Monday, March 13, 2017

Things I've learned about labor: fourth edition

There is an old saying that goes like this: The fourth time is the charm.

I'm pretty sure that's how it goes. It's a very ancient saying.... you've probably only heard of its more contemporary cousin.

Okay, so the fourth time may not be the charm, but sometimes in life there are mysteries that just don't come together until you have all the pieces.  And, for some of us extra-special people, all the pieces can take a lot of tries to gather.

So, as I near the finish line on this last time around, there are a few things I've learned about myself in labor that I hope may help me this time around.

1. My babies don't engage in the pelvis.  It literally took me three tries to figure this one out.  I couldn't find any information on it.  No doctor ever told me... aside from the fact that I have the hat trick on doctors and nurses who exclaimed, "WOW!! These babies are high up!!" immediately before or even after hours and hours (and hours) of labor. (Sidenote: what does that even mean?!  I'm just a mom laying here spread eagle, trying to have a baby!  HOW IS THIS HELPFUL INFORMATION?!  More importantly: what can I do about it?)

Much more helpful is the information I've stumbled across during this pregnancy (whole article here):
"Lack of engagement is a common issue for the woman who labors but the baby remains high in the pelvis. For about half the cases, the uterus gets overworked trying to get a baby into the pelvis for days of labor. Contractions may be very, very strong and very grinding on the pubic bone and dilation isn’t the predictive factor."

Ah-HA!  Now, that sounds familiar!  Even more familiar:

"Early labor can go on for a day, or two or three. Sometimes the woman thinks her starter is broken. This is because the labor can start and stop as the baby tries to get into the pelvic brim. Women may not dilate beyond 3 cm when the baby remains high. 
Labor can feel so strong as the uterus works hard to rotate baby’s head to drop into the pelvis. These strong contractions can go on for days. Once baby engages labor becomes effective and the baby is born in 8 hours or less."
This is it!  The missing piece.  The explanation I've been waiting for that finally makes my experiences make sense!
I've never been dilated past a four on my own, even after something like 35 combined hours of labor in two pregnancies. It explains why things move so quickly after the epidural: getting an epidural isn't about pain management for me, it's about bringing the head into the pelvis so labor can progress.  (PS - don't ask me why an epidural helps with that.  I simply don't know, although I suspect it has something to do with forcing the pelvic muscles to relax and spread out.)  I go from a measly 3 or 4 cm dilated after hours and hours - or even days and days - to ready to push in something like 2 hours once baby engages... but so far, I haven't been able to get there without the help of the epidural.

I have been learning so much I wish I'd known before about positioning baby for his exit.  It has given me renewed hope that I might be able to do this without an epidural.  Not to mention, a few actual, practical strategies to try if I get into labor and baby's head is still high and unengaged.

The Spinning Babies website has been so very helpful to me in identifying and educating myself about my own experiences in labor.

And luckily for me, they have a "daily three" exercises to help best position our little guy for his exit:
Step 1: Rebozo Sifting

This activity helps "jiggle" the mother, taking away the weight of the baby and relaxing her ligaments.

Step 2: Forward-Leaning Inversion

Which is pretty much exactly as much fun as it looks like for a great big pregnant lady.  The idea is to invert and take the pressure off of your lower uterus.  When you return to an upright position, baby uses that space and the pull of gravity to create more space for the head to fit in preparation for labor.

Step 3: Sidelying-Release 

Full disclosure, I'm not 100% sure I'm doing this one right, so I'm going to let you read all about it and draw your own conclusions.  But the basic idea is that, when done correctly, this movement uses a static stretch to slightly enlarge and soften the pelvis.  When done in labor, it may help encourage a stalled baby to rotate and descend.

They also have several recommendations about positions specifically for babies who do not drop once labor has begun.

2. All those contractions I had with Livvy were actually Prodromal Labor.  What is Prodromal labor, you ask?  Since I didn't know, even when I was experiencing it, let me tell you!  Prodromal labor is a type of labor that happens before the onset of active labor.  It is not Braxton-Hicks.  It is sometimes described as "false-labor," but the truth is that Prodromal labor is real labor contractions in terms of intensity and frequency, but labor that comes and goes without ultimately producing a baby.  Prodromal labor can go on for days or even weeks before active labor begins.

Two years ago, I could not figure out why I was contracting night after night without fail.  They would begin about ten minutes apart, get stronger and closer together over the course of 5-7 hours.  Just as I was convinced it would soon be time to go to the hospital, my contractions would simply... disappear.  This went on for more than two weeks, usually at night, but sometimes during the day as well.  One sleepless night I did the math and realized I would have more than 100 hours of contractions before active labor even began.

But why?  Well, that question is trickier to answer, as there does not seem to be a consensus I can find from the medical community.  One theory seems to be poor positioning of the baby, which again rings true in my case.  The uterus attempts to reposition the baby with contractions and eventually stops if it does not work.

Of course, there are no guarantees in labor, and the most important thing is to have a healthy baby and mommy at the end, however we get there.  On the plus side, we've changed hospitals so we're only a 9 minute drive.  That frees me up not to have any concerns about timing the trip; I can be ready to push and we'll still make it to the hospital in time.

I feel pretty confident though.  I think we have our best chance of having this baby truly the natural way.  Certainly, I understand my body and labor process better than I ever have before.  That is in itself a victory, however things go.

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