Posted by My OB said WHAT?!?.
Jan
29
Posted by My OB said WHAT?!?.
“…Your Tailbone Will Open Up Much More If You Push While Lying On Your Back.”
“You’re not taking advantage of all the space in your tailbone. Your tailbone will open up much more if you push while lying on your back.” – OB to mother pushing on her hands and knees.
There are 57 comments to this post.
If your tailbone opens up, you’ve got problems I would think….
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Jespren Reply:
January 29th, 2012 at 6:17 pm (Quote)
Well ‘opens up’ isn’t a good word choice, but sometimes the tailbone does move back to open the birth canal up. I have a tiny pelvic arch, which means a tiny birth canal, until my tailbone (and lower vertebra) move down and away when baby engages. Pain? Yes. But it sure makes for a bigger opening! (And requires me *not* to be laying on it at the time!)
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What the what?! I can’t even wrap my head around this one. It’s just a jumble of ridiculousness. I pray the OB felt just as stupid once they realized this came out of their mouth.
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Knitted in the Womb Reply:
January 31st, 2012 at 12:15 pm (Quote)
I can assure you that the OB did not feel stupid, just as the nurse who tried to convince my client to lay on her back to more effectively utilize gravity did not appear to feel stupid. My client was kneeling…and shot back at the nurse “what about this position doesn’t utilize gravity?” and the nurse actually came up with a crazy explanation. Good thing my client was too busy pushing her baby out–before her OB got there–to listen to it.
I really think I should be bringing my pelvic model and baby doll with me to births so that I can do “pelvic engineering” lessons on the fly. “The stupid” makes my brain hurt some times.
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Translation: “I don’t know what to do if you’re not on your back.”
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Kristin Reply:
January 29th, 2012 at 3:05 pm (Quote)
“This position makes it hard for ME. Don’t you want ME to be comfortable while you birth?”
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Mama Wrench Reply:
January 29th, 2012 at 3:48 pm (Quote)
Well, we all know the doctor is the most important person in the room.
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With all the evidence to show that birthing on your back is generally the WORST and most difficult position to birth in, why on earth are doctors still insisting on that position? Why wouldn’t they see hands and knees as easier seeing as there will likely be a much shorter pushing stage?
I honestly don’t get it.
For me, during my pushing phase my body gets itself into a position and I can’t bear to be on my back. Even with my 1st birth where I had an epidural I made my mum and partner stand on either side of me holding my arms so I could lean on them to squat, with my feet on the lowest part of the broken down bed and my bum perched on the edge of the bed.
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Kristin Reply:
January 29th, 2012 at 3:00 pm (Quote)
They insist on it for the following reasons:
1. It’s easy to see the baby coming out.
2. It’s easy to manipulate/pull on the baby from this position.
3. They can make an episiotomy very easily.
4. This is the position you need to be in for the doctor to use suction, forceps, vacuum, etc.
5. It lets the doctor be in control during the pushing phase.
6. If something goes wrong, the doctor has clear and easy access to the baby.
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Dreamy Reply:
January 29th, 2012 at 3:28 pm (Quote)
And perhaps most saliently…
7. That’s the way “it’s always been done.”
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Katy Reply:
January 29th, 2012 at 5:29 pm (Quote)
Also, it is easier to forget that it is a real person you’re helping, rather than some random piece of anatomy, when you can’t see her face.
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Jane Reply:
January 29th, 2012 at 5:37 pm (Quote)
Robbie Davis Floyd says it’s the capstone of the ritual inversions that have been going on during the entire process of hospitalized birth, when the mother’s private parts are on display and the doctor is facing the mother’s vulva, turing her upside-down in effect so her vulva is where her head should be.
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IDS Reply:
February 1st, 2012 at 8:43 am (Quote)
It’s not ALWAYS been done like that, only since some queen was giving birth so the king could see that the baby he was presented with is the actual baby that came out of the queen lol,
…and all mentioned n the previous points probably won’t be necessary if the women is allowed to birth being upright!
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Because the bed does not put any pressure against your tail bone if you lay down on it.
I tried explaining this to my sister:
Imagine a tunnel mounted on the ground. It’s 1ft wide. A 6ft tall man is trying to get through the tunnel. The top and sides of the tunnel expand, the bottom does not. Wouldn’t it be easier for the man to get through the tunnel if the bottom also expanded?
