5 Ways Labour Pain is Different than Broken-Bone Pain

Some people compare labour pain to that of breaking bones. Besides scaring pregnant people, that’s not an accurate comparison. On the other hand, some women share stories of pain-free birth. Here are 5 ways the sensations felt in labour are different than “broken-bone pain”.

  1. Broken-bone pain is unrelenting and doesn’t go away without strong pain meds; labour pain comes and goes in a rhythmical manner. In fact, throughout labour, much more time is spent in the rest between contractions. Even in advanced labour, most contractions last between 60-75 seconds but can sometimes get to 90 seconds. Then there’s a rest before the next once. In active labour that rest will generally be between 1-3 minutes. In earlier labour that rest will be up to 10 minutes. There is no rest with broken-bone pain. It’s constant.
  2. Broken-bone pain is all encompassing, resulting in the release of stress hormones and injury responses in our body. Labour pain is accompanied by powerful pain-killing hormones such as endorphins. The female body is equipped for labour with strong, naturally occurring hormones that are released as labour progresses. The effect of these hormones has been compared to morphine by physiologists. (However those hormones are not as concentrated and isolated like morphine. Still, that’s a powerful comparison!) Stress makes pain worse.
  3. Broken bones are a terrible injury; labour is a normal human process.
  4. Broken bones are due to an accident; labour is a known and sometimes planned event. Therefore we can prepare for the intensity of labour. There are many helpful tools and strategies for comfort measures that can be done by the labouring person or their birth companions. We teach many of these in our How to Ease Labour Pain Class.
  5. Doulas! Birth doulas can make a significant difference in how labour is experienced and felt. There’s ample research showing the benefits of doula support through birth, including shorter labours, half the rate of Caesareans, significantly fewer requests for epidurals. To my knowledge, there’s no such thing as “broken-bone doulas”. Everyone around someone with broken bones is providing medical care – good thing too. Ideally, labouring people will have someone knowledgeable with them whose only job is to provide comfort and support.
  6. Broken bone pain is measured in weeks and months; labour is measured in hours.

* It’s interesting to note that I’ve only heard men make this comparison. Many pregnant women fear this will be the case but I’ve never heard anyone who’s gone through labour and had a past experience of broken bones say they were the same thing. I’m one of them. A couple of years before being pregnant, I broke my pelvis. There is absolutely no comparison between the two events.

Choices in Planned Caesarean Births

One of the benefits of a planned caesarean is that there’s time to consider options, ask questions and make choices beforehand. 

Many hospitals are willing to take extra steps to make a caesarean birth more gentle and family friendly. The following is a list of practises that are being requested as part of a “Gentle Caesarean”. Yes I’m aware that the very nature of a caesarean and the postpartum recovery do not seem gentle to most people. However I appreciate that there are medical staff working hard to make the experience as positive, healthy and family-friendly as possible.  

  • Watching your baby being born. Clear surgical drapes, surgical drapes with a panel that can be lowered to a clear panel, or having the drapes lowered entirely.
  • Cord cutting. Most hospitals don’t allow anyone other than staff to cut the cord in the surgical field. But they can leave a longer cord and have the partner trim it – like a ceremonial cutting of the cord.
  • Skin-to-skin contact with the birthing parent, from the chest up.
  • Maternal heart monitors on their side or back, leaving the chest available for holding baby skin-to-skin.
  • Music of your choice – played on the sound system or your headphones.
  • Support through the entire procedure, from the moment of entering the O.R. until heading to the recovery room. Most hospitals allow one support person in the O.R. and recovery room. Some allow doulas to come in as well. 
  • Healthy baby stays with the parent(s); family stays together in O.R. and recovery room. In some hospitals babies born by caesarean are automatically taken to NICU or a medical nursery for observation.
  • Photos / videos – always bring your device. There’s often a nurse who is waiting for the baby to be born and will take some photos of the birth, the first time parents hold the baby, etc. There are many beautiful moments to celebrate at any birth, including caesareans.
  • Flora for the baby – vaginal seeding. You might ask for a GBS test a week before the surgery before going ahead with this. Note that this is still new enough that most medical staff will not participate. Plan to DIY.
  • Covid testing options – find out if this is something that will affect your birth. What happens if you take the test or don’t take the test?
  • Any cultural / spiritual aspects you might wish to include. I’ve seen an obstetrician lead a prayer before starting the surgery and have joined the surgical team in singing happy birthday to a newborn.
  • Obstetrician of your choice. Certainly a perk of scheduling your birth. 
  • Volume of monitoring machines – ask for the volume to be turned up or down if it’s reassuring for you, or not, to hear things like fetal heartbeat, maternal heart beat. 
  • Delayed cord clamping – up to 1 min is considered safe with caesareans. (I’ve heard of a hospital that keeps the placenta and baby attached after the placenta is removed – definitely not standard of care in most places. Never hurts to ask.)

