Saturday, January 10, 2015

After the External Cepahlic Version

After a breech is turned head down by the doctor in a manual,  external cephalic version some babies end up with limbs over their head or similar mix up. Here's a suggestion, 
To help resolve a compound presentation or twist, it is up to the mother if she wants to do the balancing work.

An external cephalic version is  a technique by a doctor or midwife to turn the baby head down manually by pushing the baby via the abdomen. ECV has a set of risks of its own, including a difficult birth afterwards. ECV works about 50% of the time, with a few midwives and doctors having better rates. No technique is without risk, no life is without risk.

Baby's heart beat should be listened to carefully before and during and after the ECV.  Pausing when baby's heart rate drops, stopping if the baby doesnt respond well to the next attempt to turn the baby more, and doing an emergency cesarean if the heart rate doesn't come right back up are 3 ways to protect baby and reduce the small but present chance of death. Please don't push the baby around at the Chiropractor, massage therapist's office or your girl friend's house. It can be done gently, but baby needs to be listened to.

Want to find other ways to flip a baby? These are gentle, mother-led, baby-responded to techniques that have good results and can be tried before the ECV to work or to make the ECV work more easily without force. NO technique is without risk. Check with your midwife or doctor before setting out on a series of activities to flip your baby. Bring information with you as they may not understand why you would get upside down in pregnancy. Its all about the ligaments!

After the ECV, women can do things to make the upcoming head down birth easier. Actually, if the ECV doesn't work and the mother goes for a vaginal birth (with a skilled breech care provider, I hope!) these will help the mother's muscles be more balanced for birthing.

Some women will begin with a gentle but persistent rebozo with her on hands and knees, not knee chest and not vigorous! -  just gentle for as long as the helper can do it, 3-6 minutes? 10 minutes?. Rebozo the tummy then buns.

She may benefit by doing 5 forward leaning inversions in one day for only 30 seconds each. These may be key. Not with high blood pressure or risk of stroke. Avoid doing with heart burn.

Then do Sidelying release and Standing sacral release. How to do these are on Parent Class, which you can download now.

When labor begins in earnest, she may benefit from 10 abdominal lift and tucks (posterior pelvic tilt) during the contractions.

Here's a sample issues that SOMETIMEs occurs,
ECV worked!  They decided to stay and get induced.  Baby tanked during version and I think they were nervous and wanted to be in hospital...[Baby recovered well and induction was attempted.] 
Now it's 3 days later and many doses of cervidil and cytotec later her cervix still thick and closed. Baby is high [above pelvis] and not engaged.  I sent her the page from Spinning Babies about ways to engage baby but so far she hasn't had much change...  I wonder if there is something else going on??   
Her and baby both healthy, baby doing well, waters intact etc.  I don't know if she just needs to have more time until she's ready or if baby is trying to tell us something...

What baby is trying to say, is head down is not enough. We must resolve the twist that may be there and that had caused the breech position in this case. Balance first. Check out The 3 Principles of Spinning Babies to see more on Balance.  

Sunday, January 4, 2015

Birth Detective: Why didn't my OP baby come down? Part 3

This is Part 3, Read Part 1 to start from the Beginning,
Read Part 2.

Jessica processes her birth

"Hi Gail, 
  "I know I was at 0 station for sure. I will request my birth records as well to make sure. I have joined my local chapter of ICAN and have already found tremendous support! Thank you so much for suggesting this.  They did say he was Left OP. Does that mean he was facing my left side? He was favoring my left side my entire pregnancy it seemed. I felt hands up front down low and kicks up near my ribs on my left side. I also had a dip I my belly that was visible.

  "I think where I gave up and lost faith was when the second epidural kicked in and I lost all feeling in my legs. I was numb up to my chest and remember thinking how am I going to feel the urge to push and was disappointed but relieved at the same time for the ease of the pain. It was such a blur at the end I remember thinking how am I going to get through the rest of the stations if I was at zero for so long. I wish someone would have told me I could do it and gave me encouragement. At that point all I wanted was to be done unfortunately. 

