Saturday, December 20, 2014

The 5 Steps to Birth Happiness

We all get emails promising the 5 steps to financial wellbeing or life's little happiness habits.
Let's try finding 5 steps to birth happiness and see how we do.

The house is quiet; the rhythm of your baby's sucking lulls you into a reflective mood.  (Finally, after 8 weeks you can feed your first baby without focusing on every detail of the feeding.)  With your baby in your arms, your thoughts return to the birth...

1. Choose Experience Over Technology or Degree.
You've given birth with the most prestigious doctor or hospital in your area. Or, you've chosen the most popular midwife.
   How was your experience as a birthing woman?
I'm not talking about the "Consumer Experience" of having chosen the "Right Brand" of doctor or midwife or unassisted birth philosophy.
   Was your transformation into motherhood celebrated and supported well?
   Were you heard and your questions and desires taken into account?
   Were you able to focus on internal or external sources of strength?
   Was there a comforting voice and, if wanted, a guiding touch of someone who respected you?
   Do the people you are seeking support from hold you in high regard?

Tip: 9 months and 8 weeks ago, when you first met with a provider for your pregnancy and birth care, there were some instincts to heed. Make your choices on what will make you satisfied when you look back at your birth:
   Whether you used their services for gynecology or not, feel your body's reaction when you ask them,
   How do you support women with my birth plan, women who want _____?
   How do you support my first moments with my child?
   How does your birth team (nurses, partners, apprentices, etc.) fit in with decision making when you aren't there? Have they experienced births with women who have my desires or situations?
   Would you give birth yourself this way? What would you feel is the best way to give birth?
   Do you allow my baby to have their blood back after birth or do you clamp the cord in less than two minutes?
 
There are more questions than these, of course. Make up your own questions according to your values. Be realistic. Don't assume that all nice birth providers share your values. You can share a smile and even a laugh without them knowing how to support your birth choices. They can have the best credentials and know a lot, but if they aren't interested in knowing you, you might not have a particularly personal experience. You can choose someone with a good credential, but pick a good person with a good credential. :D

Which brings us to #2.
2.) The second step to birth happiness is to match your expectations with reality.
You left your first, second, third, or ninth prenatal with a confidence and glow. You really felt supported and heard. How did this feeling play out in your birth experience?

Sure, there are going to be some challenges in birth. Birth is a demanding physical activity.

I just went on a Boonie Stomp in Guam with a group of island hiking enthusiasts. I only had thin canvas shoes, $17.00 at K-mart on the island.
   Fortunately, the thin shoes were perfect because they let my feet mold to the rocks and had a good tread for our path.
   Unfortunately, they didn't have levitation powers to keep my left foot from going right through the false floor of dried palm leaves down a break in the heavily foliaged cliffside above the waterfall.  
   Fortunately, I happened to be holding a young and sturdy tree trunk at the moment.
   Unfortunately, the walk my son's neighbor's remembered as easy wasn't so easy as we climbed down rocky (not quite slippery) and steep hillsides (not quite cliffsides).
   Fortunately, the noble young men on the tour held my hand for dangerous crossings (Should I say embarrassing? Oh, no, I graciously accepted their nobility they offered the elder and, ahem, most inexperienced in the group! Stepping off the cliff wouldn't be a point against competency, would it??)

Cooling off in the falls was delicious.  The sights and sounds of rainforest all around us with only our shoe prints to reveal the date from any date in history.

And though the hike back up the rocky slope (with ropes) and then further up through the high, grass covered hills was gorgeous but hotter than the ocean breeze would make it seem. The nausea of tropical heat almost ruined the memory of the walk. I peed behind a knoll, drank more water, and rested in the speckled shade under a single tree. What more could I do but walk? So I turned my face to the breeze and felt the joy. I choose to ignore a small physical discomfort I could do no more about. I felt instead, the satisfaction of having the hike completed well, even though I wasn't done walking yet. I felt the state of mind I desired and let it come on early. Suddenly the rest of the walk was easier.

-- Point? There will be unexpected happenings when your body interacts with nature and when your nature interacts with other people.
   Fortunately, a bit of graciousness and communication can bring many diversions back on track for a positive memory. A bit of acceptance for the heat and humor for the hole in the trail keeps the beauty of the island and the joy of fulfilling a task by physical exertion. The dream of seeing a waterfall didn't fade under the realities of the hike to get there because I kept fluid and open to the immediate situations and didn't judge them or try to exert my ego about whether my dignity or even my life was endanger.
   I was grateful for serendipity (or divine protection!) as I was for the first offer of unsolicited help that I have received for being an elder in the eyes of a young man. By staying in a gentle state of bliss even while facing the realities of the climb, the memory emerges as a positive experience treasured far into the future.

Which brings us to Birth Happiness #3.

3.) The third step to happiness in birth is to bring a nurturing, third party person with you when you talk to your midwife/doctor about your birth ideas/plan/choices. This is useful because nurturing hormones are already in action in the pregnant body. A pregnant woman can easily skip her own needs to keep her provider comfortable (read: and not having to face change or her personal request). In such a protective natural state, a woman sometimes (not all lionesses do) translates making the doctor or midwife's experience with them easy as equal to keeping their baby's birth safe. If only this were true.

