Natural Birth: No need for vaginal examinations 

By Natalie Burgess As a woman I hate them. As a midwife I have used them in my role of caring for the laboring woman, assessing her progress in labor and following obstetric orders and unit protocol. 

Now I believe that vaginal examinations have no place in natural labor and birthing. 

In today’s routine obstetric care a woman in labor is often subjected to at least one vaginal examination, and often this is applied every four hours on obstetric orders or practice requirements of the birth unit.  The use of vaginal examinations as a method of assessing progress of labor is a routine practice, yet there is very little (I could not find any) research based evidence that suggests any benefit to woman or baby in natural labor and birth (Enkin, 1992). 

It was noted in 1914 by Dr Austin Miller that the use of “internal examinations” in labor and birth was an unnecessary and dangerous practice.  Dr Miller noted that the ‘internal examination’ exposed the woman and her baby to potential pathogens that could cause puerperal infection and the death of both mother and baby. 

“…the internal examination adds but little to the very complete diagnostic information obtained by the external examination of the abdomen.” 

Many women find vaginal examinations a painful and invasive procedure (Menage, 1996), and a pilot study conducted by Mary Stewart (2007) also identified that many midwives express emotional discomfort related to performing vaginal examinations.  

So why are vaginal examinations a routine obstetric practice to which many women are subjected to?  It has been suggested that the use of vaginal examinations in labor is a means of demonstrating (a health professionals) control over the laboring woman and birthing process (Stewart, 2005).  Advocates of the use of this invasive practice in natural labor and birth indicate that the vaginal examination can provide essential information necessary for the care of the laboring woman.  However, abdominal palpation can provide a skilled practitioner with a great deal of information; the presenting part (head or bottom), the depth of engagement of the head (or bottom), the position of the baby (posterior, lateral, anterior) and the strength and duration of uterine surges.  It can easily be ascertained if the membranes are intact simply by asking the woman if her waters are still intact, or even perhaps observing that her waters have broken by the little puddles of amniotic fluid on the floor following in her footsteps. 

Vaginal examinations can provide an estimation of cervical dilation, however this measure varies when performed by different examiners (Clement, 1994), and every woman dilates in response to her natural birthing rhythm.  The sounds and behaviours of the (undisturbed and uninhibited) laboring woman can also provide estimation to the opening of her cervix.  A woman in early labor will perhaps still be a little excited and somewhat talkative.  A woman in active labor will be focused, breathing, vocalizing, chanting, moving, swaying or yelling.  A woman in transition will perhaps have a change in mood, from quiet and focused to alert and confident, or from calm and confident  to emotional and overwhelmed.  A woman in second stage of labor will often indicate when the baby is about to birth, and even if she does not make an announcement she may well be making the characteristic sounds of a birthing woman; moaning and gently guiding her baby into the world. 

Vaginal examinations place a laboring woman on a time schedule for cervical opening and birthing.   Labor and birth is a natural process, and the birthing body does not follow the guidelines of obstetric progress of labor, nor should women have these limitations of birth imposed upon them and their babies. 

Clement S (1994). `Unwanted vaginal examinations’. British Journal of Midwifery 2, 8, 368-370.  

Enkin M (1992). Commentary: `Do I do that? Do I really do that? Like that?’ Birth 19, 19-20.  

Menage J (1996). `Post-traumatic stress disorder following obstetric/gynaecological procedures’. British Joumal of Midwifery 4, 10, 532-533.  Miller, A.  (1914)  The dangers of vaginal examinations during labor. 

California
State Journal of Medicine Vol Xll No 8. 

Stewart, M.  (2005)  “I’m just going to wash you down”: Sanitizing the vaginal examination.  Journal of Advanced Nursing 51 (6) 587-594. 

Stewart, M.  (2007).  Pilot Study,
University of West England. 

Warren, C.  (1999).  Invaders of privacy.  Midwifery Matters.  Issue No 81.

