Wednesday, March 8, 2017

Clarity in your birth


Many visitors to Spinning Babies Website are looking for effective help for an easier birth.

We suggest using Spinning Babies Daily Activities as a part of preparation for birth.
Daily movement and maternal positioning can be added to a great pregnancy diet, deep and full breathing, learning about birth and parenting, enjoying good communication and visits with your provider. Monitoring blood pressure and blood sugars and other health indicators are important but self care is the care you give yourself and your baby. Monitoring for disease can't create the health you want. Here are some ideas to boost your benefit in pregnancy.


  • Community involvement in a pregnancy and/or parenting group preserves sanity, soothes loneliness, and boosts health! 
  • Studies show a doula offers multiple health benefits even though they don't give medical advice. This is the magic of social support. Get a doula, you'll only know why you needed one after you find the doula who is your best match. 
  • Exercise in a group. Create a pregnancy walking meetup up to 3 times a week!


But once you are active, supple and supported, you still need to communicate your
desires, needs, and limits with your care provider.

Sometimes pregnant parents worry that their requests for individualized care, or resistance to procedures will be seen as confrontation by the providers.

Pick a provider who isn't emotionally threatened by parents who have personal needs... uh, oh right, which parents don't?


  • Then be sure to voice your needs, desires, and fears. 
  • Being personal and open yourself, without bailing at their first hesitation, is a good way to communicate with care providers. Look them in the eye expecting mutual respect.
  • Write your list in positive terms that providers and hospital staff can "do" or respond to. People in helping professions want to help. Show them how they can help you have a better birth experience. 




A healthy pregnancy and healthy baby are mostly due to self care of a healthy pregnant person. When health is a challenge, these suggestions are only more important, though they become more challenging to achieve in some cases.

More ideas

  • Join a pregnancy and parenting community, such as attachment parenting, early childhood education groups, and prenatal and parent/baby yoga classes.
  • Bring your partner to a parenting group of their interest. 
  • Learn about infant CPR and life support, home safety tips for babies and
  • How to wear your baby! Yep, the best "jewelry" you'll ever wear! Put that little jewel in a rebozo, sling, or front pack during the early months and on your back when baby is too heavy for your front (unless you know how to wear baby in a cloth sling on your back earlier).
  • Learn lullaby songs, finger play, and stories that will delight your baby and reduce your stress when baby needs connection with you and you need some baby entertainment. Learn them now. 


Join the Spinning Babies Parent Enewsletter on the Spinning Babies Website. It's free.




Will Shoulder Dystocia occur?

A doula friend of mine, "J," asks how real the concern is that a mother with an estimated projected fetal weight of 11 pounds by the time of the due date will have a shoulder dystocia.

"They had her see the OB and heard the reasons for perhaps choosing a repeat surgical birth. She was told that if gestational diabetes is back that they see these big babies with a weight distribution in the upper body (shoulders) that could be problematic during birth. ...

This mama is hoping for a vaginal birth but she is philosophical about the whole thing. She knows there are no assurances but feels she needs more info right now. She is wondering about continuing the Spinning Babies stuff she has been doing. Her abdomen is pendulous and she has been using a rebozo to get some relief for the back discomfort she is having...

Thanks for being out there doing what you do.
Gratefully,
J"

Practicing a typical hospital resolution of Shoulder Dystocia.


Gail Tully responds
Dear J
Hi. I can only share what I would have recommended as a midwife. As a doula I would not have made statements about my opinion of risk or stated recommendations in the following way. This is my post-midwife voice here.

Movement, good nutrition for her blood type (meaning a serving or two of grains and milk products for the Os and As) while getting good protein and veggies, salt-to-taste and water. Minerals help reduce sugar cravings. Red Raspberry Leaf with Alfalfa steeped together is really amazing.

Wearing a pregnancy belt and getting balancing work down, she can have her helper (you?) do standing release with her.

The pendulous uterus is more of a risk for shoulder dystocia than the baby's size alone. Ultrasounds can be off, of course. and her chance of no shoulder dystocia is somewhere around 4 out of 5 if this info is accurate, between the hanging uterus and large baby. What will improve her chance of no obstruction?

