Tuesday, December 29, 2009

March of DImes Prevent Prematurity with Midwives & lowering induction

Medscape interviews Dr. Fleishman, expert from the March of Dimes, on the prevention of prematurity. The March of Dimes has gotten my respect these last 7 years for their prematurity prevention campaign. In the beginning, I used to muse, what we midwives could teach these folks. Well, someone else must have been thinking that same thing. And better than that, Dr. Fleishman is watching the numbers.
Here are some of Dr. Fleishman's bold statements:

"About 72% of all premature babies are now born "late preterm," defined as 34 and 0/7th to 36 and 6/7th weeks' gestation. That so many of these babies are being born early is directly correlated with actively managed pregnancy... We believe that a substantial proportion of these births are not medically indicated.

"...actively manage pregnancy has gone overboard. It has caused any small change -- any increase in blood pressure, any concern about diabetes, or fetal well-being -- to result in a very aggressive management strategy with inductions before they're needed. Inductions tend to result in cesarean deliveries.

"The other thing that has increased iatrogenic prematurity is the fact that both women and health professionals are scheduling deliveries. This clearly has convenience benefits for both parties, but I don't think we were sufficiently aware of the serious consequences of doing this....

"The reason we're fairly certain that much of the late prematurity is iatrogenic [Doctor caused (and could be midwife-caused, too, if the midwife induces early] is because of what happened at this symposium. We invited the Hospital Corporation of America, Ascension Health, Premier Health, Geisinger Health System, Intermountain Health, and United Health to give us their data. All of these programs have done interventions of one sort or another to decrease early -- pre 39 weeks -- inductions and consequent cesarean deliveries. And, in fact, when they do that, they dramatically decrease, first, their late preterm birth rate, second, their C-section rate, third, their neonatal intensive care admission rate, and they have better outcomes and lower costs with no increased adverse outcomes of pregnancy, and no increase in stillbirths.

"What we see from those programs -- and we now have published data, which were presented at this meeting -- is that you can decrease these inappropriate iatrogenic deliveries and have better outcomes without any adverse effects. So, that proves the hypothesis that some of these [early births] are certainly unnecessary."

So what he's saying is that when the March of Dimes acts as a Watch Dog group and fewer inductions are done before the mother is 39 weeks pregnant, injuries and illnesses are reduced without causing more problems in other areas.

Women are often told to be induced because amniotic fluid is low, their baby is large, or their blood pressure is a little high (if it is a lot high induction can be a good idea, especially if no one knows to counsel the mother to eat high protein, greens, water and a bit of salt immediately and daily).

Anyway, such generalized reasons for induction are not proving induction is good but that induction is bad. When mother's are not induced before 39 weeks, there are not more problems. If induction was a good idea then we'd have seen healthier babies after induction. We do not generally see that. Some doctors and midwives understand this and do not generally induce.

When to induce? There are times, perhaps lack of fetal movement even after feeding the mother (and so the baby), lack of fetal heart rate variability (and not just for the baby's nap) or when the mother is truly sick with high blood pressure or worse - the kind of thing that only giving birth can solve (though you know from my other posts that I have seen amazing things from 100 grams of protein daily plus other dietary rescues). There are times to induce labor, but rarely.



More from Dr. Fleischman: "...I think that the increase in cesarean rate directly correlates to the increase in induction rates. If you induce women early, when the cervix and uterus aren't ready for labor, you will have an increased cesarean rate. Once the woman is admitted and induced, and her membranes are ruptured, that's a train that isn't going to stop until the baby is born. The increase in the rate of cesarean deliveries is a big part of the increase in late preterm births.

"The obstetric community, to its credit, is absolutely in favor of no inductions or C-sections before 39 weeks unless there is a clear medical indication. ... We're helping them [our obstetric colleagues] to learn... to insist that women not deliver before 39 weeks.

"... we can't leave it up to doctors alone. We can't leave it up to the nurse who's booking the induction or the C-section; we've got to create rules in hospitals with clear standards. That's why quality improvement -- analysis of data, the creation of rules, and holding people accountable -- is so important.

"...there is an increase in prematurity around the world; we reported in the March of Dimes White Paper on Preterm Birth: The Global and Regional Toll that in fact there are 13 million premature babies born every year around the world. About a million of those babies die. The United States leads the increasing rate of prematurity in developed countries. North America and Africa are the 2 regions with the highest rates of prematurity. "


Read that again, folks. North America and Africa lead with prematurity. We know Africa is afflicted with a drought and AIDS and I guess American pregnant women have a drought in their aid. They aren't getting the simple care they need to prevent prematurity.


Now it gets fun.

Dr. Fleishman, expert at March of Dimes, goes on to say,

"In comparing outcomes between women using midwifery, home birth, or expectant management vs a more active management strategy ... there is no question that the midwifery programs end up with deliveries not being induced unless there are clear indications. Midwifery services don't just wait until 39 weeks; they wait until the initiation of labor, which God in Her wisdom used to think was a good idea, and I think that it's probably a good idea for most women, yet only about half of the women in America are being allowed to go into natural labor. So yes, there is a lot of benefit to thinking about the expectant management, "high-touch," caring approach, which we think is quite appropriate."

Read more straight talk from Dr. Fleishman at Medscape.

Pregnant women today need to know that some midwives, as well as some physicians, will push for induction for practice standards rather than indicated reasons. This means that when they advise for induction they will give scary reasons why a woman should comply. It may be that all women in their care are induced by 42 weeks, or if fluid is low, the baby is big, etc. And to get free-thinking women who chose midwives to agree to questionable intervention fear is sometimes played upon, let's be honest. I've seen it played out many times.

Even if a woman who is 42 weeks has a baby who is active, passes her biophysical exam with and 8 out of 8, etc, the midwife is still so unlikely to say Your particular baby is healthy, we can wait a few days on this induction. No, she will push for induction to maintain a working relationship in her clinic and hospital (to get along with her colleagues).

Thats the dark side of Standards of Care. There is a bright side, too, but I'm ranting here.

Women will comply rather than disrupt their support system, rather than alienate their midwife. They will go home in tears and rant to their doula and come back and get induced. They will sit by their babies bed side in NICU and hold their head in their hands and not go back for their second birth, but they will not walk away from the bad idea of induction for a less than obvious health reason.
Dr. Fleishman says March of Dimes is teaching Dr.s a script to hold women off from inducing so that grandma can give postpartum care during her scheduled visit.
Midwives and Birth Activists must give women a script for talking to their doctor or midwife when induction is discussed.

Its not uncommon for a woman to be told she must be induced to save her baby's life on, let's see, theirs an opening on Thursday morning. Your baby's life is in danger, so come Thursday morning. And then on Thursday morning it may be that there are no available beds. So the mother is told to come back tomorrow. Now, finally, she has the evidence to see that there is no emergency. Yet she is so scared by now that she can't relax. She fears that some crisis is impending and she wants her baby to survive it. She now begs to be induced when instead, she can go home, eat well, relax in her own bed, and come back when labor starts on its own.


How can a woman tell when an induction is necessary and when it is not?
How does a woman navigate the fear of her providers?
How can women disagree and still hope to get compassionate, quality care during spontaneous labor? Leave a comment and tell us!

Thursday, December 24, 2009

low hormones and posterior babies!?

I've been promoting iodine in pregnancy for a couple years now.
And didn't even guess low thyroid levels could be related to posterior fetal position! I just had a hunch we were seeing more slow starts to labor, to the frustration of the mothers and to a point that didn't seem like a simply gentle start. Also, for women who had a tough time getting pregnant due to hormone issues.

