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Birth Sensations & Protecting The Perineum Through It All

15 Mar

Birth-Sensations-&-Protecting-the-Perineum

Let’s talk about the perineum! (Yeah, high-five if you’ve got one – okay, it’s no secret everyone has one.) It’s a big concern among expectant moms, will my perineum make it out alive?

Sometimes in my childbirth classes I can literally see a huge floating question mark sitting on the tops of women’s heads. Like a thought bubble pleading silently, “Can you talk about vaginas, now!? Will mine ever look the same!? Will I be normal after birth? What will happen to my perineum during childbirth?”

Well, before we answer those questions we need to understand some of the sensations women may experience during childbirth and what we can do to protect the perineum through it all.

Alright, let’s dive right in, shall we? First let’s examine the vagina, or rather the vulva, and talk about the perineum and what happens towards the end of labor:

Screen shot 2013-03-14 at 1.33.42 PMThe perineum is the skin between the vagina and the anus, which thins out and stretches over the baby’s presenting part (usually the head) as it is born. (Source) During second stage (pushing) the perineum plays an especially vital role in the birth of the baby.

Okay, let’s talk about what’s going on down there as we approach second stage!

(“Down there” and “bottom” are lite and easy words that I use to describe the vagina, vaginal opening, vulva, perineum and rectum. These are the words my midwife used with me and I will use them with you! Okidoki?)

Building Pressure:

As baby descends and engages and labor deeply progresses, a woman will experience increasing pressure in her bottom as her pelvic passage begins to stretch open. Often, the stimulation sends a signal to a laboring mother’s brain that she needs to have a bowel movement. And sometimes that’s exactly what a laboring mother may do.

I’ve worked with a lot of moms who, while in the thick of labor, look up at me with urgency and quickly move to the bathroom. Baby’s decent stimulated her bowels. On occasion the laboring mother may have a genuine need to go (this is nature’s lovely way of making sure that doesn’t happen during second stage), or other times the mom may simply relax on the toilet, letting her muscles soften till she becomes more comfortable with these new sensations. Either response is totally normal.

Keep in mind, the pressure felt during birth is sometimes really alarming, because, let’s be honest here, we’ve spent our whole life learning to be discrete about the urge to poop. But in the case of childbirth (and possibly a few other occasions!) this sensation is cause for celebration, it tells us baby is descending and the mother is moving closer towards holding her baby in her arms.

Grunting:

Often at this stage in labor, you’ll begin to hear mothers grunt at the peak of their contractions. Imagine, mom is moaning through her contraction and suddenly her breathy bellowing goes like this, “ooooooooooooooh, oooooooooooooooooh, ooooo uh, uh, uh, uh, uhr, uhr, uhr, oooooooooh, oooooooh, oooooh”

Aha! That’s a great sound! Those short little grunty noises that mom just made in the middle of her contraction signal that her body is beginning to involuntarily push at the peak of her rush.

Stations-of-Presentation

As baby descends, increasing pressure is felt in the bottom and the rectum is stimulated.

Supportive Hands:

You’ll also sometimes see, as a laboring mother begins to feel that all-consuming pressure, that she will place her hands right on her bottom, cupping her groin and supporting her vulva. That’s wonderful and absolutely normal! Besides for giving her bottom additional support during this stage, it also allows the laboring mother to stay more in touch and in control of her body’s response to labor. What’s not to love!?

Pressure, grunting, and supportive hands are clear signs that birth is progressing…

Does that mean it’s time to push yet? No, not necessarily. It only means what she’s telling us from her body language: her bottom is feeling pressure, things are being stimulated, baby is descending and birth is progressing normally.

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Enjoy, Accept, Relax

At this transitional stage between first and second stage of labor, it’s ideal for mom to not add additional force (just yet!) as she begins to feel those early urges to push. As her uterus contracts, the bands of muscle thicken at the top of the fundus and begin to push down on their own, expelling baby further into the birth canal, this is the beginning of what will soon become a very strong urge to push.

It’s a good idea at this cross-road in labor to encourage mom to enjoy knowing just how well her body is working, accept the intensity of the change in sensations she’s feeling, and relax into her rushes a little more fully. This provides mom with an opportunity to wrap her brain around the idea of what the pushing urge feels like before diving right into it.

Powerful Pressure | Second Stage | Pushing

As labor thickens into heavy travail (an old Biblical word that I feel really adequately describes transitional labor) the intensity of pressure a woman begins to feel increases exponentially.

