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: http://sistermorningstar.com/shanti.html

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.

Tuesday, June 20, 2017

Dr. Marshall Klaus, Champion of the Doula

Dr. Marshall Klaus, the world renown pediatrician, who with the late Dr. John Kennel, researched the power of a birth companion (doula) and followed other's research to discover the modeling that birthing women will sometimes even verbalize themselves!

Link to see this in YouTube to see Spinning Babies 2001 video of Dr. Klaus talking about the doula with doula Malik Turley.

Malik Turley: "Dr. Klaus, I was at your talk yesterday about "Sensitive Period" and I was wondering if you have a couple minutes to go over that again for me?"

Dr. Marshall Klaus: "Sure,... You know,  John Kennel had been working for about 30 years on the problem. One of the things that we saw in the beginning that made us wonder if this period was unusual is that if mothers got her babies just one hour after birth the mother was different for as long as nine days. We'd never seen this. They were much more responsive to their babies. They were more interested in their babies. Yet, we hadn't given them any more education.

And then when the new studies came up, related with mothers having more support during labor, and the South African group seeing that those mothers were less depressed 6 weeks later, we began to see that if mothers had their babies 6 hours on day 1 and 6 hours on day 2,  after birth, remember down South, in Susan O'Connor's data, there was less child abuse in the next 17 months and the study was randomized.

We think that because the woman is having a large amount of oxytocin, the love hormone, being secreted, and its going to the brain, that theres a major change in the brain of the newly delivered mother. And that this was placed in an evolutionary way so that women would be very sensitive to their new babies. So they have to begin to take the baby, because each baby is different.

And the mothers are staring at the babies and staring and staring.  They don't take their eyes off baby. When I asked some of these mothers years ago, they said they were taking in the baby.
And I didn't quickly realize what this meant. It means they are incorporating, by watching the baby closely, the needs of the baby.

What this means for physicians and nurses and doulas, is that you have a woman who is like a sponge [hence the Sensitive Period]. The more caring we are of this woman, she incorporates the care we give to her and it becomes the quality and the kind of care she gives her baby.

And I think that what stimulates this especially is the doula. Because when the doula holds the mother and rubs her back and even though the labor takes 6, 8, 10, 12 hours, you don't leave her. You're with her and even though you're exhausted you stay with her.

Very few people have ever been cared for like that.

She begins to feel very warmly towards ...you.
She takes in the way you cared for her, your gentleness and your caring, and then she applies this to the baby.

And the more caring we are, she rises. Six weeks later and two months later she is still different. So she incorporates your qualities and she applies it to her baby.

If you have your baby right after delivery, and it never leaves your bed those women in three different countries those women don't give up their babies.

In Sweden, there's a woman, Kerstin Uvnäs Moberg, who has an idea how this works. Right up to the time of delivery you have more receptors in your brain for oxytocin. And you get in a sense, an oxytocin high where you're open and you're open to new things.

When you're in a Sensitive Period, it means you're mobile, emotionally.

If you have a traumatic birth and you didn't have a doula, or somebody was mean to you, it could be destructive, hurtful to you. But if you're sensitively cared for, if have a difficult birth but a doula whose with you every minute, then you are able go up in
 your functioning permanently, I'm talking about.

So, the Sensitive Period suggests we have to change obstetrical care to make it as humane as we can.

The doula is an ideal person to model, not only to the mother but you can model for physicians such as myself, and you can model for nurses for the obstetricians, and when we see the kind of care you're giving her we're going to start to think about, why are you doing this, you know.

And if we start to have more papers on the Sensitive Period then everybody that works with mothers will realize they are very powerful, but hopefully in a good way.

What's good about the doula is you won't do anything for the mother unless you check with her.

Malik Turley: Right.

Dr. Klaus: You may want to rub her back but she may want you to rub her arms. She may not want any rubbing at all. So you're always checking with her. And we don't do that enough; I don't think doctors check with the mother enough. Give them choices.

