Power Positions: Standing in Labor and Birth

If you are a person looking for options to explore for your upcoming birth, let's take a minute to talk about the power of standing up.  Yes, even for pushing!

Standing and being upright during the first and second stages of labor, while it can limit your provider's view and access to your baby during birth, has long been a traditional position for women and laboring persons to take for as long as babies have been born.  

When contractions start to come more regularly, and you creep toward that focused mindset being upright is a huge benefit.  Laboring while standing offers practical and physiological advantages over laying down.  The pressure of your baby, uterus, and organs is not resting on your back muscles and spine, so there is more blood flow and comfort.  And your hips and pelvis can ambulate in any direction, allowing for your baby to more easily enter and turn in the pelvis.  

Beyond comfort, studies conducted also show laboring persons without an epidural also had "a lower risk of abnormal fetal heart rate patterns, ...,  and less use of vacuum/forceps and episiotomy."  

One of the things that Maine Doulas hope our clients explore has nothing to do with a specific decision, position, or delivery method.  What other doulas and we know, and what we hope to model and support, is the process of families exploring what it means to make decisions that are best for them can help them to have a more satisfying birth experience.  

And one of the choices a family can explore is the choice to put your body into positions that traditional western medicine tends to suppress.  

"...Most people who give birth vaginally in U.S. hospitals report that they push and give birth lying on their backs (68%) or in a semi-sitting/lying position with the head of the bed raised up (23%). A small minority push and give birth in other positions such as side-lying (3%), squatting or sitting (4%), or hands-and-knees position (1%)."  (source)

A few reasons so many don't explore options for different positions: 

• they think they have to ask to move

• they think if it were an option, someone would tell them

• they don't know anything but how birth is presented in media

• to some, the idea that standing would make delivery "easier" doesn't seem logical and the big one...

• western medicine didn't allow women to birth in any position but on their back for decades.  
  

And what we mentioned above about standing while pushing - that is an option some explore for their birth.

There is evidence to show gravity is in favor, perineal tearing may be reduced, and pain is reported to be less acute. While standing is rarely used in a hospital setting, other upright positions, like squatting and hands and knees, can offer the same benefits. 

So when thinking about how you want to have your baby, we hope you expand your vision of delivery to include any movement you are curious to explore.  When in the moment, you may be struck to follow your body's urge to move away from the standard inclined lying portion, and to that, we say, yes!  You can do it.  

Real Stories: Plans Change

There was so much focus on creating a birth plan.

"How do we feel about delayed cord clamping?"

"Good?"

"Vitamin K Shots?"

"Good?"

"Do I want to wear my own clothes during labor?"

"Isn't it going to be messy?"

"I don't know!"

After going over all the options and templates, again and again, I felt like I had a pretty solid vision for how I was going to give birth to my baby. I would labor at home for a good while, go to the hospital when it got intense, then push out a baby and come home. Hard but doable, right?

I wanted to try to have an unmedicated birth. I wanted it to be natural. I wanted to connect with the other women who had given birth before me through the act of giving birth, and I was excited. I wanted to be a mother, and I wanted to feel the power that so many write about in books like Ina May's and blogs like Birth Without Fear.

It seemed like everyone stressed I should really try at wait to go to the hospital until I thought I couldn't be at home any longer. The choice of when to leave my home was treated as a pivotal point of many unmedicated "success" stories. They stressed that laboring at home would be way more comfortable and less stressful, and I could move around as much as I wanted, instead of being tied to a hospital bed.

I thought I would want to eat because labor takes a long time. I thought I would want to sleep in my own bed, and pee in my own toilet. I felt really at ease. I was nervous. Who wouldn't be nervous for the birth of a first baby? But I was also feeling really ready.

The one option I didn't spend much time thinking about, ended up being how my daughter decided to start her birth process.

(And no, not surgery. I always knew surgery was possible.)

The way my daughter came into the world was very, very slowly. It was so slow. So slow, that there wasn't any sign, other than me feeling contractions, breathing heavily, and being super uncomfortable, that anything was even happening.

And lo and behold, it has a name.

My birth story started with prodromal labor.

Prodromal labor is when it looks and feels like labor, but the cervix doesn’t change. My feelings were real, but to the medical world, I was not in labor.

I started feeling contractions in the middle of the night, and I could breathe through them, but I couldn't sleep. Every 9-7 minutes, until morning came, and then they backed off for a bit. I started my day. I ate. I showered. I showed the contraction log to my partner, who had happily slept through them all. And we got excited for them to start back up any minute!

And then they didn't start again until night again. And still, I had contractions, but I couldn't lay down this time, every 7-9 minutes, for less than a minute. And again, when morning came, they went away.

Were they Braxton hicks?

Did I do too much?

Was I dehydrated? Probably yes to all of those, but hindsight is 20-20.

They just kept popping up and then taking a break. Starting and stopping. I went to my 40-week appointment hoping my Doctor would tell me how close I was and that it would almost be time to go to the hospital. But when my cervix was checked, she said I was still at 1 centimeter.

So they sent me home and told me to rest.

I tried. I was really tired.

