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.

Friday, February 21, 2014

Daily Essentials is gestating nicely!

Working with Melissa Koch to bring about two videos and watch, from a distance, her produce a video for Sarah Longacre has been a growing experience. How can one small body hold such amazing talent!?
She tells the story on film of the vision I had in my head.

Sarah's video is out and gorgeous. And so affordable! I can't wait for Daily Essentials to come out next month. See the description right at the bottom of Spinning Babies home page.

Wednesday, December 18, 2013

Course of fetal position changes

What can you expect for your baby's position at any given week in pregnancy?

Before 24 weeks and sometimes to 28 weeks, the baby is often in the transverse lie. The baby floats in the womb and until the head grows heavy with all those baby thoughts, the baby may not be in a vertical lie (up and down) until 6 or even 7 months. Some of these babies then flip breech but most go head down (cephalic).
Sometime between 26 to 28 weeks most breeches flip head down. When a breech baby first goes head down, they almost always settle down on the mothers right side first. 

A common right-sided position for the baby at this stage is called Right Occiput Transverse. In this case, transverse means baby is facing the side since the other word, "occiput" precedes transverse. For some women baby is on the right side only a few days, for others it will be some weeks and maybe their babies never go to the left.

With balance, and the increasing hormones of pregnancy to soften the abdominal muscle fibers, the baby will 
settle Left Occiput Transverse or Left Occiput Anterior. Sometimes it takes labor to make this happen these days. Ideally, baby is in their final position for birth by week 34 of pregnancy.

For the mama with a twist in her lower uterine segment or other pelvic torsion, the baby may not switch to the left without daily body balancing activities and sometimes, needing professional body work to make it happen.
These women are untwisting lower uterine torsion, and increasing balance for the womb and pelvic floor.  Fetal repositioning to a left-sided presentation can happen when the twist unwinds. Keeping the torsion from returning also may take a few daily activities and good maternal body mechanics.

Few people, even providers, know this path of baby positions. Why? Because: 
A.) Fetal position changes are not observable with the eye, 
B.) Fetal position changes don't happen with the same timing or exactly this way for everyone, and 
C.) Flexion and Extension are often not considered to be associated with left and right since there are a few exceptions confusing the picture.  

People, even providers, think much of fetal position and repositioning is random, that babies are head down only because of gravity and often ignore uterine "balance" which effects shape, except in the extreme cases of bicornate uterus or something on the level of variation that can't easily be ignored. They aren't aware of right obliquity, even though it was in the obstetrical literature in the 1800s and before. 

Right obliquity is what makes the baby have 
a long, straight back and lifted chin aiming the top of the head into the pelvis when on the right 
and gives the nice, curved flexion aiming the crown of the head down when on the left. 

"Balance" is what allows the uterus the most room for the baby to move to the left. Gravity would encourage baby to settle on the left whenever, and for as long as, there is room is available for baby to rotate. Uterine surges encourage rotation as labor strengthens when there is enough balance for strong contractions to overcome the slight bit of torsion. The first job of labor is to help baby into the pelvis. See more about Engagement in pregnancy or Engagement in Labor at  SpinningBabies.com

Friday, December 13, 2013

Arm first- what is baby's position?

A woman's labor is progressing. The water sac releases amniotic fluid. The midwife/doctor examines the woman's cervix. Suddenly, the plan changes from the "routine miracle" of a second birth to an emergency cesarean. Why? The midwife/doctor finds an elbow coming first. Here's the mother's story with slight edits, including those to conceal her identity: 

My 2nd [baby was] 9 lbs 11oz...emergency c-section.  I had contractions all day and went into the hospital  where my water broke (I had extra water) and baby turned, ended up transverse and they said I was 6 [cm dilated] and wheeled me away...not really a part of my birthing plan and since it was my first surgery...I was scared; My midwife did say once they opened me up with my 2nd they saw baby head down but arm over head. All went well overall though the recovery was MUCH MORE difficult than my previous vaginal [birth].  My question is...once my water breaks...is there much I can do (as long as everything looks good) to keep this [3rd] baby in position? 

Yes, baby's position can change in labor and even after the water breaks. Fetal position is most commonly determined at 34 weeks and we know that maternal exercises, positioning and sometimes body work can be used to improve fetal position when necessary.  Even after  the water breaks.

Baby's position responds to the shape of the uterus and variations in the shape of the uterus that might alter a baby's position is most often determined by tense and loose ligaments and muscles supporting the uterus and pelvis. Read that twice. The soft tissues determine baby's position and the bony pelvis determines whether the position matters to how the baby is born. 

