Tuesday, June 20, 2017

Dr. Marshall Klaus, Champion of the Doula

Dr. Marshall Klaus, the world renown pediatrician, who with the late Dr. John Kennel, researched the power of a birth companion (doula) and followed other's research to discover the modeling that birthing women will sometimes even verbalize themselves!

Link to see this in YouTube to see Spinning Babies 2001 video of Dr. Klaus talking about the doula with doula Malik Turley.

Malik Turley: "Dr. Klaus, I was at your talk yesterday about "Sensitive Period" and I was wondering if you have a couple minutes to go over that again for me?"

Dr. Marshall Klaus: "Sure,... You know,  John Kennel had been working for about 30 years on the problem. One of the things that we saw in the beginning that made us wonder if this period was unusual is that if mothers got her babies just one hour after birth the mother was different for as long as nine days. We'd never seen this. They were much more responsive to their babies. They were more interested in their babies. Yet, we hadn't given them any more education.

And then when the new studies came up, related with mothers having more support during labor, and the South African group seeing that those mothers were less depressed 6 weeks later, we began to see that if mothers had their babies 6 hours on day 1 and 6 hours on day 2,  after birth, remember down South, in Susan O'Connor's data, there was less child abuse in the next 17 months and the study was randomized.

We think that because the woman is having a large amount of oxytocin, the love hormone, being secreted, and its going to the brain, that theres a major change in the brain of the newly delivered mother. And that this was placed in an evolutionary way so that women would be very sensitive to their new babies. So they have to begin to take the baby, because each baby is different.

And the mothers are staring at the babies and staring and staring.  They don't take their eyes off baby. When I asked some of these mothers years ago, they said they were taking in the baby.
And I didn't quickly realize what this meant. It means they are incorporating, by watching the baby closely, the needs of the baby.

What this means for physicians and nurses and doulas, is that you have a woman who is like a sponge [hence the Sensitive Period]. The more caring we are of this woman, she incorporates the care we give to her and it becomes the quality and the kind of care she gives her baby.

And I think that what stimulates this especially is the doula. Because when the doula holds the mother and rubs her back and even though the labor takes 6, 8, 10, 12 hours, you don't leave her. You're with her and even though you're exhausted you stay with her.

Very few people have ever been cared for like that.

She begins to feel very warmly towards ...you.
She takes in the way you cared for her, your gentleness and your caring, and then she applies this to the baby.

And the more caring we are, she rises. Six weeks later and two months later she is still different. So she incorporates your qualities and she applies it to her baby.

If you have your baby right after delivery, and it never leaves your bed those women in three different countries those women don't give up their babies.

In Sweden, there's a woman, Kerstin Uvnäs Moberg, who has an idea how this works. Right up to the time of delivery you have more receptors in your brain for oxytocin. And you get in a sense, an oxytocin high where you're open and you're open to new things.

When you're in a Sensitive Period, it means you're mobile, emotionally.

If you have a traumatic birth and you didn't have a doula, or somebody was mean to you, it could be destructive, hurtful to you. But if you're sensitively cared for, if have a difficult birth but a doula whose with you every minute, then you are able go up in
 your functioning permanently, I'm talking about.

So, the Sensitive Period suggests we have to change obstetrical care to make it as humane as we can.

The doula is an ideal person to model, not only to the mother but you can model for physicians such as myself, and you can model for nurses for the obstetricians, and when we see the kind of care you're giving her we're going to start to think about, why are you doing this, you know.

And if we start to have more papers on the Sensitive Period then everybody that works with mothers will realize they are very powerful, but hopefully in a good way.

What's good about the doula is you won't do anything for the mother unless you check with her.

Malik Turley: Right.

Dr. Klaus: You may want to rub her back but she may want you to rub her arms. She may not want any rubbing at all. So you're always checking with her. And we don't do that enough; I don't think doctors check with the mother enough. Give them choices.

The Canadians are ahead of us. The Canadian Royal Society of Obstetrics recommends that every mother have a continuous caring woman with them.

I would say every doula that we've seen is very gentle and caring. You have to remember you're a powerful person because she is in this unusual state of consciousness.

Malik Turley: What do you see as the primary benefits from this caring influence in this Sensitive Period?

Marshall Klaus: One of the biggest things is that mothers that are cared for in the way you are caring for women there's a chance she will be a lot less depressed. And there's data to support that. Less anxious. And I think that she'll take care of her baby using some of the care signals that you gave her.

