OMG, She Just Had a Baby and Look at that Bikini Bod!

by Michele Berg, MFT

I opened up Yahoo news today and what was the first thing that popped up? 

“Chrissy Teigen Back in Sports Illustrated Swimsuit Issue After Baby: Watch Her Photo Shoot.” 

Can I first just say…Ugh! And no thank you! Can’t she just model the damn bathing suit? Why must there be the added underlying message of, “Hey, she was pregnant and now her body is back to perfect. And guess what? If you just gave birth and your body doesn’t look like hers, you have failed. You are not good enough. Oh, and P.S. you never will be. Now go back to work or whatever and feel like crap.”

This is the message relayed to women over and over again. Your worth is in your body and beauty. You must police your body at all times.

As a psychotherapist, I have worked with women with eating disorders and body image issues for 12 years. Women are subjected to body scrutiny throughout every phase of life, including the reproductive cycle. I have always thought of eating problems as cultural problems that have become internalized within a person. I don’t know any woman who is not caught by these harmful ideas in one way or another. Of course, not every woman has an eating disorder, but these insidious ideas affect us and the way we think about ourselves all too often.

I also work with women who are having fertility issues.  These two “specialties” of mine often intertwine: Eating issues and body issues often complicate the fertility journey. Eating issues or fear of body changes might quietly get in the way of getting pregnant. Perhaps a woman doesn’t want to gain weight even if it might help her get pregnant. Or perhaps she fears eating certain foods that are recommended.  Maybe her medical team has suggested less exercise or a different form of exercise and that feels scary. Or as her body changes due to medications, hormones or pregnancy she might be torn between two conflicting cultural ideas: That she should love every moment of pregnancy (and mommy-ing for that matter) and still have some idealized version of a body. Women worry that if they speak of these things, they appear “shallow” or that they don’t really want to get pregnant. This often leaves them to face guilt, shame and sadness alone. 

If you feel any of the above, let me tell you loud and clear….you are not alone! This is so common yet rarely spoken of. 

It makes sense to have these conflicting feelings considering the culture we live in. A woman can both desperately want to get pregnant and desperately not want her body or eating habits to change. 

If you are struggling with any of these issues, I suggest getting support. Find other women who can be honest about these things. Find a team who gets it. 

When you do, there will be no need to hide. Honesty with your practitioners will help you get to where you want to go. In my experience, when the invisible ideas that weigh on us become visible…we feel a whole lot better and get moving toward our goal.

What is Mercier Therapy?

Mercier Therapy provides a holistic approach to fertility challenges, pelvic pain, and recovery from pelvic or gynecologic surgery. Mercier Therapy is a safe and gentle, soft-tissue pelvic organ visceral manipulation technique that addresses scar tissue, adhesions, malalignment and/or decreased mobility of the pelvic and reproductive structures. Mobility plays an integral role in proper blood flow and optimal function. Improving the mobility of any structure in the body, whether it’s a shoulder or a uterus, optimizes the function of that region.

Have you ever had surgery or injured your shoulder or knee? In most cases, you will partake in some sort of rehabilitation or recovery program to assist in returning you to pre-injury function. The therapist focuses on reducing scar tissue, improving blood-flow and circulation, and restoring proper mobility so that you are able to do the same activities you did prior to the injury. The pelvis should be thought of similarly in that pelvic organ mobility directly impacts pelvic organ function, i.e. regular menstrual cycles/proper hormone balance, ability to maintain a viable pregnancy. If you are having pelvic pain, cycle irregularities, or are struggling to conceive or remain pregnant, Mercier Therapy can restore proper balance and function, all keys to optimal pelvic health and successful conception.