In some facilities the things on this list may already be standard care. In others, requesting these things will provide an opportunity for staff to gain a new perspective. Patient safety is the primary concern. Some of these practices may be considered safe or not, possible or not, depending on patient health, the facility and/or the staff working in the O.R.

Speak with your doctor well ahead of time about the things that interest you from this list. 

If you get a sea of “no ways,” then ask why not. There could be valid reasons or it could be one unbending person. If it’s the latter then you might wish to explore working with another doctor or giving birth in a different facility, if that’s an option. 

Doulas and Dads

Although the information here will reassure any partner, this article intentionally addresses dads-to-be. All the quotes, links and videos are made by dads for dads-to-be, about their most common concerns about birth support:  1) Value; why should we pay for a doula if I’m going to be there?  2) Why do we even need a doula; what does she have that I don’t?  3) How will I be included if a doula attends?

C-19 Updates in Birth and Postpartum Care in Regina

I’ve been keeping in touch with the good people managing the units at Regina General Hospital. Here are all of the recent updates of RGH Labour/Birth Unit and Mother/Baby Units here in Regina, Saskatchewan due to Covid-19. Please note that any of these may change on short notice due to the coronavirus pandemic.

Some additional tips for navigating your birth journey:

I lead RGH Tours live but online multiple times a month.

Article: How to Set Up your Birth Room (i.e. What Your Doula Would Normally Do!)

Easing Labour Pain: An online 2-hr class offered monthly that teaches partners how to provide hands-on birth-support, comfort, and decrease labour pain.

If anyone’s looking for online prenatal classes please contact me. I teach all the sessions live but online so you can ask questions.

*****

Hospital Update

March 2022. 

  • Due to Covid, the Nitrous Oxide (“laughing gas”) is not available. It may be available again, depending on some supply issues. 
  • The Mother Baby Unit now allows new families to have 2 visitors at a time (11am-8pm) and they can be anyone you want. (The “no-swapping rule” has been lifted.)
    That said, postpartum hospital stays are usually short – only 1-2 days. There are many benefits to just resting with your new baby and saving the visitors for once you return home.
  • Note: The Labour & Birth Unit remains as is – 2 support persons per maternal patient, no swapping.

Feb 2022. The proof of vaccination / negative test requirements have been lifted.  Support persons no longer have to show proof of anything. 
As of Nov 8, 2021, partners, visitors, doulas, support persons, everyone EXCEPT the patient being admitted, must show proof of double Covid vaccine or a negative test within the past 72 hours from an SHA approved tester in order to enter SHA hospitals. Anyone who is not double vaxxed and wants to attend the birth might consider serial testing every 72 hours in order to be ready anytime.  

ONGOING:

There are 2 support persons allowed in the BIRTH ROOM. From Saskatchewan Health Authority:

“Effective immediately, expectant mothers and families across Saskatchewan will now be permitted to have two designated family members/support persons present during their birthing experience. Designated family members/support persons are chosen by the mother and family and may include but are not limited to partners, family members, coaches, doulas or cultural support persons.

All maternal patients and their designated family members/support persons will be screened for COVID-19 upon arrival and be required to have a temperature check, wear a mask, participate in hand hygiene and follow physical distancing guidelines. Designated family members/support persons who are symptomatic for COVID-19 or who have other risk factors will not be permitted. The designated family members/support persons must be consistent during the duration of the patient’s stay. They may leave the facility but cannot be switched out for another family member or support person. Only designated family members/support persons will be permitted at this time, other visitors, including siblings, will not be allowed.

All maternal patients will be offered an optional COVID-19 swab upon admission. Family members/support persons will not be offered a COVID-19 swab.”