   "I wonder if they can label the reason for my c section as "failure to progress" if they didn't say it was required or "an emergency" The OB said there was a 5% chance I could push him out after giving me Pitocin (if I wanted it at that point which I didn't because I was delirious and wanted it to be over). My OB also told me my white cell count was so low they had to call the first response team to be on stand by for me if my numbers didn't turn around. I wonder why this happened? Maybe because my body was working on overdrive (no food or sleep barely for over 24 hours) etc."

Gail replies:

Would pitocin have helped, you ask? Was there really just a 5% chance? I think your doctor meant that stronger contractions were not likely what was needed. This usually means that the contractions were seen to be strong enough but baby wasn't coming down. But he doesn't want to say 100% because he knows that the unexpected can happen in a good way, too.  

Back to Pitocin as a possible solution. 
The implied question is, Can increased power of the contraction force baby through the pelvis? 

The Spinning Babies look at labor progress is to the diameters of mother and baby and how they are lined up at the time of a labor stall or stop.

Spinning Babies approach to childbirth is to "balance" the passage, so to speak, by releasing what is super tight or lengthening muscles or ligaments that are shortened (tight); Opening the diameters at the level of the pelvis where baby is stuck (in your case "0" station); and a myriad of other factors supported by physiologic means. 

If Simon were OP at 0 Station and your sacrum was tucked in from a short sacrotuberous ligament, then releasing that ligament would be about the main thing, maybe the only thing, to do. Doctors and Midwives are not trained in this. A few doctors are trained to reach in, tuck the chin and turn baby's head all the way around manually. Some do this with forceps.
Not easy on mom or baby, typically, but can reduce cesareans. 

If Simon were OP and you kept going, [you may have] had 4-10 or more hours of pushing on birth stools, standing and hanging from a rope above them, hands and knees and every movement and every effort at full blast [but you] had a fever or low white blood count. That is a deal breaker and cesarean is preferred to preserve mother and child.

Essentially,... you had neither the time (due to the white blood count) nor the personnel to help you with a posterior baby and a sacrum that was pulled into his path.

This is tough stuff to read, Jessica. You didn't do anything wrong or unusual, you were living your life - we all live in a gravity field meaning we have issues of tension and sometimes torsion in our bodies that we don't even realize. Once in a while a woman will have just the combination of several issues compromise her birth, such as complications of fever or other signs of infection and an OP baby. 

Next Birth Will the next baby be Posterior, too? 
Resolving the causes that held this baby OP will help the next baby get to the Left Anterior, that would give you a tremendous boost towards a VBAC. Body balancing and core flexibility rather than core strength are emphasized. A little bit probably won't help. Go for it!

Now that you are narrowing down the likely causes, you can address them and have a much better time next time. I've worked personally with many dozens of VBAC women with a birth history like yours that went on to have a second baby vaginally.  

Getting body balance and a strategy to maintain balance and flexibility can be a lot of work, but I know you are up to it. 

Saturday, January 3, 2015

Birth Detective: Why didn't my OP baby come down? Part 2 of 3

This is part 2 of 3, Read Part 1 

Jessica wrote back,

"Hi Gail! 

Thank you SO much for responding.Your time and reply mean so much to me especially as I have been feeling down and out because I felt like "I wish I would have known he was OP etc. and I wish I would have had adequate support to birth how I planned etc."). Here are my answers--

1. Do you have a photo of you baby's molding? That will help me understand his position over the last hours of your labor. Flexed or extended (chin down or up) or posterior or did he rotate? (Photos attached! He did not rotate) [Jessica's answers are here in bold (with her parenthesis) and my comments are here in brick red.]

