Thursday, June 28, 2012

Malpositioned Babies and Prodromal Labor

What better day to start a birth story than on my birthday?  Which is, if you'll recall, also my Lizzy's birthday- you can read her birth story here if you're in a super duper birth story mood.


But unlike with my others, I don't really know where to start.  Do I start when I first really knew it was really time?  Do I start a week earlier when it could have, and perhaps should have, been time?  Do I start by explaining what that even means?

Yes.

Yes, I'll start there.

So this really isn't part 1 of the actual birth, but it's important, and might even help some of you mamas out there in the future.

See, once upon a time there were some abdominal muscles that separated during one of my pregnancies.  Which pregnancy I don't know, because none of the 4 obstetricians I've had ever bothered to check or talk to me about the importance of the upper and lower abdominal muscles going together properly after delivery.  But when my belly was low and protruding at just 16 weeks gestation this time, my dear midwife (bless her) did check and discovered that they're pretty bad. Which can lead to inability to strengthen the core, back pain, and, most importantly for this story: malpositioned babies.

God is so clever.  Once baby is big enough, his or her head gets heavy and gravity turns baby upside down.  The natural shape of the uterus combined with the super duper powers of the abdominal muscles, keeps baby in the ideal delivery position once he or she is big enough to actually be born, which is to say with back facing out and slightly to mama's left (anterior positioning.  It's labor gold).  Once baby is locked and loaded like this, the body launches it's natural labor sequence and although labor and delivery is no walk in the park, you have the best chance of a complication-free birth with as few interventions as possible and the easiest possible recovery.

When the ab muscles are separated, on the other hand, baby kind of has a lot of room to swing back and forth rather than being locked into place.  So instead of being "locked and loaded" baby is sorta-loaded-not-really-locked and trying to go back to back with mama (posterior positioning), which can cause a) a very long lead up to active labor as the "launch sequence" tries to launch (prodromal labor), b) terrible back pain during labor itself and c) super difficult (read: PAINFUL YES WAY MORE PAINFUL THAN ANTERIOR DELIVERY HOLY COW JUST TRUST ME) delivery of the head.

For anyone who put up with all my whining in the week leading up to little Mary's birth, the malpositioned little nugget being unable to properly launch the labor launch sequence is what was causing all those almost false alarms...and being at minimum 4 cm dilation without going into active labor.  And the way we confirmed that she could have, and perhaps should have, been born that week earlier is that she was an entire pound heavier than her siblings at birth, and 2-3" longer than any of them were.  Her nails were long, long, long, and my placenta....well, it was finished.  It did it's job but it was done.  It had the look of an "old" placenta, which scares me a little.  Because without a hearty placenta, baby doesn't get what she needs, right?

So here's where we are: doctor doesn't check or mention anything about separated ab muscles--> you can't fix it while you're pregnant --> baby is malpositioned --> days or weeks of prodromal labor --> more painful active labor --> more difficult delivery --> increased risk of dangers due to baby potentially being born post-term.

Now I'm not saying that no doctor ever notices or cares or shares this information with you, but I know none of my doctors ever did.  My sweet midwife has observed and taught and helped me more than I ever thought I could learn or be helped at this stage in the game.  I mean, hello?  This is my fifth baby.  Shouldn't I already have all the pertinent information?

But I didn't.  And although in the end everything worked out, there were some sticky spots and not-great moments that could have been prevented with the right post-natal care in the past.

So if you've had a baby in the past and hope to or plan to or may have another baby in the future, find out about the state of your ab muscles.  Not that they need to be visible or remarkable or anything like that.  They just need to be together- their natural, healthiest state.  Some women never have to deal with or worry about the separation, but some do.  I am one of those second some.

Once I finish the actual birth story (we'll call that part 2 of the series), I'll talk about the steps we're taking to try and get my very separated abs back to their 12-years-and-5-babies-ago position.  And if I can do it, I know you can do it too!

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27 comments :

  1. I would love to hear about the healing part! I just ended up with a section for a transverse baby (my 4th 9+ pounder!) that wouldn't move and I suspect my diastisis had something to do with it. My ob tried to repair it a bit with some stitches but it is still bad...

    So happy for you and your family. What a beautiful baby!

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  2. Congratulations on the birth of little Mary!! I just wanted to comment that a friend of mine also had her ab muscles separate a few babies ago. She also has five children. Her doctors were unable to help her and now her tummy is perpetually distended. She either looks like she's pregnant or overweight which is hard for her as she is neither of those things. Please do let us know how your healing process goes. I would love to pass along a success story to her in hopes that she can heal up, too. I don't know maybe it is too late for her. Her youngest is now 2 1/2.

