Birth and Beyond Blog
|
Have a topic you want to hear about? Send me a message on the contact form!
|
 Tiger in a tree hold It can feel overwhelming and disregulating to have an upset baby that seems to not respond to soothing. Typically, babies can have a time of day where they may seem more fussy and unable to settle than usual.
The 5 S's are a great simple tool to remember when it feels like you have exhausted options for comforting your baby. Where do the 5 S's come from? In 1981, Dr Harvey Karp began investigating the cause of colic (persistent crying in infants form 1-4 months) in Western nations. In some areas of the world like the !Kung culture of northern Namibia, babies are easily soothed in under one minute by their caregivers. The reason for this is because constant physical contact between newborns and caregivers is the norm and caregivers are able to mimic the comfort of the womb through physical contact, movements and sound. These movements and sounds are highly instinctual, and have been used by parents since parenting existed. It is the widespread Western philosophy of early parenting, with much less physical contact, separate surface sleeping, and the goal of early "independence" from caregivers that is an abnormal construct, largely related to a false sense of individualism and rush to return to work. For the first 6 months of your baby's life, they don't know that they are their own person, and they don't have any object permanence. So, when you leave the room or expect them to sleep in their own area, this can be distressing and confusing. It is my goal in my work to help bring parents closer to these instincts and unlearn the idea that a "good" baby is a baby that is independent and disconnected from their parents. We want your baby to act like a baby. A healthy baby wakes up often, needs contact to settle, and expresses their needs through crying. So, when your baby seems inconsolable, it is important to remember that your baby is a person and that they are supposed to cry! They need contact, rest, stimulation, and regulation just like we do, AND, sometimes even when they have all of those things, they may just not be calm. As they get older, you may start to recognize cues, times of day, or situations that might cause crying and work to avoid sensory situations that might make your baby overwhelmed or upset. Crying is their way of communicating that they need any type of support. Your baby will never die from crying, so when you feel overwhelmed by the sound of their cries, put your baby down and take a second to ground yourself before soothing your baby. Many parents choose to wear earplugs during times of day and night when their baby may be especially fussy to help stay grounded and calm when supporting their baby. When your baby is crying and you are feeling lost, you may choose to also follow these 5 "S" steps to help ground and regulate them: 1) Swaddle Wrap your baby tightly in a swaddle, ensuring they still have access to one or both of their hands. 2) Side stomach position Lay your baby on their side, or hold them across your forearm in a "tiger in a tree" hold 3) Swaying Babies like repetitive motion. Bounce or sway in a repetitive motion. 4) Shushing Make a repetitive "sh" sound that is as loud or louder than your baby's cries. 5) Sucking Offer some oral stimulation to your baby. If you are breastfeeding, offer the breast, even if they don't seem hungry. Breastfeeding is not only for nutritional purposes, it also offers sensory support. If you are not breastfeeding, you may choose to offer a soother or your finger to give your baby something to suck on. Choose an oral tool that aligns with your feeding goals and is approved by feeding professionals to reduce nipple confusion. These are the traditional 5 S's, but I would add to the list: Babywearing! Put your baby in a stretchy wrap, ring sling, or buckle carrier and bounce, sway, shush, and pat your baby. See if the motion and contact helps settle them down. If you are wanting to learn more about babywearing or have a consult from a local babywearing educator, check out babywearingmelody.com for local babywearing support, or The Babywearing OT for videos and tutorials about choosing a wrap and safety tips. Patting. Patting your baby's bum firmly and repeatedly mimics a heartbeat and can be very soothing for babies. Pat harder than you think! Babies often like firm, repetitive touch. And after all that? The most important thing to remember is get to know your baby! Look at your baby often, hold your baby often, and get used to parenting the baby in front of you, not Dr Google's baby. Just like in birth, your instinct is probably the right answer. You got this!
2 Comments
Congratulations, new parent! It's time to bring your baby home! Getting home with your baby might feel exciting, overwhelming, sad, daunting, or everything all at once. So, how can we set up a plan for the first day at home, to make space for all those feelings, and set you up for success?