  • Wearing the pregnancy belt all the way through the birth of the shoulders!
  • Balance and good diet for good metabolic function!
  • Supple sacrum
  • Avoiding a vacuum or forceps
  • Upright birth position and
  • AFTER the head is born, in any maternal position, a posterior pelvic tilt (which can be done preventively during ONE contraction in 2nd stage.


The pregnancy belt, the right one for her, could be amazing.

Talking to an Obstetrician/surgeon about benefits of cesarean is like talking to a plumber about home improvement. Yes, new pipes may avoid a clogged drain now, but if you had hoped for a consultation on paint colors you are going to go home worrying about potential plumbing problems. It can haunt you. Especially as birth is more important than a broken pipe. But I'm talking perspective. If her midwives are not able to resolve a shoulder dystocia, and the doctors weren't able to help her first baby be born breech vaginally, then what skills is she expecting from them that they don't also have?

There are known side effects to a repeat cesarean (she knows she will have major surgery, separation from her baby, and significant blood loss, postpartum pain in the abdomen, not able to lift or do stairs for a longer time, the risks are that she might have infection, adhesions, problems with a future pregnancy, etc. etc. and there are unknown side effects to a VBAC, such as a sore perineum, possible hemorrhoids, etc. Which is most beneficial if they go well? Cesarean offers a feeling of certainty (though not assurance) and vaginal birth offers the unknown. But vaginal birth also offers hormonal changes from labor, the finish of the hormonal cycle of reproduction with subsequent brain change and probiotic activity, and can be easier to maintain mother/baby togetherness from the start, spontaneous or at least, immediate breastfeeding is more possible but can happen or not happen with either surgery or vaginal birth.

She may have a shoulder dystocia. She may not. I don't dismiss the potential but I don't dismiss vaginal birth because of this person's risk. If she does have a SD, she flattens her lower back while her providers figure out how to rotate the shoulders free. The chance of injury to the baby is about 7 in 100 and reduces to less than 2% when providers do practice drills (Crofts 2014). Permanent injury is also low risk. Death is less but not zero.

The thing she can ask herself is, who does she want to be a year from now looking back at her birth?
What does she want and what is the next action to take to get that? And to remind herself several times a day to hold that vision in her head and body. Asking our bodies to avoid a complication is wrong. Because the mind doesn't hear no, don't, avoid. Ask the body to release, open, birth (as a verb). The physiology-first mind set.

Thank you for your continuing care of our mothers, Doula!

Much love,
Gail

On this video you will learn 5 types of shoulder dystocia and their resolutions using all-fours and other maternal positions. You will see references on how often SD occurs and reoccurs as well as see births and real life resolutions. MEAC CEUs are available with the additional purchase of the continuing education option.

Wednesday, March 1, 2017

Not Afraid to Care

"The 2014 West African Ebola outbreak killed 11,310 people. Liberian nursing assistant Salome Karwah was not one of them." says Time Magazine. "...as soon as she recovered, she returned to the hospital where she had been treated — the Médecins Sans Frontières (MSF, or Doctors Without Boarders) Ebola treatment unit just outside of the capital, Monrovia — to help other patients. Not only did she understand what they were going through, she was one of the rare people who could comfort the sick with hands-on touch. She could spoon-feed elderly sufferers, and rock feverish babies to sleep." wrote Aaryn Baker.

The Washington Post states,
"Last week, Karwah died as a result of complications from childbirth, and the lingering suspicions of Liberians toward Ebola survivors was partly to blame."

Three days after a cesarean birth on February 17th this year, Salome went home and began to convulse. Though her family rushed her back to the hospital, fear of contracting ebola through her saliva stopped the medical staff from treating her. Time reports, "They said she was an Ebola survivor,” says her sister by telephone. “They didn’t want contact with her fluids. They all gave her distance." Treatment may have included heparin if symptoms matched a blood clot, and magnesium sulfate IV if eclampsia was suspected. The anti-seizure medication diazepam may have been considered. But Salome got none of these treatments. Fear and not knowing how unlikely it was to resume an eboli viral infection prevented good medical care. Training may have saved this heroine's life. How bitter that she was so willing to serve eboli victims so these same medical staff members didn't have to risk contact and that later they let her die unnecessarily because they didn't want to risk contact.

The most common cause of seizures after childbirth may be eclampsia which can be seen as rapid shaking of the body, or convulsions. 