2. Did you have Pitocin in this labor? Were you offered it? No, I did not want Pitocin going into it. I was offered it at the very end, only when I was on my last hour of labor when he was "stalled" at the 9.5+cm). At that point when I thought about having to go through another several hours of the pain (pushing etc.) I couldn't even imagine so I opted for the C-Section out of sheer exhaustion. [I asked about Pitocin to get a sense of the interventions tried before the cesarean. Adding Pitocin when there is a delay is a common practice, and Jessica was offered it. Pitocin causes stronger contractions if contractions are not considered strong enough to keep a force on the cervix to pull it open like pulling on a t-shirt. Going for stronger contractions isn't the only way to encourage progress, as you see from the many techniques on Its a step that  Jessica chose to decline. If the baby is stuck against a bone, Pitocin may not help, the baby has to rotate off the bone, flex, or mould to get past a bony protrusion in the pelvis.] 

3. How low in your pelvis, if at all, did your baby get? He was (or at least felt) very low. My OB kept telling me at each appointment how low he was. I think I was at a zero station when I stalled. 
[I always want to know where baby is or was in the pelvis to know more about why baby was stuck. There are two ways a baby may be held back at 0 Station; one is because they face a hip and inside the pelvis a bony protrusion called the ischial spines extends  into the birth space and can catch baby's head, front and back. The other way is if the pelvis is a bit small or the sacrum is brought inwards by a tight muscles/ligaments, which seems to be the case here.]

4. Did you push at all? Whether your body's own urge or directed by the nurse/doctor? Before they knew I was stalled, the nurse asked me to try and push- but at that point my epidural was SO strong, I couldn't feel any urge. The first epidural failed and the second one was SO strong, [numbness from the epidural] went up to my boobs. I had no feeling in my legs and or urges to push. 
[Pushing during (but not between) 3 contractions even before full dilation has sometimes rotated a posterior baby and allowed progress. Push for three (or four) and then stop pushing if rotation doesn't occur. Don't continue pushing on a cervix as it will swell or, not often, rip. But a bit of pushing can make the cervix take the role of the pelvic floor to rotate baby sometimes. Its worth a shot. The epidural in this case didn't help. Could the nurse have gotten more directive? Could the doctor come in at this point and manually rotated the baby with her hand and then let the contractions "labor the baby down" until Jessica had the baby on her perineum and finally then felt a bit of urge to push?  Could the epidural have been turned down or off to see if an urge to push came back?  All this speculation is besides the point that the low white blood cell count indicated an infection present and took away the time to explore these options.

I knew that that is where I went wrong when I got the epidural. I couldn't imagined not getting it with the amount of pain I was in. I needed someone in my face coaching me through it. [A mature and experienced nurse or doula can compassionately, and with a no-nonsense approach do the "Take Charge Routine" explained by Penny Simkin.  Additionally, the side lying release may relieve that crazy pain. 

Instead, after the epidural, I was pretty much on the bed. They turned me from side to side periodically. [Understanding how to open the pelvic diameters for where the baby is will help labor progress. There are some solutions given in the next blog posting.  

5. What size head did your baby have? I am not sure! My husband is a 7.75 hat size. He has a large head. I can find out for you when I call my OB. They should have that on record right? 
[A posterior presentation always makes the head seem larger and fit less easily. A labor stall with a posterior baby with a 12" head is less optimistic for a future vaginal birth after a cesarean than if the baby had a 14" head. But as I've often said, presentation is more important than size, and this would be true here also.]

6. What positions were you in over the last 2.5 hours of labor? On my side -- I was so numb they had to put this air mattress thing underneath me to turn me! I did try hands and knees one time but it was too painful. [There are some techniques to help a baby through the outlet and some maternal positions that open the outlet, like the anterior pelvic tilt and using a peanut ball to open the midpelvis and outlet. Rolling from side to side helps a little but for many stalled labors, more particular movements specific to opening the pelvis at the level baby is stalled is critical.]

Ok, here are more questions of my heart, doula-motivated questions, that may not have as much to do with the outcome directly, but may have directed the course of your decision making. 

