Something I've wondered a long time?

[Tara2]

Hi. Question for anyone familiar with UC. But first i have to tell you a story.
I have wondered about this since my son's homebirth. We had 2 m/w there. It was a partial waterbirth, as in everything went fine and perfect in the labor, then I got in the birth tub at others' urging. Didn't really want to, but didn't listen to myself. Couldn't get comfortable in the water. Got to completion within 1/2 hour in the tub. Started pushing. Was my 3rd birth, and both my DDs came out super fast as in about 10 minutes of pushing... so thought it would be the same. First push or two and thought felt the head come out... it wasn't- was my baby's caul which ballooned out into the water-intact. M/ws said he would come out next and be born into the caul. Head did not come out next push. felt really uncomfortable in water like I just had no leverage to push in the water. Changed positions a couple times and next push his head did come out. M/w said next push he'd be born- usually after the head, whole body comes next, right? It did with my girls! We were all surprised I guess that he did not come out next. Another push and couldn't push him farther. Suddenly everything changed in one go from peaceful birth to flat out emeregency. M/w is yelling at me to get out of the tub and acting all panicky. I said I couldn't move so DH and other m/w hauled me out... i must add, BUMPING my baby's head on the edge of the tub as I was helped out! Aack! M/w said he had stuck shoulder and so is not getting born. In no time at all they had me in all these different positions, but nothing doing. M/w told me later that they consider they have 6 minutes from the time the head is out that the baby must be born with a shoulder dystocia- or else... Finally they have me lay on futon with my bum hanging off the edge, bottom in the air, pushing against gravity. oF course this goes against everything I have learned about effective birthing. Sounds very old school. M/w later told me that ironically it is the position that may help in cases of shoulder dystocia. So he is looking purpley and they don't (she later told me) obviously want the head to turn black- yikes! There are a few other details I'll leave out, and stuff i don't remember now, just little things they tried to help me like having DH rub my nipples to stimulate more oxytocin. It all happened VERY fast. So I am in this weird calm otherworldy state amidst all this panic and I just do whatever they tell me even though a lot of it felt like a violation somehow. M/w says "you need to get this baby out- NOW!" they have me push between contractions even though it doesn't work. It hurt like hell but he was born with the next contraction and I tore..
DH said he was limp, or not moving for a few seconds but had top apgars according to m/w. Then he was on my chest and laid there all calm. It was several minutes after the birth he cried the first time, but he was fine. He even climbed up my belly and latched himself on for his first nurse- cool!

So I guess my question is... I knew someone who was doing UC our babies were due around the same time. I had never thought of it before but it got me thinking. Would I do it? I didn't know before the birth, but now I would be scared to... my question pertains to the birth with shoulder dystocia as happened with my DS. If the m/w hadn't been there, I certainly would have no clue what to do. I may or may not have stayed in the water. I guess if he didn't pop out, I would get out, but it was very hard for me to move I was in laborland and totally against any change during that time. So if I had not had m/w there, it would have been a problem had I stayed in the water, obviously, DS wouldn't have come out. And if I was not in the water, but couldn't push him out past the head... would he have died? M/w later told me my son was born 3 minutes into their six minute time limit. I didn't know anything about shoulder dystocia before DS was born. I had read up on a lot of homebirth/ birth related research but none mentioning SD. So I would have been in big trouble, right? If it was just me and DH at the birth.

I guess I just wanna know. If this is a situation that had been UC, what is the likelihood that my son would have died? OR would I somehow possibly know what to do? For some reason I kept imagining birthing on all fours, even though I was side lying when DD was born, and it was easy. I had no affinity to the all fours position in theory, but it kept coming to me during labor. So I later read that all fours may be an effective position for birth if shoulder dystocia happens? Anyone know about that?

Whatever the truth is, maybe I'll never know, but I am so grateful the m/ws did know what to do and helped my son get born... even though how it happened felt kinda traumatizing for a long while after. But who knew it would go this way? My earlier births were super easy m/w assisted births, so I would have been in a good position to know and trust my body knew what to do by the time DS was born, wouldn't you think? But I am still scared if I had decided to UC what would have happened. And if I ever have another baby, I doubt I'd feel safe not using m/w, based on DS' birth. I wonder what the likelihood is of once you have a baby getting shoulder dystocia at birth, will it happen again? Or is a fluke?