The Canadians are ahead of us. The Canadian Royal Society of Obstetrics recommends that every mother have a continuous caring woman with them.

I would say every doula that we've seen is very gentle and caring. You have to remember you're a powerful person because she is in this unusual state of consciousness.

Malik Turley: What do you see as the primary benefits from this caring influence in this Sensitive Period?

Marshall Klaus: One of the biggest things is that mothers that are cared for in the way you are caring for women there's a chance she will be a lot less depressed. And there's data to support that. Less anxious. And I think that she'll take care of her baby using some of the care signals that you gave her.

I visited a close friend some years ago. I was surprised she did this well with a set of two active twins. And I asked her, 'How did this all work out? Cause I knew you like to keep things in order, and babies don't keep things in order.'

She said, 'You know when I had a doula, the doula was just wonderful with me. And when I got more upset she became more relaxed and helped me through it. Now, when the twins get upset I try to help them through it. But I don't get upset I become calm like my doula.'

Dr. Klaus looks at the camera, smiles, and says, "That's real, by the way."

More on oxytocin

Friday, June 16, 2017

Preparing strength with vulnerability

Lately I've been re-introduced to vulnerability. I don't mean I've been re-introduced to hurt. Actually I've been feeling stronger and more fluid than I have for a while within myself. I have more peace now with the process than I have had since the beginning of "my big learning curve" to give birth to Spinning Babies. And in the strength of this emergence, I add some thoughts about supporting birthing strength through the vulnerability involved with communicating needs.

Pregnancy is a series of decisions to give birth, or not, and to end the pregnancy (or grieve a too-soon end of pregnancy) or to "be delivered" and give that powerful transformation sometimes called giving birth to ones self.

One of the most treasured experiences of my doula or midwife life has been to serve women seeking again their power within to birth after a previous surgical birth. There is very often grief when birth is finished through major surgery.

Whether the cesarean was expected and accepted, or sudden after a long labor or discovery of a breech position or other issue, the message may linger than one's ability to give birth may not be unrefutable. The grief of losing the experience of birth continues even with the welcoming of a live, and hopefully healthy child. Especially when the baby is healthy. Especially when the reason for the cesarean is less than certain. Parent may then ask, who am I now? Who am I really in view of this event? Who are we? Who is he? Who is she? I thought I was (they were) the birth giver and that moment was taken, shaken or forsaken.

For many there remains a question, if I have a chance to give birth again, can I finish under my own body's power? Here the unknown is met with determination.

Life brings cycles of stability and instability, coasting and accelerating, learning and sharing. Opposite forces rotate around our lives bringing us opportunities that balance through opposing experiences.

Being pregnant and preparing for birth is a time of change. The unknown beckons while a need for comfort can bring about a want for comfort and surety. We are open in pregnancy to recreate ourselves even as we offer ourselves in empathy and hope to grow a child. In the depth of creative self, in creating self, we are in a sensitive period (as defined by Dr. Maria Montessori as a developmental period of absorbing information) where the behavior of the people we value becomes a model of social behavior.

The seeming dichotomy to achieve a powerful, strong birth may be through vulnerability. What I mean by vulnerability is the taking a risk to express the desire of what one wants to experience. Another vulnerability is trying when the result isn't certain. Giving your heart 100% to the cause and risking disappointment. But this is also giving 100% and experiencing 100% the portion of the process you are currently in. The process is the reward.

Sometimes women have told me that they choose not to tell their doctor what they want or don't want at birth because they don't want to make the doctor angry. The fundamental need is to protect access to the expert who will save your baby. Compromise is a coping skill to sustain a relationship with the person in power (the power to save the baby presumably), as well as to grow a collaborative relationship. But collaboration can only occur if communication comes first.

Vulnerable strength in communication
It's ok to say what you want to your birth professional.
Speak in a way that is mutually meaningful so that you can be heard. It's ok to agree to be rescued if something goes amiss while maintaining autonomy when the birth process is proceeding normally or near normal.