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  3. I know my ab muscles separated with Miguel - he was 9# 4 oz. I ended up with (another) C- section. Now I don't have any ab muscles at all. I mean they are there, but very squashy), but you can't tell because they are covered with fat.

    You'd think that 20 years after my son was born, I would have lost my baby fat, but I have only gained more. So, instead of sitting here with the computer, I should be out walking, but it's raining and my walking partner just canceled....

    But enough about me.

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  4. Oooh, I'm just glad you're ok. That did not sound fun. My abs were pretty much destroyed after I had the twins. I'm almost 100% sure they didn't go back together, and if they did, they didn't heal together correctly, as I feel like I still have a "bump" under the right side of my stomach. Me thinks, after Mother Nature cancels the baby making, some corrective surgery will be happening. This will be my second c-section, so I may end up just being squashy in the middle forever.

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  5. I can't believe you are writing about this because I have had it in my mind to talk about this thing that NO ONE seems to know!! I'm one of those fellow diastasis sufferers and it makes the back pain during pregnancy excruciating at times. When I see or hear women talking about doing crunches and sit ups after pregnancy I just want to scream at them to stop because it actually makes the situation worse. I did a lot during the early parts of this past pregnancy (when it's still possible) to help get my core stronger so that helped this time around. But you're right, I don't know one doctor that knows to check about this OR just as important, makes sure women after birth know how to get their abs back together. I'm so glad your midwife has helped you. So now the plan is for you to write some really great posts on it and then I'll just share them, m'kay??

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  6. Wow, it's crazy to think nobody would have brought this to your attention through so many pregnancies, but leave it to an awesome midwife to do so. Guess it also goes to show we are never done learning, eh? I look forward to hearing more about your birth and thank you for sharing all the details. Inquiring minds want to know!

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  7. This makes so much sense, but I never knew! I'm geekily excited to hear more about how to get the muscles back to where they need to be, because although I haven't been told, I'm SURE they're not sittin' pretty right now :)

    Oh, and the birth story? BRING IT!! (I mean, when you get a spare minute...)

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  8. HAPPY BIRTHDAY!! To both you and Lizzie, can't wait for the next instalment :)

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  9. Happy Birthday to you and Lizzy!

    And I've heard of this ab muscle separation thingy before - way before I considered having children so I didn't pay much mind to the effects. So thank you for the PSA because women need to know these things!! So glad everyone's okay, and can't wait for part 2 :)

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  10. Oh man. I'm sorry to hear about the post positioning.. :( I've had three of those, so I know what it's like :P I swear I was in labor with Jamie for a MONTH. Sofi was actually born "sunny side up" I can't wait to hear how your addressing the muscle separation issue!

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  11. I need more info on the separated abs because after this 5th baby, when I lean back, I get this strange bump in the center of my belly. Maybe I have it? Off to google. And HAPPY BIRTHDAY to you and your daughter! My son was born on my bday, so I know how awesome it is to share one :)

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  12. Okay, so I know I have the separated ab thing. My sis in law has it to such an extent that she was told to have surgery to correct it. Mine is not as bad as hers, and I really don't know which baby caused it. Her second baby, who turned her into a human torpedo, def caused hers.
    I have had most of my babies WAY post term. The last one was so post term he had meconium aspiration, and I just had a horrible feeling that he needed out of there right away...I don't usually let them induce, I wait it out, but that time I thought I needed them to induce, even asked and was told it wasn't yet necessary. This post just convinces me that this time, I am going to pay attention, and not argue at all when my doc says it is time. Over 40, know I go past dates, and doing a vbac...I will do whatever he says! I actually trust this doc totally, so it won't be so hard as it has before...
    thanks for the info...really informative and helps explain the last several weeks of my last several pregnancies!

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  13. Yesyesyes!! All true..and want to hear more! You can also use the Rebozo and similar techniques to bind the belly during pregnancy to help w/ the malpositioning. And I love to recommend The Pink Kit too. See my blog ad for more info on it, in the righthand side bar... www.alamomof5plus.blogger.com I have my story about using it myself pending...and also another mom (Catholic of course) and I have a dream of writing a book for Catholic mothers on birth that is way different from the Kimberly Hahn (no offense meant...she's a wonderful woman) sort of version that says "oh well, we have to be martyrs and suffer through many cesareans if that's what doc says".....to hopefully spare mothers from going through certain things we have.... and to know that there are good and healthy options...because yes it is right and good to offer up our sufferings and to be willing to give of ourselves for our chilren...to undergo major surgery when NECESSARY (I particularly focus on cesareans...but also mean lots of different things, the ab thing being one of many)...but not unnecessarily so...not putting our lives at risk when it is NOT necessary....may ask mothers like you to share your stories (nothing will be without permission btw)...can't wait to read "the rest of the story" :) but you are absolutely right that the great majority of doctors do not know anything about such things, or else they don't care enough to include it in the scope of their practice....but there ARE certain doctors and especially physical therapists who are beginning to work on this issue..we need to demand better care! And spread the word to those who will listen! Ok sorry....off my soapbox... back to your regularly scheduled babymoon :)

