Welcome to The MamasteFit Podcast! In this episode, we have Keesha and Renee, who are certified nurse midwives here in North Carolina whom Roxanne used to work with when they were labor and delivery nurses.
We’re going to be chatting all about labor stalls! What causes a labor stall, and different things we can do to help resolve those labor stalls.
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Meet Midwives Lakeesha and Renee
I’m Lakeesha, I have been a midwife now for two years. I’ve been a labor nurse since 2012, and then I’ve been a registered nurse since 2011. So I pretty much found labor and delivery as fast as I could and then I never left it. What really kind of drove me to become a midwife was when I was having my first child.
I didn’t know much of anything. I didn’t have a lot of guidance. And we were over at Fort Hood and they have a huge O.B. area and a lot of midwives there. And I actually ended up just being placed on a schedule with a midwife, and I didn’t really know the difference between them, I just know that they were people that take care of you.
And I just thought she was really nice and empathetic and it just also happened to be that she was like someone my complexion that looked just like me. And I was like, Wow, light bulb moment. I can definitely see myself doing what she’s doing. And that was pretty much my goal was to just become a her. And then along the way I did start, you know, learning the differences in how MDs and midwives do manage their patients.
So it just gravitated with me a little bit more to be… I know some people call it crunchy granola, but maybe a little bit less medical when I don’t always think that’s always the best option. We’re still learning enough about the medical side to know when it’s pertinent to use it. And so that’s a little bit about my background.
My name is Renee. I have been a certified nurse midwife since this year, so this is my reveal year, so I’m super excited. I love the field. I actually fought midwifery for a long time. I, I started out, so I’m going to age myself, I’m an eighties baby, So I graduated nursing school in 2006 and I did cardiac progressive, E.R., and I’ve done a lot of things. And essentially I fell in love with labor and delivery, but I was like, “Oh, I think I’m just going to stay right here. I just want to do this.” And then one day someone had asked me, they said, “If you’re going to do this and you want to make a huge change, don’t you think you could make a bigger change if you could see 15 patients a day rather than just the ones you come across when they’re laboring?”
And I said, “Yeah, if I want to change the face of midwifery care and the exposure so that birthers like me and like Lakeesha actually have someone that looks like them…” because there’s literal evidence that shows that providers that look like you have incidences where there’s less morbidity and mortality. So I said, “I guess I could consider it.”
And then I was like, “No…” Fought it again, kept fighting it, kept fighting it. And then a good friend of mine put in an application for me, at Frontier, using my debit card, whenever I got the acceptance letter, it was, “Oh, okay. Well, I guess I’m going to midwifery school!” Got halfway through and then they send me an email, they were like, “Ma’am, do you plan on finishing the program? You hadn’t selected the clinical side.” I was like, “Oh, this is that bridge I said I’d cross when I get to it. All right, well, I guess I pick that!” and then I graduated. And now here I am trying to just create systemic change one person at a time.
Gina: That’s awesome, that sounds like what I did to Roxanne, except I didn’t steal her debit card and force her to go to midwifery school. I just bullied her repeatedly into it.
Roxanne: And so I filled out the application. It’s actually funny because my husband, who was like very against…
Lakeesha: I think you need a little bit of bullying to get that.
Renee: Oh, yes.
Roxanne: Oh, you do. I do. But he told me he’s like, you know, after you graduate midwifery school, maybe we could have a third baby. And I was like, oh, my application’s submitted today. I submitted. I had my essay and everything and I literally submitted it.
Renee: That’s how you do it!
Roxanne: And then he obviously changed his mind because here I am, 39 weeks pregnant with our third baby before starting midwifery school instead, which probably isn’t the best timing…
Lakeesha: The timing is never right, bu it’s always perfect.
Renee: Exactly.
What IS a Labor Stall?
What a labor stall is? A labor stall is just a pause or a stop in labor. Either the contractions slow down and spread apart, or the contractions actually aren’t causing cervical dilation progress in your labor. And there are different reasons for labor stalls.
Labor Stall Definitions: can be facility dependent!! Each birth facility may define what a labor stall is differently. In general: No labor progression after six hours of adequate contractions during active labor. You must be in active labor to be classified as a labor stall!
Gina: So, when would you all typically see a labor get classified as a stall? What sort of factors are we looking at that may or may not actually be a stall? But what do you typically see in like a hospital setting as, “Hey, this patient’s not progressing. This patient has a labor stall.”?
Lakeesha: So I think it’s really up to the facility and the patients of the providers honestly. So anything that is usually 6 hours or more of which you’ve hit active labor and you have not progressed, they would call that a labor stall or if you are on Pitocin and we’ve proven adequacy of contractions with either an internal monitor or adequate contractions just on the strip in general.
And you still have not made that cervical change. You don’t have to make it always 6 hours. It will usually be closer to the four hour mark. But like I said, every facility is a little bit different. And there are, you know, some providers who are a little bit less patient than others and may call it quicker. So that’s largely dependent on where you’re going to give birth. That is maybe something that you might want to ask them, like, you know, what are their policies on labor stalls and you know, how much time do you have? Because the culture drives a lot of it, even if the evidence or the policies or the guidelines say one thing, culture drives more that, honestly.
What is an adequate contraction??
Adequate Contractions have to be 180 to 200 MVUs average over a ten-minute period. But you do not always need this "adequate" contraction pattern to make cervical change and have a baby. It can be very individualized!
Lakeesha: So, per the book, if you are using an internal monitor, that’s pretty much the only way to measure an adequate contraction, per the book. You need to be having 180 to 200 MVUs (that’s the measure that we use to measure the contraction, the force of it) average over a ten-minute period. And that’s kind of what we would call adequate.
However, I’ve seen so many women who are nowhere near adequate still make cervical change, still deliver a baby. I’ve seen moms, myself included, have those labors where they’re having one contraction every 7 minutes and they’re still making change. So it’s kind of the progress in seeing the change. And then if that starts to get more finicky, we start to implement those things like an internal catheter or a little bit more invasive monitoring to see if you are what we would call adequate.
But in the grand scheme of things, it’s all a big-dice game, honestly.
Renee: And honestly, I mean I’ve had some practitioners that say 250 is their MVUs. So once again this is provider-dependent because there’s others that are like 250?! Blow the whole person up at that point because the uterus is hardly able to sustain life, but that’s their cut off. So they’re like “If the MVUs aren’t 250 then I don’t feel like that’s adequate so give her more time.”
And then for me, the way I describe them is every contraction is a valid contraction. It’s just a matter of does that contraction end in birth that day. So to me, even like people would say, “Oh, I’m having the fake contractions, Braxton Hicks.” That’s not, that’s not fake. I’m not sure about some people, but Braxton Hicks contractions can hurt!
And I’m not going to invalidate someone’s experience because they’re not making that beautiful change centimeters per hour that they expected to see. So to me, the adequate contraction is the one that led to birth that day. That’s the active labor one. But an adequate one also gets you there. I mean, everybody started out closed, adequate contractions, got them to 6cm, which is now where we say they’re active labor, but you had to be adequate to get there.
Friedman's Curve: The Strict Labor Timeline
Friedman's Curve states that for a first time birther, you should see 1.2cm per hour during active labor. For subsquent births, it should be 1.5cm per hour of cervical dilation. However, his curve has been debunked yet still influences modern OB care.
Gina: Can you talk about the Friedman’s Curve then, and how that might affect somebody’s birth experience?
Renee: It will completely affect someone’s birth experience. So for Friedman, I actually had it written down, so to make sure I don’t mess it up. So a Nullipara, meaning someone that hasn’t had a baby before, he describes the latent period as being less than 20 hours, active labor should be 1.2 centimeters an hour, and when they hit the second stage, which is what we call pushing, is one centimeter an hour of descent.
If you have had a baby before, he says that you’re in latent phase, anything before that active labor phase that he then actually called like 3 to 4 centimeters actually, is less than 14 hours and 1.5 centimeters an hour for every hour that you’re laboring and then two centimeters an hour of descent.