She couldn’t see the metaphor, and I bet OB wouldn’t either…
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Mama Wrench had this to say,
Jan 29, 2012 @ 3:26 pm (Quote)
Kay had this to say,
Jan 29, 2012 @ 3:44 pm (Quote)
Could there be some validity to this in certain situations? My home birth midwife asked me to get onto my back (sort of an upright reclined position) for a short while after about 1.5 hours of pushing so that the baby would pass under my tailbone. I didn’t understand the logic, but I didn’t have to stay in that position for very long and spent the rest of the time on my hands and knees or side. While I didn’t find pushing in an upright reclined position painful, it did make me nauseous. Thankfully I was able to eat and drink what I wanted throughout labor and in between pushes.
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jenni Reply:
January 29th, 2012 at 3:51 pm (Quote)
under your tail bone? under your pelvic bone maybe, but you are right about one thing there, even Ina May Gaskin recomends POSITION CHANGES, because baby’s head has to turn at least twice to manuver around the bones in mommy’s pelvis, so moving around is best even if for a moment one of those positions IS on your back. as long as you also use other, NOT on your back positions as well!
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Christina Reply:
January 29th, 2012 at 5:25 pm (Quote)
Yes, in rare instances, the lithotomy position (on your back with your knees pulled towards your ears) can help a baby pass under the *pubic* bone (not the tailbone). Once the baby is unstuck, then it’s best to get into a more physioically sound position. But yes, lithotomy does have it’s place, from time to time.
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Cindy Reply:
January 30th, 2012 at 7:53 am (Quote)
Actually, with a posterior presentation, laying on your back and arching your back will help move baby under a pubic bone. The thing is, most moms will do this instinctively if allowed freedom. I’ve also seen moms arch backwards from hands and knees in a tub, does the same thing. You don’t need to pull those knees back to your ears. Soometimes a true McRoberts position, which is flexing the thighs up onto the abdomen, will notate or move the pubic bone so the baby will slide under or in a dystocia, the shoulder slides off. But you don’t want the knees pulled severely back, that chagnes what the pubic bone does and can hurt the woman.
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Wow that OB did not take anatomy if he did he would have learned that its not the tailbone that opens up its the pelvic bone and would have learned that pushing on hands and knees is the optimum position. what an idiot.
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Ellen Reply:
January 29th, 2012 at 8:30 pm (Quote)
Actually, having taken anatomy and taught childbirth classes for ten years, I can tell you the tailbone *does* open up when you’re not sitting or lying on it — squatting (the optimum position for most women, not hands-and-knees) opens the pelvic outlet by up to 30% more than the “classic” lying-on-your-tailbone positions.
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IF Survivor had this to say,
Jan 29, 2012 @ 4:13 pm (Quote)
bahahahahahah!
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I just went to a classes on shoulder dystocia and the first position the midwife suggested was flat on the back with knees up. The Gaskin maneuver was like 5th in the steps.
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Mama Wrench Reply:
January 29th, 2012 at 5:43 pm (Quote)
She was probably referring to the HELPERR mnemonic — call for Help, Episiotomy, hold up the Legs (McRoberts), apply Pressure, use Enter maneuvers (manipulate baby inside the vagina), Remove the posterior arm (physically pull arm out to change rotation of the baby), and Roll the patient onto hands and knees (Gaskin).
Supposedly the order of the HELPERR mnemonic is to go from least to most invasive and extreme, but I fail to see how cutting an episiotomy is less invasive than rolling Mom onto hands and knees…
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Jespren Reply:
January 29th, 2012 at 6:13 pm (Quote)
And wouldn’t ENTERING the mom be the *most* invasive?? (Personal experience here, my babe took Gaskin and Woodscrew method to un-stick.)
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Jane Reply:
January 30th, 2012 at 4:11 am (Quote)
Perhaps someday a doctor will explain to us how cutting soft tissue at the vaginal outlet will release the baby’s shoulders from being trapped in the pelvic bones.
(I know the answer is “If you don’t do it, a jury will find you guilty,” and other times they say “You need that for room to maneuver,” but they really should roll the mom to hands/knees first. My midwife shoved my knees back to my ears, but then again, my daughter wasn’t a true dystocia. She got halfway out and then the contraction ended, and we needed to wait for the next one when she popped right out.)