I visited a close friend some years ago. I was surprised she did this well with a set of two active twins. And I asked her, 'How did this all work out? Cause I knew you like to keep things in order, and babies don't keep things in order.'

She said, 'You know when I had a doula, the doula was just wonderful with me. And when I got more upset she became more relaxed and helped me through it. Now, when the twins get upset I try to help them through it. But I don't get upset I become calm like my doula.'

Dr. Klaus looks at the camera, smiles, and says, "That's real, by the way."

More on oxytocin

Friday, June 16, 2017

Preparing strength with vulnerability

Lately I've been re-introduced to vulnerability. I don't mean I've been re-introduced to hurt. Actually I've been feeling stronger and more fluid than I have for a while within myself. I have more peace now with the process than I have had since the beginning of "my big learning curve" to give birth to Spinning Babies. And in the strength of this emergence, I add some thoughts about supporting birthing strength through the vulnerability involved with communicating needs.

Pregnancy is a series of decisions to give birth, or not, and to end the pregnancy (or grieve a too-soon end of pregnancy) or to "be delivered" and give that powerful transformation sometimes called giving birth to ones self.

One of the most treasured experiences of my doula or midwife life has been to serve women seeking again their power within to birth after a previous surgical birth. There is very often grief when birth is finished through major surgery.

Whether the cesarean was expected and accepted, or sudden after a long labor or discovery of a breech position or other issue, the message may linger than one's ability to give birth may not be unrefutable. The grief of losing the experience of birth continues even with the welcoming of a live, and hopefully healthy child. Especially when the baby is healthy. Especially when the reason for the cesarean is less than certain. Parent may then ask, who am I now? Who am I really in view of this event? Who are we? Who is he? Who is she? I thought I was (they were) the birth giver and that moment was taken, shaken or forsaken.

For many there remains a question, if I have a chance to give birth again, can I finish under my own body's power? Here the unknown is met with determination.

Life brings cycles of stability and instability, coasting and accelerating, learning and sharing. Opposite forces rotate around our lives bringing us opportunities that balance through opposing experiences.

Being pregnant and preparing for birth is a time of change. The unknown beckons while a need for comfort can bring about a want for comfort and surety. We are open in pregnancy to recreate ourselves even as we offer ourselves in empathy and hope to grow a child. In the depth of creative self, in creating self, we are in a sensitive period (as defined by Dr. Maria Montessori as a developmental period of absorbing information) where the behavior of the people we value becomes a model of social behavior.

The seeming dichotomy to achieve a powerful, strong birth may be through vulnerability. What I mean by vulnerability is the taking a risk to express the desire of what one wants to experience. Another vulnerability is trying when the result isn't certain. Giving your heart 100% to the cause and risking disappointment. But this is also giving 100% and experiencing 100% the portion of the process you are currently in. The process is the reward.

Sometimes women have told me that they choose not to tell their doctor what they want or don't want at birth because they don't want to make the doctor angry. The fundamental need is to protect access to the expert who will save your baby. Compromise is a coping skill to sustain a relationship with the person in power (the power to save the baby presumably), as well as to grow a collaborative relationship. But collaboration can only occur if communication comes first.

Vulnerable strength in communication
It's ok to say what you want to your birth professional.
Speak in a way that is mutually meaningful so that you can be heard. It's ok to agree to be rescued if something goes amiss while maintaining autonomy when the birth process is proceeding normally or near normal.

If your doctor or midwife disagrees with your request or birth plan its ok to ask them more about their  thoughts. Ask them if it's their personal opinion, medical finding or a recommendation from statistics rather than a medical finding of your specific situation.

Common questions to help you make an informed decision are:

  • What are the benefits?
  • What are the risks?
  • What are the alternatives, including waiting.
  • What if nothing is done for a while, or nothing different?
  • Is there any medical reason not to try something physiological first in a limited time frame

Of course, in my perspective, I'd like to try a physiological approach using techniques for balancing birth anatomy and positions for opening the pelvis if the issues are related to starting labor, strengthening labor or helping a long or painful labor progress.
When we pick a physiological approach we need to know safety limits (we need to rely on medical assessment and agree upon signs of infection, range of normal blood pressure or normal fetal heart rate, etc). We are often able to resolve a labor stall, for instance, without surgery, but would not attempt to do so if risk factors for mother or baby were severe.

And even as you agree to medical intervention, it's also ok to ask for the opportunity to try something you would like to include. Just as it's ok to sample the flavor of your labor and then accept a second surgery. It's just important to be ok with the process.