  A respectful third party person who is there for you and your wishes can observe the conversation, the question and answer session, with an objective perspective.
   A mature, objective person can find and work with the positives and help both parties understand the words, needs, and intentions of the other. A few questions, like, "When you say you only do episiotomies when necessary, in what percentage of your patients do you find cutting the vaginal opening necessary?" There is a vast difference between 1% and 20% that reveals an underlying view of how a woman's body works (or doesn't) when she is too busy to advocate for herself.
  A mature, objective person is not out to "catch the provider at mischief." But rather will help you get a realistic idea of how a birth will be managed or be supported with this person or practice and in this birth place.

You may not be able, for some reason or another, to find or choose the best provider for your plan, but you can become aware of who you are working with and then choose the words and approach to bring in the support, tools, and information you need to navigate the course you are on.

Birth Satisfaction is greater with a doula (doo-la).

A doula is a person who is not a provider, student provider, apprentice, nurse, or family member, or even a girlfriend. A doula is objective and doesn't offer medical advice. The doula listens to you and helps you communicate your needs in a respectful way to the providers of your care. The trained doula is skilled in comfort measures for labor and knows about options without pushing a personal agenda on you or your birth. The doula respects your partner and loved-ones.

While I don't know of a study on happiness and having had a doula, I do know there are several studies showing that doula care reduces
  • postpartum depression
  • negative rations of/negative feelings about the birth experience

Statistics on many variable are remarkable for births supported by a doula. No harm was recorded by having a doula. Of course, pick a doula who fits Happiness step #1, an instinctually good match. Here is an excerpt from the DONAInternational.org website on doula benefits:

DONA International doulas are educated and experienced in childbirth and the postpartum period. We are prepared to provide physical (non-medical), emotional and informational support to women and their partners during labor and birth, as well as to families in the weeks following childbirth. We offer a loving touch, positioning and comfort measures that make childbearing women and families feel nurtured and cared for.
Numerous clinical studies have found that a doula’s presence at birth
  • tends to result in shorter labors with fewer complications
  • reduces negative feelings about one’s childbirth experience
  • reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
  • reduces the mother’s request for pain medication and/or epidurals
Research shows parents who receive support can:
  • Feel more secure and cared for
  • Are more successful in adapting to new family dynamics
  • Have greater success with breastfeeding
  • Have greater self-confidence
  • Have less postpartum depression
  • Have lower incidence of abuse
 From http://www.dona.org/mothers/why_use_a_doula.php

Tip: Find a doula group where you can meet several doulas at a monthly or weekly public meeting. Or meet with 3 or more doulas personally if time allows and public gatherings aren't available or available yet, in your area. Doula organizations like DONA or any number of local or national groups can help you find a doula to match your personality, needs, and location.
You may pay for a doula. Quality is not measured by expense. Follow your instincts.


4.) Breathe into Happiness.
The door to happiness is in your chest. You open it by breathing fully and stretching the muscles around the lungs and ribs. You open it by replacing old stale blood. Breath in deeply and fully so all your organs, including your brain, get a blast of fresh air.

Side thought:  Why do room fresheners sell? Perhaps because we want to breath fully. Artificial gel inside a plastic mushroom discourages me from deep breathing as I typically try to hold my breath and leave the room or car as fast as I can. For that matter, I notice smokers light up to take a deep breath through the cigarette. What's around their neck?

The amazing discovering of transferring an oxytocin high through the sense of smell, or the organ of smell, tells us that bliss is contagious and brought in on the breath.

Tip: Let's get some happy scents in the room with an open window or with flowers, herb sachets, essential oils or cooking healthy foods)  Or, go smell a happy person...



And 5.) The fifth step towards Happiness in Birth is to be grateful to others.

By moving the expression of your heart in the direction of others, you transcend the loneliness of a "me-centered" experience. The grateful one is filled with the grace of many. It's not just appreciation for what another person has given you, its even gratitude to all the people in the roles they played in while serving you in your birthing.

Each person has two points of giving, the contribution, imbued with the mood they were in while they did their action, and the point between you two as the combined energy of both your states, moods, and beliefs about your relationship and the task at hand (birthing, in this case).

Now multiply that with as many people as were with you, and then give each combination of pairs, trios, quads, and all groups a point of expression with its own personality, it would seem. That point of expression might be felt as how people calm down when a particular person enters the room, or how the room tenses up, in the case of a chronically stressed person entering.

By opening sending gratitude (a smile, a thank you, and especially an acknowledgement of the individual worth of the individual spoken aloud) the expression of emotion for the group, not to mention an individual within that group) is lifted and oxytocin flows in.



To sum up our 5 steps to Birth Happiness
1. Trust your instinct when choosing a provider.
2. Be present with real life and let go of expectations.
3. Hire a doula (then they may help with #1 and #2) for your birth.
4. Breathe fully. Now and while in labor.
5. Be the love you want to feel in your birth.



The most important thing is love.



Monday, December 15, 2014

My friend Willma's third homebirth





Thanks for sharing, Willma!

I loved being a moment of celebration early in your journey. Your baby

is strong and as gorgeous as your other children! The following pictures are of our Belly Painting in England last June (2014).  I wish you great love and every prosperity in family, joy, and service!




Gail adding Willma's eyes adoring her developing babe.



Who is this little one?



Ken Johnson taking photos of Willma's announcement!



Snuggled in the womb under the light of the moon.



Back to Birth Activism!


Willma with Jan Tritten at the Bury St. Edmunds' Midwifery Today conference in June 2014. 

