dystocia doesn’t seem to change anything.

Maybe the nurses had pink underwear? …or red hair? …or…

Squatting

When I was pregnant with my first child, my childbirth instructor recommended squatting as an exercise (along with walking, pelvic rocks, etc. — start off slow and build up in either duration, frequency, or both), either as beneficial in general, beneficial in pregnancy, or to make us feel more comfortable about squatting which is a natural and effective position to give birth in. Later, I heard that squatting as a form of exercise may not be the best thing to do while pregnant. The reasoning behind this is that while squatting is normal and natural, most Westerners have lost the ability to do it since they just don’t squat much if at all. So, trying to learn how to squat when heavily pregnant may cause strain on muscles that are unaccustomed to bearing the weight or doing the activity… as well as being just plain awkward, or setting you up for a fall, or what-have-you. With the lovely pregnancy hormone relaxin kicking in, you can more easily over-extend yourself when stretching, and squatting is a form of stretching, so it is wise to be wise.

That said, it would be beneficial for all of us — men and women alike — to get more used to squatting. One precaution should be given, however, which I learned the hard way. I was having trouble getting into a squat (although my two-year-old does it easily and effortlessly — makes me jealous!), so “compromised” by keeping my heels off the floor, balancing on the balls of my feet and my toes (and I stayed there a while). Big mistake! For the rest of the week — and it is still a little sore on occasion — that area of my left foot was sore. Most likely, I had overstretched it, or just overused it, by my mini-marathon of squatting. So, start slow and build up. Don’t feel like you have to squat like a toddler straight off. Remember that your body is probably used to sitting in a chair and most definitely not used to squatting, so treat it like any other position or exercise. You wouldn’t go from being a gold-medal couch potato to running a marathon in a day, so go easy on squatting. Just as you would start with walking around the block and work your way up slowly to walking or running a mile or five or ten, so you should squat for a little while and build up.

If you’re already pregnant, be even more cautious. If you’re not pregnant, start now, so that you don’t have to start new while pregnant. Listen to your body; go slow. Remember that the muscles you use while squatting have probably not be used — at least in this exact way — for many years, and it may take some time for them to adjust to bearing your weight.

The problem with squatting — or not squatting, as the case may be — came from our history of chairs being “proper” and squatting being “primitive.” Girls are especially coached not to squat, if they’re wearing skirts that don’t come well below the knees, because otherwise they show their panties. Even if they’re wearing long skirts or even pants, it’s still not considered ladylike to squat. Maybe not very ladylike, but that’s too bad! When I injured my foot, as I mentioned above, I was squatting (deliberately) and feeding my younger son who was standing. It felt good to squat (very healthful and counter-culture, like eating something vegan at a steakhouse or something), but after a little while, my mother pulled a chair over to me, because I looked “uncomfortable” to her. How many times do we do something, or refrain from doing something, because it makes another person uncomfortable! (Although in this particular case, even though I was not uncomfortable, I was over-doing it, as I found out later.)

I can do the splits. Something made me decide to learn when I was about 16 years old. If on that first night it came into my head to do the splits, I decided to successfully do the splits, do or die, I would have definitely injured myself. Instead, I stretched my feet as far as I could (which wasn’t far) and got as low as I could (which wasn’t low). And every day I got a little more limber, was able to stretch a little farther and go a little deeper. One day (probably a month or two later), I was able to do the splits. And I’ve been able to ever since. I’m going to take that lesson in squatting, and start by doing supported squats, and not very deep, and not holding them for very long, and gradually work my way up until I can do them like my kids. As an adult, I’m used to doing everything better than children, so it’s a little humbling to look to them as my examples, but it’s the truth.

So, what do you think about squatting — do you squat on a regular basis? do you think it is good to do while pregnant? do you have reservations about doing it while pregnant? is there anything I’ve written that you disagree with? (I make no claims to perfection, and am always ready to learn) do you have any tips or other things to keep in mind?

Rose-Colored Glasses

I’ve been frequently accused of being optimistic. It’s a true accusation. I prefer to look at the bright side of things, to visualize the glass as half-full, to wear rose-colored spectacles — “la vie en rose.”

The most recent time was this past Saturday when I went to a baby shower, and got into a conversation with some of the other people there. The conversation naturally turned to birth — the mother-to-be is planning a home birth, and was discussing if the midwife couldn’t make it (having another client also due about the same time, quite some distance apart). Also, the mom-to-be said her mom had a 90-minute labor with her, so this is something which is definitely worth thinking through!

