Pelvic Pain in Pregnancy (SPD) {San Diego Doula | Bradley Method® Instructor | Birth Photographer}

{From Birthsource} What exactly is Symphysis Pubis Dysfunction? During pregnancy or birth, about one in 35 women will experience intense pelvic pain and may find it difficult to walk, climb stairs, and other movements that involve the pelvic bones. This pain is a result of separation of the symphysis pubis which is a joint in the very front part of the pelvic bone structure. There is cartilage that fills the gap in the bones. During pregnancy, hormones such as relaxin soften this cartilage allowing the pelvic bones to be more flexible for delivery. Some women, however, have too much play in the pelvis causing a large gap between the bones. This makes the symphysis pubis area extremely sensitive to touch. When does separation of the symphysis pubis occur? Some women will notice pain beginning as early as the first trimester of pregnancy while others experience this separation during the birth or even a few days postpartum. Women who have experienced SPD with previous pregnancies will not necessarily have the problem with subsequent pregnancies however, some will. How will I know if I have SPD? If you have SPD, you may notice pain in the front of the pelvis that hurts when touched. You may also feel pain in the lower abdomen, hips, inner thigh and groin areas. Marked increased pain with activities such as walking, climbing stairs, lifting your legs, or any other large movements involving the pelvis are key symptoms. You may even experience a clicking type noise with movement as well. If you experience any of these symptoms, you should contact your caregiver for further testing. What type of testing can I expect if my doctor/midwife and I suspect SPD? The type of testing depends on when you experience the symptoms. If you are still pregnant, the likely test would be an ultrasound. Other diagnostic tools that can be used after delivery are pelvic x-rays or an MRI. Is there any treatment for SPD? The doctor may prescribe painkillers and refer you to a physiotherapist for additional help. The physiotherapist may suggest the use of TENS, Transutaneous Electronic Nerve Stimulation, to help with the pain. Other items such as support belts or crutches can be used as well. Additional specialists also offer potential benefits: acupuncturists, reflexologists, chiropractors, aromatherapists, osteopaths, hypnotherapists, and herbalists. Each in their own way may provide treatment options to minimize the pain of SPD. There is no way to prevent SPD from occurring; however, once the hormones cease production after pregnancy, the condition will gradually subside. If you are pregnant with SPD you should minimize large pelvic movements throughout your pregnancy. This includes swimming breaststroke, even though normally this is a great means of exercise. Choose other strokes if you are a swimmer. Try to continue to get exercise, just be sure to do exercises that will not aggravate the SPD. Should I be worried about the delivery? Birthing vaginally is certainly attainable and preferable even with SPD. Spreading of the legs, however, should not be extreme. Perhaps the best positions for pushing when you have SPD is either "all-fours" (hands and knees) or side-lying. Squatting may be painful as well as the most common birthing position, the sitting position with legs wide apart. Be sure that you explain to the nurses and other caregivers that you have symphysis pubis separation and need to minimize spreading your legs widely. One of the drawbacks of receiving an epidural during the birth is the pain of separation may be masked and therefore you may be put into positions that are only making the problem worse. Unfortunately, you wouldn't find this out until the anesthesia wears off and you have the extreme pelvic pain. Therefore, it is imperative that the caregivers know of your condition and do not suggest positions that could exacerbate the situation. The final word... Remember, symphysis pubis dysfunction is a condition that affects pregnant and/or postpartum women. It is a temporary situation and one that will resolve itself once the cartilage softening hormones decrease. Although there is no "cure" and it cannot be prevented in subsequent pregnancies, it does not mean that you will automatically experience SPD each pregnancy or birth. If you do, however, seek help to minimize the pain and worsening of the situation.  ------------------------------------------------------------------------------------------------------------ I am a firm believer in Chiropractic care. ESPECIALLY when you are pregnant! Interestingly enough when I was researching this topic, look what I found! Pelvic alignment/pain is connected to the C1 vertebrae being out of alignment. Wowza.  From my experience, the more I went to my Chiropractor at the end of my pregnancy, the easier my births became. My last baby I went VERY frequently and guess what? Almost pain free labor and one push. If you don't see a chiropractor and you are pregnant....GO NOW. You are crazy (in my book!) if you don't. Don't know where to go? Call Dr. Melissa in Vista/Oceanside who specializes in Pregnant women and children. She is awesome! She recently adjusted all my boys and they loved her and the beautiful, kid friendly office.

And how about exercises? Check out this information

How to Prepare for Birth by Lesley Everest {San Diego Bradley Method® Instructor & Birth Doula}

HOW TO PREPARE FOR BIRTH
The sensations of labour vary for every woman. Not only from woman to woman, but from labour to labour. I have had births that felt virtually painless for most of the labour, to having sensations that kicked my ass leaving me breathless and begging for mercy.

I honour whatever approach people take for their births. We all have different personalities and make-ups, and everyone has a different relationship to strong sensation. For me, while labour pain can be extreme, I can handle it. Unless there were a really good reason to do so, my choice is to not take epidurals or other forms of pain relief to manage the sensations. It hurts a lot, yeah, but having been through it, the endorphin and oxytocin reward at the end of the journey is so worth it. It is the most intense high I have ever had. I can draw the memory of that high into my being far more easily than I can the body memory of the pain. But the sensation of nausea?Youch. If I had the kind of nauseated labour I see some women have, or if labour felt anything like my first trimesters, I would seriously question whether or not I would want to have natural births. The sensation of nausea is so odious to me, that given the choice between a 36 hour posterior labour and a 12 hour stomach flu, I would absolutely, without any misgiving, choose the 36 hour labour. Because of my intensely difficult relationship with the sensation of nausea, I have compassion for women who have a feeling the sensation of labour might be something they absolutely abhor. Some people can handle achy pain but not sharp pain, or some breeze through a terrible bout of food poisoning cramps, while a migraine may traumatize them. It is such a subjective thing that it is important not to pile women all into one group, give them one method to prepare for labour, then send them off promising if they do it correctly they'll "be just fine". One may argue, "But labour pain is normal and natural, something good is happening in our bodies, therefore it can be done...it's not like the stomach flu or migraine, which are pathologies and trigger a stress response, thus exacerbating pain." True. But nausea and vomiting in labour are totally normal and natural as the body makes room and purges what it doesn't need..it doesn't mean I'd like it or be okay with it. Despite its normalness, it would trigger great anxiety in me. Luckily, I don't have pukey labours.