If your doctor or midwife disagrees with your request or birth plan its ok to ask them more about their  thoughts. Ask them if it's their personal opinion, medical finding or a recommendation from statistics rather than a medical finding of your specific situation.

Common questions to help you make an informed decision are:

  • What are the benefits?
  • What are the risks?
  • What are the alternatives, including waiting.
  • What if nothing is done for a while, or nothing different?
  • Is there any medical reason not to try something physiological first in a limited time frame

Of course, in my perspective, I'd like to try a physiological approach using techniques for balancing birth anatomy and positions for opening the pelvis if the issues are related to starting labor, strengthening labor or helping a long or painful labor progress.
When we pick a physiological approach we need to know safety limits (we need to rely on medical assessment and agree upon signs of infection, range of normal blood pressure or normal fetal heart rate, etc). We are often able to resolve a labor stall, for instance, without surgery, but would not attempt to do so if risk factors for mother or baby were severe.

And even as you agree to medical intervention, it's also ok to ask for the opportunity to try something you would like to include. Just as it's ok to sample the flavor of your labor and then accept a second surgery. It's just important to be ok with the process.

Finding determination within unknown elemental forces is the role of a ship's captain and a birthing person. Know what you are about. Set your course. Communicate it with your crew. Keep afloat. Keep fresh water and food available. The mast must be both strong and responsive and so must we.  Test the winds and don't hesitate to reset your sails. And let the stars guide you.

Spinning Babies member Alisa Blackwood offers these dynamic questions to assist your self reflection:

“What are the opposing forces in your life?" 
"What would you list as your uncertainties and your desires?"

Alisa guides us to Give voice to our vulnerabilities, rather than pushing them aside. By embracing our vulnerability we propose to find our inner strength as well as help us ask for the support of others to help us birth from our best selves.

Resolving Shoulder Dystocia in Europe

I just got to teach Resolving Shoulder Dystocia in Italy and in Amsterdam. The wisdom and experience of these midwife "students" is immense, humble, and inclusive to my perspective.

As midwives, we love to come together and learn from one another. Where else can midwives share insights and experiences unique to our experiences as midwives. This is particularly true about birth complications such as shoulder dystocia (baby's head is born but the shoulders remain stuck inside the pelvis). For those midwives who attend home births, we want to hear variations of experience and how other midwives "figured it out!"

Our fingers know that what they find is not always described in the medical literature. Learning from one another prepares us for the unique situations in which books can not contain.

Hear midwives stories and learn how to resolve five types of shoulder dystocia in Gail's video,

Saturday, May 13, 2017

I am expecting twins, can I use the same Spinning Babies techniques for my pregnancy and labor?
Yes! Spinning Babies approach works well for multiples. If you can, start early. Otherwise, start today. You may need to add professional bodywork help to balance uterine ligaments.
Ask your doctor or midwife if there is any medical reason not to do any of these activities (inversion, particularly).

When to start Spinning Babies approach in a Twin Pregnancy?

I typically suggest 20 weeks for a singleton. With multiples the start of daily balancing activities might begin earlier, for instance, 16 weeks… Start gently, pace yourself, and be steady rather than athletic, please!

Start now

Is it too late?

Find out what Linda writes at http://spinningbabies.com/learn-more/baby-positions/twins/

Tuesday, May 9, 2017

The Difference a Sidelying Release Makes

A happy doula, and Spinning Babies Workshop attendee, named Beatrice just emailed thirty minutes ago to rave about a VBAC birth. Many of us birth workers love to support a birthing family through a vaginal birth after a previous cesarean. The triumph of self-determination shines through the parent's eyes.  As providers, we know their life will never be the same.

Here is a labor attempting to begin. Contractions start but neither move labor along nor let the woman rest. Twice before this non-progressing latent labor ended in surgery.

The role of this doula was to bring her positive attitude and practical strategies. Let's gain understanding of which of the techniques may have actually advanced labor progress and which ones, though classic, may not have addressed the situation in play.
Of course, we are looking through the lens of Spinning Babies 
We review the good decisions of this doula with a perspective still little known in the doula world.

