Tuesday, April 15, 2014

Spinning Babies Perspective

Spinning Babies is not a method. Spinning Babies is a way of looking at childbirth.
Here, I see the mother and baby moving together as partners in birth. That makes sense, they each have a role, a choreograph or dance step to do in the birth process.
When baby is lined up with the pelvis, labor proceeds spontaneously. What do I mean lined up?

When baby's back is curled towards the front and front left side of the woman's uterus, the baby 's spine is flexed. Flexion gives the baby ease in navigating the pelvic brim. The flexed, or curled, baby can push their feet off the top of the uterus and aim themselves lower into the pelvis. Many women feel baby kicking and repositioning after a contraction. Baby is an active partner in birth.

Some babies are on the mother's right side, or along mother's back, spine to spine. Especially so in the first time mother, being on the right or along the mother's back can extend baby's back causing extension of the fetal spine. This straight fetal back aims the top of baby's head right into the mother's pubic bone. Engagement is delayed until the forehead turns to fit the brim or the baby flexes just enough to enter the bony pelvis.

Even if baby's head is able to scoot past the pubic bone while still facing mother's front, the head often remains extended (chin is away from baby's chest). This makes the head seem larger (Your baby is too big! We must do a cesarean.)

The baby's whose spine is already straighten to its full length can't as easily kick off the top of the uterus to maneuver downward. The mother has to do more of the birth work herself. This is still quite possible if the head and bones find room for one another.

Many of my colleagues state posterior is a variation of normal. But when do you see other species with fetal development in anything but flexion? Curled around the heart is the physiological norm for the developing vertebrate. I think we need to refigure what we mean by normal variation.

Common? Yes, Posterior presentation is more common today that even a decade ago. The 5% of all deliveries being posterior is now 8% and adding an epidural to the birth process increases the rate of posterior birth to 12.9% (Lieberman).

But is it a variation like hair color or ear lobe attachment? Not likely.  We'd have to be unique among vertebrates, for one thing. And while we are in many ways, I don't think this is one of them.

One study finds women whose babies were posterior at the end of labor were found to have a higher incidence of low thyroid function. Another study finds obesity correlates with more OP babies.  And yet another shows that older moms have a greater likelihood of having a posterior labor.

These findings may indicate that metabolic hormonal function is one cause, if not the root, of posterior presentation.

Body balance may be something we can improve to improve metabolic health. Our muscles, ligaments, joints, posture, alignment, and movement are areas that can be improved for circulation and flexibility.

With increased balance babies on the right tend to swing to the left. After a long day on a woman's feet or in her car, women Might experience their baby shifting to the right. If labor is long with the baby facing forward, don't we often see rapid progress once the baby rotates to the anterior fetal position?

These are clues that mother and baby's positions in relationship to each other matters.

The good news is even without entering into the ideology of posterior as a variation of normal presentations
that Spinning Babies has excellent options for comfort and rotation among a collection of techniques. 

Even my colleagues admit the techniques studied in the literature aren't amazing for rotating the posterior baby. But that doesn't mean that no techniques are effective. It means that the techniques chosen for study haven't been fantastic.
How many times will hands and knees and pelvic rocking be studied??

Some women have a long labor for a single reason. Most will have a combination of reasons. One technique often helps with one cause. So for the woman with multiple issues, a tight round ligament and a sacrum that isn't mobile combined with a large and posterior baby has three issues immediately noticeable. The size of her baby is not necessarily an issue. But it is a variable.

So we do hands and knees with pelvic rocking and nothing changes. So let's give her round ligaments a release from the painful spasms she has been experiencing that also reduce baby's success in rotating to anterior. Let's add mobility to the sacrum with a standing release, and if desperate, triggerpoint therapy on the sacrotuberous (sacrospinal) ligament. Then gravity and movement will have better results. Then her hands and knees and rocking pelvis will rock that little one around.

These are not the only techniques for this combination of issues. I'm painting a picture here.

Balance means not too tight; not too loose. So nothing is spasming or being held immobile. No muscle or ligament is flopping over without support. And so on. Next time I'll write about the slow labor start up. When women have contractions that keep them awake but their midwives tell them to go home to bed, the cervix isn't dilating.

Thanks for thinking of me. Your support keeps my world spinning.

Sunday, April 6, 2014

Follow the Love

My Other Mother died Friday. Helen was enjoying a wonderful week in sunny Mexico with our friends, Mari, Frank and sons, Ari and Marco. A small sore on her leg, where the doctor had removed a mole three years before, had never healed and was vulnerable to a virulent and opportunist bacteria that took her life in 24 shocking hours. 12 hours into it, at the hospital, Helen reassured Mari, "I had a Grand time!" 12 hours later our Helen was gone.

My Mom (R), me and Helen (L). 

