Saturday, October 7, 2017

4 cm at Grey Sloan Memorial Hospital

Ok, I'm out. I'm a Grey's Anatomy fan. Well, I can name only about 5 characters, I might not hold a candle to a true fan, but I do love the show.

The new season really got my attention with it's portrayal of a stalled labor at 4 cm. The laboring woman has medical reasons not to use an epidural and declines a cesarean. Wait, is this a spoiler?

Spoiler alert!  Don't read this further until after you've watched the third hour of the 2017 Season 14, episode 3. Pause here, go see it. You can go here: http://abc.go.com/shows/greys-anatomy

Did you watch it? Ok, you can keep reading. (Now that I went there to find the link, I also noted the character's names. I think this makes me a true fan now.)

We hear a moans coming through a closed hospital room door. In the hall, comments of medical staff are made about the sounds of labor.  Inside the room, Dr. Arizona Robbins (played by Jessica Capshaw) has just checked the birthing woman's cervix. She tells the parents, "Marnie, you are only four centimeters dilated."

Marnie exclaims, "What?! My water broke hours ago!"

Arizona claims, "Yeah, but your cervix is being stubborn."

Screech! Halt! Wait, what? Arizona usually plays the sympathetic doctor, what is this talk?

Marnie, played by Amie Farrell, can't have an epidural because in her previous labor the epidural caused her blood pressure to drop dangerously low. One thing I like about Grey's Anatomy is the straightforward exposure to the dangers of medicine right along side the miracles of medicine. No punches are held back.

Marnie's allergic to Pitocin, Dr. Ben Warren (played by Jason Winston George) is told as he enters the room. Piton is the artificial hormone used to strengthen contractions. Now why would the contractions need strengthening? I wondered, because Marnie was rolling through her waves which were coming fast and strong. The lack of dilation wasn't for lack of amplitude or frequency.

There was a social dynamic happening with the staff that stereotyped a particular attitude. The sounds of birth were making them tense. Dr. Warren hears taunts from Arizona that he's "going to be a long day" and his response is an ironic "Fantastic."
Marie, however, is standing and leaning forward, moving rhythmically and strongly with her contractions. She's coping, she's got the support of her partner, but she doesn't have support of the staff or a doula.

The prejudice in natural birthing seems to extend to patients unable to partake of the rites of obstetrics.

We get some comic relief with banter from the neurosurgeon and former Chief of Staff in the MRI room  while they compare their own brain tumors - I'm still laughing.

Meanwhile, hospital protocols are failing Marnie. The doctors shrug at the lack of progress given Marnie is doing laps around the hospital halls, squats and bouncing on the birthing ball... but she is still 4 cm. They are expecting they'll be doing a cesarean.

Ok, Spinning Babies fans,
Here's where our plot twists. What would we suggest for this active birth giver?
Hers and our favorite position changes, movements, and the "tincture of thyme" (time) seem not to help labor progress: we realize we need balance first.

The Three Principles of Spinning Babies are

  1. Balance
  2. Gravity, and
  3. Movement


Balance isn't listed first because its closest to the front of the alphabet! It is listed first because to use it first release the best advantage of Principles 2 and 3!

What's the issue?
Marnie is at 4 cm. She's got regular and strong contractions and no progress for hours and hours.
She is on the brink of active labor. She's on the brink of frustration... another comment like, you've got a stubborn cervix, and she might accept defeat... except Marnie has a vision of her outcome.
Ok, contractions are strong and close together. Cervix is not opening.

What's the protocol?
First action is "Add Balance."
This is the Fantastic Four we demonstrate in our video, Parent Class.
First question is "Where's Baby?"
The most common issue for lack of progress is a lack of engagement. If Arizona had mentioned that Marnie's baby's head was still high in her pelvis, we would have known to
Use Abdominal Lift and Tuck with ten contractions in a row.
That usually engages baby.
The squats they had Marnie doing are for the outlet. Baby is visible, or almost so, and squats actually close the inlet where most babies would be waiting in this scenario.