So every time that you, like, when you give birth, they’re going literally by the hour. And he actually had an “arrest disorder” was, by his definition, no progress in 2 hours. And so a funny fact about Friedman’s Curve, which was made in the fifties and had a very limited population, is that, since then you know, they kind of blew that out of the water.
But you still have people that are still kind of using these history books that they dusted off and they’re not taking it off their bookshelf. So they’re still going by that same theory. And so what you end up having is ending up being that person saying, “Okay, well, I don’t think she’s going to do anything,” but it’s been debunked. And his, in his actual, he had to publish it…
Lakeesha: Yeah he himself said it!
Renee: Half the women, he said were in “labor dystocia” or “labor stalling” and went on to have babies without any medication, alteration, adjustments, or interventions whatsoever- after he classified them as being a full labor dystocia and not being able to work. And it was like, yep… I would say he wrote that out loud, but I guess that’s not the way that works. But yeah, he wrote that out loud and we, we followed it.
Roxanne: We still follow it!
Lakeesha: And for a long time…he actually came back out later and said that a lot of the numbers he chose were completely arbitrary. But yeah, but because, you know, stature and his in place in the OB world, people, you know, they followed it.
Renee: He came back and then retracted that, believe it or not. So after he came out and said, “You know what, I may have been a little off,” he came back afterwards and said, “No, you know what? I stick by my numbers. ” And I was like, boyyyy…that’s….
What Are Common Solutions for a Labor Stall?
Gina: So when someone does have a labor stall or a rest of labor, what are some common solutions that we’re typically going to see at a hospital setting? Like what’s the first thing that someone’s probably going to do? If you have a labor stall.
Renee: If you’re in the hospital?
Gina: Not what do you guys would do, but what the average person can expect? We’ll talk about what you guys would do in a sec.
Renee: Yes, they have seen what Renee will do, boy! Renee will have you like SIA, hanging from a chandelier! But typical hospitals, the first thing they’re usually going to offer you is going to be something like Pitocin or a prostaglandin, depending on how far dilated you are. But Pitocin is usually what they’re going to offer you, and that’s just the synthesized form of oxytocin, which is what we usually make to make our own labor get started, which is one of the things we know is fundamental in labor.
And then the second part is that they’ll usually offer to break, your water, that’s another huge one that, “Let’s break your water that’ll make things go so much faster. Don’t worry about that whole pain part, but it will make everything go so much faster in the baby of sink down and everything will go great!” And then usually after that it’s… I mean those are of the top two I would think, Keesha, right?
Lakeesha: I would say sometimes if you’ve come in and you’ve had a long prodromal labor and you’re maybe like 2 to 3cm, they might morphine rest you, and try to convince you that you’re not really laboring, or, you know, try to send you home in that way, which sometimes I feel is more beneficial actually if you’re wanting to do a less interventive birth because it allows you that break that reset and then you can probably go home and begin to re labor at home.
Gina: Both Roxanne and I, our first labors, our early labor was like over 24 hours and like we would show up, they’re like, “You’re a centimeter.” Then we would show back up there, but like, you’re still a centimeter. I was like “What the…..”
Roxanne: It’s funny because if you’ve listened to my birth story and I talk about, “And I was texting one of my friends at the beginning of my labor and she was like, ‘You should probably just take some Tylenol and Benadryl because it’s probably going to be while,’” it was Renee, she was telling me that I was not going to have a baby that day.
Lakeesha: She can usually call it pretty well!
Renee: But I knew what you were going to do! I just, I don’t know, I it’s so sad. A lot of people ask me, like, “What makes you do this?” And I’m sitting here thinking “Honey, G-U-T. My gut. That’s all I had. I did not read it.
Roxanne: She knew I wasn’t going to have a baby that day and I did not!
Renee: And I usually call it straight, I’ll tell em! I’m like, “Let’s try this and go home. Stay away from us as far as possible!”
Gina: So in some labors there are just like normal pauses, like usually big transitional points too where like labor just kind of stops for a little bit of time. So when we go from like early to active labor, there can be like a little lull, like transition to pushing, there could be like a little lull. And even when you change like locations, we can have like a pause as you’re kind of like resetting where you’re at. So like when you go from home to the hospital, like pause in labor because your body is like, “What is going on?” as it starts to get kind of used to what is happening.
Lakeesha: Yes, very much so.
What Causes a Labor Stall? The 3P's
Gina: And so these pauses are going to happen because oxytocin is not just this linear like continuous flow, like maybe Pitocin is. It is going to ebb and flow based on like our needs. If we if are more fatigued, it’s going to lower to let us rest. If we’ve changed new locations, oxytocin levels are going to adjust because now we’re potentially not feeling super safe and supported in our new environment.
And so there are three different things that could cause labor stalls. And maybe four, depending on whether or not you define psyche is a part of power is its own thing. So we have the passenger which is going to be baby. So baby plays a big role in whether or not our labor is going to progress. We have the passage, which is going to be the structure, the path that baby is navigating through.
It can include the pelvis, it can include the pelvic floor, it can include all of the different structures that baby has to kind of wiggle and rock through. And I find that the passage and passenger are really kind of relate to one another where baby’s position can really be influencing the passage. Third one is going to be the power.
So this is going to relate to how strong our contractions are in. This could relate to whether or not you feel safe and supported in your environment. So we have elevated levels of oxytocin because we feel really safe. It could depend on the environment that you’re in. So dim lights, quiet voices tend to kind of promote those oxytocin levels.
It can also relate to whether you’re starving, if you have been eating at all during your labor, and that may or may not depend on your hospital’s policies as well. It could depend on fatigue if you’re exhausted from like three or four days of laboring. And then I also find that it can depend on your health. So if you are sick, we may start to see a pause or stall in labor.
And then there’s a lot of different things that we can do to help solve these various types of stalls, because as we can see now, each of these different types of stalls, not all of them are probably going to be solved by Pitocin. Now Pitocin, maybe, can like force your baby to rotate into a better position. Pitocin can maybe like force you to like create some more space in your pelvis by giving you more of those contractions.
And it can probably make your contraction stronger or more of that, quote unquote, adequate. But let’s break down the different types of stalls and solutions that you guys may do depending on what type of stall it is. And then I can chat about like what I’m doing as a doula to kind of interact with like what the medical team is doing.
Because I’m not going to do a cervical exam during someone’s birth. That is not within my scope. I don’t want to do those. But, cervical exams can give us a lot of information if we are hitting a stall, such as what baby’s position is, like, what is going on within the pelvis. External palpations can also be super helpful.
But again, that takes a skilled medical practitioner to do all those things.
Passage and Passenger Stalls
Gina: So let’s start with the passage or the passenger. What can we do if the passenger, a.k.a our baby, is causing some issues?
Lakeesha: So with the baby, I think that’s like a forgotten art. A lot of providers don’t look at it and honestly, I feel like when I talk to my patients about it, they’re kind of like, “What? What? I thought the baby’s head down?” And I’m like, “Oh my gosh, I know. Like now I just confused you even more.” And I have these big old posters up in my room to try to, you know, tell them, like, because, you know, to me it’s super cool, like, your baby has to make this huge journey, like, and you’re like, “Why am I not progressing?” And I’m like, “Do you realize the several circles and tight spaces your baby has to, like, maneuver through?” And it’s not always as easy, as you know, and it’s definitely not a straight shot. So the baby has to do so much as far as coming into the pelvis, you know, like turn to a hip.
That’s the optimal position to come in. So if you’re already coming in, in a weird, funky position, we might have to do, you know, some Spinning Babies and different positional pelvic manipulation to get that baby to kind of come into a more optimal position. Now, you will have babies who kind of sometimes have like their head tilted to their side.
We call that asynclitic. Doesn’t make for the best presenting part to come down and to make that space in the pelvis and to kind of guide the rest of the body out. So that’s where I think we’ll have the make it or break it providers, your nurses and all that, some are just going to, you know, like you said, push the Pit because that’s what they’ve been taught and everything else is just too much.
