Sunday, February 15, 2015

Tammy dreams of reducing obstructed labor in Kenya

  Obstructed Labor is when the mother is in labor, her body is working hard (sometimes until her uterus tires and contractions slow) and yet the baby isn't able to come through the pelvis. 

Obstructed labor. In this example, baby's hands tap at the fetoscope (stethoscope).
In the doula world, a powerful phrase is the "doula spirit." This means the social love and self sacrifice a community of doulas naturally generates for mothers, for one another, and for large collaborative causes. 

Tammy Ryan is a woman of doula spirit. She has been asked to come to a couple different countries in Africa. Her first visit in 2008, a midwife lead her through a hospital room door and she suddenly found herself responsible for a roomful of birthing women. One woman's labor had already been going on and on and Tammy tried to arrange a cesarean for her. Though they were in a city hospital, the power was out that day and the staff couldn't do a cesarean because they relied on lights and suction machines and electric pump anesthesia and such technology that no cesareans could be done that day. Though Tammy was a doula and had decent training herself, nothing she knew how to do could save the mother. She died in Tammy's arms. Afterwards Tammy escaped outside to cry and rage in her powerlessness. I can't quite imagine. I've been at close calls in American hospitals where a doctor arrived in the nick of time. So I can almost imagine. But not really. 

The death of the woman in her arms both blew Tammy's world and created a deep desire to go back with skills. She has started a GoFundMe site and needs immediate donations this week to attain her goal! Please go now and donate: 

Tammy has an invite from local midwives to return to Kenya and to Nairobi, Africa and help women in labor, too often alone, too often isolated, even in the hospital. There are just too few skilled workers or resources. Yet the women live and love like any of the rest of us. Relationships, dreams and responsibilities are universal.

OP babies drawn by Gail Tully
Obstructed labor. The baby on the left can't get his head in the pelvis. His forehead is overlapping the pubic bone when he faces forward. He must turn or engage (drop into the pelvis) like the baby on the right or he must have a cesarean or die, or his mother could die. A mother's own spontaneous movements MIGHT have him drop in the pelvis like the baby on the right, or help him to turn. But it may be at best about 50/50 with usual maternity care in labor (47%-49% of first moms with a baby that is not engaged end labor with a cesarean in studies). An unusual technique can help. Spinning Babies presents techniques for turning posterior babies and helping engagement at
Spinning Babies Workshops are available to providers and doulas; and a video,
Parent Class, is available for download or as a DVD
 I got back out of bed tonight to write this post because I can't sleep. This week we have a chance to send Tammy back to the countries she has connections with in Africa with Spinning Babies skills. Once Tammy has the Spinning Babies Approved Trainer designation she can teach Spinning Babies Workshops. She is in line as one of 6 pilot program Trainers. In fact, she started the line by insisting. Debbie Young called me at the end of 2013 and said, "Tammy Ryan is going to call you and your answer is yes." She got my attention. 

Well, we've been quietly preparing this trainer training and I've chosen 6 women. Not a lot of trainers,  but we'll talk more about the next trainer trainer in June. For now we have to get Tammy to Africa.
She's set to go back to Nigeria and has contacts in Democratic Republic of Congo and Tanzania, too. The midwives are asking for help! 

Tammy helps with teaching hygiene and the use of sterile gloves, how to diagnose diabetes by the behavior of ants to a cup of pee set in the sun (no labs in some places!) and how to take a blood pressure to catch high blood pressure before a seizure could take the mother's life. 

Tammy wants to go back with the full Spinning Babies awareness of how to resolve a stuck labor. I've analyzed the factors and teach the basics in my day long class. Tammy's taken Spinning Babies about 3 times. But we go in depth with the training. Its 9 days long! She prepares to teach and actually teaches the class before the end of the training. I'll evaluate her. Then she will be ready to go to Africa. 

Tammy can begin saving lives immediately. It would help sooth her aching heart, broken in 2008 by the pain of loss and anguish of helplessness.  Now she has skills. Debbie Young is scheduled to go with her in April. Of course, a doula isn't rich. And like many midwives around the world, African midwives don't have money for airline tickets. But many of us have a few dollars to donate. I've donated to Tammy's cause. Yes, it might be my cause, too, but Tammy is making it happen for me, for all of us. 

Some concern has been expressed to me about a white woman going to help People of Color on another continent. I wouldn't support the conceit of a person thinking they have information to "save" others on a cultural or moral level. To belittle one's culture or beliefs denies the Light of Freedom inherent in the Soul. Nope, not for me.  This is about sharing birth knowledge and while its limited but its still very valuable. 

