On February 8th, 2009 I wrote a post entitled Top Ten Things Women Say/Do During Labor (And trust me… they are totally normal!). This piece has been the most popular post on my blog yet, which is pretty exciting! When I originally thought of the piece, I figured that most women would stumble upon it by searching for something like “Things to do in labor” or “Things women say in labor”. However, upon reviewing the top searches of February/March for this blog, I was surprised to find that they didn’t include those phrases at all! Instead they all had one simple thing in common: POOP. That is right… poop!
Here are the top 7 searches for NursingBirth in the last two months: (Note: The wording is not altered at all…these phrases were actually typed into a search box and searched for!):
#1 Pooping in labor
#2 Will I poop while I push?
#3 How many women poop during delivery?
#4 Labor and delivery nurse poop
#5 L&D nurses and bowel movement during delivery
#6 Woman in labor thinks she has to poop
#7 What will happen if I poop during delivery?
Since I am a labor & delivery nurse, I am naturally inclined to jump on any opportunity to talk about bodily functions (especially during awkward times like dinner or outings with the in-laws J) and consequently, I have been inspired to write a post about, what seems to be, the number one thing on every pregnant woman’s mind…POOP!
So here they are: The Top 10 DOs & DON’Ts of Pooping During Labor & Birth
#1 DON’T forget that life does go on after an embarrassing moment. How many of you have accidentally passed gas during sex? You’re all “hot and heavy” with you man (or woman) and you’re both getting into it and then…whoops! If he/she happened to make a big deal out of it, hopefully you kicked him/her to the curb! Let’s face it, the people that are closest to us often see us in embarrassing situations at one point or another in our lives: bowing down to the porcelain god after a night of partying, passing gas during lovemaking, runny nosed and hacking up a lung during a bout with the flu, squatting to pee in the woods during an outdoor sporting event etc. etc. etc. And if those things happened in the company of someone who really loves you, they probably still loved you just as much, or even more, afterwards. Cuz hey, you’re human! (By the way, I have personally experienced all of those things so if you are laughing and thinking the same thing…you are not alone! And for the record, the guy that I passed gas on during sex ended up marrying me this summer so it couldn’t have scared him that much!)
#2 DO understand that the vast majority of women poop during the birth of their babies and that this phenomenon is NORMAL. If you think about it, when your birth attendant tells you to “bear down and push” they are really telling you to “push like you have to poop!” It is the exact same motion. And if you do poop, your nurse, midwife, or doctor is usually reassured that you are pushing correctly!! In fact, the WORST thing you can do is not push right because you are afraid to poop! I have seen it happen before and it is such a shame because these women just end up pushing for way longer than they should have all because they let their fear of embarrassment overcome them. As a labor & delivery nurse, I do not keep records of exactly how many women poop during birth (can you imagine pooping statistics! haha! J) but you can rest assured that it is the VAST MAJORITY of women. If someone you know tells you they didn’t poop during childbirth they either are: #1) part of the very small minority of women who actually don’t, or #2) just didn’t realize they did. And to be honest, #2 is way more likely!
#3 DON’T invite anyone to be present at your birth that you are not totally and completely comfortable with them seeing you in your most vulnerable and trying moments. Let’s be honest, even in the closest of relationships not many women are comfortable going to the bathroom and pooping in front of their significant other or family members but it is important to understand that the circumstances of childbirth are way different than just your daily morning bowel movement. My mother doesn’t prefer to be there when my grandmother is bathing, dressing, and going to the bathroom but when my grandmother broke her arm this past winter and needed surgery, that is exactly what my mother did because she needed her. And I would do the same thing for my mother as I know she would (and has) done for me! Passing a bowel movement or gas during labor & birth are normal bodily functions that happen during normal labor (as is burping, throwing up, grunting, groaning, crying, etc). Labor and birth are NOT spectator sports and you are NOT a “hostess” and therefore if you are going to be too preoccupied with the thought of how embarrassing it will be to poop in front of your mother or sister or best friend, then perhaps you should think more carefully about who you invite to your birth. Just because a family member loves you and “really wants to be there” at your birth, it doesn’t automatically make them a fitting labor companion. Remember, excessive worry and fear during labor releases hormones that can physically slow or stop your progress!
#4 DO go to the bathroom and empty your bowels (only if you feel the urge) in early labor. Feeling like you have to “poop” during active labor or transition is almost always the baby putting pressure on your rectum. Even if you end up passing some stool during the pushing stage, the rectal pressure you were feeling right before was NOT poop, it was the BABY and therefore you would have STILL felt intense rectal pressure even if you had emptied your bowels earlier! However, if you are in early labor and you feel like you have to poop and you can easily pass stool without straining, then go ahead. In early labor, it won’t hurt the baby or your cervix. That being said…
#5 DON’T try to go into the bathroom during active labor or transition and “try” to have a bowel movement right before the pushing stage just because you are afraid of pooping during birth. If you are in active labor/transition and you feel rectal pressure, please know that it is the BABY pressing on your rectum that is giving you that sensation. Therefore straining to have a bowel movement during this time could at best, worsen your hemorrhoids and at worst, injure your cervix by causing it to swell or tear. There is an appropriate time to start pushing, and many women tell me it is the best part (because they can actually do something about all that pressure!) but it is only time to push when your birth attendant gives you the okay.
