Any suggestions re birthing position & other tips when expecting prolapse?

Submitted by Alberta on January 21, 2011 - 1:16pm
Body: 

I am due any day with #3. I had first two babies at home and plan to have this third at home, too. After my second birth, incredibly fast, over the toilet, I sat down and noticed a brown lump hanging out. I asked my midwife what it was and wasn't comforted when a midwife with 25 years experience responds "Oh, I don't know."

She quickly determined it was my cervix, had me lie down on the bed with ice and I saw my OB soon afterwards. I have no idea what kind/degree of prolapse I had. I went through a PT program and for the most part, all is well other than incontinence. My OB never pushed for surgery, partly knowing I wanted a third, and partly telling me my pelvic floor muscles were still too weak to be a surgical candidate, anyway.

Now #3 is due on Monday and I am a bit wracked with anxiety about my delivery and subsequent prolapse, which both the OB and midwife have told me will occur. I found squatting to be a very comfortable position during the birth of #2 three and a half years ago, but I am older now and know the consequences. Any suggestions on how to minimize my anticipated prolapse? This kid is hanging very, very low and after reading some of these stories, I am worried this prolapse could be worse.

Thank you kindly.

louiseds

January 22, 2011 - 12:09am

Hi Alberta

I can understand your anxiety, as your time is very near. And I can understand your dismay as you birthed your babyto have your midwife say that she didn't know what it was when your cervix was still down. It certainly would have shaken my confidence in the midwife!

Take a deep breath and let it out again.

Prolapse at birth sometimes happens but it is not necessarily directly related to prolapse which happens later on. It sounds like that prolapse resolved quite well, though you don't describe the type of incontinence that remained, or how long ago it was that your second baby was born.

When you are pregnant at term your body has had nine months for your uterus to grow and for all the structures that support it to stretch out to accommodate this large uterus. Your skin and all its structures also have to grow. It can take 2 years for all your tissues to revert after a pregnancy, and a woman's body is always a little looser all over after a pregnancy, some more than others. There is looseness on the inside and looseness on the outside.

When you birth a baby all those supports inside your body are stretched out as long as they can be. It is possible for a woman to have her whole uterus outside her body as the baby is born. As long as it is replaced straight afterwards the body can revert pretty well and leave little evidence of the seriousness of what happened during the birth. Then, as the days, weeks and months go by, and as long as the tissues are not pushed down again and compromised while they are trying to revert, they will revert normally to a pre-pregnant state.

So, as your body has shown you, it will be fine after your body has reverted.

Many of us have had babies after prolapse has been diagnosed, and have been OK in the long term.

I have never homebirthed, but I have had a midwife telling me to push when there was no urge. Most disconcerting. You say that your second baby arrived quite suddenly, and possible forcefully. That may have been partly why your cervix came down so low instead of remaining inside you.

I would just take it as it comes on the day. Try not to push harder than you have to. Your body may not give you much choice. ;-)

You might be able to slow things down a little to let your body adjust, by using knees and elbows or hands position, so that gravity is not adding to the downward force and pulling the baby out. We are the same as mammals in the way we birth our young. If the baby has to come up, which it will when your uterus contracts, the body of the uterus will be hanging back behind the brim of the pubic bones, rather than hanging in space over the top of the baby, and able to slip out of the birth canal so quickly.

If you are standing and leaning forward, keep your weight evenly on your feet so you can relax(!) your belly, free to move in space in front of you and between your legs, rather than compressing your belly between your chest and thighs in a squat or half squat, which can only add to the downward pressure on the uterus.

Of course, I realise that in the heat of the moment, it doesn't always go to plan!

After you have birthed I would try and spend more time lying in positions where my uterus is coming forward, like on my tummy, in coma position, or even on my side with belly resting on the bed. If you spend lots of time propped on pillows or lying on your back or slouched in a chair with your uterus hanging back it will not be the optimum position for allowing your uterus to be pulled inwards and forwards, where it needs to be to allow for the best and quickest reversion. when you stand and walk allow your belly to relax and keep your chest high, which will naturally tilt your pelvis forward slightly and allow your uterus and bladder to rest against your lower abdominal wall. Don't tuck your butt under. Tucking will also tip your uterus back and down the plughole.

I wish I could be more definitive but I only a woman who has birthed babies, not a midwife.

I am sure you will get lots of replies from homebirthing Moms who may have had the same experience. You may also hear from midwives and birth helpers.

I am sure it will be fine as you have homebirthed twice before and have overcome the prolapse that happened last time. Hopefully you can hang in there for long enough for some of the other Moms to reply. Take care. Hope the birth goes well.

Louise

Christine

January 22, 2011 - 12:30pm

Hi and welcome, Alberta,

Louise has given you excellent information. I just want to remind you how capable your body is of birthing safely and naturally. Also to re-iterate that in a birthing position such as hands and knees, the body of your uterus is actually lower than the pelvic outlet. The baby is easily birthed in this position, while at the same time gravity is helping to keep your uterus well positioned. We talk about the horrors of a fully exposed cervix during birth, but consider how very little space there is between the front and the back. Only a few inches/centimeters make the difference between optimum support and uterine prolapse. Intra-partum prolapse resolves virtually 100% of the time, yet all birthing women need to understand it is the postpartum period that can alter the course of pelvic organ support. Try to maintain seated positions where your belly is over your thighs as much as possible and pull up strongly into WW posture while standing and walking. Relax your belly as you raise your chest, while keeping shoulders down, upper back flat and broad and head pulled up at the crown.

Enjoy your beautiful birth!

Christine

cararosesmum

January 24, 2011 - 5:04pm

Hi- I only just saw your post- so if you've already had the baby- congratulations!!!
I had my second baby, the first since i discovered my prolapse, 8 weeks ago. And, to date, it hasn't made my prolapse any worse than it was prepregnancy.
I birthed on my hands and knees- my back wasn't horizontal, as i thought it would be, but at an angle with my uterus hanging well forward. I did push the baby out- but in this supported position my uterus didn't try to come out with him.
Personally, I think the postpartum period is when the most damage is likely to occur witha preexisting pop (imho)- so watch your posture, your diet, try not to strain on the toilet (the absolute worst thing for my own pop) and when you bend, lift, stand up etc brace and lift your pelvic floor.
What else?Breastfeed lying down, or sitting up straight with bubs on your lap, raised up to boob level on pillows when you can. I also do my kegels in this position.
Good luck- try not to panic- if it does get worse it can also get better. And it definitely may not get as bad as you're anticipating.
Enjoy your beautiful baby and revere your wonderful body for creating and nurturing and delivering such a miracle.

Alberta

January 24, 2011 - 9:11pm

I am 40 weeks today and only 1 cm dilated. Baby will probably come within the week. Thank you for the post partum positional tips, that is critical for me. I'll keep you posted.

louiseds

February 3, 2011 - 12:52am

Alberta, I hope we haven't heard from you because you are happily engrossed with your new baby, or chilled out (no perhaps not, in the northern hemisphere), or reclining on a cosy couch in very advanced pregnancy, preparing to hatch, and being waited on hand and foot by your loved ones. No hurry to get back to us. You have important work to do. Just thinking of you.

Louise