Baby’s head is now stretching the vaginal and pelvic floor muscles. Receptors in these tissues trigger involuntary pushing, and signal more oxytocin to the body – a complex hormone which stimulates contractions. (Source) A woman will now begin to feel the urge to push through almost the entirety of her contraction and not just the peak of it.

Mom will need reassurance at this point that she is okay, she needs to know that the pressure she feels is normal, and that even if she’s absolutely convinced she will birth her baby out of her butt, she will not. (Yeah, I said it.)

The intensity of the pressure is admittedly scary, but it’s also needed in order to bring forth baby into the world. And while it’s like nothing any first-time mother will have felt before, and can be utterly overwhelming, it is still very normal in terms of childbirth and not to be feared.

This is a doorway in labor that mothers walk through, there is no way around this passage of birth intensity, only through it. It is time to push!

Your-Baby's-Birth---Dr.-Miriam-Stoppard's-New-Pregnancy-and-Birth-Book

Please note, while these illustrations are fantastic, the information on step four regarding suctioning a baby is now contraindicated and outdated. Evidence now states that unless baby is unresponsive, suctioning is not necessary. Source: //www.ncbi.nlm.nih.gov/pmc/articles/PMC2666857/

Two Steps Forward, One Step Back

As mom pushes her baby down and out in that wonderful “J” shape of pushing, we’ll often see a little two-step dance, baby descends during the contraction, pressing on the perineum and the perineum begins to bulge and expand, and after the contraction ends, baby moves up and the perineum softens and relaxes. This happens over and over again.

This is a process my own midwives and mentors taught me to refer to as “two steps forward, one step back.” This dance is very important for the integrity of the perineum. It allows the skin to stretch slowly and gently, giving the perineum time to accommodate the baby’s head without tearing.

Ring of Fire

Once the head of the baby has firmly ducked under the pelvic bone, crowning will begin to take place. We use the term “crowning” to describe how the vaginal opening and vulva stretches around baby’s head looking like a crown.

As baby crowns, the labia and perineum begin to expand and bulge, this point is often referred to as the “ring of fire.” There is a lot of stinging and burning accompanied with the ring of fire, fortunately, it doesn’t last for too long, although we shouldn’t rush through it. This stinging sensation sends a message to the woman’s body to hold off on pushing. (Source)

(On a side note, sometimes as an exercise to describe the ring of fire to my students, I’ll ask them to stretch open the sides of their mouth with their fingers. I find this gives a good sense of the type of stinging that’s felt in birth. As a bonus, everyone looking ridiculous together usually gets us all laughing, which is always good when talking about crowning!)

During crowning it’s good for the laboring mother to stop adding additional force to her body’s own urge to push. Instead she should breathe out her baby and allow her body to do the work on its own. (This is something she has already practiced in birth during the transitional stage mentioned above. See, it all comes together now!)

You see, after the baby’s head is through the pelvis, only the tender perineal tissues are holding baby in (Source), and the mother needs to be mindful of not pushing too forcefully in order to protect this area of a her body.

How does she do that? She breathes her baby out…

Breathing Baby Out

Gentle, easy breaths that resemble panting allow the baby’s head to emerge slowly and tenderly, helping to keep the perineum intact. Actually, for many mothers breathing out her baby is an innate response to the ring of fire.

Think about it: a base response to pain, for all ages, are quick short breaths. I see my children do this all the time. A little high-pitched panting expression that happens when they’ve smashed their finger or stubbed their little toe.

Likewise, when mothers are left to labor without heavy coaching, at the point of crowning, you’ll sometimes see this panting and high-pitched breathing technique occur. (Watch some birth videos, and listen for that quick high-pitched breathy howl at crowning, and then you’ll start to see it all the time.)

Supporting The Perineum

Also, a mother’s hands may instinctively reach down again and apply pressure to her own perineum. Although, I should mention it’s quite common that you’ll see the midwife or OB apply slight counter pressure to a woman’s perineum at this stage too. Also, some care providers will apply a warm compress or olive oil to a mother’s perineum to assist in preventing tears.

To view a photograph of a crowning baby and a perineum stretching out beautifully in birth click this link from wisewomanchildbirthPerineum stretching in birth.

Once the baby’s head has fully crowned, it will only be another couple of pushes before baby is born. After the birth of the baby’s head, baby’s shoulders are delivered, and the rest of the baby’s body pours out from its mother shortly after.

It’s miraculous to see and testifies to the function and beauty of the female body.Women’s bodies are just amazing, y’all!