Beatrice writes,
"Just to let you know I’ve just used your techniques today with amazing results! My lady was really hoping for a VBAC after two emergency c-sections, she went into labour yesterday but her contractions were really mild inconsistent and not getting her anywhere... so she went for a long walk in the park, up and down hills and after eating a nice meal, she went home to put her kids to bed and to rest for a little while."

Here we see the classic, natural birth movement's strategy to allow the simple passage of time to support the flow of labor. Allowing labor to establish on its own is a healthy and respectful choice...when such a strategy matches the labor situation.

In this case, the labor didn't pick up and night turned to day. Beatrice also knew that this particular mom had a history of emergency cesareans.

An emergency cesarean is surgical birth after the onset of labor. Whether the mother or baby are in a life threatening situation or a long leisurely labor is not defined by this way of using the term "emergency." In most cases, finishing the birth with an "emergency cesarean" isn't an emergency at all. It's only a few cesareans in which the baby or parent are in danger and need immediate life saving surgery to escape severe injury or death.

Most of the time, a lot of time passes as the birth team tries many strategies to help the baby down through the pelvis. After more time, the birth team (including the birthing member!) decides enough-is-enough and a cesarean is now the best option for a safe birth. In these situations, the contractions are strong enough to, but don't:
  • Rotate the baby
  • Dilate the cervix, and 
  • Bring baby down the pelvis 

For Beatrice's "Lady", these strong contractions weren't able to accomplish these three important measures of labor progress. This is exactly the scenario we hope to avoid repeating when supporting a VBAC mother. VBAC is Vaginal Birth After a Cesarean (for a previous birth).

In most cases, emergency cesareans are not because the pelvis is too small, but rather the babies aren't angled into their smallest diameters. Like a swimmer diving into the pool, a birthing baby "makes the smallest splash" (meaning the baby slips most easily into the world) when baby pulls the chin into the chest and brings the shoulders and arms close to the chest to make the body "smaller".

Beatrice knew that baby could be helped into the pelvis. She wasn't specific in her email where in the pelvis she believed baby to be. Remember, they hadn't gotten to the hospital yet to have the nurse or provider check the birthing person's cervix and check which level of the pelvis they found the baby at.

"We started a routine of stretching her psoas muscles followed by lunges and wide side squatting and calf stretches  up and down the steps and the birthing ball..." 

Let's look at these techniques to see which part of the birth journey these techniques give specific help for making room for the baby. There are three levels to the pelvis, three gates, as it were for the baby to pass through.
The inlet (top entrance to the bony tunnel)
The Midpelvis (middle)
The Outlet (bottom, exit of the bony tunnel)

I suspect from the history of repeat cesareans followed by a vaginal birth that the missing factor for the earlier births was fetal engagement. It may be that in the earlier births, and for the long leisurely beginning of this labor, the babies were up at the entrance, the brim, or inlet to the pelvis. I may be wrong, but this is a common cause of "emergency cesarean" and the subsequence avoidance of such an "emergency" by helping baby engage.

The inlet (top entrance to the bony tunnel) Stretching her psoas muscles, Forward Lunges are another way of helping the psoas muscle pair lengthen. There is a particular way of doing them that "wakens" the psoas. Going  up and down the steps helps some babies drop into the pelvis but many times there are less tiring ways to do help baby engage.  

The birthing ball can be a help when pumped up properly to let the hips be slightly higher than the knees. For engaging baby, usually what is needed for labor progress first, turn some happy music on and do hip circles and figure eights.

If a birthing mother belly dances those moves may be preferable... actually its not common for belly dancers to have a long labor, so this is a silly addition. About 30-40 minutes of dancing or using the birth ball like a "dancing seat" is usual.

The Midpelvis (middle) Side Lunges or those lunges that look like a sword player are specific to the mid pelvis or outlet. Lunging to the side would not likely help baby drop into the pelvis. Wide side squatting may mean the knees go out to the side. This may help the bottom of the pelvis open but will close the top and reduce the chance that baby will drop into the pelvis. If baby is already deep in the pelvis these may be useful. Squats reveal their usefulness in 3 to 6 contractions. If you aren't seeing good progress after that, try them again when baby is lower (if needed).

