When Checking in Hinders the Process

Wednesday, March 10, 2021

When Checking in Hinders the Process

Today I'm going to be talking about when checking in, actually hinders the process. Now specifically, I'll be talking about birth today, but I think you're going to find this makes sense in other places of your life too. So specifically when, when hindering the birth process, I want you to think about physiological, from a natural standpoint, from an undisturbed undisrupted standpoint. So if we were to allow your body and your baby to do its own thing.

Cervical Checks

So the first place that I often see checking in disrupting our natural processes is that vaginal checks in the later part of pregnancy. So it used to be routine. And I mean, it still is routine in a lot of places to do vaginal checks starting at 37 weeks. However, the science is actually pretty clear that there's no benefit to having cervical exams before 40 or 41 weeks. Now this all goes back to your due date, right? And we know that first time babies are more likely going to be born between 40 weeks 5 days and 41 weeks and 2 days. I think the stats are something crazy like 80 or 90% of first-time babies are born in this time. That entire chunk of time is AFTER your estimated due date.

Why is that important? There actually are a few risks for vaginal checks in later pregnancy. Many providers will pose these vaginal checks to patients as if they are mandatory. And that's just simply not true and they're not evidence-based. Obviously every single time you go in there, you are going increase your risk of infection. So every time we do a vaginal check, both in pregnancy and during labor, we are introducing bacteria and there's a risk of infection. It also increases your risk of rupture in your membranes early. Now this particular study showed 6% of pregnancies had premature rupture of membranes, which simply means that your membranes rupture before your contractions begin. So with no check 6%, but with checks with weekly checks, starting at 37 weeks, you'll eat, it was a threefold increase up to 18%. It tripled your risk of having premature rupture of membranes. Crazy.

This is especially important for birthing people who tested positive for GBS, because the minute that your membranes rupture, you will need to head to the hospital to have IV antibiotics administered for the GBS.

So if your doctor is saying things like 'We want to know', 'we need to know where your baby is', or 'I wouldn't want your baby to come early and us not know it' - then they are either really misinformed and not practicing evidence-based medicine, or they're using this as a scare tactic. Honestly, neither one is okay. So we, we have to be limit the vaginal checks at the end, because there are no benefits, but there are actual risks. Now, one thing I do want to mention is that if you're curious and that's impacting you negatively as in you have anxiety, because you don't know, and you would be less anxious if you knew that is a valid reason to get a cervical exam. However, if we're doing it out of curiosity and it's just a check in, typically that's not a good reason to do that only because of the risk you are taking on. But that is a personal choice. You will be able to weigh what matters to you- what risks are worth it and what benefits are worth it. Right.

Electronic Fetal Monitoring

Number two is somewhere along the same lines- electronic fetal monitoring. I want to go into the different types because there are types that don't hinder the process and that is what you could be requesting. So the first thing we need to understand is there are two types of fetal monitoring.

We have electronic fetal monitoring which involved computer monitoring where you're hooked up with cords. There are two types of electronic monitoring. We have continuous monitoring and this is going to have you hooked up to computers and monitors and wires. Here you'll be limited in your mobility limited in your ability of what you can and can't do under continuous monitoring. You also have the wireless mobile option. You'll be able to move about the room freely and some of the mobile options are even water resistant. Not all mobile options are water resistant, so this is a great question for your provider about your birth hospital.

Also under electronic, you have intermittent fetal monitoring. Where you hook up to the monitors every so often - maybe once an hour, once every two hours, whatever feels good to you and your provider. Great question again for a prenatal visit with your provider.

Now, all hospitals should also have Dopplers available, but that doesn't always mean that your provider is going to be trained in it. Dopplers have incredible benefits. So never hesitate to ask, to get someone in there that can use a Doppler if you have a strong preference. Dopplers are more comfortable to you. It really allows you for more personal space. You can be in the water. It allows you to labor in and all sorts of positions. Everyone in the room can still hear the baby's heart rate too.

The second type of monitoring is hands on monitoring. We also have hands-on monitoring options. This can be done by a Doppler, which is going to be a little battery pack with a monitor on the end of it. It's going to be wireless and allow you to stay mobile. You do also have a fetal stethoscope which can be used to monitor the baby as needed.