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    1. I'm in on that book idea...I have the same dream!! Especially focused on incorporating the Theology of the Body with birth and how mind-blowing it is :)

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    2. Just noticed I put my addy for my boring little blog in wrong :P It's www.alamomof5plus.blogspot.com

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  14. I went to physical therapy for this after the birth of my 4th child. Do you know they have PT people specializing in women? Like they also do PT for *other muscles* if you get my drift. We don't need to pee our pants or have back problems. WHy isn't this talked about more?

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  15. Congrats, i know exactly what got went through. My number two was transverse, until active labor. She ended up being between 10 and 14 days over due.( depending on which due date we used). Even though I had a wonderful D.O./ midwife Who was the most patient man, we still ended up with a c- section because she could never lube up, turns out that my peanut who was a hefty 9 plus pounds had managed to wrap the cord around her neck. I never wanted a c- section but was very happy to have her born.

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  16. I'm so glad you guys are excited about talking about this! I wonder if we've just gotten so used to the idea of inductions and c-sections and epidurals to numb the pain of posterior deliveries that it's become easy to ignore the factors that can lead to these complications. Because I was using a midwife and we knew we wouldn't have access to any of these options unless I switched to a hospital birth, I became hyper aware of trying to get her in the best position possible given the circumstances.

    Of course, I was open to and ready for any kind of delivery to get her here safely (just want that baby in my arms!), but was suddenly very irritated that this was never discussed 11.5 years ago after I had my first.

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  17. I have had these sorts of issues with my deliveries, but because my fluid is high at the end of my pregnancies (with no known reason). They are head down but still sort of floating in there and not causing any pressure and so I will have contractions FOREVER and never progress and never go into active labor. With my second baby I was determined to go into labor on my own and my OB sort of just humored me since it was an awful pregnancy and figured let me have what I wanted. Ughhhh well 10 days later having agonizing contractions and NOOO progress AT ALL (talking not even 1cm at ten days late) I finally agreed to an induction and then she came in 3hrs. Fast and furious! And like you said, she was most definitely ready to come out days before. She was almost a pound more than my other two and her skin was all shriveled and overcooked LOL. When I was ready to have my third and my fluid was high again I agreed to be induced the day after her due date rather than torture myself again!!!

    Can't wait to hear the rest of your story!

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  18. I'm certain my guy was overcooked, too. A pound heavier than my heaviest, huge! AND shoulders seriously stuck. He is also hitting all his milestones much earlier than any of my other kids did. BTW, the abdominal separation. I totally have it, too. Was four finger widths apart, and finally now two. I don't as much as I should, but befitmom.com is a great site for info and free exercises.

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  19. Just had (well, ok, 4 months ago) #2 boy 9 lb 9 oz and suspect I've got diastasts recti too. Funny enough another blog I read sometimes mentioned this the other day and suggested both how to tell if you've got it and some appropriate exercises. Granted, nobody involved here are doctors but I'm going to give these exercises a shot. http://www.aintnomomjeans.com/2012/06/pooch-banishing-exercises.html

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  20. Happy birthday!

    And wow, there's more we have in common - the prodromal labor, the malpositioned baby, the old placenta, the lazy loser abs (not to insult yours, more describing mine)...I was actually 5cm+ dilated for 8 days of prodromal labor w/ my third. I have had lots of prodromal labor w/ babies 3 - 5.

    I'm totally going to fix my core now. I don't know if there are more babies in my future, but I do know that my core muscles are important regardless.

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  21. I know that there is a lot of debate in the US at the moment about health care and some of you may have seen newspaper reports about the failings of our National Health Service here in the UK. But 23 years ago when I had my first baby, the care I had was brilliant. It was mostly midwife led - you really only saw a doctor if there were problems. And one thing they were very hot on was making sure that our abdominal muscles didn't separate. The day after delivery we were given exercises and made to do them. It doesn't stop your tummy looking squidgy - but it keeps it knit together

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    1. Yes! Definitely not about apperances (that's a whole different topic) but about being healed properly from the inside.

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  22. I have been to an optimal fetal positioning workshop and never heard of this! Thanks for the heads up. ♥

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  23. This is so interesting, because I have had 4 vaginal births, but my last one, I delivered (au naturel!) a posterior baby with a forehead-first presentation, and I know my abs had separated long ago. I just had never made the connection! PLUS I had midwives and they never said anything. I would love to hear what you're supposed to do to get them back together! I thought it was a "shrug it is what it is kind of thing". AND

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