Monday, October 16, 2017

Spinning Babies before turning a breech (ECV)

Maíra, Gail, and Mariane Menezes 

Midwife Maíra Liberdade and Dr. Marcos Nakamura work together in Rio de Janeiro
to reduce cesareans due to breech presentation. They offer External Cephalic Versions for parents pregnant with a breech baby to turn the baby head down.

Midwife Maíra has a unique suggestion. When an External Cephalic Version is scheduled, Maíra recommends doing The Three Sisters three times a day. That’s Manteado, Forward-leaning Inversion and Sidelying Release. Three times a day? That wasn’t a rate I’d thought of, but this team is quite impressed with the high rate of spontaneous and successful versions.
She is finding more babies are head down by the time the families arrive for the ECV appointment.  More ECVs are successful.
Midwife Maíra Liberdade and Dr. Marcos Nakamura work together in Rio de Janeiro
to reduce cesareans due to breech presentation. They offer External Cephalic Versions for parents pregnant with a breech baby to turn the baby head down. 

Midwife Maíra has a unique suggestion. When an External Cephalic Version is scheduled, Maíra recommends doing The Three Sisters three times a day. That’s Manteado, Forward-leaning Inversion and Sidelying Release. Three times a day? That wasn’t a rate I’d thought of, but this team is quite impressed with the high rate of spontaneous and successful versions.

She is finding more babies are head down by the time the families arrive for the ECV appointment.  More ECVs are successful. Try Spinning Babies first.

Spinning Babies Approved Trainer, Nicole Morales, CPM and midwifery educator, presents breech balancing at the upcoming Midwifery Alliance conference this Nov. 3. and periodically in her midwifery teaching space in San Diego. Spinning Babies Aware Practitioner Teacher and Spinning Babies anatomy advisor, Adrienne Caldwell, MT, regularly teaches parents a unique self care protocol in Minneapolis. See the practitioner listing on Spinning Babies Website. 

Spinning Babies® Aware Practitioner Story

Midwife Melody Morrow, a well known midwife and Spinning Babies enthusiast in Dallas, Texas shares the story of her own sister Harmony’s breech experience. An ECV was attempted by a trusted and breech-skilled doctor. The baby remained breech.  In this case, Melody’s little nephew’s arm got up behind his head. The doctor, skilled in vaginal breech birth, saw the risk of this arm getting stuck on the pelvic brim at the inlet.

So, Spinning Babies® Aware Practitioner, Kristin Hosaka, DC, went to work with Harmony for structural alignment and body balancing. Kristin took our Professional Bodywork Education Workshop in July 2018 and became a Spinning Babies Aware Practitioner. She is a well-known chiropractor in the Dallas area for pregnant parents and new babies. She’s taken several Spinning Babies Workshops and is an active member of our Spinning Babies Community as well as the Dallas birth scene.  Dr. Kristin noted the x-ray and using her advanced skills was able to gently do specific bodywork techniques to allow baby to move his own arm forward to his chest. No manipulation is necessary with this approach, but we believe this approach before a manual external cephalic version may reduce compound presentations and increase ECV success.  

Soon, labor began on its own. 

Everything was going well as labor established. Harmony and her husband arrived at the hospital and their doctor was still on his way. Melody had just arrived to give Auntie support boosted with her midwifery skills.  Suddenly the heart rate dropped. A cesarean was done quickly and baby was born with good Apgars.  While many emergency cesareans doesn't actually reveal a reason for a period of low heart rate, this time, the cause was suspected to be the umbilical cord, not wrapped but piled around the feet. Close monitoring of breech babies, as all positions, is important to catch issues like cord compression. (Some of the neurological vulnerabilities which exist for 9-11% of breech babies may not appear in electronic fetal monitoring strips.)

Benefits of beginning labor may be the higher catecholamine levels (stress hormones) that babies use to prepare for breathing air. Challenges of finishing labor with a sudden cesarean are a lack of fetal preparation with a rise in stress hormones, and the parents acceptance of unexpected changes in birth method. The informed consent process addresses the chance of finishing the breech labor with a cesarean, but actually having a cesarean can still be a change. Parents and baby were healthy and proud. The collaboration of midwife, doctor and chiropractor all worked together for the best possible outcome. And in this case, cesarean was the best outcome.

Thursday, October 12, 2017

Turning Breech Babies and cesarean outcomes

Spinning Babies has said head down is half the story.
And now it turns out that just how babies get head down is important.