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Mama Wrench Reply:
January 30th, 2012 at 8:37 am (Quote)
I’d be willing to bet it’s equal parts legal protection, the easy access for further manipulation (up to and including intentional breaking of the clavicle) and the assumption that an irregular presentation means that Mom will tear, anyway, coupled with the assumption that a surgical cut and a natural tear are the same thing.
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Kate, Ren's Mama Reply:
January 30th, 2012 at 3:31 pm (Quote)
I’ve always assumed that the HELPERR mnemonic is based on the assumption that mom has had an epidural, which would make rolling her on to hands and knees much more difficult. Still seems less invasive than ANY of the other steps, but still, it might explain something.
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Mama Wrench Reply:
January 30th, 2012 at 3:55 pm (Quote)
It’s possible. I had an epi last time and my OB didn’t think twice about putting me on hands and knees to help the baby’s HR recover between contractions, can’t imagine they couldn’t do the same for a shoulder dystocia.
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K Reply:
February 1st, 2012 at 10:13 am (Quote)
Yep, McRoberts is going to be easiest in around 90% of the births in many hospitals because that’s the epidural rate. And shoulder dystocia is something that the staff drill on, so that when it’s happening they don’t have to spend a lot of time thinking about what should happen next as the baby is being deprived of oxygen. HELPERR does throw in Gaskin at the end there, but with an unanesthetized woman, you’d look at the position she was in and see what would happen faster, McRoberts or hands and knees. Most providers have learned the internal maneuvers at the angle that McRoberts provides, though.
Basically, it is scary to improvise during a shoulder dystocia. Seconds are brain cells. The thing is, McRoberts is effectively Gaskin on the back, if you look at what happens to the pelvic opening in that position.
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Alyson Miers had this to say,
Jan 29, 2012 @ 6:53 pm (Quote)
LIAR LIAR PANTS ON FIRE!
I know what Doc means about the tailbone, but if we’re supposed to believe that lying on the back is good for that, then I’d like to sell you some land in Florida.
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Jenny Islander had this to say,
Jan 30, 2012 @ 12:14 am (Quote)
Whether you are ignorant or whether you are lying, I am not safe with you in the room. Please leave. NOW.
My husband sells building supplies for a living and he knows that tailbones cannot flex AGAINST THE ENTIRE WEIGHT OF AN ADULT HUMAN BEING PLUS A BABY. So what’s your excuse?
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K Reply:
February 1st, 2012 at 10:16 am (Quote)
During a shoulder dystocia, the woman is rocked onto her back with her coccyx actually off the bed, knees far back. This way the coccyx isn’t being compressed against the bed, so it can move, and the pelvic opening is widened.
So frankly, that is why building supply sellers and their spouses shouldn’t be trusted for medical advice.
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Lisa Reply:
February 1st, 2012 at 10:44 am (Quote)
I don’t think this post was talking about shoulder dystocia…this was a normal delivery. And during the normal deliveries that I have seen, at least, the coccyx is resting on the bed…being compressed.
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Melissa Reply:
February 1st, 2012 at 10:57 am (Quote)
I see your McRoberts, and I raise you a McGaskins…
And by the way…widened as compared to what…sitting on your tailbone in either lithotomy or c-curl positions? Because it’s certainly not widened as compared to, say, squatting.
Also…what Lisa said.
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Thanks to a fall at 23w this pregnancy my Fam dr basically told me that it would take 8-16w to heal my broken tailbone and if I even attempted to deliver on my back it would almost 100% break again from the pressure and the inability to move out of the way of the baby.
IF my Family dr knows this why doesn’t an OB who specializes in birth know.
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I was watching one of those Baby Shows on TLC and the mom was having trouble moving the baby down, so the OB suggested she get off her back and on her hands and knees. I was THRILLED to see this.
Mom turned on hands and knees, and what do you know, the baby started moving down and she was making progress.
My thrill turned to disgust when as soon as the OB saw that baby was coming down, she TURNED MOM BACK OVER ON HER BACK!!! Pushing was still another 2 hours more once she was put back on her back again. I was shocked. Mom was making good pushing progress, and then had it all messed up.
Oh well, I guess I should be glad that she was “allowed” to push for 3+ hours and wasn’t wheeled into the OR for a bogus case of CPD.
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Bull Shit…
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