Thursday, November 19, 2015

Growing (Spinning) Babies!


Spread the breakthrough message of Spinning Babies.




Spinning Babies eases birth by helping baby rotate more easily through the pelvis. Less pain and intervention is readily possible. As the Spinning Babies Lady (that's me on the left). I began a personal mission to make birth easier for mothers, babies, AND their doctors, nurses, midwives and doulas. I observed birthing women, combined information from sources outside of the birth world, and developed further some of the brilliant insights of those who’ve walked before me.

Observing birth, I noticed what most stuck or stalled labors had in common: where in the pelvis the baby waited and the angle of baby's head in relation to that part of the pelvis. In fact, my midwife friends said I could "see inside." By that seeming talent, I've developed an "assess and match the technique" approach that apparently has not been considered so fully before.

Now it is true that the position of the baby is well shown in medical and midwifery studies to be a leading cause of long labor and even cesarean. Every birth attendant knows that. But knowing how a baby can be helped out of a difficult "fetal position" is less understood. Force is too often the chosen solution - pump in the drugs to strengthen the uterine contractions or manually turn the baby by hand. Though both approaches have some risk, they are sometimes necessary and often effective.

A common, more gentle approach is to wait, and some providers get the mother moving. This approach is often successful but not if baby is stuck. So far, then, help has been random and so are the results. Meanwhile, too many women suffer hoping someone will finally know what to do.

Women are too often told, "the baby is too big" when the angle of the head that is the real issue. A better angle of the head (called flexion) lets even a large baby fit the pelvis of most all women.

For years, the emphasis on "The 3 P's of Labor: Passenger, Passage, and Pressures" has been the excuse for pouring Pitocin (Syntocin) into a woman's veins and even using life-threatening Cytotec (unapproved by the FDA for use in birth) to pressure a woman's cervix into opening with too little regard for the passenger or passage.

I've offered the world a new approach of Balance, Gravity, and Movement, the "3 Principles of Spinning Babies. Showing women how to "balance" muscles and ligaments so they aren't too tight or too loose. The pelvis becomes more mobile and the support structures to the womb lengthen, soften and “make room for the baby.” Balance allows the baby drops into the pelvis with a tucked chin and helps labor to begin –and continue– on its own. And if labor has stalled or stopped progressing, I offer a new perspective on assessment and matching solutions.

I teach providers to ask, "Where is the baby?" Then we choose a technique for that place in the pelvis. Is baby engaged? Which way does baby? And, how far down has baby descended? Asking where gives the clue to match the right technique and allow labor to finish as nature intended. And it doesn't matter much to the success of the technique if the mother has pain drugs or goes completely natural. That's the mother's choice.

Being in balance may add comfort to pregnancy, ease the birth, and lessen the pain so women can cope with confidence. Then a woman's desire for natural birth has a better chance of blossoming into the birth she wants for her child.


My website, SpinningBabies.com has given free and comprehensive information for 14 years.

Track record: I‘ve already offered the world a Belly Mapping Workbook and a couple of videos, professional workshops and 6 trainers to give Spinning Babies day-long workshops. I have an amazing Director of Optimism working 30-40 hours a week and a Director of Practicality working only 5 hours a month, new part time office support, an accountant, and myself. This would be enough if I were not hoping to reduce suffering in birth around the world. Those that I’ve  helped say I have already changed the world of birth. But honestly, Spinning Babies has not accomplished her full potential. My heart is breaking right now because so I could offer so much more. I need a professional support structure for my 5-year plan to ease the way the world addresses stuck birth. 
But isn’t this what midwives already do, you might ask? There are many smart and gentle midwives. These are the very professionals at my workshops telling me, “I wish I had known this 30 years ago when I started,” and “I could have used this knowledge yesterday, we would have avoided that cesarean.”


I need you to help me make a significant contribution to babies and mother, providers, and birth practice that lasts into the future. Doctors could turn force into "balance" when a long labor requires their expertise.

Please help me and all Spinning Babies enthusiasts to get past the hump.

Though Spinning Babies isn't a non-profit, the model IS to serve foremost. You see, I was a small time midwife with a breakthrough idea, not a person planning to start an international business.  The little engine that could is not just going over the mountain to the children on the other side. Help build the track to run with this message. Spinning Babies is going global and that's a lot of children! I need HHhelppp!!!

What will your donation do on a tangible basis?

·      A Spinning Babies Book for parents in several languages

·      A provider reference book to look up what to do when

·      A Trainer Training expert hired to head up the training for my 6 eager trainers and train the next group to expand Spinning Babies message around the world (I've found her, if I can hire her!)

·      An Office Manager will manage my time for creative efforts like a book and an app (hiring October 2015, shall I call him the Time Lord, since he'll be scheduling my every project? oh, I so want this chance to succeed!)

·      An app to help solve common labor stall issues

·      If we exceed expectations, we may be able to fund some research!


True Quote: "I have been practicing Spinning Babies for the past 2 years to the best of my knowledge, and with using the Side lying release and Abdominal lift, I believe I have saved at least 50 people from having a cesarean section! This is so empowering to women and myself as a labor nurse." Jennifer Crews, RN, California

That’s one nurse, two years, 50 major surgeries averted. That may be 25 less infections, could be 30-50 more babies handed straight to their mothers, perhaps a month less postpartum pain for each woman, and several women without the struggle wondering why their “body didn’t work.”  

Kate Lawrence, CNM, in Ohio said in the months following a Spinning Babies Workshop for nurses the head of the department noted the drop in cesareans and asked what had been the impetous.

Lorenza Holt says, the stalled labor is less often a “failure to progress” than it is our “failure to assist.” She is now teaching midwives in Mexico the Spinning Babies approach to include with their traditional knowledge about natural birth.



Spinning Babies isn’t necessary for all birthing women. But it is necessary to counter the leading cause of unanticipated cesarean – the labor that doesn’t  bring the baby. Whether it’s called “failure to progress,” or “baby is too big” or “malpositioned fetus,” Spinning Babies has immediate help and prevention throughout pregnancy that will help more women and babies than ever before. That gives a doctor, midwife, or nurse some real satisfaction.


Your donation gets you in on the wonder behind stories like these:

True Story: A man and woman have been in hard labor struggling to give birth to their child for 3 long days. No midwife lives on their Indonesian island. Something is holding up the birth but they don't know what to do. The woman's exhaustion is growing worse. Her husband takes her to the dock where the ferry will come and take them to the hospital sometime the next day but the father doesn't know if his wife and child will still be alive when the sun comes up. He sends his neighbor by rowboat to get a midwife from another small island without a hospital. She's got internet and (amazing to me) has read the Spinning Babies Website. She identifies the problem, does the technique and 15 minutes later the baby slips out--right into the sand!

 Yes, you can save lives even where no cesarean is available.

True Need: World expert Obstetrician in Frankfurt, Germany invites me to bring a technique to study after seeing me present in Brazil. Forward-leaning Inversion to allow a baby stuck sideways in the womb to turn and line up with the pelvis. His university setting would allow before and after proof. How will I leave necessary office tasks to prepare and oversee research. Other doctors, nurses, and midwives ask for research options for their sites.