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◆ Support people coming in on their own, i.e. not with the labouring patient, can be screened 24/7 at the main RGH doors (14th St entrance). They do not have to go to the ER doors.
◆A 24-hr support person who’s joining a birth or going to MBU for a maternal patient that has already been admitted can enter through the main 14th St doors at any time, 24/7. No need to go through the ER.
◆ A support person entering the hospital with a maternal patient will be screened with the maternal patient.

Please note that while the 14th Ave entrance is open 24/7 with a security guard that can screen and let people in, the registration desk is only open from 6am-6pm. Support people can enter this door 24/7 because they are not patients (don’t need to go through the registration process).
 
If you’re in labour and going to RGH as a patient, then you’ll have to go to an entrance that has an open registration desk. On weekends, holidays and evenings/overnights, that will be the ER.
 

If you have to step outside and get back in, here’s how:

◆ 14th St main entry has a security person around the clock. If you have your proof of screening and are wearing a band it’s easy to get back in 24/7. If you’ve not been screened yet, I recommend you start at this door. If they are unable to screen you, they will send you through the ER doors instead.
◆ The ER can screen 24/7 but please save the ER capacity for people who need it.
◆ 15th St admitting doors are locked overnight. The doors below MBU at 15th St parking lot are locked 24/7. You can not enter the 15th St side of RGH overnight. If you go out those doors, you’ll have to walk around to the 14th St entry.

If your 2nd support person is not at the birth but is invited to MBU, they will be screened on their way into the hospital. They must be named when you are admitted to LBU so remember to tell your nurse. You must get a coloured bracelet for them. I expect someone has to meet them outside the unit to give them the band that will grant them access to the MBU, but ask your MBU nurse about this.

“If the patient fails screening, she becomes a Person Under Investigation (PUI), therefore the support person now becomes a PUI as they have been in ‘close, prolonged contact with a PUI.’ The support will be sent home, however, the patient may have an alternative support person or people who pass screening. ” That means anyone who has been with the labouring woman for more than 2 hours will not be allowed in if she is suspected of C-19/exposure.

Folks – you need to plan for this. Plan C. New support people who have not been with you for more than 2 hours AND who pass screening may be allowed into isolation. They will be gowned, masked, gloved throughout and will not be allowed to leave the isolation room. Food will be brought in.

◆ Again, it’s up to you to ensure that a 2nd support person has been named so they can enter the unit. Ask your nurse about this.
◆ Supports must be 19 years and older. (No, I’m not sure what happens in the case of teen pregnancy, young doulas and so on. This is just what I was told.)
◆ The health region is not on the same timeline of relaxing restrictions as the SK gov’t. Restrictions are still in place at health care facilities.
◆ You’ll see staff wearing masks throughout your stay.
◆ Bring what you would normally bring for your birth and hospital stay. Support people will be given a wristband so they can go to car later for extras and car-seat. You are still allowed to bring your pillow, clothing etc – whatever you need for comfort.

Doctor

◆ Labouring women are asked to wear the mask as long as they can stand to do so. Postpartum patients are asked to wear their masks when staff are in the room.

◆ Masks are mandatory for partners and support persons throughout the hospital, except for when there’s no staff present in the Mother-Baby Unit.

◆ People can wear whatever mask they want to enter the building. Public Health does have recommendations on personal masks (on the SHA site). However, once inside the building, people will go through screening and will be given medical masks to wear in the building (the blue ones with folds). The blue medical masks must be worn in all public spaces and the assessment area.

◆ Nitrous-oxide (“laughing”) gas is available for pain management. If a tank is being used (instead of the tubes that go directly into the wall), then the maternal patient must have a negative Covid swab done prior to use. 
◆ If you or baby are at high-risk for birth complications, you may be asked to use an epidural during labour to avoid the need for a general anaesthetic in case of an urgent/stat caesarean. Best to discuss this with your OB ahead of time so you can learn your options and make a plan.
◆ Waterbirth is currently not an option in the hospital. Midwives are not lending pools out for home birth. If you have your own then waterbirth at home is still an option (contact me for info on where to get one).
◆ The installed bath-tub is available for comfort in labour.
◆ Breastfeeding is still being supported at RGH.
◆ There are plans and protocols in place so that mother-baby can stay together if mom is at risk or has symptoms of C-19 in the immediate postpartum.
◆ Even though some community restrictions are being lifted, great care should be taken with newborns once the family is home. Physical distancing and being only with members of the same household are still recommended. Anyone who enters the house can bring in pathogens/bugs.