Finding determination within unknown elemental forces is the role of a ship's captain and a birthing person. Know what you are about. Set your course. Communicate it with your crew. Keep afloat. Keep fresh water and food available. The mast must be both strong and responsive and so must we.  Test the winds and don't hesitate to reset your sails. And let the stars guide you.

Spinning Babies member Alisa Blackwood offers these dynamic questions to assist your self reflection:

“What are the opposing forces in your life?" 
"What would you list as your uncertainties and your desires?"

Alisa guides us to Give voice to our vulnerabilities, rather than pushing them aside. By embracing our vulnerability we propose to find our inner strength as well as help us ask for the support of others to help us birth from our best selves.

Resolving Shoulder Dystocia in Europe

I just got to teach Resolving Shoulder Dystocia in Italy and in Amsterdam. The wisdom and experience of these midwife "students" is immense, humble, and inclusive to my perspective.

As midwives, we love to come together and learn from one another. Where else can midwives share insights and experiences unique to our experiences as midwives. This is particularly true about birth complications such as shoulder dystocia (baby's head is born but the shoulders remain stuck inside the pelvis). For those midwives who attend home births, we want to hear variations of experience and how other midwives "figured it out!"

Our fingers know that what they find is not always described in the medical literature. Learning from one another prepares us for the unique situations in which books can not contain.

Hear midwives stories and learn how to resolve five types of shoulder dystocia in Gail's video,

Saturday, May 13, 2017

I am expecting twins, can I use the same Spinning Babies techniques for my pregnancy and labor?
Yes! Spinning Babies approach works well for multiples. If you can, start early. Otherwise, start today. You may need to add professional bodywork help to balance uterine ligaments.
Ask your doctor or midwife if there is any medical reason not to do any of these activities (inversion, particularly).

When to start Spinning Babies approach in a Twin Pregnancy?

I typically suggest 20 weeks for a singleton. With multiples the start of daily balancing activities might begin earlier, for instance, 16 weeks… Start gently, pace yourself, and be steady rather than athletic, please!

Start now

Is it too late?

Find out what Linda writes at http://spinningbabies.com/learn-more/baby-positions/twins/

Tuesday, May 9, 2017

The Difference a Sidelying Release Makes

A happy doula, and Spinning Babies Workshop attendee, named Beatrice just emailed thirty minutes ago to rave about a VBAC birth. Many of us birth workers love to support a birthing family through a vaginal birth after a previous cesarean. The triumph of self-determination shines through the parent's eyes.  As providers, we know their life will never be the same.

Here is a labor attempting to begin. Contractions start but neither move labor along nor let the woman rest. Twice before this non-progressing latent labor ended in surgery.

The role of this doula was to bring her positive attitude and practical strategies. Let's gain understanding of which of the techniques may have actually advanced labor progress and which ones, though classic, may not have addressed the situation in play.
Of course, we are looking through the lens of Spinning Babies 
We review the good decisions of this doula with a perspective still little known in the doula world.

Beatrice writes,
"Just to let you know I’ve just used your techniques today with amazing results! My lady was really hoping for a VBAC after two emergency c-sections, she went into labour yesterday but her contractions were really mild inconsistent and not getting her anywhere... so she went for a long walk in the park, up and down hills and after eating a nice meal, she went home to put her kids to bed and to rest for a little while."

Here we see the classic, natural birth movement's strategy to allow the simple passage of time to support the flow of labor. Allowing labor to establish on its own is a healthy and respectful choice...when such a strategy matches the labor situation.

In this case, the labor didn't pick up and night turned to day. Beatrice also knew that this particular mom had a history of emergency cesareans.

An emergency cesarean is surgical birth after the onset of labor. Whether the mother or baby are in a life threatening situation or a long leisurely labor is not defined by this way of using the term "emergency." In most cases, finishing the birth with an "emergency cesarean" isn't an emergency at all. It's only a few cesareans in which the baby or parent are in danger and need immediate life saving surgery to escape severe injury or death.

Most of the time, a lot of time passes as the birth team tries many strategies to help the baby down through the pelvis. After more time, the birth team (including the birthing member!) decides enough-is-enough and a cesarean is now the best option for a safe birth. In these situations, the contractions are strong enough to, but don't:
  • Rotate the baby
  • Dilate the cervix, and 
  • Bring baby down the pelvis 

For Beatrice's "Lady", these strong contractions weren't able to accomplish these three important measures of labor progress. This is exactly the scenario we hope to avoid repeating when supporting a VBAC mother. VBAC is Vaginal Birth After a Cesarean (for a previous birth).

