February Knowledge Drop: Birth Preparation
Each month for our newsletter, the Lady Blurb, we'll share answers to some pelvic health questions you've submitted. The questions below were taken directly from you! To submit a question for next month, comment below or email us at contact@ladybirdpt.com.
**The answers to these questions are not meant to be used as medical advice. These answers are not meant to take the place of a skilled physical therapist or discussion with your medical provider. If you are experiencing concerning symptoms, please contact your physician.**
This month, we’re focusing on birth preparation and answering:
What is the difference between a birth prep appointment and a birth education class?
Why do people give birth on their backs if there is so much research to support other birthing positions that are associated with better healing outcomes for the birther and equally safe for the baby?
What is perineal tearing and will it hurt?
For those of you who are unfamiliar, a birth preparation appointment offered at Lady Bird Physical Therapy is a 55-minute appointment where you get 1-on-1 time with your physical therapist to discuss your goals for your delivery and how to best prepare your body to achieve those goals. Some patients schedule a birth prep appointment as a part of their plan of care to address their symptoms during pregnancy, others will schedule their first visit as a birth prep appointment.
These are the 3 most common questions I get asked either during a birth prep appointment, or when deciding whether or not to schedule a birth prep appointment!
1. What is the difference between a birth prep appointment and a birth education class?
Truly, this is one of my favorite questions and until I entered the birthing world, I could not have told you the answer either so I think everyone needs to hear it.
Disclaimer: This is based on the birth education course offered here at Lady Bird Physical Therapy – I cannot speak for all birth education options scattered across the 7 continents and the vast expanse of the internet.
A birth prep appointment with our physical therapists is focused on the physical body – how is your body preparing for the marathon that is birth, and how does it heal postpartum? Concepts include the most up-to-date evidence-based information on topics such as:
Tearing in/around the perineum, and how to help reduce the risk of severe tears both during pregnancy and during labor
Pushing strategies to protect your energy during labor and baby’s energy during labor
Labor/delivery positions to best optimize your strengths and help you to achieve your goals
Tips/tricks on movements and positioning during labor to help mobilize the pelvis and help baby navigate their way into the birth canal
Postpartum healing timelines and return to physical activity
On top of all of this, we have the opportunity to demonstrate what perineal massage looks and feels like, and the birther gets to practice the different types of pushing while receiving immediate feedback from their PT. Oftentimes, folks say they feel more confident in their body’s ability to complete the task lying ahead of them. The other wonderful option for the birth prep appointment is our fearless leader, Dr. Rebecca Maidansky, also offers online birth prep education for nearly half the price of an in-person appointment! That being said, the down side to taking this version instead of an in-person option is there’s no modification to your body specifically, you don’t have the ability to ask questions, and you aren’t able to feel perineal massage or practice pushing with immediate feedback, in-session.
On the other hand, a childbirth birth education course with a certified birth educator approaches birth through a much wider lens. (P.S. Our March dates have just been announced so if you’re giving birth in May or June, check it out!) Concepts include the most up-to-date evidence-based information on topics such as:
History of birth and the system our clients will all deliver in (if not doing home deliveries)
Differences in practices between obstetrics, midwifery, and doula care
Physiological occurrences during labor and delivery – in layman's terms, how birth happens and the changes that occur in the body to make it happen
Stages of labor, delivery, and tips and tricks to navigate each of them
Education on common medical interventions and the most up-to-date research available on the efficacy, benefits, and potential risks of each
Tips and tricks to set yourself up for success to carry out your birth plan, if you have goals you’d like to achieve (example: unmedicated birth with low to no intervention)
Tools for pain management
Questions to ask yourself, your partner, and your provider to help you achieve your goals
SO much more!
While this list is certainly not all encompassing, it does highlight the main differences between what a birth prep appointment and online education offers and what our childbirth education course offers. For more information on our birth prep appointment with a physical therapist, please send us a message to learn more or schedule an appointment. For more information on the online birth prep option, please visit our website here. For more information on our birth education course, please visit our website here.
2. Why do people give birth on their backs if there is so much research to support other birthing positions that are associated with better healing outcomes for the birther and equally safe for the baby?
Oh, how I adore this question. I want to preface this answer with the following information:
Our healthcare system has limitations, and many providers have their hands tied by the institution they belong to. So I answer this with the utmost respect and adoration for the providers out there who have their patients’ best interest at heart.
My answer to this question is multifactorial and is based on my experience from patient perspectives, shadowing obstetricians and midwives, and having conversations with an array of others in this niche birthing world.
While this list is certainly not all-encompassing, in my humble opinion, the most comprehensive answer includes these concepts:
Most delivering providers are taught to deliver in the lithotomy position, where the patient is on their back with the knees bent, similar to being in stirrups at the gynecologist’s office. This makes perfect sense when you think about it; providers can see what they’re doing, providing intervention when necessary is easily accessible (can you imagine a provider trying to use forceps while you’re squatting or in the tub?), the birther is in a stable, safe position which minimizes the need to have to relocate them in the event that medical intervention becomes necessary, and makes it easier to medically monitor both birther and baby.
