planning for #2

I love a woman who thinks ahead :)

A good place to start might be to critically examine exactly what a POP friendly birth process would include. What does this mean to you? YOU know your body, POP and all, very well by now and this is going to be a huge aspect of any future pregnancy and birth. This will be the biggest aspect, actually, since you seem to have already noticed that the silence and ignorance from care-providers is deafening on POP in general, much less healing without surgery AND throwing another pregnancy and birth into the mix.

I am sorry to hear that the help you have found from midwives and obgyns has been less than ideal, but this can change. It often takes a lot of work to find the right support but once you do, it seems like no work at all. Please feel free to post here or message me your location if you want some help on finding some POP friendly support.

Natural birth in a hospital...well, to be blunt this is like someone looking for natural therapies for prolapse from a uro-gynecologist, generally speaking. Of course - it is possible - but really, what are you likely to find? My advice would be - if you want a natural birth, strive for birthing in a place where natural birth actually occurs. The stats are glaringly obvious about this: natural birth - i.e. unmedicated, non-induced, non-augmented, normal physiological birth simply does not happen as often in hospitals or with surgeons as it does in birth centres, at home, or with midwives.

How pregnant are you, oh-mum? I am guessing you are from Aus or the UK?

i agree with Aza--if feels like you are fighting a battle from the second you walk in. some hospitals have "home from home" units, but they are all to happy to move you over. on the other hand, at home they really think before they move you.
would you consider a home birth? our second was a home birth and such a different experience (first we tried home but ended up at hospital). i think midwives are much more natural birth focused than obgyns, so would seem a better way to go. also then you can work together more about how you need to birth.
be clear about what you don't want, and ask questions. what is the c-section rate? rate of women birthing on their back? birthing naturally? etc etc...
if all else fails, what about a doula to help you through and give you the best chance of birthing naturally?
you will get there, and it's great you are thinking about this now. just need to find those who will help...

Hi Oh-mum

If you are in Australia I think you can be optimistic. Sure, things have changed a lot since I had my babies but if you can put in the time making phonecalls I would be optimistic that you will get what you want.

I think the most important thing is to be absolutely clear about the sort of attitudes that you want in your birth helpers, and an ob who has a healthy attitude toward natural birthing, and who will talk straight with you.

First you need to write a list of what you want for the birth and what you don't want, and star rate each thing, so you know how important it is to you. Then you need to start interviewing. During the interviewing process you might find that those star ratings change as you become more aware of the factors involved in each one.

Something to think about is that there are some very good country GPs who are qualified to do obstetrics at their own hospital. They are used to not having anaesthetists and other specialist help on tap, and I think tend to let nature take its course as much as possible. If they are not confident that you will be able to birth easily they are likely to send you off to a better equipped hospital beforehand. They also tend to be older and very experienced. Sadly, they often want to retire, but can't because they cannot find a replacement, and their retirement will mean the end of obstetrics at their hospital, which is a one way path to a hospital downgrade. You can also get pretty good lowdown on them from local women. You will soon find out which doctors do obstetrics well, and which don't. The birth of our third child was at a country hospital, which was a delight compared with the emergency-charged atmosphere in big city hospitals. Yes, I had to argue with the midwife a bit, but the staff were great, very laid back, compared to their city counterparts. That hospital is still a good place to give birth, and my husband had surgery there only six months ago. They were great.

Louise

1. If you give birth in a squat or on all fours, the pelvic organs are forward where they should be, and it seems to me that it would be less likely for your uterus to come out along with the baby (which is my fear if I have another one). If I end up having another baby, this is the position I will do my best to be in.

2. Don't push. If you pant through those last contractions, the uterus will expel the baby by itself. It will put less strain on your organs and muscles. I know of what I speak (having had 4 unmedicated home births), and although it's very hard not to push, it can be done.

I'll be praying for you. I know you must be fearful, and I totally understand your worries! I hope you find someone who will work with you rather than against you.

first, the squat. know that not all squats are created equal. the squatting that's done with ww is fine, be sure you keep your bottom up and pelvis nutated.
I birthed my third baby on a birthing stool, and then right at the end got off the thing into a full squat like you see in national geographic, feet flat on the floor, knees fully bent, bottom pointed down. I had been practicing this position all pg and so it was easy to hold but I'm pretty sure it was one of the many things that set the stage for my prolapse. would never ever birth in that position again.
I had my two 'post POP' babies on all fours, felt good that way.

agree with the no-push idea. did that for number 4, couldnt not push for number five, she was just too fast for me to think about anything but getting her O U T.