TIA, kind ladies, for responding.

[SeekingSerenity]

First of all, because even though everything turned out okay, I know it was probably unnerving and scary at the time.

As for trusting your body, when you're in labor, that can be difficult. Yes, you know that your body is experienced and knows what it's doing, but your mind is in a different place while in labor. Some women become very independent and can easily stand up for themselves even in labor, because they know what they want and can make their decisions known. Personally, that's not me. I become all weak and needy and I have a hard time even asking someone to put chapstick on my dry lips. I don't typically stand up for myself anyway, unless I am backed into a corner or I get really ticked off, but it's even worse when I am in labor.

That being said, my last baby was a partial waterbirth with dystocia also. I got in the tub, but as soon as I was in... well... my bowels released. I'd taken castor oil to initiate the contractions, but it had been quite awhile since the symptoms of that had stopped. Unfortunately, when I got up to walk to the tub (assisted, of course, and thinking I wasn't going to make it there), my body decided it wasn't quite done... errr.... evacuating itself. So the decision was made to do a quick water change.

I got up on my knees so the water could be drained (this was a bathtub, thankfully) and out popped the baby's head. The first concern was not to let the head go back under water, but he didn't turn with the next contraction - his face just turned dark purple.

Now, mind you, I was somewhere else during all this. I distinctly remember them yelling at me to PUSH, PUSH NOW, KEEP PUSHING!!! and me growling "I AM pushing!!!" Then they wanted me to get up and jackknife over the side of the tub, but the contractions were just right on top of each other and I was putting every ounce into pushing. A friend actually grabbed me under the arms and hauled me over (she was in a sitting position beside the tub, not a good angle for that maneuver) so I was bent in half. I felt as purple as they were yelling that he was. I don't really remember what all was said or how long it took, only that suddenly there was this tremendous pressure and then he shot out. And I sorta collapsed back into the messy water.

So with all of that, I honestly don't think *I* would have a UC myself. I would not have known anything other than to change positions and keep pushing, and I would have freaked out if I'd have seen my baby's face turn dark purple. Panic is the last emotion you need to deal with if you're managing your own labor, I imagine. Dystocia is one thing I never considered because all of my babies are relatively small. This baby was my absolute biggest, weighing in at a whopping 7 pounds, 8 ounces. However, for all of that, I am only 4'10" tall myself. If I were to have an 8 pound baby, how would I know what to do when something like that happened? It's one of those unknowns that to me, personally, isn't worth the risk. I love midwives and I am thankful for their presence.

As for the "would my baby have died" question, that's hard to say. I don't know, and I wouldn't want to speculate. My son may have died, too, if I done an unattended, but then again, who knows? I don't know enough about the particulars of emergency situations that midwives are trained to handle.

I just wanted to share, because your story sounded so much like mine. It's hard to know what you're feeling in labor, even knowing something isn't what you really want is hard to articulate. I'm also interested in what some other ladies might have to share.

(((Hugs))) Tara2

[Delicateflower]

If you're asking if babies can die of shoulder dystocia during UCs the answer is yes, they do.

[Tara2]

SeekingSerenity- Yes, our births do sound similar... that bit about the head turning dark purple instead of the shoulders getting out... that happened. And I remember my m/w yelling at me to push push PUSH him out now and I too said something like 'i AM!' I am very grateful both of our LOs are okay. I guess given my history I wouldn't do a UC...

Delicateflower- I guess that is what I am asking, and I must know deep down that is the case. Thanks for saying.

[claddaghmom]

I'm curious, you mention the sac bubbling out...did it burst on its own? And when?

When DD's head popped out, I guess for a variety of factors such as size and angle of the head, SD was assumed. But I felt her twist and move inside me while I was turning onto all fours. She came out with the next contraction.

When I think back, it seems it could have been a better outcome. I think there was an expectation that DD required intervention, maybe an assumption of SD b/c labor took so long and she was so malpositioned. I think the intervention led to my tearing and to DD getting stimulated after birth when I would have preferred she relax w/ me.