True Story: British midwives, some of the best-trained midwives in the world, wait with a mother on a gurney cart outside an operating room. They have tried all the tricks of their training and the baby seems too big to be born naturally. The OR is being cleaned, however, and they have to wait. “As long as we're waiting,” they say to one another, “let's try that technique from Spinning Babies.” In 15 minutes, they call into the Operating Room, "Never mind, we have a baby in the gurney!"

True Need: Korean physician with a 10-bed maternity clinic has an 8% cesarean rate. She feels that rate is too high and knows Spinning Babies will reduce the unnecessary surgeries in her practice.  US rates of cesarean are over 32% and we know that 1/3 of all women are not unable to give birth if they were just supported to do so. She wants a protocol for when to do what.


True Story: A woman is induced at 40 weeks gestation and wants more than ever to have a vaginal birth of her 2nd child after a cesarean was done for her first. The midwives say her cervix is staying at 6 cm for 4 hours and she needs a cesarean. She asks for 1 more hour. Intense use of body balancing techniques including release of tight jaw muscles and then the sacrotuberous ligament changes the size of her pelvis and she dilates to 10 in 3 subsequent contractions. She pushes a long time but has her baby without any further intervention.

True Story: Midwife is about to give up after all her known techniques aren't helping a mother in a stalled labor. She texts me and over the next 14 hours I guide her through steps including releasing the jaw muscles, connective tissue holding the nose, releasing adhesions in the leg sockets and muscles to the pelvis. Her pelvis opens, as proven by the sudden increase of the size of the rhomboid of Michaelus (how much of her sacrum is seen under her skin) and she dilates to 10 cm.  The baby is born after much pushing. Not a one of these techniques is taught in midwifery school or medical training.



True Text: “I am stunned at the amount of learning that can happen at one birth even after nearly 20 years of going to births!”

This last comment is from my midwife friend Vicki who is both a CPM, the certification of the North American Registry of Midwives, and a CM, the certification of the American College of Nurse Midwives. Her excellent education didn’t provide the kind of answers to release the connective tissue spasm that pulled the mother’s tailbone into the path of her baby and stopping the birth at 6 cm. In fact, she had never read nor heard that body work that she herself could learn at a birth could change the size of a woman’s pelvis when the pelvis was only smaller due to something like a shortened ligament.



Some of the techniques are on the website and some have yet to be written down. Nurses and midwives need a “what to do when” reference. Where's the App? is as common a question as Where's the Book?







Many places in the world could use a picture book without much text to show midwives how to assess --without needing technology-- when baby isn’t coming out and what to do about it –without needing technology-- that the birth attendant just doesn’t have access to in remote locations, and parents can’t afford to pay for when it is available.

Some words from the book, A Path Appears, make me think to add some comments here. Some may assume making birth safer and less painful might make low resource areas even more populated. Nicholas Kristof and Sheryl WuDunn share that about 20 years after families stop losing some of their babies to the effects of poverty they self regulate to smaller families. Difficult birth not only harms babies but mothers, too. Long obstructed labors increase fistulas, hemorrhages (excessive blood loss), infection and incontence of the bladder and rectum. Easier birth is not just potentially enjoyable but improves health outcomes.

If Spinning Babies is going to contribute to massive improvements for birthing women, the office is going to need development and the book needs to be written!

It takes more than great ideas. Myriad steps include planning, legal advice, time management, design, production, coordination and love. It takes many of you to do a little and a few of you to do a lot.




Raising a child may take a village, but so will raising the understanding to help babies get born safely!

Would you or your family member have benefited from Spinning Babies information?

Did you or your family member benefit from SpinningBabies.com or something you learned from one of the workshops or products?

Would you have liked your birth to have been easier? And mothering more confident because of a joyful birth? Or even just a straightforward birth?

Would you like your birth practice to be more physiologic, have less interventions and more solutions?

Please donate to Spinning Babies and prove we can do this! Do it now, our time is short and our goal is big.

On the 6th day of labor in a birth center in Korea, a doula asked to try a technique she learned from Spinning Babies. The doctor agreed. “and to his surprise, mom was fully dilated and at +1/+2 and baby's head was OA. …C-section averted! Thank you so much for teaching me this. I am thankful that I was there and that my client had such an easy birth that I could help. Now, two more doulas know this technique. I had talked to them about them before but I don't think they believed until they saw for themselves.”


Watch the site for the pre-order option or donate to this effort. 

Bottom's Up

Last night I was with the wonderful Adrienne Caldwell as she led a small group of enthusiasts and parents through a hands-on protocol of massage techniques for Breech Balancing.

Wait, pregnancy massage like relaxation? 

No, massage is working with muscles and ligaments that have shortened from living in gravity to return to normal length and function. Shortened muscles are tight and may pull pelvic bones closed. Fascia may be released. Fascia is a thin but strong sheath of open membraneous fibers that carry fluid and so electrical current to help our muscles work and give our joints their range of motion.



Ok, but what is balancing?

Not too tight, not too loose.
Allowing baby the space to spontaneously move into a head down and bottom up position.



Three Chiropractors were present and learning from Adrienne. Parents come to learn what to do that may help a breech baby flip head down. This night a couple came for help for their posterior baby. I wasn't sure they needed it as they'd had two births without surgery before and this baby was then likely to rotate in labor. Some women prefer to be active in preparing for birth, adding balance and usually gaining immediate comfort.

Adrienne  was really sweet to me and said to the class, I'm going to suppose you've already done the list at
SpinningBabies.com on the Flip a Breech page.

Including

  • Moxibustion
  • Rebozo Sifting
  • Forward Leaning Inversion (from Carol Phillips, DC)
  • Breech Tilt
  • Open Knee Chest 
  • Diaphragmatic Release





Here are some of the things Adrienne Caldwell adds:

Address the front of the pelvis

  • Round ligament release (part of the Chiropractic Webster maneuver) or similar to a trigger point release on the under side and lateral side of the round ligament.
  • Release tension in the inguinal ligament.
  • Tensor fasciae lattae...
  • Posts release (See Liz Koch if you want full resolution!)


Wait, do you have to buy coffee to get babies to flip? Is it the caffeine, then?

No no, no caffiene. That's a muscle... there's another little one above that crossing under the hip bone down to the top of the leg joint. That's gotta loosen up too.

  • Side opening between the rib and iliac crest
  • Sidelying Release
  • And Leg circles. Lots of leg circles. 
  • Open the arms and shoulders. 


Why? 

Because the ribs and neck and all the body happens to connect through the train track of muscles and ligaments and fascia. And there's a few more for the pelvic floor, psoas, and respiratory diaphragm.
Massage therapist with special pregnancy training can do these things in a gentle way, respecting the looser joints of pregnancy and avoiding labor inducing ankle points and such.


Adrienne is establishing this wonderful protocol that she will teach at the Spinning Babies 2016 World Confluence and which may be recorded for distribution. Her intuitive hands and extensive knowledge of physiology makes her my "go-to" friend in learning and getting an occasional massage.
(Adrienne, when can you fit me in?)