But you’re really having to think from the outside what is internally happening. Can I visualize how what is happening and what can I do to try to eliminate some of those barriers? So, I mean, my CrossFit moms, I’m so sorry, but they’re notoriously the worst. Their pelvises are so tight and we’re having to do so much release, And I’m trying to tell them this prior to- and honestly, a lot of my runners, my really heavy lifters, they’re so overly confident, like, “Oh, I’m in great shape,” and I’m like, “Yes, that’s one part of it. But have you really prepared for birth?” It’s one thing to work out and do all these things and all this stuff.
But no, have you thought about that? You cross your leg right over left, every single day of your pregnancy. Have you thought about that? Have you thought internally of your pelvis, of how that’s affecting how your baby’s sitting? Oh, my baby all sits on one side. Well, why do you think that is? They don’t just pick a side. It’s whatever’s more space, what’s more comfortable, due to your internal structures. So some of this is way predating the actual labor, and then some of it is just kind of like, how is your baby going to come into position? And you might not have a lot of control over some of it. But Renee is like the top person I call in whenever I have a baby I can’t get out.
Renee: Oh, thank you!
Lakeesha: Yes! When I can’t get that baby to come how I want it to and I’ve used all my tips, tricks and everything else that I know, I’m like, “All right, what else? What else can I do?” Because a lot of times, in certain settings, I am that pusher of, you know, “Let’s not just push the Pit.” Because she’s adequate, she’s not changing, the baby hasn’t come down. Why? Her baby’s still sky high.
Renee: And usually it’s 7pm. I call that a “Pit and Sit”. You have some providers that literally (administer the Pitocin overnight) and I will walk in, and it’s one of the things you like, “Good morning. All right. How are you feeling? How have you been doing throughout the night? How’d you rest?” And they’re like “I’ve been resting pretty well!” I was like, “How have the positions been going?”
And they’re like, “Oh, I’ve been like this since last night.” I’m like, “Okay, all right. Right.” I gather myself, I’m like, okay, we’re good, we’re good. We’ve got this. It’s going to be okay. Whenever it comes to labor stalls for me, I’m kind of with Keesha. There’s a way that I describe it, and a lot of people say they don’t think about it until I say it this way.
So if you can kind of go to Rene’s crazy world, if you think about most facilities that you go to to give birth, you go into a locked facility, they lock the door behind you. You can’t leave without somebody badging you in or somebody badging you out. You’re away from your loved was. Especially since COVID. There’s usually a restriction on visitors, so you can’t have people that you know and love around you in large amounts.
You’re out of the safety of your house. There’s one person that’s doing something painful to you, especially if you’re an induction. We’re usually doing painful things to you on a consistent basis. We’re the ones that are responsible to tell you if your baby is safe and you have to depend on us as to whether you’re also safe, and if you put all of that into a Lifetime movie, that would be the definition of captivity.
What do they do? They isolate you. They hide you somewhere that’s locked, you can’t get access to your friends or family. You don’t know where you are. You can’t escape. There’s no one that you can depend on. And then we tell you, now do the hardest thing a person’s ever had to do right now.
And we’re the only ones I can tell you if your baby is safe while you’re doing it. And if we tell you they’re not, we’re cutting you. So if you put that into someone’s psyche. Psyche started there. You just didn’t know it, because subconsciously you actually entered that. You did it willingly, but your mind does not separate that. I’m not at home safe in my bath tub with my gut being what tells me, knowing that my baby is moving, that things are going well.
I feel more pain, I know I’m doing better. Now, here I am in situation number two, and you can’t be in those same places at the same time mentally. So that’s one of the biggest things is environment. And then the other one that I would piggyback off of with Keesha is CrossFit. You’re right. They do they have they have a relatively high C-section rate. Unfortunately, that doesn’t mean never do CrossFit again. Definitely not. Please, you know, be your things. But I want you to find people like Gina and Roxanne, that are going to help you break down, “Okay, you don’t train for labor the way you train for a marathon. So find that person that’s actually specializing on what you’re planning to do next.” What’s the next function? I really need to focus on and then focus on those moves and shifting. And please, for the love of all things sacred kick kegels in the behind and stop.
Gina: Oh, my goodness, yes!
Renee: If I have one more patient tell me “I do my kegels every day a traffic stop!”
Lakeesha: I wish you wouldn’t…!
Renee: Please, don’t.
Gina: Please, do the opposite!
Roxanne: Try relaxing!
Renee: It’d be great if you didn’t because the muscles just go like this (pinches fingers together). Like “That’s the best I can do. Best I can do is a hot dog. That’s all I can push out!” It’s all constricted, that’s all it can do. So I usually tell the instead of doing a kegel, do like an anti-kegel.
And I tell them, take a deep breath in. And the harder you blow out, your diaphragm goes up when you breathe, and it pushes your pelvic floor down whenever you are blowing out. So instead of doing your kegels at every traffic stop, take a deep breath in and try and blow out really hard when you’re at a traffic stop.
And that way you’re actually focusing on taking your diaphragm in your pelvic floor and you’re pushing down. You’re gently bringing it up, and then you’re pushing it down.
Lakeesha: Focusing more on buoyancy. Yeah.
Renee: Yeah.
Roxanne: Full range of motion. Yeah.
Gina: So the biggest thing with CrossFit athletes and I’ve done CrossFit before, I’m really into lifting weights, and obviously the MamasteFit programing is all about lifting weights. But the key is, is with most CrossFit programs and with most fitness programs in general, it’s very sagittal plane. So front to back, everything’s front to back and everything is very external rotation and extension because that’s a power position.
So we’re coming out of our squat or lifting from our deadlift, we’re doing our Olympic lift and everything is extension. So arching in the back and legs are kind of pointing outwards because that’s helping to activate your glutes and again, that’s how we get power. The issue is when we’re in this extended position and we’re really favoring that external rotation, the posterior half of the pelvic floor gets very tight.
And if we’re always living in this position with all of our workouts and we’re constantly reinforcing this movement pattern, it’s going to be really hard for our babies to, one, enter into the pelvis because we need a posterior pelvic tilt to move the sacral promontory, the junction between the lumbar spine in the sacrum backwards to create more space front to back in the top of the pelvis.
Renee: New take! New take!
Gina: I know! If we’re always an extension, we cannot tuck our butt underneath to create that space. And then the second half is if we are always favoring external rotation with all of our movements, all of our lifts, all of our exercises, we’re going to have a really hard time finding internal rotation, which is key to opening the lower half of the pelvis, where if someone’s baby does manage to like wiggle their way in, we may find that we have a late labor stall where our baby cannot finish the rotation through the pelvis.
And so that’s where we might see some issues. So if you’re a CrossFit athlete ,or you are an athlete in general, and you’re like, “Oh my God, these ladies just told me I’m going to have a C-section because I lift weights.”
Renee: You will not.
Gina: You won’t do that because you listen to the MamasteFit Podcast and you know that you can still do your CrossFit workouts. But we also have to integrate other movement patterns besides just extension and external rotation. Find internal rotation, round in your back, release your lats. We have a whole birth prep circuit that you could do that’s free.
Look at the show notes. It’s listed right there. Join the newsletter to get it, and then unsubscribe if you don’t want to hear from us ever again! But there’s a lot of stuff that we can do to help support opening the pelvis and preparing for birth while still doing those activities that you love. It’s when we’re always living in this one position, and then for the kegels, for the love of God, do not do kegels, like most of us have very tight pelvic floors as we live in high stress environments.
As women we’ve been told our entire lives, our entire lives have been told to be as small as possible. So we’re just like sucking everything in. So instead of kegeling, think more diaphragmatic breathing. So we’re lengthening within the pelvic floor, we’re exhaling to relax. Or maybe we’re exhaling to pull the ribcage and pelvis closer together. And there’s a lot of things that we can do to move the pelvic floor besides just tighten and tighten and tighten.
