Cesarean

A Necessity Disguised as a Luxury

Marie-Ange Bigelow Cesarean, Doula, massage, Medical Childbirth, Natural Chilbirth 0 Comment

“Therapeutic massage has been used for centuries to improve overall health, reduce stress, and relieve muscle tension”. *

 

As a licensed massage therapist, birth doula and postpartum doula, I have seen first-hand the benefits and effects of massage on pregnancy, labor and the postpartum period.  Today I want to tell you how I incorporate massage into all my areas of support and expertise, and teach you the many ways massage can support a mother from conception through postpartum.

Pregnancy:

During pregnancy I recommend at least one massage a month, but more if they are experiencing pain and tension. Some of my clients get massages every 2 weeks. I’ve had others who get far less. Whatever you decide, there is no doubt it will have a positive effect for you and your pregnancy. One of my clients decided to get massaged on the same schedule as her doctor’s appointments; once a month until 28 weeks, then every 2 weeks until 36 weeks when she started coming every week. I thought it was a brilliant plan.

Massage provides many benefits during pregnancy including: “*Reduced back pain, reduced joint pain, improved circulation, reduced edema, reduced headaches, better sleep and reduced stress.”  Plus, it feels amazing! Many women I know just do not take the time to take care of themselves. To me, massage is therapeutic, not a fancy “rich person” thing to do. My business slogan is; massage is a necessity disguised as a luxury. I get massaged every two weeks because I need it, and not just when I’m pregnant! My body goes through a lot and If I don’t take care of myself then I won’t be able to keep doing the work I love for long.

Some pregnancy symptoms that I have personally helped clients with include; SPD, carpal tunnel syndrome, TMJD, headaches, back aches, round ligament pain and edema. I cannot guarantee results but most of the time women see a lot of improvement.

Labor Induction:

Many women contact me during the end of their pregnancy for a kick-start labor massage. This is actually one of my favorite massages to do. Of course it doesn’t always work, but well over half the time it does. I have even had women go into labor on my table! (Which I never get tired of.) A kick-start labor massage includes relaxing the back, neck and hip area as well as focusing on the acupressure and reflexology points that are known to start labor. If it doesn’t work, at least the pregnant mama got some needed relaxation and tension relief.  I’ve learned special points to induce labor in classes and from mentors that have done this for years. I have practiced and honed my skills in the 6+ years since I’ve graduated from school.

Labor:

There is a small percentage of women who don’t like touch during labor but most of them find that massage relaxes them and lessens their discomfort.  When my clients ask me if I can massage them during labor I always respond with “Yes!  And it will feel amazing!”

Almost all of my doula clients love foot rubs and back rubs during labor, as well as the counter-pressure techniques I do. There are certain acupressure points I use to make sure their labor progresses smoothly, especially if they have an epidural. I also use clary sage oil and some blends made by my doula agency, Beautiful Birth Doulas.

Since I specialize in massage I include one massage in every doula client’s birth package, with the option of adding on more massages if requested. I actually have a good reason to include this, besides the fact that everyone needs massage. First, women seem to go into labor when they are relaxed. so keeping them relaxed in the final weeks of pregnancy is very beneficial. Second, by giving my pregnant clients a massage before they are in labor, I can gage their pressure preferences, ticklish spots, and tense areas. This allows me to know exactly what each client prefers and automatically do it when I’m massaging during labor! (Sneaky, I know, but it really does make me seem like I have “magic hands”.)  Just as you want your doula to get to know you, it’s a good idea for her to get to know your massage preferences, too.

Postpartum:

As a postpartum doula, I cannot neglect the “4th trimester.”  Though the first 6 weeks after birth are critical for recovery, this is a time most American women seem to skimp on. They feel the need to get up and go to church or go to the store mere days after giving birth. Here is my opinion, if you feel a surge of energy, save that energy for healing! And massage can be a great way to facilitate postpartum healing.