One thing that I wish more parents were aware of is that the placenta keeps your baby fully nourished for the first 24 hours of their life! This is a wonderful way to reframe feeding and sleeping windows in the first 24 hours as less of a survival need for your baby, and more of a way to get acquainted with them on the outside. This, of course, depends on how their blood sugars are, and if your midwife or doctor has recommended a particular feeding regiment (with reason to back it up) it is important to follow that. It is indicated that babies that are born bigger or smaller than a certain range be be monitored for blood sugar in the first 36 hours of their life. This is a protocol that you can choose to consent to, or make an informed refusal, but you may choose to ask more questions about recommendations for feeding in the first few days if this is the case. With that in mind, some questions you might want to keep in mind for the first day are:
Because your baby's stomach is full the first 24 hours and they are tired from labour, you may choose to also have one longer stretch of sleep with your baby. Ask your midwife or doctor about the length of this sleep. What I have witnessed care providers say is that a 4-6 stretch one time in the first 24 hours is a good amount of rest for your baby. Otherwise, you can expect them to begin rooting in that 8x in 24 hours that we strive for during the newborn phase, or even more often if they are interested in cluster feeding, which is a normal behaviour for newborns learning to feed. If your midwife or doctor has not recommended a particular feeding regiment, the best course of action is to feed on demand. You may choose to write down when your baby eats, but put the clock down and get to know your baby's cues. Your baby will also still be passing bowel movements with a thick heavy form of stool called meconium. This substance is different than human stool, as it comes from nutrients in the placenta, rather than colostrum. You can expect to be looking out for the number of poos and pees, and may choose to write this down in case your midwife or doctor asks. You may choose to also take note of your baby's "poop transition"; where their poop changes from meconium to look more like human stool (more green, yellow, or brown). You should also expect some hormonal changes in yourself as a birthing parent. This might include the need to cry, feel snappy with your partner, or exhausted. You may feel heaviness in your breasts as your milk matures, which might cause irritation or pain. It may be helpful to have a conversation with your partner before birth to develop some tools to use as your body begins this postpartum hormonal transformation. How can your whole family tend to this shift and care for one another? What does your partner need to know or hear to show up for you well? The most important thing to remember is that while your baby needs monitoring to make sure they are fed and safe, they are a human being. The biggest thing they need is love and attachment, which you can simply give them by holding them, doing lots of skin to skin, and giving them a chance to explore what it feels like to be on the outside! Take a deep breath, and take it all in! You've got this! Home births are very special events that require special preparation.
Whether you have been planning a home brith for many months, or have recently decided on one, it is important to build your birth space with sensitivity and care. When you choose to birth in your home, you are choosing to give yourself agency to create a sanctuary for yourself, and decide from scratch how you wish to be comforted by your environment during labour and birth. I often suggest to clients no matter their birth place to consider taking an afternoon of visioning for their birth. This might include drawing, journalling, collaging, or making a pinterest board. What does the birth space look like? Smell like? Feel like? Sound like? Who is present? From there, you can start making a list of how the space will be set up and start building your sanctuary. The first consideration in creating your sanctuary may be which room in the house you want to deliver in. Where do you feel most safe and comfortable in your home? Your bed? The bath? The living room? How can these parts of the home be enhanced to create a calm and positive environment? This may also include the consideration of whether you plan to give birth in water or on land. If you are planning a water birth but don't have a large bathtub, it may be the best course of action to rent a birth pool or tub from Even if you plan to birth on land (ie not have a water birth), you may want to think about how water might help you during your labour. Do you have a bathtub in your house? How can you help make the bath feel special and comforting? In the space you see the bulk of your labour happening you might choose to print photos, affirmation cards, or create a vision board for your labour, make a playlist, light candles, or purchase a special light to make the room feel different and special. You may also want to consider what time of year it is when envisioning how to decorate for the birth. I once heard of a client due around Christmas who added to her birth vision board that she wanted to labour and birth next to her Christmas tree! If it is springtime, you may way fresh flowers, an open window, and running water sounds. If it is fall or winter, you might want to focus on warmth and festivity. From there, there are items you will need to have on hand to prepare for the delivery. They are as follows: For the birthing parent:
For the baby:
For the birth partner
For the birth space:
Other
Setting up for home birth is such an exciting process. Have fun with it and get creative! Oh, and don't forget to hire your doula! As the fall looms, I thought it would be a good idea to dedicate a post to preparing for a doula interview!