In most cases, emergency cesareans are not because the pelvis is too small, but rather the babies aren't angled into their smallest diameters. Like a swimmer diving into the pool, a birthing baby "makes the smallest splash" (meaning the baby slips most easily into the world) when baby pulls the chin into the chest and brings the shoulders and arms close to the chest to make the body "smaller".

Beatrice knew that baby could be helped into the pelvis. She wasn't specific in her email where in the pelvis she believed baby to be. Remember, they hadn't gotten to the hospital yet to have the nurse or provider check the birthing person's cervix and check which level of the pelvis they found the baby at.

"We started a routine of stretching her psoas muscles followed by lunges and wide side squatting and calf stretches  up and down the steps and the birthing ball..." 

Let's look at these techniques to see which part of the birth journey these techniques give specific help for making room for the baby. There are three levels to the pelvis, three gates, as it were for the baby to pass through.
The inlet (top entrance to the bony tunnel)
The Midpelvis (middle)
The Outlet (bottom, exit of the bony tunnel)

I suspect from the history of repeat cesareans followed by a vaginal birth that the missing factor for the earlier births was fetal engagement. It may be that in the earlier births, and for the long leisurely beginning of this labor, the babies were up at the entrance, the brim, or inlet to the pelvis. I may be wrong, but this is a common cause of "emergency cesarean" and the subsequence avoidance of such an "emergency" by helping baby engage.

The inlet (top entrance to the bony tunnel) Stretching her psoas muscles, Forward Lunges are another way of helping the psoas muscle pair lengthen. There is a particular way of doing them that "wakens" the psoas. Going  up and down the steps helps some babies drop into the pelvis but many times there are less tiring ways to do help baby engage.  

The birthing ball can be a help when pumped up properly to let the hips be slightly higher than the knees. For engaging baby, usually what is needed for labor progress first, turn some happy music on and do hip circles and figure eights.

If a birthing mother belly dances those moves may be preferable... actually its not common for belly dancers to have a long labor, so this is a silly addition. About 30-40 minutes of dancing or using the birth ball like a "dancing seat" is usual.

The Midpelvis (middle) Side Lunges or those lunges that look like a sword player are specific to the mid pelvis or outlet. Lunging to the side would not likely help baby drop into the pelvis. Wide side squatting may mean the knees go out to the side. This may help the bottom of the pelvis open but will close the top and reduce the chance that baby will drop into the pelvis. If baby is already deep in the pelvis these may be useful. Squats reveal their usefulness in 3 to 6 contractions. If you aren't seeing good progress after that, try them again when baby is lower (if needed).

The Outlet (bottom, exit of the bony tunnel) Calf stretches can be helpful for the sacrum to move out of baby's way. The mobile sacrum is dramatic for moving out of the way in the mid or lower pelvis, but may help fetal engagement at the top as well. I put it here because the effect of a calf stretch in labor might be minimal on pelvic mobility at the top of the pelvis but may be slightly better on the bottom. Daily calf stretches for a couple weeks followed by weeks of daily squatting would show the effectiveness of the calf stretch in the big picture, but an immediate effectiveness is less likely to occur.

The baby lines up with each of these openings in the pelvis by rotating.  When the head lines up at each gate, the contractions can move the baby down. Balancing tight or loose muscles and untwisting any crooked ligaments help soften baby's path through these three pelvic levels.

You may have noticed in the story that labor wasn't active yet. Strong contractions are necessary. The womb has been working for many hours without building up a momentum necessary to move labor along.

The doula was thinking and the mother was now ready to try something new. They'd tried some gravity friendly positions and movement without success.  Now they began the Queen of the Static Stretch techniques, the Sidelying Release. This is far more than lying on one's side!

Done on both sides to relieve lopsided muscle tension in the pelvis, Sidelying Release is often the solution for uneven pelvic floor muscles. This baby didn't seem to be so far down the pelvis to be on the pelvic floor yet. The doula is using Sidelying Release to help the mother get into active labor.