Tuesday, December 9, 2014

The Fantastic Four

There are four mutually supportive "Body Balance" techniques that a pregnant woman and her trusted support person or provider can do to prepare for a gentler birth. In the new Spinning Babies' Parent Class each technique is thoroughly demonstrated with a pregnant woman and her support person.

Here is the Fantastic Four:

Very gentle but rapid jiggling of the abdominal and pelvic muscles helps to relax the smooth muscles of the ligaments and connective tissues supporting the womb.

Rebozo "sifting" helps make room for a good starting position for baby to begin labor. This vibration like jiggle also helps the receiver of this gift get into a relaxed state that is conducive to peace and spontaneous onset of labor. Read more about how to lift and sift at the same time.



 A daily forward leaning inversion helps make room in the lower uterus to welcome the crown of baby's head.

Get help to get into position the first few times so not to lose balance.

Hold the position for only 30 seconds. Or, simply take three relaxing breaths to fill the belly and sigh out.

Gently stretch the pelvis and spine to release tension as your body guides you.



Add the Sidelying release to "balance" the length and "strength" of the pelvic floor. The sidelying release is much more than simply laying on one's side with the leg hanging off the bed, couch, or table! Be precise, see the instructions! 

The helper holds the top hip directly over the bottom hip. The helper presses the top hip straight down into the bottom hip (not too strongly) so that pelvic muscles relax. Leg muscles stretch. Comfort is achieved and the pelvic floor becomes more navigable to the baby's head. Repeat a few times a week and do every 6-10 hours, as needed, in labor for comfort or to support labor progress.




The Standing Release is also helpful for sacral mobility and so, labor start and progress in harmony with nature.

Standing Sacral Release, the proper name, comes from Dr. Carol Phillips, DC, and is a variation of the diaphragmatic release common in myofascial therapy.

Benefits which may be experienced:

  • Very nice after a long car ride. 
  • May reduce premature contractions that are due to pelvic instability (Is this happening to you? See a midwife or doctor immediately upon 5 contractions in one hour before 37 weeks gestation. Drink a gallon of water while you get to the hospital to be seen for premature labor!)
  • Reduces chance of breech presentation
  • Reduces chance of posterior presentation. 
  • Supports comfort in the pelvic girdle (the joints of the pelvis) especially when used with pelvic stabilizing exercises. 



These four activities are so fantastic and support the benefits of one another.
The Fantastic Four will support your comfort in pregnancy. The Fantastic Four will also help an induction go better and easier, since a good head position helps all birth, not just spontaneous birth.


Additionally!
Walking with a full stride is crucial and will help control blood sugars while helping to lengthen the psoas muscles to balance the pelvis. Let's  emphasize the power of a daily, brisk and free-strided walk!

Another powerful preparation for birth is to squat. Two types flex the sacrum well.


  • Squatting with the back flat against the wall (posterior pelvic tilt), and 
  • Squatting with the bottom flared out while pulling on door handles (the door is open, in an anterior pelvic tilt). 





Find the way to peace in the heart. To do this, breathe deeply in and out in a way that expands the belly and fills the full lungs. Release fear and worry and replace with love and a surety that your love to your baby is more important than events will help you navigate the conversations to bring about your best support possible.  This helps you let go of the outcomes and be one with your intent.

Daily exercise is essential!
See the downloadable video of gentle but specific exercise activities on my site. The Daily Essentials Video is excellent for those who dislike exercise as well as those who love it!

Prepare for spontaneous birth and yet, be able to identify a labor that needs help to release tight muscles to return to the spontaneous progress you desire for the birth of your beautiful intent.
The Spinning Babies: Parent Class shows the Fantastic Four in detail. The segment on labor is geared to help avoid a section in labor incase of labor stalls.


Saturday, November 22, 2014

When the doctor says "No."


"I am a doula to a mom with Mo/Di twins. I recommended SpinningBabies to her since her wee ones are transverse right now. She spoke with her Dr. who said to avoid the Spinning Babies exercises stating they were not safe for her type of twins.

I would like to know your opinions and thoughts on this. "


My response may help those of you who are facing two seemingly opposing points of view.

Monochorionic Twins
"Which exercise does her Dr. mean to avoid? [Spinning Babies presents dozens of exercises when you combine the website and the videos. The doctor may not have meant to ban walking,  Maya abdominal massage, or many others.  He is likely concerned that her movement might have the twins bump each other and move in the uterus and so entangle the cords or the twins. When the twins are small, 12-18 weeks or even 24 weeks, their own play in the watery environment might do just that. Life is mobile and so objects and people interact.] I would suspect [the doctor meant for her to avoid] is the forward-leaning inversion. There are, instead of the forward-leaning inversion, balancing exercises that do not require an inversion.

Your hand will follow the tension later in the release
The standing sacral release requires nothing more than standing with soft knees (for both the mother and the helper), breathing into a relaxed belly, and the lightest touch, no lighter than that even.
She can ask her doctor about that one.
My approach [to support the best release of maternal hormones]  is to honor the relationship that the mother has chosen and not to interject my opinion. I find there are many avenues to "yes" and seek those that lie within the scope of practice for the doula and within the parameters the mother has set by her choice of care provider.
Balance is a spectrum. Unwinding or untwisting the lower uterine segment is a goal and while the forward-leaning inversion is most efficient at doing this unwinding, there may be other places in her body that, once balanced, can encourage her body to find the space to allow the lower uterine segment to unwind.