The growing movement to bring awareness of white police officers shooting unarmed men of color, of the inordinate percentage of African American young men going through prison (I just read one city it was 66%) to keep a prison system funded, and a harsh inequality in health access for minorities can detract from people being helpful to others. I've been shared with good ideas to support organizations of Color who help their own. There is such good in coming to a place of help where you can feel safe. I know I have a great deal more privilege to do that than many a Woman of Color in my country.   Yet as many turn away should others be turned away? Now is just when we need to celebrate turning towards one another.  I read of The Creek of the Ohio region having two villages and as children grew the elders would assign the child to one of the villages according to their nature, the warriors to one and the peacemakers to the other. They saw the value in both.    Life brings us many ways. I have been helped by Persons of Color that didn't turn away from me, thankfully. Some were elders, others I saw as peers. I was taught to see the inner person and though that is not the warrior way, it is my way. Now back to Tammy Girl!

Debbie Young (left) and Tammy Ryan on the day they insisted I begin a Spinning Babies Approved Trainer Training.
(I just love these ladies!)

You can do good through Tammy by supporting her. We can trust her with this task. Debbie Young and Tammy Ryan have both served on the board of DONA International and worked together with Baby Matters. I feel confident that real service will come out of this trip. As Tammy calls herself, Servant's Hands, she is dedicated to this journey. And you can take Tammy's Spinning Babies class yourself in the US or Africa. She'll begin teaching in March already!

The cause of an obstructed labor might be that the baby is too large for the mothers pelvis, which might be because malnutrition or an accident reduced the size of the pelvis. 
Yet many times, I'm finding, though women are told that their baby is too big, a unique move to open the pelvis lets labor finish bringing the baby.

When baby is high, standing and flattening the lower back during contractions can let the baby that was high drop into the pelvis and arching the lower back can open the outlet and let the baby out the bottom.

Sidelying release, isn't just lying sideways. Pressure and rocking and keeping the hips straight (ahem) while the leg hangs over the side of a bed or bench allows shortened hip muscles to lengthen and free movement in the pelvis, soften the pelvic floor, and let baby come lower into the pelvis.

 Sometimes obstruction is from a muscle that has shortened, tightened and pulls the pelvis into a smaller diameter. That would make the pelvis seem too small but the Sidelying Release (not just lying on one's side) can lengthen muscles, the standing sacral release can relax ligaments and fascia and mobilize the pelvis.

There are many moves like these. Many American providers don't understand the concepts until they are experienced and felt. Through our body these concepts enter the mind and flow out again through our hands.

So matching where the baby is in the pelvis to the technique for that muscle, joint, diameter, etc. is really enough to save a noticeable percentage of mothers and babies from death, injury, or cesarean section. That doctors and midwives, whether North America or Africa, don't know movement anatomy. This means that some babies and women die of ruptured uterus, exhaustion and infection because labor is too long or too hard without bringing the baby. It is less common here, but happens. And, an unnecessary cesarean is not without risk at the time and for the next pregnancy, too. So let's reduce misunderstanding in when major surgery is needed to save a life.

Many long labors can be just fine, of course!  Good nutrition and experienced assessment of labor saves lives. Skills for labor progress at all levels of the pelvis should be basic knowledge for all birth workers. Please help this educator empower others through the knowledge of Spinning Babies.

Tuesday, February 10, 2015

Women are Women where ever we birth

“Women are women where ever they are.” said Dawn Russell on Skype today. Dawn’s been nurturing and hosting Spinning Babies for the past several years. Today, as 16" of snow head her way, she is setting up my (going subscription strength April 2015) and asking about my many travels since we sat together in her Brattleboro, Vermont office. Dawn's business, MyArtisanWeb, was walking distance from my hotel when Dr. Michele Sayball, ND, had me present Spinning Babies a little over a year ago. Then the October leaves looked fantastic, today its a white and frosty wonderland.

We used to have cold and snow in Minnesota. Now we give it to New England!

Dawn mused how amazing it is that I get to meet women in so many parts of the world. I agree. I
see women wanting the same things, afraid of many of the same things, and able in the same ways.

Women know birth. They live birth. They give birth with a power and knowing within, deeper than logic.  Women also want compassionate and responsive help during childbirth. Women everywhere have a need for hope. Childbirth is getting technologically complicated- from the social point of view. And as we've heard, humans are social animals. When women have a sense of empowerment, they give each other hope.

Any particular woman has her social standing in her family, community, work and home.  She has skills in caring for herself and others in her home and work circles, whether that's web work, like Dawn does for me or other jobs, or that's personalized to self and family. 
A pregnant woman feels the changes of pregnancy and seeks experienced helpers for a safe passage for her and her child. This is a seemingly universal and social response to pregnancy.