Breech babies have a human right of birth. But where will such compassion and skill be found today? Not many places. So meanwhile, gentle art of breech balancing is growing. Nicole Morales, CPM, and Deb B. are having success in San Diego, Carol Gray in the NW, and Carol Phillips in Maryland. Deb McLaughlin in Duluth. There are several more people, too, lovely practitioners in our Minneapolis/St. Paul area. So many it is hard to list.  Chiropractors, like the three magical women that were with us last night, Sharon Prahl, DC at 7600 Parklawn (around the corner from Flutterby Birth Services where we meet in Edina), Amber Moravec in St. Paul at Health Foundations, and Angie Graper, DC. We also have Acupuncturists, and Massage Therapists, and you know I love CranioSacral Therapy and Myofascial Release and Maya Abdominal Massage.




Please, Mamas, start considering hands on help between 32 and 34 weeks. Don't wait much beyond that. We see success is highest between 32-34 weeks, with diminishing but continuing success for some women after 36 weeks.
If you've had a head down baby before or this baby was head down at 32 weeks before flipping it maybe easier to get baby head down.
If you are under 35, don't have a family history, don't have low thyroid, or a history of an accident including a twist, etc.
Otherwise start about 30-32 weeks. Is that early? I don't think so even though some others do think so.

You get to decide.






Thursday, October 15, 2015

Olive Marie's Elevator Birth: Using the Abdominal Lift & Tuck to Engage Baby

Melissa Thornton shares her fourth baby's birth story. She wouldn't have found it so funny if she didn't have other births to compare:

"I will start by saying that this pregnancy has been a major blessing from day one. I was sick in the beginning but after that felt great. I slept great, gained the right amount of weight, it was all just great. Her being a girl was just icing on the cake. All along though I did have this “fear/thought” that this would be a fast labor. Mostly based on the fact the fact that Zael’s labor was slow then super fast at the end. I thought for sure I could skip the slow part and go straight to the fast part. Ha. Anyways, Zael was born at 40 weeks and I thought for SURE she would be born earlier. Funny. Anyways. it gets to be 38 weeks and I decided that the baby is coming soon, so I get all ready for her. I still felt fine but mentally I was “done” with the pregnancy, bad idea by the way. That week went by then by 39 I thought for SURE this would be the weekend, I even went to the chiropractor to move things along. Nope. 40 weeks (my due date was on the weekend) I start having contractions, I walked, get ready, then after a day or so it all stops. That was fine, I was glad for the break. The following week I got my membranes stripped, which started contractions, but nothing real or strong. Every day that week I thought would be the day, nope. Finally on Thursday night I started to have contractions, painful ones. I tried to stay in bed but it was too painful so I spent the night watching Dance Moms (gag me) and laboring between 5-7ish min apart. I thought those were painful, and they were, now i think they were early labor. I let Michael sleep and woke him around 5:30am and told him about the labor. I wanted to get out before the kids woke up and I wanted to get to the hospital before it got bad.

We bring in reinforcements for the kids and get in the car, we drive to the hospital, the way there I had one contraction. Michael says “Well I guess you wont get that car birth you were worried about” (ha). We get to the hospital and they hook me up and it all stalls. Not 100% but didn't continue enough to stay. Not to mention a night of labor and I was at the same dilation and effacement as I was at the doctors office the day before. I was not a happy camper. I knew then that it had to be positional and she just wasn't in the right position (spinning babies became my go-to source). The nurses would say “she's just not ready” those are NOT words anyone wants to hear at this point of life by the way. Amanda (the midwife I saw AND has been at all of my natural births) told me my choices were to either stay and walk for a few hours or go home with a shot of morphine in my rear to help me rest. I COULD be induced but there were no rooms and we would sit in triage for hours and that meant monitors and wires. I chose the shot of morphine, best decision ever. The morphine helps you rest and kinda stops contractions while you are sleeping. When it wears off your labor either stops or picks up quickly. I went home, and basically laid in bed all day. I don't think I slept the whole time I just felt like i was laying on clouds..ha. I did have some contractions and when it was almost worn off I was woken by a strong contraction. I got up, had dinner, Mike took the kids. That night I went to bed around 8pm. And thats when the “fun” started. From 8pm until about 4am I had VERY painful contractions almost exactly 10 min apart on the dot. I read spinning babies and decided around 2:30am to try the Abdominal Tuck and Lift for 10 contractions. Of course that took about 1.5 hours. And it HURT but I really think it hurt less than the contractions without it; because she was shredding my bones with her sweet little head. Around this time I also called L and D and told them the situation, they said if the contractions aren't at least 5 min apart then Im probably not making progress (AHH!), so wait for that. They were totally full and had no room for me and that was probably part of why she said that. But I knew that the pain I was feeling WAS active labor.

Around 4:45 am I called Michael (keep in mind Olive was born at 5:30 am). Michael was sleeping in our little guest house, I called and said “mike, I need you to come in, I think we should go”. Soon as I hang up BAM, transition hits. I decide to take a shower (??) and I think I completed transition in the 10-15 min between the shower and brushing my teeth. Meanwhile Im screaming during contractions and Mike is like we have to go NOW! And Im brushing my teeth….

As he's dragging me out I feel like I need to go to the bathroom, when I tried to go and couldn't I knew I was getting “pushy”. I did NOT tell Michael, he was freaked out enough. Mikes mom still wasn't there but we had to leave anyway, the kids were still asleep. We get in the car and start the very quick drive to O'Neal. Only to realize that O'Neal is CLOSED (?), Michael turns the car around and is asking me how to go. I start trying to give him directions, through my screams…lol. It was those contractions that I tried just letting my pelvic muscles relax and I knew she was headed out the birth canal; my water bag was bulging. I was in the most uncomfortable position possible in his truck bc I couldn't sit down. Ok, back to the drive. I gave him the correct direction until O'Neal and Harrell's Ferry. So he went the wrong way and pulled into a parking lot that I have seen a million times but didnt recognize at that moment. He said “where are we? What way do we go??” I was in that stage of labor where you are fake crying/moaning/complaining. I looked around had no clue and said “I don't KNOOOOOOOOOOWWWWWWW :insert hysterical crying here:” Contractions coming like nuts, no breaks. By the grace of God he turned the right way. Somewhere in this time he called L and D and begged to have someone waiting at the door. They told him to meet them at the ER (a place we have never been). We FINALLY pull up at Ochsner, Mike then pulls into a parking lot, can't find the ER entrance, rides over a curb (big bump!) and pulls in at the front entrance (the same one we had used the day before). He gets out of his side of the truck and comes around to my side. Right as he opens the door my water breaks, I was like AHHH MY WATER JUST BROKE! He said just get out!! Lets get inside!!!! He tells me to sit in the wheel chair that he found but I couldn't sit so I pushed it in. The door was open, it should not have been open, a miracle. We go in the lobby, Im screaming. As we get onto the elevator I start to feel “the ring of fire”. I hear mike saying “what floor?” I know what floor but have no way of getting those words to my mouth. So he pushes 2 (its not 2). We get to floor 2 and it opens, I can see its the wrong floor, the door opens and Mike says something along the lines of “we need help!” two cardiac nurses get on. Out of the 4 of us on the elevator I was probably the least scared/nervous. While on floor two the elevator goes back DOWN to floor 1, the doors open and there is a couple standing there (I don't remember this as I was delivering Olive’s head at just that moment). For obvious reason the couple decides to wait for the next elevator. Before we FINALLY get to floor 4 she is completely born. Thank goodness for skirts rights? (I was standing up) Goo/fluid flies everywhere. 
All over my legs, the floor (gross!). I cant lift her completely bc she is still on the cord so I hold her on my belly. She cried a little, but just to be sure I flipped her and made sure she was breathing, she turned pink instantly. The nurse gives the ol’ “your doing a good job mama” but it doesn't hide the fact that she is totally freaked out. I sit in the wheelchair and they roll me out. 