Massage is appropriate and useful any time after a woman has given birth. Massage done within the first few days postpartum is typically most comfortable for the woman inside her own home, and I am always happy to provide these (even when mom is wearing her postpartum underwear!).  Most moms who’ve had epidurals find that their back muscles around the injection site are sore and tender. Also many women give birth squatting or are bouncing on the birth ball during labor, which leads to sore legs and glutes.

Generally I tell women that 2-6 weeks postpartum is an ideal time to come in and get a massage. During postpartum massage I always include the stomach, which most women love. Don’t confuse this stomach massage with the often painful “uterine massage” nurses perform soon after a woman gives birth. This is a very gentle, soothing massage that can help your uterus shrink down to normal, organs return to place faster, helps with constipation and also with digestion.

If you have had a cesarean birth, I can’t do stomach massage until 6 weeks. If you are breastfeeding, postpartum massage can help with your strained back and neck from those awkward breastfeeding positions we sometimes find ourselves in.

Pregnancy changes the body drastically over 9 months. I believe massage can help facilitate these changes and make for an easier birth and recovery. I would encourage all pregnant women to make prenatal massages a part of their pregnancy journey.

14012479_10153671714621971_1486364333_o

Written Jennifer Anderson LMT, Beautiful birth doula and postpartum doula

Owner of Tachi Massage

898 S State St STE 310, Orem UT 84058

Mention this post and get $15 of a massage or $50 off a doula package.

Jennifer has been a licensed massage therapist for over 6 years. She graduated from UCMT. She’s loved every minute of it. The last few years especially, Jennifer has focused on prenatal massages, and is now a birth doula and postpartum doula. She usually incorporates massages into everything. Over the years she has worked at spas and chiropractor’s offices as well as private practice. She is always hungry to learn and grow her knowledge to share with clients and friends. Jennifer is married to an amazing guy Dennis and together they have 2 daughters, 6 and 4 as well as another on the way!

 

*I am not a doctor and you should discuss any lifestyle changes with your doctor or midwife

When it Comes to Cesareans, We Need More than Just Awareness

Marie-Ange Bigelow Cesarean, Research 0 Comment

It’s April, meaning my daughter just turned 11, and it’s Cesarean Awareness Month!  As a childbirth educator and doula, my Facebook feed has been exploding with all the current improvements to cesarean births.  Like my colleagues, I applaud these changes as they not only humanize the surgical birth, but also make the birth healthier for both the infant and mother, and more fulfilling for the mother.  But unlike many of my colleagues, I find that these measures fall short of what should really be done to improve cesareans in America.

What’s currently being done?

A new technique called seeding introduces the infant to the healthy bacteria found in the mother’s birth canal.  Babies born vaginally are naturally exposed to this, and their immune systems are strengthened this way.  Cesarean born babies miss out on this natural exposure to healthy bacteria, so women now can ask for their vaginal fluid to be gathered and swabbed around the baby’s face shortly after birth. (1)

There’s also news of care providers now allowing skin-to-skin contact between mother and infant directly after the birth.  This is a great step in humanizing the experience, improving birth satisfaction for the mother, and eliminating unnecessary separation of mother and child.  The benefits of skin-to-skin have been well documented for quite some time, (2) and honestly, it’s ridiculous that it has taken this long to include mother-child interaction in 1/3 of American births.

Some hospitals now are giving women the option of clear drapes so they can view their cesarean.  Though not for the faint of heart, this measure helps include the woman in her own birth.  It can help her feel like she participated in her birth, instead of making her feel like her birth was something that was done to her.  There’s even a new drape with a flap for the doctor to pass the baby through so the mother can have contact with her child.  (3)

I think that women requiring cesareans absolutely should have access to all the improvements listed above, as well as any other reasonable request they may have.  (ie: her choice of music playing, her husband/doula/photographer present)  But these new measures are far from being routine, and parents shouldn’t assume they will be offered all or any of them.  As a country we need to get behind these improvements and encourage them to become routine practice.  But there’s also a lot more we need to do.

Why aren’t these improvements enough?