The challenge with birthing is that, if you've never done it before, you're not aware of how intense it's going to feel or how you're going to cope....whether the sensation is one of those types that's "safe" for you or challenging on a deeper level. This creates anxiety in women. When I work prenatally with my ladies and they invariably tell me they are nervous about their upcoming births, I say, "Great!" This is an opportunity to explore where she's coming from. I reassure the lady in front of me that it is perfectly appropriate to be anxious when teetering upon the precipice of the complete unknown. Using that energy usefully aids women in gathering to them what they need: resources, both external (support, primary care, knowledge of ways to help them cope) and internal (emotional exploration, cultivating an ability to relax and breathe deeply, maintaining presence with challenging sensations or emotions). A doula's job is to help a woman build up her resources.

Part of my prenatal care is to ask a woman what kind of approach she'd like to take with her birth. This helps me to figure out whether or not she's interested in having a natural birth. Contrary to popular belief, it is not only the flowery skirted ladies with a stockpile of incense to last through the Age of Aquarius, or whatever age we happen to be in, who hire doulas. In fact, those who procure the services of doulas in my neck of the woods are usually urban professionals in their mid to late thirties who are highly educated and well read about the birth process, with a lot of concrete ideas as to how they'd like to approach their birthing sensations. They've found whom their friends and relatives have told them are the best obstetricians in town. Their belief is that the combination of good obstetric care and the nurturing supportive care of a doula creates the best of both worlds for them. While many of them really do want to "go natural", there are those who are not that interested, and want their doula there to help assuage their fears and hold their hands through the epidural and just be a friendly face to hang out and make them and their partners comfortable. Fair enough. I serve whomever wants me at their birth, and my mandate is for them to feel like rock stars no matter what their approach. But I do have a few guidelines I feel are important for all of them to consider.

1) Prepare for anything and know you're great no matter what. Just about the only thing I can guarantee about birth is that it is unpredictable. I guide my clients into getting their heads around all contingencies. While I absolutely believe that the VAST majority of healthy women with good heads on their shoulders, if well surrounded but undisturbed in a cozy environment they felt safe and supported in, could have their babies with little to no intervention, birth, especially hospital birth, takes some preparation and knowledge. The whole, "Do nothing, have no fear, and you'll just open like a flower" approach is not useful or realistic in an environment that tends to make sphincters shrink rather than blossom. Neither is the, "I'm going to have an epidural the second I have pain, and my doctor will 'get the baby out' at some point and then it will be done" approach. Both extremes have the potential to leave one feeling disappointed at best, to downright traumatized at worst.

Imagine this: What if you are planning to have an epidural as soon as you feel pain and it doesn't work out that way? For instance, what if you have one of those types of labours in which you're having a huge amount of pain at 1cm? Some women just have a lot of pain in early labour. This doesn't mean they're wimpy...we have to get out of the mind set that a number of dilation equals an expected sensation. This isn't true. So what if you're having 2 minute apart contractions that you consider rate an 8 on the pain scale, you're planning an epidural, and lo and behold, nobody wants to give you one because doctors don't really like to give epidurals to people at 1cm (for good reasons)? You would be offered other kinds of medications like narcotics, but anyone who's taken those during labour knows they don't really do the job that well if you're truly hurting.

What if you were planning an epidural, you get to the hospital and the pain starts, you ask for the Epidural Man, and lo and behold, there are 3 Cesareans in a row he must be present for? I have seen women have to wait 4 hours for an epidural. Sometimes they give birth before it comes. It is not the norm, certainly. But it can happen. Or, what if you have the epidural, and you are one of those ladies it doesn't work for, or it's all weird and makes you feel numb everywhere except for a two inch patch of excruciating pain in one little area on one side of your belly? What if you planned and epidural and you give birth too fast to get one? You can begin to see where having skipped the chapters on pain coping techniques in your books or caught up with text messaging during that part of your childbirth education class might not have been the smartest of ideas.

If you are going to plan an epidural, that's fine. But always prepare for natural birth too, because you never know. The last thing you want is to be faced with pain you never expected or prepared for because you decided to give all your power and jurisdiction over your sensations to an external source. Give over all your power, and the potential for birth trauma here is enormous. Do yourself a favour and get some tools to help you cope.

Conversely, what if you're planning a natural birth, you've done all the preparing and totally believe in yourself, that you can do it and everything feels like it's going to begreat...but it doesn't end up this way? This is not a bad approach at all, and I believe very much in the power of positive thinking and visualization, trusting that the bodies who made these babies know how, without a lot of instruction, to birth them normally. Childbirth preparation truly comes more from the work we do on the inside than reading a bunch of intellectual information. However, having an understanding of what might happen IF something comes up and you find yourself in a position needing to make some hard choices about things like pain relief or you end up having that Cesarean you NEVER expected would ever happen to you, is important.

I don't think it's a bad thing to at least skim the info on what goes on when things don't go the way you'd hoped. I know this sounds silly, but it bears keeping in mind: reading or talking about a Cesarean will not make it happen. As logical and rational as a culture we are, superstitions linger. One day I was talking to a group of OB residents about birth plans. You know what their number one reason for not liking them was (for this group, anyway)? They believed they "jinxed" labour, that if a woman commits her deepest wishes on paper, it basically evokes the wrath of the evil eye.