#6 DO make a pact with your labor companions (husband, partner, mother, sister, etc.) to NOT tell you that you are or did poop during your baby’s birth if you happen to be really self conscious about it. The vast majority of the time the mother doesn’t even know that they did poop because the nurse, midwife, or doctor quickly wiped it away. Trust me, as a nurse, you see it all the time and if vomit, pee, spit, poop, or blood bothered us, we wouldn’t be nurses, midwives, or doctors!
#7 DON’T ask for an enema/accept an enema before or during labor. Please! Given enemas to women in labor is an outdated and unnecessary practice. Birthingnaturally.com writes:
“A substantial portion of women in labor will have bowel movements, whether or not enemas are given,” especially during both early labor and pushing (Mahan and McKay 1983:247). Available evidence indicates that enemas do not in fact decrease the chances of elimination during birth nor the incidence of fecal contamination during labor, whereas they do often cause considerable pain and distress to the laboring mother (Romney and Gordon 1981; Whitley and Mack 1980). Moreover, the expulsion of feces during labor does not seem to increase infection rates: in a study of 274 birthing women randomly assigned to enema or no enema groups, no difference in infection rates was found (Romney 1981), and the risk of neonatal infection was very remote (seven babies from each group showed signs of infection which may or may not have had to do with bowel organisms). Another finding of this study was that the two groups had similar durations of labor, contradicting the notion that enemas shorten labor.”
Also as a side note, please don’t take Immodium AD before labor to “prevent” pooping! It will at best, not work and at worst, make you constipated.
#8 DO remember that your body will probably “cleanse” itself out during “pre-labor”. After all, mild diarrhea or loose stools can be a sign of “pre” or “early” labor. And even if you do experience “pre labor diarrhea” you might still poop during delivery and that is okay!
#9 DON’T limit your food intake during labor if you are hungry because you are afraid that you will poop (or throw up for that matter). A runner does not prepare for a marathon by starving themselves and you shouldn’t prepare for birth by starving yourself either. Both you and your baby need energy to have the endurance for a successful vaginal birth. If you aren’t hungry, well then that is different, and you should still be encouraged to drink at least 4 oz of water, juice, or Gatorade every hour. If you are preparing for a normal vaginal delivery, even if you are being induced, you should not have to follow a “clears only” or “nothing by mouth” diet. Good prenatal nutrition recommends women eat 6 small meals per day with frequent healthy snacks so why should we starve women during labor? The answer is: we shouldn’t!!
If after reading all of the above you are still worried about pooping during delivery, then:
#10 DO realize that “WORRY is the WORK of pregnancy!” In her book Birthing From Within, certified nurse midwife Pam England tells the story about a patient of hers (Hannah) that worried a lot about having a natural birth experience after having had a highly medicalized birth with her first baby. She writes that Hannah longed to hear her say things like “Don’t worry” and “Everything will be alright” but instead England encouraged her to face her fears. She instructed Hannah to write down all of her worries and explore each of them with questions like “What, if anything, can you do to prepare for what you are worrying about?” and “If there is nothing you can do to prevent it, how would you like to handle the situation?”
England lists the “Ten Common Worries” of Pregnancy as:
1) Not being able to stand the pain
2) Not being able to relax
3) Feeling rushed, or fear of taking too long
4) My pelvis not big enough
5) My cervix won’t open
6) Lack of privacy
7) Being judged for making noise
8.) Being separated from the baby
9) Having to fight for my wishes to be respected
10) Having intervention and not knowing if it is necessary or what else to do
I would like to add #11:
11) Fear of pooping in labor/Fear of embarrassment regarding bodily functions
In summary, if you are a pregnant mom reading this post, please know you are not alone in your worries! Please use these next few months, weeks, or days, preparing not only physically, but mentally and emotionally for the amazing journey you are about to embark upon. Please understand that getting ready for labor doesn’t just mean a tour of the hospital or learning about birth technology/interventions, but also means acknowledging and talking about your worries and fears with people you trust, especially your birth attendant! No mother can give birth if she feels unsafe, senses danger, or has never explored her fears, even if they seem “trivial.” Please know that although the thought of it might be “mortifyingly embarrassing,” when you actually are working hard to push out your baby, anyone that really cares about you and loves you will not be bothered by a little poop and most likely, you will not even notice it! Please know that although birth might be one of the messiest experiences of your life, no amount of fluids, cursing, farting, vomiting, striping naked, howling, crying, peeing, bleeding, or pooping will take away from how honestly empowering, mind blowing, and touching this experience can be for you and your family J.
