Rebirth After Birth Trauma: My Story

Posted on August 2, 2009. Filed under: Birth, Breastfeeding, Cesarean, Face First/Mentum Presentation, Rebirth | Tags: , , , , , , , , , , , |

This post could be upsetting to someone who is currently pregnant. If you decide to read this and you are pregnant, please remember that many of the birth injuries mentioned are rare. You can also help prevent some of these injuries by preparing your body and your mind for an unmedicated birth as the use of forceps and vacuum extractions are reduced when unmedicated. Also, pushing in an upright or squatting position can help prevent the need for these interventions.

Birth trauma comes in many forms and can occur during vaginal deliveries and cesarean deliveries.  Trauma can be caused by:

fetal positioning
an irregular shaped pelvis
pushing in a supine (on the back) position
a very long or very fast labor
very large fetal head
fetal anomolies
sometimes there are unknown reasons

Trauma can range from mild to severe and can include:

Bruising and Forceps Marks – Sometimes a baby will have bruising on the face or head simply from passing though the birth canal, and from associated contact with the mother’s pelvic bones and tissues. If forceps are used during delivery, they may leave temporary marks or bruises on the baby’s head. Vacuum extraction can also cause bruising to the head, and may cause a scalp laceration. In extreme cases, forceps use can cause depressed skull fractures, which may require surgical elevation.

Subconjunctival Hemorrhage – This common birth injury results in bright red band around the iris of one or both of the baby’s eyes. This does not cause damage to the eyes, and usually disappears completely within a week to ten days.

Caput Succedaneum – This is a severe swelling of the baby’s scalp, and is more likely to occur as a result of vacuum extraction. The swelling will ordinarily disappear within a few days.

Facial Paralysis – Pressure on the baby’s face during labor or birth, or the use of forceps during childbirth, may cause injury to a baby’s facial nerves. If a nerve is merely bruised, the paralysis will ordinarily clear up within a few weeks. With more severe nerve damage, it may be necessary to surgically repair the damaged facial nerves.

More severe injuries include Brachial Palsy Injuries, broken bones and brain damage. These are all very rare. Fetal birth injury accounts for less than 2% of fetal death.

When a newborn has birth trauma it often times causes breastfeeding and bonding problems. I learned this first hand in the birth of my own son. He was in a mentum (face first) presentation and I labored for 52 hours before having a c section.  I discuss both mentum presentations and my birth story in separate posts if you would like to read them.

Because of my sons positioning, his face took the force of 52 hours of contractions. His birth by cesarean was violent.  His face was so wedged into my pelvis that he could not move forward and the doctors could  not pull him back out. The OB tried to pull his head out my pelvis with six failed vacuum extraction attempts. It eventually took three different people pulling on his little body at once to get him out. He was swollen to the point that he could not open his eyes, had bruising and abrasions all over his face,  a hematoma, and what we initially thought was a broken nose.  Luckily and thankfully his nose wasn’t broken and he had no long term damage. Today he still had a little bit of a ‘birth mark’ where some of the bruising was (he is 16 months old) and I personally think it was from his birth trauma.

Once he was born he had deep suctioning because we had thick black meconium and of course he was poked and prodded and force fed formula until he puked. He had also had the cord around his neck twice and because of the way his neck was hyperextended with his face first positioning it was very tight. He remembered it and my husband said that when he was in the nursery while I was being put back together, he kept reaching for his neck.

This was a very rough start for my little guy and for the  first two days he was very very sleepy. We had to undress him to make him wake up to eat. He had so many drugs in his system. After that two days, the crying began and he cried so much. I think he was shell shocked. I was shell shocked myself so I totally understood how he felt but I just didn’t really know how to make him feel better. He had complete breast refusal and even though we had no separation, we were not bonding. My body was also in a state of shock and hardly producing any colostrum to make him interested. I didn’t get milk until six days postpartum. By day three after he was born and of not being able to express any colostrum or having any luck getting the baby to quit screaming at the breast long enough to try to latch, we began finger feeding him formula. I refused to give him a bottle because I knew my milk would eventually come in and I didn’t want for him to have nipple confusion. In the mean time, I pumped as frequently as I could with the hospital grade pump.