America has been busy exporting a technological approach to childbirth which brings a perhaps unintentional message to fear birth. Medical tools as simple as a scalpel all the way to the highly trained anesthesiologist and his or her console of dials and drugs can help save a baby during an obstructed birth (so thankful for their ability!!). To have a medical rescue takes a lot of investment in schooling, production, and administrating of these tools and technicians. They are important. 

The shadow side is that the skills to save babies without technology are being lost. Skills are lost because natural birth don't have wide social standing and support for saving. Money is too often a representation of social standing and salary is a glaring difference between doctor and midwife. We have the knowledge to mix the birth team to appropriate percentages of midwives, doctors, and anesthesiologists to support the highest rate of good birth outcomes. Its not the same percentages in professions as brings the best income to hospital corporations. 

So Corporations and their speakers justify why its ok to lose more women to overuse of surgery when a less than 10-15% cesarean rate has the best mom and baby outcome. One administrator told the doctor she was firing that if she wouldn't sustain at least a 25% cesarean rate that her position wasn't going to be profitable for the hospital and she'd have to resign or be fired. Good doctors are made to leave

If a cesarean rate is over 30% (over 70%?) as it is in Asian and South American cities, even in Mexican cities, women are left wondering two things at once. Isn't birth natural? And Is Birth Safe? 

Can't we preserve the skills for assisting birth along with skills for drugs and scalpels? If we could, providers could be reassured that they could handle a long labor or a shoulder dystocia, a breech birth or a posterior or transverse arrest without surgery. I'm not saying that all troublesome labor can be handled naturally. Of course not. I've been attending births for over 30 years. Ideology is not a good midwife. 

But we can calm down the cesarean train in the US. 
At Yeon & Nature Women’s Clinic, Dr Jiewon Park interpreted a day of Spinning Babies and another of Resolving Shoulder Dystocia and Breech Basics. She was thrilled to learn ways to reduce her cesarean rate! Was it 90% like some South American or Chinese cities? Was it 30-40% like many other Seoul, Korea maternity hospitals? No, see the rate on the video below! Yet, Dr. Park wanted so much to get it down. For two months she had a 4% rate and felt much better. And now she is eager to help women whose babies hadn't engaged on their own and women with signs of a long labor starting with the Spinning Babies approach. 


She catches breechlings at her maternity hospital (birth center). So she isn't afraid of life's variations. Dr. Park experiences extremely low numbers of shoulder dystocia. Her solution? She tells women to climb 20 flights of stairs every day and once they can do that then do it twice a day. The rhythm of the pelvic joints and pushing off the step behind are excellent for pelvic stability and balance. Dr. Park is not going for a higher natural birth rate, she's going for a better birth experience for women. 

In Singapore, Dr. Lai has a similar outlook. He's the go-to guy for breeches, twins and vbacs. He works with doulas and midwives and takes workshops himself in natural birth approaches. His hired doula, Ginny Phang, saw that he came to Spinning Babies. So women are women and I'd add, Birth Keepers are Birth Keepers around the World. Innovation and ingenuity and a love and compassion for birthing families unite us.

Busan, Korean midwife finds the little hands in a baby during Gail's birth skills day. Doctors and Midwives attended Spinning Babies and then a day of advanced skills at Woosik and Jaquey Chang's pregnancy and life resource center. 
Birth Keepers like Dr. Woosik John Chang of Busan raise the bar of what can be achieved.  Dr Chang has revolutionized the simple resource center to include the full scope of human happiness in his curriculum, including cooking, money and language lessons! Imagine that all beginning with prenatal care.

Around the world, women are seeking joy and pleasure in becoming a mother. In their meditations and their preparation. Women want to be celebrated as brings of life. Women want the busy world and the busy provider to slow down and gaze in amazement for just a moment. Birth is the most potent miracle in the range of human existence. Asking for acknowledgement in women's emotional needs for their childbearing does no belittlement of their identities as strong, capable, contributing women. 

Women are women around the world. And I am astonished and grateful to hear their heart's desire and assist them to have their dreams come true.

And if you are interested in Dawn helping your web dreams come true, she's interested in helping social motivators and eco conscious businesses. Check her out at
White Glove Joomla Hosting as a Service
214 Main Street BrattleboroVT 05301
Tel (802) 579-1417

Saturday, January 10, 2015

After the External Cepahlic Version

After a breech is turned head down by the doctor in a manual,  external cephalic version some babies end up with limbs over their head or similar mix up. Here's a suggestion, 
To help resolve a compound presentation or twist, it is up to the mother if she wants to do the balancing work.