Mercier Therapy is beneficial for the following:

  • Amenorrhea (lack of period)
  • Anovulation
  • Blocked fallopian tubes
  • Dysmenorrhea (painful periods)
  • Endometriosis
  • Infertility
  • Ovarian function
  • Painful Intercourse
  • Pelvic scarring from previous trauma or surgery ( laparoscopy, laparotomy, D&C, LEEP, abortion, cystocele or rectocele repair, cesarean section, or hysterectomy)
  • PCOS (Polycystic Ovarian Syndrome)
  • Uterine Fibroids

Our fertility program is 6 weeks in length, custom tailored to each individual, and can be used as a stand-alone regimen or in preparation for a medically assisted cycle such as IUI or IVF.

Mercier Therapy™ completed an on-going four year medical study to show an 83% pregnancy success rate within one year of finishing the Shared Journey Fertility Program. The study concluded in September 2012 and was published in Midwifery Today, Spring 2013.

For questions or to schedule a consultation, please contact Dr. Merkel at info@drbrookmerkel.com or (323) 863-5154.

HOW TO TURN A BREECH BABY

This is part one of three part series examining how to turn a breech baby.  Part 2 will look at a Chiropractic Method called the Webster Technique and Part 3 will look at Chinese Medical approaches, including acupuncture and moxibustion.

One spring day in the 1970’s……

“Heidi, it’s a foot!”  Those were the first words proclaimed by my father at the sight of my unexpected tootsies as they shuffle-ball-stepped out into the world.  You see, I was born a footling breech, back in the day when such things were simply considered a way to be born, rather than the perilous, surgically warranted, lawsuit-waiting-to-happen that they are today.

I’m not implying that breech births are a breeze… by all means they are trickier than the average, low risk vertex (head down) presentation.  In addition to being challenging and possibly riskier than head down birth, most doctors these days are not very experienced in breech deliveries.  This is because of a decade worth of studies, position papers and retrospectives that went from proclaiming vaginal breech birth universally unsafe, to updated positions concluding that while it might be just fine to deliver a breech baby vaginally, no one is really trained to do it anymore. (source)

In fact, the most recent recommendation from ACOG (American College of Obstetrics and Gynecology) states that the decision to go forward with a breech birth should be based on the experience of the physician and institution.  Here in Los Angeles, where I practice, there are only 2 MD’s who deliberately deliver breech babies (some exceptions are made for twins when baby “b” is breech).  One of them practices in a home birth setting and the other one is nearing retirement, with no predecessor in sight.

So what’s a pregnant lady with a foot (or a bottom) in her pelvis to do?  I took some time to speak with Dr. Jay Goldberg, one of the finest OB/Gyn’s in the LA area, about the practice of External Cephalic Version (ECV).  I have had the pleasure of working with Dr. Goldberg on several occasions, both as a doula and as an acupuncturist co-treating patients for various conditions, including breech presentation, and I can attest to both his uber-exceptional bedside manner and way above average clinical expertise.  Here is what he had to say:

Me: In your opinion, what causes a baby to stay breech instead of turning head down? Is there something the mom-to-be could have done differently?

Dr. Goldberg: There's nothing [a patient does] to cause this.  Sometimes, the baby settles into this position and likes it, so they don't want to move.  Sometimes, there is an architecture to the uterus that doesn't allow the baby to turn.  Sometimes, there may be a short umbilical cord that is preventing the baby from turning to the down position.

Me: What do you recommend to your patients who have a breech baby and really want a vaginal birth?

Dr. Goldberg: [I say] we still have time to try different things.  You can make an effort to help the baby move through chiropractic work or acupuncture, and I have referrals.  We can check every 1-2 weeks and maybe the baby will turn on its own.  OR, I can try to turn the baby through a procedure called external cephalic version (ECV).  This procedure is done in the hospital usually between 36-39 weeks.

I say that there are 4 scenarios that can play out.  1) The baby turns and is not stressed out.  We'll send you home until you go into labor.  2) The baby turns and then shows distress and we'll keep you at the hospital and proceed with induction. 3) The baby does not turn but there is no distress.  We send you home and schedule a C-section for > 39 weeks.  4) The baby does not turn and shows distress.  We proceed with a C-section.