I’ve seen people be like, “My OB told me to do this, or my midwife told me to do this, or I saw it in a mom group forum.” And then we’ll be like, actually kegels are not great. And they’re like, “Well, you need it for postpartum.” But you also don’t need it postpartum. Even postpartum, it’s not a good idea.
Lakeesha: I find actually a lot of times when I’m doing exams, even just, you know, annual, not even, OB related, I have more women struggling to release like, you know, you have an exam and say, okay, squeeze my fingers, you have that control- and then release, and the releases so delayed and so long. And they’re having to consciously think like, “Okay, how do I let go of her finger?” That’s really harder for people because they’re quickly like, “Oh, I got it,” and you’re like, “Okay, but now can you let go?” That’s the full range of motions.
Gina: They’re like, “What do you mean?!”
Roxanne: Like the bicep curl, you know, you got to fully extend your arm out.
Renee: Exactly. Not just bring it in. That’s one of the biggest things for people. I always ask my patients, I say, okay, you have one of three categories. Are you where I am? Like, “I haven’t ran ten miles collectively since high school,” or, “I run almost 3 to 4 times every week and I consider myself pretty athletic,” or, “I am the alpha, the omega, the sun, the moon, I am a beast.”
Which of the three? Which of these three would you put yourself in? Because I already know whenever I get that answer, what am I starting with for you. For the one who hasn’t ran ten miles since high school, Girl, nothing’s too tight in there. We’re going to do some stretching and we’re going to do some getting your body to accept.
But for the ones who are really strong and they’re muscular, fit, etc., I asked them, start now but find where you’re looking toward. Keep your goal there because the muscularity still needs to be there, you don’t want that disintegrating. You don’t want your body going through that many changes and losing that during this physiological process. But focus where your next goal is. So do your CrossFit but focus- the next biggest thing coming up is birth.
So I can probably tone down on the bicep curls and focus on the boot scoop and things like that- scooting my booty across the floor and stuff like that.
Gina: Absolutely.
So do your workouts, exercise throughout your pregnancy. But, we don’t want to wait till labor to address potential labor stalls. We can address preventing potentially that. I’m not giving you guarantee, but we can address preventing labor stalls by ensuring that we can open each level of our pelvis and that we know how to release tension and pelvic floor.
And that’s going to really help to support resolving a passage related labor stall. So something related to the path that baby is navigating through. And then when it comes, if we rewind back to the passenger or baby like we want baby to present as small as possible to our pelvis because human babies have big heads. And if you’re like Roxanne and I and you have mated with a gigantic head person who gives birth to 99th percentile baby heads, these little heads are going to mold and fold and change and shapeshift through your pelvis.
But they do that best with a chin tucked position. So they’re tucking their chin to their chest. They are going to present the smallest. And then we have to align that small chin tucked position to each pelvic level. So top of the pelvis, they’re going to be more of that OT position. So back to the head towards a hip.
They’re going to then rotate through the mid pelvis in front of the ischial spine and then they’re going to finish their rotation underneath the pubic bone in that OA, or the back of the head towards the front of the body. So baby’s going to rotate through the pelvis, but we need to help baby do that by one, ensuring that they can get into the best position for them.
So we’ll have some folks that will message us and be like, “My baby’s OP, I’m 36 weeks. What I do?” I’m like, “Exist. Just exist”. We don’t have to totally worry about it. But what we can do during pregnancy again, preparation stuff to help prevent these labor stalls ,is we can ensure that baby’s path to rotate is clear. So are the uterine ligaments balanced with one another? Do we have even pelvic floor tension? Can you easily move the pelvis?
So all of the different structures that support baby, are they clear of adhesions and obstacles so that when labor does begin and we do have those strong contractions, baby can rotate into their best position? Because if we have a lot of obstacles and speed bumps along Baby’s path, they’re going to stay in that OP position, or they’re going to stay in that less optimal position for them, or maybe even like tilt their head a little bit.
And so during pregnancy, again, we want to make sure we can open all the pelvic levels. Our pelvic floor is released to help prevent those passage stalls. But then we want to make sure a baby can rotate whenever labor does begin. So ensuring the path to rotation is clear as opposed to trying to force my baby into what I believe is the best position.
Because some babies do move through the pelvis in a different way, but each pelvic level is going to open the same so we can think about the preparation for pregnancy. But if we do have a stall during labor, it can be really helpful to, one, understand where that baby is within the pelvis, not just head down.
Which direction is baby facing in correspondence to what pelvic level are they? Because each pelvic level opens in a different way and they all are different shapes, like they all look a little bit different.
Renee: Exactly.
Gina: And so if baby is in this OP position, or the back of the head is sort of the back and spine, posterior, sunny side up- whatever phrase that you may be understanding posterior as- we want to usually make them rotate more towards the front. And so we first have to think, okay, is my baby like caught up in a pelvic level that maybe they they kind of jammed themselves in a little bit weird, and this is where things like inversions can be really helpful to kind of rotate baby upside down, then kind of wiggle out.
And there’s so many different inversions that we can do. Like if you are unmedicated, you could do one anywhere. You could do handstand, like do it on the couch, you can do it over here. You do do it over there if you like. But if you would like to stay in the bed because the bed is soft, it’s like a transformer so you could change sizes. You can also put the foot of the bed down and lift the middle of the bed put your knees on the middle, forearms on the foot, and then we’re in an inversion right there. If you’re like, “I have an epidural and I am not moving,” we can do an inversion by tilting the bed, but you usually have to ask the nurse or the provider if you can tilt the bed.
So if somebody wants to trendelenburg the bed and maybe their provider or their nurse is like, “No, thank you.” What would you guys recommend in that moment?
Renee: So I actually haven’t that often… because I know if I have the bed trendelenburg, I’m timing it around my anethetist, because they have already decided, “She’s going to die right there!” because if you tilt her with her epidural in place now, she’s not going to be a move her neck, you know. And so that’s one of the first things I always do.
I’m always like, okay, how much how much clearance of time do I have right now? So I’m kind of sassy planning that. If other people don’t feel comfortable doing that, I go in and I talk to the parent and I actually tell them this is the best way that I could think of to do it. There is no contradiction to this. Whenever you have an epidural, a properly placed epidurals is made to be at a certain level and a certain amount for that reason. They were originally created to be able to walk with for people with long term back pain. So it’s not as if this is something that you can’t do.
So A) I first advocate and I’m just like, “No, still doing it…” and then B) if they can’t put the bed in trendelenburg, then a lot of times what I’ll do is I will prop them up so high with pillows on their side that by default it’s almost like their butt is here in their head is here. By the time I put all of the pillows there, they’re tilted in their own right. So I’ve done that before so that sometimes will help.
Gina: How long would you recommend someone stay in trendelenburg where the bed is tilted?
Renee: So for me, every situation I will say is different. I, I am a firm believer that positioning is typically a 45 minute, no longer than an hour, situation. So for trendelenburg itself, just to do that, I had patients in it and said, do this side for one hour and then I come back, readjust them, have them empty their bladder, and they turn to the other side and be that for an hour.
I’m going by how long does the baby need and how long is the parent, the birthing parent, tolerating it. If neither of them are doing poorly, then it’s still not contraindicated. And I’m going to get that baby the best time they have to move and to turn. Because some people, it’s it’s the passenger, but if you think about it, it’s the pelvis and some are meant to go OP so inversion is actually not what they need.
There are certain pelvises where if you try to deliver a baby in OA, it’s a N-O! It’s not going to happen. They have to come out in that OP presentation. So there will be times where I’ll look at it and if I’ve done it twice and that baby is still coupling or it still looks like that I don’t try to fix it anymore. The baby is smarter than me.
Gina: Absolutely.
Renee: I take my pride out of that perineum and I say the baby is smarter than me and I can’t put my pride in that pelvis. And Keesha taught me that she said, “It’s just a uterus. You can’t take it personally.” And I’ll never forget her telling me that. And so if it’s still doing the same thing after I’ve done a good amount of inversion, it’s probably the baby talking to you and telling you, “Actually, this is the only way I need to fit. You just need to find other ways to help me. Instead of looking like I’m asynclitic and I’m talking on the phone, maybe that should be your focus instead of trying to rotate me towards her back.”