So this new study by researchers from the University of Tilburg is a Christmas present to Spinning Babies :
12-23-09 BBC news (http://news.bbc.co.uk/2/hi/health/8425901.stm)

"Low hormone levels in pregnancy linked to hard birth

Too little of the hormone thyroxine is already known to complicate pregnancy, increasing the risk of miscarriage, premature birth and pre-eclampsia.

Now a Dutch team has found even "low to normal" levels of thyroxine may cause problems, Clinical Endocrinology says.

Babies were more often positioned wrongly, making labour more difficult.

Although still head down, the babies tended to face the wrong way - towards their mother's back rather than stomach.

Not only are these labours generally longer and harder, they are also more likely to end in an assisted delivery with forceps, ventouse or a Caesarean."

It does highlight the importance of checking thyroid hormone levels in pregnancy
Hormone expert Professor John Lazarus

Friday, December 18, 2009

Where fear is seen as compentency

Another surge of gratitude for not having gone through the system.
Read this insightful report of this test for an "OB" class.

http://myhousesmellslikevanilla.blogspot.com/2009/12/reflections-on-exam-of-doom.html
The blogger, I can't see her name, compares a care plan for a woman who has a breech baby at the end of pregnancy.


Of course, I've met many dozens of wonderful hospital care providers. And many that would like to trust breech, and a few that actually do. But usually, I notice that if I speak with a hospital provider about breech in such a way that reveals my trust in breech birth I am met with an incredulous and even offended look. The message I get is that if I don't fear breech birth then I must not know much about it; that somehow I'm irresponsible to trust birth.

This is a trained response that tightens the hospital community into a shared culture of fear. An "appropriate" level of fear is bonding. Shared meanings create shared perspectives and allows one to be part of the group. Doulas, childbirth educators, and parents can fall into this response to breech birth, not from education or information, but to feel connection with the nurses, midwives and doctors. Not just fear, but a shared "awe." By adapting the same emotional response in the manner of the person with more authority or power - the person with less power seems to rise in status and get brought more securely into the group.

The radical birth trusters are those that stand a bit apart. Sometimes they can win the respect of the hospital staff when relationship and repeated results are favorable and their communication style is winning. This is the case for the calm and calming obstetrician who continues to attend breech babies in spite of ACOG and the fear culture within obstetrics and maternity care.

Homebirth midwives trust breech birth in more numbers, but not universally. In this group education is more likely to expand trust, especially when the content reflects birth physiology and the natural progression of breech through spontaneous cardinal movements when the mother is leaning forward. Midwifery traditions have safe breech practices, but not all midwives know the traditions and techniques.

Carol Phillips, DC tells how the forward leaning position shifts uterine ligaments in a favorable way for spontaneous birth.

We can trust birth when we know how to support spontaneous birth. Often, this is to do nothing. Providers can learn quickly to distrust birth when they see, time after time, difficult outcomes. They may never link how the outcomes follow a course of prenatal care without relationship, nutrutional counseling, community support and connection, and other ways of helping a healthy woman stay healthy throughout pregnancy. They may never link how bad outcomes follow multiple interventions, including multiple doses of various drugs. They may never link any of this because they don't have the opportunity to see the woman's life before and after the birth to gain understanding of lifestyle influences on birth, or medical intervention influences on breastfeeding and newborn alertness.

Well, that's my soap box for the evening. Stay warm!

Monday, December 14, 2009

Belly Mapping Problems

Women have contacted me lately with some frustrations doing Belly Mapping. (See Michelle's comment to the previous post.) I haven't been hearing the details of what the problem is, but it sounds like there is some confusion. I'd like to address that today.

Belly Mapping becomes easier the later in pregnancy the mother attempts it.
Here's a mom beginning her third trimester.
She lies down to relax her abdominal muscles.
She is exploring, deeply, what is in the lower part of her uterus. She is glad to find the round head. She has to reach deeply.

Think about what you find in the top of the uterus, and what are on each side and whether the lumps are different on either side.

Then take a doll and match the head. If the head is presenting, or leading the way out of the womb, then put the doll's head there.

Put the doll's back where the largest firmness is, the solid back.
Put the doll's feet where the most kicks are being felt.

Fine tuning comes with practice.

Try this and see if it makes more sense!

Wednesday, December 9, 2009

Dynamic body balancing weekend

Last weekend was really amazing. It started out with me having a meltdown into the magma of unworthiness. Forget "inadequate pelvis," my head, my heart, my whole life sucked. Maybe being on such a steep learning curve curve with life was getting to me. I really lost my peace.
Anyway, the Dynamic Body Balancing class was about to start and I felt that I was facing a cliff to climb to get my attitude together to attend.
Carol Phillips, the Chiropractor who teaches this mixture of methods, called to see if I had time for lunch Thursday. What a blessing. We sat at The Good Earth. Soon she was reassuring me with her story of how shaken her world became until she devoted herself to writing her book, Hands of Love.
Discontent with everything, she also left her practice and began writing...for 8 years (doing a quieter practice on the side). Her story made me feel much better.
Much of my angst is from going in too many directions. I surrendered myself to the weekend. It was the last of four weekend workshops with Carol.
How will I ever have time to practice these new skills? Right now, I have every day booked for my various projects. God would have to decide how this would work, if at all.
As I put on my coat to leave the house, I felt strongly that I had to go back and listen to my phone messages. Confession- I hadn't listened to messages for two days while I was in my snit. I heard those tell-tale etheric bells even as I heard a woman's voice tell how she was facing an induction for her VBAC at 42 weeks. Her baby wasn't engaged in her pelvis. Her first baby never engaged either. She and her midwives had noted that this baby was posterior so she had begun the techniques from Spinning Babies and saw a Chiropractor.

I headed over after class to see what we could do. Her baby had just rotated to LOT the night before, a lovely starting position - except that this baby was still not engaged. I bit my tongue rather than say she was at an increase risk for cesarean because her baby's head was yet above the pelvis (Stronge; and Shin; both studies say 12 x the risk for cesarean, Shin's study is for 1st time moms over 41 weeks). Well, its a second baby, I rationalized, that may be why the head was up. Early labor might yet bring the baby into the pelvis. Though I didn't think so. Her history indicated a torsion in her pelvis. She'd been in a car accident two years before when a woman ran a red light. So, we did a series of activities Friday night.

Sunday, just before the workshop ended, I got a call from the hospital.
She'd been induced the night before with IV Pitocin. Super strong contractions resulted. The Pit was turned off to let her uterus rest (and avoid a rupture). In the afternoon, the midwife broke her water to see if she could labor without more medication. No contractions came so the Pitocin was turned back on. Her cervix was 4 cm dilated (10 cm is fully open and ready for the pushing urge).
What could they do? I suggested a psoas release and Carol's famous three-some: the forward leaning inversion (again), the sidelying release and the standing sacral release. After the workshop, I called back and offered to come out to the hospital. Everyone was tired so a fresh face was welcome. They'd been at the hospital about 24-hours now.

Her labor was just revving up as I arrived. We went through as many of the myofascial release techniques as I could with her standing and contracting every 2-3 minutes. As she stood and leaned towards her husband, I noticed her sacrum and tailbone were pulled unusually inward. Bilateral pressure anteriorly on both insertion points for the sacrotuberous ligaments had a most beneficial effect. I did specific massage to relieve her TMJ, including inside-the-mouth pressure point release. Afterwards, she wanted to lay down on her side. Then I was able to do some cranial fascial release. For an hour, I followed her around like a sucker fish on a shark.

The nurse-midwife came in and offered to check her cervix for dilation. The mom was laboring internally and didn't answer. The doula and I had been with her that hour and we said we couldn't discern a change, though the contractions were closer and quite strong. So the midwife left saying, just let me know...
The very next contraction brought the urge to push. The nurse was there and asked if she should check. Yet, the mom felt no downward pressure and her sacrum was still pulled anteriorly. The next contraction came and again I said, well, the sacrum hasn't come out yet. The mom still complained of the same discomfort she was having from the head being on her bladder.
The third contraction was quite different! The sacrum flared out and I smiled at the nurse, now her sacrum has come out. Now this could have been the fetal ejection reflex (Michel Odent) or it could have been that the ligament release let the sacrum become free to move.