Did you feel adequately supported? Yes, I did have a doula. My husband was amazing, but I think I needed more guidance on how or what to do to get through the pain. We needed someone that knew this type of labor and positions/things we could have done to help me progress. [Support by partner, doula AND medical providers and professionals helps give confidence and endurance. In the case of a labor needing an unexpected and unwanted intervention feeling supported helps the emotional resolution. Feeling heard and supported is more important than a good feeling. Support is a basis for the quality of relationship with self and baby.]  

Did you feel stressed at the end and pressured for time? No, I did not feel pressured for time, but I did feel like I couldn't give it another minute I was in so much pain and had trouble breathing with my fever not going down. [An originally undesired intervention can become a rescue. After the crisis, the woman who hadn't wanted the intervention goes back to her original feeling of not wanting the intervention, but now she has had it. How she feels about herself is often mixed with this disappointment. Reframing the view of the intervention in a way that adds compassion to the choice to take it adds self compassion and self acceptance. In Jessica's case, she was in a moment of crisis, more than a moment. Her pain was not adequately addressed as it was beyond the usual labor experience. She was sick. It is so much harder to cope when ill. The first epidural didn't work and was hope dashed. She thought she'd have immediate relief only to continue in pain. The second epidural went high on her spine and gave her the feeling of not being able to catch her breath. Stress was mounting and no one had an answer for her. But no one was saying her time was up. It wouldn't have been typical for her medical team to let her fever continue with the baby unable to come down and no end in sight.  

Did you sleep during the epidural? Barely- maybe for an hour or so. I did not eat anything.
Were you helped to change position during the epidural? Yes- with the air mattress. (not very effective at all) [So no help for coping by sleep.]

Did anyone tell you that you were too tired, or were tiring? I was SO TIRED I had nothing left in my tank. [This is asked to determine if the seed was planted that she couldn't go on. In her case, the fever added to her state.]

And my husband and I own a gym. I workout every day and have strong endurance. Nothing could have prepared me for the pain that I felt with him on my sacrum especially after my waters broke. It was immense. My goal was a natural drug free birth. I got more than halfway so I feel good about that. [Ahh. A big clue that Jessica may have a very strong core, which is code for short pelvic floor. Extra fit bodies may hold a baby posterior and a short pelvic floor resists baby's rotation and descent. Very fit women are often surprised that they have difficulty birthing a posterior baby, if they have a posterior baby. The sacral pain can be associated with tight or short pelvic floor and other pelvic muscles. The sacrum is trying to move but can't. I feel that Jessica got a long way in labor and the solutions for her situation are simply not known by most doulas or nurses. (I'm working on that.)] 

My OB said that my pelvis goes inward a bit and therefore a more limited space for the head to get through... [This may be from a shorter pelvic floor. This may be from a shortened sacrotuberous ligament. Education and body work can address these issues.]

Anyways... Maybe his thought is that if I were to be induced, we would have known his position sooner ... but how would that mean that he would rotate? [I don't think he would have rotated with an induction 24 hours before. He'd have been 1-2 ounces lighter; is that really significant?
 Induction at 39-40 weeks is common when women have providers who seek induction to reduce complications more common with larger babies. One set of complications and compromises are traded for another set and not statistically significant. Cesaresan rates are higher among labors that are induced. 
The birth team didn't know physiological ways to increase midpelvic and outlet diameters. That's established. In part 1 of this series, Jessica says her doctor told her if she would have accepted the recommendation of an induction when it was given the day before she wouldn't have needed the cesarean for an OP baby that didn't rotate.
Does that seem like blaming the mother for the birth teams' lack of skills for OP babies?

My reply back:

"Dear Jessica,
Your answers tell me much!

Now I feel very very confident an induction would not have prevented a cesarean in this situation. 

Yours was just the type of birth that catches both parents and providers unawares - unaware that this is upcoming or what to do once this labor pattern occurs.  I even feel negligent for not educating pregnant parents and the birth world adequately. What if your husband and doula knew where to turn?

This sacral situation is not likely to be something you were born with but rather something that developed at some point in your past.

