Below is a compilation of common terms and acronyms that women often will come across during pregnancy, labor, and delivery.  Check back as more will be added from time to time.

• AROM – Artificial Rupture of Membranes – using a finger or tool to open the amniotic sac to to allow the fluid to release.
• PROM – Premature Rupture of Membranes – when the amniotic fluids releases before labor starts.
• SROM – Spontaneous Rupture of Membranes during labor.
• ROM – Rupture of Membranes
• Miso – Misoprostol is the pharmacological name for Cytotec a drug used for cervical ripening and induction though a controversial, off and against label used ulcer Medication
• VBAC – Vaginal Birth After Cesarean
• HBAC – Home Birth After Cesarean
• WBAC – Water Birth After Cesarean
• UBAC – Unattended Birth After Cesarean
• CBAC – Cesarean Birth After Cesarean – This is a repeat cesarean after a woman desires and tries to have a vaginal birth after cesarean.
• ERCS – Elective Repeat Cesarean
• RCS – Repeat Cesarean
• Natural Birth – Labor and vaginal delivery free from intervention except for intermittent fetal monitoring. In the hospital only a saline lock and intermittent monitoring.
• Vaginal Birth – Baby born vaginally with or without medication and intervention.
• First Stage – Early, Active, and Transition. This encompasses the effacement to 100%, dilation to 10 centimeters/complete, position movement of cervix from posterior to forward as contractions begin while staying longer, strong and closer together prior to pushing and delivery.
• Second Stage – Pushing phase after cervix is completely dilated to delivery of baby.
• Third Stage – Delivery of baby to delivery of placenta.
• Fourth Stage – First hours after placenta is delivered.
• Oxytocin – A hormone made in the brain that plays a role in childbirth and lactation by causing muscles to contract in the uterus (womb) and the mammary glands in the breast. It also plays a role in bonding with mate, child, and socially.
• Pitocin (oxytocin injection, USP) is a sterile, clear, colorless aqueous solution of synthetic oxytocin, for intravenous infusion or intramuscular injection.
• Prostaglandin – Any of a group of hormone like fatty acids found throughout the body, esp. in semen, that affect blood pressure, metabolism, body temperature, and other important body processes such as cervical ripening.
• Uterus -The muscular organ in which a fertilized egg implants and matures through pregnancy. During menstruation, the uterus sheds the inner lining.
• Cervix -The lower portion of the uterus that provides an opening between the uterus and the vagina. Also known as the neck of the uterus that softens, effaces, dilates and changes position during labor.
• Vagina – A muscular canal between the uterus and the outside of the body. Also known as the birth canal.
• Perineum – The area between the anus and the vulva (the labial opening to the vagina).
• Pelvis -The basin like cavity formed by the ring of bones of the pelvic girdle in the posterior part of the trunk in many vertebrates: in humans, it is formed by the ilium, ischium, pubis, coccyx, and sacrum, supporting the spinal column and resting upon the legs.
• Pelvic Floor Muscles -The sphincter mechanism of the lower urinary tract, the upper and lower vaginal supports, and the internal and external anal sphincters. It is a network of muscles, ligaments, and other tissues that hold up the pelvic organs.  Includes bladder, rectum, vagina and uterus.
• Fundus –  Top of the uterus. During labor contractions the fundus thickens and gets more firm as the strength of contractions increase and dilation increases.
• Placenta -The organ that develops during pregnancy that transports nutrients to the fetus and waste away from the fetus. The placenta is attached to the uterus and is connected to the fetus by the umbilical cord.
• Umbilical cord – The cord that transports blood, oxygen and nutrients to the baby from the placenta.
• Bloody Show – Mucous and blood mixed together as dilation and effacement occurs.  Starts off as blood tinged mucous and becomes heavier as labor progresses.
• Stripping membranes –  Pressing the amniotic sac away from the inside of the cervix.
• Mucous plug – The mucous that blocks off the non-dilated and non-ripened cervix for protection.
