This Birth “Helper” is a Stretch

Here’s the gist of today’s post: A company called Materna Medical is conducting research on a device that will pre-stretch a woman’s pelvic floor during the first stage of labor.

NO I AM NOT JOKING.

YES I AM AGOG.

There is so much going on in this article, I don’t even know where to start.

http://medcitynews.com/2013/09/medical-device-lead-shorter-labors-become-standard-care-childbirth/

I want to believe that the creators of this device have nothing but good intentions. I want to believe that someone is paying attention to the (in hospital) birthing stats about women and their pelvic floors. There is, indeed, a major problem with unyielding pelvic floors, stalled labors, perineum tears as well as avulsions and it is time that this issue be thoroughly addressed. Unfortunately, it is my opinion that the designers of this device have entirely misread the problem.

STAND BY FOR SEMANTICS

In the case of an unyielding pelvic floor, the problem is not “the hole is not getting bigger,” the problem is “the muscles are not releasing.” So instead of forcing a woman open, literally against her will (even if her will is subconscious — see tension lesson below) can we please spend $1.2 million dollars looking at WHY the pelvic floor is so tense it doesn’t release? And before we spend that $1.2 million dollars on NEW research, can we review all the OLD research on pelvic floor tension and its relationship to chronic stress, heavy exercise, too little movement, diastasis recti, trauma, anxiety, and myofascial disfunction? Or are we happier continuously circumventing the problem? (P.S. If anyone has $1.2 million dollars, or even 1/10th of that, I am happy to design and source this project.)

Since I’m not a Women’s Studies scholar, a psychologist, a medical doctor, or therapist I won’t comment on the grander implications of a device that overrides firm, physical boundaries set by a woman at what is, perhaps, the most vulnerable time of her life. I am, however, a biomechanist so let’s talk mechanics.

(But before we do, check out the weirdest picture on my blog, ever. I was going for “jaws-of-life-meets-pelvic-floor” visual but ended up with a creepy picture of my one-year old’s shirt on the head of my suspenders-wearing husband. I’m leaving it in for effect. A creepy effect.)

photo(431)
Today’s lesson on tension: Although we use the same word (tension) in many cases, not all tensions are the same. Tension can be created actively through a conscious “tense this” signal. The same kind of active tension can also be created through a subconscious reaction to a stressful situation. Tension can also be created passively through long-term skeletal malpositioning. In these cases, the orientations of the proteins that make up the muscle are different.

Some examples to “picture” what I’m talking about:

  • I tell you to flex your right elbow to 90° and you do it (conscious active tension).
  • Something startles or scares you and you tense your traps, drawing your shoulders up toward your ears without you realizing it (unconscious active tension).
  • Your arm in a cast that flexes your elbow to 90° for a summer, resulting in an arm that doesn’t straighten all the way when you cut the cast off  (passive tension).

Got it?

Tension is, literally, the resistance to deform, but having tension says nothing about why or how the tension was created. In some women the pelvic floor is being tensed actively and in some it is passive. And to make things more complicated in some woman there are both active and passive tensions occurring. In many cases the pelvic floor being brought to the delivery room is in an unnaturally high state of tension — both active and passive. To stretch it passively and aggressively is the equivalent to your Physical Therapist busting open your frozen shoulder that took a year to create.

I understand the device developers believe TWO WHOLE HOURS is a ton of time, but I would ask them all to lie down to see if the experience of me getting FULL RANGE of motion of their hamstrings over  TWO WHOLE HOURS is without pain or discomfort. Oh, wait, it appears that the device would have to be used with pain medication: “In order to reduce or eliminate any discomfort, the device could be used under epidural analgesia or local anesthesia on the vagina. ”

Wait, there’s more: “Based on preliminary work, it is anticipated that this device will need approximately 1-3 hours of dilation time to successfully reduce the internal stresses in the tissue in preparation for the 2nd phase of labor.”

It appears that the developers of this device see the pelvic floor damage problem as a rate issue. If they can figure out a way to stretch out the pelvic floor over two hours instead of the few minutes then ALL THE PELVIC FLOORS CAN BE SAVED. I actually get what they are going for here, but again, the developers are attempting to solve the wrong problem. It is entirely natural for the pelvic floor stretch-load to occur over a very short period of time (minutes). As long as women have been having babies, the rate of loads widening the urogenital hiatus have been quick. It is, however, entirely unnatural for the pelvic floor muscle to stretch to 3.5 times its resting length over a two-hour period.  The problem is not the rate — the problem is the resistance. Applying general sports-medicine stretching theory to the pelvic floor — a tissue that’s been doing this for eons — is a large scientific misstep.

The tension in a woman’s (or man’s for that matter) pelvic floor is the long-term accumulation of habit, whether that habit be repetitive positioning, loads through exercise, chronic stress, or plain old practice. In the case of a vaginal delivery, the pelvic floor can have both inactive and active tension going on (toss in a little apprehension, especially if you’re a first-timer and you up the resistance).

