Childbirth Companion

Our daughter was twenty months old when I gave birth to our second child. This pregnancy had gone very differently. Although I’d had some swelling in my feet, none of my previous complications showed up....When the doctor arrived, I was still hanging out at 9 cm dilated. The minutes ticked by and still no progress. He kept checking me, and I began to worry that at the last moment my body might be failing me.....

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Did you know that your baby’s position for birth may impact the length and ease of your labour as well as your success with a vaginal birth? This isn’t specific to just breech babies. Even those presenting with their heads down can influence labour and birth outcomes. The most common reason given for preforming a cesarean section is Failure to Progress (FTP) in labour. This is often a catch-all phrase that fails to specify what was really going on and more often than not would be better described as “failure to be patient”.

So, what would cause a labour to reach of point of apparent non-progression? Women are commonly led to believe that it is a fault in their own bodies or the size of the baby in proportion to the mother’s pelvis. However, there is much more related to this physiological process than a cursory glance may detect.

Of huge importance is a woman’s need to feel safe and comfortable with her environment and with those surrounding her during labour. If she is uneasy or fearful, she may produce too much adrenalin which can supress the birthing hormones, in turn affecting her labour progress.

The high rate of inductions is another contributing factor to a slow or dysfunctional labour. While induced labours may be prodded along faster than a spontaneous one, this speedy approach can force things to happen too quickly, not allowing the mother’s body or her baby enough time to adapt and maneuver adequately. In the end this can result in the cervix not opening completely or the baby not moving down through the birth canal.

Impatience can also play a large role in labour progress or, more accurately, the lack of progress. Some women and babies simply need more time than many policies and practitioners allow for.

What of the phenomenon that a woman’s pelvis can be too small and/or her baby too big? How does this explain the smaller or average size woman who gives birth to a large baby with apparent ease in contrast to a larger mother who ends up delivering her smaller or average size baby by cesarean for failure to progress? It is thought that our modern, often sedentary lifestyles may cause our pelvises to become compressed and misaligned. When we consider our counterparts of 50 – 100 years ago, the modern woman spends much more time at a desk, traveling in a vehicle, assuming semi-reclined positions, and, in general, being less active. Since babies will seek the path of least resistance, they may end up in a breech or posterior position or some other form of misalignment. So, we must look at ways to remain proactive in our prenatal health, in preparing our bodies for birth, and in encouraging our babies to assume an optimal position.

There are self-care recommendations that a woman may utilize to promote pelvic flexibility and the baby’s ideal position. These include self-administered round ligament massage, as directed by a chiropractor, activating certain acupressure points, taking quality prenatal supplements, getting regular exercise, and using techniques such as standing figure 8’s (i.e. belly dancing) to aid in good pelvic flexibility and alignment. Pregnant women should also avoid reclining chairs and cross-legged positions as well as prolonged, repetitive motions, and one-sided stances such as carrying a toddler on one hip or a bag on one shoulder.

Despite their best efforts, many women still encounter various discomforts in pregnancy and approach birth with a baby that is not in an ideal position. They are more likely to struggle through longer, more challenging, and more painful labours. This often results in a greater use of pain medication and medical interventions, including cesarean sections. While there are various techniques and procedures that are often tried, particularly for turning breech babies, many are awkward at a minimum or invasive and even painful. One such technique is the External Cephalic Version (ECV), a medical procedure which entails a doctor or midwife manually manipulating the baby to rotate. There is, however, a proactive chiropractic approach relative not only to optimal fetal positioning, but greater comfort in pregnancy, and shorter, easier births. This technique may also offer a greater rate of success than an ECV as indicated by the International Chiropractic Pediatric Association (see link 1 below).