There is basically one technique that I know of for a tucked in sacrum, maybe two, as I have recently learned a new technique in Australia but I don't know quite yet if it will solve the tucked in sacrum.

  • A tight, short sacrotuberous ligament may have been the deciding factor here.  
  • Perhaps, another lesser factor is a well-developed core strength as a hamper to rotation.

These are "trending" issues with the times and are in no way a woman's fault. People assume "fitness" is a sensible way to ease in birth and what a shock it is when labor is not easy. 

Not just fitness, but myriad twists and turns in the uterine ligaments, sitting positions, even the way we use the toilet instead of squatting, sudden stops or jolts that misalign muscles and ligaments and even the cervix so that baby has a hard time navigating the space. There is ignorance in the birth profession about how the labor pattern and pelvic station reveal the issue. And fewer professionals know what needs to be done for mother and baby to finish such a birth on their own power.

I, myself, am not sure why the sacrotuberous ligament spasms (painlessly) to bring the sacrum deeper in to the pelvis and making the pelvic space smaller. 
It may have to do with a fall, with core strength, tight pelvic floor, or something with the neck and jaw or nose and sphenoid... 
I am seeking more info on the situation of the super fit woman's posterior labor dystocia (stuck labor) which has been one of the trickiest to address. 

I would like to keep the dates known, as 41 and 4 days, following a few days of start and stop contractions is a very important clue that this was not likely due to thyroid issues.

[This start and stop  would be a significant clue if these were the strong contractions lasting over a period of 6-12 hours without changing the cervix. Such a start and stop labor pattern is consistent with a lack of engagement, though not all labors with the baby still above the pelvic brim will express a start and stop pattern.

Jessica did not have the type of start and stop contractions I associate with a lack of engagement. 
Jessica: the OB said that he was Left OP if that makes a difference? 
Gail: Yes, LOP babies may be more likely to engage than the ROP baby. Most LOPs will rotate to LOT and engage in the pelvis. But a few engage while still in occiput posterior. In your son's case, he engaged direct occiput posterior. Once engaged in the posterior, some may rotate lower down the pelvis, and others remain OP, as your son did.]

"Please, Jessica,  also consider if I may please use your son's picture at his birth,... His molding shows he was posterior for sure, which you knew, but many people wonder how to tell after birth if baby was posterior and would learn from seeing his molding. 

He looks so strong. You both worked so hard! I am so glad you reached out to me. You did the best you could in a tough situation and made sensible decisions given the awareness every one had at the time. 

I am quite impressed with how far you got and think that you can surely achieve a vaginal birth and perhaps more easily with some preparation for body balance, lengthening your pelvic floor muscles, and releasing the sacrotuberous ligament from its short, tightness (the key thing here). 

Please know that you faced and solved a very challenging labor. The cesarean is an appropriate choice to end suffering for you and your baby. When labor pain crosses the line from challenging to agony, you get to decide to use that intervention wisely, right!?  

Your baby got some good labor hormones and gut bacteria which are beneficial. That was only possible because you labored before the cesarean. That is a gift you gave your son to be proud of, a compensation for the struggle. It was for something important, as better gut flora is vitally important to the immune system! 

Jessica's reply again:

"What finally did it  in my opinion) [started labor] was a visit to an osteopath that we have here in Sacramento CA (where we live). He is amazing and my husband went to him for a neck issue the day I went into labor. When my husband told him that I was 11 days late, he said for him bring me in for a visit. Needless to say I went in for a visit and in a matter of seconds, he pressed on my (pituitary gland if remember correctly) and my pelvis. I felt an immediate release [Awesome] as if something was unlocked [And it was!]. I even felt a gush of fluid (not water breaking but just more mucous). He promised I'd be in labor about 6 hours later and sure enough I was!! 

He said that he works with pregnant women all throughout their pregnancies to help with ligament tightness and other issues. I wish I would have been seeing him from the start. I definitely will next time around especially now that your email mentions the same thing that he told me about pelvic floor tightness etc. He really is an amazing osteopath."