The first thing that I always advise clients of is to interview multiple doulas. This gives you a chance to get acquainted with the different styles of practices and offerings, since the umbrella of "doula" is so wide. On a practical level, some doulas offer additional supports like TENS rental, meal preparation, placenta art, or placenta encapsulation, that might be important to you to have included in your contract. On an emotional level, interviewing multiple doulas allows you to notice how you feel interacting with each doula. Picture yourself during an incredibly vulnerable moment in your life. Do you want this person close to you? Do you feel safe and nurtured by this person's energy? Comparing how each doula makes you feel about your upcoming birth and postpartum is important information into how they might make you feel in the moment. Other things to notice: - Was the doula on time for the interview? Maybe this is old fashioned of me, but I truly and deeply care about respecting people's time! - Did the doula interrupt you? - Did the doula try to talk you out of certain wishes or plans for your birth or postpartum? There is a fine balance between advising with expertise and assigning one's own agenda onto someone else's experience. Do you feel like this doula has a preconceived notion of what a beautiful/respectful/empowering experience is, or do they make space for you to share what feels important? - Is the doula guaranteeing an outcome that is not guarantee-able? I.e. promising you will have a home birth, unmedicated delivery, or promising you won't have a c-section? To me, the traditional questions (and questions I hear a lot) focusing on experience (number of births attended) and emergency response can be misguided. What this signifies to me as a practitioner is that this client is looking for reassurance of safety and needs to process some fear about the birth experience. Being able to be a calm, grounded presence for a family in a moment of chaos, disappointment, or fear does not come from experience. Alternative questions to ask that might get at the heart of the matter might be this:
Additionally, you might want to ask a doula about their values! How do they relate to birth and postpartum in the broader political context? Birth does not exist in a vacuum and purchasing a doula is not a transaction outside of power structures and capitalism. How does this person represent themselves to their community? Do they use gendered language about birthing people's bodies? Have they spoken out against the perinatal health crisis in Palestine? Do they use the term "natural labour" rather than unmedicated, or non-epidural? These are all things that would matter to me much more as a client than number of births attended, or ability to catch your baby in the car if you have a precipitous birth (if you are a first time parent - you probably won't). So, from my perspective, it is most important to steer the conversation back to how a doula makes you FEEL. If you leave the interview feeling like this is someone you want to continue talking to, that makes you feel excited for this transition; if they asked you questions getting to the heart of the matter and really cared about the answers, and wore their values on their sleeve this might be the doula for you, even if they've only been to 10 births! If you leave the conversation feeling uneasy, overwhelmed, coerced into changing your mind about your plans, unprepared, interrupted, or dismissed, or just "meh", it might be time to keep looking, even if they've been to 400 births! The doula right for you is out there --- you might just need to ask the right questions.  Image: The VBAC link The hospital system has a term for describing a lack of change in cervical dilation. They label this pause in labour as "failure to progress". Yes! Sometimes labour stalls or full on stops, but this language is laden with value and implies that the pause is progression is somehow a failure on the birthing person's part to "do" labour. This is simply not true. Nothing about a stall in labour has anything to do with success or failure. The progression of cervical change and contraction pattern is indicated by so much, including: - Whether your body started labour naturally, or your labour was induced. - The position of your baby's head on the cervix. A baby that is "sunny side up" may result in a longer labour with more stalls. Read further to hear about positions to try to get baby to rotate! - Your hormone levels, cortisol levels and sense of comfort and ease. Labour uses the right side of the brain, and when people are far into labour, they often appear to be in a sort of trance, where the left side of the brain shuts down. Their speech may slow, and they may not be able to answer practical questions. When birthing people are stressed out, being poked and prodded at, and being interrupted out of "labourland", the flow of the right side of the brain is interrupted and labour can stall and stop. (Source: Birthing from Within). - How long you have been labouring and you and your baby's exhaustion levels. Babies have a point in labour where they struggle to tolerate contractions. At this point you may choose to transition to a surgical birth, if your baby's heart rate is showing signs of distress. Also, are YOU distressed? Do you feel like you're just done? Birth is a balance and if you truly feel like you are ready to switch gears, there is no shame in doing so. - Your provider's schedule and the demand on the labour and delivery unit. If there is high demand on the unit, there may be more pressure for providers to "keep things moving". This is a good reason to consider an out of hospital birth or midwifery care if your pregnancy is low risk, because there is no one waiting to take the room you are in. - The "rest and be thankful phase". Right before your baby is born, your contractions may slow or stop altogether. This is a natural mechanism from your body to give you enough energy to push! So, what to do? The first option is just wait and see! Depending on whether you are still at home or are in your birthing setting, the cervix may change rapidly just by waiting and taking the pressure off. It's important to remember that there is no rush, and you get to call the shots of whether to shift to chemical augmentation or a surgical birth. If you have an epidural, you can go to sleep for a few hours and get into a comfortable position with the pelvis open (using a peanut ball if you wish). There are lots of ways to increase oxytocin that don't include medical intervention. Some examples are: - Sex and intimacy - Nipple stimulation (bring your breast pump to the hospital) - Dancing and playing joyful music - MILES circuit (www.milescircuit.com) - Touch from a loved one or doula - Change in environment - Use of water for comfort (bath or shower).