But the contractions started again, and they didn't stop. They got closer together, ranging between 4-6 minutes. So I moved when I needed to move. I took bites of food when it was put in front of my face. I peed, I walked, I sat, I bounced, I laid on my side, I took a shower, I contracted over and over.

I have a hard time being objective about the level of pain I was in because I was so tired. I would fall asleep between contractions and then be jolted awake. I stuck with what the books said about labor progress and stayed home because I was still contracting every 4-6 minutes.

This lasted for two days. When the third morning came, I was desperate and told my husband we were going to the hospital.

I was done.
I was over labor.
I was over birth.
I was not prepared to be in labor for 4 days. Even if this wasn't "real labor," I was done.

We went to the hospital, we went into triage, and after all that, I got what I thought was horrible news: I was 3 centimeters dilated. 3. I was so sad. So defeated. So angry. And it just didn't seem fair. I was trying to do everything right, and my body wasn't following the plan.

They asked if I wanted to go back home and continue to labor there, and I said, "hell no. I'm done."

My Doctor was at the hospital that morning and came in to talk about my options.

• I could be admitted, have an IV line set to rehydrate me, and that might help labor progress.

• I could have Pitocin to help make my contractions get stronger and closer together, to encourage more cervical change.

• I could get an epidural and sleep, which may help my cervix dilate.

• I could have some IV pain relief that might allow me to sleep for a few hours.

• I could have my bag of waters broken and have the baby's head press against the cervix to help encourage it to open.

• Or I could have an elective cesarean.

I cried.

I looked at my husband and just cried.

There were too many options. I was too tired to pick. I wanted someone else to take over making the choices, and I just wanted to be taken care of for a little bit.

I just sobbed. No one told me I could be in labor for 4 days and be driven to what felt like madness.

Sleep sounded so good. So, so, good.

I said, "I want to sleep. How can I sleep?"

So I chose to get an epidural.

As soon as that medication went into my back, my eyes dropped. My husband said they had to wake me a couple times to take vitals and blood pressure, but I don't remember any of it.

I slept. And it was glorious.

I woke up 4 hours later.

I changed positions.

I drank more water.

I went back to sleep.

They would come in and check things and I would answer some questions, and then roll over and go right back to sleep.

Around 2pm, my Doctor came in and asked if I wanted to be checked to see how things were going.

I laid back and waited, and she looked up at me, smiled, and said, "Are you ready to meet your baby? You are complete. Let's get the room set up, and we'll get going. Has anyone talked to you about pushing?"

WHAT?

The room jumped to activity, and I just stared at my husband. It went from 0 to 100.

Nurses were calling people.

A cart was set up.

My Doctor was getting a gown on.

The bed morphed into a half bed with footrests.

A light came out of the ceiling.

My room was a Transformer.

And then someone told me to push like I was pooping. So I did. And I did again. And again. And then all of a sudden she was there! I was holding her, and she was perfect!

With all my reading, all my planning, and all the encouragement I had from my family to have this baby on my own, I don't know why my labor was so drawn out. I'm sure there are those people who would say I didn't need the epidural. I'm sure some may say I just needed a different position, or different mindset, or different whatever.

But I know I had villanized getting an epidural. I had thought that people who got epidurals just didn't try hard enough. And now I'm ashamed of those beliefs. I needed the relief that came from having that medicine, and I needed the sleep.

My plans changed, and I changed, and I am proud of the work I did at home. I'm proud of asking for help. And I'm no less connected to those wise women before me.

Real Pregnancy: 5 Lesser Known Truths

There are so many birth and parenting books out there that it seems silly to imagine that anything about pregnancy is "lesser known" at this point, but alas, it's true.  Trends change, research is updated, and now it's you who are looking!  Here are some things about pregnancy that you may not have known, and could be helpful!

1. Swelling happens for all sorts of reasons - some harmful, and some not.  

Swelling, or edema, can be one sign that you are pre-eclamptic, which is a severe condition that needs attention from your medical provider.  There are other symptoms as well, like high blood pressure, and protein in your urine, but those are hard to know on your own.  Swelling is then an indication that something might be up.  

But swelling is normal in pregnancy and can happen from diet, exertion, and from the fact that your body is literally filled with more blood and fluid when pregnant.  

Some ways to find relief is to:
 

• use cold compresses on the swollen area

• use compression garments, for feet and wrists

• elevate the swollen area and rest

• drink more water
  
  

2.  Provider Appointments

If you were like me, when you found out you were pregnant, you didn't know what to do next.  So I called my mom.  And then I called my doctor to schedule an appointment.  At this appointment, you will be asked about the dates of your last menstrual cycle, and you may have a transvaginal ultrasound to confirm the age of the baby.  From there with a normal pregnancy, you will have appointments every month up until your 28th week, twice a month until 36 weeks, and then they will happen weekly until you deliver.

In addition to these appointments, there will be other appointments for routine ultrasound near 20 weeks, and a glucose test between 24-28 weeks.  