Gail's Comments here: 
About 1/3 of babies who are posterior at the start of labor (30%, Liebermann) continue to be posterior throughout the labor. The rest will rotate. Because so many eventually rotate, and because cesarean surgery is safer than it was just a few decades ago, the skills to support a posterior labor have waned and skills for surgery have increased. 

Here was a challenge of how to comfort a woman in extreme back labor and how to help her into positions that add comfort and aid rotation. 

Would a forward leaning inversion through 3 contractions have helped reduce pain once the technique was over? 

Jessica faced a very difficult labor made complicated by the baby's posterior presentation. She gave an exemplary effort with few maternal position changes. Hands and knees was not acceptable to her due to the pain she felt in that position. She didn't know her baby was posterior and didn't know which exercises were beneficial to birth compared to gym fitness. 

In my opinion, based on what has helped others with this labor and body description, she really needed her sacrotuberous ligament softened. This is a temporary fix (temporary when done by the lay person) that let's the sacrum swing outward in the middle and lower parts of the sacrum. The baby will drop and perhaps rotate in the added room. 

Gail Suggested: 

"Balance First!
Craniosacral therapy with therapeutic massage by a pregnancy master if possible.
Sacrotuberous release by the doctor, nurse, midwife if possible. The doula can explain it but it may be outside of the doula scope of practice to do this technique, though it can be done externally.
Sidelying release for the muscles supporting the pelvis, including the pelvic floor for pain relief and making "room" for the baby - making flexibility and softening the way.
Alternating the compression/extension of the ASIS and ischial tuberosity in circles that stop in extension (a massage therapist can work this out)
Give Cook's Counter pressure a try on the tuberosities, if on hands and knees or the pubic arch if on back, this helps relax the pelvic floor by giving the stretch receptors of the pelvic floor some slack. (They are stretched already and need some slack for 2.5 minutes at a time.)

"[You might like to n]ow try these techniques:

  • Give Cook's Counter pressure a try on the tuberosities, if on hands and knees or the pubic arch if on back, this helps relax the pelvic floor by giving the stretch receptors of the pelvic floor some slack. (They are stretched already and need some slack for 2.5 minutes at a time.)
  • Lunges during 3 contractions on each side.
  • Dangle through 3-6 contractions.
  • Do not squat.
  • Rope pull from "McRoberts" position if in bed, or 
  • Standing while holding a rebozo or sheet over the head. The sheet is knotted and the knot is thrown over the bathroom door which is then closed. The birthing woman's back is straight and knees are bent. 3-6 contractions. Don't go down so far as to be in a squat until your nurse can see the baby's head.
  • Try pushing for 3 contractions, then rest through 3 contractions without pushing!
  • Rest
  • Do the 3 Sisters and rest again.
[The 3rd Sister particularly] helps relax the pelvic floor by giving the stretch receptors of the pelvic floor some slack. (They are stretched already and need some slack for 2.5 minutes at a time.)

It seems no one at the birth knew how to find and use Spinning Babies Website. Let's get a link out to your sites, blogs, and social network pages to reach more 
birthing and pregnant women and their helpers.

Post on your page to link to Spinning Babies

Next Post in this series, Jessica processes her birth and Gail makes suggestions for the next birth. 

Friday, January 2, 2015

Birth Detective: Why didn't my OP baby come down? Part 1 of 3

Posterior presentation alone will not predict the course of labor.  Posterior presenting babies can come within 3, 5, 24-hours, though some posterior labors take 36 hours or longer labors. 
Add tight or short muscles, or a small pelvic outlet, and delays and interventions increase.

Spinning Babies take on the 3 Ps (Power, Passage, and Passenger) was discussed in the previous blog post. 

Here's Jessica's story of her first labor and birth. Emailing back and forth together, we sought a likely reason her labor went to cesarean that may differ from what she was told.  

I've cut out some redundancy (especially my own), edited my wordiness, and made the points easier for you to track the flow of conversation. Parenthesis shows verbatim content.

