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Discussion Starter · #1 ·
A while ago we had a mom who, once she hit transition was completely resistant to labor. She spent a lot of energy screaming, "I can't" and "Help me," fought pushing and was generally just opposed to the entire process of birth. There were two midwives, myself (the apprentice) and her husband with her. The midwives had to get very directive and firm with her to keep her legs open, keep the oxygen on between pushing, and to even continue pushing. After the baby was born the mother was very apologetic about how she'd acted in labor (not that she needed to apologize to us) and clearly traumatized by the birth. She also sustained a 3rd degree tear and we had to take her to a local hospital to get stitched up, another very painful and traumatizing experience. My preceptor has only had a few other moms react like this in all her years of practicing and the other midwife had never experienced it.

So, when a mom gets that out of her own control and locked into such a flight response, how do you help her?
 

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OK, I'm sooooooo not a birth professional, but I've been with my SIL for both of her labors and she totally has this response. It really has nothing to do with her commitment to her child and birth or even her personality under normal cirumstances...it really seems like an extreme involuntary response to losing control. The first time her doula got there just as she started to lose it, and she got right up in her face and was loving but very, very firm. "You CAN do this, you ARE doing this, you can't go back now, you HAVE to go forward." And it helped. The second time, a nurse and I tag-teamed her with a similar approach. "You CAN do this, you ARE doing this, get your chin down, focus, and breathe." Strong, firm voices, no hesitation, no sign of fear or worry in our body language or voices. The nurse was right in her face. She wasn't rough or mean, but she meant business. We got very specific with what she needed to do in terms of positioning her legs, her breathing, how she was pushing. I would have hated anyone telling me what to do like that during labor, but for where she was emotionally, it seemed like she needed and welcomed someone coming in and giving her such strong direction. It acted like an anchor to pull her back into herself.
 

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Assuming there is no medical emergency going on, the first thing I do is actually back off some and suggest mom get in a position where she feels more control - standing perhaps, or hands and knees, or sitting on the toilet, or some position that isn't so open-your-legs-and-we'll-stare-at-your-crotch. Sometimes I find that if women can get a few minutes to catch their breath and just focus on getting control without having someone insist they be working on getting the baby out RIGHT NOW, they can sometimes regain some control and go on. We (the nurses and I) say lots of encouraging things along the lines of the last poster - You are doing this! You are so close! You've been doing so well, just a little bit farther! Just get through this one contraction - just this one, don't worry about the next one, just get through one. I know you're scared - we're here, you can do this, it's almost over.

I'm not too worried if a woman won't keep her legs open or whatever. I haven't yet met the woman who didn't spontaneously open enough to let her baby out without me telling her to. Often, I feel like women feel more control in a position that isn't so spread out - in hands and knees support people can be at her face, helping and supporting, instead of fighting with legs and trying to keep her butt down on the bed. Also, standing and hanging from a loving partners arms often seems to help. Sometimes doing a big position change seems to satisfy some of that flight response - mom feels like she needs to get away, so getting up and moving to the bathroom, or whatever sometimes helps that, and then we can keep going. I've had more than one woman have a good freak out, and then re-focus and push their babies out, and just providing loving support through it has helped, and changing what we can change.

If you are in the middle of a medical emergency, it's a lot more difficult (baby's hearttones way down for example, or mom is bleeding and flipping out) I've only had this happen a couple times, and then I try to just keep talking calmly and explaining what is happening while doing what I need to do to help the situation. I haven't yet met the mom who couldn't respond to being told that baby really needed her help right now and could she please try to . . . (push really hard right now, move to hands and knees to help with the shoulders, etc.)
 

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Discussion Starter · #4 ·
That's pretty much what the midwives were doing. Lots of "look at me, mama, look up here"
Personally I wasn't as disturbed by her behavior as were the midwives (not that they were upset with her, just unsure how to connect with her and get her back into the birth), probably in part because as the apprentice I wasn't in charge, and partly because I've watched too many birth shows with ill-prepared and unsupported mothers thrashing about in hospital beds
Interestingly, the birth was being filmed and the girl filming (who is also pregnant and planning her first homebirth) thought it was an amazing birth.
 