The midwife returned and found a bit of cervix left, but baby was coming down. She went from 4-10 cm during the hour I did the body work. She coped so well I wasn't sure she was progressing; it was easier for her to cope in transition than when she was first on the Pit getting to 4 cm, probably because of the tension in her pelvic floor and sacrum from her car accident. Suddenly, she was getting relief and felt hope. Ultimately, she had to push very hard to bring her baby out. He was quite a good size.
The nurse and midwife were pretty impressed. I guess it could have been a coincidence. I don't think so, though.
Thank you, Carol Phillips, for all you've taught me. I'm pretty sure it saved this mom from having another cesarean. It took all four classes. TMJ and a tight psoas...I think these were the issues. The TMJ can pull up the sacrum or something... let me check my notes... Anyway, never underestimate the fascia!

What a fun way to learn. Take the class during the day and go to a birth in the evening. God arranges everything!
Carol is returning to St. Paul, Minnesota in 2010. Here's Carol's schedule:

2010 Dynamic Body Balancing Workshops with Carol Phillips, DC
Each 20-Hr workshop is $400/$450 with CEU's


Minneapolis / St. Paul, Minnesota
Level I February 12th-14th
Level II April 9th-11th
L III Pregnant Women and Babies July 19-20th?
Level IV October 1st-3rd
Level I December 3rd-5th

Annapolis, Maryland
Level I March 12th-14th
Level II April 30th-May 1st
Level III August 20th-22nd
Level IV October 15th-17th


Thursday, November 26, 2009

Thanks giving

Thank you to all the mamas and babies and papas and siblings and nurses and midwives and doctors and doulas and childbirth educators and yoginis and lactation consultants and public health workers and authors and painters and singers and bringers and pot luck cookers and visiting home nurses and hucs and apprentices and hypnobabiebirthingteachers and prayers and hopers and givers and takers and everyone all around the world.

Monday, November 23, 2009

Funny! More breech coincidences

Ok, this is getting weird.
I got a series of calls from three women who are all friends in WA state looking for support for the one of them who is at term (pregnant and due) and whoses baby is suddenly breech. They wondered if I knew of any breech resources in Washington state. Well, sorry, I didn't actually. Portland, OR and Vancouver, perhaps, but not WA itself.
I opened my email, didn't even have to do a search, and found a link to this Breech Birth in Seattle and Washington State blog.

And here's a blog for fun... fun to midwives and birth junkies, anyway.
WithWoman.co.uk/

Sunday, November 22, 2009

Teri posted my breech update pics!



Ok, the topic of breech is so daily in my life right now. I wish I was done with my other projects to travel somewhere for more training. Somethings up. At least we are working on a related project....more on that when its manifested. I got another call today from a birth educator, out of town, looking for a breech-skilled provider. Just what those skills are does need to be discussed.

Today, Teri's Passion for Birth blog post with a couple of my midwife partner, Emme Corbeil's photos of our other partner Clare Welter, CNM (the footling here) and Sylvia Kosloski, CPM (my own midwife!) with me at our Midwifery Now! (MN!) Breech Update showing the cardboard pelvis I made the day before the workshop. Teri said to friend me on Facebook and learn the Cardinal Movements of Breech ... er, ah,
ok, I guess that's an assignment for me. Didn't mean to steal the honor, as other midwives are more qualified! Meanwhile, here's Teri Shilling's blog http://childbirtheducation.blogspot.com/2009/11/mega-pelvis.html

The person who really describes breech cardinal movements well is UK Midwife Jane Evans. She explained the best starting position for the breech is Right Sacral Lateral (Transverse in our country's English). That's just the opposite for a head down baby. Very enlightening!

The baby starts on the right.
When the hips enter the brim, they may be transverse then. Even if they're coming in posterior, the baby will rotate around to the anterior by the ribs, if there is no touch, and no obstacles to the cardinal movements of the baby (such as lying on one's back) during the movement through the pelvic floor.


The mother is on her hands and knees most often for safety. We show the pelvis as if the mom is standing simply because of the size of adults and showing a room full of midwives.

And the box wouldn't support a person moving through it if it were on its side. So the pictures are not exactly how it'd go, but they show the general idea.

The baby turns to face a hip as the chest comes into the pelvic floor and the first bun appears. The first bun to appear is the anterior cheek. When the buns are one above the other, you see one before the other rather than both at once, its reassuring of success with the arms.

After the birth of the hips the umbilical cord appears. It is easy to see if the cord is happily pulsating. It is easy to see if the baby's tone is good. But do not touch the cord to bring down a loop.
The baby rotates again and faces the spine as the shoulders enter the pelvic brim. The arms, often over the chest, drop out in this position. The baby is still not touched. The midwife may be going crazy with desire to touch the beautiful child or to check the cord by touch. She'll get over it. Don't touch.


The baby pulls the knees up to the belly and this brings the chin to the chest. The baby is likely to drop out now or with the next contraction. Remember, you are watching the umbilical cord and tone of the baby to assess health.
As the baby drops from the mother the midwife or doctor quickly catches the baby. This is the appropriate first touch.

In this way, the baby's work to rotate through the pelvic floor is not interrupted. Disturbing the baby increases the likelihood of having to rescue the baby from extended arms.

Anyone hoping to catch a breech has to know the specific ways of releasing stuck arms or the extended head. Just because touching the breech is one common cause of extended arms or head, it is not the only cause. I'll leave that information for another venue.

I have only had my hands on a few breech babies that needed help and am fortunate to have studied and studied, and practiced and practiced with dolls and pelvis and a very astute senior midwife before needing to put those lessons to action. We are fortunate to have some good breech How to's in print:


B BREECH BIRTH, book by Benna WaitesBREECH BIRTH, book by Benna Waites






Breech Birth Woman-Wise by Maggie Banks, Publisher Birthspirit Books, New Zealand, 1998 ISBN 0 473 04991 0




Wednesday, October 21, 2009

Coalition for Breech Birth Conference

Life made sure I went to the Coalition for Breech Birth Conference in Ottawa, Canada.



Robin Guy and her Coalition co-madres joined efforts with UnderstandingBirthBetter.com Midwife Betty-Anne Daviss. They brought several top breech experts to Canada to share their hope to continue vaginal breech birth on Earth. Starting with Dr.s Andre' Lelonde and Robert Gagnon of the SOCG and ending with Ina May Gaskin, I also got to meet Jane Evans of the UK.
Jane reminds me so much of my late partner and friend, Jan Hofer. They both so get birth and what's important without getting lost in the mental maze, and at the same time, Jane Evans explained breech cardinal movements so well that several of the OBs were saying that now the lights were on. Now they got it and would be trying hands and knees breech birth when they got back to their cities.
Dr.s Frank Louwen and Anke Reitter came with cheerful stats on knees and elbows position (hands and knees, but without straining the wrists). Of 300 breech births with mothers using "knees and elbow" position, only 2 needed help with extended arms and head, even the footlings. Even the primes. This correlates perfectly with midwife observations of hands and knees breech births. Hands-off-the-breech really means hands off. They also didn't touch the baby, basically until trying to catch the baby in mid air before the baby hit the mattress. Hands-off doesn't mean don't touch until the umbilical cord is out, but rather until the head has just come out past the parietal bones and you prevent a fall.