There are a lot of appointments!  Usually, the time you have with your provider is 15-20 minutes, and it can feel like a whirlwind.  However, prenatal appointments are your opportunity to learn about your provider's standard practices, discuss your birth preferences, and have any questions addressed.  Writing down your concerns before your meeting can help ensure you are getting all the information you need to feel prepared going into labor. 

3. Dressing Your Pregnant Body

Pregnancy trends have fluctuated dramatically from loose-fitting gowns to closely cut stretch everything.  There is no wrong way to dress.  Some items may seem more practical, but practical may not be your style.  Do you! Regardless of when you have your baby, you will be moving through 9 months of weather, and each comes with its pros and cons: 

Spring: 
Pro: Mild temperatures and light layers
Con: Wild fluctuation possible as spring storms roll through and you may be caught unawares

Summer: 
Pro: No need for bulky jackets and extra garments
Con: Sweat, Swelling, and Possible Sunburns (Your pregnant skin is more sensitive!) 

Fall: 
Pro: Back to light layers and the most fashion-forward of the pregnancy seasons (as is the case for all fashion)
Con: The beginning of carrying more stuff to be equipped for cold spells

Winter: 
Pro: Many pregnant people appreciate the colder weather because they feel hot most of their pregnancy
Con: Finding an outer layer that fits over your bump, watching out for ice on the ground

4. A new relationship with your bladder

There are so many jokes about pregnant people needing to pee all the time, that it is probably one part of pregnancy you knew was coming.  But the reality of it is something hard to plan for until you have experienced it.  

The reason you are running to the restroom more often is two fold - you need to drink more liquid during pregnancy, and your bladder is being compressed by your growing baby (and uterus.)  There simply is not as much room for your bladder to fill up.  

And when you can take the opportunity to void your bladder's contents, there is a new struggle as you may not be able to empty it completely.  The same reason your bladder can't fill as full is also pressing down on your urethra.  So when you are there, take a deep breath, and try to relax to loosen the muscles in your pelvic floor fully. 

5. The Stuff

When you become pregnant, you unknowingly have become the target market of a whole new industry.  The adds in your Facebook feed will change.  The adds on your browser will do the same.  

Many gadgets and products can be handy, and you get to choose if you want them or not.  Having an awareness that you are in a very short, and very impressional part of the retail market may help you find tools that will help you solve a problem (sleeping unwell, swelling, or supporting your back), instead of collecting the newest craze.  Go to town if you want to, or don't.  It's totally up to you!

Real Fertility

The number of factors that need to align for a person to become pregnant and carry a baby is extraordinary.  Hormones, ovulation, intercourse, fertilization, and implantation all have steps that need to ruction properly for a pregnancy to be viable.   1 in 8 couples can have trouble conceiving a child on their own.  

A person or couple's fertility does not come into question until there has been frequent unprotect intercourse that does not result in pregnancy over a year. 

A large variety of factors can affect infertility in women:

• Irregular or absent periods

• Ovulation

• Cervical Disorders

• Blocked Fallopian Tubes

• Age

• Polycystic Ovarian Syndrome (PCOS)

• Endometriosis

• Adenomyosis

• Lifestyle

• Cancer

• Blood Clotting Disorders
  

Several factors can affect infertility in men:

• Azoospermia (no sperm cells are produced)

• Oligospermia (few sperm cells are produced)

• Erectile Dysfunction

• Genetic disease

• Chromosomal abnormality

• Smoking

• Excessive alcohol

• Stress

• Excessive heat exposure
  

For people who are trying to conceive, knowing when you are most fertile is a reasonable place to start.  A woman's most fertile window is the three days leading up to and including ovulation. 

Tracking periods and ovulation can be helpful information to have and will be necessary if a couple decides to see a fertility specialist.  A woman's cycle starts on day 1 of her period and ends the day before her next period.  Ovulation typically happens 14 before the start of her period.  So depending on the length of the cycle, determining an individual "fertility window" can be mapped.  

If mapping your fertility becomes complicated and adds unnecessary stress, having sex every 2 to 3 days can be a helpful guide. There are also ovulation kits that are available at pharmacies.  And as a natural predictor, vaginal mucus tends to become clear and slippery a few days before ovulation as well.  

Something to consider when discussing family planning and fertility is age, as fertility declines as we all get older.  Women younger than 35 and men younger than 40 have a better chance to conceive then people who are older.  In the medical world, A woman aged 35 or above is automatically deemed "AMA," or Advanced Material Age, and is considered High Risk in most practices.  

If you are older than 35 or 40, respective to your sex, know that it is appropriate to reach out to a fertility specialist after only 6 months of trying to conceive, and not the full year.

Fertility and Infertility are often not discussed openly. If you are looking for a support group, or additional resources, consider including your physician or therapist in a conversation. If you would like more information before taking any next steps to explore your fertility, Resolve may be a helpful, as well as The Portland Fertility Clinic.

For more insight into preparing for pregnancy, https://www.yourfertility.org.au is an excellent resource for information.  Also "Before Your Pregnancy: A 90-Day Guide for Couples On How to Prepare for a Healthy Conception" by Amy Ogle, M.S., R.D./ and Lisa Mazzullo, M.D.