Deep down, I think a lot of people believe that if they read the chapter of their favourite birth book on Cesarean and invite that knowledge into their minds, it might "make" it happen, and it is better to be blissfully ignorant. Saying all the magic words and doing everything right goes a long way to co creating a wonderful experience, sure, but again, there are no guarantees. Having a basic understanding of what it might be like to switch plans is a resource, not a hex, and will lend well to the situation if it ever comes up. For example, "I'm lying on the operating table shaking as if I'm having convulsions..oh, phew, that's normal, I remember reading that...it seems hard to breathe, am I dying? No, wait, it's just the muscles that are a little numb, I actually can move air into my lungs...breathe, breathe, breathe, I will be meeting my baby soon." You can see how not having a little knowledge here about the Cesarean process could make this a more terrifying experience than it already is.

So PREPARE! The process of birth IS important to a woman's experience of motherhood, sexuality, feminine empowerment, all of that. This is what I'm all about. AND, it is unpredictable. It is so important, especially if birthing in a hospital, which, frankly, does tend to generate more need for intervention than you would expect, to prepare at least a little. AND, it is important to remember that the gold medal is the BABY, not the birth. All women get this somewhat patronizing message when faced with an intervention they didn't want, but there is truth to it. It is not uttered just to placate you into accepting something you never thought you'd want or need. It is the truth...absorb it, own it, breathe it...that you are amazing no matter what. You are noble and fierce for all the work you have done. This is not to say grief and disappointment are not warranted in a birth that didn't go the way you wanted. There is nothing selfish or unrealistic or stupid at all for having hoped and believed you could move mountains in labour. Normally you can. But sometimes it just doesn't work that way. We are not the only ones on the journey...sometimes the baby has his own ideas. It is vital to healing to emotionally process our births and it is important to recognize and deal with situations in which you felt less than empowered or honoured. But YOU are amazing. Dude, you had a BABY! No matter what, you are a hero

2) Manage your expectations. Preparing for natural birth is all about stretching...stretching your body, stretching your mind, stretching your heart to open to the magnificent love of and for a new being, and stretching your limitations. Expect it to be a challenge. Don't be cocky. Everything about you will open wide. When I get to the part of my prenatal meetings with my ladies where we talk about whether or not they're interested in birthing naturally, I often get the answer from well read, well informed women who are choosing to birth in a hospital, "I would like to do it as naturally as I can...but if it gets to be TOO much, then I'm open to taking an epidural." What this says to me is, "I have a secret wish to have a natural birth and reap all the amazing benefits for me and my baby as well as be like those tranced out women in the film Orgasmic Birth....but because this is unknown territory, I don't want to feel like I wimped out if they have to scrape me up off the floor in a quivering mess of pain induced insanity. I give myself permission to call time out to spare myself from entering into what I fear could be my worst nightmare."

There is also fear of judgement. "What if I share my precious dream of natural birth to the world, then I don't have it and everyone will say, 'ha ha, told you so!'?" We always feel like we need to qualify. Personally, if I stated I was intending to have a natural birth and resisted the temptation to give the pat disclaimer of "if everything goes well", but if it didn't happen and I got judged for it by certain people, well, I'd tell them to go jump in a lake and not associate with them anymore. A woman who's birth reality ends up not matching her expectations doesn't need judgement and messages like, "poor little woman, it was really cute for you to think you could do it...know now you're just like all those other people who yelled for their epidurals when the going got tough"..she needs SUPPORT.

Anyway, back to that "I want a natural birth but am open to an epidural if it gets to be too much" statement. I like to take this opportunity to ask women what "too much" means to them. Because quite honestly, there WILL be points where it is "too much". People rarely have natural births when they have a well padded "escape plan". If I were to say, "oh, sweetie, you'll be just fine. The pain isn't much. In fact, if you breath into point A while chanting phrase B, you shouldn't feel anything at all," I would be a liar and deceiver of the worst kind. Women may say, "why are you telling me it's going to be so hard? Won't that make me nervous and make it so, given that stress makes birth hurt more?" Ah, again with the superstition. I'm not personally so powerful that my words prenatally can make you hurt or not. If I tell you it's going to be hard, two things can happen..it ends up being hard and you are prepared with resources to cope with it, or you've expected it to be so long and hard that it sneaks up on you and we arrive at the hospital to find you're in way more advanced labour than you thought..woohoo (this happens frequently with my clients)! Don't ever think that if I DON'T tell you about the challenge it won't exist. Better to know.

Even those who never knew they were even pregnant and give birth birth after having thought they were just REALLY constipated feel a lot of pain. I don't buy that ignorance of pain is bliss in the case of birthing. But I do like to discuss how the pain can be transformed into power, and that it can be a total thrill ride.

When I ask ladies what "too much" means, they often don't know what to answer. I'm so curious to know what they think is going to happen to them. I ask them, "what are you afraid the sensations of birth are going to DO to you?" I get all kinds of interesting answers. Some say, "I'm afraid the pain is going to make me really mean to my husband or the staff, and they'll get mad at me." Interestingly, media paints the pictureof women turning into these impossible hellions during labour, scratching their husbands' eyes out. My experience shows me that in normal birth, oxytocin tends to make women quite loving, trusting, and snuggly. Yeah, they're fierce too, but the ferocity is directed towards managing the energy of their sensations, not emotionally castrating their partners. There can be some irritation, but I rarely see a woman go rabid like Old Yellow. This is reassuring news for those who define themselves by their polite and good behaviour.