So check these resources for current breech conversations
Society for Obstetrics and Gynaecology of Canada Guidelines for Vaginal Breech Birth
Stand and Deliver
http://www.breechbirth.ca/Welcome.html
http://www.birthinternational.com/product/book/bk846.html
Hands off the Breech by Jane Evans
http://supportdrfischbein.blogspot.com/
http://video.who.int/streaming/rhl/breech_web.wmv
http://www.abreechinthesystem.com/home.html
http://enjoybirth.wordpress.com/2009/09/25/unexpected-cesarean-due-to-surprise-breech-baby/
http://blog.givingbirthnaturally.com/2009/06/vaginal-breech-birth-socg.html

and of course, www.SpinningBabies.com The Breech info has been reorganized, made simpler, but more detailed.

Have fun surfing, there's lots more, but I have to go make dinner...

Thursday, October 8, 2009

Fun w Belly Mapping

This post from an expectant mother's blog lifted my spirits today.

"We also got to find out our baby's position in the womb (called belly mapping). S/He was enthusiastically responding to our hands. So our baby's back is on my left side and the knees & feet are up against my belly's right side (which would explain all the kung-pow action going on over there). And the head is down!"

They feel the baby responding to their hands, and to their hearts. Wonderful!! What and extra blessing with Belly Mapping !

http://theswensonfamily.blogspot.com/2009/10/two-more.html

Sunday, October 4, 2009

"Women always have a choice. The question is not whether they have a choice, but are they willing to make a choice." - Kim Wildner,
in Midwifery Today Issue 68, Winter 2003, "The Ties that Bind, How Belief Creates Birth Realities"

This is exactly why I say Homebirth isn't a choice, its a way of life.


Wednesday, September 16, 2009

More on the value of apprenticeship

Considering the ACNM letter of late, I hope that each of you would take the time to promote the apprenticeship model of care. If midwives are only trained in institutional settings, how would we learn normal birth (home birth?) Institutional settings utilize obstetrical solutions for pregnancy and birth problems, but not traditional midwifery care. If we want to preserve traditional wisdom we need to preserve the traditional model of education.

http://mana.org/ICMSurvey.html

Apprenticeship is an avenue for gifted, hands-on learners to succeed.
Apprenticeship allows the learner to "absorb" the modeling behavior of the preceptor (in this case experienced midwife).
I learn what I do; I become what I feel.
Apprenticeship in midwifery allows the student to come into the culture of birth.
Apprenticeship in homebirth midwifery allows the student to serve the culture of homebirth and so help to preserve the culture of homebirth, including mother child skin-to-skin bonding in a family flora environment, delayed cord clamping (if at all), less need for resuscitation, less vagus nerve reflex (gagging and breath obstruction)
Apprenticeship relies on relationship building, not the business model of the institutional educational setting. So, personal growth is enhanced rather than the profit margin-ization of people who want so much to learn that they'd pay and do anything to enter into the world of birth only to find that they've entered the policy world of institutions.
Oh, ok, university learning has value, yes, but its destination is not the only valuable destination, especially when we are seeking to preserve hormonal function for spontaneous birth and breastfeeding.

Sunday, September 6, 2009

More proof that homebirth with Midwives is safe


I'm so glad that I learned my midwifery from midwives in the home during homebirths. I learned there what I do there. (I know that's a silly sentence, but think about it. Women go to an institution hoping to learn how to honor birthing women and then practice in another institution that depends on interventions and complications to make a profit...)
I help in the home and I've learned the culture of homebirth. Through the apprenticeship model, though the midwives I worked with didn't have a formal apprenticeship during the years I was learning, I learned the skills I share today:
  • reductions in hypertensive disorders through diet
  • avoiding premature birth
  • achieving a healthy birth weight for babies
  • safe breech birth at home
  • vaginal birth of posterior babies
  • safe vaginal birth after cesarean
  • resolving shoulder dystocia
I didn't learn that out of the approved textbook or classroom training that tells many an enrolled past homebirth midwife not to share their knowledge about breech and other midwifery skills with the other students, but to stick with the curriculum. I'm grateful that homebirth (and hospital trained midwives!) came together to form a model of testing to show that the apprenticeship model works well. And I'm proud to put that to use as I hold the CPM credential from the North American Registry of Midwives.
Canada is promoting CPMs and has come out with statistics that also include CPM births. http://www.usatoday.com/news/health/2009-09-03-midwife-home-birth_N.htm

Tuesday, August 25, 2009

New Navigation at Spinning Babies

I fixed the messy menu problem. I don't know why I didn't get the fix earlier. I thought I'd double clicked on some extension or module. But, no, it was just me being wordy. Now cleaner.
Please visit www.SpinningBabies. com

Monday, August 3, 2009

Can this cause a breech position?

"Hi Gail,

"I wanted to run something by you... We had a client a couple weeks ago with a somewhat irregular but progressive labor pattern, and we used the rebozo to do a little sifting, plus some abdominal lifting (which seemed to regulate and intensify ctx). After several hours things picked up rapidly, her water broke, and we went to the hospital. Upon arrival she was 7cm, baby's shoulder was presenting and by birth (by c/s) he was full breech. The CNMs were stunned, as they'd thought baby was vertex for months. [My doula partner's] question to me was, "did we cause this with the rebozo??" I couldn't imagine how, but she spoke with another homebirth midwife who said indeed it was possible. Thoughts??"


Dear [Doula],
Is it possible the sifting caused the baby to go breech or the abdominal lifting? I would think not. But let's analyze this in detail. Lets examine the possibilities.

Sifting with the Rebozo will relax the broad ligament of the uterus. A relaxed broad ligament will not cause a breech presentation. Sifting is done with the mother either on her back or, more comfortably, on her hands and knees. Neither posture is likely to cause a baby to flip to a breech position. I doubt that sifting was the cause of the breech presentation.

If one of these techniques caused the breech, I would suspect that doing the abdominal lifting too much might be a possible cause, but not the sifting. The reason to do an abdominal lift is to relieve distracting back pain or reposition a stuck posterior head. A fetal head in the posterior position is also often deflexed, the chin is up.
Abdominal lifting will lift the baby's head and reangle it, ideally to fit the pelvis better. Abdominal lifting helps tuck the posterior baby's chin towards the baby's chest, making rotation and/or descent easier to accomplish.

It is incorrect to lift the baby aggressively, or too high out of the pelvis in some cases. Its incorrect to use an abdominal lift without the need for one. A fast, progressing labor would not indicate an abdominal lift, even with incoordinate contractions.

Done incorrectly, the abdominal lift can bring up the head and, if the pelvic alignment were to be off or the pelvic floor asymmetrical there could be a possibility that the baby might flip in response.

Now I would like to examine signs that the baby may flip on its own in response to labor.

Was this baby posterior before flipping breech? If so, labor may have been the cause of the flip, or labor with abdominal lifting.
Incoordinate contractions indicate an asymmetry in how the baby is presenting in the pelvis. Likely the fetal position is dependent on a preexisting asymmetry in the Asymmetry in the pelvis is associated with a higher rate of malpositions, in my experience. Carol Phillips, DC, explains how the misalignment of the bony pelvis pulls the soft tissues out of alignment, including the pelvic floor. The baby is forced to accommodate as best he or she can. Sometimes, rarely, this includes flipping to a breech presentation. It usually means, a posterior or asynclitic presentation.

While rare that a baby would flip in labor, this has been a summer of breech babies, and some babies do flip in labor.

In other words, doing nothing may also have seen a flip because the downward movement of the baby's head may have brought the head into contact with a type of restriction that can cause a breech presentation.

...This is a very important consideration. Unless we start sharing these experiences we won't know if the techniques themselves can cause a malposition. I don't think so at this point, but without dialogue, we'll never know.


