Wednesday, December 18, 2013

Course of fetal position changes

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

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

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

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

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


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

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

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

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



Friday, December 13, 2013

Arm first- what is baby's position?

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

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


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

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

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


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

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

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

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

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

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

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

Sunday, November 24, 2013

Cesarean rate

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

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

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


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

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

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

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

http://offbeatfamilies.com/2012/05/surprise-twin-roadside-vbac 

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

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

Saturday, October 12, 2013

Orgasmic Italy with Debra Pascali-Bonaro

Agerola is in another world and time far above the tourist speckled Almalfi Coast.
 








How many of us have ever wanted to be in a time machine to a simpler, kinder kind of life? Exploring Agerola, Italy within the magic of a womens’ retreat offers the kind of time travel any woman would love.


What would your requirements be?  A clean and comfortable bed and a shower, right? Good Italian wine, of course. Homemade, award winning, and abundantly fresh Italian food? Time itself? Time to relax in authenticity?


Would you like, truly? Good conversation in a circle of women with like interests and diverse life experiences? Women who, like you, are also stepping through a gateway to a new phase of life?



Why travel as a tourist? 

This present-time, time-travel gives an intimate exposure to another culture, hand made cheeses made by family cows whose straw was cut by hand and carried in on the back of a donkey? 


   
 

















Enter the last wood-fire bakery in the area.



Learn Gnocci making from Nonna herself! 




















 Feel the love of a large Italian family and the timelessness of a 2-hour lunch under the filtering leaves on the veranda.

Walk through lemon groves into Roman ruins (the age of the ruins is the only reminder you are in 2014) and a temperate forest wonderland that makes you look for the National Geographic photographer. 







  Enjoy crafts passed down through generations and created in front of your eyes? Imagine looking over the exotic slopes to the Mediterranean below. Don’t you love the smell of the sea here? Let’s go swimming in the over-hanging grotto. Float in blue hues that will continue to live in your memory years after you’ve returned…





Yes, I’m just back from such a trip with Debra Pascali-Bonaro. 

We quickly renamed our Almalfi Coast Womens’Retreat with the new name, “Orgasmic Italy,” to recognize Debra’s work raising awareness of the pleasure of birthing. 



Personally, I was quite intimidated before I came. Could I leave a stress-filled life for a week of climatic present-awareness?? Pleasure? That felt really vulnerable. What would be expected of me?


Debra’s activities are all of the highest character. The orgasmic aspects are all about the pleasure of good company, healthy food and exploring the local culture. Whew. No junior high double dares. Just open and honest conversation. We could say what we wanted and get full support. No judgement, no agenda. Just welcome and trust. 

I felt it had to do with the natural good intention of our group and the high oxytocin connected with pleasurable travel. But most of all, the graciousness of our hosts, Debra and our new Italian friends.






In fact, we all noted how comfortable we were as a woman among women. I thought we’d be a group of birthies since Debra is so well known in the birth world, but no, most of the women were not birth workers. The diversity added a breadth to our circle that I found so enriching for its own design.  



Debra’s guided activities gently led us into the authenticity we all crave in new friendships. 

Here, we safely explored the best in ourselves and one another on whatever we wanted to share. 

Each group of women will weave their own tapestry of topics and moods. 

Debra’s joy and true pleasure in each of our persons quickly establishes a warm interplay between us. 

The warmth of being together merged our circle with the Italian sun overhead. Exotic surroundings, the feeling of adventure, exploration and delight. We were that week the best we could be and integrated a peace, a thrill for life, the highest enjoyment of culture and travel and friendship. 

Read more about Agerola and grow your dream of traveling with Debra at debrapascalibonaro.com blog.


 




 






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.