Others say, "I'm afraid I will lose control of myself." "What does that mean?" I ask. "What does being out of control look like to you?" What they usually mean is that they will be in such a state that they will lose all semblance of who they are. I tell them that they will change, yes, but they will still be themselves within that pain/endorphin haze, able to take in, process, and communicate what is needed in the moment. Yes, they may lose their modesty in front of strangers, find themselves nude with blood, amniotic fluid and mucus running down their legs, little rivulets of barf drooling from the corners of their mouths from time to time, and that they will be making uncontrollable noises they never thought they'd make. To some, this animalistic image is deeply disconcerting. But really, if you're willing even a little bit to go there, what you will find is freedom and even possibly a level of intimacy you never knew could exist with your partner and those in attendance. There is nothing more liberating than being in that space of pain and mess, looking up in your misery and finding eyes that meet yours in total acceptance of your experience, eyes that mirror back absolute approval and praise for what holy work you are doing, giving you energy, and even having those messes tended to with love and honour. You are safe, and everything is okay. You have "hit bottom" in terms of what our culture deems ladylike behaviour, but having gotten there and found strength in yourself and awe from your attendants, you have found your rawest nature, the one that gets you through to the end of the journey. You have found ultimate surrender in pushing away all cultural expectations of your femininity which believes having it all together is the sign of an accomplished woman; now you learn that where you find your truest power is not in keeping your shit together, but in letting it all go. Sometimes literally. What you have been afraid of all this time is becoming the birthing animal you actually are and have been programmed to be since your DNA decided to light up as "girl". You will come back...I promise. But you will come back having witnessed and activated a deep part of your Self that we are meant to bring to motherhood. You will come back feeling like you've been through a very important rite of passage. And so you have. It is a biological blueprint we fail to honour as a whole, and we must begin to work to reclaim it rather than do dumb things like have women birth in machines while a gaggle of pimply students oggles them with clip boards clutched in their hands, trying to figure out why women can't give birth properly anymore (duh).

We all read the birth books with the secret hope we will make it unscathed and maybe avoid that scary animal place. There is no chant or prayer to spare you from that. It is meant to be. Whether it is painful or not for you, you will go to that growly, trance-y place whether your expression of it is outward or more internalized. You will temporarily lose that intellect we cling so fiercely to and go into an incredibly dreamy place inside you...Labourland. It's the best place to fall in love from.

I dare you to make a commitment to natural birth without a disclaimer. We already know it. You will not have to go around wearing some scarlet letter if you don't reach your goal. Be willing. Be willing to get down and dirty, to open up your THANG, in every sense of the word. If you can't figure out how to "do" a hard contraction, yell your head off if you can't breathe through it. It's okay. What you can always choose to do is use the spaces between. Choose not to waste your in between times negotiating with yourself how much longer you're going to do it for, or how much more you can take. Sink down into what you will find is a deep, beautiful, profound space of rest and quiet. Trust that as the pain cranks up, so will your ability to cope. You will say "I CANNOT do it anymore" only to find three hours later you still are and are just fine. As I mentioned, you stretch in every way...your resources too. Be willing to ride the sensation even when it hurts, be willing to have those huge waves crash down over you, knocking you down. Be willing to get up again tearing at your clothing with your nails, bearing year chest and yelling, MORE! I CAN! Trust that strong contractions are GOOD contractions, and that each one brings you one step closer to meeting your baby...and in between, soften, soften...soften.

I will never candy coat labour pain to a woman. That is not love. That is disempowerment. I just talked to someone who used a method of pain "control" in labour. When I asked her if it worked, she said, "well, I DID feel pain at some points, so I guess we just can't get away from those cultural expectations...the idea of birthing pain is so imbedded in us that we'll always believe it's there even if it's not meant to hurt because it's natural." This broke my heart, because what these methods teach us is that if we do hurt, it's our fault, that the stain and stigma of normal pain must be attributed to the woman's failing the method, not the method failing the woman. I like to see the strong sensations as conducting the hormonal flow. It's a good thing. And perhaps the more we dive in, embrace it, open to it, accept it, work WITH it instead of against it and trust it, the less it may actually "hurt" us.

I remember with my first kid believing with all my heart birth would be the worst pain ever, that I'd probably go crazy, that it would be horrible, but that I just would do it. I'm a paddy ass, so I planned a homebirth to keep myself away from the drugs. I just went with it, saying, "one foot in front of the other, one contraction at a time". And when my midwife came into my room asking me if I felt pushy because I was making some convincing sounds and she found me fully dilated, I said, "What? I did it? Already?" Because even though the sensations were the fiercest, craziest, most mind blowing sensations that made me yell so loudly I thought I was gonna bust, it was never actually bad...if that makes sense. All I'm saying is, if I can do it, wimp that I am who cries when my tummy is upset, you can too.

3) Own your choices. . When it comes to normal labour, I think it's really important for women to own their choices. "I had the epidural because I just couldn't do it anymore" (at 4cm five hours in) is not the truest of statements. This is not to be mean, but I have a hard time with that. We're not victims of our normal labours. Culturally and mentally unprepared maybe. Our physiologies profoundly effected by our modern psychological and emotional landscape perhaps. But what does that mean, "I couldn't do it?" Well, yah, technically, you probably couldda. If you had been walking around in the middle of nowhere and labour came upon you and there was nowhere else to go, you'd just do it....with nobody telling you how. There would be no opportunity to say "I can't do it", you would have to. If this same labour comes upon you in modern civilization, "I can't do it" is what many women say when the crunch is on. Actually, when given the choice and available epidural, and admittedly the much more challenging birthing environment to labour in, the truer statement is "I don't want to do it." And you know what? That's perfectly okay. You are in no way, shape, or form expected to have a natural birth you don't want just because you think you should. If you didn't in the end want a natural birth when you got to active labour, it's important for the sake of your friends and daughters and women everywhere not to blame your labour for your personal choice. This desacrates the brilliance of your body, of the brilliance of the bodies of your Grandmothers. I'm not talking about situations such as inductions, or you're at 9cm for years, or you have a permacontraction that doesn't let up,or hideous back labour, or you have a PTSD reaction to a trigger, or the staff is so challenged by your coping methods that they simply drive you to distraction so you lose your mojo, or it's really long and you're truly exhausted, or there's some kind of problem, or your in laws refuse to stop wandering in and out of the room causing a case of family dystocia...these scenarios are more about survival than personal choice. I'm just talking about regular labour you decided wasn't your thing.