So actually, the experience makes me want to try for a UC even more. It showed me that even though asking for help is important, the birth still lost its individuality. The birth wasn't viewed on its own, but within the concept and expectation of that MW's previous experiences.


*sigh* I don't know. She was still an amazingly loving person.

But I just want to be left alone. I want my baby to be left alone. What she did was a drop in the well compared to a hospital birth but it was still too much for me. This pregnancy has got me thinking about my entire life...and I noticed that everytime I end up with a healer, doctor, chiro, MW ANYONE my life is negatively affected. Every surgery, treatment, medicine etc causes me harm. So I am going to follow my instincts and stay away.

[Carlyle]

Well now, I'm not a UCer, but I'm going to butt in here anyway, sorry

Babies can die of shoulder dystocia anywhere--hospitals, home, with mw, with ob, or UC. It's one of those rare things that are an emergency anywhere, and even being in a hospital doesn't guarantee survival. My dd was "sticky" coming out too--and people got a bit panicky about it as well (in the hospital). Medical professionals try to get babies out (hopefully using some of the methods below), but last resorts are to break the baby's collarbones, and then (heaven forbid), push them back inside and emergency c-section. Not a good scenario even in a hospital.

In my opinion, what you need to do if you want to UC (or really, no matter where you're planning to birth, because it's good for YOU to know what works instead of just relying on your medical team to tell you .... because some medical teams don't know the best things to try...) is research the heck out of what to do if your baby is "sticky." Train anyone who is going to be at your birth (dh, whoever) in how to help too.

My understanding (and I'm so not a midwife or anything, just a scared mama who doesn't want to be uninformed about shoulder dystocia again!) is:

1. Change position. If you aren't on all fours already, get there. If you're on all fours, try something else...swivel your hips...check in with your baby--ask yourself how you can move in way that feels like it will help him/her get out.

2. Apply hard pressure right above your pubic bone--this is supposed to loosen the shoulder--try to push it into your belly and towards the baby's face (??hopefully others can describe this better). When my dd was born, I was lying on my back and the nurses jumped up on the table and did this for me/dd.

3. Some people will tell you to wait for the contractions so that you can give 120% of your energy working WITH your body. I don't know if I buy that because my contractions were decently far apart, but it's something to consider.

4. If baby is still not coming out, have dp or someone try to get a finger in there to sweep the baby's shoulder towards his/her face. Hook under the armpit (which I have read can cause some nerve damage, but is better than death)?? I dunno. I'm treading into "I hope I never have to go there" territory.

5. Episiotomy to make more room for manually helping the baby turn.

Anyway, I hope your next baby slides out like butter (and mine too!) and you (we!) don't have to worry about this at all. There are some great medical sites out there about it and you can research it through a google search. Good luck! I'm glad your lo is okay

[craft_media_hero]

Well, I just finished reading Ina May Gaskin's guide to childbirth, and it seems like they deal with SD pretty calmly and about the same way every time it's mentioned in that book.

With SD, flipping to all fours is supposedly the best way to get the babe to come out. There are a couple of instances in the book where the baby gets stuck, midwife has the mom flip to all fours and PUSH and if the babe and mom need a little help, then the assistant fishes in and gets fingers under the baby's armpit and helps pull the little one out while mom pushes. Nipple stimulation is also mentioned. Anyways, the books cites studies and such that show that this method if dealing w/ SD is more effective and it's now called "the Gaskin maneuver" because it has become so widely used.

You said that you kept imagining birthing on all fours and that you didn't really "want" to be in the water. Perhaps the lack of gravity in the water contributed to the amniotic sac not having enough pressure to pop and thus making it a little harder for you babe to come out? Maybe just being on all fours from the beginning would've been enough to help your lo's positioning? I think that if you had not had others telling you what to do, then you probably would've naturally birthed in that position since that's what you wanted.

For me, I'm going to talk to dp briefly about how if the babe gets stuck, we flip to all fours and he should grab under the armpit and help. I don't think it's going to happen, but we'll talk about it a little and then if it does happen, that's what we'll do.