In the mystery,
Gail



Sunday, August 2, 2009

Obama, what we can do for health care


Jennifer Block is, again, on her toes.
http://rhrealitycheck.org/blog/2009/07/29/wheres-the-birth-plan

"Compared to healthy women who get standard obstetric care and deliver on high-tech labor and delivery wards, women with low-risk pregnancies who get care with a midwife and deliver in birth centers or even in their own homes, benefit from a five-fold decrease in the chance of a cesarean delivery, more success with breastfeeding, and less likelihood that their baby will be born too early or end up in intensive care. And all of this for a fraction of the cost of the status quo. A new economic analysis forecasts savings of $9.1 billion per year if 10 percent of women planned to deliver out of hospital with midwives. "

We live the savings. And not only savings, but as midwives, we see the spirit of a woman grow as she herself gives birth to her baby. The family benefits. Its just not corporate.

Wednesday, July 8, 2009

Be part of a breech study

Heads Up! Study on Breech Pregnancy and Birth
If you gave birth to a breech baby, or if your baby was breech at some point during pregnancy, we would like to invite you to participate in a research study. Please share this announcement with others who might be interested in participating.
Research goals:
Breech research is often aimed towards health care providers and tends to focus on maternal and fetal health outcomes. Our research explores women�s experiences and feelings about carrying a breech baby; their decision-making process when discovering that their baby was breech; their care providers' recommendations and protocols for breech birth; and the birth options available to them, from vaginal breech birth to elective cesarean section. We will present the results at the International Breech Conference in Ottawa. We also hope to submit an article to a peer-reviewed journal. Participation is confidential.
Who can participate:
All North American women who have had breech pregnancies or births are invited participate in an essay-response survey, which takes approximately 15-30 minutes to complete. We are interested in participants who had breech pregnancies (breech babies who turned head-down before birth). We would also like to hear from women who have given birth to breech babies, whether vaginally or by cesarean section; with midwives, physicians, or unassisted; at home, in a birth center or in a hospital. We welcome input from both singleton and multiple (twin, triplet, etc) breech pregnancies and births.

How to Participate:
To take the survey, please visit the Breech Pregnancy and Birth Survey (http://tinyurl.com/mco7kp).
About the researchers:
Dr. Rixa Freeze has a PhD in American Studies and focuses on childbirth and maternity care. She blogs at Stand and Deliver. Julie Searcy is a PhD candidate at Indiana University with interest in the cultural discourse around birth.

Saturday, July 4, 2009

Natural still better after cesarean...

Janna Farley wrote an excellent article on the high value of vaginal birth after a previous cesarean (VBAC). Her article caught my attention because one of the mother's interviewed describes her cesarean as necessary for a posterior baby who didn't descend in labor. I address this very issue in my chin tucking article under Baby Positions on the Spinning Babies Website. Here's the description from the ArgusLeader.com article:

The 32-year-old Sioux Falls mom was a good candidate for a VBAC. She had an unplanned C-section with her first child after 24 hours of labor because he was in the posterior position. "He never really descended into my pelvis," she says.

Did her homework

When she was pregnant with her second child, Redetzke considered a VBAC but did her research.

Monday, June 22, 2009

Spinning Babies on the top 100

A busy student radiologist has gifted Spinning Babies on her top 100.
She calls her list, 100 Best Health Blogs for Soon-to-be Moms. Fun!
See who L. Fabry has picked. From the familar to the unusual...

Sunday, June 21, 2009

More from John on Breast milk!

My husband's son John is a published young scientist who recently presented at the American Society for Mass Spectrometry on his research team's discoveries about human breast milk. I have no idea what phosphorylation is, but here's some highlights. First, their title:

Analysis by Microfluidic LC-MS/MS with Integrated Phosphopeptide Enrichment Reveals Dynamic Human Milk Protein Phosphorylation during Lactation

If you are about to nurse your baby, you might just meditate on that title. Its sure to induce a let down response.

Johnny says in his speech, "People ask me all the time why I’ve chosen [breast milk] to study, and the reason is that breast milk is a rich and varied source of bioactive species."

"...there are a variety of species in breastmilk that you wouldn’t normally think would be there including,
Cytokines
Enzymes
Oligosaccharides and other components..."

John explains these species combine a number of biological activities including
Immuniomodulatory ,
regulation of inflammation,
mineral transport and absorption,
and are prebiotic.

He says, "These species are there not only for the direct health of the infant but also to promote the growth of healthy commensals in the infants gut." Commensals are microflora.

While he reported on peptides and Phosphoproteins found with a spectrograph he made lovely statements that would warm every mother's heart, such as,

"Phosphoproteins also degrade into
Opioid agonist peptides which give the infant a sense of well being during digestion."

"Breast milk is highly dynamic. As the lactation period progresses there are a number of changes that occur.
Our first studies into milk post translational modifications related to glycosylation in milk and we found that during the first month of lactation there are dramatic changes both in the amounts and in the glycosylation amounts of Phosphoproteins ..."

Okay! Now, wake up, because you don't want to miss this next, particularly thought provoking side comment,

"During the first week when the baby’s gut is transforming from whatever first colonizes it, often times bacteria that are present in hospitals (when) the baby is born in the hospital, to commensals or bifidobacterium."

From my homebirth midwife perspective, the thought of rouge bacteria in a newly born human gut is quite distressing. The point is that the first bacteria to arrive begin to colonize and, it seems from John's comment, to influence the structure of the person's gut.
Are you thinking irritable bowel, diabetes, food intolerances? Could not only what we first feed a new person matter, but also where the baby is born matter in relation to the health of the gut? I guess I've known that superficially, but I didn't know it to this level!



The UC Davis team's analysis identified 38 milk proteins.

John noted that the breast milk composition as well as the proteins change over the first month. Though the California Dairy Research Foundation is one of the funders, its hard to imagine a commercial imitation of breastmilk approaching a dynamic design. Could these signals have something to do with reduction in breast cancer rates for breastfeeding women?

From his conclusion,
“Phosphorylation is a dynamic process and it could
describe cell to cell signaling both
in the gut and in the mammary gland.”

Though I didn't have anything to do with John's brilliance, it is fun to share his accomplishments!

Friday, June 19, 2009

Breech Birth Coalition is having a conference

Breech Conference registration for October 15-16, 2009 in Ottawa, Canada ...do whatever you can do to be here.
"Let's make some noise."
- Robin
www.breechbirth.ca

Denying vaginal breech birth is a human rights violation in that it forces a woman to consent to surgery in order to obtain medical care. The right to informed consent is meaningless where there is no right to informed refusal. - Henci Goer, author of "The Thinking Woman's Guide to a Better Birth" (Robin has Henci's quote on her email signature)

Lamaze on Canada's breech news

Amy Romano wrote a brief bit yesterday in her Lamaze Science and Sensibility blog about the history of Canada's change to support vaginal breech birth from the Term Breech Trial to this month's decision by the Society of Obstetricians and Gynecologists of Canada. http://www.scienceandsensibility.org/?p=239.
You can get a copy of the SOGC breech guidelines there. Learn more about Amy Romano

Henci Goer wrote When Research is Flawed:
Planned Vaginal Birth versus Elective Cesarean
for Breech Presentation

Learn more about Henci Goer

Henci's commentary is on what's called the Term Breech Trial: Hannah, M. E., Hannah, W. J., Hewson, S. A., Hodnett, E. D., Saigal, S., & Willan, A. R. (2000). Planned caesarean section versus planned vaginal birth for breech presentation at term: A randomised multicentre trial. Term breech trial collaborative group. Lancet, 356(9239), 1375-1383. [Abstract]

Thursday, June 18, 2009

The baby is born!

This beautiful family has just welcomed their baby girl. She was born alert and vigorous, (Apgars 9 and 9) welcomed by two smiling doctors, two wonderful, calm nurses and two doulas (me with the camera). The Dad was confident and this mother truly radiant, practical and about her work. Dr. Hartung welcomed this baby so gently, talking to her and handling her and her mama with such grace. Truly beautiful to witness. I hope that someday my hands could move so .... oh, listen, the lullaby chimes are playing over the hospital speaker system; a baby is born.