My milk came in six days postpartum, the day we left the hospital. Because of how difficult our birth was, we stayed twice as long as most other c section birth stay at the Army hospital in Seoul. I guess I just needed to be home and able to relax a little bit but once it came it in I had a big full supply. For the three days that we had been finger feeding the baby I had continued to try to latch him at the breast and he continued to scream. Once we were home and I had my own milk to give him I decided to take a day off from latching him because quite frankly, I was a wreck about it. I felt that at least I could give him my own milk and not formula and for then that would be ok. The next day, my husband borrowed two breastfeeding videos from the nurse that taught the breastfeeding class at the hospital. At that time there was no lactation consultant, so I was own my own in fixing this breast refusal problem.

About halfway through the video, which by the way was Australian and I have no idea what it was called now, a woman with inverted nipples started telling her breastfeeding story. She talked about how difficult it had been and how her baby had been OP (face up) and that she pushed for over two hours and he came out screaming and wouldn’t latch. He developed breast rejection because of her inverted nipples but she didn’t give up. She said that she and her husband decided to perform a ‘rebirth’ and recreate the birth experience that they wanted for their baby. I was fascinated and willing to try anything so when I told my husband that we were doing it that night.

The idea of rebirth is to recreate the birthing experience for the baby so that he can be born in a gentle and peaceful way. We had a garden tub and filled it with warm water and lit candles and warmed the bathroom up. I got in and my husband passed the baby to me. He was seven days old at this time.  As soon as he was naked he was screaming but I put him in the warm water and held him close and he calmed down a little, just to a cry rather than a scream. After a few minutes I put him in the water, floating him around with only his face out of the water. He fought it a little at first but after a few minutes he completely gave in. His entire body went limp. We were completely amazed at this point. We had successfully recreated the womb and he remembered it! This was the most relaxed this baby had been since he was born.

In following the idea of infant rebirth, I slowing began to lift him out of the water. The idea is that the change in temperature and the removal of water from his environment will trigger the hormonal response that is similar to that of what a baby experiences in a peaceful vaginal delivery. I took him completely out and put him to my chest, just as I would have wanted had our birth gone the way we wanted. He didn’t cry or fight it, he just went limp against me. I let him lay quietly for a bit then decided it was time to try latching on again. I used the nipple shield because I wanted it to be as easy as possible for him. I had tried it before but he screamed at the breast regardless. Not this time, he latched right on. He latched and nursed for almost an hour. I was in awe and shock and disbelief.

We continued using the nipple shield until he was six months old. I tried to get him to nurse without it for months but he refused. I didn’t care, he was breastfeeding and I had a great supply. I knew we would eventually get rid of it and we did when he was six months old. As of 16 months old he is still nursing. Our bonding really began that day. I know that you can bond with your baby if you do not breastfeed but we had so much anxiety between the two of us that we needed that moment to begin healing from our traumatic birth.

I would recommend rebirth to anyone who has birth trauma. As soon as you get home from the hospital, get in the water. Get skin to skin. Recreate what you wanted for you and for your baby. Even if the baby didn’t have a birth trauma or injury of any kind, but you did, do it. If your milk is taking a while to come in, do it. It will help your body to relax and produce the hormones necessary for milk production. I truly believe in this process and it’s healing powers and hope that more moms can learn about the benefits of rebirth after birth trauma.

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Optimal Fetal Positioning for a Better Birth

Posted on June 10, 2009. Filed under: Birth, breech, Face First/Mentum Presentation, inverted t incision, Pregnancy | Tags: , , , , , , , , |

Optimal Fetal Positioning‘ (OFP) is a theory developed by a midwife, Jean Sutton, and Pauline Scott, an antenatal teacher, who found that the mother’s position and movement could influence the way her baby lay in the womb in the final weeks of pregnancy. Many difficult labors result from ‘malpresentation’, where the baby’s position makes it hard for the head to move through the pelvis, so changing the way the baby lies could make birth easier for mother and child.