Electronic Fetal Monitoring was brought into labor rooms in the 1970s, despite the fact that there was no research or evidence to show that it was safe or effective. So why did we do it? Well, we did it because we thought we could save more lives. However, what studies have actually shown is that it increases your risk of a C-section without providing the benefits that we first thought it would. We thought we would see lower infant mortality, but those are actually on the rise. We thought we would see better APGAR scores, but we haven't seen better scores there either.

Hands on listening is evidence-based and produces better outcomes for birthing people and babies. So again, I want to bring up that any provider that cannot provide you with hands-on listening at your request, it's worth requesting a different provider if you have a preference. It has the potential to change the outcome of your labor. It's important for you as the consumer to understand that there are some things that your provider is not going to be able to offer you without you suggesting or asking for it. This is going to be one of those things.

We need to understand that a lot of hospital policies do suggest and require that their providers suggest to you continuous fetal monitoring. So you're going to have to request alternative options. You do have some science on your side. The American College of Obstetrics and Gynecology has endorsed hands-on listening as an appropriate and safe alternative to electronic fetal monitoring since 2009. In the UK, The National Institute for Health and Care Excellence actually recommends doing hands-on listening with all low risk pregnancies and not to even offer electronic fetal monitoring.

'Don't Push'

The third thing that I want to talk about is when you have the urge to bear down and someone tells you to stop. We can actually disrupt the natural process of birth, because what you're feeling when you have that urge to push is the fetal ejection reflex. You want your body to help you eject your baby with this natural process that your body already has- the fetal ejection reflex.

This is something I teach with our clients- how to recognize it, allow it to activate itself, and how to work with it in order to push your baby out. When we are able to teach clients how to work with this reflex, with our 'secret sauce to pushing', we consistently have women who push for less than one hour with zero tearing. Also, it's so powerful to know that if you, as a birthing person, really understand your body and the natural processes that your body gives you to help you to support you in birth, and make this labor and delivery easier. How much more powerful you are in birth as a birthing person? That for me, oh my gosh, I love it.

If someone is telling you not to push you, you don't have to necessarily listen to that. There is science on your side, proving that if that's what your instincts are telling you, you can go with that and you should go with that. Even if there is not research and your instincts are telling you something, you should go with that. But regardless if you're a very logistical person and you like the data and the hard numbers, I can appreciate that. Listen to episode 135, it breaks down how, if you have a cervical lip or you're not 10 centimeters, that pushing can actually a alleviate some pain and help that cervix go ahead and dilate the rest of the way. It also kicks in your fetal ejection reflux. This generally shortens the time of not only the second stage of labor, which is active labor, but also the pushing time. Check it out. You guys episode 135.


Boundaries

My final one - is boundaries. Ugh, who wants to talk about boundaries? Nobody ever, but we got to do it. So here we go. The end of pregnancy, when people are constantly checking in with you, your friends, your family, your coworkers, your neighbors, your laundry people, your mail man, the barista at Starbucks, your doorman. Everybody's going to be asking you if the baby is here or not.

Keep in mind, people ask because people love you and they care about you and they want to love on your baby. I hear you that it can be so annoying, overwhelming, and also just a big reminder that your baby was supposed to be here, but they are not.

(Side note. That goes back to you having a healthy, realistic expectation of what a due date is. If your due date is here, you know that you really need to add five to nine days so that if you're a first time parent based on the stats. You really don't want to set yourself up for additional stress or anxiety around the due date unnecessarily.)

You get to decide who gets what updates and how often. You can go with a narrower group of family and friends with who you update with what. You don't have to feel pressure to keep up with it all. This can be a super hard one. Keeping boundaries and not feeling the pressure or guilt. It's a little bit easier with coronavirus. That's a very easy excuse to keep people at arms length, which has been helpful for a lot of people. A double-edged sword, because it's also extra lonely as if new Parenthood wasn't isolating enough. However, it has also provided us the space that we need to keep people at bay and protect our mental health.

And remember: you are about to this sweetest, hardest, and probably most valuable transition of your whole entire life. I am so honored to share this information with you. To help educate you to advocate for your ideal pregnancy, birth, and postpartum.

Links:

  • - Secret Sauce to Pushing Course: JOIN HERE!
  • - Longer Labor Times with Directed Pushing: Here
  • - Early Pushing Urge: Here
  • - Dilation and the Cervical Lip: Here
  • - Pushing: Leave it to the Experts: Here
Don’t forget to check out our newest adventure The Birth Lounge, listen in to The Birth Lounge Podcast, and follow us on Instagram at @tranquilitybyhehe and @the.birth.lounge!

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