The Webster Technique, requiring specialized certified training of a chiropractor, addresses imbalance in the pelvis and tension in the uterus. By righting the pelvic misalignments and releasing the uterine tension, the baby is freer to assume the best possible position for birth. While often associated with aiding a breech baby to turn, the Webster is recommended to any pregnant woman even if her baby is already in the optimal position. Many mothers who have received regular treatment report experiencing fewer of the discomforts commonly associated with the prenatal period. The technique may also decrease the potential for a long, complicated labour by providing the baby with an unhindered path through which to navigate.

Many misconceptions and myths abound regarding chiropractic care in pregnancy. It is important to note that a Webster-certified chiropractor does not palpate for the baby’s position or manually attempt to turn the baby. The technique also does not involve awkward contortions or intense manipulation. Pregnant women need not be afraid of the procedure inducing labour or that it will cause a baby already head down to turn into the breech position. Since babies will move themselves along the path of least resistance, a relaxed uterus and well-aligned pelvis will only encourage the optimally-positioned baby to remain in its ideal placement. In short, the Webster Technique does not turn babies but provides a more conducive environment for the baby to rotate itself.

With high intervention rates and about 30% of North American women giving birth by cesarean section, it stands to reason that a proactive approach to optimal positioning is essential. If the causes for labour failing to progress can be rectified through simple preventative measures, imagine the possible reduction in unnecessary interventions and cesareans. These reduced uses of medical procedures would correlate with better outcomes for moms and babies and even save in health care costs. It is then important for women to take charge of their bodies, their babies, and their births by learning about their options and making informed, proactive choices.

To find a Webster-certified chiropractor in your area, visit http://icpa4kids.org/Find-a-Chiropractor. Gravenhurst and Muskoka area residents may consult Dr. Kelly McIntosh at her Gravenhurst clinic or visit www.gravenhurstchiropractic.com.

See also:

1. http://icpa4kids.org/Wellness-Articles/for-many-pregnant-moms-webster-technique-is-the-key-to-a-safer-birth.html

2. http://icpa4kids.com/about/webster_technique.htm

3. http://www.youtube.com/watch?v=ry7rHUFrx5M&feature=related

©2012 Stephanie Hayes, CD(DONA), CE - Childbirth Companion

He was baby number three with two sisters at home. The oldest was also born prematurely by induction due to the same complication – pre-eclampsia. When I realized that it was happening again, I thought it would be no big deal. We had been through this before; I could handle it again. But nothing prepared me for how our son’s birth would forever change the direction of my life....

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     Many individuals and organizations understand and promote the benefits of breastfeeding. A good many reasons also abound for why a mother should choose to nurse her child, not only in infancy, but into the early years as well. These benefits range from nutritional and immune system building properties, to convenience and financial savings, to bonding. God’s design for nourishing a young child is phenomenal, and we can find references scattered throughout the Bible relating to this natural connection between a mother and child.

     Breastfeeding is referred to in the Bible in a very natural, socially accepted light. Nursing mothers were mentioned specifically as ones that should be included when the people gathered together. Breasts that are “full of milk” symbolize bounty, fulfillment, peace and contentment. Many will acknowledge that children are a blessing of the womb, but what of the “blessings of the breast” presented in the same context? What did God really intend when He designed this feeding method for the smaller human beings?

     The symbolism of breastfeeding becomes very vivid when He describes Jerusalem in terms of a nursing mother. Through this we learn more of the blessings God has provided to an infant through his own nursing mother. Among them we see a child who will be satisfied, consoled, delighted, fed, carried, comforted, joyful (happy), grow strong, and benefit from a peaceful mother.

     Isaiah 66:11-14 That ye may suck, and be satisfied with the breasts of her consolations; that ye may milk out, and be delighted with the abundance of her glory. For thus saith the LORD…I will extend peace to her like a river… then shall ye suck, ye shall be borne upon her sides, and be dandled upon her knees. As one whom his mother comforteth…your heart shall rejoice, and your bones shall flourish like an herb:

     A baby obviously uses the breast for nourishment, and we see growth as his “bones flourish like an herb”. Although the scientific properties are not given here, it is clear that breastmilk is hugely beneficial to the child’s development. And we know that breastmilk contains not only nutritional value but antibodies that help to develop and strengthen the baby’s immune system.