Copyright © Natalie Burgess 2008

Relaxation for labor and birth

By Natalie Burgess 

This is taken from my upcoming new book Beautiful Birth. Relaxation is a skill that requires practice.  Some women spend the time of pregnancy choosing nursery equipment and reading baby books, but not taking the time to prepare themselves psychologically for labor and birth of their beautiful baby.  Research studies have shown that relaxation reduces a laboring woman’s perception of pain as it works to decrease tension and anxiety, promoting a calm and relaxed woman, therefore reducing the release of adrenaline and promoting the release of endorphins.  A relaxed woman breathes more effectively, promoting optimum oxygen levels for the uterus and baby, and reducing muscle tension. Before we can learn to relax we must first become aware of how we breathe, and this is where I find the practice of yoga is beneficial as it creates awareness of the breath.  Remember we need to breathe to oxygenate the uterus as it works (in labor) and also breathe to oxygenate our baby.  If the breath becomes short, shallow and sharp, as it often does when we are feeling anxious or fearful, the baby is deprived of oxygen, resulting in dips in your baby’s heart rate.  If this occurs when you are in labor, it will more than likely result in a cascade of intervention to monitor your baby more closely and potentially limit your ability to move around to find positions of comfort, reducing your feelings of control and involvement.  The uterus also suffers from a decreased blood supply, and like all muscles, the uterus will suffer as a result of decreased oxygen.  The uterus will continue to rhythmically surge and retract, as it is designed to, but will do so in less than optimal conditions…resulting in discomfort as the muscle strives to do its job.  Additionally when we don’t breathe efficiently, our ability to make decisions and remain ‘feeling’ in control is somewhat lessened, and for the laboring mother-to-be takes away her confidence in her ability and positive interpretation of the birth experience. 

Breathing, we all do it, everyday without thinking.  It is a natural and necessary function, but how often do we actually think about the inhalation and exhalation of the breath.  First take a look at your posture.  Poor posture does not facilitate the expansion of the lungs.  Sit or stand, keeping the torso upright, activate the pelvic floor and draw the navel back to the spine, open the chest and relax the grip of the shoulders, allow the neck to lengthen.  Now you can take in a breath.  As you inhale enjoy the sensation of the cooling air working its way from the nostrils, down the back of the throat and into the lungs.  Feel the chest expand.  Pregnant woman can sometimes feel a little inhibited opening the chest, as the breasts are fuller and larger.  Don’t feel inhibited in pregnancy, there are not many times in your life when you can proudly stick out your well formed breasts and poke out your beautiful round belly, do not shy away from it, welcome it, embrace the feeling of being pregnant.  As you exhale, feel the chest release, the warmth of the breath as it moves out of the nostrils.  Do not attempt to hurry of force the flow of the breath, and take a moment to pause in between the inhalation and the exhalation.  Take care also to not hyperventilate, limiting this breath cycle to 2, and building up to 5 cycles with practice. 

It is important to take the time to practice this quiet awareness of the breath on a daily basis, so that it is a familiar process and one that you feel comfortable with.  Learning how to relax in just a few moments is certainly an essential tool that I have found invaluable in the day to day life of motherhood. 

Once you become comfortable with your breath awareness you can then move onto effective relaxation, and also find more enjoyment in the yoga sequences.  Use the yoga sequence for pregnancy to adopt breath awareness, and you will discover with regular (daily) practice that you can find a comfort in the yoga poses, interpreting the stretch not as discomfort, but rather as a wonderful release.  Once you learn how to embrace the release of the muscles, then you are well on your way to a relaxed working state (as you are when laboring). 

Of course you do not need to practice yoga to learn relaxation.  You can practice relaxation simply sitting down at the end of the day, and take the time to close your eyes, not to fall asleep, but to bring your thought to the present, the feeling of the breath, and awareness of body.  Let your minds eye wander around your body, starting from your head and working down to the toes, releasing muscle tension, identifying areas of the body that are fatigued, tight or feel wonderful.  Take the time to practice this simple technique for 5 minutes everyday, and when you feel comfortable with the simple quietness that this relaxation practice brings, challenge yourself.  Perhaps try the relaxation technique standing in the shower, focusing on the feeling of the water beating on your back or belly, or perhaps if you are constipated try as you sit on the toilet to release and relax the pelvic floor muscles to help empty your bowel. 

