Thursday, July 31, 2014

Encouragement to a new Baby Spinner

There is much for a birth worker (doula, nurse, midwife, family medicine or obstetrician)
to learn at Spinning Babies. There is often a transitionary phase between workshop and confidence. 

Observe the mother with your new paradigm and listen to intuitive guidance. From this gentle approach you begin introducing comfort measures and balancing activities appropriate to  nurture a calm inner focus of the late pregnancy hormonal state.


The new Baby Spinner will begin to notice that pain is not something pregnant women have to accept as a normal part of pregnancy. You have seen in class that something can be done. 

Pain that is not associated with the muscle and joint movement of a normal progressing labor may be a sign of imbalance. In any case, lengthening and softening core muscles gives room for baby.

Look for ways to find balance in pregnancy first, and labor when its happening. 
What activities add balance? 

Are the 3 Sisters appropriate? The standing sacral release?

You will grow in confidence as you try your ideas in gentle ways to nurture your women.  
As you listen, you will be led. 

Thursday, July 3, 2014

What I'll talk about at Lamaze DONA conference 2014

 September 18, 2014 from 8-noon, I'll be talking how educator's can gracefully talk about malposition in labor.
Come on down to Kansas City! http://www.lamazedona2014.org/p/cm/ld/fid=473

Resolving Fetal Malposition in Labor; An Educator’s Opportunity
Presented by Gail Tully, CPM, CD (DONA)
Given the increased complication and intervention rates of posterior and asynclitic babies childbirth educators and doulas need to know facts, solutions and practice strategies to prepare to resolve fetal malposition in Labor.
This session will explore reasons for malposition and ways we can communicate its dangers to parents.
Childbirth educators, labor an delivery nurses, doulas and other childbirth practitioners will be able to prepare a plan to minimize a labor stall due to posterior arrest with epidural use, describes a technique to open the pelvic brim for fetal engagement in labor and demonstrates a technique to resolve transverse arrest.

   If you've heard me talk, check out Patty Brennen as she talks about writing winning grant proposals to prosper your birth work. 

Wednesday, July 2, 2014

His flipping was the talk of OB


 Edited Emails, (Consultation call missing)
KC Teasley writes,

Dear Gail,

I wish to have a natural birth with no medical intervention. My baby is incomplete breech with his left foot by his face. He is also turned to my left. My amniotic fluid levels fluctuate between 14 and 10 percent.


I've never given birth. I believe natural birth is best for my baby and me. Obviously if something is terribly wrong I will do anything I have to do to take care of him.

I am desperate to have my child moved for natural labor and delivery... I have been doing everything from all the positions you list: I've been doing all the yoga, Spinning Babies positions, cold pack, flash lights music, talking [to baby], standing on my hands in a pool, seeing a chiropractor for the Webster adjustments. Today I had an ECV scheduled but opted out because the Dr. said she would have to have an OR team ready and most likely could pull his hip out of joint! Of course, I don't want that!


They have me scheduled for the 25th of this month for a C/section. I will be a little over 39 weeks on the 25th. My baby would loose all the benefits of being born naturally.

The doctor was not enthusiastic and made [vaginal birth] sound like such a burden, stupid and risky so I'm left feeling very confused and second-guessing the decision not to have [a cesarean].

Thank you for any help!
Kacey


Gail and KC had a consultation call and afterwards, Gail wrote:

Dear Kacey, 

I'm so hopeful for the 
  • release of the broad ligament, round ligament, 
  • the muscles to the pelvic floor to be lengthened; 
  • the muscle border between your abdomen and the underside of your ribs, and 
  • the muscles to your hips to be released;
  • and your hip sockets to be gently distracted and compressed, 
  • followed by circles to the least resistance 
but not forced with any of these moves.

Rebozo sifting (Manteado)
5 Forward leaning inversions a day for 1 min each [30-seconds is usual], but not after meals. 
Followed by [use of an] inversion table or breech tilt or the open-knee chest for 10-minutes minimum;
Sidelying release for ten minutes or more on each side,
repeat and have your arm up over your head to stretch upper back muscles and help your respiratory diaphragm.

Look on youtube for myofascial release, 
and for toning and lengthening pelvic floor muscles.
Reference Leslie Howard, or Katy Bowman and look for tips to relieve pelvic pain. Pelvic floor pain techniques [are often] the same exercises to lengthen [and tone] your pelvic muscles. 
Deep hypnotic conversations with your baby is another proven technique.
Can your chiropractor do a myofascial technique for release a diaphragmatic hernia. To get rid of heartburn ? And that is a good breech flipping technique. 


