Sunday, October 24, 2010

Fetal position and Thyroid

Check out this post at Perfect Health Diet on Thyroid health and breech rates. We have also heard that low thyroid is associated with posterior babies.
Optimal TSH levels are not what the current tests indicate. This is obvious to anyone struggling with thyroid symptoms who is told their levels are normal. Read the fine print about the test...

But it may be worth the test anyway...
and don't forget Vitamin D levels.
For women without insurance... dietary enhancement can be inexpensive.

And you and your baby are worth it.

Any way, I'd started asking women to eat seaweed in pregnancy. What's your favorite way to enhance thyroid function in pregnancy?

  1. Perfect Health Diet » Thyroid

    Now, a Dutch study shows that the likelihood of breech birth rises monotonically with the mother’s TSH levels at gestational week 36. ...The Dutch study found that:

  • Pregnant women with a TSH of 0.5 or less had NO breech births at all, and those between 0.51 and 0.71 had only a 1% chance of a breech birth.
  • Pregnant women with a TSH between 0.71 and 2.49 had about a 5% chance of breech birth.
  • Pregnant women with TSH of 2.50 to 2.89 had an 11% chance of breech birth, while those with TSH above 2.89 had a 14% chance of breech birth.

  1. Perinatal Outcome of Children Born to Mothers with Thyroid ...

    by T Mannisto - 2009
    Thyroid autoantibodies are also associated with an increased rate of LGA infants. ... thyroxin during early gestation: a risk factor of breech presentation? ...
  2. Werner & Ingbar's the thyroid: a fundamental and clinical text

    Sidney C. Werner, Sidney H. Ingbar, Lewis E. Braverman - 2005
    Patients with idiopathic hypopituitarism may have a history of breech delivery or birth by vacuum extraction. The rate of progression and the degree of ...
  3. High TSH levels increased risk for breech delivery

    Jul 23, 2010 ... Women with thyroid stimulating hormone levels greater than 2.5 mIU/L during the end of pregnancy appear to be at increased risk for breech ...

A doula once again...

Sometimes I ponder if a birth I attend will be my last one. I don't know, I've always been on the verge of some ending or another. This summer God gave me another chance and so did a mother from Wisconsin. Well, actually, I asked her if I could be her doula! Can you believe it?

I've mentioned her before on this blog. She's the woman who felt in her heart that having a routine cesarean for a breech baby didn't make sense. She found a great doctor by the time I returned her call. (She was fast!) and I said, "with your birth plans, even with such a supportive doctor, in this culture, I really suggest having a doula... And if you don't have one in mind, I'd love to be your doula."

Kinda bold, huh? But she called me back after talking with her husband and they decided yes. I met them at their doctor's office and afterwards, decided that they'd call me in labor. Halfway through Karen Strange's Midwifery Management of Neonatal Resuscitation I got the call. I hope to pick up the second half of Karen's great class again. I've attended it before, too, its phenomenal... but then, it does support what we do.

So during this lovely birth in which I got to love and adore this really cool, self-assured first time mother, I asked the doctor, "Would you be comfortable not cutting the cord until either it stops pulsing or the baby transitions? And if baby needs faster care, could we milk the cord blood back into the baby before cutting the cord?" I was really hopeful since this first baby was coming bottom first rather than head first and sometimes breeches start a bit slowly. He didn't hesitate, but said, sure, we can try that.

Dr. George Morley would be so pleased.

Surprisingly, the cord snapped right after the baby came out. Just snapped! I'd never seen that but called out to the doctor, holding the baby, who had just turned to pick up the bulb syringe. You should have seen him spin around and grab that cord in mid air. There was no blood spilled it was so fast.

I really didn't have what would be noticed as an active role in the labor. Cooing and smiling doesn't seem to be doing much. Some call it holding the space.

The parents were calm and perhaps I reinforced their own confidence by being calm also.

If you don't know the role of the doula, you should look up some things at because I'm understating here.

I opened a treasure tonight. Its a card from this family with pictures of this fine boy! He's over 12 pounds at six-weeks old - he was 9.9 at birth - (!) The milk in Wisconsin is good, and not just from the cows!

He is so cute! Clear eyes and trusting gaze. His mom said, if you don't mind, "You were like an angel sent from God Himself."

Many a doula has heard this praise, so please don't think I'm special. Though, it did seem this connection was put together so easily and quickly as if Divine cords were drawn together.

It gets me thinking of how important the doula role is. A midwife isn't a doula, neither is the dad. A good nurse isn't a doula and neither is the grandmother. The unique thing about a doula is that she is a woman who is the mother's peer, but not her relative; she is knowledgeable about birth, but she is not responsible for decision making.

She may advocate for things, as I did when I asked for delayed cord cutting. And I did that out of range of hearing of the parents in case the doctor had a reason to say no, I wouldn't be worrying the parents about a possible diversion in perspectives. We all work so harmoniously to welcome this woman into motherhood.

The reality of it all is, I get to look good simply because the mother sees her own beauty and strength reflected in my eyes.

That is the role of a doula.

Monday, October 18, 2010

Breech updates

The Midwives Alliance conference offered two wonderful presentations on breech. First, Midwife Abby Kinne of Ohio (right, helping a student) taught a day long class emphasizing no-touch but helping midwives get hands-on skills with a wonderful womb-anikin from Australia called Sophie and her Mum.

Thanks to Candace Robinson for the pictures.

I couldn't sit back! I so wanted to "feel" the models.
This picture could have the caption, "Each one teach one."
Which is
not to say, "caught one; taught one."

My turn. Hands-off, remember, unless... there's a compelling reason to go get your child.
For instance, in a class room where resolving the shoulder dystocia of a breech baby is being taught!

I nearly cried when I saw Jan's expression
- on my face!-

I miss her so and
am deeply grateful that she yet comes to visit me during breech births,
even with a manikin.

No, you can't get the anterior arm like this. Rotate and get the posterior arm.
You know this from Lovset. 180 then 90 degrees... unless 90 will do it without rotating the baby's chin to the symphysis.

Now I can get the posterior arm. (of course, if the mother were on her hands and knees, this would be easier on the baby. But this is if the mother has been knocked on conscious and there's no one to hold her on her hands and knees, I guess! )

Find the "nape" of the neck...

Lift the legs to bring the face slowly out...

And here's the baby!

I'm laughing in amazement and surprise at how heavy "Sophie" is. She's 7 and an half pounds and comes out feeling much like a newborn.
Don't worry, we won't cut her cord and she'll pink up very soon!

(I'd love to get a "Sophie and her Mum" --as soon as I can raise several thousand dollars!! I'd love to present the shoulder dystocia training with this set up. We can rig her for hands and knees birth...

It will require a grant from somewhere...)

Next, Betty-Anne Daviss of Understanding Birth Better taught us what recent studies were out, and the news from Frankfort and Tel-Aviv and Ottawa on breech. One of the recent articles on breech is hers and Ken Johnson's!
Rixa Freeze does a wonderful job discussing the breech articles at her blog Stand and Deliver.
There was much more fun and education at the conference. More later!

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.