She's wide eyed and nursing in her mother's arms, skin to skin. She's been on her mother's chest since she was born, never separated to the warmer. She hasn't been weighed yet. Mama asked to delay the weighing until after the nursing. She doesn't want to interrupt her daughter's first journey to the breast. But the nurses and Dr. Hartung were guessing over 8 pounds. She came as a frank breech, after something like 18-hours of labor and one hour of pushing. Very smooth, so smooth. She is her parent's second child.

I just had to share this breech birth story since the Society of Obstetricians and Gynecologists of Canada just gave the recommendation of vaginal breech birth! If the parents give permission later, some discreet pictures will be added here.

Canada recommends vaginal breech birth

The Society of Obstetricians and Gynecology Canadian has switched to supporting vaginal breech birth. The next step for Canada is to train their doctors to catch babies who come butt or feet first. Read Carla Wintersgill's article

"C-section not best option for breech birth

The Society of Obstetricians and Gynecologists of Canada will launch program to teach physicians breech vaginal delivery"

at Globe Life/Health

This decision comes after research analysis refutes the "Term Breech Trial." Canada listens to the statistics.
America? You on? Well, parents will have to make American physicians pay attention.

What's even more fun than this wonderful news? That the guidelines were released the same day I get to be present at a hospital breech birth! As the photographer for this lovely family I got a moment to check my emails and read of the guidelines.
My midwife partner is the doula. When the parents found out their baby was breech, and remained so after three manual versions, they opted to change care providers - and states - to labor for a vaginal breech birth. At this moment, the mom is 8+ cm and is relaxing in the bath.

There are physicians here and there that have breech skills (actually, Dr. Dennis Hartung is right here!). Dr. Hartung is squatting on the floor listening through the crack in the bathroom door to the mother breathing through her labor. He is waiting for the catch in the breath that signals the urge to push. The lights are low...

Wednesday, May 13, 2009

Twins and Spinning Babies

For optimal fetal positioning with twins, use the same 3 Principles of Spinning Babies that you use for a single baby.

Manual cephalic version (when the doctor or midwife manipulates the baby into a head down position) is too risky for most twin breeches.

Bring your body into balance to allow the babies to wiggle into head down positions on their own. Most times this will be helpful when the mother works routinely on fetal positioning from the 2nd trimester, or early in the third trimester. Don't wait till a breech is known, the non-interventive techniques will not make a head down baby flip to breech. Keep the inversion short - 30 seconds is enough in the 2nd trimester no matter what the baby's position is.

When doing the forward leaning inversion for a KNOWN breech baby, increase inversion time from 30 seconds to 2 minutes and repeat the inversions up to 3 times a day. Keep it up until you feel your baby kicking in the top of your uterus, or your care provider determines that your baby is head down.

There are various reasons that a twin may become breech, including trying to fit the available room in the womb. Body balancing will increase available room by softening the broad ligament and reducing a twist that might be present in the lower uterine segment. Chiropractic adjustments can also help, especially when used with the Webster Maneuver. The forward-leaning inversion is a slower way towards the same goal.

Thursday, April 16, 2009

What should I do to help my breech baby turn?

Dear Gail,
I was wondering what yoga position is good to help turn a baby. I have tried laying on a board upside down and my lower back gets really soar. I went to the chiropractor today and she is going to see me [again]. I am wondering what else I can do to turn this baby....


My response,
I've answered this question pretty well on my Spinning Babies Website. Let me tell you how to find it!
Go to Baby Positions and a drop down menu appears. The second link in the drop down menu is "Breech, or Bottoms up." You'll get a lot of information from About Breech.


For twins, use the same 3 Principles of Spinning Babies that you use for a single baby, increase inversion time from 30 seconds to 2 minutes or up to 20 minutes. But I'd suggest 2-5 minutes and repeat the inversions up to 3 times a day until you feel your baby kicking in the top of your uterus.

I don't recommend any particular yoga positions, for instance, I don't believe that down dog is a key position. Look to positions that balance the pelvis, especially the pelvic floor. Balance, whether through yoga, body work or repeated body balancing exercises and techniques will help baby's flip head down.

Chance to promote midwifery

Senator Berglin's Birth Center Bill if passed, would provide the most amazing opportunity to promote midwifery that this nation has ever experienced.

While physicians can certainly establish and/or work at birth centers, the birth center is commonly associated with midwifery care. We have about 300 midwives of both CNM and CPM credentials. About 50 of these midwives attend now, or have attended, homebirths in Minnesota.

Should the bill pass, the appearance of many birth centers in our state would make many midwives needed here.
The first birth center, Morning Star Womens' Health and Birth Center, opens June of 2009 in St. Louis Park, MN. The new birth center is independent of the bill and opens coincidentally. Several midwives are needed now. Paula is looking for midwives with out-of-hospital birth experience.

Out-of-hospital birth experience will not be required at most of the birth centers that would arise with the passage of the bill. Midwives could come out of a school setting and begin working in a birth center. Midwives could also choose to leave hospital practice and work in a birth center.

There will be a wide variety of midwifery philosophy and so therefore, styles of care. Parents will choose birth centers, either because their insurance covers that birth center, or because they sought a center that matches their vision of birth. Expectant parents might also attend parent meetings, such as the Parent Topic Nights of the Childbirth Collective or Northland Birth Network, to hear other parents and doulas speak about their birth center experiences just as they do now to hear of both hospital and homebirth practices.

Competition among birth places

The new Birth Center Bill is gaining grumpy support. Grumpy, because though hospital birth practitioners support Senator Berglin's bill there is a lot of behind scenes gossip that having birth centers will take the patients from area hospitals. Hospitals are concerned about loss of income.

Even hospitals compete with each other as noted in this article:

Park Nicollet doctors won't work at new Maple Grove hospital

Its doctors won't see patients there

Park Nicollet announced Wednesday that its doctors will not care for patients at a competing hospital in Maple Grove when it opens this year.

A statement from the health system listed better care as a reason ...

Unmentioned in the statement was the financial incentive for Park Nicollet — which like many health systems is laying off staff and taking other steps to curb economic woes — to keep its patients in-house.


There will be a change in birth once birth centers are set up in every county of the state. Healthy women will be able to choose to give birth in a setting that emphasizes normal birth. What a relief to be cared for by midwives and physicians who see birth as a normal event, not as an emergency needing expensive management.

The first birth center to open will be right in the Methodist Hospital neighborhood - Paula Bernini Feigal is opening a new Morning Star Women's Health and Birthing Center on Excelsior Blvd in St. Louis Park walking distance from Methodist.

Paula may not get many referrals from Methodist medical staff at first, but once birth centers become the norm, it will seem reasonable and right to care for women who are ill, have risks, or who desire to be numbed for birth and refer healthy women who want a more active involvement in their birth to the birth centers.

Women who have to pay out of pocket for their births may choose the lower cost birth care at birth centers. Many women, women who wish to, but don't Have to, will find birth center birth supportive of early family adjustment, breastfeeding, and women centered birth. To compete, hospitals are likely to begin listening more to birthing women. Competition in a free market can promote improvement in services.

Monday, April 13, 2009

Reducing the Cesarean Rate


One of the ways to reduce the Cesarean rate is with the Pelvic Floor Release. The pelvic floor is a strong bowl of muscles that has a front-to-back opening for the baby to go through. A crooked or tight pelvic floor lengthens the birth, increases OP position and Asynclitism (tipped head).

See the new article on how to do the Pelvic Floor Release under Techniques, at the Spinning Babies Website.