I feel so sad that many women think they need to apologize for their choices for pain relief and perhaps even cover up unneccessary shame by trying to convince themselves and others that their bodies were lemons for not birthing "properly" when in fact there was no problem. Maybe it means they felt they failed themselves and didn't feel as strong as their friends who had natural births. It's not a competition. Or maybe, they just really don't know what normal labour means, which is kind of a societal failure. Shouldn't girls be taught this in detail from a young age instead of know more about what celebrity was "too posh to push"? Though this choice may often be made without the correct information on benefits vs. risks of elective Cesarean and is not one I'll ever feel good about as a doula, claiming to be too posh to push is at least really honest, and the choice is totally owned with emphasis on the woman's desires for her Cesarean rather than blame on the probable birthing excellence of her body. There are very sad and misguided aspects to this choice, for sure, and it does create collective harm definitely, but at least there is no blaming or creating victimization to justify a choice.

You know, there are other ways women can experience surrender and raw power. It doesn't HAVE to be in the realm of childbirth. It's not "for" everyone. I have seen a few incredibly beautiful births, which were intensely empowering, with women whose mandate it was, for personal reasons, to feel NO pain in labour. I learned a lot from these births, and came to an honest place of honour for these women, not just paid them a lip service because I have to be diplomatic as a doula. While I may not personally agree with some choices, meaning I wouldn't choose them myself, I can totally appreciate an informed choice and ownership for that choice. Personally, if my labours felt like intense nausea instead of the way they did, I'd probably be strutting around saying, "Yeah, I had them knock me unconscious the minute I felt sick. I was simply not interested in going there. There are no benefits to my feeling that way in any circumstance in or for anybody in my life. Wanna make something of it?" Well, no, I'd probably just deal with it anyway because I believe so strongly in the benefits of natural birth. I would do my very best to heal my issues surrounding nausea. But if I did in the end make the choice to end the discomfort, I wouldn't make any apologies for myself. It is what it is.

Lesley Everest | MotherWit Doula Care

The Lie of the EDD: Why Your Due Date Isn't when You Think {San Diego Bradley Method® Instructor & Birth Doula}

September 24, 2008 by Misha Safranski

We have it ingrained in our heads throughout our entire adult lives-pregnancy is 40 weeks. The "due date" we are given at that first prenatal visit is based upon that 40 weeks, and we look forward to it with great anticipation. When we are still pregnant after that magical date, we call ourselves "overdue" and the days seem to drag on like years. The problem with this belief about the 40 week EDD is that it is not based in fact. It is one of many pregnancy and childbirth myths which has wormed its way into the standard of practice over the years-something that is still believed because "that's the way it's always been done".
The folly of Naegele's Rule

The 40 week due date is based upon Naegele's Rule. This theory was originated by Harmanni Boerhaave, a botanist who in 1744 came up with a method of calculating the EDD based upon evidence in the Bible that human gestation lasts approximately 10 lunar months. The formula was publicized around 1812 by German obstetrician Franz Naegele and since has become the accepted norm for calculating the due date. There is one glaring flaw in Naegele's rule. Strictly speaking, a lunar (or synodic - from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we've been lead to believe is average. In fact, if left alone, 50-80% of mothers will gestate beyond 40 weeks.

Variants in cycle length

Aside from the gross miscalculation of the lunar due date, there is another common problem associated with formulating a woman's EDD: most methods of calculating gestational length are based upon a 28 day cycle. Not all women have a 28 day cycle; some are longer, some are shorter, and even those with a 28 day cycle do not always ovulate right on day 14. If a woman has a cycle which is significantly longer than 28 days and the baby is forced out too soon because her due date is calculated according to her LMP (last menstrual period), this can result in a premature baby with potential health problems at birth.

The inaccuracy of ultrasound

First trimester: 7 days

14 - 20 weeks: 10 days

21 - 30 weeks: 14 days

31 - 42 weeks: 21 days

Calculating an accurate EDD

Recent research offers a more accurate method of approximating gestational length. In 1990 Mittendorf et Al. undertook a study to calculate the average length of uncomplicated human pregnancy. They found that for first time mothers (nulliparas) pregnancy lasted an average of 288 days (41 weeks 1 day). For multiparas, mothers who had previously given birth, the average gestational length was 283 days or 40 weeks 3 days. To easily calculate this EDD formula, a nullipara would take the LMP, subtract 3 months, then add 15 days. Multiparas start with LMP, subtract 3 months and add 10 days. The best way to determine an accurate due date, no matter which method you use, is to chart your cycles so that you know what day you ovulate. There are online programs available for this purpose. Complete classes on tracking your cycle are also available through the Couple to Couple League.

ACOG and postdates

One of the most vital pieces of information to know when you are expecting is that ACOG itself (American College of Obstetricians and Gynecologists) does not recommend interfering with a normal pregnancy before 42 completed weeks. This is why knowing your true conception date and EDD is very important; if you come under pressure from a care provider to deliver at a certain point, you can be armed with ACOG's official recommendations as well as your own exact due date. This can help you and your baby avoid much unnecessary trauma throughout the labor and delivery. Remember, babies can't read calendars; they come on their own time and almost always without complication when left alone to be born when they are truly ready.

Sources:
Mittendorf, R. et al., "The length of uncomplicated human gestation," OB/GYN, Vol. 75, No., 6 June, 1990, pp. 907-932.
ACOG Practice Bulletin #55: Clinical Management of Post-term Pregnancy

A Belly Grows! {San Diego Doula, Birth Photographer, Bradley Method® Instructor}

Magic- A Belly Grows from The Panic Room Videos on Vimeo.