I didn't know this at the time but Michael had run to the front desk and yelled “WE NEED HELP! NOW! WE JUST HAD A LIVE BIRTH!”. The nurse came and told me later that they thought that was super funny, ha! When I told mike later he realized how dumb that sounded too and he laughed at himself. I am wheeled into triage (where we will stay for 7 hours due to a lack of rooms even though Amanda had a nice room for me complete with a relaxing tub of water). I stand up, blood goes all over my shoes and legs; and I never saw those shoes again. They were my favorite but somehow they got lost in the crazy. I get on the bed and Amanda and another nurse come and say that they were waiting in the ER for us when they were called up because we were already there. She even told me about the nice room she had set up for me, boo I never got to see it. So i get on the bed, deliver the placenta, no tears, no stitches, not much bleeding. And all I felt was SERIOUS relief that it was over. They tried to clean me up, they weren't totally successful. But thankfully in about 10 min I was able to to the bathroom where the nurse cleaned me a bit better.

I am very glad that this was not my first natural birth, because although it was interesting and a great story it was NUTS. Im happy that I do have 2 other births to look back and say “aww, birth is such a beautiful event”. Also you hear stories of women giving birth in cars and get jealous, nooooo, the car is hands down the most uncomfortable birth position. 
 
So baby girl is here, she is THE calmest and sweetest baby I have ever had the pleasure of meeting. Which is good, because we named her Olive bc we needed a peace maker around this house! I have no idea how to wrap up this story but I hope you enjoyed it! :)"

-Melissa Thornton

Monday, October 5, 2015

Happy Breech-Cephalic Twin birth

 Midwife Jewel shares a happy birth story: "Kathryn came to me at 8+6 wks gestation. At the time her fundal height was more like 15-16 weeks. We talked about possibility of twins, dates being off, how she often measured large for dates early in her other pregnancies. She wanted to wait until 20 weeks for an U/S, but I think we both knew something was afoot and she had one at 14 weeks that confirmed twins. 


"It seemed like the most important thing was to find someone experienced with supporting a mom with twins and there just wasn't an option in Casper, WY. Plus, even though Kathryn had had 3 previous straight forward, no issues, VBACs (after a primary c/s for FTP ). [failure to progress, an obstetrical phrase generalizing a lack of progress leading to cesarean.] The local hospital has a VBAC ban and that was going to be an issue too. The most frustrating part I think was that the doctors kept stringing her along, perhaps thinking that she would just give and schedule a c/s. Little did they know of Kathryn's determination.

"I have a good friend in Boulder, a midwife," Jewel shares, "and I called to get some referrals and encouraged Kathryn to contact them. We continued to see one another monthly so that I could do Mayan Abdominal massage, review The Three Sisters, keep encouraging her to eat adequately for twins (enough protein etc) and just keep her spirits up. I think all of that played into the awesome outcome she had with her twins. She also did moxa with an acupuncturist several times and that may have helped turn baby A. Kathryn was doing Rebozo Sifting twice a day, and following it with a forward inversion. She was also doing belly massage and have done the sacral and pelvic release. She walked for 15-30 minutes each morning."

Kathryn, herself, adds:

After the childbirth options in Casper WY left me hanging, I decided to pursue other options out of state. My midwife was not able to deliver twins (per Wyoming state law), the OB I transferred to was a kind but was not comfortable (or very experienced) delivering twins naturally and counseled me to have a C-section. Further the local hospital has a VBAC [vaginal birth after a previous cesarean] ban and even if I persisted against my OB's wishes, I would still be met with a non-supportive hospital staff. 
My midwife and other friends helped seek out VBAC/twin friendly doctors in Denver Colorado (4hour drive). I interviewed the first doctor and felt very confident that he was the one (Dr Breeden) but in the week prior to meeting with him (33 weeks) we discovered that both babies were breech. ...I needed a VBAC friendly doctor who was not only  experienced with twins, but also willing to do a first twin breech delivery. 

I had been given Dr Hall's name, but felt inwardly nervous about a breech delivery. And of course, anyone I mentioned a breech not only thought I was crazy, but also thought I was taking my babies lives in my hands. While thinking and praying about consulting Dr Hall,  I continued with Spinning Babies recommendations for rotating breech babies. The website was extremely helpful. I started by keeping it simple (Rebozo Sifting, Forward Leaning Inversion, walking, rocking, staying upright etc). After a week went by but no shifting, I consulted a chiropractor and a acupuncturist. I also went ahead and made a future appointment to see Dr. [Michael] Hall. 
Just because of scheduling, I saw the acupuncturist first for Moxa treatment. I was able to see her twice before the babies came. One baby did rotate from full breech, to vertex/transverse, but would you believe it was Baby B!? So we were still looking at a breech delivery for a first baby and by now I was 35 weeks.
I went ahead and met with Dr. Hall, Denver's own breech specialist. We left the appointment with joy and peace! After almost 35 weeks of closed doors, a door finally opened that would allow a natural delivery. Praise God! Dr. Hall was humble and kind, he was informative and helpful, he talked with my husband and I for over an hour... Discussing breech birth, what it would look like, what the risks were etc. He even counseled my husband on how to deliver the babies should we not make it to the hospital in time. We talked about birth plans and how to facilitate this birth without having to make a drive in labor.

Dr. Hall asked us to come back at 36 weeks. The babies were both measuring big (6lbs) and the plan was have a gentle induction in Denver to rule out the risk of driving in labor (or going into labor in WY that would end in a C-section per hospital policy). At 36 weeks he would do a cervix check. If dilated we'd go ahead with the induction then, if not dilated, we'd hold out another week (37 weeks) and induce then. I wasn't thrilled with the thought of an induction, but considering the alternative (C-section) it seemed like the best thing.

