Friday, March 27, 2015

Springing Into Perspective

Springing into perspective

The late season snow, so necessary in our midwest drought, is gently melting into our soil.  Thoughts of renewal frame the season change.

Renewal comes in cycles in our lives as much as for the earth in the annual Spring. Renewal is by definition out of something gone old, even decayed or perhaps wiped flat by storm. Somethings given up, there is a loss, there is a death. Winter is likened unto a sleep among the Seasons. Spring like an awakening.

A human life is a journey of growth, and even though the body is full height, the mind and heart grow on. In middle age, each decade or half decade seems to bring a broader perspective, in youth its by the year and in childhood by the quarter, and in infancy by the week. So my steps may be slower than they once were, but oh, so much more landscape is covered.

Birth is the first big visible, social celebration of a person's life. The community recognizes a new member. The older members of the community, the elders or the providers, depending on the culture of the birthing mother, guide the birth by actions founded on the beliefs held in their established values.  Often these are protective actions,  and some actually do protect. Coming to a location set aside for birth, whether a hospital or a hut, eating and drinking or intake of certain foods, fluids or substances, and having certain rituals, whether IV fluids or prayers and things to effect the environment (disinfectants or incense, for instance). Whatever it is, the action carries great importance to the people providing this service. Looked at spiritually, these are gifts to the life of mother and child. Looked at from a wider view, the results may or may not be useful to the wellbeing of mother and child. Let the mother have a say and enter the discussion.

All these actions also act to guide the mother and child into the values of the larger community.  To step outside of those protective actions can seem like a rejection to the people who are prepared to help. So why would someone choose a variation from the expected path?

I think one part of it, not all, but part of our reach beyond is because our heart and mind reaches further than the norm. A growth spurt, perhaps, a Spring branch stretching for the Sun.


There is often a struggle involved. This may be in the search for the birth attendant who has the skills, both in birth and in personality - and legal rights! It may be in the personal relationships with those who are happy not to reach. It may be within amongst the very parts of our own spirit as we reach in one area and are unsettled from a deep comfort in another.

The evolution of the human spirit is dependent on this reach. Birth rights are also dependent on the reach and the support for that reach. I am proud to be part of a World community of BirthKeepers, parents and providers, womens' circles, social activists, lawyers, doctors and even marketers who help us spread the word for how birth can be better.  Oh, that morning stretch!!






Wednesday, March 18, 2015

Where OP babies get stuck in labor and what to do

Occiput Posterior Presentation
Facing forward in the mother's body, the posterior baby's head presents in a bigger because of the angle the baby must pass through the pelvis. Baby can't help with the birth because their neck is already extended, they have less spinal movement because of spinal extension. 

Anterior babies have the room for more flexion to get into the pelvis (at the brim) and can then help with the birth better.Spinal flexion and extension helps with the birth - when they occur at the proper level of the pelvis. 



Arrest at the Brim
For first time mothers, just less than half have a vaginal birth if the baby is not engaged when labor begins. Not even half of the babies who are in direct OP at the time of delivery were born vaginally. I believe many of the babies who do not engage are in the posterior position and can be helped to rotate and engage.

Posterior babies may have their chin up and when so, can have their forehead on the front of the mother's pelvic brim. Even if the dome of baby's head is low in the pelvis, the fact that the forehead remains overlapping the pelvic inlet means that the baby is not actually engaged. 

Baby has to flex, or to flex and turn, to fit into the pelvis. We hope the baby turns to face mother's right side, putting their back to mother's left. Baby being hung up on the brim is a common reoccurrence in VBAC (Vaginal Birth after Cesarean) labors when the first labor was due to lack of engagement.


Transverse Arrest at the ischial Spines (found at 0 station):
If a baby was stuck at 0 station, the usual reason is that baby remains facing one of the mother's hips and hasn't turned to get past the boney bumps called the ischial spines- the narrow part of the middle pelvis. The baby may, alternately, have started labor posterior and began the turn at the pelvic floor found at 0 Station. Now stuck on the ischial spines, the baby can't fit the long angle of the head, which is to the mother's side, through the narrow midpelvis. Rotation can be hard for baby to turn at 0 station due to the ischial spines are holding baby from turning, and sometimes from pelvic floor tension. 