We began talking of a friend whose 3rd birth was only 45-minutes. It was a planned home birth, and the midwife couldn’t make it in time, the husband caught the baby, and a friend who lived down the road and had had a couple of home-births herself was also able to make it. (Had it been a planned hospital birth, the baby probably would have been born on the side of the road, because they would have been hard-pressed to make it to a birthing hospital from their home in less than 45 minutes — and that’s assuming they would have hopped in the car at the first contraction and not had to do something with the other two children!) So, anyway, in discussing this birth, one of the people in the conversation said that as the baby was being born, the husband was telling his wife things like, “Just let this baby be born” — in other words, “don’t push” — and other similar things. To me, that sounds like a pretty normal comment — soothing words, reminding her to slow down and not push too hard so she didn’t tear. In fact, I had something similar in my 2nd birth plan to remind me to take it slow to hopefully avoid tearing as I did in my first birth. (The funny thing is, my younger son was born much faster than my older son, and he was a good pound and a half bigger, and I didn’t tear.) Anyway, that’s the first thing I thought of when I heard the phrases he used.

Of course, most of the women there were not birth junkies, although a few had had home births and some had had several children — most had had typical medicalized hospital births, and wouldn’t know what a “doula” was if she walked up and gave them a honey stick! So I was defending this man, and the woman who was relating the story, even after acknowledging that she herself “labored down” instead of pushed when she was VBACing with her epidural, which is not too different in my (never humble) opinion from what this man was encouraging, said (in that “pat the little girl on the head” tone of voice), “You just keep your rose-colored glasses on, Kathy. But we know that he was just being controlling.”

It is possible that he was attempting to be controlling — he has that personality, and I’ve seen him be “controlling” a few times — but I honestly believe he loves his wife and his children, and was reminding her to slow down to avoid some potential problems, not being controlling.

They can keep their jaundiced-colored glasses on and be snide and miserable if they wish. Most gladly will I keep my rose-colored glasses on! It makes for a better life.

 

What does natural birth sound like?

This is probably one of the biggest questions people who have never given birth without pain medications or who have never seen such a birth might have — just in general, as well as particularly if they are planning a natural birth.

Here is a good video that shows a woman vocalizing through her contractions, and as the contractions increase in intensity, her “singing” or moaning also increases in intensity. While many of you may possibly be put off by hearing this (if you’ve never heard something like this before, only watching the medicated births on “The Baby Story” or “Discovery Health” or other similar shows), and may even feel more inhibited now, the reality is that when you’re in labor, the last thing you’ll likely worry about is what other people think of you. After all, if you’re allowing half a dozen people (mostly strangers) to stare at and touch your genitals possibly for hours, then how can vocalizing be any worse?!

One caveat, though, is that since most women have some sort of pain medication — typically an epidural — in the hospital, some nurses may be uncomfortable with how you’re sounding. It’s a typical human response — see somebody in pain and want to help them. Unfortunately, if you’re wanting to give birth without pain drugs, and the only “help” a nurse has available is pain drugs, then she can’t do anything and may feel bad, and may undermine your attempts and desire to give birth unmedicated so that she will feel better. (I’m not talking bad about L&D nurses that do this — I think many of them have the right desire, but just don’t have the right tools to help you; some nurses, though, will not be supportive and will deliberately undermine you just because you’re not fitting into their little mold.) I read a blog recently which is written by a newbie L&D nurse in which she said just this thing — that she feels bad for women in labor and wants to make things better, so she offers them drugs, since that’s the only help she has. I suggested that she take doula training (or at least read some books on what doulas do) so that she has more ways of helping women other than just giving them shots or calling the anesthesiologist.

But enough of the intro: here is the video (which I found by way of Empowering Birth blog)…

This doesn’t mean that every woman is going to vocalize like this. Some women sing, some pray, some chant, some moan softly, some keep it all inside. One woman whose birth story I read said that she felt like she was roaring loudly when she birthed her baby, but when she watched the video, she found that she was absolutely silent — all the “noise” she thought she was making was just inside her own head. I understand that. I felt like I was being loud, but my husband said he didn’t remember me making much or any noise. But this video is an excellent visual and auditory lesson (for anyone attending or giving birth) of what a real birth might sound like. Too many birth videos don’t show this type of thing — only the “sanitized” or “quiet” version. You know the type — where they cut the audio and start playing soft, flowery music. The video only tells half the story; without the audio, you’re missing a hefty dose of reality.

 

This poll allows repeat voters and is multiple choice, so if you have five children but only three birth videos, you can choose “yes” three times and the variations of “no” that fit the other two.

— Update — For some reason the poll associated with this question won’t show up in the post, so if you want to vote, click on “poll questions” in the right-hand sidebar and look for the poll that asks if you have videos of when your child(ren) were born. Also, just in general, if you choose “other” on any poll question, there should be a little box to clarify what the “other” is, and I always burn with curiosity when I see that somebody would do some “other” thing, and I don’t know what it is! (Yeah, I’m curious that way.) 🙂