At 36 weeks (a Thursday) we went down for my appt. I was dilated to 4cm, but Dr Hall was in surgery and was traveling out of town the next day. (still wish this had been timed better!) Dr. Hall's midwife told my husband and I that we should not go back to Casper, but should stay in Denver until Dr. Hall returned the following day. So we had a short "baby moon" and tried to relax and not do anything to get labor started, until our breech friendly doctor was home available to deliver the babies. It was a challenging few days for me-- it was hard to relax and wait, but we did our best! On Saturday, we started walking and actively trying to promote labor on its own. Sure enough, contractions began to get closer and more steady, coming every 3 minutes and hard enough to breath through. We didn't want to wait to long (we'd had a very fast labor with baby #4 and barely made it to the hospital) so we called Dr. Hall (he had given us his personal cell phone!) and headed in. 

As God had ordained it, the contractions all but stopped during our walk from the parking garage !! I was so disappointed I was crying by the time we got to L&D! Dr Hall was right there ready and waiting. They checked my cervix. I was still at 4cm 40%effaced, station -3) but they were not going to discharge me, pregnant with twins and a history of precipitous labor. 

We started the plan for a gentle induction, and all Dr. Hall did was strip my membranes, and tell me to start walking. We walked and walked. I rocked on a birth ball, hit the jacuzzi tub, practiced lunges in the hallway, but labor would not start up again. It was evening by then, and so we just went to bed. Contractions seemed to appear and get harder while I was lying down, but almost disappeared when I got up and moving. This was unlike anything I'd experienced! After a rough night trying to sleep in a not so comfortable hospital bed, I was ready to give up and go home the next morning! 

Dr. Hall came in again that morning. Did another cervix check, now 5cm, and 80%, and said he really didn't like inductions, especially not with VBAC's and breech births, but said given my situation (multi para, history of fast labor, twins, breech, distance to home) he couldn't think of a reason to send me home. We couldn't think of a reason either (except that I was still a little nervous about an induction, but really what else could we do than indefinitely wait in Denver for labor to start?) So we decided that he would let us rest a bit and then come back to break my water. 

Anesthesia came in to discuss my options during this respite, and I declined an epidural or any pain medication. I had been on the fence about possibly getting an epidural placed (but not used) in case of emergency and need for c-section, but truly felt that Dr. Hall would do all he absolutely could to deliver these babies naturally and if it came down to a section it would be a true emergency (not a convenience thing). And in a true emergency I was okay with being knocked out with general anesthesia.

When Dr. Hall came back and broke my water. Later that afternoon things progressed very quickly. They placed an internal monitor on breech baby A which allowed me to get out of bed and move around while still keeping track of my little breech baby. [This is not typical, but then, neither is a breech Baby A in twins.]

With my water broken, it took about 10 or 15 minutes before I felt regular contractions but then I dilated rapidly. from 5cm to 10cm in less than an hour. Maybe less than half an hour. 

We called the nurse when I hit transition and the Dr Hall came right in and checked my cervix (we later found out he has never left labor and delivery but stayed close by so he could watch the babies-- they say he loves his breech babies and twins). While he checked my cervix, they got the team ready to take me down. 

By the time we got to the OR I was ready to push but needed to wait until we got situated. There was a huge team of medical professionals (anesthesia and her team, pediatrics and their team, OR nurses, L&D nurses, my doctor and his team, and a handful of random medical professionals who just wanted to watch). And they all hustled to get ready. Once we were all set (this seemed to take a while, but it was really only a few moments), I was moved to the OR table, where I laid on my back, with my legs resting in stirrups (not my feet). This would allow for me to deliver the baby at an angle that would let the breech baby dangle. It was an awkward position, but we had agreed on it before hand and Dr. Hall thought it the best/safest way to deliver a first breech twin. 

Once on the table, I was given the okay to push with the next contraction. Dr. Hall had also instructed me to push hard and stay focused as he didn't want that breech baby getting into trouble. So when told to push, I pushed!! Baby A, our dear sweet Abigail, was born in just two pushes. She was born breech, with her hands raised up over her head as though in victory! :) it was truly a moment of victory and excitement! She was here! The breech delivery was by far the most painful of my births, but it was over so quickly and the reward so sweet, I've all but forgotten. 

They right away put her on my chest, and delayed cord clamping, but only for a few moments as it was Baby B's turn! 

Dr. Hall manually positioned Baby B, who had been sitting transverse/vertex and she came down head first. She was born just 3 minutes after her sister with just one push. Baby B, Elizabeth Hannah,  was put right on my chest and had delayed clamping her cord for quite a bit. Time stood still as we reveled in the joy of two healthy babies!

Next was the enormous placenta, which never got weighed, but it was likely the size of one of the babies. I was so wiped out I did not want to push anything again, but I did. Dr. Hall said he'd never seen such a healthy twin placenta. It had been two placentas, but they joined together during the pregnancy hence the large size. 

It was over! My twins were here and here safely. What joy and amazement! The hospital staff just about cheered, and people kept congratulating me as they packed up the OR. Dr. Hall gave me a huge hug and stood by me stroking my head and praising me for making him look like a breech specialist. It was a touching moment.

Both babies, though fraternal, weighed in exactly the same 6lbs 12oz each. I was commended again and again for the size and health of the babies, twins born at  36 1/2 weeks. The twins were so healthy and did not need intervention or NICU time. 

This took me weeks to type out, but was such a wonderful way to process the birth of these girls. Everything went so smoothly and in hind sight I don't think it could have gone better. Truly what a miracle it was to find a breech doc and then to have an experience like this with two beautiful healthy babies. 

Thank you, Jewel, for all your help and support in this process!! I'm grateful for you in so many ways. Despite the, often time, unsettling circumstances , God really showered his blessings on us and caused us to trust His plan. We are so thankful."

Gail adds: It's wonderful to read about breech and twin births
happening in a variety of settings.
Would you like to share a story with me? Email it in a reply here or start a new thread.
I like to include stories that show use of Spinning Babies topics, of course! This month we are sharing a happy outcome when Spinning Babies didn't work!  

Thursday, September 3, 2015

Birthful podcast with Gail and Adriana

What is the key to an easier birth?
How do we get there?
Adriana Lozada interviewed Gail on her wonderful Mirthful Podcast.


Hear the inside scoop on the beliefs I share through the message of Spinning Babies. You'll hear about birth anatomy in a totally new way. More than the basics are given, so get your cup of tea. If you have a doll grab it for late in the podcast and line your baby up in the baby positions with Gail and Adriana.

Here's some illustrations that will help you understand the baby positions and pelvic shapes!









What is Dip the Hip? See it in action here, http://spinningbabies.blogspot.com/2013/04/deb-lawrences-dip-hip-circles.html
After this podcast I got some really good body work on my respiratory diaphragm and the sexy breathiness is now gone. Sigh.

Wednesday, September 2, 2015

Preventing The Epidural Labor Stall

Here's a picture from an Austin, Texas Spinning Babies Workshop of a labor progress technique shared by Dr. Diane Peterson, OB.

Purpose: Engage the Baby into the pelvis when mother is on an epidural and can't stand up for the Abdominal Lift and Pelvic Tilt.

Gail was a doula in Minneapolis, long ago before she had the knowledge of Sidelying Release. At one birth, Dr. Diane suggested we help baby move down into the pelvis by draping the determined mother over a ball and having her rock in a wide, and circular motion. The nurse and I stood close by her sides holding her shoulders to keep her from coming off the end of the hospital bed. I would call this extreme circling! It wasn't super fast, but the circles were large.