After trying positional changes and oxytocin boosting activities, you may choose to talk to your provider about augmenting your labour in some way. Your provider may agree to rupture the amniotic sac, which can pick up contractions depending on baby's position. You may also choose to use synthetic oxytocin to augment labour. This is a medication that is given through an IV that simulates the hormones your body uses to make long and strong contractions that result in cervical change. You may also choose to get an epidural which can sometimes help the pelvic floor relax and the cervix to open. The reality is, nature's design is not perfect! And neither is the hospital's. It is always your choice whether to continue labouring and wait and see with position changes, or shift to a surgical birth. There is no wrong or right answer and any choice you make is the right choice for you. But, make the choice for you, not your provider. And no, you are not a failure. Your body is doing amazing things and you are giving birth to your baby no matter how and when they come! The reality of our healthcare landscape often means that new parents begin their postpartum period with birth experiences that need deep processing and that include a wide range of feelings that aren't only the joy of meeting your baby. Arguably, birthing in our current medical system most of the time gives way to disappointment, anger, and frustration, and resentment of others who had a better experience. Even if there was no emergency, it's likely that you will leave your birth with a need for some amount of processing.
Birth trauma exists on a continuum, from care providers' comments that dismiss your confidence in your inherent ability to birth, to having a baby separated at birth to go to the NICU, a "stalled" labour, instrumental delivery, disruption of the golden hour, unwanted touch of your body, or the sometimes deep disappointment that comes with an emergency or unplanned cesarean birth. The most important thing to remember coming out of an experience that didn't go how you wanted is that it was not your fault. You are one individual birthing in a landscape of obstetric violence. Your body and your baby's body are responding to the environment around them. And, even if that is a beautiful, patient and nurturing birth environment that supports progression, sometimes the body or the baby has a different plan. Birth going to plan has mostly to do with luck. Yes, there is a lot of preparation involved. But, doing the mental and physical preparation for delivery is one part within a landscape of a system that is used to your birth looking and going a particular, hegemonic, controlled, and disempowering way. After a difficult delivery, you may feel alienated from your partner, your baby, and your doctor. You may feel alienated from yourself and your body, violated, or ashamed. You might feel worse if others are making comments about how happy you should feel now that your baby is here. Please know that you don't need to be over the moon or rush to bond with your baby. There is plenty of time to bond with your baby. The most important thing after a hard birth is to tend to your needs. So, what might those needs be? Space and quiet for you and your baby to rest at the hospital immediately after birth and hands off from nurses and providers. Low or no interruptions on the postpartum unit. No visitors to your house, or only visitors who will understand and support that you may not feel the happiness and satisfaction that you thought you would with your new baby. Help from a mental health practitioner who understands the specific intricacies of birth trauma. Support groups for new parents who had similar difficult birth experiences (see perinatal resource list) Nutritious meals of your favourite warm food. An artistic outlet. You may choose to draw a picture of how the birth experience felt, what moments felt the most difficult and violating, and rip the paper up when you are finished. You may choose to dance or listen to loud music to let the energy of anger and disappointment move through and out of your body. Connect with nature. Take your baby for a walk, or go with a partner or a trusted friend to a park or near water. Notice what your body feels like as it is in that moment with the changes of postpartum. You might choose to say something out loud to yourself or give yourself a self-hug. File a complaint with the hospital or care provider. Let the hospital know that you were disappointed and upset with the care you received and exactly why. The more people who speak up about these violations, the more change will occur to disrupt obstetric violence. What do children do when they feel angry and disappointed? They scream, yell, cry, and stomp. I strongly believe that adults should do this more! Use sound and force to release the energy of the disappointment of anger through and out of your body. Have a pretend or real conversation