This is near and dear to my heart and something that I tend to go into depth with my clients on. It is SO SO SO very important and it is rarely discussed in prenatal visits with OBs. It’s not really something discussed at prenatal visits with OBs amd I’m assuming that it’s because positioning doesn’t really matter when the baby can be cut out if it’s a problem.  Midwives and my homebirth OB in Korea as well as other natural minded OBs tend to spend more time on this. Anyway, it’s near and dear to my heart because I had a difficult position with my first baby, face first. Face first and face up or occiput posterior, OP, are two different presentations. Face first is rare, one in 500 at most. It is a position that is refrequently sectioned because the labor is very slow but it is vaginally deliverable in some situations. It is very uncommon and there are reported cases of broken necks and facial paralysis but I think that is generally due to pitocin augmentation causing much stronger contractions that the face first baby can handle. I planned a natural birth and after three days of contractions, meconium and fetal distress was sectioned (for failure to progress) only to find a face first presentation that ultimately resulted in an inverted T incision (which I will discuss in depth in another post).

The first picture is a face first presentation. The second is the optimal occiput anterior presentation.

150px-Smellie_XXV

190px-Smellie_XIV

I am also including the chart below that shows the presentation view from the outlet. My son was Face First, LMT, left mentum transverse. This is considered to be a physically impossible presentation for vaginal delivery and the occurrence is extremely rare.

fetal position

I spent a TON of time talking and reading and researching what happened, what caused this and how it could have been prevented and there are many things that I did wrong. I have healed from all of this and am completely capable of talking about it as I think that everyone should know how they can affect their labor, by the way. My situation was a series of events. First, poor diet in early pregnancy led to early swelling. Pitting edema at fifteen weeks usually raises red flags and of course I was told to sit with my feet elevated above my hips as much as possible, which of course I did (I mean who doesn’t want to be lazy when pregnant???). I continued with my poor diet and now lack of exercise throughout the pregnancy and managed to gain 60lbs. Sitting in a reclined position is the worst thing you can do in pregnancy because it causes the pelvis floor to tighten and the uterus to tilt so the baby has to find a comfortable position somehow and mine settled ROT (right occiput transverse, right side of my stomach, back of the head towards my back and sideways, you would see the babes profile). This apparently is the best position for a baby to flip OP (occiput posterior, face up) during labor. Instead of doing that, mine just stuck his face in my pelvis. This causes a hyperextended neck and really, faces don’t dilate cervixes.

There are a number of things that I could have done differently but I’ll get to that in a bit. First I want to discuss what the optimal position is. Then I’ll tell you how to get there.

The ‘occiput anterior‘ position is ideal for birth – it means that the baby is lined up so as to fit through your pelvis as easily as possible. The baby is head down, facing your back, with his back on one side of the front of your tummy. In this position, the baby’s head is easily ‘flexed’, ie his chin tucked onto his chest, so that the smallest part of his head will be applied to the cervix first. The diameter of his head which has to fit through the pelvis is approximately 9.5 cm, and the circumference approximately 27.5cm. The position is usually ‘Left Occiput Anterior’ or LOA – occasionally the baby may be Right Occiput Anterior or ROA.

Gail Tully, creater of http://www.spinningbabies.com
is a midwife who is very knowledgable in OFP and who helped me understand my situation better, created this to help explain positioning:
_katie-belly-rose-wroa

SO, how to achieve optimal fetal positioning? Very simply actually. First, posture. Gail Tully and Jean Sutton say no furniture! Sit indian style in the floor, this helps open your pelvis and release your pelvic floor. Use a birth ball for better posture. “Rest Smart” Nap or sleep in positions that let your baby’s back settle in your “hammock.”

To help facilitate good positioning, pelvic tilts should be done daily and several times a day. Walking and prenatal yoga also help with positioning by moving your hips and pelvis, stretching things out and encouraging the baby to engage in an occiput anterior position. Remember though, HEAD DOWN IS NOT ENOUGH! Babies can be head down but OP (face up) or asynclitic which can cause really long hard back labors. Read here to learn more.

So you may need to figure out what position your baby is in to begin with. Belly Mapping can help with that. By feeling where the baby is, where you feel movement, where the heart beat is, the shape of moms tummy, we can figure out how the baby is positioned. It isn’t hard to do at all. Once you learn the postition, you can then focus on improving it or changing it completely. Sometimes we know before labor even starts that the baby is OP and can get the baby to rotate. There are also ways to get a breech baby to turn.

Every pregnant woman should know this information. It is so vital in ensuring that you have the best labor and delivery possible. Sometimes breech babies won’t turn and sometimes OP babies stay OP but by learning OFP techniques you are at least giving yourself a chance to make a difference.