If you do not have high blood pressure or glaucoma:
Can you do 5 forward-leaning inversions and 3 breech tilts today and tomorrow, and Sunday??
Stop inverting if you feel kicks in a new and higher place [indicating the baby may have flipped].

Another goal is finding an experienced, skilled practitioner [who may help with a vaginal breech birth].
Dr. Peter O'Neill is in Winnipeg, Ontario.

I so admire your strength. 
Keep in touch!


KC:
I have been to the chiropractor 5 times now for the Webster adjustments and I feel the baby get very active afterwards.

Thank you for being so diligent with me! I feel like whatever happens someone was on my side and I appreciate that!

-Kacey



Gail,
I had my baby on June 21st vaginally! I went in on Friday with contractions. My Dr. was on call at the hospital, she says, 

"Oh my God, he isn't breech!"



His flipping was the talk of the OB! Everyone wanted to know how we accomplished that and I told them I had a consultation with Spinning Babies, Chiropractic, yoga, ice packs, flashlights, music, talking, and Lots of Prayer!

I was dilated all the way up to 9 and my water still hadn't broken so the Dr. popped it. Instant relief! I watched my belly slowly sink down and it was so nice. The contraction I had been going through we're not pleasant but when they were over I was ok.

After about 10 minutes of draining, I got up to use the bathroom and as I was walking I got hit with the worst contractions! There was no build up. This was crippling. I hung onto the door and for the first time since they started I started like a high-pitched squealing! The nurse came in asked if I wanted an epidural and I looked at my husband, who said, "You told me to remind you that you wanted to do this naturally.'' I told him the other contractions didn't feel like this and I was already at 9 getting ready to have a baby. I caved at 9! Ugh!

But it worked out!  As I was delivering, the baby went sunny side up and got stuck. My pushing didn't do anything and the epidural was wearing off. So the Dr. put her hands inside and helped turn him manually! She later explained that if I hadn't had the epidural she would not have risked turning him like that and would have given me the C section anyways! She also said I ripped because she turned him but if baby would have just come out normally she didn't think I would of.

So even though I didn't get everything I wanted, at least my baby came out vaginally, had a milked placenta [the blood in the cord was squeezed into the baby], was immediately placed on my chest, daddy cut the cord, and spun a baby!



I loved all the questions the Dr. and nurses were asking about turning him! It's funny, I don't see the medical community, chiropractic, or midwife community working together. The advice the Dr. originally gave me was basically a cat/cow yoga pose and a pamphlet on c/section for breech.


How many more women don't know there are options 
and hope for not having major surgery?


it was the most beautiful experience for me and my husband. Soren is amazing and we feel so blessed and privileged he is ours!


Soren weighed 8.6 lbs, is 22 inches long, with a head circumference of 14 1/2 inches! Born at 39 weeks 1 day.  My doctor was so surprised and said she's never seen a 22-inch baby spin around at the end of a pregnancy!
It's like the stars aligned just for us!  Thank you for making yourself available to help us!


 Kc Kacey, William and Soren Demarest

Tuesday, May 20, 2014

Oblique lie at 35 weeks

Hi Gail,

I’m 35 weeks pregnant (actually 34.5), second baby...  First baby was born at home, this one will be in a hospital for practical reasons.  Baby girl #2 is still changing positions and moving a ton, but she seems to be in an oblique position quite a bit.  At my last midwife appt, she was oblique with head in my right hip, back diagonal, butt up near belly button height on left side, and feet up high near/under my ribs on the right.  Sometimes I feel feet more belly button height.  Sometimes she flips and her head seems down to the left hip, and her torso mostly on my right side.  I can’t quite tell exactly what I’m feeling and where the head is and I don’t have a Doppler to find heart/chest so my Belly Mapping is not certain by any means.  

This painting is opposite to the mother on this blog's description but  is oblique.

She’s in a different position at every recent midwife appointment when they check her and listen for heart tones. [Such changes are indicative of an unstable fetal lie.] 

My first baby was a brow presentation, long labor, but she came out vaginally finally and never turned (she was face/brow first and OP).  My midwife and doula said I had a great pelvis for birthing.  The chances of a malposition, or the same malposition, this time I am told are extremely low.  So, maybe I’m just being paranoid.  But, your website seems pretty adamant that transverse or oblique lie after 30-32 weeks is a problem.  The midwives I see and my doula keep telling me it’s too soon to worry and baby is still moving and changing positions.  But, I’ve been told not to do inversions (not really sure why)....

