No waterbirth... now what?

[karanyavel]

Brief history: I've had two babies, both of which were born in the hospital, in the lithotomy position. I'll be having the next one (whom I am currently pregnant with) at a freestanding birth center.

I have multiple sclerosis, but this shouldn't have much of an effect on my pregnancy nor on delivery. There's a slightly increased risk of c-section due to maternal exhaustion but I have a history of very easy, very fast births (e.g., two pushes and out comes the kiddo).

However, I found out (during my last appt.) that I couldn't have a waterbirth because of my MS. One of my primary symptoms is heat sensitivity and the midwife told me the water needs to be 98 degrees for the baby. Makes sense, and she said of course I could labor in the tub in cooler water, but I'll have to get out before it's time to push.

And now I'm clueless about positions. Waterbirth, kind of sitting/lying slightly back on an inflatable pillow, sounded great. I am incapable of squatting. Not sure if I could do it on my hands and knees.. maybe with a birth ball and knee pads! At this point I'm thinking I may wind up giving birth on the bed in God-knows-what position, haha.

Anyone have any ideas for a non-waterbirth position that a semi-disabled woman might be able to pull off? I have a very ample pelvis and small babies, but tend to have horrible tears (probably due to coached "purple pushing" at the hospital... getting the baby out in two pushes is not great for my vagina apparently).

--K

[MyFullHouse]

I'm a fast pusher, too. I've delivered one on my back, two reclined, and one on hands and knees. Honestly, the reclined deliveries were easiest for me.

If you really like the idea of hands and knees, you could always try it right on the bed (mattress instead of knee pads ), maybe will a smaller ball than usual.

With #4, I didn't have any plan to deliver on all fours, mostly b/c I always assumed the arthritis in my knees would make that miserable. I had to exit the tub suddenly, due to drastic heart decelerations. By the time my hands and knees hit the bed, moving any further seemed too daunting, and that turned out to be my path of least resistance, lol.

I've never delivered on my side, but that sounds like a plausible option, too. Or even leaning over the bed, onto a birth ball or pillows, with your feet on the floor. That's one of my favorite labor positions, so why not for delivery?

Even if you do try to slow down the pushing stage, it sounds like you might go relatively fast, anyway. I would just try to go with whatever feels most comfortable in the moment, and there's no real telling what that might be!

[karanyavel]

You're absolutely right that I'm not really going to know until it comes down to it. I guess I'm just trying to get an idea of what positions might work given my semi-disability so I have some ideas about what to try when the time comes.

Probably I am overthinking this... but it's a new idea to me that I can give birth in any position I like and the choices seem overwhelming!

All fours on the bed could work, but I think I'd feel more exposed than I'm comfortable with.. that position in particular seems like it puts a lot more in view than I'd like! Then again, I might not care at all in the moment.

I definitely want to slow down the pushing stage if I can. The first time, it was the typical coached pushing, baby was out very fast, and I had severe damage (intact perineum but 4" vaginal sidewall tear and an inch-long anterior tear).

In round two, I had (again) the typical hospital coached pushing -- despite the fact I'd warned my OB. I pushed gently the first time, and was told not to do that, to push HARD and hold my breath... it ticked me off so much I did exactly as they asked, just to demonstrate why it was a bad idea (not thinking clearly LOL). Baby practically flew out, leaving behind a 3rd degree tear in my perineum. (But I did get to say, "I told you so!")

With my previous precipitous labor and the fact we live 45 minutes from the birth center, there's a good chance I'll wind up having the baby at home or in the car! I brought this up... midwife said: no problem, if the baby comes in the car, don't worry about doing anything with the cord, just tuck the baby under your shirt for skin-to-skin contact and continue to the birth center

--K

[MsBlack]

I'll give you the same advice I give any mom: push in the position that feels right, at that time. You will know--you, your body and baby will be able to work it out in the moment, if you just pay attention. No need for pre-planning it at all.

And heck with any more purple pushing! Try to emphasize your reasons for wanting physiological pushing, during this pregnancy. And during the birth, just don't listen to anyone who advises/insists otherwise--unless of course they have a good reason that baby should come out faster rather than slower (unusual, but possible).

good luck!

[nia82]

A birthing stool maybe? And since it will be your first time moving around freely during pushing, you might not even know yet what position feels right to you. Both my sisters had waterbirth available, however they left the pool cause they wanted to squat on dry land...

[Ola_]

Pushing on your side could help to slow things down. Would you have someone that could hold your leg up for you? Upright positions would probably cause the baby to come out faster since they work with gravity. Hands and knees on the bed sounds like it may be a good option too. Good luck!

[wombatclay]

I had a 4th dgree tear with dd2 and did some research on birth positions that might reduce tearing... side lying seemed a good choice. With ds's birth I tried side lying (dh and doula holding my leg/supporting my back) and I had a pretty minor tear (well, minor for me ). The chest down, bum up polar bear position is a good "slow it down" birth position but I'm not sure how comfy it would be for you. It's essentially hands and knees only you fold your arms/put your head and chest down. Maybe with a hospy bed you could adjust the sections to get the effect without the effort?