  "My name is Jessica and I'm about 6 weeks postpartum. This was my first birth and we have a healthy baby boy. He was malpositioned and I ended up delivering via C Section due to extreme exhaustion and fever after 23 hours of labor.
  I had a question for you about my delivery and was curious if you would be able to help me and provide some feedback for the type of labor that I had? (I did not know he was OP until the latter part of my labor).
   I was 41 and 4 days or 11 days late. Original due date was 11/2 and I went into labor naturally (after a few days of stops and starts) on the night of 11/12
My concern is that my OB said that if I would have listened to him and been induced, I could have had a vaginal delivery. 
"I was a low risk pregnancy and his heart rate showed no sign of decel throughout my labor.
After my water broke (around 7cm), I asked for the epidural due to the intolerable back pain.
  I ended up getting to 9.5++ in about 5 more hours after that and got stuck there for 2.5 hours.
I developed a fever of 101 and my white blood cell count was super low and felt like I had NO energy left to give. I just wanted him to be out and begged for the C section.
His head would not come down and was very long coned at delivery from trying to fit!

  "At an rate- I was made to feel like I did the wrong thing by not letting him induce me a day earlier and thus ended up in a C section.

"What is your experience with OP labors and induction? He was very stubborn and barely moved in my belly (aside from his feet and hands). I'm not so sure he would have turned  if I was induced."

Gail's Reply:

"Dear Jessica,
   I am so sorry for the distress that statement of blame has put into your birth memory. Your labor was hard enough.
   You labored fantastically well with a posterior baby! You got to 9.5++ - And what a gift to your baby to have spontaneous labor, this shows he started labor with good hormones and readiness.

Personally, I do not believe that 24 hours would make a difference in your labor pattern.

I am not aware that induction has been shown to be that effective in rotation. Pitocin can be, but induction as the path to an easier birth does not have sufficient proof.

"The statement that an induction 24-hours before would have prevented this cesarean is very upsetting to me.

"Time can be a factor in birth outcome, but not the key factor once baby is term, and 24-hours is too short a time. Most often, labor ease is not about time, progress is about head-to-pelvis angles and "room" for the baby, which are made by making room in the pelvis through muscular and ligament techniques. [In labor,] maternal positioning [may] open the diameters of space at the level of the pelvis where baby is waiting for help.

"Your answers to these questions will help me to understand if my own assumptions are warranted.
1. Do you have a photo of you baby's molding? That will help me understand his position over the last hours of your labor. Flexed or extended (chin down or up) or posterior or did he rotate?
From Oxorn and Foote, Molding shapes tell us how baby came into pelvis

[For the blog, I'm going to add why I asked this question. Seeing the immediate molding will help me identify the angle of baby's head. This indicated which head diameter was coming through the pelvis. Molding will give clues to whether baby was at the brim or deeper in the pelvis. Flexion (chin tucked to chest) gives a smaller diameter to the head and extension (chin up) makes the head seem larger because more of the head is trying to come through at once.] 

2. Did you have Pitocin in this labor? Were you offered it?

3. How low in your pelvis, if at all, did your baby get?

4. Did you push at all? Whether your body's own urge or directed by the nurse/doctor?

5. What size head did your baby have?

6. What positions were you in over the last 2.5 hours of labor [while at 9.5++ cm dilation]?

"Ok, here are more questions of my heart, doula-motivated questions, that may not have as much to do with the outcome directly, but may have directed the course of your decision making. 

Did you feel adequately supported? 
Did you feel stressed at the end and pressured for time? 
Did you sleep during the epidural? 
Were you helped to change position during the epidural? 
Did anyone tell you that you were too tired, or were tiring?

"Please know that I ask all of these questions with compassion to you. You really were in an "extreme sports" situation and it sounds like you were there without the kind of support one would hope for in such an exerting physical experience.

Please hold your sweet baby and forgive both of yourselves, for you both did the best you could in the limited knowledge given to you for this birth. You showed your strength and your maternal fire, Jessica! I so wish I could give you a big HUG!
Bless your heart!"