[NettleTea]

Originally Posted by craft_media_hero

You said that you kept imagining birthing on all fours and that you didn't really "want" to be in the water. Perhaps the lack of gravity in the water contributed to the amniotic sac not having enough pressure to pop and thus making it a little harder for you babe to come out? Maybe just being on all fours from the beginning would've been enough to help your lo's positioning? I think that if you had not had others telling you what to do, then you probably would've naturally birthed in that position since that's what you wanted.

Exactly what I was thinking.

It sounds to me like your instincts were telling you ahead of time what needed to be done to birth your baby.

[zoebird]

I cannot say whether the birth or the results would have been different with a UC. and, as a PP mentioned, infants do become injured and die in UC births--just as in attended births. What the numbers are, we cannot say, because we do not know how many people UC and only have anecdotal evidence of what happened and can therefore only conjecture about what the cause of the injury or death might have been.

that being said, i believe that UC creates a situation where a mother is better able to follow her own instincts rather than somehow wandering lost in labor land.

i know that "labor land" exists--as i experienced it in my own birth--but instead of experiencing it as an unaware, away state (as many seem to describe it), i experienced it as a deeply aware, present state with total access to my body, mind, and spirit and that of my child, with every ability to know what to do moment-to-moment to help my child without the need for assistance from another.

what i know from our discussions of it is that my son was posterior and born "star gazing" or "sunny side up." technically, this is a malposition and also creates the most painful labors and births. while i might agree that it is a malposition, i did not have a painful labor or birth. I believe that this was, in part, due to the UC (see relaxation thread for my other ideas on why my birth was pleasurable, in addition to my own pain-pleasure neurological matrix).

i was able to move, sound, and position myself as my body directed. i was able to do whatever needed to be done without encouragement or suggestion from others about what i "should" be doing to make it easier on me, the baby, or anyone else for that matter.

i believe that, while the suggestions of your midwife or other labor partners to get into the tub were intended kindly and with your and your baby's best interests in heart, it was a distraction from your own self-knowledge about the right position for you in labor to birth your child safely and efficiently (or perhaps, effectively).

then, when the labor and birth were not progressing properly, an emergency came up, and positions had to be changed and measures taken.

so, i could see how what you experienced was a "cascade of interventions" starting with the suggestion to labor in a certain way, potentially leading to the problem of being stuck, and then requiring the heroic measures of the midwife.

but, this isn't absolute. it could be that no matter what happened or how you labored, the baby might have gotten stuck, and it could be that with or without help you could have gotten him out, and it could be that with or without help he could have been seriously injured or have died.

so, all in all, i think it's good for you to think about whether you were hindered in your labor and birth, whether or not it was a cascade of interventions, and how this may inform future births (if you choose to have one or more). in the end, you will have a clear picture--for yourself--of what happened as well as more self knowledge.

many blessings!

[Delicateflower]

Originally Posted by Carlyle

Babies can die of shoulder dystocia anywhere--hospitals, home, with mw, with ob, or UC. It's one of those rare things that are an emergency anywhere, and even being in a hospital doesn't guarantee survival. My dd was "sticky" coming out too--and people got a bit panicky about it as well (in the hospital). Medical professionals try to get babies out (hopefully using some of the methods below), but last resorts are to break the baby's collarbones, and then (heaven forbid), push them back inside and emergency c-section. Not a good scenario even in a hospital.

You can pretty safely assume, though, that an untrained person won't be able to break the collarbone in time to get the baby out, so the babies that don't come out with simple techniques like Gaskin and McRoberts are going to have worse outcomes than births attended by people who are experienced in active interventions to get the baby out. There would be two risks, that they could do the technique, and that they'd do it wrongly and harm the baby. Birth professionals do try all the positional changes first, just like you can try yourself, but then they can go on and do active, difficult things to help that we can't do ourselves.

Pushing the baby back up for a c-section (Zavanelli), is only to save the mother, as I understand it.

[Tara2]

Thanks ladies for resopnding..

Originally Posted by Delicateflower

Pushing the baby back up for a c-section (Zavanelli), is only to save the mother, as I understand it.

Jesus.