with yourself, your provider, or your baby. Imagine what you or your baby needed to hear in the moments that felt the hardest. There is nothing wrong with my body. My body is important. My body withstood a lot. My baby withstood a lot. My instincts were violated and it wasn't fair. Other people have beautiful birth experiences and I didn't get that and it isn't fair. Say these things out loud to yourself and perhaps try a self-hug while you are saying them. Rest in bed for as long as you need. Cover yourself in warm blankets or a heating pad. Have a stay-cation with your baby for as many days as you need until you feel like you are ready to face the world again. Accept help from partners, friends, and family members or a doula who understands your feelings and isn't going to push any other feelings onto you. Let the housework, cooking, and cleaning be a village effort while you pick up the pieces. There is no need to bounce back from any type of birth, especially a difficult one. Taking the time to be with yourself and accept all the feelings that come with birth and postpartum is incredibly important on the road to healing. You will need anger, sadness, and rage to navigate parenthood just as much as you will need joy and tranquility. It is my hopes that the more we talk about birth trauma, the more we can open ourselves to these feelings as welcome visitors, and see what they can teach us about building a future of empowering births for generations to come. The "due date" has come (or not) and you are beginning to feel changes in your body that might indicate that your baby is preparing to meet you!
These changes might include: - Pre-labour contractions (previously referred to as "Braxton-Hicks" contractions) - Low back pain and pelvic pressure (although this may not be new in late pregnancy!) - Release of the mucus plug - Hind waters leaking (a slow leak of amniotic fluid) - Fore waters breaking (a big gush of amniotic fluid) - Early labour contractions: contractions that follow a clear pattern but are less than one minute long and mild to moderate in intensity. Especially for first time parents, the instinct when these signs begin is to gather your belongings and rush to the hospital, or call the midwife immediately to settle in for an out-of-hospital birth. But, birth may still be days or weeks away! The biggest piece of advice I give to clients at this stage in labour is to REST. Rest as much as possible until you cannot ignore the contractions, and then keep resting more. Imagine not sleeping for 2 or 3 days and running a marathon. Many many parents (and I used to struggle with this too as a new doula) get overly excited during early labour, go to the hospital sooner than needed, and exhaust all energy and tools before the really intense part of labour sets in. Then when things get ramp up towards transition and pushing, there is no energy store to draw from. Exhaustion is usually the first step in the cascade of interventions that lead to an unwanted surgical birth. Additionally, seeking clinical care earlier than needed often leads to unnecessary augmentation or so-called failure to progress. So, here are a few ways to spend your time in early labour: - Sleep or rest between contractions. You may even be able to sleep through contractions in very early labour. - If it is daytime, go for a long low impact walk in nature, taking in the sensory experience of a slow walk. - Date night or time with friends and older children and pets. - Immerse yourself in water. Take a long bath or shower. - Listen to a birth-focused meditation, practice intention setting, or pray. Get into the zone of the mountain of birth you are about to climb. Breathe deeply and notice how it feels to surrender to your body's timeline. Talk to your baby! Tell them you are excited to meet them soon and that you will take care of them as they embark on this journey of labour with you. One of my favourite birth meditations is linked here. - Do a short, low stakes project that is easy to abandon, like a puzzle, knitting, or low-stakes household task. - Low impact movement, like lunges, cat-cows, and hip-openers. - Put your phone away! Don't record the space between contractions until they become regular and unavoidable. You may note the time that contractions began, but expect things to stay mild for a long time, especially if you this is your first pregnancy. And did I mention REST?! Have other favourite rituals for early labour? Leave a comment!  Whether planned or due to unexpected complications arising during birth, needing a c-section can invite different type of needs from a vaginal delivery. One of the most common fears with a c-section is that the birth isn't "real" or doesn't hold the same type of gravity that giving birth vaginally does. This is simply not true. Having a baby via cesarean is still giving birth. Both types of entrance for baby can be beautiful and meaningful for you, your baby, and your family.