Think of the cervical ligaments and their fibrous, living rope, connection to the pelvis, particularly the sacrum. If we can't "move the lower uterine segment" via the forward-leaning inversion, is there a way to mobilize the sacrum gently without inversion? Seek these ways. Seek a greater connection to the babies and a more parasympathetic nervous system state. So calm and open though inward and peaceful, rather than alert and aware.
There is much we can do even though there is something we can't do. Seek the way to "yes" without orienting yourselves against the "no."  Then you will find the parasympathetic state of maternal hormones.

In 2001, before Dr. Carol Phillips conceived of the forward-leaning inversion, I helped a friend with approximately 7 pound transverse twins. We did Rebozo and a thorough abdominal massage (not a relaxation massage but working with fascia and smooth muscle, much like Maya Massage) and an abdominal myofascial release. After these three, her babies when head down.  
There is always more than one way to "yes."

Thursday, October 23, 2014

Incarcerated Uterus

Her uterus was retroflexed (aimed backwards).  During the first trimester of pregnancy her womb, still tipped back, grew into the curved space in front of the sacrum and tailbone under the sacral promontory. The uterus is not up in the abdomen at all!

Picture from Wikipedia
Once upon a time, a doctor wrote about this rare condition and used the phrase, "incarcerated uterus." Wikipedia reports the frequency as 1 in 3,000 pregnancies.

Why would this happen? Seems related to ligament weakness. The round ligaments aren't able to do their job or the uterosacral joints are too short - or both. Immediate help may be necessary.

Potential solution? If the mother has not high blood pressure or other risk of stroke, she can begin doing forward leaning inversions and sidelying releases. Standing Sacral release will give the sacrum more mobility to,  hopefully, release the womb.

 I would also add, gentle jiggling ("shake the apple tree" in a sublte style) while in the open knee chest (thighs to spine are in the letter "A" - its not about the knees being apart, Ladies!)

In knee chest position with knees further from tummy than the mother's hips are... making that letter "A" again, could a doctor gently, gently jiggle the womb up to the abdomen. Balance muscles first, side lying release first, empty bladder and empty tummy... Would this be safe to do? I'd want the baby listened to and monitored and the mother monitored an hour after. So this would be a hospital technique in case of tragedy.

What if nothing is done? Pain, bleeding, urinary difficulties and infant loss are associated problems. Act sooner than later.

With supervision, I'd think the above techniques may work. They wouldn't be without risk and the jiggling can be gentle - to stimulate stretch receptors in the muscles so they lengthen and soften and let the womb come up in the abdomen which during the inversions is lower than the pelvis for the moment. Ask your doctor, if this problem happens to you, and let me know what happens next.

References are at http://en.wikipedia.org/wiki/Uterine_incarceration

Prevention? Balance your ligaments with guidance from professionals and with wisdom from Daily Essentials DVD or the upcoming Spinning Babies Parent Class. Get Body Balancing before pregnancy if you've been found to have a retroflexed uterus. Usually this won't happen, even then, but preventative measures will also help move towards an easier birth all around.

See Prisondoulas.blogspot.com for women with actually incarcerated wombs... And more on IsisRising from Everyday-Miracles.org

Monday, October 20, 2014

Father Faruk protects his twins natural birth

Midwife Lina Duncan is a Global Midwifery Council friend living and serving birthing families in India.  She helped Faruk and his wife find the resources to help their full term twins get head down on a recent Spinning Babies adventure. 

Here are Faruk's own words: 

"...Me and my wife, Yasmin, went for sonography. We were all the time visualizing to have twins as that would make us more happy. And guess what, Sonologist said yes you have twins! 'Bingo!' So all happened as per what we had visualized.

Now, all the nine months went great we never had issues. We went for regular check up with a hospital that we felt was great in Jogeshwari (Millat), Mumbai [India].
Doctor in all my wife's visits said 1 thing, that you are healthy and all is fine with you and babies, and we were as happy as ever .

In the 9th month visit, Doctor said to please be prepared as there will be a cesarean in your case, as first [baby is] breech and second baby head down =-O 
We were in almost shock as how can she say this now or she should have informed as much prior as sonography reports were all same all these months. 
[Gail's note. Her doctor was likely reserved due to the risk, especially in cases where the second twin's amniotic sac has opened, that the second twin's head gets in the way of the first twin when the first is breech and the second is head down. This would likely be fatal. With an intact sac for the second twin, this is less likely. I have noticed that twins usually come smoothly when a mother is well nourished, moves freely, and babies are full term. Their doctor declined helping a natural breech/vertex birth. So, Faruk and Yasmin continued their quest.]  

Still, we insisted her that we want to go for normal delivery. Doctor said that in her entire studies and work experience never ever she has seen such case end up with normal delivery. She said if you don't trust me then better change doctor. She was not ready to listen. In fact, she was not ready to answer all our queries. She was just like closed door.

All right, now my wife looked worried and so was I. While we were on our way to home I was driving, I smiled to my wife and said, don't worry that's what doctor feels, not us.
But we will get what we think and we want things just normal and it will happen, so just  relax. 