• Lochia – Post birth bleeding that though a wound site from the placenta detaching from the uterine wall, it mimics a heavy and long menstrual period.
• Cesarean – Baby born via a surgical incision made through the abdomen into the uterus.
• Obstetrician – Is the surgical specialty dealing with the care of women and their children during pregnancy, childbirth and the immediate post birth time.
• Midwife – Is a person usually a woman who is trained to assist women during pregnancy,  during childbirth, and postpartum as well as the newborn post birth.  There are many types of midwives – some work in the home, at birth centers or in the hospital.
• Doula – Is an assistant who provides various forms of non-medical and non-midwifery support (physical and emotional) in the childbirth process. Based on a particular doula’s training and background, the doula may offer support during prenatal care, during childbirth and/or during the postpartum period. A birth doula provides support during labor. A labor doula may attend a home birth or might attend the laboring at home and continue while in transport and then complete supporting the birth at a hospital or a birth center. A postpartum doula typically begins providing care in the home after the birth. Such care might include cooking for the mother, breastfeeding support, newborn care assistance, errands, light housekeeping, etc. Such care is provided from the day after the birth, providing services through the first six weeks postpartum. In some cases, doula care can last several months or even to a year postpartum – especially in cases when mothers are suffering from postpartum depression, children with special needs require longer care, or there are multiple infants.
• Birth Center – Free standing location usually run by one or more certified nurse midwife. True birth centers are almost always independently run. They are not overseen by a hospital or in a hospital. May be near a hospital. Often set-up like a home birth space and epidurals or other pain medications are not available.   Hospital “birth centers” are labor and delivery floors not birth centers in the true sense of the term.
• Intervention – Anything that does not exist in a naturally occuring labor and delivery that is done.
• Saline Lock/Buffalo Cap/ Hep Lock – Is the apparatus that the IV line hooks into.  It is silicone tubing that is lightweight with a plastic needle that stays under the skin to allow easy vein access.
• Foley – A foley catheter is used to release the bladder if a woman unable to urinate due to an epidural, post surgery, or with a swollen urethra post birth.  It can also be used for successful cervical ripening in lieu of cytotec.
• Induction – To attempt to artificially start labor usually by pitocin, artificial rupture of membranes with or without cervical ripening (Cytotec or Foley Catheter).
• Epidural – A medical method of giving pain relief during labor. A catheter is inserted through the lower back into a space near the spinal cord. Anesthesia is given through this catheter, and results in decreased sensation from the abdomen to the feet.
• Contraction – Tightening and loosening of your uterus. Productive contractions are often felt at the bottom of the uterus, start out like period cramps and progressively grow stronger, longer in length, and closer together.
• Braxton-Hicks – Practice contractions that do not dilate or efface the cervix often felt at the top of the uterus versus the bottom.
• Episiotomy – A surgical procedure to widen the outlet of the birth canal to facilitate delivery of the baby and avoid a jagged rip of the perineum. (Natural abrading or tearing is preferred and episiotomies are not evidence-based to be used except under specific circumstances).
• Ina May’s Sphincter Law -Tapping into the concept that if one sphincter is open and relaxed, the others will also open, relax and be able to handle, quite adequately, the task at hand. This also includes the aspect of birth requiring privacy, sacredness, and honor as well so a woman feels safe, unwatched and supported.
• Kegel Exercises – Named after Dr. Arnold Kegel, consists of contracting and relaxing the muscles that form part of the pelvic floor (sometimes called the “Kegel muscles”).

