Wednesday, June 30, 2010

Frank breech home birth

I've just been given permission to post this lovely breech home birth video.

This is a third baby, her second natural (vaginal) birth and first home birth for this family. The baby was small and full term. Apgar Scores were 10 and 10. You also see the first 30 seconds after the birth.
The t-shirt was worn to make Robin Guy and the women of Coalition for Breech Birth smile --they made these t-shirts for the CBB conference in 2009. It says, "Whose afraid of a little bum?" and on the back, "Not me." I almost didn't wear it because of magical thinking, but choose faith instead of fear, community instead of isolation. Thanks, CBB community!
Thanks especially much to the brilliant Jane Evans, UK Midwife and the full-hearted Drs. Anke Rietter and Frank Louwen of Germany for their Day at the Breech training in Ottawa which improved the way I attend breech births. I'm no expert, but simply responded to this woman's clear determination.

She had a cesarean for breech with her first, and had a homebirth for breech with her second.

If she'd have been able to have a hospital breech birth she wouldn't have gone looking for a homebirth midwife. That being said, I do believe we gave her excellent care. This birth is probably safer than what would have happened in a typical US hospital right now. Being hands-off allowed her baby to do the cardinal movements.
Now, honestly, I'm a bit appalled to see that I started to reach to intervene for the birth of the head. (I was thinking the cord on the shoulder was taunt and restraining the baby). I can't remember touching the mother then at all! --and in speaking to the mother (we spoke just now on the day I posted this nad I'm editing accordingly) she does not remember me touching her either. I had thought about it though before looking again and suddenly she was out.
This little girl gained half-a-pound in her first week of life and two full pounds at exactly one month old. She was never separated from her mother, got skin-to-skin contact much of the week, and nursed(s) on demand and not on schedule. Her mother is still blissed out and agreed to let me use this video for education. Please do not try to download it or copy it.

You may be interested to know that there was also a surprise breech birth in June and that momma did have to leave her home to get a safe cesarean because the baby was not able to conduct the breech cardinal movements to get through the pelvis. There was much time to discover that and plenty of time to discuss it and drive to the hospital. We were welcomed and the family was cared for so kindly and well. There is no place for ideology in birthing. Each birth has its own story and we must respond to what the baby tells us.

The family, other midwives and I hope for safer breech births. There is quite a difference in the safety of spontaneous breech birth and what is really a breech extraction. The breech extraction involves pulling the baby through the pelvis and pelvic floor without the fetal reflexes involved to make the breech cardinal movements. Bruising, nerve strain and brain swelling may result.

The mother's hands and knees position lets the baby make a safe rotation through her pelvic floor. Gravity pulls the baby to the sacrum anterior position by the end of the birth when it is important for safety. Never pull on a baby.

Sunday, June 20, 2010

Breech sifting

Ok, I haven't been blogging for a while. Two breech labors lately. Were still waiting for footage from the first to be edited and in the second family the poor little breech guy couldn't line up on the pelvis so thankfully the warm folks at Hudson, WI welcomed the family in for care and ultimately a cesarean. Two other babies were born with compound presentations. Those two probably would have had a cesarean if birthing in a busy hospital. Not for sure, because with the right mix of people women do still have long labors in the hospital. These weren't THAT long.

Sarah Shannon of our local ICAN (International Cesarean Awareness Network) chapter sent me a link to make my day! This is an excerpt:

Traditions In Prenatal Care

Liz Jones

...In the U.S., about one in every three births are Cesarean. The procedure is more expensive and can be riskier than a so–called natural delivery. But often, a Cesarean is necessary because the baby is breech, meaning it's not head down. Many mothers will try anything to get that baby in the right position. So will the staff at a clinic near Tacoma, where they've hit on an alternative method that's delivering remarkable results. KUOW's Liz Jones has our story.

We stop at Timothy Panzer's office. He's a family doctor here. He works with [Kara] McEvoy and the other nurses to provide pre natal care to expectant moms. He says with a breech baby, the stand

ard medical approach is to try something called a cephalic version.