For everyone who thought I had instincts coming up that i should have listened too, to birth my baby... I agree. My only homebirth regret is that I did not listen to how I wanted to move or be during labor... at least not at the end. Yes it led to a 'cascade of interventions' though it seems odd to call it such since it wasn't in a hospital. My m/w told us after a list of several things they try in the event of s/d they were listed by pps. like hooking the shoulder to breaking the collar bone. One m/w pushed hard on my stomach... i forgot about this, to try to force him out during ctx. She did the pubic bone thing, I think. This was after they had DH do the nip stim also. I was having ctx fine but after they moved me out of the tub, they also stopped for a couple minutes I think... not surprising cause it was a big disruption to leap out of the tub and all the panic in their voices.

There is a part of me, I think, that would like to do UC if I have another baby. But because of this experience, I think I have lost trust in my body to birth right. Too bad cause with my DD/s my body seemed totally geared for birth... quick labors and they slid right out in a few pushes.

Someone asked about the amniotic sac. A bubble of it, the size of a grapefruit or so slid out ahead of my baby's head. We thought he'd then be born into it, as I said. I am trying to remember, but part of it was the awkwardness of holding onto the tub edge from behind, kinda floating on my back and trying to get down, to sit/squat in the water but I kept floating up... too much water in the tub. So not a good angle/grounding for pushing in my book. They then grabbed a plastic tub, like a big tupperware box that was in the room, and shoved it under my bottom to provide some sort of seat. Still not high enough, and very uncomfy. So that didn't work. And I am trying to remember... I want to say either I pushed hard on the next ctx and the head didn't come, but the sac burst into the water... or when I changed to kneeling, his head was born with that next ctx, and the m/w might have broke the sac open around his head. I can't remember which.

I do remember seeing the bits of sac floating in the water. Yeah, pretty much pushing in the tub the whole time was a disaster. I was so uncomfortable there. Yet didn't want to get out and then be wet and cold, and had no idea what was coming next or that there'd be this big crunch time suddenly. Who knew?

[zoebird]

birth has curve balls, you know?

i see the suggestion of the mw or whomever to get into the tub to be the first intervention, even if it's not at the hospital. but, that's just how i think of it.

i would say that it hindered the birth, but even so, you might have been in the same situation anyway, you know?

things happen in birth, becuase it's a microcosm of life.

[Serenyd]

http://www.mothering.com/discussions...1&postcount=46 ~Shoulder dystocia resources

http://www.mothering.com/discussions...1&postcount=23 ~UC with "sticky shoulders"

http://www.mothering.com/discussions...30#post6645730 ~stillbirth d/t shoulder dystocia (UC)

[flapjack]

My ds4 (now 5 weeks old) had a mild dystocia despite me being on all fours- or in my case, possibly because of it. We resolved it by me standing up (onto left foot, then right foot) kneeling down again (left knee down first) and then DH pushed the uppermost shoulder back (the one nearest my spine) and hooked the bottom shoulder over my pubic bone. It isn't featuring on my to-do list ever, EVER, ever again. I still have an exceptionally sore coccyx, difficulty sitting on certain types of chairs and I can't believe that we got that lucky. Apparently his colour changed after he was born to the head and that's why DH knew to be worried.

This wasn't a planned UC, btw, because we KNEW that we were going to need the midwives, though not why, but it was a fast labour- from calling them to birth was 17 minutes and the weather was atrocious that night. My only other child born with me in that position also got stuck, though not as badly, and my midwife at the time used gentle traction (and a similar manoeuvre) to get him out. The two born with me standing, and even the one born with me absolutely flat on my back? No problems. Sometimes, birth is quirky.

[MsBlack]

"interventions" can happen anywhere, not just in the hospital. I submit that even in a UC, with mom in charge, an 'intervention' could occur by her own doing. That is, if she is following rules rather than instinct!

For instance, I was at a birth where, when pushing time came, mom started on her back and it looked like baby was coming down great. Suddenly, she decided to move to all 4s--where baby got a bit stuck and mom tore getting him out. Later, discussing the birth, mom said she didn't know why she didn't just stay on her back since it felt right! But moved to hands and knees because she'd read that it was a better birthing position! Now in her case, all was well in the end, but she and I both wondered if maybe her belief about birthing position, instead of following her body, had caused or at least worsened the small problems with baby's emergence.