Emotional safety is also important. Marnie, we hear, had complications due to interventions in her first birth. She's stressed about that (details in the show indicate so) and so is her partner. She is also situated right across from the busy nurse's station. She also is about to have five doctors outside her door discussing her situation...

4 cm stalls are classic for a lack of emotional safety or security. Quiet, dim lights, privacy. These are key to helping us leave our logical brain and enter the birthing depth of the midbrain.
Is there someone negative or scary in the room or hovering? Is someone distasteful observing the birth giver? Many times a gocking family member or group of friends and family have to leave the birth room or home for a birthing person to enter the midbrain hormones for labor to continue.

5 -7 cm has a different issue, typically the pelvic floor, but sometimes restrictions to movement in the bony pelvis because of ligament spasms. Resolving these issues are discussed in the workshop and Parent Class video.

4 cm is classically emotional. We ask "Where's Baby?" to know where to make room in the pelvis. but at 4 cm, we ask "Where's Mama?" and give her the room she needs for privacy and inward attention.
That's not to say labor obstruction isn't possible at 4cm, but we tend to see that more at 7 cm - and we offer solutions at Spinning Babies.


The show's dynamics get juicier when when Grey Sloan's new obstetrician arrives. She suggests oxytocin and Arizona says she's allergic to Pitocin.

"No, no, I don't mean synthetic oxytocin. I mean natural oxytocin. No one is allergic to that."

Then revolves a charming little discussion with 3 male doctors, Arizona, and Italian actress Stefania Spampinato as Carina De Luca (and Arizona's new love interest).

Carina describes the anatomy of the clitoris allows stimulation for oxytocin increase without adding a risk of infection because "nothing has to go up there." A series of cliche phrases gets us through the prime time description of masturbation.

Grey Sloan finally puts the culture of the call room into the protocols for patient care. Marnie won't get a resident assigned to her case, however. Good thing she brought her own birth partner.

  Labor progress has a new protocol. New for television that is.

Replacing pain for pleasure is the premise of Orgasmic Birth. Debra Pascali Bonaro, founder of Orgasmic Birth, has created a dynamic childbirth education online. Spinning Babies has joined as an affiliate.

Debra and Carina both agree, that "What gets the baby in, gets the baby out."

That's a quote we learned from Ina May Gaskin, midwife and author of Spiritual Midwifery in the 1970s. It was lovely to hear her truism on Grey's Anatomy. Love is the principle. Oxytocin is the result.

Spinning Babies eases birth by releasing muscle spasms that create pain and misalignments in the pelvis. After restoring some body balance the pelvis is supple and the pelvic floor softened.
Now pleasure is more possible.

Spinning Babies promotes the release of tension and twists so the uterus is aligned with the pelvis and with itself.
Orgasmic Birth also promotes release. A little different use for the word, perhaps. Or not.

Orgasm or simply pleasure may become even more possible using Spinning Babies approach. Certainly it makes sense that a muscle spasm in the pelvis would be a likely detractor from pleasure.
 Debra Pascali Bonaro and I are good friends in a shared purpose. More empowering childbirth and even pleasurable birth. Empowered women are empowered mothers. Mothers enjoying life seem to me to be quite desirable to any baby seeking a mother.

Suddenly the birth sounds coming from behind the closed door sound more progressive than the beginning of the show. Dr. Carina says to Arizona who is hovering around the desk, "When you pleasure the pain the pain turns to pleasure."

Learn how to turn childbirth pain to a pleasurable birth through this link and support the intent of our affiliate http://www.paintopoweroptin.respond.ontraport.net/optin?orid=4834&opid=29

And while Marnie and her partner cuddled their new baby (hopefully skin-to-skin to integrate their pleasure as they arrive earthed)  Dr. Ben Warren's partner Miranda benefited his new awareness that very night. Pleasure comes in many forms. Sexual pleasure is basic and primal. Birth pleasure is the ultimate expression, the completion of the sexual expression of conception.

Doesn't it make sense that the full expression of conceiving, growing and birthing a baby could be, even should be, pleasurable?  What would the world be like then?

(Hey, I did pretty good listing names, too. I'll remember better now.)



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