It is important going in to your experience, whether it is medicalized or non medicalized (or sits outside of that binary) to know that ALL birth is inherently meaningful and sacred. Whether a through surgery, at the hospital, or at home it is possible to tap into that spiritual significance while adapting to the circumstances. No matter how baby comes to meet us, we can tap into the magic of birth when we find pathways to do so. This post will include a few practical ideas for highlighting the spiritual transition of birth in surgical settings. First of all, if you are planning a c-section it will be easy to incorporate spiritual or religious significance into your plan. This may mean playing a certain piece of music in the OR while baby is emerging (yes, this is allowed in many hospitals), or having your support person read a poem while baby comes. In the OR, you can also request delayed cord clamping and skin to skin once baby has arrived, the same as if a vaginal birth occurred. Skin to skin can and should happen in the OR! This may look like your support person placing baby against your chest while the tissue is being repaired postpartum. You may ask for the placenta to be saved for your observation or keepsake. Once you reach the recovery area after surgery, you can continue skin to skin and baby may begin to root to try a first feed if you are planning to breast/chest feed. Another wonderful idea that one of my clients with a planned cesarean had was to have her friends and family all light a candle in their respective homes during the time of her scheduled surgery. This is one of the beautiful things about a planned c-section - your community and loved ones will know when it is happening and be able to send you well wishes or say a prayer or thought for you on the day. While recovering from a cesarean can bring its own pains and challenges, there are many resources to support in recovery and it is okay and a good thing to ask for support. One of my favourite resources that I often draw from is nurturingthemother.ca. Janelle provides many resources that support expectations and needs around cesarean birth, and has a recovery guide available on her website. The most important takeaway is that giving birth via c-section is still giving birth. It will still release the hormones that move through the body to promote bonding between birthing person and baby and support lactation. There are so many ways that c-sections can be made meaningful through ritual, music, poetry, and bonding and it is more than possible to leave your c-section feeling satisfied with your birth experience!  Attention ALL pregnant people!
Have you visited a pelvic floor physiotherapist? I cannot stress enough how much misinformation is out there about pelvic floor health for all people and how much a pelvic floor physiotherapist will help you in preparing for birth and postpartum. Below are a short list of benefits of pelvic floor physiotherapy for the pregnant and postpartum person. I won't touch in this post about pelvic floor health for non-pregnant people, though I recommend it for all. Education Dr Juan Michelle Martin, PT and doula is an advocate for skilling up in information about pelvic floor health (Listen to her speak here). She attests that unfortunately, gynecologists and doctors often do not voluntarily offer information about pelvic floor health, forcing the client to initiate questions that can feel vulnerable and uncomfortable, especially when they pertain to sex or incontinence. This creates a widespread culture of uncertainty and shame for all people around asking questions about pelvic floor dysfunction. Speaking with a pelvic floor physiotherapist, you will likely have more questions asked and issues addressed than with a doctor who does not specialize in the field. Prolapse Prevention Out medical system is more reactive than preventative. This is why it is prevalent for doctors to often under stress the importance of pelvic preparation for birth, because they are comfortable supporting repair and reconstruction from perineal tears and pelvic prolapse. I have spoken with birthing people who tell me that their doctors say not to worry too much about tears because "we can fix that after". But, what if we worked to prevent injury as much as we do to repair it? Your pelvic floor physiotherapist will help with strategies to stretch the pelvic tissues, to prevent common injuries that occur with a pelvic floor that is either weak or too tight during birth. In her book The Fourth Trimester, Kimberly Johnson writes that, to many of her clients' surprise, more pelvic floor muscles she works with are overly tight than they are weak. The goal not always strength, the holistic goal is to create a responsive pelvic floor to cede to let baby through. The overprescription of pelvic floor squeezes (also commonly referred to as "kegel" exercises) is a lazy, sometimes harmful lapse in care when we are aiming for RESPONSIVENESS in the pelvic muscles, not strength. Reducing Back Pain Pelvic floor physiotherapists offer exercises to reduce and manage back and sacral pain during the third trimester. Additionally, physiotherapists will help with addressing back pain that can occur during breast/body feeding. This is because the musculature of the pelvic floor is closely linked to all of the lower parts of the body including the spine. Safe Strengthening and Recovery Postpartum pelvic PTs will know the level at which to work at to support a safe recovery of the core muscles. They may also be able to massage scar tissue from perineal injury or cesarean section. Pleasure Sexual pleasure and access to sexual pleasure is a basic human right. Let's throw out the idea that new parents shouldn't get to choose to have good sex when they are ready, please! Becoming a parent does NOT mean that your sex life is over, or that you will be wearing pads or feeling pain perineally for the rest of your life. Pelvic floor physiotherapy gives the postpartum body tools to strengthen and recover to feel pleasure and comfort again at the pace that the postpartum person wants and consents to. In summary, your pelvic floor health is not disposable and your comfort is important. So much of our medical model teaches pregnant people to see themselves as passive vessels for their baby's growth and health. There is no reason to allow for preventable injury just because it can be fixed afterwards. It is never too late in pregnancy or postpartum to visit a pelvic floor PT whether you are struggling or not, to support your comfort and well being! Looking for a pelvic floor physiotherapist in Toronto? Ask your care provider, or explore this list of providers linked here. This week’s blog post is all about what to expect during a membrane sweep, otherwise known as a “stretch and sweep”, a common method used by practitioners to release labour-inducing hormones.