Shock, disbelief, confusion. Also, a strange new thought that comes with age; her suffering was short. A better death than many. Bitter reassurance sticks like gall in the throat quickly followed by anger at such stupid sentiment. I want her back. I want to do something to light up her day again and again, not once a month while I'm home from my travels.  But again, in her last week she felt great, was surrounded by the love of a family of dear friends who treated her like a queen, as their family, too. She was honored by their happy and gracious natures, by their respect of elders, by kindness and hospitality of heart. She was so happy to go and so happy to be there. Hard for them, but glorious for Helen.

Helen added so much kindness. 

Here's Helen and Jeanne enjoying Gairm's comedic genius after
 his high school drama performance.

Our family was SO much better for having Helen in it. 

My sister, Kathy, and I talked about Helen, her gift of love, her goodness in our family, but also about serial losses, slashing at the heart again, intensified by the grief of losing our Helen.

How does one find oneself again when life's landscape changes so radically after a series of losses? When family, friends, even work or talents change, leave or actually die, how do you recognize your self when these defining anchors of "self" let go?

"Follow the Love”
Meaghann, my late niece, and Kathy talked about maintaining happiness and purpose in life. 
When trying to do what we should becomes disjointed and disappointing the stress and strain, the pain of life, bursts out in a big, “Why!?" "Is this mess really what we’re here for?!" 

There is actually purpose to the pain. And that painful awareness shows how far we are from the point of being here. Circumstances can be painful, it’s evident. But there are people in difficult, even tragic, circumstances that find a serenity and peace with life. Some people call it acceptance. Its a way of navigating the troubles of life. 

But how do we get back to our inherent serene center? Every person holds the key to their own solution within their own bodies, souls, and minds. Because we have a brain, we contain the power of the brain. Because we have a heart, we possess the power of the heart. Because our thoughts and feelings can change, we can initiate the change in our lives to climb out of miserable circumstances. Some will climb a higher, steeper slope. Some will slip, but all can climb. And it is in climbing we come to the top. Or, maybe, we just start at the top. 

We activate different parts of our brain with thoughts and feelings. When we smell, feel, or talk some unique part of our brain lights up the MRI imagery. When we remember, a different part of the brain lights up. 

If that same part of the brain is artificially stimulated with electricity, a memory, smell, or sensation could flash into the subject’s awareness. So it seems that brain stimulous can come from our own action (by our intention or habit). Or, it can come from outside, through medical experimentation - or divine intervention - or even perhaps by the foods, substances, and chemicals we ingest, breath or absorb. 

These discoveries tell us that healthy thoughts can build a habit to focus on more good thoughts. Thoughts are associated with the release of brain chemicals into our blood. Hormones, and their associates. These chemicals create feelings. So in this way, thoughts create our feelings. And so, happiness can be learned. 

This good news gives us inspiration - and a reward -  to change our thought habits. 

We do need an avenue that makes sense to us. A new pathway in our brain to light up.

What made sense to my niece and sister when my niece’s brain tumor thrust a terrifying change into our lives is that we’d follow the love. Could my sister give up her job to care full time for her daughter? Could she change her work hours and pay bills? Should they move in together so my sister could care for her adult daughter? (Easy answer!)

Meaghann, the Spring before the tumor returned.

Each decision began with one priority. Follow the love. If love was protected, nurtured or increased by any choice to be made, that was the choice to make. 

The questions of how the bills could be paid were answered when love was upheld. Kathy’s apartment management company transferred her to an office in apartments that had wheelchair access where she could work on site. 

Love opened possibilities. The resentment of the disease and hopeless resistance to change pushes away opportunities that, when offered, seem impossible or too uncomfortable to consider.

That is the response of the stress chemicals. “No!” “Get me outta here!” “Go away!” Even if said this way, “Oh, that’s ok. We’ll be alright,” which is “Minnesota talk” for not having a clue how to include another into the emotional vulnerabilities of life's struggles.

With Meaghann and Kathy’s “Follow the Love” motto, when help was offered, the love mission statement gives an immediate “Yes!” “There’s room and appreciation for your talent!” 

The brain immediately begins lighting up the circuitry for possibilities towards more and more “Yeses.” We all love “Yes!” That is, when we lower the level of stress chemicals in our blood stream so our brains can find oxytocin. 

Oxytocin building events become easier. Sharing a meal, sharing a task. Even saying good bye becomes a life shattering, heart wrenching, soul searing act of love. 

We didn’t run, we stayed. We didn’t curse (as much), we prayed. We saw hope for a future, not one we chose. We couldn’t sustain oxytocin in the grief consistently or even very often, but we had a previous pattern and our brain more easily recognized "good thoughts" when we came up for air later on. Then we could climb up upon our resolve and find a life in which purpose and happiness are one and the same. A life that moves forward, not inspite of Helen or Meaghann's deaths, but inspired by the lives they made. A life which shows us how to “follow the love." 

Helen was all about it. I will miss her every day, every holiday, every kindness. But it will be knowing that she lived the fullness of her self and gave her kindnesses to others everyday. 

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.