"...then Sidelying Release on both sides for the duration of three contractions. After nearly three hours of hard work she went in nice long bath... " This description gives us the clue that Sidelying Release allowed a regular, strong labor pattern to establish over the next three hours. Then she took a gentle bath to adjust her mind to labor and perhaps find pain relief. When baby drops into the pelvis and comes on to the cervix for the first time, the emotional release as well as the added pressure deserves a little deep immersion in a warm (but not the exhausting heat of a hot tub) pool or bathtub. If a deep tub or shower isn't available, a gentle version of shake-the-apple tree (jiggling the buttocks muscles) is another way to relax the pelvis.

2 hours later she was on her way to the hospital with contractions every five minutes, she was three cm on arrival [being 3 cm after 5 hours of stronger labor is a good indication that I was right with my assumption the baby was not engaged before the doulas good suggestions. Lack of engagement may have been the leading factor in the previous cesareans.]  but continued mobilising [moving freely] until her contractions were much more intense and soon after she was feeling pressure with each contraction and we barely had time to reach the delivery suite for her to start pushing... baby was born soon after with a very smooth clean and gentle delivery no stitches... mother and baby went home a few hours later!" 

Congratulations VBAC Family and Doula Beatrice! We, at Spinning Babies, are so happy to help!
And we appreciate the chance to discuss this lovely birth with you as an teaching tool for the 3 Levels Solutions.

You can learn more about 3 Levels Solutions to help you pick the right techniques sooner on the
Spinning Babies; Quick Reference Guide digital download for providers;
Spinning Babies; Parent Class for parents digital download or watch it streaming on Vimeo.com

US customers can visit the Spinning Babies online shop for the booklet or DVD.

Tuesday, April 11, 2017

Uterus in a twist

When seeking an answer about what to do to protect the normalcy of birth, Spinning Babies asks the question, Where is Baby?

This is because the baby's position reflects the shape of the uterus. For instance, if the uterus is well positioned, the baby is well positioned.
If the uterus has gotten into a twist, perhaps from a woman playing softball or golf, the baby may be angled above the twist. The uterus might look tipped. It seems like baby is all over on one side sometimes, or perhaps at a diagonal.

The twist will be low in the uterus where the musculature is softer. Cervical ligaments seek to anchor the uterus at and around the level of the cervix. It is about this area that the twist may be the most significant. Car accidents, sports, and sudden stops in gravity when the body is at an angle from the stopping point (the bike hits the curb at an angle rather than straight on).

Dr. Carol Phillips taught me this view of the uterus and Debra McLaughlin is her student who has taken the teaching of this concept to excellence for the providers of birth care.

Spinning Babies happily brings this information forward for the purpose of comfort in pregnancy and ease in birth. But perhaps more important than ease is function. Our bodies function when in "balance."

Labor pain awakens the brain release of endorphins which prepare the birthing parent for love. The birthing mind becomes the parenting mind. Too much pain is frightening, or rather, fright is inhibitory to a healthy response of instinctual  movement. Less fright, more love, but not less pain more love...

Yet labor pain increases unnecessarily, and can even become insufferable in some cases, when the uterus is so far out of alignment with the pelvis that the uterus can't contract smoothly to bring the baby into and through the pelvis. The uterus pushes the baby against bone in many cases.

I've asked doctor friends of mine about cesareans. Did they see a twist in the uterus? One friend said oh, yes, but she saw it in cesareans for failure to progress.
Well, that made my case particularly!

When the uterus is significantly twisted babies weren't coming through the pelvis. They were lying at funny angles and uterine contractions weren't able to drop them into the pelvis. In some cases, babies were lying sideways with the uterus twisted around so that the back of the uterus was now in the front of the woman's body. One uterus had to be untwisted before the cesarean because the ovary was in front. Other twists were discovered only after the surgery because the condition wasn't as obvious without a structure like an ovary to give the clue.

These are cases in which the doctors found torsion in the uterus. Torsion is also noted in the literature.

Definition of Uterine Torsion

Uterine torsion is defined as rotation of the uterus of more than 45° on its long axis. (Fatih; Nicholson)

Uterine Torsion can be associated with fetal malposition (Pelosi)

What to do about Uterine Torsion?

Body balancing by addressing the soft tissues brings the uterus into alignment. Chiropractic and Osteopathics can help align the pelvis.  Together these modalities work the best. Some Chiropractors know the myofascial or fascialtherapy and add it to their protocols.

Forward Leaning Inversion with head in flexion at a Korean Birth Center.

Spinning Babies offers the Forward-leaning Inversion, a technique created by Dr. Carol Phillips which allows the weight of the pregnant uterus to hang freely and unwind like an old fashioned telephone ear and mouth piece hanging from a tangled phone cord. This is a self care technique that is quite effective in pregnancy for the baby in a transverse lie, or in labor for the anterior lip and other slow-downs of labor progress.