◆I always tell people to bring their own hot water bottle or Magic Bag to the hospital. That’s because the hospital does not provide any warm tools other than blankets from the blanket warmer. They are lovely but they are not the same as a hot water bottle. The new update is that the staff are not allowed to take people heating devices to the microwave or kettle. Therefore if people want to use heat it will have to be a plug-in device or they can fill the hot water bottle with hot tap water in their own room. Stay warm and stay well during your visit!

◆ Paid parking has resumed in the RGH parking lots. You will need cash for the main lot. Also, the 15th street parking is reserved only for people who have appointments or are being admitted to the hospital. Vehicles are being ticketed again on the streets around the hospital so no more free parking that way.

◆ There is nowhere for the second support person to wait as all waiting rooms are closed. The second support person should wait at home or somewhere outside the hospital until the labouring person is officially admitted and moved to a birth room.

◆ Partners/support persons will be provided with a mask at the entry doors. (Bring a big paperclip or string if you want to save sore ears.) Check out these tips for saving your ears from mask-pain.  Everyone must wear masks in the hallways. Labouring people do not have to wear a mask once they’re in their patient rooms in the birth unit and the mother-baby unit.

◆ Food outlets now allow people to sit in.

◆ Galleys are still closed to patients in both units. The nurses will get food for you in the birth unit but not in the mother-baby unit so people have to bring their own snacks. There is no access to the microwaves, kettles, food, water-ice machines. There is no access to the big fridges and freezers, but every room has a small mini-bar fridge.

Birth Room

𝐏𝐫𝐞𝐧𝐚𝐭𝐚𝐥 𝐂𝐚𝐫𝐞

● Attend appointments, diagnostics (ultrasound, lab) solo. Routine appointments might be done over the phone or spaced out. High-risk and special circumstances will still get the extra care they need.
● Midwifery offices are doing the discussion part of the consult by phone and then a quick in-person appointment for the hands-on part. They prefer pregnant patients attend alone but will allow partners. No other family members/friends/support are allowed.
● Anyone under midwifery or GP care who tests positive for C-19 at any point in their pregnant, birth or postpartum will be immediately transferred to OB care.
● If you’re an early-bird you may be asked to wait in your car until your appointment time.

𝐀𝐧𝐭𝐞𝐧𝐚𝐭𝐚𝐥 𝐂𝐚𝐫𝐞 (𝐋𝐚𝐛𝐨𝐮𝐫 & 𝐁𝐢𝐫𝐭𝐡)

● Early discharge is being offered as an option for those that are healthy and feel comfortable with newborn care. That means to go home a few hours after your birth instead of staying 24-36 hours.
● Anyone getting a cervidil induction will be monitored and then sent home to wait for labour to start, as per usual, then rescreened at RGH doors and LBU doors upon return.
● Support people are allowed at homebirths but must be screened. If anyone in the home (residents or support people) doesn’t pass screening, then the birth must be transferred to RGH. In that case, the one support person rule applies. Home birthers – screen your people before they come over!

𝐏𝐨𝐬𝐭𝐩𝐚𝐫𝐭𝐮𝐦 𝐂𝐚𝐫𝐞

● Doors that don’t have an admitting desk are locked tight; security will not let anyone in. That includes the convenient door just below the MBU.
● Families are being asked to stay in their room as much as possible.
● Support people may not visit any other patient areas.
● Food trays are being provided for new moms in the MBU.
● Breastfeeding class in the unit is still running but only birth mother and baby attend, and only up to 3 participants. If there are less than 3 maternal patients, then partners may be allowed to attend.
● Midwives and public health nurses are still providing postpartum home-visits. Some may be done by phone or video, depending on your needs.

Please contact me if you have any questions about this information or any of my services.

Checklist: Things to Learn About Your Hospital / Birthplace Before Labour Begins

This is also available as a Printable Birthplace Checklist.

Ideally, you will learn these things before 36 weeks of pregnancy. 

This list includes things available in most city hospitals, where units are specialized. In smaller hospitals, there may not be a specific birth and/or mother-baby unit and some of the services and amenities listed may not be available. Small town hospitals may have a birth room rather than a unit, and then the family stays in the general acute care unit. Sorting these details out is part of good birth-prep. 