A stretch and sweep is different from a cervical exam. During a cervical exam, a practitioner will use their fingers to feel the cervix. This may occur before labour, to gather information about the state of cervical softness, thinness, and level of effacement. Cervical exams may also occur during labour, to estimate cervical dilation and assess your baby’s level of descent through the pelvis (also known as pelvic station). However, during a cervical exam, a practitioner will not manipulate the tissues to induce labour. It is important to note that consenting to a cervical exam does not mean automatically consenting to a membrane sweep. You may choose to request a membrane sweep at OB or midwife appointments within your due window (usually 37.5 weeks onward), or it may be important to you to avoid any interventions to a spontaneous onset of labour. It is important to be clear with your provider your wishes for or against a membrane sweep or any other intervention offered. You always have a right to refuse cervical checks and interventions at all times throughout pregnancy and labour. However if you are wanting to get labour started but are wanting to avoid induction through synthetic oxytocin, a stretch and sweep alongside other less invasive induction techniques may be a wonderful choice for you! What a stretch and sweep involves: A stretch and sweep involves your provider inserting one to two fingers into the vagina to feel the texture of the cervix. If the cervix is soft and thin, the provider may choose to use a finger to gently “sweep" the amniotic sac away from the uterine wall, in an effort to move membranes away from the wall of the womb. This action helps release hormones called prostaglandins, which, along with oxytocin, stimulate labour. If the cervix is hard and closed, the provider may use their fingers to massage the tissue in an effort to begin cervical softening. Is the procedure painful? A stretch an sweep can cause discomfort and may feel alarming, especially if the provider performs the procedure without consent. Always ensure your provider is aware of your preferences and knows you require warning should they choose to perform a membrane sweep. Lubricating jelly will help ease some of the discomfort, though you may wish to implement some pain management strategies like deep breathing or visualization during the procedure. What happens after a stretch and sweep? After a stretch and sweep, it may be common to experience bloody “show”. This show is a clear mucous plug which, when released, may continue to be produced during labour. It is normal for the mucous plug to contain a small amount of blood. You may also begin to feel cramping which comes and goes, which may be a sign of early labour contractions. What are the benefits of the procedure? Studies show that membrane sweeps may improve your chance of having a spontaneous labour. Alongside other non-invasive induction techniques, it can be an effective way to avoid induction through synthetic oxytocin. It is also a zero cost intervention, and relatively non-invasive. It does not come with other interventions and can be repeated if desired. Does a stretch and sweep include risks? The risks of a stretch and sweep may include a higher chance that the membranes will rupture before labour, especially in the absence of cervical softness (read more here: https://evidencebasedbirth.com/updated-evidence-on-the-pros-and-cons-of-membrane-sweeping/). When membranes rupture before labour, there is a risk of infection to you and/or the baby and medical induction is recommended. For more information on membrane sweeps, talk to your provider! The bottom line is, consent for membrane sweeps needs to be verbal and informed. A membrane sweep is not a routine part of a cervical check. A membrane sweep is a relatively non-invasive and low risk intervention that may help your body naturally begin labour. Still have questions? Leave a comment on this post with your email, or contact me! |