Baby must turn or all the Pitocin, pushing or contractions will not bring baby down. The rotation solution is to help baby turn to the oblique diameter or to face the back directly to fit. 


  • Sidelying Release softens and lengthens the pelvic floor and other pelvic muscles temporarily. Follow with lunges with one foot flat on a chair through 3 contractions on each leg. 
  • Rotation off the protruding spines while lying down requires a "bed lunge,"  
  • A peanut ball to straddle  while on a sort of hands and knees position to open the pelvis, 
  • Few doctors, nurses, or midwives know to manually turn the baby, but that is another option. So a cesarean is the only solution known and if baby can't fit or turn, then the cesarean is a lifesaver. 
Would it happen again? It might, small chance? Solution? Works like a charm - if the sacrum isn't pulled in...But Pitocin will not help unless you were having nearly no contractions and then, it won't help by itself, but with these techniques given here.


Immobile Sacrum or one that is pulled inward by ligaments: 
An immobile sacrum doesn't move out of baby's way in labor. All the exercise and most of the self-care suggested on my website and in my workshop is not likely to help if the sacrum is pulled in by a short (due to a chronic spasm) ligament pulling it into baby's path. 

Pitocin is unlikely to help bring baby down.

Mobilizing the stuck sacrum outward takes a specific release from a body worker or physical therapist. There is a trigger point release that isn't well known. It takes about ten minutes generally. In tougher cases, longer. But once done the sacrum swings out and, if the baby was held back by it, now descends to give the birthing mother an urge to push.

Massage of any small adhesions surround the sacrum, acupressure or acupuncture, chiropractic, and forward-leaning inversion followed by "shake the apple tree" may also help a lot if this is a borderline issue or tension is from muscles not sacrotuberous ligament.

Would it happen again? Yes, unless the sacrum was mobilized to swing out into its neutral position. Recheck the sacrotuberous ligaments periodically in the later part of the next pregnancy AND during birth. 


Summary
A little less than half of persistent posterior babies are born vaginally in modern university settings (See Lieberman, 2005). With better knowledge of how to open pelvic diameters, soften and lengthen pelvic muscles and ligaments, I believe we can increase the rate of vaginal birth for persistent posterior babies. 

Monday, March 16, 2015


    Hi, Spinning Babies,
   I am 39 week pregnant and been reading and doing Spinning Babies exercises on and off since 30 weeks as baby been on Right Occiput Lateral (Right Occiput Transverse in US) and Right Occiput Posterior for all pregnancy. I had him go transverse for a week and back down again. 2nd baby. I can't find links to the positions to do in labour since the site has changed and my partner has just taken some time off work to get up to speed with what he needs to be telling me and helping me with in labour, as was clueless last time! Was wondering if you could send a link?
    Thank you!
    -N____ in the United Kingdom

Dear N,
Here's a few direct links which will hopefully lead you to what you're looking for:



For a list of techniques (you can click on them to go to individual pages with descriptions) you can see the lists here and here.

I hope that helps! If there's anything else you're looking for specifically, please don't hesitate to write. 

Thank you!

Kelly


Wednesday, March 11, 2015

New website goes up tonight!

We're so excited to announce that the new Spinning Babies website will be going up tonight. There might be some time while the old site is migrated over to the new one where you can't access SpinningBabies.com. We've compiled a list here of important articles if you find yourself in need of some guidance while the site is down!

In Labor Now? Here's what to do.
How to do The Fantastic Four
Why won't this labor start properly?
Arm first -What is Baby's position?
Help! I want to avoid induction
Labor isn't starting or starts and stops?
Deb Lawrence's Dip the Hip Circles myofascial release
The abdominal lift and tuck to help engagement during labor





SpB Trainer Training 2015

Please help me to welcome our new Spinning Babies Trainers with me!

Preparing for months ahead, our Trainer Training brought everyone together for 10 days from our arrival on February 27th through March 8, 2015.

My sister, Kathleen, and I are proud to announce the lovely emergence of
6 Spinning Babies Approved Trainers!