If you are pregnant here’s a list to help with positioning:
Pelvic tilts 20 each 3x per day
Sit indian style
Do not recline
Use a birth ball
Take at least a 20 minute walk every day
Learn what position your baby is in now
Learn what to do to improve the position
Learn what to do to keep the baby in that position
Get help if you are unsure
Get help if the baby won’t move

Good luck!

EDIT: Here is some information sent to me by Ann Tumblin concerning OP babies and epidural use.

Epidural Analgesia Linked to Increased Risk of Occiput- Posterior Babies
Lieberman, E., Davidson, K., Lee-Parritz, A., & Shearer, E. (2005). Changes in fetal position during labor and their association with epidural analgesia. Obstetrics & Gynecology, 105 (5, Part 1), 974-982. [Abstract]
Summary: This prospective cohort study used periodic ultrasound examinations during labor to evaluate changes in fetal position and their relationship with epidural analgesia. The researchers sought to determine whether epidural analgesia is responsible for higher rates of fetal malposition (occiput-posterior (OP) or occiput transverse (OT)) or whether women experiencing labor with a malpositioned baby have more painful labors and are therefore more likely to request epidural pain relief. A total of 1562 nulliparous, low-risk pregnant women were enrolled in the study.

The researchers found that the position of the baby (occiput anterior (OA), OP or OT) at the time of enrollment (in the early part of active labor) predicted position at birth poorly. For instance, of the women with an OP baby at birth, only 31% had a baby in the OP position at the initial ultrasound scan. Similarly, sonograms done later in labor were also poor predictors of position at birth. The data demonstrated that changes in fetal position were common during labor, with 36% of participants having an OP baby at the time of at least one scan. More than one-half of the women who gave birth to a baby in the OP position never had an OP baby at any ultrasound assessment in labor. Overall, 79.8% of babies were born in the OA position, 8.1% were OT, and 12.2% were OP at birth.

Epidural analgesia was strongly associated with delivery from the OP position: 12.9% of women with epidurals gave birth to babies in the OP position versus 3.3% of women without epidurals (relative risk 4.0, 95% CI 1.5-10.5). Transverse position was not related to epidural use. In a statistical model that controlled for various medical and obstetric factors that could affect outcomes, epidural use was still associated with a 4-fold increase in the risk of OP birth.

The data suggest that the association between epidurals and OP babies is not because women in labor with an OP baby are more likely to request an epidural. Women who received epidurals were no more likely to have OP babies at prior to or at the time that the epidural was administered. Furthermore, women with OP babies in labor or at birth reported the same degree of pain as those with OA or OT babies and were no more likely to report “back labor,” which is commonly thought to be related to the OP position. Finally, women with OP or OT babies at birth were much more likely that those with babies in the OA position to give birth by cesarean section, with 6.3% of OA babies born by c-section versus 64.7% of OP and 73.8% of OT babies (p<.001).
Significance for Normal Birth: Epidural use increases the risk of instrumental (forceps or vacuum) delivery in first-time mothers. Experts have proposed various reasons for this association, including diminished urge to push and changes in the tone of the pelvic floor muscles that inhibit proper rotation of the fetal head. Letting the epidural “wear off” has been thought to increase the likelihood of unassisted vaginal birth, however, this systematic review calls into question that common practice.
In normal birth, there are complex hormonal shifts that help labor progress and facilitate delivery. The laboring woman produces natural endorphins that help her manage the pain of labor. Her ability to move freely and assume a variety of positions while pushing work in concert with these hormonal changes. Epidural analgesia numbs the sensations of birth, and the production of natural endorphins ceases as a result of the disruption of the hormonal feedback system. When the epidural is discontinued, the woman’s pain returns but her natural endorphins may remain diminished and therefore her pain may be greater than if the epidural had not been given in the first place. Furthermore, when an epidural is administered, the woman is usually confined to bed and attached to fetal monitors and an intravenous line. The woman and provider may become accustomed to laboring in the bed attached to machines. When the epidural is discontinued the restrictions! on her movement may persist. Under these conditions, it is likely that the impact of an epidural on normal birth may outlast the epidural itself.

EDIT: Ann Tumblin also sent me this regarding OP (face up) babies. It was done by Penny Simkin who is basically the mother of all doulas. It is very informative so if you have ever had an OP baby and are nervous about it a second time, I highly recommend you taking a look at it.

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