Jessica's response and more from Gail in Part 2 and 3 of this blog post dialogue

Please help more people find and use Spinning Babies Website when facing a labor like Jessica's. Let's get a link out to your sites, blogs, and social network pages to reach more 
birthing and pregnant women and their helpers.
Post on your page to link to Spinning Babies

Thursday, January 1, 2015

Three P's in a pod

Especially the invention of artificial Pitocin birth providers have increasingly seen labor progress as a result of an opening cervix. After all, if we have a hammer, every thing looks like a nail. If we have a long labor, everything seems to be about the cervix not opening fast enough.

The focus of labor progress has been on the combination of three birth factors. The 1.) power of contractions moving 2.) the baby through 3.) a woman's pelvis.

These factors are known as the "3 Ps:"
Powers, Passage, Passenger.

So the question has become, Can increased power of contractions force baby through this particular pelvis? How far can we push this before the baby gets exhausted. How much Pitocin/Cytotec can we put in this woman without bursting her uterus or breaking her baby.

And the pod, the group-think, becomes less focused on listening to the birth and sensing the movements of the mother's muscles (or not) or listening to her sounds for clues to what she might need in a labor that isn't progressing. When a baby isn't fitting well, especially when labor isn't able to progress, the mother May not get the hormonal signals to guide her movements and instincts. The baby isn't on the cervix releasing a bunch of hormonal clues for her deep inner knowing. 
You can see why this can be a frustrating experience when the helpers are waiting (patiently) for something to happen and the mother first thinks this is how labor goes and after a day or two thinks why don't these people DO SOMETHING!

Spinning Babies looks at labor progress a little differently. I don't deny the 3 Ps, I just look at them a little more specifically. 

The first thing in a labor stall is to honor the diameters of mother and baby and how they are lined up at the time of a labor stall or stop. (The first thing before a labor stall is to honor the mother, but not just her expectations but also to honor her body balance so her expectations can come true more easily. 

Reading the signs in pregnancy helps direct the midwife/doula/ even doctor to nurture the needs of the whole woman and support in her what modern culture, especially sitting and driving positions, suppresses in her innate birthing ability by way of tensions and shortness in trunk and pelvic muscles.)

Spinning Babies approach to childbirth is to "balance" the passage, so to speak, by releasing what is super tight or lengthening muscles or ligaments that are shortened (tight); Opening the diameters at the level of the pelvis where baby is stuck (in your case "0" station); and a myriad of other factors supported by physiologic means.

Spinning Babies approach is to notice the baby's head diameter on the level of the pelvis the baby is at and see if a rotation or added flexion may help the progress. If progress is happening, then we hold the sacred space and do not give advice or distract the birthing woman! If the baby is actually stuck or the mother is frightened by pain or teetering close to suffering, we would also act even if labor was gradually progressing. 

The perception of the attendant is key to knowing when to act and when to be patient. Some signs are clear (to me and others who've learned to look for clues like I describe here) and should be heeded. 

Rest is a valid and appropriate response to finally having the baby engaged after having been contracting for a day or two. This is not failure to progress. A cesarean now would be due to A failure to Perceive. The uterus will rest and then resume the labor because now the baby is engaged.  

In Spinning Babies I talk about what to do when we find the baby at each level of the pelvis in a labor stall. This is crucial information and best learned at a Spinning Babies Workshop or on the Spinning Babies Parent Class download or DVD. 

Three levels of the pelvis; brim, midpelvis, outlet

By addressing needs at each of the levels of the pelvis and for any angles of baby's head  (which way baby faces and how much is the chin tucked) that are not matching the room in the pelvis, we can actually encourage the mother's contractions to come on strong and finish the birth!

Spinning Babies offers a very different approach to how things are now "managed" in a typical birth practice. I am confident we can resolve many stuck labors with little to no technology and reduce suffering, damage, and even death from obstructed childbirth. 

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.