The Twin Cities Chapter of the International Cesarean Awareness Network has a great site with a map of where VBACs are supported in Minnesota hospitals. I'm heading over to the Twin Cities ICAN meeting tonight at 6:30 pm for a meet the midwives night.

By the way, today, April 13 is the date on which I attended my first birth 30 years ago. 1979...

Saturday, March 7, 2009

KFAI Radio today

Support our birth activists on International Womens' Day!
KFAI, 90.3 Minneapolis

11 am Cesarean Voices (Twin Cities Chapter of ICAN)
11:30 Midwives and Doulas (with Akhmiri Sekhr-Ra and Gail Tully and friends)

Health System glitches, no insurance, no obstetrian...




Publication Logo

Institute Sees More Americans Losing Insurance


Click to read the entire article by Will Dunham

WASHINGTON (Reuters) Feb 24 - More Americans will lose their health insurance as the economy weakens, health care becomes more expensive and fewer employers offer coverage, the U.S. Institute of Medicine said in a report Tuesday...

An institute panel urged the White House and Congress to take urgent steps to ensure all Americans have coverage. The government says 45.7 million Americans, or 15 percent, had no public or private health insurance in 2007.

President Barack Obama Monday announced a summit on health care next week...

....Meanwhile in Minnesota, we are marching for better birth at lower cost. What will it take?

On the East Coast, hospitals are replacing Obstetricians with "Laborists."

These are doctors paid $125-150 an hour to come in and catch babies. The mother receives no continuity of care, other than her chart. The benefit, Obstetricians claim, is that the mother will have a safer, less sleep deprived person to help them, and that less mistakes will be made.

Funny how we find out the dangers of a maternity practice only when a replacement is on the scene. Obstetricianists will claim that home birth, or even midwifery, isn't safe and then this comes out that they are saying that they themselves aren't safe... Oh brother.

Another reason for a doula, bring someone with you whose slept the night before!

Friday, March 6, 2009

Susan's legislative update

Susan Lane for the MN Better Birth Coalition:
"We have four bills, one almost done, one introduced but not heard and two in preparation.
The one that passed the Senate today (SF 401) gives women in Minnesota hospitals the right to continuous doula from a certified doula of her choice; it's expected to pass the House on Monday. [Susan Lane led the way on this bill with our legislator heros.]
[Senator Berglin's bill] has been introduced but not heard in committee [and] would establish free standing birth centers (SF 0780).
The two that are being written for introduction this year include one that protects women seeking a vaginal birth after cesarean, and one that would require insurers to pay for evidence-based applications that are currently not consistently covered, such as doula care, home birth, and childbirth education.

All legislation is based on the findings of the Milbank report, and the MN Better Birth Coalition exists to pursue the recommendations in that report.

Overall, the report reveals that as costs for childbirth have risen, the outcomes for both mothers and babies have declined. The very good news in this report is that the way to reverse that trend, to have better outcomes for mothers and babies, is to apply less costly, low tech methods, to have greater transparency and better informed mothers. We can save money and have healthier women and babies.
For details of this report, see www.childbirthconnection.org and enter Milbank Report in the search.

Thursday, February 26, 2009

Thank you, Salma Hayek

When I was nursing my youngest, now 19, three of us breastfeeding mothers would trade off with our babies and toddlers for two hours of free time each week. Occasionally during that short time, if one of my friend's babies was hungry I'd nurse them. They would do the same for my baby. Breastfeeding is a normal way to nurture a crying baby.

That's a drop in the ocean of compassion that Salma Hayek showed a hungry baby on her tour of Sierra Leone. She grew up hearing the story that her Great Grandmother had nursed a starving baby in Mexico. What would be more natural?

And Salma, its not addiction, its oxytocin. Continuing to breastfeed past the first year of life is not comparable to alcholism...though she may have made that comparison in jest. Why, its simply motherhood.

I'm voting Salma for the most beautiful mother in the motion picture world.

One more Pulsatilla try


Well, After 38 hours of labor, our 5th posterior baby within two weeks, was born OP.

Starting at home was useful. Progress began to improve following ten abdominal lifts done while maintaining a pelvic tuck (flattening the lower back). Still, labor was so gradual and back pain returned. When homeopathics, herbs, water tub, and even intradermal water injections don't work as anticipated, a woman just might decide to go where the narcotics are.

This mama did decide to transport to the hospital for an epidural, and subsequent Pitocin. These interventions are seen, in our homebirth culture, as meddlesome when used routinely but can be useful tools. After a couple nights of closely spaced contractions, persistent back pain and no sleep, narcotics may move over from the no list to the gotta-have-that list.

Arriving in the hospital at 6 cm, the baby was already low in the pelvis. The chin was nicely tucked. I said posterior, but I'm not sure I can say "persistent posterior." The forehead came posterior, the face began to turn as soon as emerging, the chin started to come anterior and once the head was out the baby faced the mother's right thigh. Then, as the shoulders began to come the baby suddenly turned her face directly OP again. Should we coin a phrase, "mobile posterior?"
I have a video of a nice big boy making these very same rotational moves. His story is at Spinning Babies, The Long Labor That Wasn't. Only this labor was long. Contractions were 3-4 minutes within three hours of the water breaking (first sign of labor) and were not often much further apart so rest was hard to come by.

The Pulsatilla had no noticible effect. Either that or my observational skills are lacking. The baby was already deep in the pelvis, most likely in an OP position. I think the Pulsatilla didn't make a dramatic effect, as it certainly did with the preceding four, perhaps because the head was so low when it was given. Pusatilla's softening effect of the lower uterine segment may have allowed the baby to descend in this position, but the Pitocin would also help descent.

Posterior babies who stay posterior through to "time of delivery" have a bit less than 50% chance at a vaginal birth, by literature reports (Lieberman and others). I think our homebirth families have a better statistic than that due to freedom of movement, eating in labor and, so often, excellent partner support. Her partner's willingness to go on with a positive attitude is tremendously vital.
We so appreciate the nurses and doctor willing to abide with this family who needed their help but was also determined to maintain many of their values and choices within the institutional setting. As for the Pulsatilla, 4 out of 5 isn't bad, and those first 4 were particularly dramatic.

What a gift to see this little girl nursing vigorously with her mama and her mama and papa's tears of joy.

Wednesday, February 25, 2009

Posterior labors at home


Among the three Trillium midwives, Clare Welter, Emme Corbeil and myself, we had 4 posterior babies at the beginning of the labors last week. Yes, in one week.
Each of these women took a deep dose of Pulsatilla. I'm not saying which dose, because I'm not prescribing here, I'm describing.

Three of the women took Pulsatilla before labor began, and each began labor soon after, within days. Each dilated fast and each baby emerged OA. Was the quick start after the remedy a coincidence? Was it because of the snow storm? One woman, who was having a planned hospital birth with Emme as support person, took a dose when labor wasn't picking up after a full day. Her labor then took off and she had the baby quickly.

Now we have another mom in a slow labor. Hard to tell if baby was OA or OP in this particular mom. After a day of SROM, and a few other OP symptoms, we tried the remedy.
I'll let you know.

Meanwhile, enjoy Jessie's Girls, a blog with Theia's birth story and how Jessie helped her OP baby rotate in a deep tub of water.

Monday, February 23, 2009

Why Gaskins Maneuver isn't used in hospitals

Ina May Gaskin popularized a solution for stuck shoulders which she learned from traditional midwives. When a baby's head is born but her shoulders are stuck inside, the mother is helped to flip over onto her hands and knees (if she is not already there). The act of the mother's rotation often frees the shoulders. Ina May keeps a registry of hands and knees attempts, and both UnderstandingBirthBetter.com and the MANA statistic data bases keep track of shoulder dystocia outcomes. Ina May has found this a very favorable technique.

