The Sphincter and Birthing

The Sphincter: The law of the sphincter seems to make so much sense, almost as if it’s a no brainer, and it’s not something I ever thought about until recently. My next post is going to start to address interventions and the models of birth / maternity care. Before I do that, I wanted to cover the often looked over, but vital, concept of the Sphincter Law. A lot of people don’t understand the Sphincter Law or consider it. Once we do, I think so many of our conceptions about birth may begin to change.

Ina May is one of the first people to discuss this sphincter and how it’s involved in birth. It’s a part of our body that has always been there, and always will be, and we may not know or understand the function. The importance, like many other things in our bodies that we don’t understand, is one of the most influential pieces to understanding how this process goes. One interesting fact to consider is that indigenous cultures have the knowledge of the sphincter deeply embedded into their workings around birth. Curious MD’s have wondered why women from more primitive cultures have an easier time giving birth than women whose connection with the natural world isn’t as present as these women who live so closely to the earth and the natural rhythms of nature.

What is a sphincter? There are sphincters in the body (they are excretory sphincters) for the bladder and rectum. This is how we go pee and poop and how we control these functions. If you’re into physics, it’s the area of your body that opens so that something can be released, and then closes to keep you safe and protected from releasing when you don’t want / need to. It opens and closes, it’s like a little flap that is soft but also mighty strong. There are also sphincters for the cervix and the vagina, two areas of the woman’s body that are always, 100% of the time, involved in pregnancy and birth. If a woman has a cesarean birth, these parts of the body are involved in pregnancy no matter what. No woman has a baby without the cervix and vagina being contacted. Whether it’s intercourse or artificial insemination, without these areas of the body, none of us would be here to have this conversation. I see this discussion as a gift. To begin to understand these areas of our body that are so often perceived as mysterious or taboo is a blessing and I welcome and encourage it in myself and in you.

Apply it to yourself: When you think about going pee or poop, what comes to mind? One of the biggest things I learned about this (before I even know about sphincters) was when I went to Europe last year. For the whole first two days, I couldn’t have a bowel movement. There wasn’t enough safety and consistency. Unknown place, changing hotels everyday, new languages, rich and new foods. It was an amazing trip, and my body was simply not having it for the first few days. My sphincter was locked and that part was no fun! Once I began to soften and relax into the environment, that’s when I was finally able to go. I heard of a story of a little boy whom took a long time to go to the bathroom and if his parents rushed him, he would tell them he needed to relax. Rushing doesn’t work!

Here are some general principles to think about for sphincters (keep in your mind how this may relate to birth, if the vaginal and cervical sphincter doesn’t open, no baby is coming out!). If you read nothing else here, read these things:

* sphincters function best in an environment where there is privacy and intimacy (for example a bathroom with a locked door or a place where interruption is unlikely or impossible)
* sphincters cannot be opened at will and do not respond to commands such as “Relax! Push!”….nothing is relaxing about that
* When a sphincter is in the process of opening, it may suddenly close if the person becomes upset, frightened, self-conscious, or feels another stressful emotion. This is because high levels of adrenaline in the blood do not support (sometimes they even prevent) the opening of a sphincter. I’ll explain this more below
* The state of the jaw and mouth is directly related to the ability of the cervix / vagina and the anus to open to full capacity (if you’ve ever suffered from hemorrhoids, especially during pregnancy or post-labor, remember that the fear of pooping, will get in the way of the sphincter being able to release). A relaxed jaw = relaxed sphincters. Clenching = tense sphincters
*Sphincters are affected by emotions. They function beautifully when the person is comfortable in an environment where the people and the energy is smooth. A place that is free from stressful emotions will support the sphincters the most.

Orders: Sphincters simply do not obey orders. Standard / institutional birthing practices have women begin pushing once their cervix is fully dilated. This is for time management, not for the ease and health of the mama and baby. There is often little consideration about if she needs a break, when she is ready to push, and what her energy level is like. The urge to push, when allowed, comes completely naturally most of the time. That urge to push, when it’s natural, is unavoidable. It simply happens, it doesn’t take thought and orders. A mama does not need someone telling her to push, it is a spontaneous urge and is naturally followed by the mama who trusts herself and her body. Some women are able to push their babies into the world while being coached / told / even yelled at. But that is considered to be an accomplishment in spite of (not due to) this unnecessary distraction.

Shut Down vs Safety: In simple terms, and I can’t say this enough (I know I’ve hammered it home in all of my posts so far)…it has to be safe. We are vulnerable when we are releasing fluids or feces and we are especially vulnerable when we are releasing a baby. When it comes down to survival, we’re not going to go poop or pee or release a helpless baby if we feel that we need to first be safe. Our rational mind may think we are fine and safe, but our body knows the most subtle intricacies that our mind tends to dismiss.