Mother-catching-her-baby

Image source unknown

There are a lot of things a woman can do that will increase her chances of having an intact perineum, here are a few of my tips, please note this list is not exhaustive or comprehensive:

  • Diet and hydration play a valuable role in the health of a woman’s perineum, for a great post on this go here: Protecting Your Perineum From The Inside Out
  • Practice pelvic floor exercises during pregnancy. (You may want to rethink Kegels, here’s a link that says why: Pelvic Floor Party, Kegels Are Not Invited)
  • A mother should avoid birthing on her back, but rather birth on her side, in an upright position, or on her hands and knees.
  • Warm compresses (not hot!) on the perineum during labor.
  • Avoid power pushing. Power pushing, or what is known as purple pushing, is when a woman holds her breath for long periods of time and pushes beyond what feels comfortable or natural to her body. This type of pushing increases a woman’s chance of tearing.
  • Avoid widely flexed legs. Knees should be pointing forward and not to the sides. Source | Source
  • Follow her own body’s cues during crowning and slow down her pushing.
  • Use a mirror, if she’s comfortable with that. Seeing what’s happening during second stage can help the mother connect to her body, and allow her to direct her body’s urges better.
  • The laboring mother should move to positions that are most comfortable for her during second stage. For example, the mother could say, “Before my next contraction starts, I would like to turn to my left side. Would you help me do this, please?”
  • Hire a doula! A doula reduces a woman’s need for an epidural and for forceps delivery, both of which increase the laboring mother’s odds of perineal damage.
  • The mother should find a care provider who supports birthing in ways which allow for an intact perineum.

Related articles

What You Don’t Know About Episiotomies Can Hurt You (parenting.blogs.nytimes.com)

Get Through Childbirth in One Piece!

Avoiding Tears and Episiotomies

Perineal Protectors (read the comments, too!)

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Dear Mommy Blogger: Your Perfection Makes Me Distrust You

5 Mar

perfection

Dear Mommy Blogger,

You are amazing!

Your body is svelte and chiseled. You are a greek goddess and you look dazzling in that dress you’re wearing.

You made that dress with your own hands, or rather ‘hand’ because your left hand was tied behind your back – just for fun.

The dress is made out of nothing but scraps of plastic Walmart bags you collected from the ocean while rescuing sea turtles caught in garbage.

(How do you manage everything?)

You wear all natural make-up. In fact, the lipstick you’re wearing right now is from the beets that you grew on your own farm. You hand-pressed the beets for their juice and mixed the crimson colored liquid with organic coconut oil. You shaped the all-natural ingredients into a tube of lipstick using molds which you hammered out yourself one evening after you cooked up a GAPS meal for the George Clooney. (He likes to visit sometimes.)

You ‘unschool’ your well-behaved and genius children who have already read all the classics. And gee wiz, if sweet Junip and feisty Cosmo are only four and six years old. Your children are also models for Calvin Klein.

(For real?)

Every day you have exuberant and young-love like sex with your PhD rock-star husband (literally he’s a rock-star and an MIT scientist) on your upcycled kitchen table (because your children are sleeping peacefully in your family bed). You never ever have to worry about faking it. EVER. (You’re careful not to knock over the paleo apple-crunch cooling down, fresh out of the stone oven, which you built by hand during labor with your second child.)

(I saw the pictures! I still couldn’t believe it! Of your labor, silly, not the other stuff.)

Your ec0-friendly ranch style home sits on 25 acres of organic land, it’s perched next to a lake your family has owned for three centuries. You have a chapel directly across from the lake made out of glass and twine. You meditate there every morning at 5am. Sometimes, after your most divine meditations, you write about your revelations of true love – when you do this doves cry.

You maintain a daily 5-mile barefoot run with darling Junip snuggled in your hand-woven wrap, happily breastfeeding on demand as you pound the pavement.

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You’ve already written three eBooks and you’re working on a fourth right now. The title is, “How to Parent Without Feeling Any Negative Emotions … Ever, Ever, Ever.” You’re currently taking pre-orders for this book.

You started an orphanage. It’s named after you. Mother Teresa came back from the dead to be there for its grand opening.

Your husband sometimes logs onto your blog so he can write 850 words on what a fantastic woman you are. You are always totally surprised when this happens.

You run giveaways on your blog. Your last prize was a chance to babysit one of your kids. 500,000 people took part. Mother Teresa won.

Your children don’t play with store-bought toys of any sort, ever. Instead they craft toys out of leaves, clay, twigs and Mother Teresa’s stray hairs. (She decided to move in with you to become your nanny.)

You post photos of your home on Instagram. Martha Stewart takes notes.

(Why is every piece of furniture you own white? How do you keep it all so clean?)