The procedure is performed > 36 weeks because we prefer not to deliver prior to that, and if the ECV results in fetal distress and we have to deliver, we prefer that the patient is farther along.  Our group typically does them around 38 weeks.

Me: What does an ECV entail?

Dr. Goldberg:  An ECV involves the patient going to the hospital and being monitored for 30-60 minutes.  An IV will be inserted and medication is administered to attempt to relax the uterus.  Sometimes an ultrasound will be performed to document the fetal position as well as the fluid around the baby.  Two physicians with then place the patient in the supine position (completely flat on her back), pour mineral oil onto her abdomen, and then physically press on her abdomen to attempt to turn the baby to the head down position.  2-3 attempts will probably be made.  They may try a forward somersault or a back flip of the baby.  The ultrasound machine will be used frequently to check the fetal heart tones and the fetal position.

Me: Is ECV painful?

Dr. Goldberg: Attempting to turn the baby is usually described as quite painful because the physicians will need to push hard to get the baby out of the pelvis and flipped to the vertex presentation.

Me: What is the success rate for ECV?

Dr. Goldberg:  The success is approximately 50/50, but I usually say 60/40 success with multiparous (women who’ve already had at least one baby) women and 40/60 with primips (first time moms-to-be).

Me: Does your group ever do breech deliveries?

Dr. Goldberg: Our group does not deliver singleton (one baby) vaginal breech.  We will deliver a second twin who is breech, but under certain circumstances

Me: Thank you for taking the time to speak with me today.  Your answers have been really helpful.

To ECV or Not To ECV… is that still your question?

I must admit that it would still be mine, too, were I to find myself in such a quandary.  At the end of the day, it’s a really personal choice, and you won’t get any judgment from this Bao either way.  I think it’s important to consider a few things:

1)   Acupuncture, chiropractic and other types of body work can go a long way to loosen up the pelvic muscles & ligaments, which may make it easier for the baby to turn.  I recommend starting these protocols by 32 weeks.  Much of the time, the baby will turn on it’s own and an ECV will never come into play.

2)   If you reach the 38 week mark and you’ve tried these other methods to no avail, you might just want to give ECV a try.   It’s important to keep in mind that an ECV could result in the birth of your child that day, so plan accordingly.

What if my ECV doesn’t work?

It’s so important to remember that, at the end of the day, we cannot control our childbirth.  All we can do is set it up to be the birth me imagine, and then let go.  After all who are we, mere mortals, to determine what’s best for anyone?  Of course, very few wish for a surgical delivery of their baby, but at the end of the day, we must be present to the medical model we are all a part of, and accept that which we cannot change.  While it is my sincere hope that someday, in the near-as-possible future, vaginal breech birth will go back to being just another way to be born, I understand that we are some way from that reality.    Talk to your doctor about your wishes, seek out medical care in your community that supports breech birth, and encourage the few who perform it to train others.  Be the change, even if your baby won’t make the turn.

About Dr. Goldberg:   A Fellow of the American College of Obstetrics and Gynecology, Dr. Jay M. Goldberg earned his medical degree from the Medical University of South Carolina in 1996 after completing his undergraduate education at the University of California-San Diego. He completed his internship and residency training at Kaiser Permanente in Los Angeles. As a founding member of the Cedars-Sinai Center of Excellence in Minimally Invasive Gynecology, he has been at the forefront of laparoscopic and hysteroscopic surgery. Dr. Goldberg has been awarded the Cedars-Sinai Obstetrician of the Year award and was recipient of the Golden Apple Award-given by the resident physicians he teaches. His charity work includes: Autism Speaks, Hirshberg Pancreatic Cancer Foundation, First Ladies Initiative Birthing Center in Namibia, and Hole in the Wall summer camps.

He can be reached through: www.womenscareofbeverlyhillsgroup.com