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Discussion Starter · #5 ·
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Originally Posted by doctorjen View Post
Assuming there is no medical emergency going on, the first thing I do is actually back off some and suggest mom get in a position where she feels more control - standing perhaps, or hands and knees, or sitting on the toilet, or some position that isn't so open-your-legs-and-we'll-stare-at-your-crotch. Sometimes I find that if women can get a few minutes to catch their breath and just focus on getting control without having someone insist they be working on getting the baby out RIGHT NOW, they can sometimes regain some control and go on. We (the nurses and I) say lots of encouraging things along the lines of the last poster - You are doing this! You are so close! You've been doing so well, just a little bit farther! Just get through this one contraction - just this one, don't worry about the next one, just get through one. I know you're scared - we're here, you can do this, it's almost over.

I'm not too worried if a woman won't keep her legs open or whatever. I haven't yet met the woman who didn't spontaneously open enough to let her baby out without me telling her to. Often, I feel like women feel more control in a position that isn't so spread out - in hands and knees support people can be at her face, helping and supporting, instead of fighting with legs and trying to keep her butt down on the bed. Also, standing and hanging from a loving partners arms often seems to help. Sometimes doing a big position change seems to satisfy some of that flight response - mom feels like she needs to get away, so getting up and moving to the bathroom, or whatever sometimes helps that, and then we can keep going. I've had more than one woman have a good freak out, and then re-focus and push their babies out, and just providing loving support through it has helped, and changing what we can change.

If you are in the middle of a medical emergency, it's a lot more difficult (baby's hearttones way down for example, or mom is bleeding and flipping out) I've only had this happen a couple times, and then I try to just keep talking calmly and explaining what is happening while doing what I need to do to help the situation. I haven't yet met the mom who couldn't respond to being told that baby really needed her help right now and could she please try to . . . (push really hard right now, move to hands and knees to help with the shoulders, etc.)
She couldn't seem to get refocused. She was in the tub, didn't like it much got out, thrashed about on the bed for a while, back in the tub with one knee up to try to get a cervical lip to move away, back to the bed, onto the floor on her back, and finally on her hands and knees. She seemed completely lost inside herself and the amount of tension she was holding in her body was amazing. When we were trying to help support her leg while she was pushing she could have thrown one of us off the bed. Her perineum was also extremely thick and rigid as the baby was crowning, no give at all. She must have had an incredible amount of adrenaline coursing through her body.

There was lots of, "I can't do this" followed by, "you are doing it, you're having a baby, she's almost here, etc." Perhaps we should have addressed her obvious fears a little more, I don't know really. I'm guessing that she was probably thinking, "just take me to the hospital and let me have a c-section; I've done it before and at least I know I can survive that" or at least that's what I'd be thinking if I were in her situation
I guess there's probably no magical answer; it was definitely challenging for the midwives but more importantly I wish we could have helped the experience be a little less traumatic for her.
 

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Quote:

Originally Posted by doctorjen View Post
I'm not too worried if a woman won't keep her legs open or whatever. I haven't yet met the woman who didn't spontaneously open enough to let her baby out without me telling her to. Often, I feel like women feel more control in a position that isn't so spread out - in hands and knees support people can be at her face, helping and supporting, instead of fighting with legs and trying to keep her butt down on the bed. Also, standing and hanging from a loving partners arms often seems to help. Sometimes doing a big position change seems to satisfy some of that flight response - mom feels like she needs to get away, so getting up and moving to the bathroom, or whatever sometimes helps that, and then we can keep going. I've had more than one woman have a good freak out, and then re-focus and push their babies out, and just providing loving support through it has helped, and changing what we can change.

I am not a professional, but a mom. However, I agree with this sentiment. If I had a bp trying to force me to keep my legs open or anything like that I would find it very triggering and traumatic. I would try to find a position that she liked. That kind of behavior on the mw or birth attendent would only be harmful. Just reading that gives me horrible, horrible feelings. I would think the tear would be more likely from being forced like that and adding to the stress.
 

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Discussion Starter · #7 ·
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Originally Posted by crunchy_mama View Post
I am not a professional, but a mom. However, I agree with this sentiment. If I had a bp trying to force me to keep my legs open or anything like that I would find it very triggering and traumatic. I would try to find a position that she liked. That kind of behavior on the mw or birth attendent would only be harmful. Just reading that gives me horrible, horrible feelings. I would think the tear would be more likely from being forced like that and adding to the stress.
Okay, I wasn't very clear about this. Her legs weren't being forced open, we were trying to help support her leg in a side lying position and then I think in more modified semi-recline) and she was so tense that they would cramp and/or keep pulling together. I thought you didn't want a mom's legs together when the head was crowning but I'm new at this so...
We tried lots of positions with her and ultimately she gave birth on hands and knees. She didn't like anything, that was part of the problem and challenge, there was no helping her get in a place either physically or mentally where she wasn't frantic and at times physically flailing around. For future consideration if we have another frightened mom then perhaps we should try an upright position sooner, although she was so weak from the tension I'm not sure she could have stood long, even supported. I guess birth just happens this way sometimes and there's not necessarily anything that can be done to improve the situation beyond getting the baby out
 

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The "Take Charge" routine from the book "The Birth Partner" is what you need for a situation like this.

