Sunday, March 6, 2016

Maternal Postions at the levels of the pelvis

Much has been written about maternal positioning in labor. Some of it validates and some of it seems to contradict what we have been recommending. I'd like to offer a look at maternal positions for pregnancy and labor from a "3 Levels" perspective.
Get the entire set in the Quick Reference Cards Download.
These are not cards, but a download you can print and make cards with.
http://spinningbabies.com/product/quick-reference-cards/


In pregnancy, the assumption seems to be that positioning mothers with gravity is enough to reposition the baby also. Providers don't expect an immediate change. However, common questions arise by those who haven't rejected the Optimal Foetal Positioning approach, "How long does a fetal re-position take?" or "Which position will rotate a posterior baby or flip a breech?"

In labor, maternal positions are chosen for comfort by mothers and are suggested for progress and comfort by providers.


Rest Smart simply means maternal positioning with gravity. Alignment promotes muscle relaxation and an open pelvis.

In Pregnancy use alignment in your posture to allow better function of the muscles.
This means sitting on the front of your sitz bones and not lounging back on the sacrum in a semi sitting position very often. Sitting up makes the belly a hammock, as Midwife Jean Sutton describes in Optimal Foetal Positioning.

Spinning Babies adds muscle balance to allow room for baby to settle spine to front in the anterior position. We understand that when gravity alone doesn't bring baby head down, and then over to mother's left side, then there may be a reason relating to the uterus having enough room to let baby slide into place. Sometimes that is a placenta or a unique shape to the uterus, like a septum in the upper uterus holding the head in place, - or a twin in the way! But more often it seems to be a bit of a twist or tightness in the ligaments, connective tissue or muscle. A lack of room might be because the mother's hip is rotated (twisted) enough to shorten a leg or pull the cervical ligaments over to one side, creating a fold or slight twist of the lower uterus.
The normal uterus often seems to lean to the right. The fundus, midway through pregnancy,
is often noted to be slightly higher on the right than the left. The right side is steeper and the left side more round.
Normal "right obliquity" of the uterus makes the uterus steeper on the right side. Baby's flexion
is likely to result from laying on the round side (usually left) and babies who are extended may be more likely to
come from the steep side (almost always the right side).
Balancing the muscles and ligaments and aligning the pelvis may support a good fetal flexion.


Movement in special ways to lengthen and "balance" the muscles helps make room for the baby.
Yoga in general is good. But yoga in and of itself may or may not balance the pelvic muscles. Whether or not the muscles that a particular mother needs help with is addressed in her yoga class depends on the full range of motion and style of yoga promoted by her class instructor. Daily Essentials download video is designed for that full range of motion that seems to help the majority of women using it from 20 or 30 weeks gestation.

Addressing ligaments and the fascia (connective tissue) helps address the levels of the pelvis - a fancy way of talking about baby's pathway in birth.
Above the pelvis is the respiratory diaphragm, broad ligament and round ligaments.
At the pelvic brim is the sacral promontory, they symphasis, and inguinal ligaments.
Deep in the pelvis are the pelvic floor, ishiocavernosis and performis (on the back side, but effecting sacral movement and the internal surface of the sacrum is deep. Ok, the analogy needs tolerance.

Use Balance, Gravity, and Movement to enhance pregnancy comfort and potentially ease childbirth.

Now in labor, open the inlet with the posterior pelvic tilt to make room for baby to drop down.
MRI of the Pelvic inlet with and without the line showing anterior-posterior diameter of the inlet. 

Once baby is half way through, at or near the ischial spines, the peanut ball is a helper, or the diagonal lunge (stand and lunge towards the side while still facing forward).


Once the nurse can see baby's head, doing an anterior pelvic tilt opens the outlet. The lunge will help again. And the birth stool is brilliant! Make it a medium height birth stool so the mother isn't in too deep a squat for strength in pushing and have a squat when baby is almost crowning. Or a hip squeeze.

You can learn more about the levels of the pelvis with these three products

  1. Insights for Labor tear-off sheets for educators and providers which gives parents a one-page handout, two-sided, to refer to during labor. Maternal positions are illustrated so they know what to do when, for comfort and labor progress. These cost shipping, and can't be mailed to Australia or South Africa, two countries where my products seem to disappear into customs. See Capers Bookstore in Australia to order your copy, Mate!
  2. The Quick Reference Cards (not cards, actually, but a download) which I sometimes call the 3 Levels Cards, but they include brief instructions (reminders really, the full instructions and contraindications are on the Spinning Babies Website. 
  3. The video download, Spinning Babies, Parent class which goes into the balancing techniques and the tips for labor - in depth! The 3 levels of the pelvis are well explained. You will learn a lot even as a provider from this "birth geek parent" video. This can be ordered as a DVD, too.











1 comment:

Tory Carriere said...

I'm trying to figure out is the difference in the two DVDs--the parent class vs the home exercises. :-/ Are they similar? I am a Lamaze educator and doula and wondering what I should get to expand my skills and possibly eventually use in class. Just wondering if I need both. Thanks!

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.