With a little preventive work, women can learn about relaxing those active tension patterns. And one can work on the inactive tensions leading up to delivery. I do like the designer’s idea of preventive muscle “conditioning” very much, but ask any physical therapist how long it can take to soften up the pelvic floor. Does it take two hours? Two months? Two years? The time to prepare the pelvic floor is not at the final hour, but throughout a lifetime, or at least throughout the pregnancy. Note there is a big difference between softening a pelvic floor to yield in the exact way nature requires and opening it to 10cm. The second stage of delivery does not begin with a pelvic floor wide open and no one knows why or if a natural level of initial resistance is needed. From my favorite integrative gynocologist, Eden Fromberg, DO (in response to the linked article):

“The pressure of the presenting part of the fetus on the pelvic floor is part of the dance. I just can’t see isolating the pelvic floor the way this device intends to, as if it won’t affect other parameters. My thought is to educate women about how to best achieve their physiologic potential and to try that before resorting to drugs and devices.”

So. Is it possible that a device like this can improve the rate of vaginal delivery? Absolutely. But does it  matter only that the rates be improved? Can we raise the bar and consider the entire birthing experience for mother and child — before, during and (long, long) after?

Amen.

For more on pelvic floor hypertonicity, please read:

TooTightPelvicFloor

TooTightPelvicFloorToo

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35 thoughts on “This Birth “Helper” is a Stretch

  1. Oh lord. Another insulting thing medicine is doing to women. Ever read the book MALEpractice by Robert Mendelsohn, MD (the author of that other awesome book, How to Raise a Healthy Child In Spite of Your Doctor)?

  2. I was one of those who had no advice about the pelvic floor and never dialated, even with 12 hours of pitocin. Of course, I know now that continuous pitocin doesn’t work either – 23 years ago information was much harder to find. Anyhow, this sounds like torture on top of the pain our bodies go through during labor. I can’t imagine having this device added to the experience I had – and I would have probably emasculated my son’s father afterwards! Sounds like good intentions with a bad outcome. My heart goes out to those women that are going to be talked into using this thing…

  3. This is the part that got me: “The device could be inserted any time during the 1st stage of labor, and dilation could occur in short 5-15 minute increments. In between dilations, the mother could remove the device and ambulate if needed…. In order to reduce or eliminate any discomfort, the device could be used under epidural analgesia or local anesthesia on the vagina.”

    So basically, rather than just stretching things out, this device interferes with the ability to move around, and introduces additional discomfort. In other words, it creates new problems. That’s besides what could happen if it becomes “standard of care” or whatever they call those things that you can’t really say no to in the hospital.

  4. There needs to be some natural tension in the pelvic floor to assist rotation of the head. If there is no tension the head will descend straight but babies are meant to rotate / corkscrew during birth. Also the head hitting the pelvic floor triggers the urge to push, if that nerve has been overstimulated, will it work at the appropriate time? The only time this device would be useful if if a woman has an epidural and is expecting a delivery with forceps!! (UK homebirth midwife)

    1. Yup, I’m totally thinking about chicks or other baby birds. They HAVE to get themselves out of their eggs. If you try to “help” them, by pulling away the shell for them, then they are likely to die.

      Stay home, if not the entire time then as long as absolutely possible.

  5. Helena, you took the words out of my mouth! Having the pelvic floor prematurely opened will affect the baby’s ability to perform the cardinal movements – you will wind up with a baby with a deflexed head and unable to rotate. It could also potentially affect Ferguson’s reflex (the involuntary pushing the occurs at the onset of second stage). The short-sightedness of this device leaves me shaking my head. (US homebirth midwife)

  6. Why can’t medicine respect the eons of time women gave birth with just the assistance of other women who gave birth. It is a numinous, dangerous time that requires peace, and confidence that nature will work. To make birth a horror of “mistakes” and contraptions and misunderstandings is so terrible. Yes, bad things can happen during birth but adding manipulations that are not natural????????

    1. and the assistance of other women who haven’t given birth. my favorite midwife, who delivered my last 2 babies, has never given birth. BUT she’s delivered about 10,000 babies (and that number is from 5 years ago). also, older sisters or female cousins of the new baby can be exposed to natural child birth by attending and assisting, even thought they’ve never given birth.

  7. Oh, Katy – THANK YOU for writing about this device. I find it infinitely frustrating the way we try to interfere with childbirth to make it “shorter”, “easier”, etc. For most women it take a bit of love and support and a lot of patience with watchful waiting from a doctor or midwife and birth will happen on its own without much intervention. Trying to “help” often does more harm than good. This device is quackery.