Indeed, The Gaskin Maneuver is the first of 4 techniques listed in FlipFLOP, a memory aid for shoulder dystocia resolution, which I created.

Alison Bastien writes her frustration at finding out that physicians are often not using the Gaskin Maneuver - even though many acknowledge the usefulness of this technique! Read about the conversations she had one day at a medical seminar discovering the real reason why the Gaskin Maneuver is an underused lifesaver.

Saturday, February 7, 2009

Minnesota Birth is Live

Gail's new website, MinnesotaBirth.com is live and growing. A referral source for birth and pregnancy related services and products in Minnesota. Word of mouth referral is key here.
Not meant to be a corporate site, this is a friendly, grass roots info site for birthing in Minnesota.
Its just developing, so be patient. Send your ideas to gail@spinningbabies.com or post here.

Birth Centers in Minnesota

Read the health care article in the Minneapolis Tribune,
called DFLers vow to fight for health care aid.

Senator Linda Berglin, D, has shared her Birth Center bill wording with Minnesota Better Birth Coalition lead, Susan Lane. Susan then showed us Trillium midwives who have been attending the coalition meetings. Susan in fact, had showed Senator Berglin the Milbank report with the cost saving power of birth centers.
Senator Berglin had a bill written up in record time.
Go, Linda! Go, Susan!

There is not much opposition expected for this bill. All players are included in some way in the bill. The crashing economy is forcing some major money saving efforts and this one would save the state thousands of dollars quickly. 37% of MN births are paid for by state aid. A birth center birth costs approximately $5,ooo dollars compared to 8-15,ooo for a simple hospital birth, with no complications. Birth centers have excellent birth outcomes for low risk women and VBAC women (who are statistically rather low risk after 2 previous cesareans).

Inversion after baby flips?


Several women have emailed in asking what they should do after their breech babies flipped to head down. At this time, I recommend continuing to do a short, 30-second inversion on most days. Here is Chiropractor and Craniosacral Therapist, Carol Phillips helping a mother do an inversion and an inset to show the uterus hanging from the cervical ligaments. See more at Spinning Babies.

I believe the same soft tissue causes of breech are the soft tissue causes of posterior (excluding septums, anterior placentas, bony pelvis).
The breech baby, who flips head down late in pregnancy, after 33 weeks, let's say, in the 34-40+ weeks, and flips after the mother has had body work, done inversions, or some action to flip her baby,
is likely to settle in a posterior position.
So if the baby has his or her back on the mother's right, and or hands in front wiggling near the bladder (not a thump of the head, but a wiggle of the hands), then the recommendation is to continue the soft body work, including inversions. See inversions on the Spinning Babies website. Look under Techniques and scroll down to find Inversion.

Monday, February 2, 2009

British "Green Guru" says Abortion is green...

Responsible parenting, responsible child bearing, yes. But the the timing of taking responsibility is of crucial importance. What is our response-ability to our reproduction? Proactive or reactive? Health promotion or scramble to return to the male-model of normalcy (which, in this case, is not to be carrying an embryo).

Where is the discussion about holistic approaches to conception and preventing conception?

British parliment leader Jonathan Porritt blames parents of more than two children as irresponsible. He says aborting millions a year (and generally then burning with the trash) will prevent green house gases. This is a bit of a stretch.

To twist a phrase of Popeye's,

Violence is wrong even when it helps ya.

Lets come up with a solution that works, starting with empowering young women around the issue of sexual vulnerability and women in their late teens and 20s in how to determine who really is a good mate for them before conception changes how likely a father that a sexual partner is perceived.

Additionally, we could green -up birth quite a bit with washable, reusable absorbant pads, less garbage due to fewer interventions, and home births.

Friday, January 30, 2009

Are Certified Professional Midwives properly trained?

The statistics for Certified Professional Midwives, CPMs, are excellent in comparison to Certified Nurse Midwives, CNMs, who also have superior statistics. And all midwives have excellent statistics compared to physicians when each profession helps low risk women.

Direct entry midwives prepare for a test by either apprenticeship or by a nationally recognized college. Before qualifying for the CPM test, aspiring midwives attend births learning hands on skills and then, when they have attained the necessary skills, give continuous care to ten families through pregnancy, labor, birth and the full postpartum period.

The outcomes of CPMs are so impressive that Canada has revamped its maternity services to include CPMs not only for increasing the numbers of homebirths but also giving CPMs hospital privileges. Britain has increased midwife births also following the British Medical Journal's CPM2000 report. The American Medical Association may have missed the news. They have a paper which purposely attacks midwifery as a celebrity fad. Medical advocates, in our country, on the other hand, address the growing interest in CPMs by suggesting CPMs be brought into the current system with university training, licensing, and oversite by nurses or physicians.

If CPMs are already achieving excellence with the inexpensive training they currently receive, why increase their training? Why fix what is not broken?

Rather, our maternity system overall seems to be broken. Induction rates, cesarean rates and prematurity rates are increasing, and relatedly. Nurse Midwife practices are too often closed by hospital administrators urging high volume, low touch prenatal care. Physicians hands are tied by the profit margin.

So, why bring in the midwives who are already giving the best of care into a system that isn't working for the health professions that are held in it? Let them break free.

Let our nurses and doctors discover the joy of walking beside a woman who is making life style choices that will improve her and her baby's health in pregnancy, birth and for weeks afterwards, even years, as she is more likely to have prolonged breastfeeding. We aren't getting better birth outcomes in the insurance driven system. We get better health when health providers are autonomous.



Canada

Monday, January 26, 2009

The ethics of intuition

Clare and I were talking today at Kat Man Do on Grand in St. Paul (eat there, its spicy and delicious!).
When a mother calls me to help with her birth, I occasionally get a premonition of how it will go. Not in detail, but enough. It might be a split second view or a strong feeling as if it were the moment after birth. My sister says its the Holy Spirit. My paternal Grandmother, I heard, was like this, too.

The point isn't that it happens, but rather, what is the purpose of it, what should I do?
What should I do when I get the feeling that the mother won't be having a home birth? Or won't have an easy birth, or maybe will have a cesarean. What do I do at a home visit when I walk through the house and "can't see" the birth there? Twice this absence of "seeing" or "feeling" the birth in the home was preceded by cesareans, and several times, by transfers. I hadn't been tracking it because I felt a sense that I should be more positive.
Is it important to only say yes when I "feel" the tinkle of fairy dust?
Shortly into that initial conversation I start connecting to the mother's dream and her heart and want to walk that walk beside her, very often. So does it matter where the birth is at?

Clare says its not about where the birth ends up, but its about walking with the mother.
What is the ethics of saying, I'm not sure that your birth will end up as you see it, but I'm willing to walk that walk with you... I couldn't see myself telling a sincere woman, well, you're not having a homebirth so are you sure you want to work with me and pay for a homebirth midwife?
Wouldn't she think I was nuts? Am I sure I really know each time? Isn't there a reason for Hope?

Wednesday, January 21, 2009

March 9th March

Better Birth. Lower Cost.
Join the Minnesota Better Birth Coalition Facebook group.

We'll be marching to our state Capitol by noon on Monday, March 9th, 2009 with signs and strollers and slings. Several birth, postpartum, and early parenting groups are united for bringing about cost saving legislation that will improve birth outcomes for mothers and babies.
We propose to do this by increasing access to evidence-based (study proven) avenues such as continuous doula care and homebirth midwifery. Increasing access means that when parents pay for insurance that they are actaully able to get their costs covered by their insurance. It also means that since a third of all Minnesota births are paid for by state funds (taxes) that, if elegible parents want a homebirth, they can have their homebirth paid for just as they would have their hospital birth paid for. Discrimination between providers must end. The quality of our births and lives depend on equal access to appropriate birth care.

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.