We all know what it feels like to shut down, or to be shut down. The sphincter is the same. It’s so sensitive, we may not even know or be aware of what’s happening in this tender area of our body. A sphincter can slam shut without the owner wanting or intending it to. We may WANT to open, but something is blocking us. A relaxed sphincter that goes from being open or working towards opening into suddenly shut is a fear-based reaction.

Neuroscience: This is the neuroscience of birth. When a mama is put into her fight / flight zone, her blood flow is not in her vagina and uterus, it comes into her limbs. The sphincter shuts, there is less support for her to be opening, and everything changes. This is the law of nature. A wild animal who is giving birth in nature may be so close, and if they sense danger from a predator, they will halt the process of giving birth instinctively, and run from danger until they can safely continue the process. This is the natural urge to protect one’s young and oneself. We as humans, even with our evolutionarily developed consciousness, do the same thing. During birth women go into a primal space and the urge to protect and react may be stronger than she’s ever known. Anyone who wants to mess with that is really asking for it.

How to support the sphincter: Fear aside, there are so many ways we can love and nourish and support the mama and the sphincter to feel safe enough to open. Endorphins are nature’s pain numbing agents. These emotions involve joy, love, laughter, happiness, faith, intimacy, and care. They are instantly effective and have no negative side effects. Smiling, giggling, and a full belly laugh are the most immediate and effective forms of pain killer…who knew.

The breath always supports us: Deep breathing that is supported to come into the abdomen is especially helpful for relaxation of the muscles of the body, particularly the pelvic floor. Yoga practitioners already have something helpful in their tool bag and is often why prenatal yoga can be so helpful to a mama. Many of us women have been conditioned to feel bad about softening our bellies, letting them be big and full. But letting the belly muscles relax and contract is the best way to support opening of the body, and to build strength in these important muscles. They are supportive when we allow them to be. This deep breathing is also relaxing to the mind, heart, and nervous system. It allows for the deepest lung expansion.

Permission: I think we all know how important permission is. And how often it gets stepped on. When a mama gives permission, even if it’s the smallest thing, or for an intervention, she feels ownership over the process that so directly involves her and her body. These little things, are what allows the sphincters to relax. Trust and permission are huge if you want labor and delivery to progress. If the trust is there, this permission can include asking to gently massage the mama’s sphincter to help it soften and open. If skillfully done with gentleness and care, this can sometimes make a huge difference in progress and opening.

The mouth / throat / and the sphincter: There seems to be a deep and profound connection between the vaginal and cervical sphincter. In all of the books and advice, a relaxed mouth means a more elastic cervix. Women whom open and relax their mouths, and often include a lot of sounding, seem to have more relaxed births and rarely need suturing post delivery. Women whom grimace and clench their jaws while pushing have a greater tendency to tear because their perineal muscles are rigid.  There is a direct correlation with the release of perineal muscles when a woman softens her jaw and mouth. These tissues are linked in our bodies. If you feel the need to clench your teeth or jaw or grind your teeth, have someone watch out for it for you. If you notice it in yourself, catch it! If you know you do this unconsciously, ask for support tracking it. Focus on relaxing, do the horse lips where you blow the breath out of your lips, and let your mouth open to release sounds. The horse lips has proven to be one of the best and most simple techniques available!  All you have to do is blow like a horse and let your lips be free. It’s impossible for the cervix to tighten when this horse lips happens. And if you feel silly doing it, that’s the best reason! Do it and laugh. Do it and let others laugh with you.

To close…I hope this information about sphincters has been helpful. It’s always an interesting experiment to see how these things play out in our own lives, even if we’re not the one doing any birthing. Notice what supports you to be relaxed and open. Notice what supports your most easeful time with using the toilet, that’s a sure way to see what your personal needs are. It can also provide a lot of empathy. No one wants to go poop or have sex with people whom they don’t trust. Why would someone want to push a baby out in that same circumstance? Can you imagine what it must be like for the woman in your life who’s about to go through this experience? A little dose of empathy goes a long way.

Next up…I’ve done a lot of preparation writing and education with these first posts. I wanted to lay the foundation and build ground for us. To help you build tolerance for all of this language and thinking about these things that might feel overwhelming. My next post will finally begin to address interventions, what they actually entail (the full story so often isn’t given and people end up agreeing to something that they are in the dark about), and what the risks and benefits are.

Choice: I want to hit it home once again that while I enjoy the concept of natural childbirth and always want to support that in the women who want it, I also support interventions when they are needed and necessary or wanted by the mama. The mama and her family’s choice is what is the most important to me. Fully informed consent and choice often looks very different than being blindly guided into something and then having regret and pain around it. So, cheers to choice, and look out for the next post.

With love, Alicia

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About Alicia Patterson

Alicia Patterson is a Psychotherapist / Dance Movement Therapist, Birth Doula, Energy Worker, Dance and Yoga Facilitator in the Boulder / Denver area.
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