     The infant is also satisfied at his mother’s breast which would indicate a plentiful milk supply and good access to it. When a baby comes off the breast after a long period of sucking but still acts hungry and dissatisfied, that is a good indicator that he likely wasn’t getting all he needed. Although this could be due to a low milk supply in the odd occasion, the more likely problems are related to the quality of the baby’s latch and his activity at the breast or lack thereof. If the baby is poorly latched, he will not be getting the full flow of milk that should be available to him. As well, if he is just content to suck at the breast without actually drawing out the milk (milking the breast), he is not going to have a full tummy and, of course, will likely be dissatisfied after the feeding is assumed to be done. For this reason it is important that the mother learns how to tell when her baby is properly latched and swallowing at the breast to ensure that his nutritional needs are being met. In this regard, quality of time is most important rather than quantity of time.

     Although nourishment is of huge importance, there is far more to breastfeeding than just eating. We also see that a child is meant to be consoled and comforted at his mother’s breast. Even older, weaned children often instinctively bury their faces in their mother’s breast when seeking comfort and soothing. There are times when a baby simply needs to nurse for comfort and not for food, when he’s not interested in filling his stomach, just in sucking. A mother should not feel guilty about soothing her baby this way or worry that she is spoiling him. She is fulfilling God’s design for nurturing her little one.

     It also is apparent that the breastfeeding mother is inclined to carry her baby by her side (very likely to readily nurse him as needed) and bounce and play with (dandle) him on her knee, showing the close physical connection between them. Because his needs are so closely knitted to her ability to provide, it is quite natural and logical that the infant’s mother will choose to keep him close to her day and night. This closeness and comfort near or at his mother’s breast produces a happy, delighted child and a peaceful mother. This has been proven scientifically. When a baby nurses, hormones are released in the mother that cause her to relax and become enamoured with her wee one. Many women find breastfeeding euphoric and calming to themselves as well which helps to enhance the bonding between her and her infant.

     It is amazing to see that the things we have discovered about the intricacies of breastfeeding and bonding have been laid out by God long before medical and scientific studies proved them. This should encourage women in their breastfeeding abilities as well as in the completely natural and nurturing proposes of a child at his mother’s breast.

 KJV References: Joel 2:16; Job 21:24; Genesis 49:25; Isaiah 66:11-14

     In looking back over the changing tides of health care for the birthing family, we may come to wonder how much is truly for the benefit of the primary individuals involved - the pregnant mother and her unborn baby. Do women really have options and a voice about what goes on during their labours and births? Or is this simply an illusion that clouds a reality of a litigious, systems-oriented society that no longer has faith in a purely natural, physiological process – the age old art of childbirth?

     As women begin to question their birthing rights and freedoms, there is a drive to become more informed about their options, and to take back birth. But what is “informed choice”, really? Is it a real, viable option available to expectant mothers, or just a phrase coined to make us feel more in control? And what if we want to choose to say “no” or to utilize an unconventional option? Will our wishes be honoured, or will we be pressured and guilted into complying with the policies and procedures primarily designed for the political comfort and security of the institution rather than the emotional and physical wellbeing of the birthing woman? Will unbiased, clear, detailed information be provided to assist us in making a well-informed, educated decision, or will it be minimal and tanted in a way that is intended to steer us in a direction which confines us to the comfort zone of another whose birth experience this is not?

     To understand this more fully, we need to explore the phenomena of Informed Choice and its sister entities, Informed Consent and Informed Refusal. Each woman must know what this means in relation to her rights and her caregiver’s responsibilities. It is more than saying yes or no, and goes beyond simply signing a consent form. Each birth is unique with its own set of circumstances, and it is important that all those involved enter it with an open mind and a willingness to think outside the box.