Must Read Blog: “It’s Your Birth Right!!” April 26, 2009
Tags: birth, birth attendant, cascade of interventions, delivery, health care provider, home birth, hospital birth, L&D, labor, labour, midwife, midwifery, OBGYN, obstetrician
Stemming from a comment left on my blog, I was directed to check out a relatively new blog entitled It’s Your Birth Right!! and I have to report that this is quickly becoming one of my new favorite blogs J!
Blog creator Nicole Deggins, CNM, MSN, MPH is an author, educator, childbirth enthusiast, and woman’s advocate. She writes that the goal of her blog is “to help women and their families make INFORMED decisions about their birth experience based on HONEST/ UNBIASED information.”
I am most excited about two of Nicole’s posts entitled: Choose Wisely Part I & Part II. These posts are great because they are better than any other article I have ever read about how and why families should be picky about choosing their best birth attendant. In my opinion these posts not only give great, unbiased advice and reference variety of helpful resources, but they are also honest about the Top 4 TERRIBLE reasons for picking a birth attendant.
Nicole writes,
“I get questions, all the time from friends, friends of friends and even strangers. They want my thoughts about pregnancy, labor and childbirth. I have spent HOURS talking with women providing answers and information they should be able to get from their prenatal provider/birth attendant. I think to myself at the end of those conversations, “Why isn’t she able to get this information from her? If he doesn’t make her feel special, does not answer her questions, and doesn’t agree with her philosophy on childbirth and labor, why on earth is she allowing him to be her birth attendant?!”
When I pose this question to the women themselves, the answers unfortunately never include “Because I did my research and I found him to be the best match for me and my desired childbirth experience.” Most of the answers I receive fall into the four categories below, none of which are good enough reasons alone to choose a prenatal care provider/birth attendant.”
The four categories that Nicole is referring to are:
1) “She delivered my sister/girlfriend.”
2) “She is my gynecologist.”
3) “He is the best/most popular person in area.”
4) “Her office is so close and convenient to my office/house.”
I have to “second that” to every thing that Nicole writes about in her two posts. I too am flabbergasted at how many women spend more time researching a new car, camera, computer, appliance, or handbag purchase than they do researching their care provider or birth options. I am also floored by many of the women I take care of that seem to have NO IDEA how their doctor or midwife actually thinks, feel, and behaves in a labor & delivery setting. One time, and I am not exaggerating, a woman I was assigned to care for looked up at me after a particularly upsetting encounter with her attending obstetrician (he was very rough with her vaginal exam, was down right pissed off that she refused an amniotomy and an epidural, and stormed out of the room) and said, “Wow, I didn’t realize he was so pushy! He was really rude! I don’t know if I want him to deliver my baby!” I was thinking to myself, “HOW in God’s name are you just figuring out now that he is an asshole?!” (Excuse my language but this particular doctor is a high intervention, low patience physician with the stats to prove it, on top of the fact that he treats nurses like his personal empty-headed gophers…ARG!) Turns out the only research she did to find this doctor was that her cousin went to him and was happy with his services since he agreed to induce her early because she was “sick of being pregnant” (her words, not mine).
Of course there is also the lying phenomenon as well and this is one area where I feel the most sympathy for my patients. That’s right ladies…people LIE and I hope that I am not the first person to tell you that doctors and midwives are people too!! That’s why, as Nicole writes, interviewing potential birth attendants and ASKING FOR THEIR STATISTICS is so important. Someone I know ended up switching her birth attendant at 36 weeks along because it had turned out that he flat out lied about his experience and philosophy regarding VBACs (vaginal birth after cesarean). For example, if you have a question about a particular intervention, say episiotomy rate, and the birth attendant you are interviewing either skirts the question or says something vague like, “I only do them when I deem necessary,” I encourage you to ask him for his STATS. You might be surprised at how often he “deems it necessary.” It is also important to note that you cannot make sweeping generalizations about a care provider just by their credentials, that is, not all midwives follow a midwifery model of care and not all obstetricians follow a medical model of care (although by the very nature of their education many of them do). So it is still important to research your birth attendant even if you are planning on choosing a midwife!
Also, I wonder if many women do not research their care providers/birth attendants because they come from generations of women who nodded their heads, smiled, and did exactly everything their doctor told them too regarding their reproductive health. I mean, if a woman’s mother, aunts, and grandmothers didn’t question their doctors, what influence does she have to act any differently? The good news however is that in today’s day in age, unlike our mothers and grandmothers, we have a most wonderful thing called THE INTERNET J. So you have no excuse!
But really, I am preaching to the choir here aren’t I seeing as if you are reading this blog you obviously are seeking out more information J. Rock on! But to all the ladies out there who might be thinking about getting pregnant or are currently pregnant who haven’t yet started to do their research, I hope at some point someone tunes you in to all of the fantastic, helpful information that’s out there J!! In my dream world, no women ever feels the need to say “If I had only known…”