In recent years, the manual turning of the breech baby to head down has been poorly reviewed for adverse outcomes (Culver's review of the Cochrane data base, 2013, 2015). 

This September new research compared the cesarean rate after successful External Cephalic Version (ECV) with the cesarean rate after spontaneous cephalic version (Boujenah, 2017). ECV is the procedure when a doctor or midwife manually turns the baby head down by manipulating the baby through the mother's abdomen, while spontaneous cephalic version is when a breech baby turns head down on their own.

And now it turns out that just how babies get head down is important.
A research team wanted to assess if the cesarean rate went up or down after successful External Cephalic Version (ECV) compared to when babies turned themselves head down. ECV is the procedure of a doctor manually turning the baby.

This study had 643 women who attempted ECV, and 198 succeeded in getting baby head down. These women’s labors were compared with the next two women who presented for labor after their breech babies turned head down spontaneously. Both groups, then, had breech babies in pregnancy and one group had head down babies after babies turned on their own and the other group’s babies were turned head down by the doctor.

After ECV the cesarean rate was about 1 in 5 compared to fewer than 1 in 10 for babies who had been breech but turned themselves head down (respectively 20.7% versus 7.07%) Funky head positions were more than 1 in 4, 28.6% versus 0% between the matched baby positions.

Boujenah concludes, a successful ECV increases risk of caesarean section compared with a spontaneous cephalic version in which the baby flips under their own power. See more on this at


Yesterday Jennifer Walker, Spinning Babies Approved Trainer, spoke in The Netherlands at a conference dedicated to improving External Cephalic Version (ECV) skills. Among the questions raised by the Dutch midwives and obstetrician-gynecologists was, "Why is there a higher cesarean rate after successful ECVs than spontaneous versions?" and "How might we raise our 48% national rate for successful ECVs?"

From the Spinning Babies perspective, Jennifer Walker opened with a new question, "Perhaps, we're asking the wrong question. Instead of asking "How can we improve our ECV rate?" should we not be asking, "Why are babies in the breech position?"

In Spinning Babies we often say babies find the best position in the space available. Baby's position is not random. The pelvis is not only a bony passage. It's filled with muscles and ligaments that support and anchor the uterus in the pelvis. These soft tissues allow or restrict anatomical space.

ECV success is not just babies being able to be head down, true success is babies being able to be born vaginally and without injury. Force doesn't resolve a lack of space or uterine torsion which is necessary for both the successful ECV and ease in the labor following ECV. A research study on a protocol using Spinning Babies before the ECV may show improved outcomes.

Jennifer invites us to consider that "when a woman has done this in contact with her body and her baby then she is at peace, because this is their journey, together."

Successful external cephalic version is an independent factor for caesarean section during trial of labor - a matched controlled study.

(Cochrane Database Syst Rev. 2015 Feb 9;(2):CD000184. doi: 10.1002/14651858.CD000184.pub4.
Interventions for helping to turn term breech babies to head first presentation when using external cephalic version.

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:

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

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.)

Friday, October 6, 2017

What does Spinning Babies do?

Spinning Babies offers recommendations to prepare for childbirth in pregnancy.
  • Increase range of motion
  • Balance the body (not too tight, not too loose, not too twisty)
  • Movement daily
  • Rest Smart

We do this with our Daily Essentials video (stream, download, or buy the DVD)
We do this with myofascial releases (the main ones are on our Parent Class video)
Providers may like the background and details of the myofascial releases taught by Dr. Carol Phillips in the Better Birth with Body Balancing video (stream or download only)

Daily use of our Daily Essentials and maternal positioning recommendations (on the same video and on the website under Rest Smartsm) seems to allow a high number of pregnant parents easier births than average.  This is even a higher number when matched with the myofascial techniques.
Some parents begin at 30 weeks. Others have been doing the daily activities since 20 weeks. How soon do you want to:
  • Add calm
  • Restore innate body function
  • Enhance comfort

Once in labor there are times for the myofascial release as well. These are the same as in Spinning Babies; Parent Class video. Spinning Babies Aware Practitioners are trained in even more techniques. The goal in late pregnancy and in early labor is:
  • Help baby flex, rotate, and descend - the necessary movements of birth!

The attentive reader of the Spinning Babies Website will gain a revolutionary amount of information to enhance childbirth. Nurse, midwives, and doctors who are interested in physiological birth are signing up for our provider newsletter - a lesson a week in our Spinning Babies approach. 