In the late stage of pregnancy, you may start to experience aches and irregular uterine tightenings (Braxton Hicks) as your uterus prepares itself for labor.  Take this opportunity to visualize the tightening of the uterus, the muscle embracing your baby, and relax the body and the breath.  Gentle energizing inhalation, gentle releasing exhalation.   

Another simple form of relaxation is to visualize the body in 5 sections (of your choosing), and, with the eyes closed, as you exhale visualize those 5 areas relaxing as you mentally count 5, 4, 3, 2, 1.  This is also a useful technique that you can practice with your partner or intended labor support person, as a means of encouraging you to focus and relax during labor. 

Copyright © Natalie Burgess 2007 - ABN 96 282 733 677 

Beautiful Birth 2007

The pregnant Women

A women’s back and pelvis is particularly vulnerable during pregnancy because of the stress caused by carrying the unborn baby. The most obvious factor is the dramatic adaptation the musculoskeletal system must make to accommodate the forward shift in the centre of gravity. This as well as hormonal changes make the ligaments throughout the spine and pelvis more supple, and therefore at a greater risk to sprains and strains.It has been documented that up to 96% of women have been shown to suffer back or pelvic pain during pregnancy, with the onset mainly in the third trimester although sooner in multiparous women.

Pain has been documented in the back and pelvis, sides, uterine area as well as legs groin and pubis, which is due to the significant muscular strain placed on the mother’s muscles and ligaments by the growing child.

Care after birth

It has been found that women with low back pain during pregnancy continue to be at high risk of pain for more than 10 years after the birth.

The process of childbirth places great strain on the mother’s spine and pelvis, as well as the supporting musculature. The action of the hormones also continues to have an effect on making ligaments suppler for up to 4 months after the birth.

Care for the child

Significant stress on the head and spine can occur even during the most straightforward birthing process, and even more so in forceps and vacuum extractions. This in babies can lead to symptoms such as, prolonged crying, sleep and feeding problems and colic. We get our children’s teeth and eyes checked regularly so why not get there spines checked too?

How the chiropractor can help

Chiropractic care can help correct any restricted joint movements and maintain spinal balance as well as ensuring the pelvis is correctly aligned both before and after the baby is born.

The chiropractor can accurately identify the source of pain in order to dictate the treatment. This can involve soft tissue muscle massage, pelvic blocking and gentle manipulation. All techniques are modified to ensure comfort and safety to the mother and child.

Many difficult labours result from the malpresentation of the baby. By treating the spine and pelvis the chiropractor prepares the mothers musculoskeletal system and the babies position in the womb for birth, thus decreasing birthing times and complications of labour.

Adjustments and pelvic exercises aid a faster return of the new mums shape and health and decreases the risk of back pain that may initially be absent but often presents as the child grows.

Chiropractic care should be considered for all women who want a healthy, comfortable pregnancy and easier labour and many women return after the physical stress of childbirth for checkups for themselves and their children.

Dr Rachel Hippolyte, DC,  RN, Bsc hons chiropractic

Central City Chiropractic

Upper

Perth 6000

08 9221 4567

One of the great joys in pregnancy is decorating the nursery for the arrival of your new baby.  Options for your newborns nursery are endless from wall murals to floor rugs and everything in between. The costs for your new nursery can also become endless.  

Parents have moved away from just painting there children’s bedroom in traditional pastel colours with “Winny the Poo” stickers and are seeking to immerse there children in a warm and stimulating environment.  The Melbourne Herald Sun Newspaper recently published an article highlighting that some parents are spending up to $30,000 on designer bedrooms with decorating becoming as complex as to included painted walls and designer furniture and accessories. 

Owner of Murals 4 Kids, Jeanita Pearson said “They are designed to last many years and capture children’s imaginations.  Children can safely playing with many items such as fish and butterflies.  We started our business in February and have been supplying our products to private homes, childcare and play centers around the world.  Both children and parents love our products.  We have been shipping our products around the world”.