Lubarsky (1994) studied late postpartum eclampsia, most of which took place after hospital discharge. After 48 hours the risk lessens but eclampsia can strike two weeks or even three postpartum.

Sibai concluded that postpartum convulsions three days after birth are likely to be cerebral vein thrombosis (1980). Up to 30% of victims do not have headaches preceding convulsions, finds Coutinho (2015). Hormonal contraceptives, pregnancy and postpartum period increase risk. 

A 2012 case report also cites dural puncture from a difficult epidural. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371498/
This woman was given diazepam to stop the seizure and magnesium sulfate through intravenous fluid injection until it was determined by spinal tap examination that a dural puncture was the cause.

So many health care workers and others who give selflessly are reeling from this tragic loss. Those who have worked in similar extreme conditions are all so close to the split of the courage and the fear and the human behavior reflecting the opposites. I can only assume the poignancy with which these fearless rescue worker must feel this news. 



Might I be correct in suspecting many Americans would assume that US medical workers would not bow to fear. We have evidence, we have protocols, hey, we have gloves! 


A recent series of emails with a breech bearing Mama is a common but seemingly less extreme example of fear stopping proper medical treatment.


The pain within this first email may not be blazing, but it's chronic and also epidemic. The loss is not only to be the parent struggling to find help in a society which turns away from natural breech birth but to be a midwife reading her desperation. 


A pregnant woman writes to a group of providers, seeking skills and willingness that is nearly extinct in the USA.
"I am almost 32 weeks pregnant.  My baby was head down but at my check up just presented breech.  I know its early, but my current provider will not even consider anything but a C-section if the baby remains breech.  ...
I have heard no hospitals in the twin cities offer vaginal breech delivery...

Please let me know if you or anyone you could recommend has experience with natural breech birth and still is willing to attend one, and would take me as a transfer patient at 32-33 weeks. Please include cost of service too ..." 

Compounding the sadness is that the outcomes of vaginal breech birth is similar to those of cesarean with a skilled provider. The problem is that the skills are rarely taught in schools and not many providers can travel to breech experts to attain training.

These obvious mourners, mothers and midwives, are not the only ones to grieve skills lost. Thomas van den Akker served birthing families in Malawi. He warns European physicians that there are also hidden victims of denying breech vaginal birth are the subsequent siblings who may die from cesarean after-effects of rupture in later pregnancy and the women and breechlings of low-resource countries whose care providers have now also lost the skills of breech delivery before a system of high-tech surgical suites can be supported in communities.
(Who pays the price? (Foreign) women, future siblings, 2016,Thomas van den Akker MD.PhD, Resident O&G at University Medical Centre, Leiden, The Netherlands as reported in the Amsterdam Breech Conference, 2016 Teach the Breech!) 
Thomas van den Akker at 2016 Teach the Breech
Breech skills retained in high-resource countries save lives in low-resource countries as well.

Cesareans replace the recommended procedures in spite of electricity not being available 24/7 in many rural hospitals. These same communities are devaluing and banning midwives and so lose their knowledge as well. Can the western medical invasion comprehend the resulting die-off caused by the inoculation of hybrid birth practices devoid of community networking and manual skills which need no electric lights to succeed?  Like a viral tsunami, surging western high-tech values wipes the cells of culture, birth, and family from the bed of hands-on skills. 


The late Abby Kinne teaching breech skills to a midwifery student.
Abby was a dedicated teacher to first responders and medical and midwifery students.
Who in her area has taken her place? Does anyone know breech like she did in her region? 
New understanding in physiologically-based exercises for what Carol Phillips coined body balancing seem to help women themselves achieve head-down fetal positions for their babies. Spinning Babies suggests self care and professional bodywork and other ways to help baby get head down before manual force of external cephalic version or skipping attempts at turning babies and going straight to cesarean. 

If no one is available for breech skills, then breech birth is more risky but parents who choose vaginal birth have the right and are, importantly, not wrong to choose vaginal birth. It is the responsibility of providers to insist on breech skill wisdom and to seek it, bring it to teaching venues, and preserve it in law and protocol. We must not find ourselves to afraid to act correctly. 

The same mother writes, 

Thanks so much, Gail!  I did a lot of exercises to try to help the baby turn, and thank God, she did turn head down in just a few days... I am just hoping and praying that she stays that way:)  

Thanks again for all your help and your warm response.