Now I started searches, all in google, [and] starting speaking to many people on this till finally I landed to Ms. Lina Duncan, miracle lady :-) 

She was the only person I found to be realistic in all her approach and I felt quite positive when I had spoken to her. She was in constant touch with me gave me many ways to come out of this situations. I [tried] whatever she told until finally she send me email links on Spinning Babies...  and it was great. 

Midwife Doctor examines pregnant woman in India
Photo thanks to https://www.globalgiving.org


We understood the technique watched all videos in there and finally decided to make positive try on Spinning Babies techniquesNow we are in 9 months and 15 days. Babies are also big. Almost each are 2.7 kg and babies were very [far] down, we did the spinning like toe and knee on bed and both palms on floor [forward-leaning inversion].

We did for 2 days and went to a new doctor in HABIB Kurla, Mumbai whom we had spoken during this phase who was very positive ready to talk and ready to give positive try for normal delivery. 

Just in the check up doctor said your baby is head down and not breech. We then did sonography to get it confirmed. Yes! It was head down 'BINGO!' :-D

We were very happy and in next 2 days my wife had normal delivery. The pain was just 10 minutes and babies were out with no need for NICU for babies so finally all went as per what was visualized.


My hearty thanks to Lina Duncan, her group, Mother Gail Tully.  You all guys are amazing as you had created a whole new way of looking at critical situations into a simple fun and enjoyable exercise and change things overnight. Your team is a real time success team with 100% commitment, coordination, help, support.

I would request Mother Gail Tully that such education has to spread in India as the need is more here I have seen. Just in this 1 month, many other twin moms don't want cesarean but are forced by doctors saying it is the last option. All these mothers need education...

Wish you all best of luck for all your future endeavors.

Kind Regards
Faruk


From my response:
Dearest Faruk, wife of Faruk, and our mutual and gentle friend, Lina Duncan. 

How lovely to receive your precious story! This beautiful fulfillment of your healthy birth of twins is a testament to the significant benefits that the faith of a father for his family creates for their birth. A father's loving certainty relaxes his wife and allows peaceful hormones and a state in the parasympathetic nervous system which is ideal for helping mother's relax smooth muscle and allow babies to shift head down. 

You also did the technique called the forward-leaning inversion that helps "make room for the baby."  The forward-leaning inversion helps give a gentle stretch to the lower uterine segment which may lengthen a shortened utero-sacral ligament or release a tight posterior or transverse ligament whose job is to support the lower womb. This technique may resolve a twist or tightness that may make less room available in the lower womb. Perhaps it was this technique that made a bit more room for your first twin to slide head down towards the cervix. 

With all this, dear Faruk, you and your wife kept your vision, kept your peace, and continued your determination to find a way for a peaceful twin birth. 

Thank you for your kind request for this education to spread in India. I feel the pull of a billion souls and will work to make my next book so that I have something to show Indian parents...



Friday, September 26, 2014

Breech then and now

Thirty one years ago I caught my friend's breech baby in Omaha, Nebraska. I was thinking of this Monday with a group of midwives and doulas at the lovely Mommy Fitness Omaha with Julie Summers and Kelly Langfeldt of Five Stones Massage and Birth Services. Kelly invited me down to present a Spinning Babies Workshop to the now thriving Omaha birth circle.

My friend's midwife was unexpectedly delayed on that night so long ago.  But I'd done my best to  prepare for just this contingency. She'd loaned us the resources she had; Williams, Oxorn, a booklet by Sheri Daniels, and the already popular Spiritual Midwifery by Ina May Gaskin and Farm Midwives.
The week before her birth, I'd called Sheri Daniels, Pamela Hunt at the Farm, and a midwife in Minnesota to gather words of wisdom. The consensus --get to the hospital and don't do this at home! If the baby gets stuck the baby could be brain damaged or die. We were looking for hospital options.

My friend's hospital option: cesarean surgery, ten day stay, no husband allowed to hold the baby until baby is home. My friend's history: her aunt had her first baby breech at home with a veterinarian some decades earlier. My friend's decision: stay home at all costs.

Now there is a change that happens in life between the waiting for and the holding of a baby. Her decisions were during the "waiting for" period.  My nights were spent on my knees after reading through the books again and again.

She found a willing doctor, who could take her on Monday when her insurance coverage could be changed over. Friday, this doctor tried to do an External Cephalic Version but the baby couldn't turn with it. Her labor started Friday suppertime. In the wee hours of Saturday morning her little girl was born. Seven pounds of wailing wonder.

Today women face similar politics. Women struggle to find care in the hospital. Few doctors have breech skills. Few midwives have them either and those that do are generally home birth midwives without hospital privileges.

Today we have emerging breech skills. England is taking full responsibility to train doctors and midwives in breech skills and birthing women can find the options with a internet search or word of mouth referral. North of England Breech Birth Conference starts tomorrow in Sheffield on 27-28 September. My dear friend Jane Evans is speaking on the mechanisms and physiology of breech birth and Dr Frank Louwen will present on the dynamic benefits of "upright" maternal position for breech - the knee-elbow (very similar to hands-and-knees) for breech birth. I heard them in Ottawa in 2009 and know that breech lives have been saved for the goodness of their sharing their wisdom.

The three pillars of safe breech birth are:

  1. Don't touch the breech (when rotating and descending spontaneously), 
  2. Knee-elbow position for the woman (spontaneous upright positions are supported or hands and knees suggested for new breech providers and when other upright positions aren't spontaneously chosen by the mother (not the midwife or doctor), and 
  3. Don't cut the cord (the baby's blood in the cord returns to the baby expanding air sacs and reviving most slow to cry breech babies).