We invite parents themselves, and providers who serve birthing parents to use Spinning Babies
 in these moments: 
  • Early labor when contractions are mild and parents are interested in techniques for easing the upcoming labor (yes, this means routine use in early labor for interested birth givers)
  • Early or prodromal labor when pain or anxiety effect a birth givers ability to cope or sleep
  • Spontaneous Rupture of the Membranes (SROM) and no contractions or irregular contractions (dilation is not progressing)
  • Pain or anxiety distressing the birth giver
  • Strong contractions without fetal rotation, descent or cervical dilation
  • Lack of decent even though the cervix is 10 cm
  • Lack of descent when you see the head

    We call this Physiology Before ForceSM 

Thursday, September 28, 2017

Oxytocin as a Safe Birth Activator

"...oxytocin functions rather like a system activator and often influences the release of other signaling substances such as opioids, serotonin, dopamine and noradrenaline. Through these activations, different behavioural and physiological effects are facilitated and coordinated into adaptive patterns, which are influenced by the type of stimuli and environmental factors." 
Uvnäs-MobergK., PeterssonM. Oxytocin, a mediator of anti-stress, well-being, social interaction, growth and healing. Z Psychosom Med Psychother 2005;51:57-80. [Article in German]. 

Oxytocin is a key hormone in the mother-making processes of birth and breastfeeding — which influence the regulation of the heart and mind communication through the vagal nerve complex. Regulation of the vagal nerve complex is the biological determinant for the quality of social contact in the otherwise normal human being (Porges). How well our oxytocin flows, we could say, is how well society functions.

Innate in the process of natural birth are:
  • The awakening brain to the relationship and tasks of parenting
  • Physiological processes connecting the birth giver's heart to the brain function for nurturing
  • The experience of spontaneity and the resulting growth in trust
  • The power gained from facing fear and finding a way past it
  • Breathing skills
  • Body signal recognition
  • An aware and awake baby after a physiologically normal childbirth (not one that is normal in the technological model which has the hormones reduced by medication or by the lack of labor)
  • Oxytocin surges in birth and breastfeeding for both mother and child
Literally. The heart leads the brain, which releases the hormones. When you take the heart out of birth, a whole new set of trouble begins.

Improving society's ability to function civilly and kindly brings up a new definition, therefore, for the question of safety in birth.

The old definition seems to include the techno-medical control of the natural process. 

"Wait right there! The what control?"

Techno-medical — as compared to the physiological model of care. 
Another way to compare is medical vs. midwifery, but since some doctors value physiology more than some midwives, this division is a bit presumptive.

Author and sociologist, Robbie Davis-Floyd wrote a description of the Technological Model of Birth in The Journal of American Folklore. (Expressing her astute sense of humor.) 
Davis-Floyd describes the Technological Model as:
  • Obstetrician focused
  • Routine with procedures
  • Birth is to be managed
  • Rituals to draw birthing people into conformity with a dominant reality model
  • Based on Rene Descartes's body-as-machine mind-body separation
  • Resulting in routine mother-baby separation
  • Institution is more significant than woman
  • Baby is seen as hospital product
Efficiency and de-humanization of birth is justified for the safety of the mother and baby. 
"You could die. The baby could die." 
However the technological model has not proven to save lives. With America expressing one of the highest cesarean rates in the world, the most technological birth method, we would expect to see the lowest death rate to babies. Instead, the U.S. has a high rate of infant death — and a rising maternal death rate, with many causes being unpublicized side-effects of major surgery during childbirth. 

So, to even begin to consider another approach, we need to clear our heads about the nature of safety in childbirth.

The natural process includes unknowns that frighten people into registering for a technological birth. Some unknowns that stress parents and providers alike may be: 

  • when labor will begin
  • the amount of pain that may be felt in labor 
  • the length of time that labor takes, and 
  • whether there may be unforeseen complications.
One of the shortcomings of technologically-controlled birth is that complications still occur. Effects of interventions can include higher blood loss from major surgery, a lack of hormonal transformation, exposure to bacteria that is foreign to the mother, plus the lesser-known, but researched, effects of interventions on breastfeeding, suicide, and long term health (diabetes, for instance).  Drs. Michel Odent, Sarah Buckley and others do a great job bringing forward the issues of interventions on human behavior and health. 

But isn't it safe to be in the hospital, monitoring the baby and having a circle of experts around you?
Fast driving is safer in the race track with a crew to care for the driver and car. The grade of the road, the degree of the curve, and the condition of the tires all need expert control and monitoring, too. 