Trust Birth Initiative {San Diego Doula & Bradley Method® Instructor}

I came across a neat website today. TRUST BIRTH. Do you trust birth? I do. And I support and educate families to do the same. 

Read on....excerpt from Trust Birth website.

What is the Trust Birth Initiative?

The Trust Birth Initiative is a grassroots birth advocacy and support initiative for families. It is supported by small, voluntary donations of time and money by individual mothers and fathers all around the country.

What does a Trust Birth Facilitator do?

A Trust Birth Facilitator holds Trust Birth meetings to facilitate discussions about pregnancy, birth and parenting related topics. The facilitators might also have booths at birth fairs, conventions, etc. To become a facilitator, you must first have your application approved, complete the three initial training assignments and you need to go through ongoing training assignments and conference calls. 

What are the beliefs of the Trust Birth Initiative?

Please see the "What We Believe" page. 

What is the Mission of the Trust Birth Initiative?

We are aiming to help families realize that they are the authority, they're able to empower themselves to make informed decisions about their pregnancies and births, rather than submitting to their care providers as authorities. We want them to take their power back from care providers and use it to make healthy and empowering choices for themselves and their babies. 

Does Trust Birth have a conference to attend?

Yes! The next conference will be held in Nashville, TN at the Hotel Preston in 2012. For more information, see theTrust Birth Conference website.

Does Trust Birth think that all pregnant mothers should hire a midwife?

No, we believe that women should be "in charge" of their births, and view care providers (no matter the title) as paid consultants. We believe that women have the right to give birth with any type of care provider she chooses, even if that is no one.  

Does the Trust Birth Initiative promote Unassisted Birth (Freebirth, DIY Birth, etc.) as the best way to give birth?

No. However, we do support it as a valid choice. We believe birth is generally safe, and we do not add qualifiers to our trust in birth.

Is the Trust Birth Initiative against hospital birth or Obstetricians?

Absolutely not, we are "For" telling the truth about birth, and the truth is that Birth is safest with minimal interference, and Hospitals are not the best environment for avoiding intervention. We believe that women should be "in charge" of their births, and view care providers as paid consultants.

---

We recommend that you do enough research on the following topics to find out the Truth about them. We do not want to tell you what you should believe or what you should do in any particular situation. We'd rather you empower yourself by doing your own research. 

Are vaginal exams during pregnancy really necessary? 

Are there any risks associated with doppler/ultrasound scans? 

Are routine prenatal tests really necessary for me and my baby? 

Isn't home birth dangerous? What about unassisted home birth? 

Is any kind of labor induction without risk (i.e. herbal, Castor oil, acupuncture, etc)? 

Is vaginal birth after cesarean [VBAC] safe? 

Is it better to have an episotomy or to tear? 

Is Epidural anesthesia safe? 

My Baby is breech, can I still give birth vaginally? 

When exploring your options, ask questions of everything you research, such as: 

Is there any reason why [the writer] would misrepresent the facts on this topic (do they have anything to gain from it)? 

What evidence is there for or against this? 

Do the risks outweigh the benefits for me personally? 

Birth Trauma: healing after a traumatic birth experience {San Diego Doula & Bradley Method® teacher}

{Reposted From Solace For Mothers}

What is Birth Trauma?

When a woman looks forward to giving birth to a baby, she may not know exactly how the birth will go, but she has a basic expectation of respectful and protective treatment from her partner and from maternity care providers. This expectation includes the right to understand and to participate in health care decisions, and a confidence in her own and her infants’ safety. When these things are not present, the results can be severe.

Cheryl Beck, who researches the subject of birth trauma, observed:

“Mothers with post-traumatic stress disorder attributable to childbirth struggle to survive each day while battling terrifying nightmares and flashbacks of the birth, anger, anxiety, depression, and painful isolation from the world of motherhood…”

In another study, Thomson stated:

“...for women in this study, their self-defined traumatic birth was experienced as violent and abusive. Some described their experiences as torture, resulting in a profound sense of being disassociated from the childbirth experience, and alienated from societal regard”

In our culture, when a baby is born, a woman is expected to be grateful and joyful. However, when a woman has a birth experience that leaves her feeling traumatized, she is not only unhappy, but can experience severe emotions.

Postpartum Posttraumatic Stress Disorder (PTSD) was once estimated to only affect 1.5% to 6% of women. Many researchers and clinicians now feel that the number of women experiencing trauma following childbirth may actually be much higher.

Actual rates of trauma following childbirth may be higher than previously predicted because of the way PTSD is diagnosed by mental health providers. Trauma is generally recognized and diagnosed when all 9 of the criteria for PTSD, as described in the Diagnostic and Statistical Manual of Mental Disorders IV-TR (American Psychological Association 2000), are observed.

Further, if a mother who has experienced birth trauma is good at “avoiding”, the hypervigilence and perhaps the intrusive symptoms may be kept at levels that are not detectable by a clinician. Mothers with postpartum trauma may minimize discussions about their experiences with health care providers and even avoid health care providers themselves, particularly those associated with the birth. For so many reasons, a woman suffering from traumatic stress is often left unheard and untreated by professionals.

Some women may not fit the DSM criteria for PTSD. However, research that is centered on the woman’s definition and experience of trauma suggests that debilitating traumatic stress following childbirth is extremely common. Some studies suggest that over 30% of women have experienced multiple symptoms of trauma. Also, research has shown that women who have a “normal” vaginal delivery also can experience PTSD or traumatic symptoms.

Trauma is not currently included in the standard screening for mood disturbances after the birth of a new baby. Frequently, very competent providers staying within the current standards of care, will misdiagnose any disorder as “Postpartum Depression” (PPD) since that is what their screening questionnaires diagnose. The likelihood is high, therefore, that some women currently diagnosed with postpartum depression may actually be exhibiting a traumatic response to their childbearing experience.