Gina: Yeah, absolutely. So with positioning the inversions, I find to be really helpful. So if you have, like strong contractions every like 3 minutes, like three contractions for like a forward leaning inversion, if you’re trendelenburging the bed, it can really vary depending on what’s going on after that. It’s usually creating space in the pelvic level, like wherever the baby’s at.
Typically, if baby is OP or we have an issue with them entering into the pelvis, we want to create more space either in the inlet or we want to create more space in the upper mid pelvis to help baby rotate or begin their rotation into the pelvis. And this is going to look like really open hip position. So if you think like a dog that’s peeing on a fire hydrant like those kind of positions and you could do that with a peanut ball, which is what Renee and I did one time together.
You can do it with like either in all fours or down and like an exaggerated side laying. And both of those are helping to create more space in the upper mid pelvis to help baby begin their rotation. But if baby’s in mid pelvis, baby’s near the outlet, we want to create more space based on where the baby is to give them that opportunity to kind of wiggle and rock and move into a better position for themselves depending on which pelvic level they are.
And so pelvis or the passenger and the passage definitely correspond with one another a lot I find. And so when we’re trying to like help labor progress, maybe it’s due to baby’s position, maybe it’s due to some tension within the path like working on both of them together I find tends to resolve the labor stall or baby is just, they don’t want to come out! Like, that is just not today is not the day for vaginal birth and that makes me really thankful to have C-sections because sometimes like there is something else going on.
Like we had one baby that the umbilical cord was like totally wrapped around the shoulder and they were just they were just not going to move down into the pelvis. And so I think knowing when maybe we’ve done enough is also really important.
Power/Psyche Stalls
Gina: So, Roxanne, do you want to talk about the Power stall and the different things with that? Because like we were talking about before, the power is how strong the contractions are, which really relates, I find, to your environment, to your your current homeostasis status. So are you starving or are you fatigued are you sick?
Lakeesha: Are you hydrated?
Gina: Are you hydrated enough? Exactly.
Roxanne: Or, over hydrated? Like under hydrated and over hydrated. So the power is just us as birthers, like what is going on inside of us, whether mentally or physically,
Gina: That’s a better way to word it!
Roxanne: I explain this a lot, Gina, so I’m just better than you… Now I lost my train of thought. But like mentally or physically, what’s going on that is potentially causing this stall? Do we feel unsafe with the people? Like do you need somebody to leave the room? Kindly ask them to leave or ask your nurse to ask them to leave.
Or maybe it’s the nurse they can leave too.
Gina: So how would you ask someone to leave, though? Because I feel like for people like me that are conflict adverse.
Roxanne: So for you, your husband, you just say, “Tell them to leave, please.” And then Barron is just like, “Oh, could you give us some space?” Because Barron seems like a really nice guy.
Lakeesha: I really push that though. Honestly, a laboring woman should not be her biggest own advocate, honestly, because in that time you have a different job, you have a different focus. And so honestly, everybody always wants to be in a room. Can I be there? Can I be there? You’re going to get a job when you come in.
So if I give you that honor and privilege of you being at my birth, than the least you can do is create a safe environment for me. And if you’re uncomfortable doing that, then maybe you don’t need to be in the room. Also as your partner. So just, you know, traditional male/female type relationship, your partner, even if he is, you know, not… it doesn’t have to be a fight.
It doesn’t have to be anything. But, you know, he’s also at that moment your protector, so you can do your job. You know, we’re not protecting like back in the days when we were in a cave and we’re having to, you know, hunker down and protect from animals and beasts. But there are still real stressors in the hospital, in the world, that to our brain and our body are perceived as such threats.
So like you guys said, if you’re not feeling safe when you have those stalls coming in the hospital because, what is this place? What is going on? Yeah, mammals, labor at night in small, dark, confined spaces, safe spaces, a hospital is everything but that. Yeah. So trying to have your labor team on board is big. And a big pet peeve of mine is men, I will be like “You have any questions?”
“Oh no, it’s all her thing.” And I’m like, okay, yes. But one, is it also your baby? I’m assuming if you show up to all the visits, maybe not, I’m not judging, whatever. And then secondly, like, no, you need to be on board with her plan as well.
Renee: And to kind of piggyback off of Lakeesha, I was clapping so hard when you guys said that. Oh, boy, there’s a song by Rihanna and Eminem that says, “Love the way you lie.” Oh, honey, I love to lie. I can come up with an excuse so fast. Why your mother-in-law can’t bring her annoying behind in that labor room! Oh, Child! All I need you to do, and I ask everyone, give me a code.
All I need is your code. And once your code is there, I find an excuse for us to be found by ourselves, and then I want to know what you want me to know. And that code can be like a lot of times I’ll tell them to have a sneeze and then say, Gosh, there’s like dust or something near me!” That tells me, okay, something is going on that you don’t want. What exactly is? And then I want to say, “If you guys don’t mind, I want to go over something that we talked about outside with the doctors, and I don’t really want to share it with the group.” And then I find out what it is that you want to happen. And then I go out and then I come back in and I’m like, “Okay, guys, I just got word. I don’t know what exactly is going on, but there’s some kind of a protocol going on and we have to had only so many visitors in the room.” And I will straight up walk you out to the exit. If I could do that for one birther, I would do that all day!
Roxanne: Yeah.
Renee: I will personally escort you with a red carpet out of this birthing person’s room because she wants her safe space to be there.
Lakeesha: Make you feel so happy, like, “Oh she was so nice! She was so pleasant!”
Roxanne: Yeah.
Renee: Yeah. So that is one of the big ones. And to me it’s an honor. It’s like I get a chance to get a toxic person out of your birth story. Yeah, but I am honored that you’re trusting me enough to let me know this is someone that’s toxic to me. This is someone that I am fearful of.
And I am advocating enough for myself that I let them gone. And the second part to that is that whenever you have like someone that has a significant other and they’re trying to be nice and they don’t want to say anything out loud, that’s great. But you have to have someone that’s in charge, almost like people have wedding planners.
You can even have a friend that’s in charge of all the group texts and things like that. Like, “Just got word from them, hospital has a restriction on so-and-so,” and they’re the ones that send out the text message that way. Is your best friend Lawanda, who is telling all the parents in the group text there can only be this many or there can only be that many and everybody’ll know. Because to me, the last thing in the world I find it so, I don’t want to say “American” because that sounds so terrible, but it is so… what’s the word? Patriarchy! That tells us not only should I be in labor, have a birth, do all of that, I also should instruct you on everything I need to help me feel the most comfortable I can while I do that.
Lakeesha: While maybe I’ve never done this before. Yeah.
Gina: I’m doing a lot. Yeah, I’m doing a lot.
Renee: I shouldn’t have to do that. I’m already doing literally the most. So let me just do that. But I’ll be darned if I’m going to have you as my patient and you are still responsible to “I also need to labor, but I also need to tell you to try this or tell you to try that.” Because one of my codes, I think I shared it with you all,
“I don’t know,” that is like the banner statement for 4 to 5 centimeters. They don’t know anything. You want some heat to your back? I don’t know. Do you want to drink water? I don’t know. Do you wanna try hands and knees? I don’t know. And lot of times I look at them like, okay, you’re about four or five centimeters because they don’t know.
Whenever they get to six or seven, they’re like, stop with the fan!
And it’s that transition. You can tell like when they transition, they know exactly what they want. They’re out there and they’ve got their suitcase and they’re looking back and they’re like, “You coming?!” Like, they’re not wondering if they should go to the hospital, you know, they’re just going. And so that’s one of the biggest things like I don’t feel like you should have to advocate for yourself while birthing.