My Reply:

Every birth and baby are unique but certain situations do tend to follow one another. I have no hard data on what I am about to say. You may accept it or not, or even use what you like. You are welcome to share this with your midwives; I encourage it. 

Your description of your baby's current fetal position and your previous history may indicate a possible pelvic floor issue of short or tight muscles on one side and/or a slight twist in the lower uterine segment. Your history is typical of these causes, occurred by moving in a gravity environment (Earth!) and having a sudden stop or jolt such as in sports. Its not so uncommon and can come from a variety of interactions with gravity.

The relevant techniques are: 
  • Forward leaning inversion as described on my site 
  • Sidelying release as described in detail
  • Standing sacral release 
  • Abdominal release
  • Then wearing a pregnancy belt to support baby's vertical lie and reducing the oblique lie.
  • Aligning the pelvis
  • Releasing round ligaments with Webster Maneuver

Some of these are on my site, the last two are done by a chiropractor. 
Your midwives might read my description of the forward leaning inversion and feel more confident. 


Labor with an Oblique lie
Baby cannot be born in this diagonal position.

Lunges in labor may also help move the head down and avoid a cesarean. 

Waiting in labor reduces chances of success and yet you have a reasonable chance of success with waiting. Asynclitism may be more likely making a vaginal birth a bit of work, if so, and not always possible, though, I agree, more so in your case than in some. 

Without baby's head in the pelvis there is a small but increased chance of cord prolapse. This can be reduced by attending to the soft tissues now. Baby's accommodate the space in the womb they find, and are not random in settling in an oblique position at this gestational age. 

Whether or not this is important in your personal situation is not 100% clear, this is just a trend. Where will you fit on the trend? You can move yourself to a more easier birth with body balancing sooner than later, in my opinion. 

The rest is up to you. 

Tuesday, April 15, 2014

Spinning Babies Perspective

Spinning Babies is not a method. Spinning Babies is a way of looking at childbirth.
Here, I see the mother and baby moving together as partners in birth. That makes sense, they each have a role, a choreograph or dance step to do in the birth process.
When baby is lined up with the pelvis, labor proceeds spontaneously. What do I mean lined up?

When baby's back is curled towards the front and front left side of the woman's uterus, the baby 's spine is flexed. Flexion gives the baby ease in navigating the pelvic brim. The flexed, or curled, baby can push their feet off the top of the uterus and aim themselves lower into the pelvis. Many women feel baby kicking and repositioning after a contraction. Baby is an active partner in birth.

Some babies are on the mother's right side, or along mother's back, spine to spine. Especially so in the first time mother, being on the right or along the mother's back can extend baby's back causing extension of the fetal spine. This straight fetal back aims the top of baby's head right into the mother's pubic bone. Engagement is delayed until the forehead turns to fit the brim or the baby flexes just enough to enter the bony pelvis.

Even if baby's head is able to scoot past the pubic bone while still facing mother's front, the head often remains extended (chin is away from baby's chest). This makes the head seem larger (Your baby is too big! We must do a cesarean.)

The baby's whose spine is already straighten to its full length can't as easily kick off the top of the uterus to maneuver downward. The mother has to do more of the birth work herself. This is still quite possible if the head and bones find room for one another.



Many of my colleagues state posterior is a variation of normal. But when do you see other species with fetal development in anything but flexion? Curled around the heart is the physiological norm for the developing vertebrate. I think we need to refigure what we mean by normal variation.

Common? Yes, Posterior presentation is more common today that even a decade ago. The 5% of all deliveries being posterior is now 8% and adding an epidural to the birth process increases the rate of posterior birth to 12.9% (Lieberman).

But is it a variation like hair color or ear lobe attachment? Not likely.  We'd have to be unique among vertebrates, for one thing. And while we are in many ways, I don't think this is one of them.

One study finds women whose babies were posterior at the end of labor were found to have a higher incidence of low thyroid function. Another study finds obesity correlates with more OP babies.  And yet another shows that older moms have a greater likelihood of having a posterior labor.

These findings may indicate that metabolic hormonal function is one cause, if not the root, of posterior presentation.

Body balance may be something we can improve to improve metabolic health. Our muscles, ligaments, joints, posture, alignment, and movement are areas that can be improved for circulation and flexibility.

With increased balance babies on the right tend to swing to the left. After a long day on a woman's feet or in her car, women Might experience their baby shifting to the right. If labor is long with the baby facing forward, don't we often see rapid progress once the baby rotates to the anterior fetal position?

