What I wish they would tell you about having babies - Part 2

by Dr. Sarah Shimanek, PT, DPT, WCS, PRPC

In the first part of this series, we talked about changes to our bodies during pregnancy and how to take care of ourselves during pregnancy. So, today, we’re going to tackle the next part - birthing! How do we prepare our bodies for birth and how can we minimize complications during delivery?

This is one of my favorite topics. There’s so much fear put into our heads around something that is most often a really normal process. People having been giving birth since the beginning of humanity. While we want to prepare ourselves and do what we can to have a great birthing experience, a big part of that is not letting fear drive our preparations. Instead, let’s talk about things you can do to prepare your body so you have a fantastic birthing experience.

Speaking of fear, have you ever noticed that the only people who seem to want to share their birth stories are those that had bad ones? “OMG, I was in labor for 72 hours”. And that they seem to get much more dramatically awful the more times they tell it? (the first time they told that story is was only 20 hours) But it’s not really true that most births are scary and painful. Most of them are normal, calm, and peaceful

So, let me just start by briefly telling you my two birth stories as some anecdotal “proof” of my point. With my daughter, I was induced at 41 weeks on a Friday afternoon, I got an epidural that evening at about 10pm when I was 4cm dilated, went to sleep, woke up around 4am and was 9cm dilated, and a half hour later it was time to “push.” The nurse had me do a couple “practice pushes” and then told me to stop and wait for the doctor. My husband remembers the nurse pleading with me not to have my baby until the doctor got there… way too much paperwork for her.  When the doctor arrived, Anna was born five minutes later. No pain, no lingering effects of the epidural, healthy baby, and the nurse was very happy.

With my son, I opted for a home birth with a birthing tub. I started having contractions during the day at 41.5 weeks, the midwife arrived to check me in the afternoon and said labor was progressing but it was not time yet, so she left and told me to call when contractions were closer. We called again around 2am, and she got there, checked me again, and said “closer, but not time yet;” she then went to sleep on our couch. As time passed, I felt the waves of the contractions but no real pain, so I just breathed through it. At around 6am, I had felt the pressure to push, we woke the midwife, I got in the tub on my knees, leaning against the wall of the tub, and in about 20 minutes, Benjamin was born. He was a big baby at 9lbs, 4oz. Only hurt a little when he was coming out, and just briefly. Felt easy and not painful overall.

What do these two stories have in common? I was relaxed. In the first one, I had anxiety about being induced and being stuck in the bed, and I was tired, but the epidural let me relax and allowed my body to do the work of dilating. I was more relaxed going into my second birth since I had already been through this before, but I was also in a comfortable environment with calm people around me. I had also done a better job of my hypnobirthing preparations, and so I was able to stay relaxed and have a peaceful and easy birth.

When it comes to the pelvic floor, this relaxation is essential for birthing. The pelvic floor has to stretch 150% of its capacity for birth, which shouldn’t be possible, yet it is. If the muscles are already tight and having trouble relaxing, this stretching can be more difficult. Therefore, practicing relaxation of the pelvic floor with diaphragmatic breathing can help. You want to do this while you’re pregnant so you get used to what it feels like to relax your muscles. Lying down in a comfortable position, take a deep breath in, letting your belly expand but keeping your chest still. As your belly expands, try to feel a downward motion of your pelvic floor. I like to think of a hammock between your legs that you’re relaxing into as it drops down toward your feet. You’re not pushing here, just letting your pelvic floor fall naturally, which is the normal motion for the pelvic floor as you breathe in with your diaphragm. A pelvic floor therapist can help you practice this and give you feedback, as well as help you feel the difference between relaxing and pushing.

Another thing you can do to prepare for birth is to try to keep abdominals and hip muscles strong.  If you’re planning a vaginal birth without an epidural, you want some good strength through your trunk and hips to support you in a variety of birthing positions, such as a squat or positioned on your hands and knees. Basic bodyweight squats and lunges can be good preparation for this, though you should consult with a PT to make sure it’s the right exercise for you. When performing squats and lunges, make sure you keep your abs pulled in throughout, as well as your pelvic floor, then do some relaxation afterward to release your pelvic floor so you’re not holding tension. Complete 2-3 sets of 8-12 repetitions, 2-3 days per week for strengthening. Don’t do these exercises if you’re having any pain, and in particular no lunges if you’re having pain at your pubic bone or SI joint (the SI joint is the very lower back, closer to your tailbone). Again, consult a PT to make sure this is the right exercise for you.

What about perineal massage? If you haven’t heard of perineal massage, it’s when you do some stretching at the perineum for prevention of perineal tears with childbirth. The perineum is the part between the vaginal and anal openings, and is a common site for tearing during childbirth. Small tears are very normal and typically heal very well, but pregnant people are often told to do perineal massage to help prevent tears. Does it work? Yes and no. It’s been shown to be effective when it’s done during labor, but research on doing it preventatively prior to going into labor is more mixed. That said, it’s a pretty easy thing to do that isn’t going to hurt and may help, so I always recommend to do it. This should be started around 36-37 weeks, and all you need to do is take some kind of lubricant or oil (coconut oil works well), place it on your thumb, and insert your thumb just slightly into your vaginal opening, pressing down toward the perineum, then move it back and forth in an arc, stretching. It will feel uncomfortable but shouldn’t be painful. You can also have a partner assist. If you feel unsure about this process, see a pelvic PT, and they can help show you how or even do it for you.

Speaking of tears, what else can we do to prevent tears? Positioning during labor is an important one. If you plan to have an epidural, your options for position are more limited, but you can still assume the position that research says is best for decreased tears, which is lying on your side. Talk to your OBGYN or midwife about whether or not this is a position they are okay with, but most are. You may also want to play around with positions on your own to see what feels most comfortable. A pelvic PT can also help you determine in which position your pelvic floor is the most relaxed.

The other important part of positioning during labor is choosing a position where your pelvis and sacrum can move, which isn’t possible when you’re lying on your back. Side lying is a position that works for this, as does quadruped (hands and knees), or kneeling while leaning on something like a birthing ball or your partner. That last one is what I did when birthing my son, and I got away with a fairly short “pushing” phase and minimal tears, and he was a big baby, 9 pounds and 4 ounces. Squatting can also feel like a natural position for many people, but since that’s not a typical position for many individuals in U.S. society, it may not be one that’s comfortable where you can relax. For this reason, it’s also one that has the highest incidence of tearing. Try it out when you’re not in labor and see how it feels for you.

At the end of the day, being able to relax and let go of any fears is the most important thing. One of the best childbirth preparation courses / series that focuses on relaxation is hypnobirthing. We have a great hypnobabies educator and doula locally, Kim Gross with Serene Births. You can check out her website at serenebirths.com. You can also find more info on the Hypnobabies website or the Hypnobirthing website. I personally used the rainbow relaxation hypnobirthing tracks to prepare for my birth.

Lastly, a pelvic PT can take you through the key physical parts of preparing for birth, teaching you how to relax your pelvic floor, telling you what exercises you need to do to help prepare, teaching your perineal massage, and taking you through positioning options for labor, helping to determine what some of the optimal positions are for your body.