2 things really disturb me about your birth story, Tara2: one is that you were acting on instruction for pushing, instead of being invited to do what felt right to you. IME as a hb mw, moms either instinctively birth in a self-chosen position, or they ask me to tell them what to do--and I say, "do what feels right". Most do, once they are assured that it's a good idea to feel their way into it. If mom seems at a loss, I'll suggest a position but also say, "see how that feels--you'll know if it's right for you. If not, just move again and you will find what feels right". Anyway, in your birth, you were directed and this is a set up for problems if you ask me.

2nd disturbing thing is the panic, and the panic driven instructions you were given. Moms should not be inspired to have MORE adrenaline flowing at that time (or ever, during birth). THere is a certain amount of natural adrenaline flowing when moms are pushing--but it's not the panic induced type, it's an amount inspired by excitement of baby's imminent emergence and the hard work of pushing/fetal-ejection contrax. Adding panic to the mix is counter productive! Tenses up the body generally, clouds thinking....

So it seems to me that in those 2 ways, you/baby were actually set up for a scary, sticky time of it. Yes, it can be a good idea to read up on birth positions and such--info can be very helpful. But in the present-moments of birthing, you have to pretty much let that go and follow your body, not a set of instructions from outside yourself. For helpers to remain calm, focussed, calming to mom--even when things become 'urgent seeming', is the best thing for moms and babies.

By the way--from what you describe of your baby's apgars and other behaviour following the birth, he was never really in trouble at all. Sometimes, it does take more than one contraction following the birth of the head, for the shoulders to come out. A baby with a purple head is a baby whose heart is still beating strong--it is scary looking but not usually a problem. Now, a head going from purple to ashy or white (no heartbeat anymore), THAT is something to worry about.

I don't see any reason, from your first birth, why you shouldnt' UC with confidence in the future. Just be sure to follow your inner dictates, not anyone else's instructions (whether that be people present at the birth, or your online friends/favorite authors)

[cathicog]

Couldn't have said it better. 1) the atmosphere should remain calm even if it IS an emergency, to avoid alarming mom and her tensing up...2)the shoulder distocias I have seen have been remedied by moving the mom, and in one case the midwife did have to reach in and get her finger around the babys upper arm(hooking PAST the armpit, not in it) and corkscrewing the baby out. It was body distocia, not shoulder, in that case- the baby was 12 lbs. Apgars were 9 and 10... and 3)MsBlack is right on about head color- purple is the congestion of the blood in the head, while the rest of the body is being born, even if it takes a few contractions, grey or white is LACK of circulation and that isn't good...I have only seen one watrbirth where we had to get mom out of the tub(but mom wanted to be there) the head was born and it turtled, (squished back up against perineum) so we knew baby might need a little turning help. Got mom out of tub and on the edge of the bed on her back and baby turned and was born. mom had 2nd tegree tear...baby's shoulders looked like a linebacker for the LA Rams! All was well...

[Tara2]

Tried to post but it disappeared...ugh.

Thanks ladies for all your replies. Your words mean a lot.

Serenyd- i looked through all your links and bookmarked for future reference... thank you!

cathycog- I had forgotten... the m/w said after the birth that DS turtled back in like that.

Something I wonder though is that one resource said explicitly not to do pressure on the fundus. Why did the m/w have her assistant lean/jump on my belly during ctx? I was on my back w/ butt hanging off the edge of the futon at the time. I remember being having a bit of disbelief at her doing it... like putting her whole upper body and leaning with her forearm on my full belly. NOT the pubic pressure thing as discussed in resources... They also at one point attempted a hooking the shoulder maneuver (don't know which) but she said she couldn't get it.

[MsBlack]

Not clear on the leaning-on-your-belly thing.

ETA--I just reread your last post and did see that you believe it was fundal pressure, not pubic. I'll leave the rest of my post as-is, though--JIC it's helpful to you or anyone else in some way. Also because honestly, if your mw was using fundal pressure inappropriately and quite possibly dangerously, then maybe you will want to discuss your birth with her again, to clarify things...to find out if she's taken any recent workshops in handling SD, to improve her response....maybe even to talk to your state midwifery association about her, ask for a peer review, something.

