An acquaintance shared her birth story with me. We’ll call her Shelley. Her child was born at a local hospital less than four years ago. Here’s a summary of the birth of Shelley’s first child:
Shelley’s water broke (also called “ruptured membranes”) a few days after her due date. As instructed during the last weeks of her pregnancy, she called the hospital, and was asked to come in for an evaluation. After a quick test, it was determined that her water had indeed broken, and she was admitted to the labor and delivery floor. Shelley was then asked to get in bed so that staff could check on her baby’s heart rate with an electronic monitor.
She stayed in bed for 13 hours.
Over the course of that long night, not much changed for Shelley or her baby, except that she got pretty darn sick of sitting in bed. When morning came, the birth of her baby did not appear to be any closer than it had been the night before. He doctor decided to administer Pitocin, a synthetic hormone used to cause or strengthen labor contractions. For the next 11 hours, Shelley sat in bed experiencing strong labor contractions with no pain relief. (Because her cervix had not dilated to at least 4 centimeters, she was not eligible for an epidural.)
After a full day of Pitocin-induced contractions, Shelley was exhausted, frustrated, and dilated to only 3 centimeters. By this time her water had been broken for over 24 hours, which many practitioners believe increases the chances of infection. Since Pitocin had not helped her labor to progress, her doctor diagnosed her with labor dystocia (also called “failure to progress”) and recommended a cesarean section. Shelley gave birth to her baby via cesarean a few hours later.
Shelley was left very disappointed with her birth experience. She had wanted a vaginal birth and couldn’t understand why her body had not cooperated. She was left to recover from major abdominal surgery while learning to care for a newborn.
Shelley’s story is a classic example of a concept childbirth educators call the “Domino Theory of Interventions.” Like dominoes falling, one medical intervention leads to another, and that one to another, and so on, often resulting in a disappointing birth experience overall.
Could Shelley’s cesarean birth and subsequent difficult recovery have been prevented? I believe so.
There is a specific reason Shelley’s labor did not progress: Her baby never “dropped,” which means his body never moved down far enough for the top of his head to press on her cervix. Especially in first pregnancies, without pressure from the baby’s head, a mother’s cervix can dilate the first few centimeters, but usually no further. Mother and baby truly work together to make labor happen.
Why didn’t Shelley’s baby drop? The likely reason is that she was stuck in bed. Her body was not allowed to opportunity to work with gravity and move her baby deeper into her pelvis. The most frustrating part of this story is that, according to Shelley, there was no medical reason for her to stay in bed for those 13 hours. She simply wasn’t offered other options. Once the Pitocin was administered, staying in bed was necessary, since Pitocin augmentation requires continuous monitoring of fetal heart tones. (This is because Pitocin contractions can be more stressful on the baby than naturally-occurring contractions are.) As we know already, Shelley’s baby hadn’t had a chance to drop, so the 11 hours of painful and exhausting Pitocin contractions were relatively futile. For Shelley, confinement to bed interfered with both her own body’s and her baby’s natural impulses, which resulted in Pitocin administration, which necessitated staying in bed and further stole the opportunity for Shelley to work with her contractions. In all likelihood, it was medical intervention that created the need for a cesarean.
So what to do if you find yourself in a situation like Shelley’s? If you give birth in a hospital, starting your labor in bed is highly probable, since most hospitals require 15 minutes of fetal monitoring upon admission. If this is your hospital’s policy, you still have options. You can sit upright in bed for 15 minutes, then get up and move around. Another option – one that works especially well if your situation requires continuous monitoring throughout labor, instead of just 15 minutes – is to labor near the machine but not in bed. You can stand or walk near the machine, or sit in a rocking chair or (my personal favorite) on a birth ball directly next to it. As long as the monitor stays in place on your abdomen, and you don’t move further than the wires can reach, there is no good medical reason for staying in bed.
Our weekly prenatal yoga classes incorporate many poses that can encourage your baby to “drop” and engage in your pelvis at the final weeks of pregnancy. The majority of the poses we practice are equally helpful during labor, and some can even be used for birth. Any expectant mother who wants to learn more about helping to create the birth she wants for her baby is invited to join an upcoming prenatal yoga class or childbirth class series.