General Planning

  • Name & location of hospital / birth centre
  • Do they offer pre-registration or do you register on the way in?
  • What you need to bring
    • Birth bag / supplies
    • Documents for registration
  • Support people 
    • How many
    • Ages
    • Requirements (e.g. hours, ID)
    • Payment required – covered by provincial health, private insurance, or out of pocket
    • General policies e.g. most hospitals have no-scent policies

Parking / Transit

  • Fees
  • Methods of payment 
  • Hours
  • Apps
  • Street parking? Hours/tickets
  • Access to hospital doors

Entry & Registration:

  • Entry to go in as a patient – which doors to use and hours for each
  • Entry for support persons 
  • Security / screening requirements
  • Documents / ID required
  • Who can be with you?

Birth Unit

  • Floor #
  • Elevator location
  • Path from door to elevator to birth unit
  • Assessment area (documents needed, support persons allowed?)
    • Private or shared space?
  • Support – who can go in, when, and in what areas
  • Caesarean / O.R. – who can be with you
  • Recovery Room / Post-op – who can be with you, how long are you there?
  • Food – Galley / kitchenette & rules
  • Food machines – location, form of payment, products
  • Washrooms for patients – shared or private?
  • Washrooms for partner / other supports
  • Sleeping arrangements
  • Fridges in the room?
  • Wifi?
  • Labour tools such as birth balls, birthing stools, squat bars, electric beds
  • Lighting – windows, blinds, dimmers?
  • Shower / bath – shared or private
    • Supplies – soap, shower curtain etc
  • Where to put your stuff

Mother-Baby / Postpartum Unit

  • Is it the same as the birth room or a separate unit?
  • Which floor
  • Path from the birth unit and also from the entry/exits
  • Length of admission
    • Early discharge and extra nights
  • Visitor policy – hours, numbers, ages
  • Shared or private rooms
    • If there are both, how do you get a private room 
  • Support people – who can stay overnight
  • Sleeping arrangements for baby
  • Sleeping arrangements for partner / support person(s)
  • Entry / exit doors & hours e.g. food run, visitors
  • Food – Galley / kitchenette / food machines
  • Are patient meals provided? How many daily, special requests/diets
  • Washrooms for patient
  • Washrooms for partner / other supports
  • Managing interruptions
  • Fridges in the room or availability of other places to store perishables
  • Security in the room
  • TV / wifi
  • Lighting
  • Shower / bath and supplies
  • What is supplied and what do you need to bring
  • Where to put your stuff

Discharge

  • What is the shortest / easiest way out
  • Need to show a car-seat to the staff?
  • Paperwork requirements
  • Hours

Services and Other Units

  • Food
  • Gifts
  • General supplies
  • Quiet spaces – chapel, multi-faith center, Indigenous services
  • Library
  • Neonatal Intensive Care Unit (NICU)
  • Special Care Nursery
  • Lactation Consultants
  • Meetings / classes available during admission
  • Special services – e.g. social workers, translators, spiritual/faith leaders, help for special circumstances or unexpected outcomes

Other

  • C-19 policy for maternal patient
  • C-19 policy for partner / primary support
  • C-19 policy for 2nd support
  • C-19 policy for other visitors (if applicable)

Optimal Fetal Position – Turning Baby Prenatally

Fetal position (position of the baby in the maternal pelvis) at the onset of labour is one of the greatest determining factors of how the birth process will proceed.  The optimal fetal position is pictured below.  A good way to remember the best position is to be able to give your baby a back rub every time you rub your belly.

The terms “posterior” or “sunny-side up” describe a baby who faces out, or is spine-to-spine with the pregnant woman. “OP” is the medical jargon, meaning occiput posterior. The part of the head that enters the pelvis is bigger in this position and the baby doesn’t flex and rotate as well as if they’re in the optimal position.  That can make for a much longer, more painful and more complicated birth.

Problems Related to Posterior Position

  • More difficult for baby to drop into and through the pelvis
  • Pregnancy may last longer
  • Membranes are more likely to rupture before the onset of labour
  • Labour may progress slowly or not at all
  • Back-pain during labour that doesn’t disappear between contractions
  • Increased risk of tearing
  • Increased risk of instrumental or surgical birth
  • Increased stress on baby’s head and nervous system

Some women birth a posterior baby just fine.  Those include but are not limited to, women who’ve given birth without difficulty before, those with an average or smaller baby, a labouring woman who’s able to move about freely and allow her baby to rotate into an “anterior” (the optimal) position.