The Outlet (bottom, exit of the bony tunnel) Calf stretches can be helpful for the sacrum to move out of baby's way. The mobile sacrum is dramatic for moving out of the way in the mid or lower pelvis, but may help fetal engagement at the top as well. I put it here because the effect of a calf stretch in labor might be minimal on pelvic mobility at the top of the pelvis but may be slightly better on the bottom. Daily calf stretches for a couple weeks followed by weeks of daily squatting would show the effectiveness of the calf stretch in the big picture, but an immediate effectiveness is less likely to occur.

The baby lines up with each of these openings in the pelvis by rotating.  When the head lines up at each gate, the contractions can move the baby down. Balancing tight or loose muscles and untwisting any crooked ligaments help soften baby's path through these three pelvic levels.

You may have noticed in the story that labor wasn't active yet. Strong contractions are necessary. The womb has been working for many hours without building up a momentum necessary to move labor along.

The doula was thinking and the mother was now ready to try something new. They'd tried some gravity friendly positions and movement without success.  Now they began the Queen of the Static Stretch techniques, the Sidelying Release. This is far more than lying on one's side!

Done on both sides to relieve lopsided muscle tension in the pelvis, Sidelying Release is often the solution for uneven pelvic floor muscles. This baby didn't seem to be so far down the pelvis to be on the pelvic floor yet. The doula is using Sidelying Release to help the mother get into active labor.

"...then Sidelying Release on both sides for the duration of three contractions. After nearly three hours of hard work she went in nice long bath... " This description gives us the clue that Sidelying Release allowed a regular, strong labor pattern to establish over the next three hours. Then she took a gentle bath to adjust her mind to labor and perhaps find pain relief. When baby drops into the pelvis and comes on to the cervix for the first time, the emotional release as well as the added pressure deserves a little deep immersion in a warm (but not the exhausting heat of a hot tub) pool or bathtub. If a deep tub or shower isn't available, a gentle version of shake-the-apple tree (jiggling the buttocks muscles) is another way to relax the pelvis.

2 hours later she was on her way to the hospital with contractions every five minutes, she was three cm on arrival [being 3 cm after 5 hours of stronger labor is a good indication that I was right with my assumption the baby was not engaged before the doulas good suggestions. Lack of engagement may have been the leading factor in the previous cesareans.]  but continued mobilising [moving freely] until her contractions were much more intense and soon after she was feeling pressure with each contraction and we barely had time to reach the delivery suite for her to start pushing... baby was born soon after with a very smooth clean and gentle delivery no stitches... mother and baby went home a few hours later!" 

Congratulations VBAC Family and Doula Beatrice! We, at Spinning Babies, are so happy to help!
And we appreciate the chance to discuss this lovely birth with you as an teaching tool for the 3 Levels Solutions.

You can learn more about 3 Levels Solutions to help you pick the right techniques sooner on the
Spinning Babies; Quick Reference Guide digital download for providers;
Spinning Babies; Parent Class for parents digital download or watch it streaming on Vimeo.com

US customers can visit the Spinning Babies online shop for the booklet or DVD.

Tuesday, April 11, 2017

Uterus in a twist

When seeking an answer about what to do to protect the normalcy of birth, Spinning Babies asks the question, Where is Baby?

This is because the baby's position reflects the shape of the uterus. For instance, if the uterus is well positioned, the baby is well positioned.
If the uterus has gotten into a twist, perhaps from a woman playing softball or golf, the baby may be angled above the twist. The uterus might look tipped. It seems like baby is all over on one side sometimes, or perhaps at a diagonal.

The twist will be low in the uterus where the musculature is softer. Cervical ligaments seek to anchor the uterus at and around the level of the cervix. It is about this area that the twist may be the most significant. Car accidents, sports, and sudden stops in gravity when the body is at an angle from the stopping point (the bike hits the curb at an angle rather than straight on).