HGTV came and took pictures of your house because they were looking for inspiration on their “Dream Home Giveaway.”

You have a Pinterest account and you only pin your own blog posts.

You have a cat named Princeton, he uses the toilet instead of the litter box. You taught him this in under 30 minutes.

(Whew…that’s all really nice, but let me just get honest with you.)

Your home made mattress, the one you crafted out of goose feathers you collected by hand in a field where the geese wandered freely is beautiful, but doesn’t help me much if that’s the only thing you share.

I would like to know a little more about you, your struggles, your honesty, your screw-ups, and your “I can’t believe I did it” successes.

Show me your vulnerability. Tell me your most wicked stories. Share your most humbling learning experience. Tell me where it hurts and why.

Let me know you’re not that much different from me.

Because I really do have enough Barbies in my life, and your perfection only makes me distrust you.

Go ahead include me in your world…

just please don’t try so hard to impress me with your world.

Thanks,

joy.

The Best Parenting Advice I Ever Received Wasn’t Spoken

3 Mar

 

The-Best-Parenting-Advice

I remember one miserable day, that wasn’t unlike a long-string of awful days I already had with Noah. He had been crying all day long and was comforted by nothing. I was at my wit’s end and truly felt that I was losing it.

When my husband came home from class, I put Noah in the car with me, (he screamed even more frantically if he was away from me) and drove to Walgreens to buy a bottle of colic calm. (I cannot remember why I decided to go to Walgreens instead of my husband!)

Noah continued to frantically and angrily scream the entire drive. I was an emotional wreck and tried my best to focus on driving. When we arrived, I took a deep breath, stepped out of the car, wrapped Noah up in my baby carrier (yes, he was still screaming) and prepared myself for all the assumptions.

As expected, everyone in the store glared at me. What kind of trashy mom lets her kid scream like that? I could feel their judgment. The “oh poor baby” sentiment was dripping out of their eyes. The silent thoughts about what kind of terrible mom I must be for having a baby cry like that felt palpable to me.

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Keeping it real. Motherhood ain’t always about looking cute.

I was standing in line at the register, Noah was still screaming, an older woman walked up to us and said,

“Oh, poor baby.”

I was furious. I didn’t want her two-cent sympathy. She didn’t know me. She didn’t know anything about anything. I was so sick of everyone feeling like my son was the only victim of his colic. I snapped back at her and said, incredulously,

“Poor baby? Good one! How about poor mom, because that’s a little more like it!”

She took a step back and looked at me like I had a foot growing out of my forehead. (Really, at this point, it was in my mouth. Like I said, I was officially losing it.)

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My mom and sister came for a vist in July. Noah was three-months old. I made things work by wearing Noah all the time.

I tried to rush out of the store and get home, but not before I was stopped again, this time by a young mom.

Noah was still crying, of course. The conversation went something like this, with us slightly yelling to be heard over my son’s screams:

“Oh, I just had to come tell you my daughter had colic too.”

“Oh really?”

“Yes, for like a week she screamed all the time. And then I did (insert unscrupulous and irrelevant advice here) and she stopped crying.”

“A whole week of colic, huh?”

“Yeah, it was the worst thing I’ve ever experienced. I’m so glad I figured out what to do. How long has your baby been colicky?”

“Well, my son has had colic for over four months now. And yes, I’ve already tried everything you’ve suggested.”

“Oh…”

“Well, as you can see, I need to get home.”

I spun on my heels and headed to my car. Feeling relieved to be away from everyone’s speculations.

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Noah, 8 weeks old, with a cute grin.

You’re Not Doing Enough

I can’t tell you how many moms came to me and told me what I needed to do. Cut out dairy. Eliminate wheat. Stop eating eggs. Meditate. Put my son in orange clothing. Stop stressing. He’ll be happy if I get happy. Stop doing this. Start doing that. Stand on my head while I drink green tea from a red straw and recite Byron poetry. See a chiropractor. Get Noah craniosacral therapy. Stop breastfeeding. Breastfeed him more. Stop coddling him. Swaddle him tighter. Just let him cry. Stop bed-sharing. Have your husband hold him more. Clip his tongue tie. Give him reflux meds. Give him Chamomile tea. Get him tested for allergies. Tell me that I’m paying for my easy and beautiful birth with a difficult baby. Recommend I go see this (really expensive) doctor. Spit on a string and tie it to Noah’s forehead. Try this herb. Use this oil. Rub sage into his diaper. And my favorite: get demons cast out.