March is Womens History Month. http://womenshistorymonth.gov/about/


Wednesday, February 1, 2017

Is there still time to flip my breech baby?

Spinning Babies helps flip a breech 
The look that says, "I did it myself!"

At 36 weeks the midwives were adamant there was a less than 3% chance of my baby turning from the frank breech position and had never heard of any exercises to do. 
I was recommended to have ECV [external cephalic version is when a doctor (or occasionally a midwife) tries to turn the baby by pushing on the abdomen in a very specific way] or a C-section, and told my homebirth was out of the question.
I did the exercises you outlined. And at my 37-week scan little Pearl was head down. The Sonographer [ultrasound specialist] said she had never seen it before and said she had thought it was anatomically impossible for a baby to have turned that late?!
She was born in the pool in our sitting room while her 2-year-old big sister slept upstairs.

"Spinning Babies empowered me to have 
the most perfect birth for my family."


Spinning Babies offers hope for women who want a vaginal birth. Many women will succeed in improving baby's position with self care techniques. Others will find interventions are less taxing. The sooner you begin, the more likely you will find the "balance" you need for more comfort in pregnancy and more ease in birth.


Typical timeline for breech position 

10-24 Weeks Gestation

Baby is often transverse or a bit oblique. Few babies are vertical now.
By adding body balancing now, the baby has an increased chance of ideal positioning later at 34 weeks and beyond.

24- 30 weeks

Babies are moving towards a vertical  Routine good posture with walking and exercise will help most babies be head down as the third trimester gets under way.

30-34 Weeks Gestation

Chiropractors  may add specific maneuvers for fetal positioning, sacral and symphysis alignment, Webster Maneuver, and other soft tissue work. 
The best time to flip a breech is now. Oxorn and Foote recommend external version at 34 weeks, but most doctors want to wait for baby's lungs and suck reflex to be more developed in case the maneuver goes wrong and starts labor or compromises the placenta.
There is often enough amniotic fluid for an easy flip before 35 weeks.

34-35 Weeks Gestation

A study showed this is the most effective period for moxibustion to help babies flip head down. We suggest doing moxibustion as part of a complete routine for helping baby head down.

36 -37 Weeks Gestation

An external cephalic version may be recommended about this time for the doctor or midwife to manually turn the baby head down. It's about a 50-50 success rate. We wonder if preceding the maneuver with body balancing will increase the success or ease of moving baby. Less tension or torsion in the path of the baby seems like a goal to me.

38 Weeks to Birth

A small number of babies will turn head down in late pregnancy. It may be that up to 1% of breech babies flip head down during labor. That's not a big chance, but it shows it's possible and does happen.
An external cephalic version might be appropriate to try even up to and including early labor.
You can work with your body to prepare and work with your care provider to turn baby safely, if possible, until either your water releases or contractions are regular.


Dr. Michel Odent in his book "Cesarean" suggests waiting for labor even if you plan for a cesarean birth for a breech baby. It's a bit challenging to pull together a surgical team in the middle of the night, but helps baby establish the brain changing catecholamine and other changes for living in air.

Gail and a pregnant couple show a short version of advice for helping the breech baby get head down, Spinning Babies Parent Class.

Planned birth benefits and risks

Women today are sometimes encouraged to finish pregnancy and have their babies delivered.
The suggestion can create a sense that induction or a cesarean is the route to safety. For many pregnant people the alternative of continuing the pregnancy until nature decides the birthday no longer feels natural or safe.

But what are the actual risks? Here is an Australian study looking at the results of delivery baby with technology.