Dr. Carol Phillips taught me this view of the uterus and Debra McLaughlin is her student who has taken the teaching of this concept to excellence for the providers of birth care.

Spinning Babies happily brings this information forward for the purpose of comfort in pregnancy and ease in birth. But perhaps more important than ease is function. Our bodies function when in "balance."

Labor pain awakens the brain release of endorphins which prepare the birthing parent for love. The birthing mind becomes the parenting mind. Too much pain is frightening, or rather, fright is inhibitory to a healthy response of instinctual  movement. Less fright, more love, but not less pain more love...

Yet labor pain increases unnecessarily, and can even become insufferable in some cases, when the uterus is so far out of alignment with the pelvis that the uterus can't contract smoothly to bring the baby into and through the pelvis. The uterus pushes the baby against bone in many cases.

I've asked doctor friends of mine about cesareans. Did they see a twist in the uterus? One friend said oh, yes, but she saw it in cesareans for failure to progress.
Well, that made my case particularly!

When the uterus is significantly twisted babies weren't coming through the pelvis. They were lying at funny angles and uterine contractions weren't able to drop them into the pelvis. In some cases, babies were lying sideways with the uterus twisted around so that the back of the uterus was now in the front of the woman's body. One uterus had to be untwisted before the cesarean because the ovary was in front. Other twists were discovered only after the surgery because the condition wasn't as obvious without a structure like an ovary to give the clue.

These are cases in which the doctors found torsion in the uterus. Torsion is also noted in the literature.

Definition of Uterine Torsion

Uterine torsion is defined as rotation of the uterus of more than 45° on its long axis. (Fatih; Nicholson)

Uterine Torsion can be associated with fetal malposition (Pelosi)

What to do about Uterine Torsion?

Body balancing by addressing the soft tissues brings the uterus into alignment. Chiropractic and Osteopathics can help align the pelvis.  Together these modalities work the best. Some Chiropractors know the myofascial or fascialtherapy and add it to their protocols.

Forward Leaning Inversion with head in flexion at a Korean Birth Center.

Spinning Babies offers the Forward-leaning Inversion, a technique created by Dr. Carol Phillips which allows the weight of the pregnant uterus to hang freely and unwind like an old fashioned telephone ear and mouth piece hanging from a tangled phone cord. This is a self care technique that is quite effective in pregnancy for the baby in a transverse lie, or in labor for the anterior lip and other slow-downs of labor progress.

Debra McLaughlin teaches how to recognize and undo uterine torsion.

Debra McLaughlin teaches us to activate the adductors and abductors and correct the symphysis. She is teaching this in a way that a midwife can understand. Learn about aligning the uterus in context this summer to our Spinning Babies community.

Spinning Babies Professional Bodywork Education week in July will move this conversation forward. Chiropractors, Osteopaths, Craniosacral therapists, Fascial Therapist and Therapeutic Massage therapists will love this week. Birth workers are invited but be aware that the teaching is assuming more anatomical awareness than you would learn in midwifery text about the supporting structures. Some of this will be taught but foreknowledge is empowerment. The more you know the more you will learn, let's put it that way! http://spinningbabiesconference.com/


Uterine torsion in second trimester of pregnancy followed by a successful-term pregnancy.
Fatih FF1, Gowri V, Rao K. BMJ Case Rep. 2012 Aug 21;2012

Jensen, J. G. (1992). Uterine torsion in pregnancy. Acta obstetricia et gynecologica Scandinavica, 71(4), 260-265.

Nicholson, W. K., Coulson, C. C., McCoy, M. C., & Semelka, R. C. (1995). Pelvic magnetic resonance imaging in the evaluation of uterine torsion. Obstetrics & Gynecology, 85(5), 888-890.

Pelosi 3rd, M. A., & Pelosi, M. A. (1998). Managing extreme uterine torsion at term. A case report. The Journal of reproductive medicine, 43(2), 153-157.

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.