An external cephalic version is  a technique by a doctor or midwife to turn the baby head down manually by pushing the baby via the abdomen. ECV has a set of risks of its own, including a difficult birth afterwards. ECV works about 50% of the time, with a few midwives and doctors having better rates. No technique is without risk, no life is without risk.

Baby's heart beat should be listened to carefully before and during and after the ECV.  Pausing when baby's heart rate drops, stopping if the baby doesnt respond well to the next attempt to turn the baby more, and doing an emergency cesarean if the heart rate doesn't come right back up are 3 ways to protect baby and reduce the small but present chance of death. Please don't push the baby around at the Chiropractor, massage therapist's office or your girl friend's house. It can be done gently, but baby needs to be listened to.

Want to find other ways to flip a baby? These are gentle, mother-led, baby-responded to techniques that have good results and can be tried before the ECV to work or to make the ECV work more easily without force. NO technique is without risk. Check with your midwife or doctor before setting out on a series of activities to flip your baby. Bring information with you as they may not understand why you would get upside down in pregnancy. Its all about the ligaments!

After the ECV, women can do things to make the upcoming head down birth easier. Actually, if the ECV doesn't work and the mother goes for a vaginal birth (with a skilled breech care provider, I hope!) these will help the mother's muscles be more balanced for birthing.

Some women will begin with a gentle but persistent rebozo with her on hands and knees, not knee chest and not vigorous! -  just gentle for as long as the helper can do it, 3-6 minutes? 10 minutes?. Rebozo the tummy then buns.

She may benefit by doing 5 forward leaning inversions in one day for only 30 seconds each. These may be key. Not with high blood pressure or risk of stroke. Avoid doing with heart burn.

Then do Sidelying release and Standing sacral release. How to do these are on Parent Class, which you can download now.

When labor begins in earnest, she may benefit from 10 abdominal lift and tucks (posterior pelvic tilt) during the contractions.

Here's a sample issues that SOMETIMEs occurs,
ECV worked!  They decided to stay and get induced.  Baby tanked during version and I think they were nervous and wanted to be in hospital...[Baby recovered well and induction was attempted.] 
Now it's 3 days later and many doses of cervidil and cytotec later her cervix still thick and closed. Baby is high [above pelvis] and not engaged.  I sent her the page from Spinning Babies about ways to engage baby but so far she hasn't had much change...  I wonder if there is something else going on??   
Her and baby both healthy, baby doing well, waters intact etc.  I don't know if she just needs to have more time until she's ready or if baby is trying to tell us something...

What baby is trying to say, is head down is not enough. We must resolve the twist that may be there and that had caused the breech position in this case. Balance first. Check out The 3 Principles of Spinning Babies to see more on Balance.  

Sunday, January 4, 2015

Birth Detective: Why didn't my OP baby come down? Part 3

This is Part 3, Read Part 1 to start from the Beginning,
Read Part 2.

Jessica processes her birth

"Hi Gail, 
  "I know I was at 0 station for sure. I will request my birth records as well to make sure. I have joined my local chapter of ICAN and have already found tremendous support! Thank you so much for suggesting this.  They did say he was Left OP. Does that mean he was facing my left side? He was favoring my left side my entire pregnancy it seemed. I felt hands up front down low and kicks up near my ribs on my left side. I also had a dip I my belly that was visible.

  "I think where I gave up and lost faith was when the second epidural kicked in and I lost all feeling in my legs. I was numb up to my chest and remember thinking how am I going to feel the urge to push and was disappointed but relieved at the same time for the ease of the pain. It was such a blur at the end I remember thinking how am I going to get through the rest of the stations if I was at zero for so long. I wish someone would have told me I could do it and gave me encouragement. At that point all I wanted was to be done unfortunately. 

   "I wonder if they can label the reason for my c section as "failure to progress" if they didn't say it was required or "an emergency" The OB said there was a 5% chance I could push him out after giving me Pitocin (if I wanted it at that point which I didn't because I was delirious and wanted it to be over). My OB also told me my white cell count was so low they had to call the first response team to be on stand by for me if my numbers didn't turn around. I wonder why this happened? Maybe because my body was working on overdrive (no food or sleep barely for over 24 hours) etc."

Gail replies:

Would pitocin have helped, you ask? Was there really just a 5% chance? I think your doctor meant that stronger contractions were not likely what was needed. This usually means that the contractions were seen to be strong enough but baby wasn't coming down. But he doesn't want to say 100% because he knows that the unexpected can happen in a good way, too.  