With these beginning guidelines the rates of complications for breech drop dramatically. Frank Louwen will be sharing data from over 350 upright breech births in Frankfort. Babies get stuck far less often. When they do get stuck babies need a practiced provider to free most of them. Good luck only goes so far. Practice with a doll and pelvis until the techniques live in your hands.

I wish I were in England this weekend with Jane, Helen, Frank and friends. I'm grateful to my Omaha friends for starting me on this grand adventure I call Spinning Babies! 

Thursday, September 25, 2014

Why won't this labor start properly?

This post discusses onset of labor.

A woman is commonly considered in labor when her cervix is progressively opening and continuing to open. Stages of labor are the first stage of cervical dilation, the second stage of "pushing" or until the actual birth of the baby, and third stage which begins after the baby is out and until the placenta is out. A fourth stage of labor is described as the following period of newborn and mother's adjustment from birth to physical stability.

Early labor from 0 or 1 cm to 3-4 cm.
Early labor is a time we expect baby to be engaged. In an experienced mother, engagement may not occur before latent labor in an on and off labor pattern, or in early labor, where dilation is gradually moving to 3-4 centimeters. A minority of women are open to 3 or more centimeters when labor begins to open their cervix further.

In first births, for first time mothers and for many VBAC (vaginal birth after cesarean) we expect baby to engage before labor starts. When a first baby isn't engaged until labor begins the rate of cesarean is high. (Oboro; Siddiqui; ROSHANFEKR) Fortunately, we can let babies engage in labor with the help of labor contractions in certain maternal positions described at www.SpinningBabies.com.

This baby is not engaged although the nurse can feel the back of baby's head.  The forehead overlaps the pubic bone.  Overlapping the pelvic brim may keep labor from starting smoothly, or, oddly enough, the woman can get to 10 cm and pushing but the baby remains high at -3 station. The overlap can only be felt when a woman lays on her back. 

The slow labor start up.
Women may have contractions that keep them awake. Yet when the cervix isn't dilating they aren't considered to be in labor. Doctors and midwives often tell them to go home to bed and come back when contractions are longer, stronger and closer together.

The stop and start labor.
Other women may feel their contractions come strongly but then they taper off and stop. They can get very strong, but seem to back off. Later the contractions may start up again only to stop again. The cervix isn't changing or isn't changing in any encouraging amount.

Strong contractions like transition, but the cervix is 2 cm dilated.
Once in a while a woman has many symptoms of strong active labor. She may feel a bit nauseous, shaky and have hot and cold flashes. Sometimes she feels like pushing. Rushing to the hospital, she and her loved ones and doula may expect to find out that the baby is coming quickly. Imagine the frustration when the nurse checks and finds out that the baby is still high in the pelvis or even above the pelvis. The cervix is hardly opened and the os or opening of the womb is still tilted far back.

If labor doesn't start smoothly, determine through an exam or your own exam if baby is engaged well or not. Engagement is the first step to labor progress.

The help to engage is within the mother's body. Balancing the body (fascia, ligaments, muscles and joints) help soften those anatomical features that may be tight or shortened, spasming or asymmetrical. Simply put we release what is tight.  The psoas muscle pair are key players and walking is a way to support their length and suppleness.

She does an abdominal lift while flattening her lower back.

Dad helps with an abdominal lift in early labor to engage baby and let labor progress.

In labor, the abdominal lift and tuck through ten contractions often helps baby engage. See more on this great technique devised by a mother, Janie King, in her book Back Labor No More.

Only if this technique doesn't work, try Walcher's Open-the-Brim position. For details on Walchers and more on Engagement in Labor see www.SpinningBabies.com

Tuesday, September 16, 2014

Flexion matters

The Anterior Positions and LOP

At Spinning Babies, fetal position matters.

Babies positioned on mother’s left side more often curl and tuck their chins more easily (flexion, flek’-shun). This makes baby’s head measurement smaller and lines up baby with the pelvis to be able to help in the birth process.

Flexion is more imporant than position. Muscles and ligament “balance” is more important than size.
Discovering how to tell your baby's position is in the Belly Mapping book and the Spinning Babies website.


A flexed head can measure up to 2 cm smaller than the same baby's head extended, or having the chin up.

Not only that, but a flexed head molds even smaller. An extended head takes hours longer to mold, if it needs to. And first babies almost always need to reshape the top of their heads to fit the bones of the pelvis.

A flexed baby can use their spine, back and shoulder muscles to help themselves be born. Flexed babies bodies are lined up to make their kicks at the top of the womb (fundus) be more effective in moving them down through the pelvis. Most babies on the left are anterior and flexed. The Left Occiput Posterior baby may be flexed and rotate readily with the help of strong labor contractions.

Gail and her sister, Kathleen, will be exhibiting Spinning Babies at the great Lamaze DONA 2014 conference. Come to our booth and see the book. If you're pregnant, come for a free belly painting!  

Sunday, September 7, 2014

A new start for active labor, a new question for progress

The new guidelines from ACOG

Recent changes in defining active phase of labor from 4 cm to 6 cm. This change is intended to help first time mothers avoid being given a cesarean when labor is simply slower than what was considered normal. Longer labors can certainly be normal. So when the question is asked, "How far dilated is she?" or "How far dilated am I?" the pressure for progress is extended to 6 cm now.