Birth is a little different. Safety is not obtained by control alone. The human body is not a "well-oiled machine" but a living organism with function far beyond mechanics. 

And so emotional safety has been highly valued in the natural birth world. The fourth "P" of Psychology is added to Passenger, Passage and Powers to explain details in the birth process that the 3 Ps don't fully explain. Our behavior as providers comes under examination for the good of the mother and child and their very important start to the primary human relationship. We ask then, how to behave both for the mother and baby and for meeting the requirements of safety.

So how do we protect birth and let it be spontaneous at the same time? Rather than try to control the process, let's look to control ourselves and our influences within the birth environment. 

Safe practice by definition is a structure of behavior upholding a standard of care. How much do we care what parents want at birth? How much pride do we take in the equipment and even the building design itself? But mainly, this is about our screening or triage, monitoring and treatment or referral.

By nurturing the environment to suite the mother's physiology, the creative process of birth can be free to express. Birth is very much also an expression of hormonal function!

The environment of safety can support the transition from maiden to mother when the birth giver receives support for the inner psychological process. And the environment can support the transition of fetus to newborn through protection of the hormonal release and its effect on lung and brain readiness for birth. Stimulating the maternal forebrain to process logic may actually be dangerous in birth, seems to warn Dr. Michel Odent, the oracle at Primal Research. Quiet, dark, privacy and emotionally nurturing (but not incessant murmuring) may be just the list to include to increase the safety of birth.

Hormones which allow spontaneous birth also allow the transition into motherhood  — the state of activated nurturing of the helpless infant. All of us can nurture but not all of us have the chemical changes made in the brain of a person in labor. These are chemical. Suckling also creates hormonal changes and actual labor optimizes hormonal release. 

Even a labor finished by cesarean includes more brain changes via birth hormones than can occur with no labor.

Spinning Babies is involved in protecting birth by offering an approach to take the fear out of birth. Many women who choose an epidural or elective cesarean do so for fear of pain in childbirth. Not all, but many. Don't, however, assume that many women would choose to skip labor. Most pregnant parents state they would try labor and if they found it manageable, would skip the intervention. A birthing parent's intent is heard in this common response, "I'd like to go natural if I can..."

So let's take the fear out of the unknown by offering an active approach to let the spontaneous release of hormones begin and carry through the process of birth. 

More on oxytocin in our October 7, 2017 blog post. 

Tuesday, August 29, 2017

Emergency Birth

Some of the facebook community midwives are offering conversation during an emergency birth for Texans trapped by water and birthing under dire conditions. I thought I'd add some general tips here to share.
Please find stable ground, and when baby comes, have a level floor or surface under you. Kneel on one knee and put the other foot flat on the ground as baby comes out. You can use your hands now to catch your own baby before baby touches the ground. This is particularly good if the ground is dirty, contaminated with flood water, or mold. The first flora wins; make it Mama's.

Help baby breath
Some babies are born ready to breath. If not, it is usually because they have amniotic fluid in their mouth.
Tip baby face to the side and chest lower than hips in the safety position so baby can spit fluids out of their mouth. Make the neck straight, don't let baby's head fall back or forward all the way to their chest or  breathing will be too hard for baby!
Stimulate baby by rubbing back. Don't spank baby. If necessary, clean mouth and give a very small puff of breath into mouth. Don't be stressed and breathe a mouthful of air into baby. Baby's lungs are little, a cheekful of breath is plenty and exhale steady into baby mouth, don't blast air in or lungs can burst. A straight neck is best for this, chin slightly up, but not down.

Some babies are limp at birth and just need a little moment before they breathe. If they need help, remember, tip, rub, talk to them, and if necessary, gently inflate lungs with a small puff of air.

Bring baby to belly or chest keeping the neck straight and place a dry cloth over baby. Use a shirt from a family member. Wipe blood and fluid off baby, and put a different dry cloth over baby, but not over face.
Keep baby on mother's chest or belly for warmth and cover.

Don't try to cut the cord. It will dry by day 3-5 if kept clean. Add salt and herbs to the placenta but don't get a bunch of salt on baby. Nurse baby to reduce blood loss. Massage the uterus if necessary. It's deep in the belly. Pee often to reduce unnecessary blood loss. Nurse often, too, every hour to 3 hours is typical the first week. The baby may sleep about 5 hours on the end of the second day but if baby sleeps more than 5 hours too often, wake and nurse baby during the first few days or weeks until baby is alert and looking around sometimes each day.