As I tell people--a midwife may be a wonderful person at heart, and great to work with at a normal birth. But at a completely NORMAL birth, you dont' really NEED the mw--she is kind of like an 'expensive insurance policy', as one mw likes to say. It is when birth is NOT SO NORMAL that you want to be sure your mw can cut the mustard--has the *current, most evidence-based* skills to help handle complications. Because it is only when complications (of any degree) occur, that you actually need her at all! In that case, it don't mean sh** how much you like her, how many of your friends had normal births with her, or whatever--what matters is her ability to 'first, cause no harm', and second, do what it takes to handle the problem *appropriately*, and, *without panic*. Any mw who is not up to that task should be helped to improve--sometimes that means conversations with her peers, instigating some sort of overview of her practice if possible.

Sorry for the hijack! We now return to our regularly scheduled thread

--onto my initial post at last:

1. Was the apprentice putting downward pressure on the area *just above* your pubic bone (in bladder area)? "downward pressure" meaning, pushing toward your spine?

2. Or was she leaning on your belly at the top of your uterus/just under your ribs? In this case, the pushing would be in a direction from your ribs toward your pelvis--trying to push the baby toward your yoni. THere might be significant pressure downward/toward your spine, but would also be toward your pelvis/yoni.

#1--this pressure is meant to push directly (through your flesh, of course) on the baby's shoulder that is stuck behind your pubic bone. It is meant to either shift the baby's shoulder into enough rotation to slip UNDER the pubic arch and so release the impaction, OR, to break the baby's collarbone, also allowing release of impaction. This sounds awful, I know--but in rare cases of shoulder impaction, only breaking the baby's collarbone lets the baby out. The pressure over the pubic bone is not directly intended to break baby's collarbone, mind you--it's intended to shift the shoulder under mama's pubic arch. But if breaking the collarbone occurs with this pressure, baby will also come out. Anyway, pressure on mom's belly, immediately above her pubic bone, is one of the 'correct'/accepted methods to use if needed for shoulder dystocia.

#2.--this is 'fundal pressure', and if your baby's shoulder is stuck behind your pubic bone, then THIS kind of pushing pressure will do nothing but make the baby's shoulder impaction WORSE. Now, if the shoulders were already released from behind the pelvis, but the baby was still not moving out much, then some might use this fundal pressure to speed up the baby's full delivery-- if they feared that baby was seriously compromised, and resuscitation was needed ASAP. In other words, there *may be* some logic to fundal pressure....however it is a dangerous manuever that is likely to bring on worse problems than just a baby who needs some help getting started (uterine prolapse, postpartum hemorrhage...). Meaning--not ONLY do you have a baby who needs resuscitating (possibly), now you may ALSO have a mom who needs a lot of help as well.

Anyway....do you remember much about this pushing, where it was focussed and such?

[Tara2]

MsBlack-

Thank you for asking. I certainly don't want to mis-remember, because my recall of the order of events is chaotic and not 100%. But my memory is of her leaning on the top of my belly using her forearm and such. Not at pubic bone. That's why it kinda stood out to me as being weird at the time... something I read about or saw in a movie set in the 1800's at a birth. Not necessarily wise idea. And I do know that they were panicking and the only goal ( m/w said as much later) was GET THE BABY OUT as fast as possible. Honorable of course. I am truly thankful my baby is alive and healthy. But I think maybe all she could think about was the clock and this 6 minute limit. So that was filling her mind, not anything to do with mom's well being. I don't blame her, really, but it left a deep impact on me. We processed a bit later on. But we have since moved out of the area again.

TMI ALERT: I read in the above resources cited by Serenyd that a possible complication of s/d can be rectovaginal fistula. While I don't have that, thankfully, I have noticed in recent months a distinct weakening of the rectovaginal wall. Not severe symptoms, but when I ahem reach in to check cervix and CF for charting purposes, I can tell when I need to evacuate cause there is a definite narrowing of vaginal canal, partially blocking cervix which I can tell is from contents of rectum. After voiding, it's normal again. NEVER had this before in my life. I hope it doesn't get worse! I understand this could be a side effect of the S/D itself not the fundal pressure? But still, it probably didn't help. It took me MUCH longer to recover from this birth than my first two, physically and to be able to DTD again.