In recent months I have noticed that during the end part of pushing and through delivery, care providers and/or nurses are doing very, very aggressive vaginal and perineal stretching.  This is not the gentle perineal massage I have seen in the past.  Even though I do not believe even that is necessary, it certainly was a far cry better than this.

To demonstrate, take your index and middle fingers from both hands and place them in your mouth on both sides with fingers facing in an outward pulling position inside your cheeks.  Now pull outward, stretching your cheeks and lips while “massaging” the inside.  Start gently, then get more aggressive. This is happening while soon a large malleable and smooth object will be pressing along those worked tissues.

How long do you think it would take for you to become swollen and bruised from this activity?  Can you imagine that there might be small tears and abrasions would be present from this if you continued for up to 30 minutes?

Now imagine after all that activity you have a large object in your mouth inhabiting the entire area including the widely opened and stretched lips. Next instead of you gently pushing the object out under your own control and power, you are told to NOT push it out but to allow for it to be removed for you. So imagine you already hyper extended lips being pressed further open with quite some force until it move through your open mouth.

How do you think the over worked, sore, possibly swollen,  and forcibly stretched tissues will react? Do you imagine tearing and damage?

Incredibly challenging and graphic descriptors to be sure.

Now imagine the alternative, there is no stretchy and pulling.  The large malleable and smooth object enters the space slowly so your mouth has time to adjust and accommodate it.  As the object approached your open lips, you slowly offer pushes to allow your lips to slowly stretch more than the norm.  Though it may sting and pull it is bearable.

Imagine now what your tissues would be like after that?  Sore? Some abrasion or some natural tearing?  Swollen a bit?  Even some bruising? Sure in reality you could be.  Accommodating a human baby through your vagina is a different experience than the usual.

How did the two processes sound to you?  To me I would much prefer the second one. Hands down.  How about your husband or partner?  Do you think this would be remotely decent to witness and then think ahead to actually having sexual activity with you again?

Though in my area, I rarely see an episiotomy done, I do see this very aggressive handling of the vagina and perineum routinely now.  To add to this, I am seeing more tearing severe tearing as well. When I ask the women about how their bottom is healing and feeling, I hear about more soreness, swelling, and bruising in the women who experience this.

So what do you do about it? Saying no to episiotomy during appointments and in making your birth plan is not enough.  Talk to your care provider ahead of time about the type of care you expect in late pushing and delivery. Talk to the nurse who is with you when you begin pushing. Tell your husband or partner to be on the look out for this aggressive technique so you can say NO. I also find that having warm compresses covering your perineum and vaginal opening can help abate it to a degree.

Here’s to a much healthier vagina, labia, and perineum post birth!

A couple of weeks ago I went on a quest to find out just what pushing was like for other women.  As an educator and doula it is probably one of the more challenging concepts to address.  Why?  Well some of the imagery can be quite vulgar.  “Push like you are pooping.” Do women REALLY want the image of pooping out their babies?! “The urge will overwhelm you and you cannot help it.” That also is not quite right some women never get the urge until the baby is very low and engages the nerves and some women will have the urge when baby is high and dilation isn’t complete (I did not say premature because I believe when the urge comes pushing “gruntily” with the peaks is alright as perhaps that will facilitate complete dilation and rotation of babe).  Some women feel great rectal pressure, some feel it in their abdominal muscles, and some don’t feel much at all going into it. Hey I do not believe we need to be fixed in this area.  I think whatever a woman’s body does is right for her body.

Below are many quotes that I frankly trolled for to edify women everywhere on the spectrum of what pushing is like. I could bore you to tears with the physiologic nature of the process but that isn’t what you really want to know now is it?! If you have questions on the new perineal massage, please refer to my previous entry https://prepforbirth.com/2009/08/25/new-episiotomy.html.

Quotes from real women

“My babies #1-4 practically fell out. #5 I was in what looked like early labor for 4 days. Midwife assistant came over, checked me, I was at 7 cm but ‘not in active labor’. I got into it quickly! Long story short I pushed, painfully, for 3.5 hours, baby had 11″ cord with a true knot. She needed to be pinked up but is almost 3 and is doing well.”

“When I was coached to push (w/ no 3..first natural birth) I was in agony. When I was left alone and did not push (w/ no 4), life was good.”

“I feel like if I can just get to the pushing phase, it will be a breeze from there.” (and it was. The whole “surrender/dilate” phase is much more challenging to me than the whole “take control/pushing” phase.)”

“Pushing was fantastic with my 2nd baby and awful with my 3rd! It was really surprising because after my 2nd birth I thought “Okay so pushing is the really fun and satisfying part! That’s when it gets EASY.” Then my third birth totally shocked me. Pushing was the most painful and difficult part of the birth. I had stayed so calm and collected… until then. Every pregnancy and birth is so different!”

“I love the way it feels to have a baby move through me and into my waiting hands.”

“I *loved* pushing. I didn’t do it for very long (two contractions), but it was so great to finally get there. I was told to purple push (not in those terms – the nurse told me to hold my breath), and intellectually I knew I shouldn’t, but I tried it and it really did feel like I was more productive that way. I felt like a warrior. It was awesome.”