Back to Pitocin as a possible solution. 
The implied question is, Can increased power of the contraction force baby through the pelvis? 

The Spinning Babies look at labor progress is to the diameters of mother and baby and how they are lined up at the time of a labor stall or stop.

Spinning Babies approach to childbirth is to "balance" the passage, so to speak, by releasing what is super tight or lengthening muscles or ligaments that are shortened (tight); Opening the diameters at the level of the pelvis where baby is stuck (in your case "0" station); and a myriad of other factors supported by physiologic means. 

If Simon were OP at 0 Station and your sacrum was tucked in from a short sacrotuberous ligament, then releasing that ligament would be about the main thing, maybe the only thing, to do. Doctors and Midwives are not trained in this. A few doctors are trained to reach in, tuck the chin and turn baby's head all the way around manually. Some do this with forceps.
Not easy on mom or baby, typically, but can reduce cesareans. 

If Simon were OP and you kept going, [you may have] had 4-10 or more hours of pushing on birth stools, standing and hanging from a rope above them, hands and knees and every movement and every effort at full blast [but you] had a fever or low white blood count. That is a deal breaker and cesarean is preferred to preserve mother and child.

Essentially,... you had neither the time (due to the white blood count) nor the personnel to help you with a posterior baby and a sacrum that was pulled into his path.

This is tough stuff to read, Jessica. You didn't do anything wrong or unusual, you were living your life - we all live in a gravity field meaning we have issues of tension and sometimes torsion in our bodies that we don't even realize. Once in a while a woman will have just the combination of several issues compromise her birth, such as complications of fever or other signs of infection and an OP baby. 

Next Birth Will the next baby be Posterior, too? 
Resolving the causes that held this baby OP will help the next baby get to the Left Anterior, that would give you a tremendous boost towards a VBAC. Body balancing and core flexibility rather than core strength are emphasized. A little bit probably won't help. Go for it!

Now that you are narrowing down the likely causes, you can address them and have a much better time next time. I've worked personally with many dozens of VBAC women with a birth history like yours that went on to have a second baby vaginally.  

Getting body balance and a strategy to maintain balance and flexibility can be a lot of work, but I know you are up to it. 

Saturday, January 3, 2015

Birth Detective: Why didn't my OP baby come down? Part 2 of 3

This is part 2 of 3, Read Part 1 

Jessica wrote back,

"Hi Gail! 

Thank you SO much for responding.Your time and reply mean so much to me especially as I have been feeling down and out because I felt like "I wish I would have known he was OP etc. and I wish I would have had adequate support to birth how I planned etc."). Here are my answers--

1. Do you have a photo of you baby's molding? That will help me understand his position over the last hours of your labor. Flexed or extended (chin down or up) or posterior or did he rotate? (Photos attached! He did not rotate) [Jessica's answers are here in bold (with her parenthesis) and my comments are here in brick red.]

2. Did you have Pitocin in this labor? Were you offered it? No, I did not want Pitocin going into it. I was offered it at the very end, only when I was on my last hour of labor when he was "stalled" at the 9.5+cm). At that point when I thought about having to go through another several hours of the pain (pushing etc.) I couldn't even imagine so I opted for the C-Section out of sheer exhaustion. [I asked about Pitocin to get a sense of the interventions tried before the cesarean. Adding Pitocin when there is a delay is a common practice, and Jessica was offered it. Pitocin causes stronger contractions if contractions are not considered strong enough to keep a force on the cervix to pull it open like pulling on a t-shirt. Going for stronger contractions isn't the only way to encourage progress, as you see from the many techniques on Its a step that  Jessica chose to decline. If the baby is stuck against a bone, Pitocin may not help, the baby has to rotate off the bone, flex, or mould to get past a bony protrusion in the pelvis.] 

3. How low in your pelvis, if at all, did your baby get? He was (or at least felt) very low. My OB kept telling me at each appointment how low he was. I think I was at a zero station when I stalled. 
[I always want to know where baby is or was in the pelvis to know more about why baby was stuck. There are two ways a baby may be held back at 0 Station; one is because they face a hip and inside the pelvis a bony protrusion called the ischial spines extends  into the birth space and can catch baby's head, front and back. The other way is if the pelvis is a bit small or the sacrum is brought inwards by a tight muscles/ligaments, which seems to be the case here.]