When should a woman suspect that she is suffering from a trauma-based anxiety disorder and not postpartum depression? Click here to read through information that will help you identify whether you may be suffering from PTSD or traumatic stress.

The birth of two mothers: Andrew’s birth story

Andrew’s birth story: by Robin Baker, the ‘Birth Mom’
In 1996 I was 19 and renting a room out of my friend’s mother’s house while going to College in Orange County, CA. I was like many 19 year old college students –rebellious, unproductive, and irresponsible. This was not my normal character and had not been going on for long. Luckily it came to a screeching halt when I found out I was pregnant. I was unmarried and unable to care for even myself. Now that would seem like a major dilemma for most, but for me it was very cut and dry. Adoption was my only option. Period. 
So I set out to find a home for my baby. This proved to be too much for my fragile emotional state, so I backed off for a bit. Making matters more difficult, no one was supporting me. Everyone suggested I have an abortion. I just could not even fathom it. One day, my Aunt called me and told me about her good friend, Kris. This lady had been trying to adopt for years and years and was unsuccessful. That’s it! She is the one! And just like that, I made the decision that Kris would be the adoptive mother of my baby. And from that point forth (it was very early in the pregnancy) it felt like a surrogate pregnancy. I felt as if the baby I was carrying was really hers, not mine, and I was just the vessel to bring it to her.
It seemed overnight my life changed from unproductive and irresponsible to the opposite. I resumed a very healthy lifestyle and did all the things a good pregnant girl should. I had regular prenatal care from a midwife at Kaiser Permanente. She loved me! She said I was her model perfect patient. Pregnancy was easy for me and I had zero complications. I loved feeling the baby move inside of me and was happy I could bless someone that was unable to birth their own babies. I worked as a bank teller and went to school full time, achieving almost straight A’s. Life was back on track and I was grateful. Sometimes it takes a major event to point you in the right direction, and boy was this major!
At the end of the 9 months, Kris and her mother flew to California from Pennsylvania to be present for the birth of *our* son. After all, we were both becoming mothers. She, the ‘adoptive mom’ and me, the ‘birth mom.’ They came out around my 38^th week. And waited. And waited. My professors were getting worried that I would give birth in class, but I assured them that ‘babies don’t just fall out.’ One professor was very impressed that I was the only one with perfect attendance in his class. Finals came and went and so did my ‘due date.’ My midwife seemed pleased with my progress and all was well. So we waited.
I read the 3 ring binder of information that Kaiser gave me about pregnancy and birth and attended their hospital class. That was about it. I had very little knowledge of birth choices and figured that when it was time, someone in the room (there were plenty!) would tell me what to do. The internet was pretty new back in 1996, and I didn’t have home access. I was so busy reading textbooks that it never occurred to me I should read books on birthing. *In hindsight, I wish I had.* I had no fear of the labor itself, but was very adamant that I must not have a C-Section. I recalled that my mother had natural, drug free births, and didn’t hear any horror stories. So I had nothing to fear.
My ‘estimated due date’ was May 31^st, 1997. I celebrated my 20^th birthday in February and looked forward to resuming my young adult college life after the birth. In my third trimester, a local rock radio station had it’s first annual pregnant bikini contest. Supported by my only friend over 21, my sister, I went down and participated as a joke. Well guess who WON? Me! We all got a kick out of it and I used the $1,000 to buy a camera. Finals were over so I left my little place in Orange County to stay with my Aunt in Vista, where Kris was also staying. We hung out and got to know eachother. We rubbed the belly and encouraged the baby to come out. I even tried jumping on the trampoline! Braxton hicks had been occurring since about 20 weeks, and I started to dilate around 37 weeks. By 40 weeks I was 3 cm dilated. We waited and waited. And rubbed the belly some more.
June 5^th (40 wks 5 days) I had an appointment with my doctor for a check up. She was working at the hospital that day so we traveled 45 minutes south to Kaiser Permanente Hospital, San Diego. They did a stress test and all was well. Actually, they told me I was in early labor! Yippee! I was admitted after we had a nice big lunch in the cafeteria and induced with pitocin around 3pm. I couldn’t get a hold of the baby’s father (this was before cell phones!) but had a lot of support from my friends. They all came immediately. In attendance were my girlfriends - Mary, Laura, and Christy (and Christy’s husband), my guy BFF- Brian Breen, my sister, my mother, and my deceased ex-boyfriend’s mother, Colleen. Kris and her mother were present off and on too. It was a big party. Everyone was so excited that the day had finally come. We were young and no one had really seen an actual birth before! I was in the bed hooked up to all the contraptions and everyone was chatting and having a good time in the room. At one point this really concerned my mother. She didn’t think there should be so many people present and got upset, leaving the room.
The contractions started around 6pm and labor moved rapidly as I sit in the bed talking and waiting. The nurses were very conscious of my young fragile state and really paid attention to my emotional state. They made sure to let me know that I could tell them if I was uncomfortable at any time with the adoptive mom and grandma in the room, or anyone else for that matter. It seemed like the nurses paid special attention to me, since this was a special circumstance that probably doesn’t happen very often. I felt very loved and cared for by everyone. Just a few hours later the contractions were strong and effective. The doctor broke my water and it really got going. I wasn’t in a lot of pain but they asked if I wanted an epidural. I kinda looked around the room and asked everyone’s opinion. The consensus was, “go for it, what if it gets really painful? Might as well get the epidural now!” So I agreed. Afterall, my sister was induced and had an epidural and everything “was fine.” She birthed twins vaginally!
The epidural is where this birth story goes awry. I was nearing transition when they placed it so it was very uncomfortable to get in the “mad cat” position for the needle. Then the doctor missed the epidural space and tapped my spinal fluid. He tried again. It seemed to work for a bit, but then I had only partial anesthesia. One side was numb and the other wasn’t. So the needle went in for a 3^rd attempt, and failed. I felt mostly everything and labor progressed quickly. The epidural caused my body to shake uncontrollably and my mother got very worried. She thought I was freezing and asked for warm blankets. I tried to assure her I was not cold at all, but she remained nervous and unhappy about the number of people in the room. Just 4 hours after contractions started I was feeling the urge to push. The men left the room and Kris and grandma stood quietly in the corner. My three girls were locked arm in arm, watching at the foot of the bed…crying. My sister had my right leg and Colleen had my left. My mom was nowhere to be found…she sadly missed the birth when she went down the hall to call my aunt.
Everyone got very vocal in counting and yelling at me, “push!” “One, two, three….ten! AGAIN! Push!” I was confident in my ability but was feeling like I couldn’t breathe from all the breath holding. It was amazing and I was trying to take it all in…my loved ones holding me and my friends watching and crying. The sensation of the baby moving down the birth canal. What a trip! I got so out of breath and hot I wanted to stop and breathe. The nurses knew the baby was coming so they tried to put towels on me – I immediately threw them off. “no no, I’m hot and I can’t breathe!” They all encouraged me to keep going and I yelled out, “I can’t, I can’t” because I just wanted to rest and breathe. I heard Brian yelling from outside the door, “Yes you can Robin, you can do it Robin, you can do it!” This really encouraged me and I tried again. Then came the ring of fire, a little tearing, and the head! The girls start really crying now. And my sister and Colleen were so happy and encouraging me. I was very surprised at how hard it was to push out the shoulders. From my limited knowledge of birthing, I thought once the head came out, it was easy. Not this time. I pushed a few hard times to finally get the shoulders out and then the baby came.
I did it! 5 hours of labor and 45 minutes of pushing brought Andrew Christopher Nealon to the world at 11:03pm. He weighed 7 lbs 12 oz and was 21 inches tall. I asked Kris to cut the cord and that really got everyone in tears. We were all amazed and in awe of the birth. The birth of a beautiful baby and the birth of two mothers. A birth mom and an adoptive mom. No one would ever forget this day.
When everything settled down and the visitors left, I was alone and trying to recover but I had a horrible headache. The doctors were waiting to see if my spinal cord would fix the hole, but it remained and so did my pain. Almost 3 days later, they drew a huge vial of blood from my arm and shot it into my back (4^th needle in the spine) to patch the leak. It worked and I was feeling better. I was finally able to hold the baby without pain and fed him a few times with a bottle. The nurses were again very sensitive to giving me time to bond and say good bye to Andrew. I stayed with him and watched the circumcision on the 2^nd day. My mom and I took lots of pictures with my fancy camera and black and white 35mm film. We gushed how handsome he was. When it was time for me to be discharged (finally on day 3!) they let Andrew go home with Kris (to my Aunt’s in Vista). My mom drove me home to her house in Escondido and I stayed there a few days recovering.
   