So I always tell people if you’re going to be there, like, Lakeesha said, you’re going to get a job. Offer water to her and let her decline. Offer to rub her feet. You think of things that you could possibly do and let her refuse or accept those offers of gifts, but she shouldn’t have to come up and say, “Could you do this?” If that makes sense?
Gina: Yeah. No, that makes a ton of sense. Protecting your space is definitely huge. I had a father-in-law, like, randomly walk into the labor room, and I’m like, no one was like, “Hey, this person is here. Do you want me to let them in?” They were just like, “They’re in that room right over there. Go ahead!” And he just busted in, while she was in the middle of labor and she was like, “Glenn?!” And I was like, “Who is this person? Is this is a doctor that I’ve never met before like who’s just, you know, who’s off call and just coming to visit?” And then I found out it was the father-in-law.
Renee: Exactly, just walking in?!
Roxanne: It’s just like…do you have kids? Do you really want to watch your daughter-in-law….
Gina: I mean, I don’t know. I guess some fathers are like they’re connected in that way. Where it doesn’t bother them… Our dad is like, “I don’t even want to be in the same state. Call me when you’re done.”
Lakeesha: Pretty sure my dad would have been in the room, but like, tilted at an angle..
Renee: And I’ve had that too where I’ve had a lot of people in there, it’s like, I value both sides because I’ve had times where one of my, I’ll never forget, I had a birther that she was laboring and she finally hit transition and her mom was with there the whole time, but the father wasn’t there and she, she was like, “I just texted Dad. I just texted Dad.” And I was like, “Why are they doing a lot of texting the dad?” If it’s not a sexualized thing, most fathers can separate that. So I’ve seen many times where the father is in the room because it’s not a sexualized event. American television makes it that way because you can’t see it.
Now, you can watch a video and you’ll see everything until it’s time for the man to pull his pants down and then all of a sudden, the camera changes angles, right? Because they don’t have to be accountable for what they’re showing. But you see all of us. But seeing all of us in THAT moment isn’t the same as seeing all of us on the internet.
And so I love it whenever they’re able to be in the room and they show it is literally just a physiological phenomenon. You make it sexual in your own head, and that’s fine, but it doesn’t have to be either way. The end of the story, she texted she was, “I don’t care that you texted.” And then when she hit transition and knew what she wanted and she started telling me everything that she needed, the mother just broke down and she was like, “I’m so sorry. I knew he was abusing you all of these years.” And to this day I have not forgotten that birth story. The mother cried. She got down on her bare knees on the floor, and she crawled and begged this patient to please forgive her for all the years of abuse that she knew was going on. And she just didn’t have the guts to tell and to do something because she saw the strength that birther there had at that moment.
And she was in such awe that she was doing this unmedicated and she couldn’t believe that that’s how strong her daughter was. So she thought she was protecting her by keeping everything encompassed in the home. And to this day, because I’m not going to cry on a podcast today, I have never… I know the room number of that birth. I have never forgotten that. And it was it was a heart wrenching and beautiful at the same time. And she stopped texting him and it was like I knew when they left the hospital nothing was going to be the same, nothing was going to be the same. And that was that person’s birth story. Like, could you imagine having a baby and that was the purpose of that birth story?
Gina: Oh my God.
Renee: Was to change your family life forever. I can’t imagine it. So it depends. Like who was in the room really is important because you don’t know how toxic of a view or a history they may have.
Gina: Absolutely.
Renee: And that’s why he wasn’t in the room. But she kept texting and kept texting and finally got through to the end. And I, I just sat there and and I’m just seeing him. I don’t know what to do. And so I’m just staying focused on the birther. And then she’s yelling and they’re yelling. And I just sat crisscross applesauce legs.
And I just listened. And then whenever they had a break in between, I just stepped right back in and it went beautifully. But it was still, to this day, one of my most memorable births.
Roxanne: That’s… man. Birth, though. It brings up all the trauma in your life. It brings it all up. You could suppress it all you want, and it’s going to prevent, or come up during, labor. And that’s the power of power.
Renee: I actually have the mind of the psyche and the power of it because you’re bringing it all with you. You don’t get to draw it. None of it is suitcases in the airport that get just left behind. It’s with you the whole time. And so I, I have actually labored patience and just been laboring them.
I knew they were a sexual assault survivor. Never claimed it, never said it. Never. I knew, by the way that they labor. I said, “Okay I’m on to it and now I know what to do and I know how I’m going to change things.” This certain trigger words that I make sure I already don’t use, but other things that I add in that I say to them and kind of take them into a more nurturing state someone who would be an ally if they were a runaway.
If that makes it.
Gina: Yeah, it’s important to be a trauma informed provider and medical practitioner to understand that, you know, everyone’s got this different experience that they’re bringing to their birth. And so it’s not always like, oh, this patient’s got this gigantic birth plan. Like, what a loser. Like, well, maybe she has this really big birth plan because some sort trauma that she’s experienced in the past.
And this is her way of protecting and taking control. And so instead of like passing judgment on a patient, or a person, like maybe you try to understand like where they were coming from. So like, like we were talking the other day about declining C-sections because ultimately the patient has the decision and whether or not they want a Cesarean.
And this patient kept saying, no, no, no even though baby was like not looking great. And ultimately it was because like there was a cultural thing for her where, you know, if I have a C-section, I lose my community like there’s so much stigma attached to it for me. And so if we can understand, like where a patient is coming from, it’s going to allow us to provide so much better care, especially if the things and the traumas and the fears that they’re having is starting to affect their ability for their labor to progress.
So again, like power, the strength of our contractions and the release of our oxytocin is really going to depend on how safe and supported we feel in our environment. And so if we’re showing up and we’re afraid of something, maybe we’ve had prior birth trauma or other trauma in our life and our provider and the medical team and the people there to support us are like, Hey, like we’re here for you.
Like we are going to do everything we can to support you like you’re you’re going to have an amazing birth- as opposed to them looking at your birth plan and like rolling their eyes and, like, whatever, like that is already in a completely changed the experience for somebody. So for, for me, when I have like a doula client who is like afraid of something like maybe their mom had a bad birth experience or they had some birth trauma, maybe they’ve had a prior birth experience that was more traumatic for them, or like all of their friends are telling them these stories.
What I usually find helpful to do is one, just address the fear and this is easier for me to do as a doula because I usually have a relationship established with my client that like the labor and delivery nurse or the midwife or the provider may not have the same relationship depending on how often they’ve seen them. And so I’m already going to kind of have a history or background on like what might be going on with this person.
And I usually just address it where I’m like, Hey, is, are you afraid of this? And so if like Mom had like a really traumatic experience at birth, are you afraid that you’re going to have a birth like your mom? And then they’re like, yes. And they start crying and like they have this huge emotional release. And I’m like, okay, let’s talk about it.
Let’s figure out what about this is freaking you out right now and talk about the things that we can do to help mitigate the things that happened to your mom. Like what can we do as a team to ensure that you don’t have the same experience? And if you do have a similar experience, these are things we can do to keep you safe.
And then once we kind of address like what the rational fears are and ways to mitigate those fears or we address like this is this is kind of an irrational, well I don’t say that, I’m not like this is irrational, like let me just gaslight you. Like when we can understand, when they can understand, like, okay, this thing that I’m afraid of is not rational.
Like, not a realistic thing that’s going to happen to me. They can just kind of let it go. And then I like, massage their feet and we diffuse some oils and they’re like, they just kind of release and like just let it go. And then labor progresses and it’s like, well, yeah, like your, your psyche plays a huge role in the oxytocin release.
So creating that safe and supportive environments, you know, eating food at some point,and hydration is wonderful. And then the last thing is going to be your health. So if you have declining health during your labor, then your uterus is not going to work as well. And so this is something that I think will be a really good discussion for us all is, for some of my doula clients who their health is starting to decline, like they’ve started to develop a fever and then baby is also starting to not look great but it’s not an emergency yet. Like we’re all still alive. Like we’re probably going to stay alive for a period of time. But it’s not looking promising in the future, maybe the far future.