4. Did you push at all? Whether your body's own urge or directed by the nurse/doctor? Before they knew I was stalled, the nurse asked me to try and push- but at that point my epidural was SO strong, I couldn't feel any urge. The first epidural failed and the second one was SO strong, [numbness from the epidural] went up to my boobs. I had no feeling in my legs and or urges to push. 
[Pushing during (but not between) 3 contractions even before full dilation has sometimes rotated a posterior baby and allowed progress. Push for three (or four) and then stop pushing if rotation doesn't occur. Don't continue pushing on a cervix as it will swell or, not often, rip. But a bit of pushing can make the cervix take the role of the pelvic floor to rotate baby sometimes. Its worth a shot. The epidural in this case didn't help. Could the nurse have gotten more directive? Could the doctor come in at this point and manually rotated the baby with her hand and then let the contractions "labor the baby down" until Jessica had the baby on her perineum and finally then felt a bit of urge to push?  Could the epidural have been turned down or off to see if an urge to push came back?  All this speculation is besides the point that the low white blood cell count indicated an infection present and took away the time to explore these options.

I knew that that is where I went wrong when I got the epidural. I couldn't imagined not getting it with the amount of pain I was in. I needed someone in my face coaching me through it. [A mature and experienced nurse or doula can compassionately, and with a no-nonsense approach do the "Take Charge Routine" explained by Penny Simkin.  Additionally, the side lying release may relieve that crazy pain. 

Instead, after the epidural, I was pretty much on the bed. They turned me from side to side periodically. [Understanding how to open the pelvic diameters for where the baby is will help labor progress. There are some solutions given in the next blog posting.  

5. What size head did your baby have? I am not sure! My husband is a 7.75 hat size. He has a large head. I can find out for you when I call my OB. They should have that on record right? 
[A posterior presentation always makes the head seem larger and fit less easily. A labor stall with a posterior baby with a 12" head is less optimistic for a future vaginal birth after a cesarean than if the baby had a 14" head. But as I've often said, presentation is more important than size, and this would be true here also.]

6. What positions were you in over the last 2.5 hours of labor? On my side -- I was so numb they had to put this air mattress thing underneath me to turn me! I did try hands and knees one time but it was too painful. [There are some techniques to help a baby through the outlet and some maternal positions that open the outlet, like the anterior pelvic tilt and using a peanut ball to open the midpelvis and outlet. Rolling from side to side helps a little but for many stalled labors, more particular movements specific to opening the pelvis at the level baby is stalled is critical.]

Ok, here are more questions of my heart, doula-motivated questions, that may not have as much to do with the outcome directly, but may have directed the course of your decision making. 

Did you feel adequately supported? Yes, I did have a doula. My husband was amazing, but I think I needed more guidance on how or what to do to get through the pain. We needed someone that knew this type of labor and positions/things we could have done to help me progress. [Support by partner, doula AND medical providers and professionals helps give confidence and endurance. In the case of a labor needing an unexpected and unwanted intervention feeling supported helps the emotional resolution. Feeling heard and supported is more important than a good feeling. Support is a basis for the quality of relationship with self and baby.]  

Did you feel stressed at the end and pressured for time? No, I did not feel pressured for time, but I did feel like I couldn't give it another minute I was in so much pain and had trouble breathing with my fever not going down. [An originally undesired intervention can become a rescue. After the crisis, the woman who hadn't wanted the intervention goes back to her original feeling of not wanting the intervention, but now she has had it. How she feels about herself is often mixed with this disappointment. Reframing the view of the intervention in a way that adds compassion to the choice to take it adds self compassion and self acceptance. In Jessica's case, she was in a moment of crisis, more than a moment. Her pain was not adequately addressed as it was beyond the usual labor experience. She was sick. It is so much harder to cope when ill. The first epidural didn't work and was hope dashed. She thought she'd have immediate relief only to continue in pain. The second epidural went high on her spine and gave her the feeling of not being able to catch her breath. Stress was mounting and no one had an answer for her. But no one was saying her time was up. It wouldn't have been typical for her medical team to let her fever continue with the baby unable to come down and no end in sight.  

Did you sleep during the epidural? Barely- maybe for an hour or so. I did not eat anything.
Were you helped to change position during the epidural? Yes- with the air mattress. (not very effective at all) [So no help for coping by sleep.]

Did anyone tell you that you were too tired, or were tiring? I was SO TIRED I had nothing left in my tank. [This is asked to determine if the seed was planted that she couldn't go on. In her case, the fever added to her state.]