I finally got a hold of Joe, the birth dad, and he came down to visit for a day. We asked Kris to bring Andrew to my mom’s house for the day so Joe could see him and say good bye. I told him the entire birth story and we hung out holding and feeding him on the couch. Joe even fell asleep with the baby on his chest, and of course I took pictures. My milk came in and I showed off my big chest to all my friends who came to visit. We all laughed and couldn’t believe how big they got overnight. Friends who didn’t make it to the hospital to visit at my mom’s while Andrew was there for the day. My mom got emotional and suggested maybe we keep him and I move back to live with her. I was very set in my decision and stayed the course. When Kris came to pick up the baby she was also very emotional. I remember there being a lot of crying and even some loud voices of pleading. I didn’t understand why the adults were getting so worked up when I was the one who just gave birth! I was very matter of fact and reassured them that as soon as they calmed down, I would give the baby back to Kris and she could resume her role as the mother. It was an emotional good bye for everyone, but I never regretted my decision. I knew I could not care for the baby the same way an established married adult could and I felt confident I did the right thing for Andrew.
Papers were signed and they flew back to Pennsylvania. My back was so sore that I couldn’t stand up straight for about 2 weeks. I kept recalling the birth over and over and was a little traumatized from the memories of the drugs, shaking, my mom missing the birth, everyone yelling at me while counting, not being able to breathe from holding my breath, partial anesthesia, spinal headache, and then prolonged back pain. I thought, “the pain wasn’t unbearable from the contractions and I felt the entire labor! That epidural was the worst part and totally not worth the risks.” Over the years I would think about it from time to time and wondered what I might do different if I ever gave birth again.
We have an open adoption and keep in touch via email and letters. When they travel to California we have little family reunions. Andrew feels special when he comes here because he gets to celebrate having moms. Not one, but two. The more the merrier! I am open in sharing my story and encourage young teens and young adults who find themselves in the same situation, to consider adoption instead of abortion. She gave him a life I never could and for that I am grateful. I gave her a baby that she couldn’t birth, and for that she is grateful.
Legacy of an Adopted Child
By Anonymous
Once there were two women
Who never knew each other
One you do not remember
The other you call mother

Two different lives shaped
to make yours one
One became your guiding star
The other became your sun.

The first gave you Life and
The second taught you to live in it
The first gave you a need for love
And the second was there to give it.

One gave you a nationality
The other gave you a name
One gave you the seed of talent
The other gave you an aim.

One gave you emotions
The other calmed your fears
One saw your first sweet smile
The other dried your tears.

One gave you up,
It was all that she could do.
The other prayed for a child,
And God led her straight to you.

And now you ask me through your tears,
The age old question through the years;
Heredity or Environment, which are you a product of?
Neither my darling, neither
Just two different kinds of Love.