Like we’re not looking great. And so something that I’ll talk about with my doula clients is, hey, like let’s discuss our threshold. At what point do you feel comfortable calling it so that you can feel comfortable that yes, if we kept going, it was probably not going to go in a good direction and I’m good with not having a vaginal birth, like for my health and safety and for the health and safety of my baby, versus like I want to go as long as possible and I would rather have the emergency in hopes that before that moment happens, I have a vaginal birth.
So figuring out the threshold as a family, because that’s going to differ from person to person, is going to be really important. And this is like a hard conversation that I’ll have with my clients who either them their baby or both of them, health is starting to decline. It’s like, okay, when do you want to call it?
So how do you guys approach that situation where someone is not looking great? It’s probably not heading in a great direction, but it’s not an emergency yet. Like what are some different conversations like that you might be having or different points that you might be making? Because ultimately we want them to decide that this is the best thing for them without feel like they were coerced or pushed into it. Like we want them to feel confident that this is the best decision for me. I maybe didn’t want a C-section, but this is what I need. Like, would you guys approach the conversation?
Renee: A) I love that you do that with your clients on that front end because that means a lot to me because whenever they do show up, I want them to have that healthy line. The way that I start is I A) I break up the toxic covert bullying. What we use to monitor your baby’s heart rate is great.
Science is great. But I make two big things clear. A) the number one thing, the biggest thing that has changed since we started putting people on continuous fetal monitoring is it has shown to change a couple of things, and two main things. A) it increases the C-section rate and B) it decreases the rate of neonatal seizures. So let’s start there. It does not show a correlation of less infants dying because they were continuously monitored.
It simply does not they can say how they want to say it, but that’s still what the evidence supports. So I get where it makes sense that if you’re watching a baby that doesn’t look good, that you should be doing something. But honestly, they looked like that on Monday when they were at Jack in the Box. They just were at the hospital and they continued, on. So that’s the first thing that I tell them.
Second, the fetal monitoring that we use, it is a good predictor of a good baby and a poor predictor of a bad baby. And that’s something that’s hard to understand. So I’m going to say it again. It is a good predictor that your baby looks good, but it is not a great predictor to prove your baby looks bad.
So I try to deescalate fear. Now make your decision from what makes the most sense to you. Once they know that I tell them, you get three categories. Category one, coolest kid ever getting the scholarship. Category two, normal kid doing everything right, not really giving you much problems, but we’re keeping our eye on them. And Category three, I’m literally carrying you to the operating room this very moment with your clothes on and legit will pull your pants down on OR table.
So when we break down the categories of how we’re looking at them in the hospital, most patients, when I break that down and I tell them your baby is nearing that category three, they are unplugging the IV themselves because they’ve learned to trust that the information I’m giving them has been thorough and true. And I’m telling them this is a light category two.
This is a kid that missed curfew once, he’s not out there doing this, that and the other. This is a heavy Category two. This baby is nearing what I would do a C-section on literally myself at my in your house with a kitchen knife if I had to choose. And when you establish that type of rapport, that becomes an easier decision because you’ve actually instituted trust in this informer.
So that’s the first thing. Second, when you come into a room, and I hate to say this because they don’t mean to do it, there is there’s the total absence of malicious intent, but when someone walks into your room as a surgeon and they say, “Well, we can’t guarantee you that the baby’s looking really good, we can’t tell you what’s going on in there. But what we’re seeing now here, I mean, this baby’s look really bad. And so, I mean, I would really say we need to go straight into this.” How, and I can’t express this enough because everyone says all that matters is healthy baby, healthy mom, okay, don’t give me that toxic sentence, first off, because no one is saying, oh, boy, oh, boy, I pray that I have the kid that has like one eye. Maybe a toe or two and, like, never reads or walks or speaks. Like, no one was looking for that when they conceived. So telling me all that matters is a healthy mom and a healthy baby, that didn’t do anything for me. That told me nothing different because I did that whenever I conceived. I was already hoping for that.
So give me some new news. And so whenever I want you to go over what exactly is the risk right now, if the baby looks like what you see on the monitor, what is your biggest fear? If we are not nearing that C-section, have that healthy trust in your body, if you’re consistently making change. If your baby is that strong category two and I’m looking at you and I’m telling you, in my honest opinion, this is where, and I look at them and I tell them, I truly will tell you when I get uncomfortable.
I am not that person that I don’t live in, that “I have to be so prideful that I’m never showing face.” I will look at you and I, I feel uncomfortable with your tracing right now. And if I were laying down right now, I would go for and I would go for a C-section due to this. That’s not for you to decide what you would do based off of that. That’s me giving you something that’s on your level. Most people want someone to be relatable and on their level because they just want you to do what you would do for your sister, your daughter, your friend, your cousin, someone like that. So usually whenever you break it down to them and you look at it and you’re like, I feel comfortable and I will tell you when I feel more uncomfortable.
That’s usually a good point where patients, they really are more so ready to make that decision. I want them to feel comfortable the entire time. I, I still go by my gut. They are babies that look like absolute dirt on the monitor and I am absolutely comfortable. I mean, everyone is out there they’re grabbing vacuums, they’re grabbing for vacuums. They’re looking for anything, you know, by any means necessary to get this baby to come out. And I am sitting there looking at the patient and I’m like, fine. I feel comfortable. I feel comfortable. Because there will be some things that makes sense. If you think about it, your baby’s head is like this.
And yeah, you’ve been pushing the baby’s head out and it’s been about 6 or 7 minutes. I’m comfortable that the heart rate is 90. I feel like if I were being born, my heart rate would probably be 90 at best. And so you have to consider where you are in the laboring point. If you’re two centimeters. I’m having a different discussion with you.
If we’re crowning and we’re talking about this or that, totally different discussion.
What if a C-Section Becomes Necessary?
Gina: So Keesha, how would you approach like discussing C-section with a client or with a patient?
Lakeesha: I mean, that rapport is first and foremost. And also, I, like Renee, I don’t sugarcoat a lot of things. I’m going to be pretty honest with you throughout the whole process because you are the decision maker in this. I’m just I want to say the brains, but pretty much my job is to inform you of all the latest details, of all the knowledge that I have and pretty much let you use me as a tool to make decisions that you find best for yourself.
And honestly, you know, sometimes I think with some people they are so preconditioned and this society is so precondition to be like C-section is okay, you know, that’s cool, that’s fine, whatever. So it’s a lot of it’s easier for some people to grasp. You have to do a C-section? Okay, that’s fine. I gave it a try, you know? And I’m probably sometimes a little bit more heartbroken. Like, no, you didn’t give them the full chance! But, you know, to them, they’re okay with it. So then I hold myself because it’s fine for them. It is fine. And they, they that was their threshold for me. It would have way up here and right here is fine for them. So, you know, I have to take myself out of that. A lot of times, you know, by the time that I bring in someone to evaluate a C-section is necessary, I’ve already in my head decided it’s probably the only safe option anymore, because at that point, I’ve done the TUMS, I’ve done your calcium carbonate, I’ve done your propranolol.
I’ve gotten Benadryl for your swollen cervix. I’ve rested you. You know, we’ve done all these things. I’ve had you in all the funky positions. I’ve had you hanging upside down from a squat bar. You know, I’ve done it all. So by that time, if your baby does not look good and there’s no progress, most women in most moms are okay with saying, okay, we’ve, we’ve tried it.
We’ve done everything that we know to do. And it just did not work for me this way. So now we’re going to go a different way. And it’s still you know, people are crying and, you know, you’re about to have major surgery. This was not what she came in thinking it was going to be in that holding space where that is okay too.
I think sometimes with providers because we do it so frequently, we’re not really recognized and this is the one and only or maybe second time only ever that this person is experiencing this. So letting them feel comfortable and confident in my capabilities, one, talking to them throughout the whole process, being very truthful. No, your baby does not look good.