That being said, another component that factors in is most providers are bound by hospital policy. It is no secret we belong to a very litigious society, and obstetric and gynecological care has some of the highest malpractice insurance costs among all medical providers. This makes sense though, right? They’re delivering YOUR CHILD, and we all want our kiddos to make it out safely without any complications. If you’re still wondering why hospital policy is written to protect the hospital and its providers with regards to obstetric care, the statistics speak for themselves. Many birthers do not sue for injuries to themselves, but they’ll sue for injuries to their children. OB/GYN’s have a higher risk job given that birth can become a life-or-death situation very quickly (way more often than let’s say, an orthopedic surgeon), and people quite frankly just care a lot more about the outcomes of this type of medical procedure than they do most others because – it’s your kid!
Obstetric care is also responsible for the higher complexity cases, which skews their outcomes but also skews their malpractice insurance rates, complication rates, and therefore skews hospital policy. Many midwifery care centers do not accept high risk birthers and pregnancies. The more variables that are controlled and standardized, the easier it is to provide highly specialized, skilled care to those in need, which in turn, minimizes risk of severe injury to either birther or baby, (and, the easier it is to protect the hospital from being sued in the event of a birth injury because this is standard practice of care.)
At the end of the day, what’s important to know is that hospitals have more policy in place and standardize their care than any other birth setting, and therefore, can make it appear as though you have less autonomy in the birthing space than you actually do with regards to labor and delivery positioning based on how much medical intervention you receive. The reality is, you have every right to choose what is best for you and it is illegal for them to force you into anything you do not consent to. We highly suggest you (and your partner, when applicable) discuss your provider’s preferences as well as limitations based on hospital policy with them leading up to your delivery, and if you should choose to do so, you have every right to pursue a different delivery space if your preferences do not line up with your provider’s, for whatever reason. If you are interested in receiving a list of resources that support alternative labor and delivery positions, sign up for a birth prep appointment by following this link.
3. What is perineal tearing and will it hurt?
Again, an excellent question – good on you for asking. Let’s break down anatomy. The perineum is a diamond-shaped structure inside of 4 boney boundaries. The boney boundaries are: the pubic bone in the front, the tailbone in the back, and the sit bones on either side. Tearing can occur throughout this space while baby is being delivered – by the clitoris, in/around the inner labia, around the urethral meatus (where urine exits the body), on the walls inside of the vagina, or in the space between the vaginal opening and anus. Here’s a summary of the various forms of tearing that can occur during childbirth.
Spaces closer to the center of the triangle are more common to have tearing occur – which makes sense, because the center of the triangle is the space that stretches the most when a baby is delivered vaginally.
For the sake of clarity, we will focus on the most common space for perineal tearing: the space between the vaginal opening and the anus.
Now, there are 4 degrees of perineal tearing:
1°: Through skin and mucosa layers, so a more superficial tear. However, being more superficial does not equal smaller. Tearing can occur very superficially but can still be longer in length.
2°: Tearing down to the muscular layer – this is often when stitches enter the chat.
3°: Tearing that runs down to the muscular layer and travels to the external anal sphincter, or what is commonly known as the anus
4°: Tearing that runs down to the muscular layer and travels to the internal anal sphincter, or inside the anus.
Onto the next half of the question – will it hurt? Before I answer that, a few things should be mentioned:
Perineal tearing is so common it’s practically considered normal. Perineal tearing occurs in ~80% of vaginal deliveries depending on the study you pull this statistic from, and the vast majority are Grade 1-2 tears. When I say vast majority, I mean over 80%.
In your birth prep appointment when we discuss ways to reduce the risk of perineal tearing, what we’re actually looking to do is reduce the risk of SEVERE perineal tears – meaning Grade 3-4 tears, which are associated with more complications during the healing process (as you could probably expect). These occur in less than ~6% of vaginal births.
All efforts to decrease the risk of perineal tearing have only been shown to be effective in reducing the risk of Grade 3-4 tears in the literature, meaning, we’re not necessarily trying to reduce the occurrence of Grade 1-2 tears.
Grade 1-2 tears are easier for your body to heal from than episiotomies. This is why episiotomies are not common practice any longer.
With all of that said, most patients report that they did not feel when they tore and the sensation was indistinguishable from their overall birth experience. There are so many other sensations occuring at the same time in the same small area (lovingly referred to on the streets as “The Ring of Fire”) that tearing blends into the background.
And there you have it! A quick birth preparation knowledge drop. If you find yourself having more questions or wanting to dig a bit deeper into this information with us, or know of someone (birther or partner) who would really benefit from hearing this information, please don’t hesitate to reach out to get scheduled for a birth prep appointment today!
Working with a pelvic floor physical therapist can help address sexual dysfunction, bowel and bladder concerns and help you prepare for pregnancy, birth and postpartum recovery. Contact us here to learn more about setting up an appointment with us, today!