The measures mentioned above are good ideas to improve certain aspects of the cesarean.  But to the overwhelming majority of American women who receive cesareans, these improvements are a consolation prize.  Why?  Because over half of these women did not medically require a cesarean.

www.MarieBigelow.com (3)

The big issue here isn’t only “how can we make a cesarean a better and safer experience?”  We also need to address the fact that our cesarean rate is triple what it should be, that many doctors feel more comfortable performing a cesarean than they do supporting a difficult vaginal birth, and there are financial incentives that feed into our high cesarean rates.

Our rates are way too high.

The number one reform needed to the cesarean is a lower cesarean rate!  The World Health Organization believes that the cesarean rate should be between 5 and 10%, yet America’s rate is a whopping 33%.  (4) So no matter how family friendly a cesarean is, the truth of the matter is, 70% of women receiving a cesarean don’t even need one! Cesareans have a large list of potential risks, and improving one aspect of the birth will not remove the side effects of having a cesarean that you didn’t need.

Doctors need to feel more comfortable with vaginal births.

With a reasonable cesarean rate, women know they are only getting a cesarean if they truly need one.  In order to lower our rates, American obstetricians need to get more comfortable outside of the operating room.  New doctors to the field report feeling less confident in delivering a baby with forceps or a vacuum as opposed to doing a cesarean. (5) If doctors feel the most competent outside of vaginal birth, then vaginal birth has a very small chance of survival.

Get Rid of Financial Incentives for Doctors

If someone told you they would give you a hefty bonus if you could get the job done in a fraction of the time, would you be tempted?  Studies indicate that doctors sure are, as long labors are the number one reason for cesareans (5), and doctors make more money performing a cesarean than they do supporting a vaginal birth (6).  Hospitals can also pocket thousands of more dollars after the procedure.(6)  (Shouldn’t insurance companies just be outraged over this?!)

The American Congress of Obstetrics and Gynecology states that labor dystocia (long labor) is not an evidence based reason for needing a cesarean, and that most women will be able to deliver vaginally when given more time to do so.  And since most women desire a vaginal birth, their care providers should be patiently encouraging them, not offering a quick fix with the potential of long-term side effects.

This research suggests that some doctors are performing cesareans out of convenience and financial payoff.  And that puts moms and babies last, when they should be first.  Imagine telling a women, “Hey, don’t feel bad about your unwarranted cesarean that cost twice as much as a vaginal birth and will take a lot longer to recover from, and may even prevent you from having more children.  At least you got the clear drape!”

Getting it Right

What women really want and deserve is the peace of mind in knowing that they are getting the best care available.  Reassured they will be supported through a vaginal birth – even if it’s long and inconvenient.  Confident they will receive a cesarean only when medically necessary,

For many women, cesareans are scary and their recovery can be long and burdensome.  It’s time for the medical world to make some accommodations that improve the experience for women.  All women who truly need a cesarean should be treated with respect and given as many family friendly options as possible.  We need to improve the cesarean without normalizing it, or using improvements as justification for the continued over-use of them.

 

 

Notes:

  1. http://commonhealth.wbur.org/2014/06/birth-canal-bacteria-c-section
  2. http://www.medscape.com/viewarticle/806325
  3. http://www.richmond.com/business/local/article_6a61730c-f78b-5cef-8c96-0967a9da554d.html
  4. World Health Organization, The Global Numbers and Costs of Additionally Needed and Unnecessary Cesarean Sections Performed Per Year: Overuse as a Barrier to Universal Coverage, World Health Report (2010) Background Paper, No 30.
  5. ACOG, Safe Prevention of the Primary Cesarean Delivery, Obstetric Care Consensus, March 2014.
  6. http://www.npr.org/sections/health-shots/2013/08/30/216479305/money-may-be-motivating-doctors-to-do-more-c-sections
  7. Carol Sakala and Maureen P. Corry, Evidence-Based Maternity Care: What It Is and What It Can Achieve (Milbank Memorial Fund, 2008), 44–46.