In alphabetical order,

Lorenza Holt, Massachusetts
Marya Molette, Virginia
Nicole Morales, California
Ginny Phang, Singapore
Tammy Ryan, Iowa
Jennifer Walker, The Netherlands

We gathered, prepared, filmed, learned, shared, taught, and everything in between!
Enjoy the love and eagerness in these faces. I could look at these pictures for hours.

In labor now? Here's what to do.

Are the following happening?
  • Strong labor seems to start and stop, or surge and withdraw, for some hours to days
  • Surges come on at any time
  • Contractions may be long and irregular, but strong for hours and then fade away
  • Pattern occurs with or without back labor
  • An internal exam reveals that baby is still high in the pelvis
Baby might not be engaged. For some, the uterine action to engage baby seems like labor, sometimes as strong as labor associated with transition. But the baby isn’t even on the cervix.
When the baby is not engaged in the pelvis the uterus works very hard to try to get the baby into the pelvis. The pain is on the pubic bone, but can also be felt in the back or rectum. When baby moves, baby may “grind” the forehead on the pubic bone trying to rotate away from the front of the pelvis. Sometimes there isn’t pain to give a clue.
The cervix is often open less than 3 cm in a first time mom. But don’t rely on the cervix! Sometimes women open all the way to 10 cm and yet the baby hasn’t come into the pelvis.
If the baby isn’t engaged, the nurse, midwife, or doctor may say the baby is -3 station. This unengaged posterior baby often must rotate to left occiput transverse before engaging. Spinning Babies techniques aim to help rotation. Rotation may solve the problem to let baby engage and descend through the pelvis, helping the mother potentially avoid a cesarean.
The mother can check her own abdomen for a little tell-tale “ledge” resting on her pubic bone. If the ledge is there, it’s usually baby’s forehead. Then we know contractions may start and stop until the baby is turned.
High in the pelvis might also be termed -2 station (2 cm above the halfway point of the ischial spines).
When baby is directly posterior the back of the head might be felt in the pelvis at -2 and the provider thinks the baby is engaged. This is also because the head won’t wiggle. If the forehead overlaps the pubic bone then the forehead isn’t in the pelvis and the baby isn’t truly engaged.
Spinning Babies has the solution for many women in this situation:
3 Sisters of Balance relaxes the mother’s abdomen and makes room for fetal rotation.
  1. Rebozo sifting
  2. Forward leaning inversion through 3 contractions
  3. Sidelying release through 3 contractions on each side
Now the laboring woman can often rest. Labor may be mild for an hour. She can snooze.
Surges begin again.  If a woman isn’t pushing her baby out, she follows the 3 Sisters with the techniques to match pelvic level.
Baby still high? We balanced, now we reposition the baby for flexion! Do the Abdominal Lift and Tuck through a contraction for 10 contractions in a row. Let the belly down and relax the back in between contractions. Doing the Abdominal Lift with a posterior pelvic tilt to flatten the lower back and move the sacral promontory out of the way will help baby to tuck the chin and rotate out of posterior and descend.
Or, Baby is Zero, “0,” station, in the midpelvis, or +1, +2 station, lower down in the outlet. Either way, strong labor isn’t progressing labor. Do 3 lungeson each leg, resting between contractions.
This series of techniques will help almost everyone.
A woman with an android pelvis, large baby and low thyroid may need help with more techniques, including a manual rotation of the baby by her OB or Midwife (done internally). If the posterior baby is large for the mother’s pelvis and the mother’s ligaments are tight, an excellent myofascial therapist who is specially trained in pregnancy may be necessary to avoid a cesarean. To prevent that crisis in a labor, begin before pregnancy or early in pregnancy to release spasms and imbalance in the whole body and pelvis to promote optimal fetal positioning in labor.
The 3 Sisters is the most powerful contribution of Spinning Babies to the birth world. These Sisters work to balance the pelvis in pregnancy and in labor. Starting balance in pregnancy may mean you won’t need them in labor. Starting balance in pregnancy may mean you don’t end up with a crisis in labor to a stalled labor or a case of “baby won’t fit.” Some women may need more specific balancing activities.

Sunday, February 15, 2015

Tammy dreams of reducing obstructed labor in Kenya

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

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

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

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


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

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

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

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



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


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

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

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


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

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



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


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

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

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

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

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

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

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.