Monday, December 21, 2009

Just Call me Elastigirl

After our family saw “The Incredibles” in the theater we were talking about the movie, and someone commented that Elastigirl’s powers had a nice side-benefit when it came to the childbirth department. After all, she can streeeeeetch with ease!

As I mentioned in the birth story, after Eagle’s birth (with his big head, nuchal hand, stuck shoulders, and even the midwife’s hands in there with him working him loose) my midwife anticipated that I would have torn a lot and that she would have “a big sewing job.” Although I had not thought about it at all as I was actually giving birth, as soon as she mentioned it I realized that, since I’d had 5 stitches after Bear (who was smaller), I probably did need some stitching up. And yet, as you know if you’ve read the story, I didn’t have any tearing at all. Not even one of the tiny tears commonly referred to as a “skidmark.” I have spent some time pondering over why this was.
I don’t know the answers of course, but I thought I would share some of my speculations, and perhaps they will be helpful for others mamas preparing for birth.

Belief in the possible
In her book “Ina May’s Guide to Childbirth,” Ina May Gaskin tells the story of a first time mom who was nervous about labor and how a baby could fit through. Ina May taught her the physiology of birth, and explained “you’re going to get huge.” During labor Ina May noted that this woman dilated well and had plenty of room for her large baby to come through. Afterward she congratulated the new mother, who said, “I just repeated that mantra you told me ‘you’re going to get huge.’” Perhaps it’s a little easier to believe in your body’s stretchiness if you’ve done it before, or if you’ve seen it happen (especially in person). Perhaps simple affirmations are sufficient. In any case, I believe that a genuine belief that my body could do this—was made to be able to stretch this way without incurring damage—was an integral part of its doing so.

Fear --> Tension --> Pain...or not

If you have read any natural childbirth books then you are almost certainly familiar with the concept of the “fear-tension-pain cycle,” which states that a woman who feels fear will tense up, being tense (rather than relaxed) will make her pain more intense, and of course intense pain will increase her fear. The solution then is to break the cycle—many methods promote relaxation with the idea of breaking the cycle at the ‘tension’ point, but what if you could break the cycle at ‘fear’? If a woman can go into labor feeling comfort and love and support rather than fear, might not that reduce (or remove) the tension and thus the pain? In my experience, yes it can. It’s not that labor wasn’t intense (it was) or even hard (parts of it were), but I felt sufficiently comfortable with my environment and supporting team that I felt no fear, and felt no tension, and (depending I guess on your definition of the word) felt no pain. I’m not saying it was an orgasmic birth—it wasn’t—but it was genuinely fearless, and thus my body was loose and able to stretch as far as it needed to.
Fearless labor and birth may sound lovely but figuring out how to actually do it is another question of course. I think that being able to choose a birthing location and provider that made me comfortable was vital. I happened to choose to be at home with a hands-off midwife, but I don’t believe that there is a universal ideal: some women will be most comfortable with a hospital setting and OB, some will want to be alone in the woods. The people present at the birthing matter too. Many women want to have their mother and/or spouse present, but some do not. Some invite a friend or sister or hire a doula or have their other children there. Many women feel safer and more relaxed with low light, music, massage, water, or aromatherapy. The point is not to do any one certain thing, but rather to know yourself well enough to choose what makes you feel safe and comfortable.

Gentle, supported birthing
Gentle birthing in the physical sense means that the baby is able to descend gently through the birth canal and vaginal opening. When the mother is coached in “purple pushing’ (the chin-to-chest-and-hold-your-breath-while-we-count-to-ten kind of pushing) the results tend to be not so gentle. At a postpartum visit my midwife commented that I had brought him down very gently, which I think is accurate, but I can honestly say that I wasn’t doing it consciously; I was just going with instinct. Some labor techniques talk about “breathing the baby down” rather than pushing, and I can say that that is definitely not what I did. I pushed and I pushed hard. I put my chin on my chest. I probably even held my breath a little—though if I did it was of my own volition and not because I was told to do so. BUT I pushed when I felt the urge and not when I didn’t. I let the baby come down, then retreat a little, then come down some more, then another small retreat…two steps forward, one step back. That back and forth motion helps things stretch more gradually and therefore more gently. I knew he was coming, and while I was eager to have him out, I also knew that he WAS coming and that there wasn’t a point in trying to force him to come any faster. Basically I just went with the flow.
When I say ‘supported’ I mean it in two ways: first, the emotional support that comes from having the right people (and none of the wrong people) present. I already went into that. Second, the physical support of the vaginal opening as the baby (especially the head or presenting part) emerges. Most providers who promote natural birth will use their hand(s) to put gentle pressure on the perineum, however when Eagle was crowning there was more than one set of hands supporting me. I know her hands were there, and I believe Hubby’s were too, and I instinctively reached down as well, so I was supported all the way around rather than just at the back. Since tearing can occur in any direction, I think that the all-around support definitely helped. I’m glad that my environment and birth team were comfortable enough that I was able to be uninhibited enough to do that.

The final thing that I think contributed to my stretching rather than tearing is that I labored and birthed in warm water. The warmth during labor definitely helped my body relax, and as I explained already being relaxed and loose increases stretchiness. I think that the water also provided some gentle lubrication for the baby as he came down the canal. We all know that a little lube can facilitate and increase the comfort of other vaginal activities, and I don’t see why birth should be any different. Many midwives use KY Jelly or olive oil on the perineum during birth, but being immersed in water provides a more, shall we say, complete lubrication.
For what it’s worth, while I loved birthing in water and hope to do it that way in the future, not everyone likes waterbirth, and many providers do not allow it. Don’t for a moment think that delivering “on land” precludes a tear-free-birth. Water is just one contributor of many, and it is my belief that while all of them may help, probably any of them is sufficient.

So there you have it: my thoughts on why I didn’t tear during Eagle’s birth (and why I did with Bear’s). I’m interested to hear your thoughts (or experiences) as well.


Mallory said...

I tore a little with Bug's birth. But they were lateral tears that were barely big enough to stitch. I think I tore because...well...I didn't have all that you described in this post! I am so excited to see what it is like when I get to birth how I am more comfortable!

Christa said...

It is so funny that you said this! Being only 10 days from my due date, I have done alot of thinking about my elasticity. When I had my twins I remember saying that I hoped I would discover that I was really and truly Elasti-girl in hiding. I did pretty well. I had a skidmark because I dilated and delivered so quickly. Which scares me because the twins were so small. But it really happened so fast there was no time for stretching. This go around we will have a crockpot full of hot washclothes and lots of support for my perineum.

Destiny said...

Well, I had an episiotomy with my first, which was just awful and tore with both my other two. I'm hoping this time around having a water birth, midwife and being much more confident in my ability to birth will change those circumstances. We'll see.

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