Planned births occur where a considered decision is made to deliver an infant, and in recent years there have been significant changes in clinical practice resulting in an increase in planned births before the ideal time of birth at 39-40 weeks' gestation. This is mostly attributable to the increased use of elective caesarean section and induction of labour.
The study of 153,000 Australian children published today in Pediatrics reports that overall, 9.6 per cent of children were developmentally high risk. In particular, infants born following planned birth before the optimal time of birth were more likely to have poor child development.
Using the Australian Early Development Census instrument, children in the study were assessed in five domains: physical health and wellbeing, language and cognition, social competence, emotional maturity, and general knowledge and communication.
Children scoring in the bottom 10 per cent of these domains were considered 'developmentally vulnerable', and children who were 'developmentally vulnerable' on two or more domains were classified as 'developmentally high risk'.
Compared to children born vaginally following spontaneous labor, the combined adjusted relative risk of being 'developmentally high risk' was 26 per cent higher for a planned birth at 37 weeks and 13 per cent higher at 38 weeks. This is after taking account other important factors associated with poor child development such as socioeconomic disadvantage, lower maternal age, maternal smoking in pregnancy and fetal growth restriction.
"The timing of planned birth is potentially modifiable, and the benefits of waiting should be communicated to clinicians, mothers and families," says study co-author, Dr Jonathan Morris of the Kolling Institute and the University of Sydney.
The study also reports that the risk of being 'developmentally vulnerable' increased with decreasing gestational age.
Compared to children with a gestational age of 40 weeks, the adjusted relative risk of being 'developmentally high risk' was 25 per cent higher at 32-33 weeks, 26 per cent higher at 34-36 weeks, 17 per cent higher at 37 weeks, and six per cent higher at 38 weeks.

Tuesday, January 3, 2017

Doctor was surprised: Transverse baby went head down at term

Doctors schedule a cesarean when a baby is lying sideways in the womb and the due date is less than a month away. This may be because it is rare to have the transverse lying baby move on their own to a head down position. 
The transverse baby lies sideways
across the top of the pelvis and
can't be born naturally.
Transverse lie is normal in early pregnancy
until about 26 weeks or so.
By 29-30 weeks we expect baby to be head down.

Common Strategies for a baby in the Transverse position after 30 weeks: 
  • Wait and see (less likely to help)
  • Manual External Version (doctor manually turns baby)
  • Cesarean (baby can't be born naturally when lying sideways)

Spinning Babies offers an uncommon strategy:

Dr. Carol Phillips, DC and Gail Tully
taken after one of Carol's weekend workshops. 
Dr. Carol Phillips, DC, friend and teacher of Gail Tully's, developed the Forward-leaning Inversion after watching the sudden ease of a birth following a ride down three flights of stairs in a gurney to the ambulance. The mother had been pushing and not able to move the baby. Dr. Carol had done all the techniques she usually saw get good results. So the midwives decided to transfer from the home birth to the hospital and get the baby born there. They just didn't want mom walking down three flights of stairs at ten cm just in case baby did come out on the stairs. So they called the ambulance crew in to help. They carried mom down on the stretcher head first -in case the baby came out on the stairs.  When they put the mom into the ambulance, swoosh, out came baby crying and kicking. 
What made that possible, Carol asked herself? The ride down the stairs head down! What anatomy did that effect?! The utero-sacro ligaments to the cervix!

Dr. Carol figured out a posture to replicate the ride this mama took. The Forward-leaning Inversion was born. 



Now we find it the perfect solution to the transverse lie. 

Read on the website about dangers and risks before you go upside down, please.

Here's the amazing story which came in today. This Mama had emailed a couple times this pregnancy and she had the same issue with her first pregnancy and used Spinning Babies to help in that pregnancy as well. Let's see what she says: 


Dear Gail, 
I have fantastic news for you. So to update you in my last email I mentioned that I was 39 weeks pregnant and had a fall 10 days earlier due to which my baby changed from head down to transverse lie position. My gynac [she may mean Obstetrician-Gynecologist] had scheduled me for a c-sec at 39 weeks 6 days because the baby was too big and they didn't think it was possible to change positions so late in the pregnancy. I consulted a second gynac who said the same thing. I had 3 days in hand to do your exercises and see if the baby's head would turn down.

On 16-18th December, I did the forward-leaning inversion and pelvic tilt. On the 17th, I felt the kicks higher up but wasn't sure where the head was. So to be sure we got admitted to the hospital at 1am so we could check the position of the baby before the scheduled csec at 8am. To our disbelief the head was down and not only that, the loop of nuchal cord around the neck was also gone. 

My [OB GYN] was in utter disbelief that the baby had turned for the following reasons:
1- the baby was fairly large - 3.6kg
2- she manually tried to spin the baby and it didn't move 
3- I was 3 days away from being full term

My labour only lasted 45mins from start to finish and I would also owe this to you for your tips of opening up the pelvic area to make labour easier. 

