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Monday
Jun042012

"Stretch"

I asked folks to “Toss Me a Birth-Related Word” on my Navelgazing Midwife Facebook Page and “Stretch” was the one of the words. Here, I’ll use it as a springboard from which to jump.

When I was pregnant, I really needed to stretch a lot. I have a short waist and grow big babies (uh, with the diet I had, I grew big babies), so had kids packed in a small area. I was thrilled when I learned to put one arm over my shoulder with my hand on my back and the other arm around my waist with that hand on my back, too, and how that opened my chest up considerably.

I loved doing that move several times a day and try to show it to clients.

I also loved doing pelvic tilts. They were a total Bradley thing; we were taught to do 80 three times a day. Seems like a lot, but really did strengthen my lower back when I was carrying 10-pound Meghann. Pelvic tilts are often done incorrectly, so I learned a way that helped me and others know the correct way to do them. Doing them the right way saves your back, including the lower back because if you sway your back, especially pregnant, it can pull a lot of muscles. So, instead of arching like a cat and swaying down (the “Cow” yoga move), go on hands and knees, back like a table top… parallel to the ground. Now, pretend you have a tail on your tailbone and then pull the tail between your legs. That’s the pelvic tilt movement that will help your lower back get some tone and stretch. After pulling the tail in, the let the tail relax, back going parallel to the ground again. No sway back! Do the tail-pulling as many times as you can… slowly and with purpose… this isn’t to be done quickly. Nice. And. Slow. Pullllll… stretch inward. Releeeaaassseee and relax. Over and over. 80 times is as long as a 3-minute song. Impossibly long if you have kidlets, I know. But, even 10 a few times a day would be a great start.

When thinking of the word “stretch” with birth, we can’t help thinking about the vagina stretching, right? While there’s a belief in perineal massage in order to help the stretching birthing vagina not tear, I am not a fan of that at all. I believe women stretch just fine and have found the less they (women) are messed with, the better they do. When hands are all over the vagina, stretching it, “massaging” it… “ironing” it… the tissues swell and tend to tear more. I’ve found women rarely tear when they birth in tubs, too, and gee, no one can manipulate the vagina from that position. I believe the vagina knows what to do and, without futzing with it, is going to tear or not, depending on the baby’s head’s position.

Now, I have helped women with the speed of the head’s delivery and that can be good for saving some tearing, but that’s different than perineal massage; that’s perineal support.

And what else stretches in birth… ah, yes… the cervix.

I’ve recently discussed my feelings about stripping membranes (which involves the cervix directly), but what about the cervix stretching on its own?

The cervix is amazing. It can be tough and thick, like a soft piece of plastic, and it can be thin and stretchy, like a rubber band. While the majority of cervices (plural for cervix) get thin and stretchier as labor progresses, not all do. But, in my more hands-on days, have lifted a stretchy cervix over a baby’s head, helping the mom get to second stage quicker. It’s as if you took dough and used a glass to cut a hole in the dough (like for biscuits) and then put your finger inside the cut-out hole and pulled on the dough. That’s what a stretchy cervix feels like and depending on how thick you make the dough, depends on how effaced she is; the “shorter” the dough (the thinner), the more effaced mom is and it’s usually easier to stretch the cervix back and over the baby’s head.

Now should we be stretching the cervix over the baby’s head? Usually not. In fact, usually you can’t. But, there are times when it can be a kind and loving thing for mom to minimize the urge to push, if it’s been going on for a long time. What’s typically happened for me is that I didn’t do vaginal exams, but would listen to mom’s urges to push, letting them lead the way. Then, when there was no progress after some time… usually a long time… I would do an exam and find the “cervical/anterior lip” (the small part of the cervix left over from the rest of the dilated cervix), stubbornly keeping the baby from coming down and into the mom’s pelvis. I’ve never figured out why some cervices do this… positioning, timing, size of the baby… it all seemed so random. But, when it happened, I thanked the Universe when the lip was stretchy and not thick and tense. Then, hooking a finger under the lip (like lifting that swatch of dough) and lifting it up, usually during a contraction, would bring the baby right down through the rest of the cervix. True, sometimes it would take a couple/few contractions and manipulating the cervix isn’t comfortable at all, but it is better than transferring to the hospital and either having the hospital folks do the same thing or having a cesarean for failure to progress. As with anything, moderation is the key.

Can you think of other stretchy things in birth? Thoughts on what I’ve written? Have you had your cervix lifted over the baby’s head?

References (10)

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Reader Comments (5)

I requested it with birth #8 this past April. I was NOT going to allow internals etc. But, I had this awful pressure in my back/anal area and then on my bladder. I have birthed 7 times before, but I couldn't help myself. I actually asked to be checked, heard I had a lip was there and I begged to have my water broken and to have the lip pulled back. I had been in labor/prodromal labor for a few days. The contractions had been the same over the days, just getting more and more pressure, more and more painful. With lack of sleep, I begged. It did hurt a bit, and with the pressure, it was hard to realize my baby actually was coming out of me right after the midwife moved the cervix. I finally felt that burning ring, and still couldn't believe it was the baby actually coming out. It just felt so odd. He emerged, and I felt such relief. I felt bad for asking for an intervention, and the midwife said, "hey, you knew what your body needed to do, sometimes a grand multipara's cervix is a bit more boggy." She was not insulting me at all, I believe the uterus and cervix are likely changed from all those births. A little help went a long way, baby was in my arms immediately.

June 4, 2012 | Unregistered CommenterDawn

And, Dawn, that's a fantastic use of "interventions."

June 4, 2012 | Registered CommenterNavelgazing Midwife

What do you think of this?

http://midwifethinking.com/2011/01/22/the-anterior-cervical-lip-how-to-ruin-a-perfectly-good-birth/

June 5, 2012 | Unregistered CommenterTrimoni

I really like the piece a lot. I've written about the cervix dilating unevenly and that that is completely normal. It doesn't take the baby's part in things into account except in passing, so I agree with about 95% of the post.

Thanks for asking! I hadn't read it and am glad it's there to refer to.

June 5, 2012 | Registered CommenterNavelgazing Midwife

when i was giving birth i had a ridge/cervical lip left. when i felt an urge to push they told me to wait to check to see if i was fully dilated. i was sorta. so they told me i could start pushing. i never felt another urge to push. but i continued to have contractions. so i pushed when i had contraction. the baby wasn't moving down. my midwife says to me," i think you just don't want to push." (rude! i wanted to tell her to leave.but, didn't have the confidence to tell her she was being mean.) well so after an hour and forty five minutes of baby not moving down and i was pushing even when i wasn't having a contraction because of what she said, baby was not moving down. so she checked me and realized she had to hold the cervix open so i could push my baby's head past the cervix. once that happened my baby was out in less than 25 minutes. She was not gentle with her hands at all. I feel she could have been more gentle. it took my vagina a long time to heal from the pressure she had applied against the sides of my vagina. it took six months to not feel sore on the inside of my vagina. i had a lot of swelling due to that. this was not the only rude thing she said to me during my labor and delivery either. i will be looking for a new midwife. also i will be discussing this issue while interviewing midwives the next time around. this is only part of the story of my birth. once my baby's head was past the cervix she took her hand out. it felt great to have the head past that point. the pressure changed and relieved the spot it was in. from that point on pushing was fast and baby was out fast. .... my stillborn twin came out fast after that too. her body was much smaller.

October 30, 2012 | Unregistered Commentermonica

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