Push placenta out when you see a gush of blood after the birth. Being upright or squatting over a bowl, clean garbage bag, or something to keep the placenta clean. Transfer it to another clean, strong plastic bag like a gallon ziplock bag (after cleaning it a bit) and still don't cut the cord unless you have sterile equipment now. Just keep the bag near baby so the cord isn't pulled on. Put a diaper on baby or use a wash cloth or even a bit of plastic bag (but not tight) to collect baby's sticky, dark meconium (first poops) which is hard to clean. Don't use flood water on a newborn! The baby isn't immune to that bacteria in the flood water.

Love your baby. Breath. Focus on your baby and your new job as a parent. Sing lullabies. You will be soothed along with your baby.

Day 2: When baby pees, make a sissssss noise each time and notice how long after baby nurses that baby pees or poos. By day three or four you can make the little noise at about the right time and baby may begin to pee when you have a bowl under baby. Make baby comfy. If you don't have diapers  learning this tip may make life easier until you do... or maybe you may not want to go back. This can be gently and lovingly taught to a 3 day old. Just be calm and accepting. There is a lot of stress around. Create the love that will carry you all through.

Share if you like. Like if you share! Share with friends in Texas.

See Sister MorningStar's free download for helpers at Emergency Shelters:

Wednesday, July 12, 2017

Birth Positions and Desseauve 2017

I enjoyed reading David Desseauve's French review on positions for labor and birth. I especially enjoyed finding a tip included from Aspasia, a midwife/gynecologist from the second century (translated from the ancient Greek by Pascal Luccioni),

If the difficulty comes from the curvature of the lumbar region ... put the parturient in a position with her knees flexed so that, with the vulva situated at the top, the pathways are easier.

Aspasia was noting the position of the legs, thighs and curvature of the lumbar spine and how this position affected the physics of birthing by letting the baby find room to descend. This is a description of a position now known as McRobert's, named for a Texas Obstetrician who popularized the position for releasing delayed shoulders after the birth of the baby's head.

McRoberts may not have known 
Whence his popular technique had grown,   
When it came to Physician Aspasia 
He simply had position aphasia
And made all the credit his own. 

Dr. McRoberts certainly may not have claimed any such credit; but this is a limerick and limericks are supposed to be naughty. Admittedly, literary liberties are no excuse for rudeness and I apologize for coarse poetry.  

See a bas relief sculpture, an embroidery and description of Aspasia.

A history of birth positions was collected by several trying to change the practice of arranging women on their backs for birthing. Engelmann may be the most famous, or possibly Caldeyro-Barcia, in their campaigns to bring upright birthing positions to the attention of institutionally-oriented physicians.

The specific relationship of the legs to the pelvis are explored in modern day by body-movement expert Blandine Calais Germain in The Female Pelvis.

Two positions illustrate the relationship of the spine to the pelvis and affect the inlet. These are McRobert's position with flexed knees and flattened lumbar, and Walcher's position with legs extended and hanging off the bed from the low level of the trochanters of the femurs. 

McRoberts doesn't open the pelvis wider, but does change angle.

In spite of Aspasia's and other providers success with McRobert's, MRI found the effect is not to open the pelvis. The success is rather to move the symphysis pubis towards the mother's head while flattening the sacrum. This changes the angle of the inlet and sometimes allows the baby to come free of the inlet when stuck there — say when pushing and baby remains high. Clinical care providers (such as nurses) seek maternal positions to avoid cesarean surgery in long second stages and often rediscover this position because it is an easy adaptation of lithotomy (on the back). This is the position I think Aspasia was discussing in her quote. 

Walcher's position is tough but effective, and deserves eye-to-eye contact and support.
Walter's adapted for use with epidural or with a high BMI. 

Walcher's was more recently described about 130 years ago in Germany. This position of extended legs does open the inlet approximately 1 cm, which is significant in childbirth. The position is more difficult to set up and may even be painful, but is quite effective within three contractions. Walcher's is used when the baby remains high in 2nd stage or late active labor. I would suggest abdominal lift and tuck be done first if the birthing person can be standing. Walcher's is appropriate for epidural with the adaption of having the foot of the hospital bed lowered. See above photo. 

Desseauve and associates give a smart article on birth positions giving the state of knowledge and biomechanics perspectives. This short discussion praises a long-awaited, intelligent review that has been missing overall in the flutter of articles on hands-and-knees birthing positions. 