When I had just about given up after a long, troublesome labor, what really got me to push my baby out was when my midwife yelled, "GET MAD! YOU'RE GOING TO HAVE THIS BABY!" She and I talked about it later, and she said she didn't know what came over her, but it was EXACTLY what I needed to hear, and my daughter was born in the next few pushes. Sometimes tapping into a woman's sense of, "I'm gonna DO THIS and NO ONE IS GOING TO STOP ME, so you better GET OUT OF MY WAY!" can be very useful!

~Rose
 

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i've been to a birth similar to this where mom was physically out of control and just really losing it. and she did indeed have unresolved issues from childhood sexual abuse. i felt really helpless, and so so bad for her.


heh, and i've also seen a baby born through closed, clenched legs that i was trying to encourage to open. yup, can happen.
 

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I was thinking about a history of abuse as well.

With all the tension she was feeling in her body, did anyone do a roving body check between contractions, touching her lightly where things were tense, reminding her to lower her shoulders, release her jaw, etc.? Try to help her relax between contractions, using the rest period? Did anyone try to help her find a rhythm for coping? Did she have comforting stuff like rocking, stroking, touch, heat/cold, pressure? Hair stroking? Music? Just wondering.
 

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I also think that some moms do just need to loose it. Sometimes there is not anything else you can do. I had one tell me afterwards that she surprised herself at "how well she listened to her body and just did what she needed to do". We had talked about that prenatally and that is what she felt she was doing, in fact did. I however, had felt bad because we couldn't get her on track, refocused, etc. It looked to us like she was "loosing it". Now obviously your momma wasn't just looking like she was loosing it while feeling like she was just listening to her body. That's different from feeling traumatized. But maybe that is just what she needed to do to get the baby out.
 

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I've attended births where I am just about positive there was a history of abuse, but the clients chose not to share that with me...ever...so I'm just speculating. Regardless of history of abuse or not, you can only help her as far as you know how to and if she hasn't expressed concern over past abuse issues, when she loses it in labor is not the time to address it.

I personally *HATE* the take charge routine. It seems so invasive and offensive to me. I very, very rarely use it as a tool in birth. I find that empathy goes a lot further. In a situation like this I'd say things like "I know it's hard, I've been there too" or "I want you to think about holding and nursing your baby" or "after this next contraction, I want you to completely relax/stand up and hang from your partner's neck/go sit on the toilet and try to pee" or some other coping technique. You mentioned in another post that she's a VBAC. In a primary VBAC, I'd say something about how she's going to get her VBAC if she sticks with this for just a few more contractions or "there's no turning back now, this baby is coming vaginally!" I also find that encouraging mom to let go instead of fighting for control helps. I do that by saying something like "you may think you can't, but your body can, just let it do this. let go of the control." I'd follow that with an encouragement to relax between contractions and pointing out specific tension spots. If she expressed fear, I'd ask what she was afraid of, then I'd address those fears. If tearing was one, I'd say "just do what your body tells you to..it will do everything it can to protect itself" or something along those lines.

It's hard to feel that powerless at a birth. There's a moment in every birth, no matter how the mom is handling it, where she looks at me with sheer panic in her eyes and I know she's looking to me to take the pain away, to make it easier for her, to give her the strength to go on, but I can't do any of those things for her. My friends laugh that this is when I pull out my "midwife voice" and do what I can to help her find the strength in herself. It's one of the hardest things to learn and sometimes you have a birth like the one you're talking about here where nothing in the midwives' bag of tricks was working!
 

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the same thing happened to me when DD2 was born. For me, it was the memory of the very traumatic 2nd stage with DD1. I never realized how traumatized I was from that experience until I hit transition with DD2. The memory of pushing flat on my back with my legs in stirrups for two hours like I did in the hospital with dd1 freaked me out and I was yelling things like 'I can't do this!' 'oh no, it's going to be just like last time' etc. My midwife adressed my fear by telling me that I was doing great, that this would not take very long, that I was almost there... bacically reassuring me that this would be nothing like my first birth. And it wasn't.
Maybe this woman had a traumatic birth that her body remembered when she hit transition?
 

