Friday, September 26, 2014

Breech then and now

Thirty one years ago I caught my friend's breech baby in Omaha, Nebraska. I was thinking of this Monday with a group of midwives and doulas at the lovely Mommy Fitness Omaha with Julie Summers and Kelly Langfeldt of Five Stones Massage and Birth Services. Kelly invited me down to present a Spinning Babies Workshop to the now thriving Omaha birth circle.

My friend's midwife was unexpectedly delayed on that night so long ago.  But I'd also prepared for just this contingency. She'd loaned us the resources she had, Williams, Oxorn, a booklet by Sheri Daniels and the already popular Spiritual Midwifery by Ina May Gaskin and Farm Midwives.
The week before her birth, I'd called Sheri Daniels, Pamela Hunt at the Farm, and a midwife in Minnesota to gather words of wisdom. The consensus, get to the hospital and don't do this at home. If the baby gets stuck the baby could be brain damaged or die.

My friend's hospital option: cesarean surgery, ten day stay, no husband allowed to hold the baby until baby is home. My friend's history: her aunt had her first baby breech at home with a veterinarian some decades earlier. My friend's decision: stay home at all costs.

Now there is a change that happens in life between the waiting for and the holding of a baby. Her decisions were during the "waiting for" period.  My nights were spent on my knees after reading through the books again.

We looked for a willing doctor and found one. Insurance coverage could be changed over the next Monday. Her labor started after the failed External Cephalic Version on Friday afternoon. In the wee hours of Saturday morning her little girl was born. Seven pounds of wailing wonder.

Today we have similar politics. Women struggle to find care in the hospital. Midwives may agree to help without clear breech skills. (Though usually come quickly!)

Today we have emerging breech skills. England is taking full responsibility to train doctors and midwives in breech skills and birthing women can find the options with a internet search or word of mouth referral. North of England Breech Birth Conference starts tomorrow in Sheffield on 27-28 September. My dear friend Jane Evans is speaking on the mechanisms and physiology of breech birth and Dr Frank Louwen will present on the dynamic benefits of "upright" maternal position for breech - the knee-elbow (very similar to hands-and-knees) for breech birth. I heard them in Ottawa in 2009 and know that breech lives have been saved for the goodness of their sharing their wisdom.

The three pillars of safe breech birth are Don't touch the breech (when rotating and descending spontaneously), Knee-elbow position for the woman (spontaneous upright positions are supported or hands and knees suggested for new breech providers and when other upright positions aren't spontaneously chosen by the mother (not the midwife or doctor), and Don't cut the cord (the baby's blood in the cord returns to the baby expanding air sacs and reviving most slow to cry breech babies).

With these general guidelines the rates of complications for breech drop dramatically. Frank Louwen will be sharing data from over 350 upright breech births in Frankfort. Babies get stuck far less often. When they do get stuck babies need a practiced provider to free most of them. Good luck only goes so far. Practice with a doll and pelvis until the techniques live in your hands.

I wish I were in England this weekend with Jane, Helen, Frank and friends. I'm grateful to my Omaha friends for starting me on this grand adventure I call Spinning Babies! 

Thursday, September 25, 2014

Why won't this labor start properly?

This post discusses onset of labor.

A woman is commonly considered in labor when her cervix is progressively opening and continuing to open. Stages of labor are the first stage of cervical dilation, the second stage of "pushing" or until the actual birth of the baby, and third stage which begins after the baby is out and until the placenta is out. A fourth stage of labor is described as the following period of newborn and mother's adjustment from birth to physical stability.

Early labor from 0 or 1 cm to 3-4 cm.
Early labor is a time we expect baby to be engaged. In an experienced mother, engagement may not occur before latent labor in an on and off labor pattern, or in early labor, where dilation is gradually moving to 3-4 centimeters. A minority of women are open to 3 or more centimeters when labor begins to open their cervix further.

In first births, for first time mothers and for many VBAC (vaginal birth after cesarean) we expect baby to engage before labor starts. When a first baby isn't engaged until labor begins the rate of cesarean is high. (Oboro; Siddiqui; ROSHANFEKR) Fortunately, we can let babies engage in labor with the help of labor contractions in certain maternal positions described at www.SpinningBabies.com.

This baby is not engaged although the nurse can feel the back of baby's head.  The forehead overlaps the pubic bone.  Overlapping the pelvic brim may keep labor from starting smoothly, or, oddly enough, the woman can get to 10 cm and pushing but the baby remains high at -3 station. The overlap can only be felt when a woman lays on her back. 

The slow labor start up.
Women may have contractions that keep them awake. Yet when the cervix isn't dilating they aren't considered to be in labor. Doctors and midwives often tell them to go home to bed and come back when contractions are longer, stronger and closer together.

The stop and start labor.
Other women may feel their contractions come strongly but then they taper off and stop. They can get very strong, but seem to back off. Later the contractions may start up again only to stop again. The cervix isn't changing or isn't changing in any encouraging amount.

Strong contractions like transition, but the cervix is 2 cm dilated.
Once in a while a woman has many symptoms of strong active labor. She may feel a bit nauseous, shaky and have hot and cold flashes. Sometimes she feels like pushing. Rushing to the hospital, she and her loved ones and doula may expect to find out that the baby is coming quickly. Imagine the frustration when the nurse checks and finds out that the baby is still high in the pelvis or even above the pelvis. The cervix is hardly opened and the os or opening of the womb is still tilted far back.

If labor doesn't start smoothly, determine through an exam or your own exam if baby is engaged well or not. Engagement is the first step to labor progress.

The help to engage is within the mother's body. Balancing the body (fascia, ligaments, muscles and joints) help soften those anatomical features that may be tight or shortened, spasming or asymmetrical. Simply put we release what is tight.  The psoas muscle pair are key players and walking is a way to support their length and suppleness.

She does an abdominal lift while flattening her lower back.

Dad helps with an abdominal lift in early labor to engage baby and let labor progress.

In labor, the abdominal lift and tuck through ten contractions often helps baby engage. See more on this great technique devised by a mother, Janie King, in her book Back Labor No More.

Only if this technique doesn't work, try Walcher's Open-the-Brim position. For details on Walchers and more on Engagement in Labor see www.SpinningBabies.com

Tuesday, September 16, 2014

Flexion matters

The Anterior Positions and LOP

At Spinning Babies, fetal position matters.

Babies positioned on mother’s left side more often curl and tuck their chins more easily (flexion, flek’-shun). This makes baby’s head measurement smaller and lines up baby with the pelvis to be able to help in the birth process.

Flexion is more imporant than position. Muscles and ligament “balance” is more important than size.
Discovering how to tell your baby's position is in the Belly Mapping book and the Spinning Babies website.


A flexed head can measure up to 2 cm smaller than the same baby's head extended, or having the chin up.

Not only that, but a flexed head molds even smaller. An extended head takes hours longer to mold, if it needs to. And first babies almost always need to reshape the top of their heads to fit the bones of the pelvis.

A flexed baby can use their spine, back and shoulder muscles to help themselves be born. Flexed babies bodies are lined up to make their kicks at the top of the womb (fundus) be more effective in moving them down through the pelvis. Most babies on the left are anterior and flexed. The Left Occiput Posterior baby may be flexed and rotate readily with the help of strong labor contractions.

Gail and her sister, Kathleen, will be exhibiting Spinning Babies at the great Lamaze DONA 2014 conference. Come to our booth and see the book. If you're pregnant, come for a free belly painting!  

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. 

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.