While Desseauve et al. doesn't claim to hold the answers, they are awakening the birth providers to the lack of answers currently in the medical literature. They suggest a system of classifying or characterizing positions of the spine, thighs and pelvis to better understand their differences in birth outcomes. 

And they call for new methodological solutions to improve measurements of contraction force and properties of soft tissues, which are changed by the passage of the baby during birth. 

Molding is caused by overlapping cranial plates. Shape of molding reflects the angle that baby's head was in the pelvis during the time in labor baby molded. 

It was interesting for me to note Desseave's adherence to the interest of force. I recently heard Bruce Lipton compare the shortcoming of Darwin's perspective of survival of the fittest as being racist, classist and capitalist, whereas Wallace's explanation, while sounding cold-hearted when you first hear the phrase "
elimination of the weakest," goes on to explain the role of cooperation for survival. Lipton lectures with a unique blend of science, social science and spirituality, which I'm not qualified to assess. But I do like his sound bite that cooperation is the key to survival. If you want to see a description of Bruce Lipton's book, click here. 

Force in contractions, and force of the baby against the soft tissues, including the cervix, pelvic floor and perineum was listed as the necessary for birth. Force was not well compared when pelvic diameters were opened or constricted because the medical literature isn't on to how which diameters are opened yet. But forces on the pelvic floor in upright birth positions were studied and found much increased over lying in bed in Ashton-Miller et al's contribution.

Aran's 2012 study was cited in this article noting that the pelvic floors of women requiring a cesarean finish to labor had "higher pelvic tone." 

Higher pelvic tone is not always good. It can also be an unfortunate result from self-protective clenching, an instinct activated from an acute or chronic (or both) onslaught of emotional and/or sexual attacks or threats. Undoing the physical effect of the forces frozen in the pelvic floor can be temporarily achieved with the neurophysiological techniques of static stretch and jiggling (vibration which acts as tiny, repeated static stretches). Longer benefits can be achieved by repeating and increasing the range of myofascial restoration of balance.

What if we looked at effectiveness of contractions on cervical dilation, baby's rotation, passage through the pelvic floor and supporting the intact status of the perineum as a cooperative dance in the body? What if we saw the mother and baby moving together for the purpose of birth? We would put off course of this supposed race of survival between parent and child. Phillip Steer catalyzed the current cesarean epidemic by claiming a Darwinist competition between increasing brain capacity of the baby (born with the intelligence to go on and develop cesarean section and so evident of successful evolution) with the reduced diameters needed for the mother to walk on two legs by which editorial proposition.

While we move closer to a comparative, prospective study on the Sidelying Release static stretch technique promoted at Spinning Babies, we applaud the awakening happening within some obstetric practices promoting the cooperative abilities of the birthing body to accommodate the baby.

Techniques such as Forward-Leaning Inversion and Sidelying Release can often redirect the mother-baby dyad away from the operating room to the sudden release of birth.

Furthermore, when we begin a simple matching game to open the pelvis where baby waits, our fear of death under evolutionary competition will diminish. We will be able to stand beside women, sit beneath women, observe the movement of instinct and rejoice in birth again.

While it may not be the same Wallace, we might then join the Scots in praise,

A light arises, a light whose brightness shines clear...

Birth position and instinctual birth are closely related. Observation is crucial to learning but is not enough. I agree with Desseauve and colleagues, assessment of various positions will help understanding. Such understanding may help reduce obstructions to birth in the pelvis — our mistaken passivity or outright wrong recommendations for maternal positions in labors that seek our support.

Let's conclude with the enthusiastic call to action of this research team:

Well-being during delivery presumes aiming toward a birth as physiological as possible. The role of the professional is thus to optimize this difficult event by increasing the woman’s efficiency while diminishing her exertion, fatigue, and perceived pain, and simultaneously ensuring the primary objective: the well-being of mother and child. This probably requires scientifically validated support and a return to a purely fundamental and modern approach through the resources available in biomechanic laboratories.”

Get the text: 
Desseauve, D., Pierre, F., Gachon, B., Decatoire, A., Lacouture, P., & Fradet, L. (2017). New approaches for assessing childbirth positions. Journal of Gynecology Obstetrics and Human Reproduction, 46(2), 189-195.

Changing the Earth by supporting Birth

Mothers bring forth life; medical corporations do not. Birth can be simple, powerful and loving. Fetal positioning, natural birthing and practical help for normal birth.