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Quote:

Originally Posted by Rachel J. View Post
, the birth was being filmed and the girl filming (who is also pregnant and planning her first homebirth) thought it was an amazing birth.

Assuming she in not a sexual abuse survivor.

I want to guess it's about being filmed that might have triggered her panic when it came to pushing, it's just too public for many women to have a room full of attendants and a filmmaker.

I personally would never be able to give birth with a filmmaker in the room.
 

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I, too, first had the thought "sounds like an abuse survivor" when reading the OP. I have had moms who have told me and moms who have not, but whether they share the info or not, when they show the signs of abuse, it is always best to assume that that is their history and act accordingly.

A great resource for this kind of history (for the survivor AND the practitioner) is "When Survivors Give Birth." It can be really helpful in getting ideas to support as a practitioner and ways to cope for the survivor.

In general, though, Bach's Rescue Remedy orally and on the ball of the foot, along with homeopathic Gelsimium tends to work really well for me to help my clients focus and get through transition/pushing if they are having a difficult time, along with the typical support phrases, "You ARE doing it. You are STRONGER than this. You and the baby are a team, work together to get this done." That kind of stuff.
 

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I think in one of the mw/dr autobiographies has a story where there is a mom screaming at the top of her lungs and running thought the hospital - won't let anyone get near her and at a point the head crowns and she can't run any more and has the baby standing right there- I too hate the keep your legs spread routine-when the baby gets low enough mom will move I have seen it- I think as long as she isn't hurting herself just be reassuring - now if she looks at you - and some women do seek out eye contact- then I look back and will try and be calming some women know this from past births so say when this happens -x will help or I just want to flee for that moment- one woman I know said she felt like that but was afraid that someone would change her care or do something to her so she internalized it and then visualized rummaging through an ambulance and getting some drugs she wanted to help
I have supported one gal though who was progressing fine, and periodiocally screaming well she went to the bathroom and I was starting to fill the tub and the mw with her( this was at the local birth center) was very unhinged by the screaming - I walked into the bathroom to help support mom she wanted a hand to crush and support in standing up- she had her eyes shut luckily because what I saw was the mw had her hand raised - trembling just infront of her face ready to hold mom's mouth shut- now she didn't do it but it was a near thing and I think that the mw was really fighting herself- anyway got the gal into the shower while the tub was filling and the mw went into the other room (to compose herself) well it wasn't over yet- when mom got into the tub she found that if she hit her head against the tub hard enough it distracted her away from the pain- well nope not going to flow with that- first we put a pillow but she moved it and wanted to argue that we should let her bang her head- and I mean she was slamming her head not just a little tapping - so this did take some of that deliberate focused ok how about looking at me and we can work through this - it wasn't long before she had her baby
so I guess it is like dealing with a one of your kids at times- first be calming,and reassuring, second distraction if possible- like change what is happening now- often going to the bathroom or getting into a shower or bathtub/birth pool or even moving from the pool to the shower, walking, dancing hip swaying- singing- like lullabies or any song a mom may want to try-- I also think that using something like the penny simpkin triggers list may be useful for all moms not just the ones that self-identify - even if there has been no abuse there may have been some type of past trauma that has triggers- overly close contact where I am breathing someone else's outbreath makes me feel trapped at times - and if someone were to talk to me in a commanding way I would really freak out= for me there would be no way that would feel safe or reassuring- but I have also had clients tell me ahead of time that they want someone to tell them what to do at a point- now I don't like it but it is what mom wants
 

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Quote:

Originally Posted by mwherbs View Post
I think in one of the mw/dr autobiographies has a story where there is a mom screaming at the top of her lungs and running thought the hospital - won't let anyone get near her and at a point the head crowns and she can't run any more and has the baby standing right there-
A Midwife's Story by Penny Armstrong CNM and Sheryl Feldman, when Penny was in training at a hospital in Scotland, since they didn't have programs for CNM's at the time in the US...
it's one of my favorite books.
 

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I'm not a birth pro, but I had this exact reaction to my labour. I was doing totally fine for 30 some hours and then I just panicked and could not get back on top of things. I scared the pants off poor DH because it is SOO not like me to freak out like that. Everyone backed right off and that made it WAY worse for me. What I needed was someone to get right down to my face and firmly tell me to breath, remind me I was already doing this and I was on the homestretch etc. I need someone to really guide me back to a calm state, slowly and firmly. I was so freaked out that without someone literally a few inches from me I was unable to focus on them.
 
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