And my husband and I own a gym. I workout every day and have strong endurance. Nothing could have prepared me for the pain that I felt with him on my sacrum especially after my waters broke. It was immense. My goal was a natural drug free birth. I got more than halfway so I feel good about that. [Ahh. A big clue that Jessica may have a very strong core, which is code for short pelvic floor. Extra fit bodies may hold a baby posterior and a short pelvic floor resists baby's rotation and descent. Very fit women are often surprised that they have difficulty birthing a posterior baby, if they have a posterior baby. The sacral pain can be associated with tight or short pelvic floor and other pelvic muscles. The sacrum is trying to move but can't. I feel that Jessica got a long way in labor and the solutions for her situation are simply not known by most doulas or nurses. (I'm working on that.)] 

My OB said that my pelvis goes inward a bit and therefore a more limited space for the head to get through... [This may be from a shorter pelvic floor. This may be from a shortened sacrotuberous ligament. Education and body work can address these issues.]

Anyways... Maybe his thought is that if I were to be induced, we would have known his position sooner ... but how would that mean that he would rotate? [I don't think he would have rotated with an induction 24 hours before. He'd have been 1-2 ounces lighter; is that really significant?
 Induction at 39-40 weeks is common when women have providers who seek induction to reduce complications more common with larger babies. One set of complications and compromises are traded for another set and not statistically significant. Cesaresan rates are higher among labors that are induced. 
The birth team didn't know physiological ways to increase midpelvic and outlet diameters. That's established. In part 1 of this series, Jessica says her doctor told her if she would have accepted the recommendation of an induction when it was given the day before she wouldn't have needed the cesarean for an OP baby that didn't rotate.
Does that seem like blaming the mother for the birth teams' lack of skills for OP babies?

My reply back:

"Dear Jessica,
Your answers tell me much!

Now I feel very very confident an induction would not have prevented a cesarean in this situation. 

Yours was just the type of birth that catches both parents and providers unawares - unaware that this is upcoming or what to do once this labor pattern occurs.  I even feel negligent for not educating pregnant parents and the birth world adequately. What if your husband and doula knew where to turn?

This sacral situation is not likely to be something you were born with but rather something that developed at some point in your past.

There is basically one technique that I know of for a tucked in sacrum, maybe two, as I have recently learned a new technique in Australia but I don't know quite yet if it will solve the tucked in sacrum.

  • A tight, short sacrotuberous ligament may have been the deciding factor here.  
  • Perhaps, another lesser factor is a well-developed core strength as a hamper to rotation.

These are "trending" issues with the times and are in no way a woman's fault. People assume "fitness" is a sensible way to ease in birth and what a shock it is when labor is not easy. 

Not just fitness, but myriad twists and turns in the uterine ligaments, sitting positions, even the way we use the toilet instead of squatting, sudden stops or jolts that misalign muscles and ligaments and even the cervix so that baby has a hard time navigating the space. There is ignorance in the birth profession about how the labor pattern and pelvic station reveal the issue. And fewer professionals know what needs to be done for mother and baby to finish such a birth on their own power.

I, myself, am not sure why the sacrotuberous ligament spasms (painlessly) to bring the sacrum deeper in to the pelvis and making the pelvic space smaller. 
It may have to do with a fall, with core strength, tight pelvic floor, or something with the neck and jaw or nose and sphenoid... 
I am seeking more info on the situation of the super fit woman's posterior labor dystocia (stuck labor) which has been one of the trickiest to address. 

I would like to keep the dates known, as 41 and 4 days, following a few days of start and stop contractions is a very important clue that this was not likely due to thyroid issues.

[This start and stop  would be a significant clue if these were the strong contractions lasting over a period of 6-12 hours without changing the cervix. Such a start and stop labor pattern is consistent with a lack of engagement, though not all labors with the baby still above the pelvic brim will express a start and stop pattern.

Jessica did not have the type of start and stop contractions I associate with a lack of engagement. 
Jessica: the OB said that he was Left OP if that makes a difference? 
Gail: Yes, LOP babies may be more likely to engage than the ROP baby. Most LOPs will rotate to LOT and engage in the pelvis. But a few engage while still in occiput posterior. In your son's case, he engaged direct occiput posterior. Once engaged in the posterior, some may rotate lower down the pelvis, and others remain OP, as your son did.]

"Please, Jessica,  also consider if I may please use your son's picture at his birth,... His molding shows he was posterior for sure, which you knew, but many people wonder how to tell after birth if baby was posterior and would learn from seeing his molding. 

He looks so strong. You both worked so hard! I am so glad you reached out to me. You did the best you could in a tough situation and made sensible decisions given the awareness every one had at the time. 

I am quite impressed with how far you got and think that you can surely achieve a vaginal birth and perhaps more easily with some preparation for body balance, lengthening your pelvic floor muscles, and releasing the sacrotuberous ligament from its short, tightness (the key thing here). 