     Informed choice means that the mother has reviewed what has been revealed, and based on that information, makes choices about her care, determining what she will or will not consent to. Medical practitioners must provide a mother with all relevant, unbiased, comprehensible information about a procedure or treatment prior to obtaining her consent to carry it out. This information must be provided in terms which she understands, covering the nature of the procedure, its risks and benefits, the availability of alternative treatments (including no treatment at all) along with their risks and benefits. As long as the pregnant woman is mentally and physically able to discuss her condition, medical care cannot begin unless she gives informed consent. And if she declines? A mother has the right to refuse any test or procedure for herself or her baby. With informed refusal, the health provider must inform her of the risks or consequences of refusing treatment, procedures or tests.

     Informed choice should not be about any one person vying for control over another or imposing their will on another. It should be about open communication between the expectant parents (the mother in particular) and their caregivers, with consideration for each one’s position. When placing her care in the hands of her medical provider, the mother is assuming that her best interests are at heart, so it is important that she is willing to consider her caregiver’s point of view. However, the same respect should be given to her feelings, wishes, and concerns as well. The pregnant woman has the right to hear the truth about birth, and not fear that the information she receives is biased or unfounded. It should be assumed that she will have full participation in all decisions regarding her care and that of her baby. Risks and benefits of any procedure or treatment should be explained clearly in terms that she understands, leaving her with the right to choose among available options or to refuse them altogether. A signed consent form or birth plan does not inhibit her from changing her mind at any time, and it is always within her rights to obtain information that is satisfactory to her, prior to her acceptance of a procedure or treatment.

     Now this may all sound well and good, but we all know that things don’t always go the way they’re intended to. How will you remember what questions to ask or if you’ve received good information? What if you don’t feel that you’re care provider is very open to your wishes or concerns? Or maybe during a busy shift change, the new staff members didn’t get a chance to review your birth plan before initiating care.

     We know that when a woman is in labour, it can be challenging for her to be aware of everything that may be going on, so she will undoubtedly benefit from having the assistance of her support team. Her husband can be specifically helpful in relaying her wishes and fielding questions due to his intimate connection with the birth of their baby. However, sometimes that can be overwhelming even for him, and the advocacy of their doula may prove invaluable. With her experience and knowledge of birth and alternative options, a doula can assist the parents in gleaning the information necessary to make informed choices. Ideally this will begin prenatally in preparation for birth, but may also become necessary during labour.

      Remembering the right questions to ask may not come easily, but this simple acronym may be helpful in “using your brains”.

B enefit – What is the benefit in moving ahead with the recommended treatment or procedure?

R isk – What about the risk involved?

A lternatives – What other options could we explore?

I ntuition – Don’t ignore your sense of intuition. Give consideration to your feelings as well.

N othing – Could it hurt to wait? Proposed interventions don’t often require immediate action.

S mile – When asking questions and stating your wishes, it is important to offer your caregivers the courtesy and respect you desire from them as well.

Questions to Consider Before Giving Your Consent

• How is this helpful to me or my baby?

• Are there any risks involved?

• Can you recommend a safe alternative including waiting? Their advantages? Disadvantages?

• How will this affect my labour? My baby?

• Will this procedure require the need for others, or can it lead to others?

• Do I have time to think about this and give you my answer later?

• If I choose not to go ahead with this recommendation, what possible consequences could there be for me or my baby?

• How do you feel about me getting a second opinion?

References

• http://www.birthinternational.com/articles/andrea10.html

• http://www.trustbirth.com/

• http://www.infochoice.org/ic/ic.nsf/welcome_consumer?openform

• http://www.acegraphics.com.au/articles/subjects.php?subject=cbe

• http://www.cancer.org/docroot/ETO/content/ETO_1_2X_Informed_Consent.asp

• Gentle Birth Choices, by Barbara Harper

For more information regarding doula care, birth planning, and informed choice, contact, Childbirth Companion.