Active labor was considered 4 cm and a changing cervix. A long stall at 4 cm, meaning the labor is not progressing past 4 cm though contractions are regular may be a reflection of the distraction to the mother. A social gathering that seemed supportive before labor began may actually be the delaying factor for a woman who is waiting for privacy to enter the active labor phase. Tension or distrust in the environment or people in the immediate area may keep a woman from "relaxing into" labor. Or, she may simply be waiting to arrive at her birth place upon when her labor may take off quickly once she feels safe to open.

ACOG had long stated that doing a cesarean before active labor for length of labor alone (and not health indications) was unfounded. In a move to reduce the unhealthy and high cesarean rate, ACOG has taken another step. Moving the start of active labor to 5 cm for an experienced birthing woman and to 6 cm for a woman's first labor gives women more time to labor.


The better question is, "Where's baby in the pelvis?"
The woman and baby may need this time to help baby engage if engagement hadn't happened yet. The baby is high, at "-3" station. Often a mother hears that baby needs to come down more and the nurse or midwife doesn't explain station. Its OK to ask. An approximate station is helpful information even if there is a little variation in the number.

Another way to ask is, "Is the baby in the pelvis? Is the baby ballotable or well engaged?"
Answers like, "The baby is high," or, "The baby isn't in the pelvis yet," also mean "-3" station.

Engagement in labor is often due to the mother choosing a position that opens the brim, and is less likely in the first time mother to be by chance or time. Opening the brim with Abdominal Release, or an Abdominal lift and tuck (not at all a tummy tuck, ladies!) can help the baby enter the top of the pelvis in about ten contractions time.

During the phase of labor near 5 cm, the first baby would often be already engaged and moving onto the pelvic floor in the midpelvis. The fetal station would be "0" or nearly "0" at "-1" or "+1".

Giving extra hours for those women having a longer labor whose baby is near "0" station may give time to help baby rotate through the pelvic floor.
Easing this time is often helped with the Sidelying Release. Choosing a myofascial release is choosing the first Principle of Balance. Labor may pause an hour as the uterus has a short rest and then will resume. Sometimes, though, baby comes quickly so be where you want to have the baby. If labor doesn't proceed when baby is in the midpelvis, a lunge will give room for the bones and for the tighter pelvic floor to open on one side. Do the lunge through a contraction for 3 contractions on each side and then repeat.

Waiting for a labor to progress that is holding at 6 cm, or 5, hour after hour may reflect a misunderstanding of labor progress. First attend to the soft tissues and alignment (or balance) of the pelvis. That's why Spinning Babies first principle is Balance. Then open the brim or open the midpelvs depending on how far down baby has gotten with the Principles of Gravity and Movement. That's where were find the techniques and moves to open the pelvis.

Understanding the rotation needs of the baby and the levels of the pelvis, we can support labor progress more smoothly and save a woman many hours of waiting. Sometimes, as in lack of engagement, or transverse arrest waiting can take days and still not lead to progress. Let's increase our observation skills and ask the right questions to find out where baby is and what baby needs to make the next turn on the journey.


Thursday, July 31, 2014

Encouragement to a new Baby Spinner

There is much for a birth worker (doula, nurse, midwife, family medicine or obstetrician)
to learn at Spinning Babies. There is often a transitionary phase between workshop and confidence. 

Observe the mother with your new paradigm and listen to intuitive guidance. From this gentle approach you begin introducing comfort measures and balancing activities appropriate to  nurture a calm inner focus of the late pregnancy hormonal state.


The new Baby Spinner will begin to notice that pain is not something pregnant women have to accept as a normal part of pregnancy. You have seen in class that something can be done. 

Pain that is not associated with the muscle and joint movement of a normal progressing labor may be a sign of imbalance. In any case, lengthening and softening core muscles gives room for baby.

Look for ways to find balance in pregnancy first, and labor when its happening. 
What activities add balance? 

Are the 3 Sisters appropriate? The standing sacral release?

You will grow in confidence as you try your ideas in gentle ways to nurture your women.  
As you listen, you will be led. 

Thursday, July 3, 2014

What I'll talk about at Lamaze DONA conference 2014

 September 18, 2014 from 8-noon, I'll be talking how educator's can gracefully talk about malposition in labor.
Come on down to Kansas City! http://www.lamazedona2014.org/p/cm/ld/fid=473

Resolving Fetal Malposition in Labor; An Educator’s Opportunity
Presented by Gail Tully, CPM, CD (DONA)
Given the increased complication and intervention rates of posterior and asynclitic babies childbirth educators and doulas need to know facts, solutions and practice strategies to prepare to resolve fetal malposition in Labor.
This session will explore reasons for malposition and ways we can communicate its dangers to parents.
Childbirth educators, labor an delivery nurses, doulas and other childbirth practitioners will be able to prepare a plan to minimize a labor stall due to posterior arrest with epidural use, describes a technique to open the pelvic brim for fetal engagement in labor and demonstrates a technique to resolve transverse arrest.

   If you've heard me talk, check out Patty Brennen as she talks about writing winning grant proposals to prosper your birth work. 

Wednesday, July 2, 2014

His flipping was the talk of OB


 Edited Emails, (Consultation call missing)
KC Teasley writes,

Dear Gail,

I wish to have a natural birth with no medical intervention. My baby is incomplete breech with his left foot by his face. He is also turned to my left. My amniotic fluid levels fluctuate between 14 and 10 percent.