I felt like all the advice I received was rooted in this idea that if I just changed one more thing in my life, if I just did something a little better, if I just tried a little harder I would fix my son. If I would just stop being so selfish by eating cheese and eggs I would fix him (or something like that). At the time, none of their advice felt compassionate, or needed.

They didn’t know was that I was doing all of that, or had already tried it. I had exhausted myself looking for a cure and wondering what the hell I was doing wrong.

Actions, Not Advice

And then one day a good friend called me. She saw my Facebook update about how…

“I’m thankful for the calm after the storm. Last night was the worst night yet, but this morning we’re all coping just a little better, even so I could really use some TLC.”

I picked up the phone, mustered up my most energetic and happy hello, and without introduction Marissa, my doula and Mommy Moxie friend, said,

“I’m on my way. Amanda (our mutual friend) and I are picking you up and taking you to my house. Zoe can play with my kids, and we’re going to take care of Noah and you’re going to sleep all day in my room.”

At first I refused. No way was I going to let my friends have to deal with my screaming baby. Inwardly, I knew a real reason I didn’t want their help was because I felt and looked my worst, and I really didn’t want to let my friends see me like this, in shambles – pathetic and miserable. After my adamant refusal she said,

“Girl, I’ve mothered four children. I promise you, I can handle you, your messy hair, your bad breath, seeing your dirty house when I pick you up, and holding your son while he cries. Besides, having two more kids in my house will not alter the intense chaos that is always present in my home as it is. Amanda and I will be there in 20 minutes whether you so yes or not. And don’t even think about trying to look cute, because you’re just going straight to my bed to sleep.”

And that’s exactly what happened. She and Amanda arrived at my home, took one look at me and hugged me tight. They took each of my children to Marissa’s mini-van and buckled them up in their car-seats, and looked at me and said,

“Alright, let’s go.”

Marissa brought me into her home. While Amanda held my son and Zoe ran off to play with a house full of new toys and friends. Marissa tucked me into bed. Set a glass of water next to me and turned on the large box fan, pulled down the blinds, turned out the lights, and shut the door. She promised me that when Noah was hungry, or if Zoe needed me they would bring them to me, but other than that, the most important thing I needed to do was sleep.

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Staying with my parents in Arkansas while Peter was in Chicago, starting his first semester of grad school and looking for a home for us to move into.

Marissa and Amanda wore Noah in his sling and they used a white noise app on their iPhones – both seemed to keep his cries at bay for a little while. It also helped that they didn’t get frazzled when he screamed because their nerves, unlike mine, were not shot to hell. They rocked him and soothed him and enjoyed my baby – even when he was screaming. All the while my little Zoe played with a house-full of happy children.

And I slept the whole day. Unlike my own home, Marissa’s house was big enough that I couldn’t hear Noah cry if someone else had him. Her room was dark and very quite – providing me with rich deep sleep.

After the end of a full day of sleeping and feeding me, they drove me home. They hugged me and told me things would get easier, that they were here for me: the good, the bad and the ugly. One-hundred percent here for me. They reminded me that sometimes the best thing to do is simply trust that this stage won’t last forever.

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My sister and parents gifted me with a trip to Maui in September of 2011. My mom took this shot. Noah was five months old here, still in the thick of his colic.

I arrived home with a full-cup. Thanks to their care I felt a little more prepared to face the world knowing I had friends who had my back. I cuddled my son and knew that even if it didn’t feel like things were going to get better that things would. (And they did, you can read about that here: To My Son On Your First Birthday: A Mother’s Understanding)

They taught me, without saying a single word, that the best parenting advice doesn’t start with words but begins with actions.

(That next day Marissa called to check on me, and to let me know she woke up with one of my used breast pads stuck to her arm. I laughed hard.)

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Marissa and Amanda. Friends who made a difference. Thank you!

10 Ways To Feel Miserable As A Parent

23 Feb

10 Ways to Feel Miserable As a ParentI came up with this list of ten things I’m learning to avoid in order to feel happier as a parent. However, I would like to clarify a couple of things that came up when I shared this image on Facebook.

My children are young, four and under, and this list applies more to this age. If your children are not showing age-appropriate public behavior then you may need to consider how to best approach those lessons with them.

I think having such young ones in my home, it’s nearly impossible to keep my house tidy all the time. A kitchen sink full of dishes and fish sticks for dinner (again) is not (what I consider) a reflection on how well I love or care for my children. 

On the other hand, living in filth and serving junk food every day of course is another story and needs to be brought up to a higher standard of care for our children. 

I hope that everyone reading this takes a common sense approach to these ten statements and evaluates them according to their children’s ages and needs.

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