See how the workshop participant shows how the mother would place the birth ball between her crossed legs? She'll lean further forward as the birthing woman is leaning over her pregnant belly, too!

One hip rises off the bed on the opposite side from the furthest arc of the circle (the direction she leans). After 40 minutes, Dr. Diane checked the baby's progress again. Baby was in the pelvis at last. 

Considered the Cadillac of Pain Relief, Epidural use is common in the technological birth care model.  Few women choose natural birth and so few providers know how to support a vaginal birth with an epidural in place. We can offer good solutions to either avoiding the desire for an epidural or to situations in which the labor may be longer due to the epidural.

The side effects of injecting narcotics between the membranes coating the spine, however, may lead to side effects and, thus, more interventions.  A large review by Anim-Somuah found cesarean section due to fetal distress are more common with an epidural than without an epidural.  A common reaction is a sudden lowering of the mother's blood pressure which may cause a later change in baby's heart rate. Kristen Kjerulff, MA, PhD, found that epidurals increased cesarean 36% compared to 8% without, and inductions more than doubled a woman's chance of cesarean. Very few mothers or babies die or are injured by epidurals. An epidural is not without unwanted and unforeseen emergencies.


A recent review by Jones of studies on alternative comfort measures (not including Spinning Babies or doula care) was done. "There is some evidence to suggest that immersion in water, relaxation, acupuncture, massage ... may improve management of labour pain, with few adverse effects. ... Relaxation was associated with fewer assisted vaginal births and acupuncture was associated with fewer assisted vaginal births and caesarean sections."

Few providers, today, know how to support a vaginal birth when labor slows down or the baby's tipped or sunny-side-up position delays birth. We can offer good solutions to help women have more satisfying birth with and without an epidural.

When a woman has an epidural, many of our favorite techniques are being used when baby's position is not ideal and/or labor progress is slow. Here are 3 ways of using techniques from the Spinning Babies Website may help avoid cesareans even when a woman has an epidural.

1.) Myofascial Releases
The relief from myofascial body work before and labor may potentially eliminate the woman's desire for an epidural since pain relief by natural means may now be sufficient. 

Our most popular myofascial (muscle and fascia, or connective tissue) technique is the Sidelying Release.  Another technique, popular around the world is called Shake the Apple Tree. Vibrating the buttocks as done in this technique might be considered a rudimentary myofascial release.

2.)  Static Stretch
Nurses have even told me they do Forward Leaning Inversion (only during and between 3 contractions per  inversion). These innovative care givers help the mom into an "elbows and knees position" facing the foot of the bed and then lower the foot section of the bed so the birthing woman's head is lower than her knees. Steep inversion may help the cervix dilate easier afterwards. Follow up by resting on the left side and placing the peanut ball between her thighs and calves.

3.) Open the Pelvis Where Baby Waits
Epidurals can add length to the pushing stage of labor. Let's examine ways to counteract the slowing effect by making more room in the anatomical space of the pelvis.

We don't just randomly seek techniques to open the pelvis at Spinning Babies. We ask the nurse how high or low the baby's head is and match a technique from the level of the pelvis that baby waits.
Listen, if you heard a knock at the door, you don't just open any door. You don't open the door nearest you expecting the person to enter. You open the door next to the door bell. Otherwise you are only opening the correct door by chance of your location, not the guest's location.

The same is typical of us birth workers. We'll use a favorite technique that works a lot of the time, but may not be specific to where the baby is located. We can improve our success by matching the technique to the height of the baby in the pelvis.

Using a peanut ball between the mothers legs allows the legs to be positioned to open either the inlet or the outlet. An internal rotation of the femur will open the outlet. This puts the mother's knees closer together than her ankles! Sounds contrary to tradition, but this makes the ischial tuberosities further apart.

Rest Smart means, after balancing with myofascial release and static stretch techniques, the mother rests in a gravity friendly position. Place the thighs (femurs) in a position that also helps open the level of the pelvis where more room for the baby is needed.

Conclusion
Epidurals are a mix of narcotics and other drugs injected in between the membranes of the spine. Epidurals can cause fluctuating vital signs which can be dangerous and may lead to an emergency cesarean. Other side effects allow for more time to try non-surgical solutions, such as those listed here. The epidural is the best medical pain relief available today. Natural alternatives may help many women cope satisfactorily without narcotics.

References
Anim-Somuah, Millicent, Rebecca Smyth, and C. Howell. "Epidural versus non-epidural or no analgesia in labour." Cochrane Database Syst Rev 4 (2005).

Cheng, Yvonne W., et al. "Second stage of labor and epidural use: a larger effect than previously suggested." Obstetrics & Gynecology 123.3 (2014): 527-535.

Kjerulff, Kristen. "Effect of Labor Induction, Epidural Analgesia and Centimeters Dilated at Hospital Admission on Risk of Cesarean Delivery at First Childbirth." 143rd APHA Annual Meeting and Exposition (October 31-November 4, 2015). APHA, 2015.

Saturday, August 29, 2015

Timeline for Fetal Position

Babies follow a natural progression to settle into the final birth position. Well, not exactly final. So I call it, the starting position for labor. It almost always changes for baby to rotate through the pelvis.
Oxorn and Foote, Obstetric text book authors, state that most babies are in position at 34 weeks gestation. This means that fewer babies will change position after 34 weeks.
We assume that the moms in obstetric studies were not balancing out their tight muscles and short ligaments. They weren't using Rest Smart positions themselves and they weren't going to get body work and Chiropractic/Osteopathic.
My doc isn't concerned about the position until 36 weeks. You have plenty of time for your baby to move. -- post on Glow


If you spend any time on this website you will know that I don't exactly agree with that statement. Baby's don't move at random. Their position matches the shape of the room within the uterus. This space is shaped by the abdominal and pelvic muscles, ligaments, and connective tissue (or fascia). The mobility and alignment of the pelvis also make a significant contribution.
So, will the baby move into an ideal starting position for labor at 36 weeks? Depends on the room in the womb, I believe.
Add balance and babies move in response to the room created by the release of tension or torsion in the soft tissues and joints. Tension comes from living in gravity. I don't necessarily mean emotional tension. I mean tightness in the muscle, a muscle, several muscles. This effects mobility and alignment.
We know that in the second trimester that babies are often laying sideways in a transverse lie. Some or oblique (diagonal).

Timeline for fetal position

26 weeks or so

Babies begin to move to a vertical lie, which means either head down or buttock down. A few more will wait to go vertical until 28 weeks and fewer at 30 weeks.
28-30 weeks, the breech (buttocks/pelvis coming into the mother's pelvis before the head does)  baby often flips head down.
A few more will move head down by 32 weeks.
Gentle balancing can be done throughout the pregnancy with the Daily and Weekly Activities listed on this site and other ways of moving in pregnancy.

28-30 weeks

You may like to get more active about body balancing if baby isn't head down.