Fetus in WombBaby in optimal position:  head down and flexed, back out.

Signs of a Posterior Baby

  • Feeling kicks or flutters at the front
  • Frequent urination (more frequent than with anterior pregnancy)
  • Belly appears flat on top or lumpy
  • Your midwife or doctor can tell by palpating your abdomen or by doing an ultrasound
  • Fetal heart-tones may be difficult to hear
  • Head is not engaged or doesn’t drop into pelvis
  • Can be assessed during labour by a cervical check

Factors Contributing to Posterior Position
Babies can assume a posterior position with no risk factors, but the following increase the chances:

  • North American lifestyle – reclining in upholstered furniture, sedentary lifestyle, sitting in cars (it’s interesting to note this position is rare in cultures where pregnant women walk a lot or work bent-over, and lack Lazy-Boy style chairs and couches)
  • Sitting with legs crossed
  • Postural or anatomical issues
  • Issue of uterine / abdominal muscles (e.g. tight psoas)
  • First pregnancy
  • Epidural use early in labour (hinders rotation and descent of baby) is correlated with more than 3x the rate of posterior position at birth (Tully, 2008)
  • Labouring in bed or without adequate movement
  • Baby who was breech and turned to vertex
  • Pregnant person with history of breech or posterior baby
  • Short or tight cord around baby
  • Emotional issues – fear of birth or parenting, not paying attention to pregnancy, family history of breech, relationship issues, financial concerns, stress (Frye, 1998)

Tricks for Turning a Posterior Baby to an Anterior Position
Sometimes there’s an unknown reason for the baby to be posterior and nothing will turn them. But in many cases a baby can be turned. Please ask for details or referrals.

  • Visualization and “talking” to your baby. Focus on letting the baby know it’s easier to get out when facing the other way.  This works especially well if combined with changing your emotional environment e.g. dealing with fears, prepping for birth.
  • Look at a picture of baby in proper position (e.g. Fig. 1), or have it drawn on your belly!
  • Webster Technique with a chiropractor certified in its use. Pistolese (2002) cites an 82% rate of success in relieving the musculoskeletal causes of intrauterine constraint.  It’s beneficial to perform the Webster Technique starting at 35-36 weeks.
  • Sit with pelvis tilted forward – knees below pelvis with straight back. Instead of upholstered furniture, use a birth ball, the floor, a kneeling chair or a regular hard chair or stool
  • Hands and knees – read, crawl around, or do “child’s pose” modified for pregnant belly
  • Pelvic rocking while on all 4’s – gentle “cats and dogs” yoga postures – several times daily
  • Swimming or floating – anything with belly down like a hammock for baby to drop into
  • Movement and exercise
  • Sleep on left side with a body pillow – left leg straight, right leg bent on pillow
  • Homeopathic Pulsatilla 200CH, 1 dose every 3 days.
  • Acupuncture or moxibustion – see a Traditional Doctor of Chinese Medicine or an acupuncturist who specializes in women’s and pregnancy care.
  • Deal with fears around childbirth and parenting
  • Postural management – check out spinningbabies.com for some excellent postures and exercises that encourage babies to assume optimal positions for birth.
  • Exercises to prepare for birth and encourage pelvic floor health, and optimal fetal positioning, such as the Miles Circuit.

References

Frye, A. (1998). Holistic Midwifery, Vol 1, Care During Pregnancy. Portland, OR: Labrys Press.

Ohm, J. (2006). About the Webster Technique. Retrieved from icpa (International Chiroractic Pediatric Association): http://icpa4kids.com/about/webster_technique.htm

Pistolese, R. (2002). The Webster Technique: A chiropractic technique with obstetril implications. Journal of Manipulative and Physiological Therapeutics , 25 (6), E1-E9.

Tayler, R. (2000). Homeopathy for Pregnancy and Childbirth. Ottawa: Ottawa School of Homeopathy.

The Midwifery Group. (2008). Posterior Babies. Retrieved from The Midwifery Group: http://www.midwiferygroup.ca/downloads/position/Posterior%20Babies.pdf

Tully, G. (2008). Occiput Posterior – OP. Retrieved from Spinning Babies: http://www.spinningbabies.com/baby-positions/posterior

Postpartum Sexuality

Many individuals or couples have questions or concerns about postpartum sexuality. Resuming sexual relations takes time and patience. During the first 6-weeks postpartum, the birth parent’s body is in recovery mode – much more than simply a return to the non-pregnant state!  Almost every culture advocates 6 weeks of abstinence for medical or spiritual reasons. 

