Saturday, August 14, 2010

The down and dirty. Yeah, I'm going to say it. Poop.

I'm going to be direct, I'm going to be blunt, and I am going to sound like a nurse for a bit.

Poop. It happens. It happens everyday for all humans (hopefully!) and for all other creatures that walk or swim on this Earth. There's even a kids book about it Everyone Poops- I highly recommend this book btw for your kiddos. It helps with potty training and associated pooping on the potty anxiety.

So, why is pooping during birth such a big deal? It is really part of the natural physiology of birth. It is normal.

First, watch this animation of a vaginal birth. Recognize that something very important lies between the coccyx and that baby's head- the rectum.



As the baby's head descends, it literally squeezes out the poop from the rectum like you would squeeze toothpaste out of a tube. If there is poop there, it is coming out- it is just a mechanical thing!

Let alone when a mother is completely dilated! What is the simplest way to teach a first time mom to push out a baby? Let alone a mom with an epidural? Tell her to push just like she is pooping! Pushing out a baby and pushing out poop uses the exact same muscles. Of course, if you are using the same muscles that you use to poop with to push your baby out, there is the possibility that you may push some poop out as well. It is mechanical and normal. Heck, if I see a first timer moving poop, than I get excited! I know that she is pushing in the right spot! (Okay, I know that may sound weird to non-birth professional folks, but it is true). I am going to share one of my tricks here that other birth professionals may know. If a woman is pushing (usually a G1 here) and when I do a vaginal exam I can feel through the vaginal wall some hard stool, I will push that poop out by pushing down on the posterior wall of the vagina. This is for women with epidurals only. That hard stool can sometimes impede that baby's head as she is pushing if she is not able to push it out on her own. Soft stool just comes on it's own.

Let's talk about diarrhea during labor now. IF you go into labor on your own (this does not apply to induction) you may have loose stools for a day or two before labor begins as well as during labor itself. This is due to the release of the hormone prostaglandins which cause smooth muscle to contract. The uterus is made up of smooth muscle as are the bowel. Prostaglandins also serve the wonderful purpose of causing the cervix to soften so that it will open! If you are in active natural labor, than you may continue to have diarrhea throughout your labor. It is normal. It is your body doing what it is supposed to do to help your labor to happen. A lot of books say that "this is the body's way of cleaning out the bowels for the impending birth". They are just trying to make you think that the body is giving you a natural enema- which it kind of is, but having loose stools in early labor does not mean that you won't poop during pushing. There is a lot of feet of intestines there and there may be a lot of stool hiding.

What brought all of this up? Well, yesterday I had a patient that I was helping another nurse with. She was a G1P0 who came into triage booming in active labor. In triage she was 3cm/100/-1 and I got her into a room and got her an epidural (her choice). After she was comfortable the doc came in and checked her and AROM'ed her (this is a hospital people)- she was 6/100/0 at this point. Several hours later she was complaining of feeling a lot of pressure. I with a new LAD nurse checked her (the new nurse is checking behind me to learn the wonderful art of sterile vaginal exams). She had an AL (anterior lip)/100/+1. This was all done on her own- no pitocin. I noticed a large amount of watery stool upon this exam that the patient wasn't even aware of. I cleaned her up, and the new nurse wanted to see if the patient could push past the little lip of cervix since she was feeling a lot of pressure. I left the room to let the new nurse push her and as she pushed more stool came out, but apparently the father of the baby kept asking the mother if she had to go to the bathroom and looking really grossed out because of the poop. Now, we nurses cleaned her up. We removed the soiled chux and soiled linens from the room. He spoke Spanish and I came in and explained to him that it was his baby's head moving down that was causing the poop to push out and that his wife was doing wonderfully well. That this all was normal. I then told him that he needed to help her and tell her how beautiful she was as she birthed his baby. He looked properly chagrined and the patient seemed to like me chastising him, but she still looked embarrassed. I tried to reinforce how normal this was and praise her for doing so well, but I could tell that this would probably be something that she would remember in a negative light from this birth. I hate that.

If the idea of pooping during labor is something that you just can't handle than there are just two things that you can do. First, do NOT take Castor oil to help induce your labor. Castor oil induces labor by loosening the poop and causing the smooth muscle bowel walls to contract, the contracting of the bowels may or may not cause the uterus to contract as well. You will be having diarrhea all throughout labor if you take this. Also, taking castor oil really increases the chance that your baby will poop in utero (passing the first poop called meconium) and that is a complication that you really don't want. Second, if the poop grosses you out that much your only option is to give yourself a soap suds enema (available at any drugstore) during your early labor. It may actually speed up your labor and may keep the dreaded poop from appearing during pushing. Of course, enemas are uncomfortable and difficult to give to yourself.

What I would really hope is that you will embrace the poop as a normal part of birth. Realize that you are joining the billions of women throughout history that have pooped as they pushed their babies out. Get excited (just like us birth professional types) when the poop happens knowing that you are just that much closer to holding your baby in your arms. Educate family on the poop so that they know to expect it and how to treat you when it happens.

Everyone poops. Almost every woman poops during labor/pushing. It is NORMAL. Do not be afraid. The act of birthing a baby is a much more intimate and important event than someone just seeing you poop.

5 comments:

  1. This is a brilliant post - thank you so much for writing about a very-little-talked-about subject that really needs airing. When I experienced that during my first birth, I was absolutely humiliated, and before my second birth I asked my midwife if there was anything preventative I could do - and she said exactly what you said here, that it is completely normal and nothing to worry about. Second birth - same thing! But I was more used to it this time, and it's also easier and less embarrassing during a waterbirth. Thanks again!!!

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  2. Embrace the poop! I love it!! I teach my patients the same thing - when you have a release of stool with pushing, then I know you're pushing correctly! And yes, I get excited when I see this!

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  3. As a long time L&D nurse now turned into baby admit at the bedside nurse - I can attest to the naturalness of pooping. However, I must admit that it still can be gross. Better to go the enema way - I did it with my birth and was much less inhibited when it came to pushing. And it wasn't fun scooping poop at the water births I attended. Just my own opinion.

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  4. Nancy, I hear you, but honestly I will clean up a laboring woman's poop any day over someone with C.Diff. Bleh. I don't mind scooping either! I am just happy that a mom is pushing!

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  5. Weird question. At my 34 week appointment I found out that I had dilated 1 cm and was 50% effaced. They put me on bed rest to make sure that the baby got to full term. I was surprised b/c I hadn't felt any real contractions to cause me to dilate. Since then I've had a some contractions, but every time I go in for an appointment there has been no change. These contractions were harder than any that I experienced before 34 weeks - so I figured if I had had contractions that had caused me to dilate I would have felt them. So now I'm thinking it was something else that caused me to dilate. A week or two before that 34 week appointment, I had a really hard poop that caused me to have to poop for one hour. It was awful and hurt a lot. I had to push like I had to push for giving labor. Is it possible that I could have pushed so hard that I caused that little bit of dilation and effacement?

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