Having an arm present first is a clue that baby is lying sideways in the womb. But a clue is a clue and not always the reality.

Transverse lie seems to be a situation where several forward leaning inversions in  36 hours help. But I don't think she had a transverse lie from this description. It was a reasonable assumption.  If I'm wrong, please forgive me. An ultrasound would have been necessary and yet I have seen ultrasounds mis-interpreted in labor after the water had broken thinking a head down baby was coming and a breech came instead an hour later. 

On my website under Baby Positions about transverse on the drop down links. And the instructions on Forward-leaning Inversion (Inversion)  are detailed to tell how to do it and how not to and when not to. Inversions can be appropriate even after the water breaks in some situations, and I would include this one whether baby was transverse lie or had a compound presentation.

I have questions about how she knew the diagnosis of transverse was correct, or did they feel the elbow and assume baby had moved sideways? That is what I assume from the finding after the cesarean.
A compound presentation means a limb is coming along side the head. In the women giving the description above, baby's arm was up by the head and bent so that the elbow was coming first.

A technique to help compound presentation is putting the mother into Knee Chest with the rebozo over the entire bum "shaking the apple tree," as Ina May calls it, would help soften the pelvic floor muscles and buttocks muscles to make room for the baby to descend with contraction surges. 

This second solution for compound presentation and not for a transverse lie. 
A long time will be needed for pushing. Directed pushing is often necessary, meaning a woman is coached to push hard and long. She might pull on a towel or sheet as she pushes. 

The mother above, in my opinion, has an excellent chance of vaginal birth after a previous cesarean (VBAC). My suggestions would include to walk briskly, balance the body with the various balance activities, including Forward-leaning Inversion, and go forward expecting the best. 

If I were her midwife, I would expect a happy, vaginal birth considering the story details shared with me here. I hope she can overcome the curse of the emotional toll of having had an emergency cesarean and be free to be present with her pregnancy today. Present and joyful, she can enjoy her birthing, expecting a lovely VBAC!

Sunday, November 24, 2013

Cesarean rate

Would you think twice if your hospital's cesarean rate was higher than the hospital down the street or in the next city?
Check out http://www.cesareanrates.com
How do we know before birth if our hospital cesarean rates even matter to OUR birth?

My friend Adrienne (meet Adrienne Caldwell) told me how she perceived her birth preparations before her first child's birth and that she know much more about the journey afterwards. I drew this comparison…

Between Adrienne's determination, the birth team she chose and really, being in sync with cosmic forces beyond all of us (God's Birth Plan) she avoided a cesarean. She went to where cesareans were not the only option for her babies' births, a rare find in the spectrum of American birth.

Check out this Facebook page, https://www.facebook.com/FromCourageToStrength?ref=profile

Here is an excerpt of Candice's VBAC (Vaginal Birth After Cesarean) birth story which is posted on the home page of my SpinningBabies.com website.

"I ended up going overdue, at 40 weeks my provider strongly recommended I be induced. He suggested that I induce at 41 weeks due to the estimated size of the baby. Based on what I read regarding induction on your site, and my own negative experience being induced with my first pregnant (that resulted in an emergency c-section), I bargained with him and we compromised on a scheduled induction for 41 weeks 3 days. I continued to do the exercises - inversions, side-lying releases, lots of time on a birthing ball, walking, swimming, and regular visits to an experienced chiropractor. Truthfully I was quite discouraged that I hadn't gone into labor at 41 weeks and was fearful that I would have to be induced. However, at 41 weeks 1 day, I went into labor on my own... and boy when my baby decided he was ready, he was ready!" - Candice 
Candice's wonderful testimony is from her brave step outside the recommendations from her medical providers. Yet, she continued to work with them in harmony and on her terms.

In case you think I think all VBACs are full of grace here's one full of spunk at the Off Beat Families blog. Nancy used the ironing board to fill her little breeching to head down, by the way, but that's not the point of
  How to pull off a VBAC like a pro. 
"Later, my mother would say that it was the cursing that tipped her off,…"
Just for excitement, here's another Off Beat VBAC story:


"Garrett called our midwife [from the car] to keep her updated, and she announced a change of plan — she said to meet her directly at the hospital. She asked Garrett if it was me moaning that she was hearing, and he said it was.

 "As they were talking, my body gave a tiny involuntary push, and I felt something come up between my legs. My first thought was, "Oh, God, the cord." But I knew what an emergency that would be, and thought that maybe, just maybe, I had somehow pooped. So I reached down (with much trepidation) and felt…"
Oh, my goodness!

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.