Birth stools seem to have a mixed track record in terms of tearing. Honestly if you have a history of tears I'd probably avoid them in favor of a birth ball. Birth ball might be more flexible too since you could position yourself in various ways on it.

Hmmmm... if there is a shower you could labor in the tub then move to the shower, supporting yourself with the birth ball? I know several babies born in showers! (put down towels to cushion the floor.

[lunarlady]

Sounds like third stage goes pretty fast for you. Maybe you could labor on land, then just get in the tub for the pushing stage? A 98 degree tub should feel neither warm nor cold. I don't know how your heat sensitivity works, but you might try a 98 degree bath before the labor to see what you think. If the water doesn't work, I would suggest side lying. I've gone all the way to crowning with both my births in a side lying position, but did go hands and knees to birth both. I like being on the bed. Very comfy on my knees, and of course it is only for about five minutes at the very end. Happy birthing!

[Marissamom]

hands and knees, side-laying, leaning over a birth-ball, chair, or bed, partner-supported positions (these would probably need to be tried ahead of time). I would try different positions ahead of time to see what you can be comfortable in for a few minutes, that way you're not trying positions that won't work at all for you during labor.

[Smokering]

Here's what I did for a while with DD before moving into a squatting position: I was upright, on my knees, leaning against the head of the bed (a hospital bed, so it was fully upright like the back of a chair). Because I was on the bed, it didn't put too much pressure on my knees, and the top of the mattress gave me something to bury my head in and hold on to and moan into. It was pretty good, although I eventually decided to move into a squatting position. I do give credit to the squatting, plus extremely not-pushy pushing (fetal ejection reflex only - it was so strong that my midwife's claim I "breathed the baby out" sounded absurd at the time, but I see what she meant now), plus the MW supporting my perineum with a warm washcloth, to my lack of tearing despite a nuchal hand presentation. But if you did the kneeling thing and maybe kind of spread your knees apart a bit more during pushing, you'd get some good pelvic space.

[CEG]

I'm a CNM but have absolutely no experience in this area, I am just thinking here. Even if you have the water cold it would be, say 83 -85 degrees at a minimum (that's what we kept our swimming pool at when I was a lifeguard) and that felt pretty cool so I am guessing you would like it warmer. So i am wondering if it wouldn't be okay to deliver the baby in the water as long as you planned to dry him or her immediately? That water temp would still be warmer than the air temp.

Again, no experience with this (sadly I am not allowed to attend waterbirth ;( but just a thought... perhaps there is something about water temp vs air temp and the breathing reflex that I am missing, sounds like your mw would know more than me in that regard, but just something that popped into my mind.

[sweetsadie77]

We like to keep the water temp between 36.5 to 38.5 degrees celcius, which is slightly below to slightly above body temp. It is not a hot bath, it is a lukewarm bath. Are you sure this temperature would bother you....especially if it was in the lower range? And that is just for the birth, you can labour in whatever temp you want. Could you labour and push in a cool bath and then just have a birth station (nest of towels to lay on, birthing ball to lean over or a birth stool and some chux baths) right by the tub to do the last push or two? Or just stand up in the tub just as the baby is coming?

Bes wishes for your birth.

[karanyavel]

Thanks everyone -- there's some great advice here

Interesting... it really sounds like I need to discuss this further with my midwife. I think she may have jumped the gun saying that waterbirth was out.

I think what I need to do is fill up a tub with 98 degree water and see how it feels! She was pretty clear that the water *had* to be around 98 degrees (the same as the baby is while inside me.. internal body temp).

Also, the other midwives may have different opinions. I'm not sure who I'm seeing at my next visit and have *no idea* who will be there when I deliver. The first one I met thought there was no problem at all with me giving birth at the birth center. The more recent one is a lot more hesitant and thinks I probably will need a clearance from my neurologist (but will be speaking with the backup OB to see what he thinks).

Interestingly, the one who thought it wouldn't be a problem at all has 40 years of experience as a midwife, and the other one is recently certified. So I don't know.

The older lady (the one w/40 years experience) was more focused on my pregnancy and birth history and said that it really works in my favor that I've had two previous vaginal deliveries, both of which were quick and easy (even if there was some damage left behind in their wake!). The newer one seemed very concerned about the heat intolerance issue and that I can't tolerate aerobic exercise (unless I'm right in front of an AC unit and it's blasting cold air at me).

Oh well, at least it looks like I can give birth at the birth center, even if I can't do it in the water as I originally planned. That matters a whole lot more to me than whether I can be in the tub. My other options (besides the birth center) are a very, very bad hospital or a UC.

I think I'm going to pick up a birth ball and see if that helps me figure out some positions I can try as well. As someone mentioned, I kind of do need to try things out in advance because of the whole limited mobility thing.

