Births

(above image from http://inexplicableways.com/tag/birth-bar-squat-bar/ )



I've had some seriously awesome births at work this week. It feels so great when I can work with a couple to help bring their new baby into this world. I've had several providers thank me for being so proactive in helping the women achieve a vaginal birth (lots of posterior and asynclitic babies lately).

It takes a lot of work and time to patiently help a posterior or asynclitic baby to turn into a better position for birth. Many of the women I care for have epidurals - sometimes very dense, heavy epidurals - and it makes it even harder to move the mom. (If you can't physically move the baby, you move the mom = the baby moves.)

I've become fairly astute and being able to detect when a baby is posterior or asynclitic. Labor is prolonged, cervical progress is slow, and often times there specific patterns in the contractions (coupling or tripling) in addition to back pain/rectal pressure felt by the mom, or an involuntary early urge to push. Also, if it's difficult for my to trace the FHR on the monitor (because of the baby lying posterior -- we listen over the fetal back -- easy to do when the baby is in an anterior position, difficult when posterior). On exam, if I can accurately feel the sutures and fontanelles, I can also tell how the baby is lying in relation to the mom's pelvis.

Anyhow, the secret to moving a poorly aligned/malpositioned baby? Move the mom. And keep moving her until the baby rotates and descends (usually fairly rapidly once the baby is in an optimal anterior position!). Far left lateral x 15 minutes, far right lateral X 15 minutes. Sitting up in a modified squat (adjusting the bed and using tons of pillows for maternal support), birth bar positions (there are several positions one can use with this!), deep squats, knee chest (cannot do this with a heavy epidural), playing tug of war with a sheet wrapped around the birth bar (I get my upper body workout this way!). Here is a birth story, with pictures of the tug of war being used, from a mom's blog. In short: changing the mom's position to help increase the pelvic diameters and encourage the baby to ROTATE!!

All of this physical work is active labor and delivery nursing care. You may not see this too often, depending upon how "active" the nurse is, or how many patients the nurse has. By this point (transition to 2nd stage labor) nursing care really should be 1:1 with the laboring woman. And yes, there are some nurses who have no clue about position changes helping to rotate a baby, or perhaps they are just too damn lazy to give a hoot about changing the mom's position.

Guess what? My goal for each mom and baby is a healthy birth, as well as a positive birth experience: no matter if it's a vaginal birth or a cesarean section birth.

This a very physically demanding aspect of this "job" as a L&D nurse. Constantly moving, rearranging, using pillows, adjusting, teaching, emotionally supportive, coaching through each and every contraction. It is physically draining, especially if it takes 2-3 hours during the 2nd stage (pushing) to encourage a baby to rotate and descend for a successful vaginal birth. I am worn out after that long of a 2nd stage! But it is all worth it when mom is holding her newborn in her arms. When she successfully gets her new baby to latch on to her breast and nurse in that first golden hour after the birth. When she looks as me, with tears in her eyes, and says "I did it!!!!"

Yep, that is why I am in this "job".

Fifth Health Birth Blog Carnival

Amy Romano at the Science and Sensibility Blog has posted the Fifth Healthy Birth Blog Carnival: Push it real good!

Check it out! Some fantastic links to posts and blogs out there about pushing and position changes.

Getting in position -- making changes to shake, rattle, and roll

I cannot emphasize how important it is to be as mobile as possible in labor and during the pushing stage. There are such an abundance of different positions to assume in labor, even with an epidural. Maternal position changes will help the baby move into optimal position for the birth process.

Many times, I have women who are laboring with 'back labor'. Back labor is when there is (obviously) pain in the lower back with contractions, and often times, also in between the contractions. This can be quite painful, in addition to the pain felt across the uterus and in the front low pelvic area. It can simply feel unrelenting. (Can you tell that I've been there, done that, bought the t-shirt?) The root cause of the back pain is usually a posterior lying baby, or even an asynclitic lying baby (cock-eyed, off to the side).

I often wonder, why so many posterior babies? Simply put - we're a reclining society. We sit back in our recliners, couches, office chairs, dining room chairs, rocking chairs and more. Our babies get into these funky positions from us lying back.

This is why it is so very important to get up and move in labor. No lying back on the hospital bed if you possibly can! Lying in the bed just lets the baby stay in a sub-optimal position for birth, leading to back labor, long labors, 'failure to progress' and yes, even some c-sections. I cannot tell you just how many c-sections I have witnessed for 'failure to progress' and the baby is in a posterior or asynclitic lie.

Up. Move. Lean forward. Lie on your far left or right side. Squat. Walk. Dance. Hands and knees. Modified lunges. Sway from side to side.

Even with an epidural -- yes, you can do many different position changes! Left lateral, right lateral, squatting with support, squatting with no support (light epidurals, when you can bear your weight on your legs), knee chest, sitting straight up with the foot of the bed lowered.

I am a huge fan of position changes. If one position doesn't work, or doesn't feel right -- MOVE! Change it!

Good bye persistent lithotomy or supine position.

Hello position changes!!

(I need a t-shirt to wear at work that says "L&D Nurses Do It In Every Position")