After giving birth, some people have no change in libido and a rare few experience an increased drive.  However the majority notice lessening or lack of sexual desire; it’s a normal result of the physical and hormonal changes that accompany birth and post-partum. Most researchers report a return to pre-pregnancy levels of sexual desire, enjoyment, and frequency within a year. The hormones of breastfeeding often lead to suppression of sexual desire. Other factors that play into the temporary decrease in sexual feelings include:

  • Lifestyle changes
  • Exhaustion or fatigue
  • Feeling “touched out” due to constant contact with infant
  • Time constrains with duration of sex due to infant needs
  • Loss of privacy as a couple
  • Individuals in a partnership dealing with new pressures such as how to be a devoted parent or deal with increased financial responsibility
  • Many birth-mothers find themselves feeling dependent on their partner partner in new ways – a major mental and emotional adjustment
  • Self-image – postpartum people may feel self-conscious of their body and it’s workings
  • Relationship satisfaction, which is a predictor of postpartum sexual desire and frequency of intercourse
  • Baby blues or postpartum depression

Did you Know?

  • It takes 6 weeks for the placenta attachment site to heal. During that time there’s actually an open wound in the uterus, at risk for infection or injury.
  • The perineum can take 4-8 weeks to heal after incisions or stitches.
  • Vaginal secretions are decreased due to postpartum hormone levels.
  • Either or both partners may feel shy.
  • Jealousy of baby, mother-baby relationship, or partner’s perceived freedom is normal.
  • Nipples may be sore or tender. Breasts may leak breast-milk with sexual stimulation.
  • Some people feel sexually aroused when their milk lets down.
  • It is not normal to have pain with intercourse or using the toilet after 8 weeks postpartum.

The top concerns by both genders at 4 months postpartum include when to resume sexual penetration, birth control, recovery from delivery, and postpartum body image. Have open discussions as a couple.

When to Begin Again…

  • To prevent infection or discomfort, wait until whichever is LATEST:
    • Postpartum bleeding has fully stopped
    • Perineal tears, injuries, sutures heal
    • 6 weeks
    • **Everyone involved is ready physically, mentally, emotionally**
  • Start slowly,  especially in cases of traumatic birth
  • Stop in case of pain or discomfort
  • Patience may be required during the time-period before resuming sexual relations. Try:
    • Mutual caring and love
    • Cuddling, hugging
    • Kissing
    • Other sensual, nonsexual contact such as massage

Challenges to Sexuality

  • Relationship as both parents transition to parenthood
  • Perceived or actual inadequate support and presence of partner
  • No time for intimacy, especially if in survival mode
  • Difficult or traumatic birth, including Caesarean, can have physical and emotional lingering effects
  • Trauma to perineum during birth process
  • Religious or cultural beliefs

Other Strategies

  • Postpartum support to ensure rest and recovery from pregnancy and birth
  • Daily connection and even romance
  • If partners find each other attractive or beautiful then tell them, or find something to compliment
  • Set aside time for sex when neither of you are tired or anxious e.g. weekly date (day or evening) when someone takes baby for a couple of hours, or a weekly rendezvous while baby sleeps
  • Use a lubricant, as it’s normal to be dry or drier than usual, especially if breastfeeding
    • Water-soluble are “healthiest” and help with irritation or sensitivity
    • Silicone-based last longer and are more slippery than water-soluble
    • Avoid petroleum products (Vaseline, baby oil, or mineral oil) as they’re toxic and can dissolve latex condoms or barriers
  • Don’t take it personally if if your partner isn’t interested in resuming sexual relations; this will improve with time as hormones and schedules normalize.

Contact Health Care Provider, such as Pelvic Floor Physiotherapist in Case of…

  • Pain with penetration or using the toilet beyond 8 weeks that isn’t lessening each week.
  • Any questions or concerns regarding sexuality postpartum.

Pelvic Floor Physiotherapy

  • Specialists in female pelvic floor care and recovery after birth; also help with prenatal pelvic floor health.

Other Practitioners who can Help

  • Painful penetration may be referred to a pelvic floor physiotherapy specialist or gynaecologist.
  • Sex therapist in case of non-physical or unidentified origin.
  • Couples counselling if relationship is strained.