These are clues that mother and baby's positions in relationship to each other matters.


The good news is even without entering into the ideology of posterior as a variation of normal presentations
that Spinning Babies has excellent options for comfort and rotation among a collection of techniques. 

Even my colleagues admit the techniques studied in the literature aren't amazing for rotating the posterior baby. But that doesn't mean that no techniques are effective. It means that the techniques chosen for study haven't been fantastic.
How many times will hands and knees and pelvic rocking be studied??

Some women have a long labor for a single reason. Most will have a combination of reasons. One technique often helps with one cause. So for the woman with multiple issues, a tight round ligament and a sacrum that isn't mobile combined with a large and posterior baby has three issues immediately noticeable. The size of her baby is not necessarily an issue. But it is a variable.

So we do hands and knees with pelvic rocking and nothing changes. So let's give her round ligaments a release from the painful spasms she has been experiencing that also reduce baby's success in rotating to anterior. Let's add mobility to the sacrum with a standing release, and if desperate, triggerpoint therapy on the sacrotuberous (sacrospinal) ligament. Then gravity and movement will have better results. Then her hands and knees and rocking pelvis will rock that little one around.

These are not the only techniques for this combination of issues. I'm painting a picture here.

Balance means not too tight; not too loose. So nothing is spasming or being held immobile. No muscle or ligament is flopping over without support. And so on. Next time I'll write about the slow labor start up. When women have contractions that keep them awake but their midwives tell them to go home to bed, the cervix isn't dilating.

Thanks for thinking of me. Your support keeps my world spinning.


Sunday, April 6, 2014

Follow the Love

My Other Mother died Friday. Helen was enjoying a wonderful week in sunny Mexico with our friends, Mari, Frank and sons, Ari and Marco. A small sore on her leg, where the doctor had removed a mole three years before, had never healed and was vulnerable to a virulent and opportunist bacteria that took her life in 24 shocking hours. 12 hours into it, at the hospital, Helen reassured Mari, "I had a Grand time!" 12 hours later our Helen was gone.


My Mom (R), me and Helen (L). 


Shock, disbelief, confusion. Also, a strange new thought that comes with age; her suffering was short. A better death than many. Bitter reassurance sticks like gall in the throat quickly followed by anger at such stupid sentiment. I want her back. I want to do something to light up her day again and again, not once a month while I'm home from my travels.  But again, in her last week she felt great, was surrounded by the love of a family of dear friends who treated her like a queen, as their family, too. She was honored by their happy and gracious natures, by their respect of elders, by kindness and hospitality of heart. She was so happy to go and so happy to be there. Hard for them, but glorious for Helen.


Helen added so much kindness. 


Here's Helen and Jeanne enjoying Gairm's comedic genius after
 his high school drama performance.

Our family was SO much better for having Helen in it. 

My sister, Kathy, and I talked about Helen, her gift of love, her goodness in our family, but also about serial losses, slashing at the heart again, intensified by the grief of losing our Helen.

How does one find oneself again when life's landscape changes so radically after a series of losses? When family, friends, even work or talents change, leave or actually die, how do you recognize your self when these defining anchors of "self" let go?


"Follow the Love”
Meaghann, my late niece, and Kathy talked about maintaining happiness and purpose in life. 
When trying to do what we should becomes disjointed and disappointing the stress and strain, the pain of life, bursts out in a big, “Why!?" "Is this mess really what we’re here for?!" 

There is actually purpose to the pain. And that painful awareness shows how far we are from the point of being here. Circumstances can be painful, it’s evident. But there are people in difficult, even tragic, circumstances that find a serenity and peace with life. Some people call it acceptance. Its a way of navigating the troubles of life. 

But how do we get back to our inherent serene center? Every person holds the key to their own solution within their own bodies, souls, and minds. Because we have a brain, we contain the power of the brain. Because we have a heart, we possess the power of the heart. Because our thoughts and feelings can change, we can initiate the change in our lives to climb out of miserable circumstances. Some will climb a higher, steeper slope. Some will slip, but all can climb. And it is in climbing we come to the top. Or, maybe, we just start at the top. 

We activate different parts of our brain with thoughts and feelings. When we smell, feel, or talk some unique part of our brain lights up the MRI imagery. When we remember, a different part of the brain lights up. 

If that same part of the brain is artificially stimulated with electricity, a memory, smell, or sensation could flash into the subject’s awareness. So it seems that brain stimulous can come from our own action (by our intention or habit). Or, it can come from outside, through medical experimentation - or divine intervention - or even perhaps by the foods, substances, and chemicals we ingest, breath or absorb. 