Debra McLaughlin teaches how to recognize and undo uterine torsion.

Debra McLaughlin teaches us to activate the adductors and abductors and correct the symphysis. She is teaching this in a way that a midwife can understand. Learn about aligning the uterus in context this summer to our Spinning Babies community.

Spinning Babies Professional Bodywork Education week in July will move this conversation forward. Chiropractors, Osteopaths, Craniosacral therapists, Fascial Therapist and Therapeutic Massage therapists will love this week. Birth workers are invited but be aware that the teaching is assuming more anatomical awareness than you would learn in midwifery text about the supporting structures. Some of this will be taught but foreknowledge is empowerment. The more you know the more you will learn, let's put it that way! http://spinningbabiesconference.com/


Uterine torsion in second trimester of pregnancy followed by a successful-term pregnancy.
Fatih FF1, Gowri V, Rao K. BMJ Case Rep. 2012 Aug 21;2012

Jensen, J. G. (1992). Uterine torsion in pregnancy. Acta obstetricia et gynecologica Scandinavica, 71(4), 260-265.

Nicholson, W. K., Coulson, C. C., McCoy, M. C., & Semelka, R. C. (1995). Pelvic magnetic resonance imaging in the evaluation of uterine torsion. Obstetrics & Gynecology, 85(5), 888-890.

Pelosi 3rd, M. A., & Pelosi, M. A. (1998). Managing extreme uterine torsion at term. A case report. The Journal of reproductive medicine, 43(2), 153-157.

Wednesday, March 8, 2017

Clarity in your birth

Many visitors to Spinning Babies Website are looking for effective help for an easier birth.

We suggest using Spinning Babies Daily Activities as a part of preparation for birth.
Daily movement and maternal positioning can be added to a great pregnancy diet, deep and full breathing, learning about birth and parenting, enjoying good communication and visits with your provider. Monitoring blood pressure and blood sugars and other health indicators are important but self care is the care you give yourself and your baby. Monitoring for disease can't create the health you want. Here are some ideas to boost your benefit in pregnancy.

  • Community involvement in a pregnancy and/or parenting group preserves sanity, soothes loneliness, and boosts health! 
  • Studies show a doula offers multiple health benefits even though they don't give medical advice. This is the magic of social support. Get a doula, you'll only know why you needed one after you find the doula who is your best match. 
  • Exercise in a group. Create a pregnancy walking meetup up to 3 times a week!

But once you are active, supple and supported, you still need to communicate your
desires, needs, and limits with your care provider.

Sometimes pregnant parents worry that their requests for individualized care, or resistance to procedures will be seen as confrontation by the providers.

Pick a provider who isn't emotionally threatened by parents who have personal needs... uh, oh right, which parents don't?

  • Then be sure to voice your needs, desires, and fears. 
  • Being personal and open yourself, without bailing at their first hesitation, is a good way to communicate with care providers. Look them in the eye expecting mutual respect.
  • Write your list in positive terms that providers and hospital staff can "do" or respond to. People in helping professions want to help. Show them how they can help you have a better birth experience. 

A healthy pregnancy and healthy baby are mostly due to self care of a healthy pregnant person. When health is a challenge, these suggestions are only more important, though they become more challenging to achieve in some cases.

More ideas

  • Join a pregnancy and parenting community, such as attachment parenting, early childhood education groups, and prenatal and parent/baby yoga classes.
  • Bring your partner to a parenting group of their interest. 
  • Learn about infant CPR and life support, home safety tips for babies and
  • How to wear your baby! Yep, the best "jewelry" you'll ever wear! Put that little jewel in a rebozo, sling, or front pack during the early months and on your back when baby is too heavy for your front (unless you know how to wear baby in a cloth sling on your back earlier).
  • Learn lullaby songs, finger play, and stories that will delight your baby and reduce your stress when baby needs connection with you and you need some baby entertainment. Learn them now. 

Join the Spinning Babies Parent Enewsletter on the Spinning Babies Website. It's free.

Will Shoulder Dystocia occur?

A doula friend of mine, "J," asks how real the concern is that a mother with an estimated projected fetal weight of 11 pounds by the time of the due date will have a shoulder dystocia.

"They had her see the OB and heard the reasons for perhaps choosing a repeat surgical birth. She was told that if gestational diabetes is back that they see these big babies with a weight distribution in the upper body (shoulders) that could be problematic during birth. ...