By 32 weeks

If baby is breech or sideways I suggest getting serious about self care techniques, such as the

If you have a history of difficult pregnancies or births, cesarean or babies in positions that are challenging, then you might want to get serious earlier. Start early, even before pregnancy if you have a history of car accidents, sports accidents, or work and activities that twist you and make a jolt or sudden stop, like soccer, baseball, running, massage therapy, Chiropractic adjustments from the side, lifting patients, throwing bales of hay, that sort of thing...
If baby is breech at 32 weeks get started with flipping activities in earnest and add professional body work no later than 34 weeks. - unless of course, you don't know you should have done this because you've been told it doesn't matter until 36 weeks.
See the Breech Timeline of when to do what in the Breech Section under Baby Positions.
If baby is transverse at 32 weeks, read that article and do the activities listed there.

Left Occiput Anterior 

At 32-35 weeks

Many babies still switch sides. You may feel the weight and mass of the baby switch, but is it your womb leaning or is it baby changing positions?
Tell by where the baby kicks, if that changes, too, then baby changed positions. If baby doesn't switch sides to kick, then the womb and the baby inside it are simply leaning over. Ligaments around the womb are loose. Wear a pregnancy belt for walking and doing activity like house and yard work.
By 32-35 Weeks, if baby favors only your right, and kicks towards your left:
Don't panic, but don't ignore it. There is a gracious center of activity without stress. May we all find it.

By 36 weeks

We expect baby to settle in, change position once or twice a week if there is room, if not, we are hoping baby favors the left by now.
LeahJeff8mos

During the 38th week

Many first time mothers' babies engage. If balance and flexibility are well established this may be less important to have happen. If baby has fingers wiggling in front, add balance. The lack of engagement is an issue for the posterior baby in starting labor or keeping labor going.
At 40 weeks, take a lovely walk and bath. Do something unrelated to pregnancy. Enjoy yourself and don't worry about when the baby is coming. Give yourself a break.

At 41.5 weeks and more

Serious focus on fetal position and engagement takes up your day but again, be chill about it. Just be focused on 3 x a day doing the engagement activities. If baby is truly in a good position, and many providers say so without knowing much about fetal position in detail, then you only have to deal with the politics of labor onset and not likely the actual challenge of helping baby engage to start labor.
Walk and make love. Changes are a'coming.

In labor

Labor wants baby engaged before labor will open the cervix. Since engagement is a result of fetal flexion and fit in the brim and an aligned brim makes engagement easier, balance and engagement activities are useful in early labor. A start and stop labor pattern is a clear sign that engagement help is needed.
Flexibility and softness helps gravity be more effective. Once a series of balancing activities have been done, gravity helps labor progress.
In a fast labor, just hang on and try to relax. You don't likely need to concern yourself with baby positions. You may want to get low to the ground if baby is coming so fast that you aren't prepared with someone there to catch!
In  a long labor, its all about softening the way and moving the pelvis at the level where baby waits to pass by. Using techniques randomly gets random results.
When baby needs helping engaging, Abdominal Lift and Tuck is specific.
When baby needs help turning from facing the side to face the back, and get lower than 0 Station, or half way, then Sidelying Release and the standing lunge or a lunge in bed or resting the leg over a peanut ball.
When baby needs help at the outlet, the nurse or midwife sees a bit of the head, but labor isn't bringing the baby lower very fast, open the outlet with a squat, an anterior pelvic tilt or put your knees closer together and your feet further apart and push in that position. Please consider the birth stool!

Lots of Labor lore and techniques are discussed in Spinning Babies; Parent Class. Stream it to your device, download, or buy the DVD before labor starts so you can get familiar with it.

Enjoy your labor! Its amazing to open up and let a brand new human being into the world!

Wednesday, August 12, 2015

You can tell if your baby is engaged

Engaged or not?
Sometimes the posterior baby's head seems low in the pelvis when checked by vaginal exam. The nurse, doctor, or midwife feels the dome of the head and it doesn't wiggle. So, they think, the head is not ballottable, and that equals engaged. Therefore, the head is engaged.

But that estimation is wrong when baby's facing the front with her or his forehead on the pelvic brim. If the forehead isn't in the pelvis we can't claim engagement.



Ask, Is baby overlapping the pubic bone?
Lay down and feel for your own pubic bone. Now feel just above your pelvic bone. Is there  a little bump, or ledge touching it? Does this object stick out further from your spine than your pubic bone or do you have to reach into your belly skin to feel the firmness of the head?
Pregnant Women can tell if the baby is resting on the pubic bone. Midwives can help them determine whether the head is overlapping or not. They may need to have the possibility of an overlapping head pointed out to them. Its not in the text books. Its only here, at Spinning Babies!

Is baby Occiput Posterior and unable to engage?
If the mother feels little hands wiggling on either side of her center line (the linea nigra of pregnancy) then she can be pretty sure she has a posterior baby and that any bump on the pubes that is not her is, indeed, her baby's forehead.
Compare OP babies 
Is the baby in an ideal position and simply waiting to engage?
Sometimes a woman has a very steep inlet with a pelvic cavity that sweeps back in a 90 degree turn from the inlet. Then a Left Occiput Transverse baby will slightly ride on the pubic bone. The hands will not be felt on the same side as this baby's back. She will have a little ledge at the top of her sacrum which seems to make the buttocks rounder. They rise higher due to the tilt of the sacum. This normal variation can make early labor longer. The tip below can help make engaging baby easier.
Remember, most first babies engage by 38-39 weeks. Engagement seems, practically speaking, like it may be easier for baby if the pelvis is aligned.  A long walk in flat, soft soled shoes helps engage babies. Walk regularly in pregnancy.

Once labor contractions begin, engagement has a friend
Uterine contractions seem to want to help baby engage. That's more important than dilation until engagement occurs. Even if you don't know baby's position, doing a series of posterior pelvic tilts with abdominal lifts during ten contractions
is a technique that is likely to help, http://spinningbabies.com/learn-more/techniques/other-techniques/abdominal-lift/.

  • The OP baby may rotate and then engage
  • The LOT baby engages for the mom with a steep brim
Learn more about engaging babies in the previous two posts on this blog.

References

Debby A Clinical significance of the floating fetal head in nulliparous women in labor.  2003 Jan;48(1):37-40.

D. M. Sherer* and O. Abulafia Intrapartum assessment of fetal head engagement: comparison between transvaginal digital and transabdominal ultrasound determinations Volume 21, Issue 5, pages 430–436, May 2003


Sunday, July 26, 2015

Engaging Baby in Labor


Engagement of the baby into the pelvic inlet (brim) is important because to fit through the pelvis, baby has to get into the pelvis first. Engagement is when the widest part of baby's head enters the true brim of the pelvis.


Figure 1. Diagram depicting the fetal head immediately prior to engagement. The straight black arrow depicts the scanning plane at the level of the pelvic inlet, utilized to depict the presence or absence of engagement of the fetal head, with the transabdominal transducer placed in a transverse fashion above the maternal symphysis pubis opposite the maternal sacral promontory. The curved black arrows depict various possible scanning planes, which may assist in depicting the fetal biparietal diameter either below or above the pelvic inlet (engaged or not engaged). The dashed lines indicate the scanning planes utilized in obtaining Figures 2a and 2b. Note the fetal head is in the left occiput transverse (LOT) position, correlating with Figure 2. (Modified from Norwitz et al.2). http://onlinelibrary.wiley.com/doi/10.1002/uog.102/full


Yes, but if baby doesn't engage at 38-42 weeks, won't baby engage in labor?