You know, I wouldn’t call a C-section right now, but your baby does not look hot y’all. And like, if it doesn’t change, we can’t do this for much longer. Okay, now, you’ve been prepped. You did not want to hear that, but now you’ve been prepped, and now you understand. And then at the end, the biggest thing I don’t see a lot, but I really love to do because also it cuts down on risk of being you know seen is talking debriefing, what just happened in the crazy situation where we don’t have the time and we’re flipping you and we’re doing all this stuff and then the doctor walks in and is like, All right, baby looks good, let’s go now.
And then they walk out and you’re like, what just happened? Why are we doing it? Like, what? So if it’s induction, I’m prepping you prior to, it’s a high likelihood that your baby might act up at some point in this time. If that happens, it’s okay. I’ll come in and we’ll do this. And if it gets even worse, more people are going to come in to help me.
You know, you’re well taken care of. You’re well watched. Getting that rapport, establishing that. And I think that is a thing that has to be looked at prior to, when you’re pregnant. A lot of people are a little bit cavalier as to where they choose, “Oh, just going to deliver here.” Or, you know, I had a patient say, “I’m going to deliver here,” and I’m like, “Do you realize they don’t have a labor and delivery there? So you would be go to the E.R.” and that’s news to them. So, you know, establishing a rapport with your provider, understanding, you know, what their limits are, what their thresholds are, what their you know, their own bias- we’re all coming into with a certain bias.
If I’ve had a a bad situation happen and this is looking like that bad situation, I’m going to call it way early and I’m not going to give you the full chance. That’s just, you know, human nature because I’m trying to not have a bad outcome for you. And in doing so, I pretty much cut off your attempt or your time to try.
So the shared decision making is huge. And, taking my ego out of it. That is a hard thing to learn on either end because you’re just so much like, “Why aren’t they listening? Why aren’t they listening?!” Why aren’t you listening? Because they told you no, what was their reason for No? Did you ask them?
Probably not. “Well, I’m telling them…” Okay, that’s fine. Cool. And also, they’re the one who has to walk away with their body and their baby. So the choice is theirs to make for their body in their baby. And I think that helps me a lot because once I present you with everything and everything that I know and you make that decision, I’m just going to document that I have talked of giving you your options.
This is the choice you have and this is the choice you’ve made. And I think with that transparency and then just that constant open dialog it makes it a little bit easier versus, you know, if I’ve not been in the room all day, I’m not, you know, and then I’m but I’m watching. The patient doesn’t know. I’m watching a strip and here I come.
All of a sudden, after 8 hours, they haven’t seen me all day. And I’m like, Hmm, I think you need a C-section. They’re going to be like, Who are you, first of all? And second of all, why are you in my room telling me like, are you an authority? Oh, I see your badge… But you know, so just having that long build up prior to if you can and if, if you, you know, not if you can while in labor then that might be a little bit different, but that’s pretty much how I usually try to approach it.
Gina: Yeah, I definitely find for at least from my perspective because I don’t always, my doula clients don’t always tell me exactly how they feel afterwards, but I do find the ones that do need a C-section in the end, but we did all of the things, they feel better about it being a good decision for them. Where they’re like, “I feel confident this is what I needed right now because we tried everything.” And it would be different if it was like the first decel and I was like, okay wheel you back! Or it’s like, “You have a stall. All right. Well, good luck. Hopefully things progress…” But if we we had been doing all of the things and they felt confident that we all wanted them to not only be healthy and happy or healthy and safe, we also want them to have a good experience that tends to make a better experience for everyone else as well.
Roxanne: Feeling heard and listened to and like an active participant in your birth can completely change your experience and your outlook on it versus oh I just showed up and they kind of told me what to do and right.
Lakeesha: You don’t want to create an enemy out of the provider when maybe they might not have been but the being heard part because you know, like I could be presenting you with options and they all suck. But I’m letting you know. I think they suck too. But these are realistic.
Roxanne: Yeah, absolutely. I mean, studies research shows not everyone can have a vaginal birth and have a safe outcome. There are people that need a C-section and modern medicine is there for a reason. Not all of us can have a spontaneous labor either. Some of us need an induction.
Let's Recap!
Gina: But if we understand why our labor is stalling, we can better apply different strategies and techniques to try to resolve labor stalls such as addressing baby’s positions. What position is your baby in? This may be something that your provider, your provider or your nurse can assess internally with a cervical exam. If they can feel for baby’s sutures, they could potentially feel it externally through your belly to kind of palpate where baby’s position is.
The next thing that we’re going to think about is the passage. Okay, can we create more space in, the area of the pelvis that baby’s trying to navigate through? So can we create more space at the top, the middle or the bottom of the pelvis, depending on where baby’s at? Both of those labor stalls we can try to mitigate during pregnancy by how we prepare for birth.
So ensuring that we can move each pelvic level, that we can create space in each pelvic level with the different types of hip movement. So external rotation, internal rotation, also asymmetrical type movements. This can also relate to your thoracic or ribcage position because that really correspond to how your pelvis can positions. There’s a lot to it. If you want more, just grab our free birth prep circuit, which is six exercises that are going to help you kind of overcome those internal rotation/posterior pelvic tilt challenges that some of us may have.
We also want to ensure that baby’s path to rotate is clear. So uterine ligaments, various structures that are supporting baby, there’s no restrictions or adhesions. So that baby, when we have those strong contractions, can easily rotate into whatever their best position is because again, some babies, the best position is OP, some babies is going to be that LOT and some is going to be all sorts of different positions.
So whatever their best position is, we want to give them the best chance to move into that position. And then last labor stall is going to be power. It’s going to be relating to how we mentally feel and how we physically feel. So who’s in your room, do you feel safe and supported by them? Give everybody a job. You should it be your biggest advocate!
Someone else should be the advocate for you because you got a lot of other things going on. You’re trying to bear the baby like you’re a little busy right now. And so having people there to support you that are your advocates is really important, both from like your family support or friends. Maybe you hire a birth doula to help advocate for you or help your family advocate for you.
And then we also have our medical team. Everyone there is there to help you, have a good experience and to stay safe and to stay healthy. But everyone should be contributing towards a better experience for you. And the other thing is going to be how you physically are. Have you been eating food? Are you hydrated? And then are you starting to get sick?
And so once we start moving into the labor stall is turning into the labor is no longer progressing. We’re probably not looking at a vaginal birth. Having the conversation with your trusted provider like, hey, this is the path that we need to go, C-section is what we recommend. And then giving you the opportunity to feel comfortable and confident that this is the best decision is again going to start during pregnancy, choosing a provider that you feel comfortable with, that you trust is huge.
Not just, you know, the random dude that’s been doing your pap smear since whenever you could start doing pap smears – I don’t, I don’t know how old you have to be – or he’s been your family doctor since you were three years old. Like, you know, maybe choosing the provider, that aligns with your birth values is going to be the better choice.
And so if you’re leaving your prenatal appointments and you’re like, “I feel good about that person,” versus like, “I have more questions than I did before,” maybe seek out some other options. Who is in your space to not only include like family, friends, likes support people, but also the medical team is going to play a big role in how you feel about your birth.
So thank you so much, Lakeesha and Renee, for being here on our podcast thanks for chatting more for our listeners all about labor stars. If you guys want to learn more from Lakeesha and Renee, they do have their own YouTube page as well. Is it Safe Space Talk?
Lakeesha: Yeah, it’s Safe Space Talk
Gina: And they both have Instagrams as well. Could you guys share your Instagram names and we’ll include this all in the show notes also?
Lakeesha: So mine is going to be thehoodmidwife_keesh on Instagram.
Renee: And then I am the inclusive midwife and it’s the_inclusive_midwife.
Roxanne: So if you’d like to learn more from Lakeesha and Renee, they have a YouTube channel, Safe Space Talk, and then on their Instagrams, they each have their own Instagrams, and we’ll link them all in the show notes below. They share such cool little tidbits and then really awesome information for you to help prepare you for pregnancy and childbirth.
Gina: And thanks for being your guys!
Renee: Thanks!
Lakeesha: Bye!
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