Midwifery Today Community

I was at a hospital birth yesterday and mama starting pushing on the birth stool.  She pushed there for about 30 min, moved to the toilet for about 15 min, back to the stool for about 20, and then moved to the bed.  I noticed that she had a lot of swelling.  The RN commented on it, but it was sort of off hand, "I thought I was seeing head in the middle there [referring to vagina] but it's actually a lot of swelling."  When the doc came in she said, "You've swelled a lot and that's from sitting on the birthing stool," and then turned to the nurse and said, "That's why I hate those things."  I've heard this from other doctors and some CNMs but never experienced it myself.  The birth ended in a repeat cesarean and when they were getting mom back together afterwards, one of the nurses put an ice pack on mama, just as they would do after a vaginal birth and commented, "You've got a lot of swelling down there.  That's probably from you being on a birth stool."

Questions:
Can the birth stool "cause" swelling or is the swelling from something different and the birth stool is blamed?
Just a coincidence that the stool is used and swelling observed?
If it is true that the stool can cause swelling, is there a way to prevent it?
Does the particular stool make a difference?

Susan,

What birth stool were they using?

I use a stool a lot. Almost every birth, if not for the babe then for the placenta.  Mine is a homemade wooden one.  I do not seem to notice extra swelling or tearing on a stool. The yoni is more isolated and visible, of course, on a stool and gravity/pressure can make the yoni seem pretty full.

I don't think it causes swelling but it may increase a tendency to swell.  Does that make sense?

Frequent, stand up and stretch it out, breaks should be encouraged to avoid any undue swelling,just as you would encourage change of position otherwise.

I like the stool for a break in mama having to hold her own self up in the pushing phase or for a change of position and it is a wonderful way to get baby around that pubic bone.  Maybe not getting on it too early is the key..

Was mama directed to push or was it spontaneous?

April,

Is your stool very different from others?

Interesting.  The baby just could not get under the pubic bone.  She had the same problem with her last baby.  Doc said that she had "a very very tight and narrow arch".  What the MD and the RN thought was 0 station turned out to be about 2" of caput.  Pushing was most definitely spontaneous.  Mama kept saying that she couldn't feel anything changing, nothing shifting.  The stool is the standard hospital-issued stool--stainless steel and wrapped in pipe insulation, u-shaped.  She changed positions a lot--stool, toilet, bed, standing, sidelying, kneeling, knee chest to see if baby would go up and find a better way, squat bar, almost flat, squatting in the birthing bed, sitting.  She tried wiggling the hips a la belly dancing.

April has a special stool....

Yep!

Mary

AWWWW, sounds like this mama worked vey hard to have her baby. 

How is she? How are you?

I have not noticed anymore swelling with a birthing stool...vs...anything else?

Mary

Yes, mama did work very hard to get baby out.  I have never seen such swelling and was wondering if it's more related to the wonkiness of the labor and pelvis than the actual stool. However, the stool does have a bad rep (at least in my area) by MDs and some of the medwives for "causing swelling" but I've never seen it myself ... until this labor and have been questioning if there was something else I could've suggested rather than the stool.  Mama kept going back to the stool because she said, "It feels better there".

Susan,

When I get  a mama who spontaneously pushes and is an effective pusher and then I get caput ( or I can't decide if it's true head or caput) and baby is in a good position, to me, that gives a signal that the pubic bone is the problem.  It's a frustrating thing to make it so far but baby just won't come any further.  Really frustrating, but things can change, babies can slide through, so you have to try. I have been there a few times though. It's just disappointing,  Sounds like your mama tried everything.  How's nursing going?

That kid latched on and was a champ from day one.  In fact, we unwrapped her in recovery and laid her on her belly and she was just a little above the nipple and before anyone could adjust her, she wriggled on down to the nipple and latched right on!

That's awesome!

I also have a hand made stool.[April has a beautiful one her dh made for her]  I really like it for support of mom in squat position.  My stool is made from a plank bottom chair and is about 12 in. tall.  Thighs go on outside of chair almost like a toilet seat,allowing the coccyx to move back and  the pubis to move out..  I sit on the floor and I can see bottom and baby. I put my stuff in reach and mess goes in a plastic bag on cross bars of chair. Some moms use it till baby is born and some just stay on it a few contractions.  I have never seen swelling with a stool.  I have seen the type of stool you are talking about and am not sure how well that will work.  Personally,I think Docs. feel intimidated by not being in charge and having to sit on the floor with wet pants when the waters break!![I am always a mess when I am done with a birth,when I paint too!!]  Same reason they don't want to do with water births.   The dead cockroch position is most handy and neat for the hosp. staff.

Actually, this doc was pretty flexible and checked mom in all kinds of positions, including lying on the floor while mom was on the stool. She never asked mom to get off the stool, just made the comments about it afterwards. I'm wondering if it's the stainless steel stool itself because at home with the wooden stools which are much lower to the floor, I've never seen swelling.  However, I've had students come back to class after hospital births or after a prenatal with their (hospital-based) CNM and say, "So-and-So says not to get on the stool because it makes you swell really bad," or "Mary said not to stay on the stool for too long because I'll swell up down there" and I think, "Huh. I've hever seen that before."  The stool that's used in our hospital is the one that's in "Giving Birth--Choices and Challenges," Suzanne Arms' movie.  The homebirth midwife that I so love to be at births with, has a stool that's copied from a toilet seat as far as shape but sits much lower to the ground and is angled.  Those hospital stools are basically the same angle as a toilet--straight down. 

You know, those stainless steel ones always looked way too high for my tastes and cold looking, figuratively and literally.  Mine is a wooden  seat, cut out like a toilet and wide on the sides so mama can grab her hands around the seat sides if she wants while bearing down.  The butt end is angled down an inch or so from the front end.  The whole seat is only about a foot off the ground for stability and squat maximization, and the feeling of being grounded to the earth. I can slide my placenta bowl underneath it between the legs and I have to sit in front of mama on the floor to catch babe or she can reach under and catch or we let babe gently down on some soft toweling.  Papa can stand or sit behind mama.  Often times we push the birthing stool up against a bed or couch and papa sits behind mama with his legs wrapped around her upper body so she can rest well in between pushes. 

Every ancient culture had some type of birthing stool.  It's just another tool in your tool bag.  For me,  I see it really work well to get that babe around the pubic bone and on the pernium. Then mama can get off it if she wants to go somewhere else.

I would think you're onto something here- the birth stool should be offering a supported squat, not sitting up high like a throne (or toilet ;)).  Have you read Birth Chairs, Midwives, and Medicine?  It's an interesting read and covers the history of the birth stool.  

Yes, I have that book in my collection.