This mama is hoping for a vaginal birth but she is philosophical about the whole thing. She knows there are no assurances but feels she needs more info right now. She is wondering about continuing the Spinning Babies stuff she has been doing. Her abdomen is pendulous and she has been using a rebozo to get some relief for the back discomfort she is having...

Thanks for being out there doing what you do.

Practicing a typical hospital resolution of Shoulder Dystocia.

Gail Tully responds
Dear J
Hi. I can only share what I would have recommended as a midwife. As a doula I would not have made statements about my opinion of risk or stated recommendations in the following way. This is my post-midwife voice here.

Movement, good nutrition for her blood type (meaning a serving or two of grains and milk products for the Os and As) while getting good protein and veggies, salt-to-taste and water. Minerals help reduce sugar cravings. Red Raspberry Leaf with Alfalfa steeped together is really amazing.

Wearing a pregnancy belt and getting balancing work down, she can have her helper (you?) do standing release with her.

The pendulous uterus is more of a risk for shoulder dystocia than the baby's size alone. Ultrasounds can be off, of course. and her chance of no shoulder dystocia is somewhere around 4 out of 5 if this info is accurate, between the hanging uterus and large baby. What will improve her chance of no obstruction?

  • Wearing the pregnancy belt all the way through the birth of the shoulders!
  • Balance and good diet for good metabolic function!
  • Supple sacrum
  • Avoiding a vacuum or forceps
  • Upright birth position and
  • AFTER the head is born, in any maternal position, a posterior pelvic tilt (which can be done preventively during ONE contraction in 2nd stage.

The pregnancy belt, the right one for her, could be amazing.

Talking to an Obstetrician/surgeon about benefits of cesarean is like talking to a plumber about home improvement. Yes, new pipes may avoid a clogged drain now, but if you had hoped for a consultation on paint colors you are going to go home worrying about potential plumbing problems. It can haunt you. Especially as birth is more important than a broken pipe. But I'm talking perspective. If her midwives are not able to resolve a shoulder dystocia, and the doctors weren't able to help her first baby be born breech vaginally, then what skills is she expecting from them that they don't also have?

There are known side effects to a repeat cesarean (she knows she will have major surgery, separation from her baby, and significant blood loss, postpartum pain in the abdomen, not able to lift or do stairs for a longer time, the risks are that she might have infection, adhesions, problems with a future pregnancy, etc. etc. and there are unknown side effects to a VBAC, such as a sore perineum, possible hemorrhoids, etc. Which is most beneficial if they go well? Cesarean offers a feeling of certainty (though not assurance) and vaginal birth offers the unknown. But vaginal birth also offers hormonal changes from labor, the finish of the hormonal cycle of reproduction with subsequent brain change and probiotic activity, and can be easier to maintain mother/baby togetherness from the start, spontaneous or at least, immediate breastfeeding is more possible but can happen or not happen with either surgery or vaginal birth.

She may have a shoulder dystocia. She may not. I don't dismiss the potential but I don't dismiss vaginal birth because of this person's risk. If she does have a SD, she flattens her lower back while her providers figure out how to rotate the shoulders free. The chance of injury to the baby is about 7 in 100 and reduces to less than 2% when providers do practice drills (Crofts 2014). Permanent injury is also low risk. Death is less but not zero.

The thing she can ask herself is, who does she want to be a year from now looking back at her birth?
What does she want and what is the next action to take to get that? And to remind herself several times a day to hold that vision in her head and body. Asking our bodies to avoid a complication is wrong. Because the mind doesn't hear no, don't, avoid. Ask the body to release, open, birth (as a verb). The physiology-first mind set.

Thank you for your continuing care of our mothers, Doula!

Much love,

On this video you will learn 5 types of shoulder dystocia and their resolutions using all-fours and other maternal positions. You will see references on how often SD occurs and reoccurs as well as see births and real life resolutions. MEAC CEUs are available with the additional purchase of the continuing education option.

Wednesday, March 1, 2017

Not Afraid to Care

"The 2014 West African Ebola outbreak killed 11,310 people. Liberian nursing assistant Salome Karwah was not one of them." says Time Magazine. "...as soon as she recovered, she returned to the hospital where she had been treated — the Médecins Sans Frontières (MSF, or Doctors Without Boarders) Ebola treatment unit just outside of the capital, Monrovia — to help other patients. Not only did she understand what they were going through, she was one of the rare people who could comfort the sick with hands-on touch. She could spoon-feed elderly sufferers, and rock feverish babies to sleep." wrote Aaryn Baker.

