Peeing and Pooping and all that jazz
Lena wrote this week with a ton of questions—most of them having to do with peeing and pooping and other messy bodily functions. I love that you wrote, Lena. You're a girl after my own heart because this is the stuff people really want to know but feel way too "refined" to ask. Lena's expecting her second baby in a few weeks and had a rough go of it with her first. It sounds like she had a long labor with a lot of rectal pressure. She felt like she had to poop through her entire labor. She peed all the time and estimates she cut loose with a couple gallons of fluid through the course of labor and pushing. Now that she's looking forward to her second labor, she wants to know how to tell if she needs to push to poop or push to "push." She wonders if pooping in labor is OK or if that kind of pushing will damage her cervix somehow.
Lena didn't mention if she was experiencing back pain with her first labor but I'm suspecting she may have had an occiput posterior (OP) presentation going on. Say what? That means the back of the baby's head was pressing on her butt while her face was looking up at Lena's bladder. The optimal position to push out a baby is with the back of the head up towards the bladder and the face looking down at the rectum. It's just a better fit than the other way around. Lots and lots of labors start in this OP, "sunny side up" position and through the course of labor, baby rotates into the easier, occiput anterior (OA) position. Not all do though and it can make for long labor with lots of back pain and more pushing than if baby was coming out OA.
Lena said she pushed for a long time and eventually needed forceps and a vacuum to get her baby out. Geez, honey, what a tough time you had. That baby girl of hers was stuck. She did deliver her vaginally though. Yahoo! Good for you. But what about this next baby? First of all, Lena, second labors are almost always easier than firsts. Baby number one paves the way for her siblings. Your uterus understands what's expected and your pelvic bones and tissues have stretched out. That constant "need to push" sensation you had with #1 may or may not recur with this baby. This one may not spend the whole labor with her head on your butt.
If you feel like you need to poop and your contractions aren't back-to-back and extremely painful—you probably just need to poop. Poop happens in labor in tandem with all those contractions as a natural way to clean house in preparation for baby. Poop happens while pushing the baby out too and there's nothing you can do about it. Poop just happens. If you're at the hospital, in labor and feel a need to poop that you haven't felt previously—tell your nurse. She'll probably check your cervix before letting you up to the bathroom just to prevent you from delivering your baby in the toilet (Yes, that happens occasionally but rarely. Baby doesn't drown and everyone's OK. We just prefer a bit more finesse and control than a toilet-birth allows). If you're not fully dilated or extremely close to it—go ahead and poop. You'll feel better and that gentle kind of pushing might even help you dilate more. You don't want to bear down with the full force you'll need for getting that baby out. If you're pushing that hard with no actual poop coming out—it's probably baby pressure not poop pressure.
Lena wonders where all that fluid came from. She says she wolfed down Popsicles and ice through labor but I'll bet she didn't suck down two gallons worth. Lena, you had an IV at the hospital. Whenever a patient gets an epidural (and Lena did), we preload with at least a liter of IV fluid. Most patients get more than that. What goes in; must come out. She said she lost gushes of fluid after her doctor broke her water too. Most women think that once the water's broken—that's it—it all comes out at once. Nope, it comes out continuously throughout labor. Gross, right? It's all part of the glamour of motherhood. Once that baby arrives you'll be wearing all kinds of body fluids (and solids) without even wincing. Milk on your t-shirt, baby pee in your lap, spit up on your shoulder—whatever. It's all in a day's work. Lena had far more questions than I can address in one column. We'll tackle more in future blogs but I hope with the next baby, Lena, you have a much easier time of it. I'll be thinking about you.
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