Many do.
One study, back in 1999, showed that only 14% of first time mothers went on to cesarean, but in that setting the cesarean rate was normally far lower. My, how times have changed.
Non engagement of the baby is one "flag" that tells us to pay attention to body balance and fetal position. After adding balance, many babies rotate and engage with labor contractions. Labor really is useful!

How can I tell if my baby is engaged?


Tips to tell if baby is engaged. Is baby in ideal starting position which support easier engagement
(but doesn't guarantee it, obviously).
Does baby overlap the pubic bone in early labor or active labor? Is baby Occiput Posterior or Left Occiput Transverse?

How can I help baby to get engaged?

Things that help fetal flexion increase engagement.

Adding body balancing will help a long, free stride, walk in soft soled shoes engage baby.
Some people walk the stairs, sideways, holding the railing, up and down one side and then the other. Go both directions on both sides, to get the best pelvic movement.

Deb Lawrence's Dip the Hip (Figure 8s) or otherwise, releasing the lower back muscles and ligaments to the pelvic crests at the back of the pelvis.

Contractions have not started yet, and/or

Membranes released (water broke) but no contractions yet


Circles on a firm birthing ball. Not so much the up and down bouncing... if the baby's head is on the pubic bone, that is going to be tough on the baby. But flowing circles and figure 8s will also loosen up those pelvic attachments just mentioned and help your little egg drop into the cup of your pelvis.

Psoas Muscle Release (or resolve short psoas issues at www.coreawareness.com)



Will Breaking the Water help baby engage?

Yikes! Please no! Well, in some cases this may work really well. In many cases, its nearly the same as signing the cesarean permission form. That's said pointedly. Add balance and then movement first if you can.

Adding body balance may help baby engage, because engagement is as nature intends, and adding balance returns your innate design closer to that which nature intended for you.


With contractions to help baby engage

Now we're talking. The first task of contractions (other than the practice contractions of pregnancy) is to engage baby. Some babies must be rotated first, and we hope the first baby, or VBAC baby, enters the pelvis from mother's left side. But flexion, chin tucking, is the most important indicator of vaginal birth. I believe that entering the pelvis from the left gives the first baby the most opportunity to tuck their chin.

There are techniques on Spinning Babies that have anecdotal claim of helping engagement.

The circles on the ball may be effective in engagement.

The next three techniques only work with contractions! They do not work in pregnancy.

Posterior pelvic tilt. Flatten your lower back so that your arm can't fit in the space where your lower back curves if you flatten it against the wall. This would only be effective with contractions!

One favorite of mine is Janie King's Abdominal Lift described in her book, "Back Labor No More." I add a posterior pelvic tilt to the "belly lift" and find even greater success for babies that are still high once labor is active.

Walcher's "Open The Brim" is specific to engaging babies at the inlet and has been studied. This is a common technique in Germany and other places in Europe. Its intense and often successful.




References for Engagement



Caughey, Aaron B., et al. "Safe prevention of the primary cesarean delivery." American journal of obstetrics and gynecology 210.3 (2014): 179-193. (...it may be necessary to revisit the definition of labor dystocia because recent data show that contemporary labor progresses at a rate substantially slower than what was historically taught.)


Debby A1, et al. Clinical significance of the floating fetal head in nulliparous women in labor. 2003 Jan;48(1):37-40.  (A persistently floating head with advanced cervical dilation (7 cm) should prompt consideration of cesarean section since little is to be gained by waiting. ) [OMG, Walchers!]

Ghi, T., et al. "Sonographic pattern of fetal head descent: relationship with duration of active second stage of labor and occiput position at delivery." Ultrasound in Obstetrics & Gynecology 44.1 (2014): 82-89.  (13.5% of babies were posterior with a 50% cesarean rate. Posterior babies came down through the pelvis better if flexed as told by observed Angle of Progression.)

Haberman, S., et al. "OP22. 08: To evaluate the value of the determination of occipito posterior position before head engagement and risk of persistent OP and Cesarean section." Ultrasound in Obstetrics & Gynecology 38.S1 (2011): 121-121.  (Before engagement, 76 (43%) fetuses were in occiput posterior position (OP), but 67 (88%) of them rotated to occiput anterior (OA) during labour. Eleven (6%) fetuses were delivered in OP, and 9 of them were in OP before engagement (P < 0.001). 22.4% of cases in the OP group underwent Cesarean section compared to 12.7% of controls (P < 0.001).

Kelly, Georgina, et al. "Women's Perceptions of Contributory Factors for Not Achieving a Vaginal Birth After Cesarean (VBAC)." International Journal of Childbirth 3.2 (2013): 106-116.

Khurshid, Nadia, and Farhan Sadiq. Management of Primigravida with Unengaged Head at Term Placenta 4.2 (2012): 4.
 (The incidence of high head in primigravidas at term was 22%.The most common cause was deflexed head, next was cephalopelvic disproportion. In 40% no cause found. Vaginal delivery occurred in 67% of cases, 33% of cases had caesarean section. No interference i.e., ventouse or forceps required in 60% of cases. In 64% cases labour lasted more than 12 hrs.)

Shaikh, Farhana, Shabnam Shaikh, and Najma Shaikh. "Outcome of primigravida with high head at term." JPMA. The Journal of the Pakistan Medical Association 64.9 (2014): 1012-1014. (The most common identified cause of non-engaged head was deflexed head in 28(28%), while no cause was found in 45(45%) women. Further, 45(45%) women presented with spontaneous labour, while labour had to be induced with prostaglandin in the rest. Vaginal delivery occurred in 59(59%) cases and caesarean section was performed in 41(41%). The duration of labour was <12 32="" cases.="" hours="" in="" p="">

Verhoeven, Corine JM, et al. "Does ultrasonographic foetal head position prior to induction of labour predict the outcome of delivery?." European Journal of Obstetrics & Gynecology and Reprod Biology (2012).

Best outcomes for first time mothers with unengaged babies were found in this 1999 study: 

Roshanfekr, Daniel, et al. "Station at onset of active labor in nulliparous patients and risk of cesarean delivery." Obstetrics & Gynecology 93.3 (1999): 329-331.iology (2012).

Best outcomes for first time mothers with unengaged babies were found in this 1999 study: 

Roshanfekr, Daniel, et al. "Station at onset of active labor in nulliparous patients and risk of cesarean delivery." Obstetrics & Gynecology 93.3 (1999): 329-331.
The rate of cesarean was still dramatically higher for the unengaged, but wasn't near 50% higher as in four other studies. In fact it was 19%, less than 1 in 5. Today 1 in 3 of all women deliver by cesarean section. So I'm not sure what we can derive from this fact. 



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.