References

Association of Reproductive Health Professionals. (2006, Sep). Postpartum Counseling – Sexuality and Contraception. Retrieved Sep 2011, from Association of Reproductive Health Professionals: http://www.arhp.org/publications-and-resources/quick-reference-guide-for-clinicians/postpartum-counseling/contraception

Calgary Health Region. (2007). From Here Through Maternity. Calgary: Alberta Health Services.

Davis, E. (1997). Heart & Hands (3rd ed.). Berkeley, CA: Celestial Arts.

Lim, R. (2001). After the Baby’s Birth – A Complete Guide for Postpartum Women (Revised ed.). Toronto: Celestial Arts.

McCabe, M. A. (2002). Psychological Factors and the Sexuality of Pregnant and Postpartum Women. The Journal of Sex Research , 39 (2), 94-103.

Pastore, L. P., Annette Owens MD, P., & Raymond, C. ,. (2007). Postpartum Sexuality Concerns Among First-Time Parents from One U.S. Academic Hospital. The Journal of Sexual Medicine , 4 (1), 115-123.

Making Informed Choices

You know informed choice is a legal right but how do you make those choices? Here’s some guidance to help you get information and ask questions, so you can be an active participant in your health care.

In my experience, medical staff usually don’t present things as options the first time around but they are happy to answer questions when asked.

How to Avoid Birthing on Your Back

Did you know you don’t have to lay on your back to give birth?

Even though almost no one says, “I want to lay on my back to give birth”, that’s how the majority of women in North America – probably other places too – do it. Why? Because even if they’re in a more comfortable position, they’re told, “OK it’s time to have your baby – get on your back.” 

I’ve seen many people give birth on all hands & knees, squatting, on their side or even standing. Midwives and many doctors know how to catch babies in any position. It’s just a habit for the staff to tell their patients to get on their back.

How can you avoid this uncomfortable and ineffective position?

  1. Don’t get into the position in the first place. It’s hard to get out of it once you’re there.
  2. Just say NO!!!  Or say nothing but give a good emphatic head shake.
  3. When you get bugged over and over, keep saying NO and shaking your head!!

Sounds obvious but saying NO and continuing to refuse is not that easy. Check out my video about the Tend & Befriend Stress Response that makes it so difficult to not just do what we’re told during labour.

Here are a few tips:

  1. We do the thing we’re used to when we’re in a stressful or vulnerable situation – which describes birth for many people. Practise getting on your bed on “all 4-s”. Every night, just get on your hands and knees and do a few little stretches – even 5 seconds – then lay down. It will start to feel normal to get on a bed without laying down.
  2. During labour, crawl up onto the bed and take positions that feel good for you. No one will wrestle you to your back. At least I sure hope not – if that happens, it’s assault.
  3. Ensure you have a birth companion who can advocate for you and help you find your voice and your best position.
  4. Avoid getting on your back for cervical checks when the birth is imminent, as it’s hard to get out of that position. If you know your baby is moving down well maybe there’s no need to check. Many MCP know how to check a cervix in a variety of positions.
  5. If you have an epidural and are confined to bed, there are still many positions available to you.

You don’t need to ask permission to assume positions of your choice!  However, if there’s a medical complication that requires certain interventions or positions, then it may be safest for you to give birth on your back – but those are not common.

Of course if it feels good to be on your back, then great – go for it!  It’s very uncommon but possible. In my dreamy, ideal birth world, everyone would be in the position that feels best for them.  

I’m AE, prenatal educator and doula. You can find all kinds of information about classes, pregnancy, birth and postpartum on my sites listed below.  I wish you an empowering birth. Thanks for watching.

How to Celebrate your Amazing Placenta

There are many ways to celebrate your amazing placenta! 

  • Simply tell it, “thank-you for nourishing my baby” after your birth
  • Ask your doula or medical staff for a “placenta tour” – take pics or video if you like
  • Plant a tree over it
  • Placenta prints
  • Bury it in the earth and do a little ceremony to honour it
  • Cord keep-sake
  • Placenta capsules
  • Tinctures 
  • Smoothie cubes

It’s easy to take it home from the hospital. Just bring a labelled container, ask your nurse to put the placenta in said container, and then keep it cold. If it won’t be used within 3 days then put it in the freezer. The hospital may ask you to sign a “Release of Live Tissue” form.   

Contact me for more information about our placenta services.