--K

[tireesix]

I am heat sensitive due to fibromyalgia, I had a water birth with my second and the water was kept at body temperature so it really wasn't warm or cold so I don't think that temperature would necessarily be a problem??????

I also have EDS with dislocating kneecaps, shoulders etc and found that I would just labour in whatever felt comfortable at the time although I did do it on my knees last time but my kneecaps seemed ok with it at the time. I think that just finding whatever position is comfortable at the time is your best bet because you just don't know.

[karanyavel]

Originally Posted by tireesix

I am heat sensitive due to fibromyalgia, I had a water birth with my second and the water was kept at body temperature so it really wasn't warm or cold so I don't think that temperature would necessarily be a problem??????

I don't know what heat sensitivity due to fibromyalgia is like so I'm not sure. I have MS and the heat sensitivity is probably my most severe symptom. If my core temperature goes up even 1/10th of a degree, I'm screwed. I know if I go get the mail during the day (right now it's in the 90s during the day here), I'll be completely wiped out and have to lie down in front of one of the AC units for half an hour to recover. And that's a short walk down the sidewalk to the mailbox... maybe 1/4 of a block?

I think my best bet is to fill a tub with 98 degree water, soak in it, and see what happens. Thing is, just being in labor may heat me up.. maybe.. I have big spaces between my kids and developed MS after the last birth so I can't recall if I broke a sweat or anything. I don't *think* so but this was something the newer midwife was concerned about. (Worried that since I can't tolerate aerobic exercise, I might not be able to tolerate labor.)

Luckily it will be February so the temperature shouldn't be TOO bad (80s is possible, but high 70s is more likely) and I can run the AC in the birth cabin all I want. Better warn my midwife and doula to wear sweaters -- I'm most functional when it's about 68 degrees

Yes, it is very very hot where I live and I am really looking forward to moving! LOL

--K

[tireesix]

With me I get dizzy, palpitations, have to lie down etc.

I think that having the water at body temperature actually helped keep me cool, I do tend to get somewhat warm with physical activity.

I wonder whether may be you could have the water birth with a fan in the room as well?????

[lunarlady]

A water birth with the water at the right temp should actually help stabilize your internal temp since water transfers heat much faster and more efficiently than air. The fear with cold water is the difference in temp could trigger the breathing reflex, causing baby to aspirate water. However, I know that most homebirth tubs have no heating element, so with a long labor it isn't unusual to birth into water that is cooler than body temp, or even close to room temp, so I can't really see why the MW was so worried about the exact temp of the water.

[karanyavel]

Originally Posted by lunarlady

A water birth with the water at the right temp should actually help stabilize your internal temp since water transfers heat much faster and more efficiently than air. The fear with cold water is the difference in temp could trigger the breathing reflex, causing baby to aspirate water. However, I know that most homebirth tubs have no heating element, so with a long labor it isn't unusual to birth into water that is cooler than body temp, or even close to room temp, so I can't really see why the MW was so worried about the exact temp of the water.

Thanks. This was a new midwife and she may not have thought it through. I have no idea how many births she might have attended but I believe she only did hospital births for her certification. She's a CNM.

I know the older midwife w/40 years of experience didn't think it was a problem. The tubs they use are actual bathtubs... large garden tubs with jacuzzi jets. (Presumably the jets are off when the baby comes out! LOL)

My case is a bit more complicated than most because I have MS, but we're hoping to get a consensus between the midwives, the backup OB, and my neurologist. As long as I can deliver at the birth center and not at the horrible, horrible hospitals we have here, I'll be happy. But I'm hoping I can convince everyone that a waterbirth would work out because it seems like the best option for me.

--K

[tireesix]

Oh, thinking as I was just reading through again, this isn't about the heat thing though.

Water was an absolutely fantastic thing for supporting me, as I think I wrote before, parts of me dislocate, have a lot of pain etc but the water did enable me to birth and labour in positions I would have other wise found hard.

I had a water birth with my second, first was on a bed but strangely, for my last baby, I just wasn't interested in water at all, I did try but had to get out, I knew from early on that water wasn't going to work in that birth and I don't know why.

http://www.homebirth.org.uk/water.htm Is a uk homebirth website. I am thinking that even though you aren't here, you might be able to email some of the MWs mentioned (I believe that is a possibility) and maybe get some idea from them about water births with your condition???? It might be a long shot but this is obviously a concern for you and I think it may well be worth trying. There is also a midwife yahoo group over here which you can post a question on, maybe have a look for that, again its in the uk but being in the uk its about the only thing I can come up with and for all I know, they might be able to email you advice etc to take along with you to an appointment????

[Jayray]

Just wanted to say that I had a waterbirth with my first and felt like the water was really, really hot. I saw that they kept adding water to get it to some temp (I guess 98 like everyone is saying?), but at the time, I was sweating and felt so hot. I wanted to be in the water rather than be out, but it did feel really hot to me.

I also wonder about the temp requirement.