These discoveries tell us that healthy thoughts can build a habit to focus on more good thoughts. Thoughts are associated with the release of brain chemicals into our blood. Hormones, and their associates. These chemicals create feelings. So in this way, thoughts create our feelings. And so, happiness can be learned. 

This good news gives us inspiration - and a reward -  to change our thought habits. 

We do need an avenue that makes sense to us. A new pathway in our brain to light up.

What made sense to my niece and sister when my niece’s brain tumor thrust a terrifying change into our lives is that we’d follow the love. Could my sister give up her job to care full time for her daughter? Could she change her work hours and pay bills? Should they move in together so my sister could care for her adult daughter? (Easy answer!)



Meaghann, the Spring before the tumor returned.

Each decision began with one priority. Follow the love. If love was protected, nurtured or increased by any choice to be made, that was the choice to make. 

The questions of how the bills could be paid were answered when love was upheld. Kathy’s apartment management company transferred her to an office in apartments that had wheelchair access where she could work on site. 

Love opened possibilities. The resentment of the disease and hopeless resistance to change pushes away opportunities that, when offered, seem impossible or too uncomfortable to consider.

That is the response of the stress chemicals. “No!” “Get me outta here!” “Go away!” Even if said this way, “Oh, that’s ok. We’ll be alright,” which is “Minnesota talk” for not having a clue how to include another into the emotional vulnerabilities of life's struggles.

With Meaghann and Kathy’s “Follow the Love” motto, when help was offered, the love mission statement gives an immediate “Yes!” “There’s room and appreciation for your talent!” 

The brain immediately begins lighting up the circuitry for possibilities towards more and more “Yeses.” We all love “Yes!” That is, when we lower the level of stress chemicals in our blood stream so our brains can find oxytocin. 

Oxytocin building events become easier. Sharing a meal, sharing a task. Even saying good bye becomes a life shattering, heart wrenching, soul searing act of love. 

We didn’t run, we stayed. We didn’t curse (as much), we prayed. We saw hope for a future, not one we chose. We couldn’t sustain oxytocin in the grief consistently or even very often, but we had a previous pattern and our brain more easily recognized "good thoughts" when we came up for air later on. Then we could climb up upon our resolve and find a life in which purpose and happiness are one and the same. A life that moves forward, not inspite of Helen or Meaghann's deaths, but inspired by the lives they made. A life which shows us how to “follow the love." 

Helen was all about it. I will miss her every day, every holiday, every kindness. But it will be knowing that she lived the fullness of her self and gave her kindnesses to others everyday. 




Wednesday, February 26, 2014

Baby not engaged at end of pregnancy


"I just came out of my doctor's appointment for 39 weeks. He says no cervical change (cervix is posterior) and baby is still floating. "
 The cervix can change in hours so dilation is no indication. The posterior aim of the cervix is expected and can be helped with improved sacral mobility, one way of achieving that is the Forward-Leaning Inversion daily for two weeks. Can we get there faster? Perhaps! 2x a day for one week? Let's try it, but only for 30 seconds each time.

Labor is the most likely time to get baby into the pelvis. For now, its all about balancing the muscles so that when labor starts, the pelvis moves freely and evenly. Baby being in LOT/LOA position (not feeling fingers wiggling on both sides of your center line) is a beneficial sign.



Baby floating MIGHT indicate, and often does, that there are more muscles to "untwist" with forward leaning inversions, sidelying release, psoas balancing, and walking.

Anterior pelvic tilts while squatting properly in pregnancy might be quite helpful. Use door handles on each side of an open door and squat as if sitting on a chair far behind you! 30 seconds of such squats after using the toilet... in fact, get a squatty potty for passive squatting on the toilet to improve alignment.

Circles on the ball helps when muscles are "open" (lengthened and not overly tight).
Once labor begins, circles on the ball to happy music may see engagement.

With a history of babies that don't engage, the abdominal lift and tuck (posterior pelvic tilt during the contraction) can bring baby into the pelvis.


Be sure to flatten your lower back. This makes a posterior pelvic tilt to bring the sacral promontory out of baby's way when the contraction is trying to rotate baby. This opens the top of the pelvis front to back. 



If after ten contractions with abdominal lift and tuck you find baby still at the brim (-3) then its time for Walcher's "Open the Brim" during and between 3 contractions.




See the descriptions on the SpinningBabies.com website under Techniques.

We don't know about engagement until labor contractions can show what potential these techniques have.

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.