I am truly grateful to you for all your guidance on your website. It not only worked to spin my first baby back in 2014 but worked this time too. Your tips and exercises on the website were instrumental in helping me otherwise I'm sure I would have had to get a csec which is something I didn't want. 

I didn't end up purchasing the video but would like to donate to your organization. Please can you give me the details of how to go about it. 

Thank you from the bottom of my heart. I am spreading the word to everyone I know and my gynac will also recommend your website to her patients.

Lynn Saldanha, Mother

Learn how to do the Forward Leaning Inversion properly in this video excerpt of the Spinning Babies Parent Class. Purchase the full class on Vimeo to help you prepare for birth!
  Transverse Baby Consultation from Spinning Babies on Vimeo.

Thursday, December 29, 2016

Belly Mapping


Gail Tully is the developer and creator of Belly Mapping. Belly Mapping is a 3-step process to estimate your baby's position in the womb. Many pregnant people can estimate with fairly good accuracy in their last trimester of pregnancy.

Step 1. Feel the contours of your baby with the pads of your fingers.

In Step 1, you will draw a 4-piece pie and draw in the fruits - locations of kicks and wiggles, firm edges and round bulges. If you know where your provider heard the loudest heart beat from baby, then draw a heart in that place. 

Draw a circle adding four parts to help you draw baby’s small parts in location. Fill in the “pie” you’ve drawn with marks to indicate the kicks, flutters, bulges and firm, smooth areas.
In Step 1: Lie on your back and bend your knees. You -or your partner or loved one - will feel through your abdomen more easily and you will be more comfortable. Roll over to your side if you suddenly don't feel comfortable. Pregnant people ought not to be on their backs very long. You can do this for 5-15 minutes and then roll over.  
 Put a doll over your map and then over your belly to visualize your baby’s actual position. Do the hands match the location of small flutters or are the doll’s hands going the other direction? Put the doll’s feet where you feel the biggest kicks and swing the dolls back around to match the largest firm, smooth part of the baby that you feel. (An anterior placenta will mask the baby with the big, smooth placenta.)


Step 2: Visualize baby using a doll. Holding a doll over your map and then your belly, put the doll's head where you know or suspect your baby's head to be. Place the doll's back where you feel the smoothest flat, firm area. Remember, you find that area on your own back. You won't likely be accurate if you try to locate baby while you stand up. Your stomach muscles will be engaged and hard to feel details through them.




In your lasts months of pregnancy your baby’s kicks and wiggles become more certain, more perceivable. When you lie on your back with your knees bent your abdomen is often soft enough to feel through your skin and uterine wall to contact your baby.



Feel your baby’s contours. The womb and your belly muscles, even though they are likely softer now, will protect your baby during your gentle but determined touch. Getting to know your baby’s shape will help you picture baby’s position in your womb. You can see the steps on my website or get a more detailed description and a template to draw in the Belly Mapping Workbook.



Seeking your baby in your mind is not as awakening as actually sketching your baby on paper or creating another visual image. “Seeing” your baby ignites fires in your heart beyond the more abstract thoughts without image. The highly technical ultrasound scan increases positive perceptions of the baby early in pregnancy while late pregnancy ultrasound has mixed results in increasing or decreasing anxiety and closeness. So, ultrasound may not inspire the same neurological firings of gentle feelings which a drawing may connect.

Visualizing baby by having a friend paint baby's picture on your belly in the actual position of baby is a fun way to finish up!
Let’s explore how bonding may increase. Your hand moves the pencil or crayon towards the curves and lines of your child. It’s as if you discover this mysterious visitor as you draw. You see the image, you feel the love of creation as you draw. This is the being within and this is the art which expresses your hope, your wonder, your own emerging self.

Belly Mapping is a three-part process to discover your baby’s position in late pregnancy.

If someone paints your belly, as Gail is about to do here, they will be more accurate if they feel your baby first. 
1.    
2.    Pu

3.    Step 3: Name your baby’s position.
 Right, Left, Anterior, Posterior are the directional words for mother's body. Baby's body part words used are Occiput for a head down baby or Sacrum for a breech. Learn more in the BellyMapping Workbook.




We show photos of paintings to help you see the end result here. But the real result is in the connection between mother and child within.







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.