Here's something. We moved to a new area in my 8th month. I had to find a new m/w and we found one of the only 2 in the area to work with. She seemed the better choice because the first one we talked to seemed rather snarky in our inquiry about our financial situation. This one was willing to work out a payment plan. So we went with her. But she had not had as much experience, and was a LM with a m/w in training. They were *very* nice. But even as much as I loved our appointments and talking with them, deep down I could not shake this feeling of disquietude about working with her/them. Like something was gonna go wrong or ? I missed my m/w back home who attended DD's birth and is a CNM in our home town for years and years... VERY experienced and capable, IMO. I had confidence in previous m/w that she could handle whatever came up. So there it is. I did tell DH about my disquietude several times before the birth. DH has apologized many times for urging me to get in the tub, along with the m/ws suggestions of it. I keep telling him I don't blame him. We dont' know for sure it would have turned out different if I had stayed on land... though that is my secret feeling. The self-doubt tells me listening to myself probably would have made everything worse and had a terrible outcome had I done UC. Sigh. wish i could trust my body again. I do want to. Even 15 months later I sometimes go over the events in a repetitive fashion and wish through willpower I could change the course, not get in the tub. I feel bad about this since I *should* just be thankful for my healthy DS... at least isn't that the rational of c/s or any other intervention proponents?

One other weirdness is that may be related to the s/d. In the month or two prior to birth, I developed SEVERE constipation issues, to the point where I literally could not go a few times and got stuck with waste half in half out of me. Ew. At one point I was laying on the bathroom floor trying to give myself an enema which I have NEVER had to do in my life. It was not pretty at all. VERY uncomfortable. At 34 weeks I even went into early labor, which seemed to halt upon visiting and getting treated at a local chiro. I kept getting chiro tx up to the birth, which seemed to help. I kept telling people like the chiro and m/w and DH that I had this weird feeling that DS couldn't come out, like he wouldn't get born, labor would not start, that I just felt *stuck*. I even visited a hypnobirth massage therapist once or twice at 9 months which helped. DS was 9 days late... but one of my DDs was pretty late too. When I told the hypnobirth lady my *stuck* feelings of worry about this birth, she was helpful but gave me the psychological explanation of what I have been telling myself would tend to manifest.. positive/negative thinking/ power of the mind etc.. well I get that, I am a psychologist in training actually. Yet I was perplexed by why I would feel this suddenly very strongly about not being able to birth DS. I already had had one homebirth in which DD sailed out very swiftly. Yes I had some ambivalence about a 3rd child.. not exactly ambivalence. It was hard to imagine a third child or life with 3, as I had only known it with 2 up til then. BUT before I had one child, before I had 2 it was hard to imagine also! You just can't quite believe it until it happens, at least in my experience. This was a very wanted baby, though my pregnancy had been rougher than I had anticipated.

So maybe I *caused* the S/D through negative thinking or self-doubt or doubts about my ability to cope with 3 kids. Maybe. Or maybe it was very strong intuitions guiding/warning me about the birth situation. My whole life I have had, well instances of *knowing*. It runs in my family... we have Ojibwe heritage. I don't know why. I can't predict at will, but without trying sometimes. But anyone could argue that I let my worry cause the obstruction. Ugh, wish I could know, maybe it was just an interdependence of events at play. But somehow, that's just not satisfying explanation.

For all who have listened here and help me process this... a thousand thank yous!

[zoebird]

i'm more inclined that it was a knowing than a manifestation process.

my experience of manifestation is that it is difficult to manifest a negative situation, and that our interpretation can create emotional patterns where we only see the negative when a positive is happening, therefore perpetuating negative *feelings*, not creating negative outcomes.

as an example, two women look out at th gqrden and see butterflies. one says to herself--how beautiful the world is and feels good. the other says to herself, well, crap, now i'm going to have caterpilalrs eating my garden and feels bad. the bad feeling didn't create eaten leaves or what have you. both women experience caterpillars and eaten leaves. but one is unbothered and the other bothered. the bothered one will continue in a negative pattern, perhaps even to the point of 'hating' gardening, while the other will persist in happiness.

so, i think that when we have experiences like you describe, you are actually getting information that is valuable and needs to be heard.