Please know that you faced and solved a very challenging labor. The cesarean is an appropriate choice to end suffering for you and your baby. When labor pain crosses the line from challenging to agony, you get to decide to use that intervention wisely, right!?  

Your baby got some good labor hormones and gut bacteria which are beneficial. That was only possible because you labored before the cesarean. That is a gift you gave your son to be proud of, a compensation for the struggle. It was for something important, as better gut flora is vitally important to the immune system! 

Jessica's reply again:

"What finally did it  in my opinion) [started labor] was a visit to an osteopath that we have here in Sacramento CA (where we live). He is amazing and my husband went to him for a neck issue the day I went into labor. When my husband told him that I was 11 days late, he said for him bring me in for a visit. Needless to say I went in for a visit and in a matter of seconds, he pressed on my (pituitary gland if remember correctly) and my pelvis. I felt an immediate release [Awesome] as if something was unlocked [And it was!]. I even felt a gush of fluid (not water breaking but just more mucous). He promised I'd be in labor about 6 hours later and sure enough I was!! 

He said that he works with pregnant women all throughout their pregnancies to help with ligament tightness and other issues. I wish I would have been seeing him from the start. I definitely will next time around especially now that your email mentions the same thing that he told me about pelvic floor tightness etc. He really is an amazing osteopath."

Gail's Comments here: 
About 1/3 of babies who are posterior at the start of labor (30%, Liebermann) continue to be posterior throughout the labor. The rest will rotate. Because so many eventually rotate, and because cesarean surgery is safer than it was just a few decades ago, the skills to support a posterior labor have waned and skills for surgery have increased. 

Here was a challenge of how to comfort a woman in extreme back labor and how to help her into positions that add comfort and aid rotation. 

Would a forward leaning inversion through 3 contractions have helped reduce pain once the technique was over? 

Jessica faced a very difficult labor made complicated by the baby's posterior presentation. She gave an exemplary effort with few maternal position changes. Hands and knees was not acceptable to her due to the pain she felt in that position. She didn't know her baby was posterior and didn't know which exercises were beneficial to birth compared to gym fitness. 

In my opinion, based on what has helped others with this labor and body description, she really needed her sacrotuberous ligament softened. This is a temporary fix (temporary when done by the lay person) that let's the sacrum swing outward in the middle and lower parts of the sacrum. The baby will drop and perhaps rotate in the added room. 

Gail Suggested: 

"Balance First!
Craniosacral therapy with therapeutic massage by a pregnancy master if possible.
Sacrotuberous release by the doctor, nurse, midwife if possible. The doula can explain it but it may be outside of the doula scope of practice to do this technique, though it can be done externally.
Sidelying release for the muscles supporting the pelvis, including the pelvic floor for pain relief and making "room" for the baby - making flexibility and softening the way.
Alternating the compression/extension of the ASIS and ischial tuberosity in circles that stop in extension (a massage therapist can work this out)
Give Cook's Counter pressure a try on the tuberosities, if on hands and knees or the pubic arch if on back, this helps relax the pelvic floor by giving the stretch receptors of the pelvic floor some slack. (They are stretched already and need some slack for 2.5 minutes at a time.)

"[You might like to n]ow try these techniques:

  • Give Cook's Counter pressure a try on the tuberosities, if on hands and knees or the pubic arch if on back, this helps relax the pelvic floor by giving the stretch receptors of the pelvic floor some slack. (They are stretched already and need some slack for 2.5 minutes at a time.)
  • Lunges during 3 contractions on each side.
  • Dangle through 3-6 contractions.
  • Do not squat.
  • Rope pull from "McRoberts" position if in bed, or 
  • Standing while holding a rebozo or sheet over the head. The sheet is knotted and the knot is thrown over the bathroom door which is then closed. The birthing woman's back is straight and knees are bent. 3-6 contractions. Don't go down so far as to be in a squat until your nurse can see the baby's head.
  • Try pushing for 3 contractions, then rest through 3 contractions without pushing!
  • Rest
  • Do the 3 Sisters and rest again.
[The 3rd Sister particularly] helps relax the pelvic floor by giving the stretch receptors of the pelvic floor some slack. (They are stretched already and need some slack for 2.5 minutes at a time.)

It seems no one at the birth knew how to find and use Spinning Babies Website. Let's get a link out to your sites, blogs, and social network pages to reach more 
birthing and pregnant women and their helpers.

Post on your page to link to Spinning Babies

Next Post in this series, Jessica processes her birth and Gail makes suggestions for the next birth. 

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.