Dr. Panzer: "Which is manually, in the hospital, at the labor and delivery floor, manually trying to turn the baby with the doctor's hands on the outside of the woman's belly."

...That versioning process also comes with some medical risks and a hefty bill. If it doesn't work, a Cesarean, or C–Section, is typically scheduled.

And if a woman gets a Cesarean once, chances are she'll need one for subsequent births.

Panzer: "So especially in the case of a first mom, a first delivery, if you can get that breech baby to turn, you've done a lot to help that mom."

When some of the nurses heard about a gentler way to try to turn the baby, called sifting, McEvoy says they were eager to give it a shot....

The exercise is designed to loosen the woman's body and re–position the baby.

Alma Pisano is the woman who introduced sifting here. She's part of the clinic's labor support staff [doula]. She explains it's a Latin American tradition that's still practiced in many cultures.

.... Alma says it's best to do the sifting a few times a day, along with other exercises to help the baby rotate.

Alma says out of her last nine breech patients, seven have turned. Granted, there's no scientific study on the effectiveness of sifting. But still, Alma's success rate so far is pretty good. Especially compared to the more painful versioning technique, which works about half the time on average.


Now, McEvoy is a sifting convert. Although she's only sent a few breech patients to Alma, she says they've all come back with good news.

McEvoy: "Flipped! Head down! Cancel the C–Section!"

Thank you, Liz Jones from KUOW News.

The photo here is of Gail "sifting" the breech baby of a Baby Expo participant this Spring, and of three students during a Spinning Babies Workshop.

Thursday, June 3, 2010

Natural Birth is economically necessary

Natural birth practices are less expensive as well as better for healthy women and their healthy babies. Even high risk mothers have better health outcomes when lower tech methods and locations are generally used (Margaret Tew). The key is knowing how to combine healthy holistic practices with the rare need for medical technology and intervention.

With less federal and state money available, hospitals are looking for ways to boost popularity with lower cost. Natural birth has been sought after by parents wanting both hospital birth and mother-centered or baby-centered care.

Spinning Babies has lots to offer. Spinning Babies has lots of tips to avoid cesareans due to long labors, posterior and other challenging fetal positions, or the routine hospital practice of reclining in bed during labor (the mom not the doctor).

Tuesday, June 1, 2010

BIrth in MN newspaper!

The Star and Tribune has run three articles lately all favorable to midwifery and childbirth. You wouldn't think anyone would be opposed to childbirth, would you? Anyway,
these articles were glowing. Thank you to reporters Chen May Yee and Josephine Marcotty!

Where C-sections are few highlights the work of midwives and physicians at St. Joseph's hospital with a walk down memory lane with St. Joe's first midwife Deb Monson. Chen May Yee also highlighted a mother's whose baby was posterior and the midwife, Melissa Hasler, helped her into a hands and knees position which allowed this baby to rotate quickly and be born vaginally. A long time ago, I was at a posterior birth with Deb Monson in which the mom was working hard but staying at 7 cm for 3 hours. Deb's simple trick of 3 pushes against her fingers as they created a false pelvic floor quickly turned the baby and let the labor proceed. Doctors at St. Joe's (Idon't know if the Midwives do this) will also occasionally reach in and manually rotate the posterior baby's head to anterior so the birth can finish vaginally. Not all posterior births need any of these interventions, but some do and I believe these skills are a big part of why St. Joe's has a low rate of cesarean section. Plus, the community midwives and doulas have long referred to St. Joe's for their quiet, kind nurses, and mother-centered birthing practices. Its not a birth center, there's still hospital politics happening. The nurses should be paid well and not given multiple patients. That's true for all hospital nurses everywhere.

I've written about Josephine Marcotty's articles earlier. Birthing a new option is online.

Let's keep the good news coming!

And hopefully these gals will come on down to St. Francis hospital in Shakopee Saturday June 5th to see me present Belly Mapping at 12:30 at the Baby Fair in Shakopee High School.

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.