The other thing with full squatting is that the woman who full squats to eliminate every day of her life from toddlerhood has developed different facets on the bones of her feet and legs that allow her to squat without tilting her pelvis back, so she is not going to have the same degree of abnormal counternutation that happens in women who use sit toilets all their lives. We (who eliminate while sitting) are often anatomically unable to maintain a full squat with nutated pelvis because we cannot get far enough forward of our centre of gravity without slouching over. We simply fall on our faces! I certainly do, which probably accounts for my little nose, all the scars on my forehead and the freckles on my bum!

Having said that, counternutation happens during birth anyway. As the baby's head engages in the pelvis, whether several weeks beforehand with a primigravida, or during first stage of labour (usually) with multigravidae) the ilia (the flat wings of the pelvis) rotate slightly back on the SI joints and the lumbar curve lessens, potentially straightening out the route that the baby will take on its way out, and enabling it to settle deep in the pelvis.

Once the baby's head passes through the pelvic brim (ring), turned sideways cos it generally fits more easily, the pelvis rotates on the loosened SI joints, kind of like a slow seesaw, into a nutated position. I assume that once the baby's head is into the lower pelvis, the head is no longer holding the lumbar curve back, and the lumbar curve re-establishes itself. At this point the shape of the passage is determined by the musculature of the pelvic floor and the baby's head turns back to where it was, normally facing the mother's anus, again because it is the path of least resistance. This nutation opens the space between the ischial spines (it's to do with the angles of the SI joints relative to each other) and lifts the coccyx, the last impediment to the baby's exit into the wide world.

Aza, can you please confirm that I have this right?

Oh-mum, I hope this will help you to understand what happens during birth, and will enable you to decide what to do with your body during the birth. Visualising what is happening is a useful way to know how to respond. I wish I had known all this when my babies were coming into the world. It was all secret midwives' business back in those days. I don't think they really understood themselves, and on the whole today I don't think hospital midwives or obs think it is possible for non-medically trained labouring women to have this level of understanding of birth, even if they have it themselves. If they don't have it themselves they won't have the faintest idea what you are talking about. Expect this, and be prepared to be positively surprised. I am not saying for one minute that hospital midwives are ignorant, but some of them don't seem to have a very full understanding of the birth process. I say this because our local hospital still uses a model pelvis and foetus during antenatal classes, which is good, except that the model does not have articulated SI joints. How can you teach people with a model that is incorrect??? I read about the degree of movement in the SI joints in Grey's Anatomy, so they do know that there is movement in that joint, particularly during pregnancy and birth, but they don't seem to understand the significance of it, because they haven't been taught that way. (The SI joint also moves slightly in everyday movement, because the two halves of the pelvis alternately nutate and counternutate as we walk and run.) In a world of passive birth, epidurals, stirrups, bedlike delivery tables, forceps and forceful extraction, movement in the mother's SI joints is simply irrelevant. They don't need to know about it. The more perceptive and intuitive midwives will encourage mothers to use their innate ability, but they have to know that you know what is happening. Second stage labour is no time for them to give mothers these complicated anatomy lessons! ;-)

This is where a small hospital with its regular staff runs rings around the big hospitals with all the surgical equipment and facilities that you don't 'need'. A smaller staff will 'probably' have better communication between staff, and so better communication with, and understanding of the Mum and what she wants. If you can meet with as many of the midwives at the hospital as you can, and talk with each of them individually during your pregnancy, when the time comes you will be reasonably confident that they will recognise you and understand what you want. In a small hospital there may only be 6 midwives. In a large hospital you would have no hope. Pop in to the hospital briefly every few days at the end of your pregnancy and figure out if there have been staff changes. Brief the newies if you can, and ensure that previous instructions are still on your notes. Also, ensure that your wishes go into your notes at admission time. Take them written on a big post-it note so they can affix it to the clipboard that will go with you. Take an extra copy to give them in the delivery suite, so if the first one gets discarded by someone along the way you can ensure that the midwife who cares for you during labour has her own copy, and that it will go with you through shift changes as new staff come on. If you keep going in there beforehand the worst they will do is say, "Not her again! Go home and wait until your contractions are established!" Just do what you have to do to get known. It is your body, your baby, and your labour. It is their job!

These are all things you can do as part of your preparation for labour and birth. They are a part of your nesting. Once you have familiarised yourself with the Staff you can relax and let it happen, which is the best way to have a safe and enjoyable labour and birth for your baby.

They'll never forget you! ;-)

Louise

you can still squat if you like - just squat while leaning forward as if you're sitting on a really low chair, instead of letting your body hang down between your knees.
not sure if I'm describing this right....
I think that planning is great (I know I spent most of my pg planning) and will give you a bag of ideas to take into labor. but ime, when the moment comes, my body- and not my brain- is in control.

Hi Oh-Mum

Sorry, I was sure for some reason you were in Australia. I was referring specifically to Australian hospitals and hospital births, but I would say that the principles of small is friendlier than big would still apply in USA.