    1. Sharon – A pelvic PT answering here. 🙂 You have to stretch out the shortened tissue, just like in any other area of the body, which eliminates the passive tension. But, before you can stretch the shortened tissue, you HAVE to make sure that the muscles are completely relaxed – free of any conscious or unconscious active tension, as Katy puts it. Once you are sure the muscles are relaxed, there are several ways to stretch the shortened tissue: have a pelvic PT stretch it with their fingers, stretch it yourself with a dilator, stretch it yourself with your fingers, or have a partner stretch it with their fingers. Tami Lynn Kent, a pelvic PT, describes how she teaches her patients to do self-stretching in her book “Wild Feminine” – she calls it “vaginal self-massage.”

      1. I have a question that I’ve been wondering about, and I’m really not being cheeky, promise, and that question is: how about good old fashioned sex? I personally experience such an increased sex drive during pregnancy that I wonder if it’s not just a weird hormonal thing. Aside from being a positive thing to keep the sense of just being a woman and helps husband and I to stay connected as a couple, and not just as parents, could it be helpful in the physiological process? I haven’t stumbled across any medical literature that addresses this possibility, and would be very interested in what your thoughts are on it.

  8. This is just one of those creations that makes me believe that we are a dumb, dumb species. That an idea like this wouldn’t have been rejected at the first mention of its development is outrageous.

  9. How many women are going to feel like less of a woman because they needed to have this done? Then they will thank God that the hospital saved them from the danger they and their baby were in.

  10. the whole idea of this “device” is creeping me out :/

    scarily, I am currently 23 wks pregnant, and had the choice of Nepean Hospital (yes the same one this device is being trialled at apparently ) or Lithgow Hospital. I chose Lithgow but have been given a stern talking to that should things “go wrong” I will prob be sent to Nepean.

    They best not be trying to use that on me or there will be hell to pay. -.-

  11. Women need to know about Pelvic Physical Therapy and work with their Pelvic PT on any issues regarding pelvic floor dysfunction, including hypertonia, pelvic pain (which may occur from episiotomy or tearing of the perineal body), dyspareunia, incontinence and pelvic organ prolapse. Perinatal issues pertaining to the pelvic floor can be addressed throughout pregnancy, preparing for childbirth, and post partum. We are few in number, but we are scattered around the USA and the EU, for the most part. Women and men can benefit from the educational and manual techniques of a good Pelvic PT and work preventatively together. This is the “device” needed, rather than the frightening one proposed by Materna Medical. Here’s to women finding the help they seek in an experienced, qualified, and nurturing Pelvic Physical Therapist!

    1. Lucia, I’m interested in your comment because I went to a pelvic pt who only offered me lessons in kegels. And a device to measure how well I performed them. That’s what led me to katy’s blog, eventually. I needed a better answer. What can I do to find someone who is qualified to offer me better than a choice of a hysterectomy or kegels?

      1. Yes, this is the issue, isn’t it: many people with the same credential and training for that credential offering entirely different protocol.

      2. Paula – There are a few ways to figure out how qualified a pelvic PT might be. The first way is to find out if they are board-certified in the women’s health PT specialty. If they list the initials “WCS” after their name, that indicates a board certification, which is a pretty rigorous certification process. (However, the certification only became available a few years ago, so you can’t find a WCS everywhere.) The second way is to look at the directory on the APTA Section on Women’s Health (SOWH) website:
        http://www.womenshealthapta.org/
        This directory only lists PTs who are members of the SOWH (hopefully indicating that they stay up on current research and ideas). The third way is to ask for a pelvic PT’s resume or list of continuing education courses taken. Most pelvic PT continuing education courses are provided by the SOWH and by the Herman and Wallace Pelvic Rehab Institute (but there are some others). In general, the more classes a pelvic PT has taken, the more treatment ideas they have in their “bag of tricks.” Pelvic PT should involve a lot more than just Kegels. And if a patient’s problem goes beyond the skills of a particular PT, the PT should refer the patient to a different (perhaps more experienced) PT – this is part of professional practice. Hope this helps!

  12. This device really disturbs me as I was “failure to progress” c-section. I had a nurse who was manually stretching my pelvic floor and cervix because I was only 2cm after 30 hours of 1st stage labor (I now know I was not actually in labor, but my uterus was contracting like labor to reposition my baby who was posterior). Having someone with their hand in my vagina for long periods of time was so invasive (and uncomfortable as I was not medicated) that it seemed counter-productive. I finally asked her to stop and worked with different labor positions to turn the baby and use gravity to open everything. Baby did eventually turn and when she did I went from 2-9.5cm in 20 minutes. Unfortunately the doctors felt she was too stressed to survive pushing.

    I cannot imagine that this device could keep a woman calm to allow tissues to open and I suspect it could do more damage to the tissues by forcing them open in an unnatural timing. They really are missing the bigger picture here! I will never be an advocate for hospital births unless lives depend on it.

  13. Wow! This need that the medical community has to “improve” a natural process through mechanical means is disturbing. The idea that birthing can be standardized is ludicrous. Missing the big picture here.

  14. The best part are the comments at the end of the Materna Medical article. What a hoot! One of my favorites…”Is this a joke?”.

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