“Before anyone hates me for only pushing through two contractions, you should know that I’d been in labor for three days – so it all comes out in the wash ;-)”

“Pushing with my 2nd was horrible. 3+ hours of the worst pain I had experienced at that point in my life. Turns out her little fist was up by her cheek (um ouch) and her head did not mold much. My 3rd I did not push because she was precipitous and we were trying to get to the hospital. I felt like all the energy in the world was gathering and swirling at my fundus and then suddenly flowed through me carrying her with it. It was the best physical experience of my life.”

“I have heard some say that pushing feels good.. um, I personally have not experienced that and I have had clients remark the same … :p”

“Hmm…Definitely the best part of labor and delivery. For me though – never had any “urge” to push but still had baby out in 20 mins…I think I was feeling determined being a VBAC mom…still, would have been easier if I felt the need to and not just contractions. “

“Heard lots of clients say it feels good after hours of labor”

“Ahhh, I’m not so fond of the pushing. Did it for 2 1/2 hours with my daughter (LOA) and though it was only about 20 minutes with my boys, they were both OP. That was, shall we say, unpleasant. I cannot relate to those who’ve told me it was such a relief!”

“My labor was surprisingly short, only 6 hours and she’s my first baby so far. I woke up in active labor and at 4 cm and I wanted to push THE WHOLE TIME! It was horrible having the nurse say I couldn’t push yet when I wanted to so badly, but once I did get to push, oh my goodness, it felt incredible. So much control and power, it felt so good to finally work to end. 3 big pushes and there she was. :)”

“Sheer, immeasurable power. Unbelievable!”

“Babies actually come out of your butt. Don’t let anyone tell you otherwise.” One of my clients recently said that. :)”

“Birth is shockingly rectal” – Gretchen Humphries. She was totally right.”

“Pushing with my first felt like I was satisfying an urge, an uncontrollable urge. It felt almost desperate I couldn’t stop it. (kinda like having that rectal urge when you REALLY have to poop). Pushing with my second was no big deal, I followed my urges again and pushed 3x and out she came in her 10# glory. It was extremely satisfying and powerful I felt like I had just finished exercising. Amazing!”

“The ring of fire OH MY it is indeed! Though as soon as the burn started the whole are went numb almost like too hot or too cold numb and the power of the urge to push my son out was almost beyond description.  Pushing was never easy for me as I have an unusual pelvic shape.  But my last son WOW no molding and quite a large head to birth him was incredible really.  No tearing, just some abrasion.  Recovery was a snap.”

“I had at the point of delivery what was the best orgasm of my life!”

“Pushing was totally primal.  I had an incredible urge and it took over.”

Questions and Answers

1. I have had a previous episiotomy, do I need another one automatically? No you don’t.  Depending on how your scar has set and the position you push in the scar can re-open or it adhesions in the scar will need to be broken up.  I would suggest perineal massage prenatally if there are any adhesions to break them up and soften the area prior and to choose a pushing position that doesn’t put all the tension on that exact area.
2. Is is wrong to push when I am not fully dilated? Not necessarily.  Now I think grunty smaller pushes with those contractions can be effective to complete dilation if you are in transition.  Prior to that change the position you are laboring in to change where baby is placing pressure.  Knee chest can be very effective to abate very early pushing desire.
3. What if I poop during pushing? Some women will pass some stool and some won’t. You may here that when pushing the right way you may pass some.  Hey open bottom is vital to pushing, so hey it is a normal but not always occurence.  A fantastic nurse, MW or doc will not actually wipe it away but simply cover as to not cause constriction of the sphincter muscles which can disturb pushing progess. If it is possible to discard the stool without disrupting you, it will be done very quietly and discreetly.
   
4. I am very modest, do I have to have all my “glory” showing? Absolutely not.  You can maintain good modesty all the way up to delivery.  Even then you do not need to be fully exposed.  Truthfully a home birth or birth center birth with a midwife if likely going to help you have your modesty concerns respected and honored. Really no one needs to put hands in you during pushing, or needs to stretch anything, or needs to see everything either.  A midwife is trained to see by taking a quick peek or simply to know when she needs to have hands ready to receive baby and to offer external positive pressure if mom wants.

Check back later more Q and A to come as more questions are sent to me.