I've never given birth. I believe natural birth is best for my baby and me. Obviously if something is terribly wrong I will do anything I have to do to take care of him.

I am desperate to have my child moved for natural labor and delivery... I have been doing everything from all the positions you list: I've been doing all the yoga, Spinning Babies positions, cold pack, flash lights music, talking [to baby], standing on my hands in a pool, seeing a chiropractor for the Webster adjustments. Today I had an ECV scheduled but opted out because the Dr. said she would have to have an OR team ready and most likely could pull his hip out of joint! Of course, I don't want that!


They have me scheduled for the 25th of this month for a C/section. I will be a little over 39 weeks on the 25th. My baby would loose all the benefits of being born naturally.

The doctor was not enthusiastic and made [vaginal birth] sound like such a burden, stupid and risky so I'm left feeling very confused and second-guessing the decision not to have [a cesarean].

Thank you for any help!
Kacey


Gail and KC had a consultation call and afterwards, Gail wrote:

Dear Kacey, 

I'm so hopeful for the 
  • release of the broad ligament, round ligament, 
  • the muscles to the pelvic floor to be lengthened; 
  • the muscle border between your abdomen and the underside of your ribs, and 
  • the muscles to your hips to be released;
  • and your hip sockets to be gently distracted and compressed, 
  • followed by circles to the least resistance 
but not forced with any of these moves.

Rebozo sifting (Manteado)
5 Forward leaning inversions a day for 1 min each [30-seconds is usual], but not after meals. 
Followed by [use of an] inversion table or breech tilt or the open-knee chest for 10-minutes minimum;
Sidelying release for ten minutes or more on each side,
repeat and have your arm up over your head to stretch upper back muscles and help your respiratory diaphragm.

Look on youtube for myofascial release, 
and for toning and lengthening pelvic floor muscles.
Reference Leslie Howard, or Katy Bowman and look for tips to relieve pelvic pain. Pelvic floor pain techniques [are often] the same exercises to lengthen [and tone] your pelvic muscles. 
Deep hypnotic conversations with your baby is another proven technique.
Can your chiropractor do a myofascial technique for release a diaphragmatic hernia. To get rid of heartburn ? And that is a good breech flipping technique. 


If you do not have high blood pressure or glaucoma:
Can you do 5 forward-leaning inversions and 3 breech tilts today and tomorrow, and Sunday??
Stop inverting if you feel kicks in a new and higher place [indicating the baby may have flipped].

Another goal is finding an experienced, skilled practitioner [who may help with a vaginal breech birth].
Dr. Peter O'Neill is in Winnipeg, Ontario.

I so admire your strength. 
Keep in touch!


KC:
I have been to the chiropractor 5 times now for the Webster adjustments and I feel the baby get very active afterwards.

Thank you for being so diligent with me! I feel like whatever happens someone was on my side and I appreciate that!

-Kacey



Gail,
I had my baby on June 21st vaginally! I went in on Friday with contractions. My Dr. was on call at the hospital, she says, 

"Oh my God, he isn't breech!"



His flipping was the talk of the OB! Everyone wanted to know how we accomplished that and I told them I had a consultation with Spinning Babies, Chiropractic, yoga, ice packs, flashlights, music, talking, and Lots of Prayer!

I was dilated all the way up to 9 and my water still hadn't broken so the Dr. popped it. Instant relief! I watched my belly slowly sink down and it was so nice. The contraction I had been going through we're not pleasant but when they were over I was ok.

After about 10 minutes of draining, I got up to use the bathroom and as I was walking I got hit with the worst contractions! There was no build up. This was crippling. I hung onto the door and for the first time since they started I started like a high-pitched squealing! The nurse came in asked if I wanted an epidural and I looked at my husband, who said, "You told me to remind you that you wanted to do this naturally.'' I told him the other contractions didn't feel like this and I was already at 9 getting ready to have a baby. I caved at 9! Ugh!

But it worked out!  As I was delivering, the baby went sunny side up and got stuck. My pushing didn't do anything and the epidural was wearing off. So the Dr. put her hands inside and helped turn him manually! She later explained that if I hadn't had the epidural she would not have risked turning him like that and would have given me the C section anyways! She also said I ripped because she turned him but if baby would have just come out normally she didn't think I would of.

So even though I didn't get everything I wanted, at least my baby came out vaginally, had a milked placenta [the blood in the cord was squeezed into the baby], was immediately placed on my chest, daddy cut the cord, and spun a baby!



I loved all the questions the Dr. and nurses were asking about turning him! It's funny, I don't see the medical community, chiropractic, or midwife community working together. The advice the Dr. originally gave me was basically a cat/cow yoga pose and a pamphlet on c/section for breech.


How many more women don't know there are options 
and hope for not having major surgery?


it was the most beautiful experience for me and my husband. Soren is amazing and we feel so blessed and privileged he is ours!


Soren weighed 8.6 lbs, is 22 inches long, with a head circumference of 14 1/2 inches! Born at 39 weeks 1 day.  My doctor was so surprised and said she's never seen a 22-inch baby spin around at the end of a pregnancy!
It's like the stars aligned just for us!  Thank you for making yourself available to help us!


 Kc Kacey, William and Soren Demarest

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.