The Washington Post states,
"Last week, Karwah died as a result of complications from childbirth, and the lingering suspicions of Liberians toward Ebola survivors was partly to blame."

Three days after a cesarean birth on February 17th this year, Salome went home and began to convulse. Though her family rushed her back to the hospital, fear of contracting ebola through her saliva stopped the medical staff from treating her. Time reports, "They said she was an Ebola survivor,” says her sister by telephone. “They didn’t want contact with her fluids. They all gave her distance." Treatment may have included heparin if symptoms matched a blood clot, and magnesium sulfate IV if eclampsia was suspected. The anti-seizure medication diazepam may have been considered. But Salome got none of these treatments. Fear and not knowing how unlikely it was to resume an eboli viral infection prevented good medical care. Training may have saved this heroine's life. How bitter that she was so willing to serve eboli victims so these same medical staff members didn't have to risk contact and that later they let her die unnecessarily because they didn't want to risk contact.

The most common cause of seizures after childbirth may be eclampsia which can be seen as rapid shaking of the body, or convulsions. 

Lubarsky (1994) studied late postpartum eclampsia, most of which took place after hospital discharge. After 48 hours the risk lessens but eclampsia can strike two weeks or even three postpartum.

Sibai concluded that postpartum convulsions three days after birth are likely to be cerebral vein thrombosis (1980). Up to 30% of victims do not have headaches preceding convulsions, finds Coutinho (2015). Hormonal contraceptives, pregnancy and postpartum period increase risk. 

A 2012 case report also cites dural puncture from a difficult epidural. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371498/
This woman was given diazepam to stop the seizure and magnesium sulfate through intravenous fluid injection until it was determined by spinal tap examination that a dural puncture was the cause.

So many health care workers and others who give selflessly are reeling from this tragic loss. Those who have worked in similar extreme conditions are all so close to the split of the courage and the fear and the human behavior reflecting the opposites. I can only assume the poignancy with which these fearless rescue worker must feel this news. 

Might I be correct in suspecting many Americans would assume that US medical workers would not bow to fear. We have evidence, we have protocols, hey, we have gloves! 

A recent series of emails with a breech bearing Mama is a common but seemingly less extreme example of fear stopping proper medical treatment.

The pain within this first email may not be blazing, but it's chronic and also epidemic. The loss is not only to be the parent struggling to find help in a society which turns away from natural breech birth but to be a midwife reading her desperation. 

A pregnant woman writes to a group of providers, seeking skills and willingness that is nearly extinct in the USA.
"I am almost 32 weeks pregnant.  My baby was head down but at my check up just presented breech.  I know its early, but my current provider will not even consider anything but a C-section if the baby remains breech.  ...
I have heard no hospitals in the twin cities offer vaginal breech delivery...

Please let me know if you or anyone you could recommend has experience with natural breech birth and still is willing to attend one, and would take me as a transfer patient at 32-33 weeks. Please include cost of service too ..." 

Compounding the sadness is that the outcomes of vaginal breech birth is similar to those of cesarean with a skilled provider. The problem is that the skills are rarely taught in schools and not many providers can travel to breech experts to attain training.

These obvious mourners, mothers and midwives, are not the only ones to grieve skills lost. Thomas van den Akker served birthing families in Malawi. He warns European physicians that there are also hidden victims of denying breech vaginal birth are the subsequent siblings who may die from cesarean after-effects of rupture in later pregnancy and the women and breechlings of low-resource countries whose care providers have now also lost the skills of breech delivery before a system of high-tech surgical suites can be supported in communities.
(Who pays the price? (Foreign) women, future siblings, 2016,Thomas van den Akker MD.PhD, Resident O&G at University Medical Centre, Leiden, The Netherlands as reported in the Amsterdam Breech Conference, 2016 Teach the Breech!) 
Thomas van den Akker at 2016 Teach the Breech
Breech skills retained in high-resource countries save lives in low-resource countries as well.

Cesareans replace the recommended procedures in spite of electricity not being available 24/7 in many rural hospitals. These same communities are devaluing and banning midwives and so lose their knowledge as well. Can the western medical invasion comprehend the resulting die-off caused by the inoculation of hybrid birth practices devoid of community networking and manual skills which need no electric lights to succeed?  Like a viral tsunami, surging western high-tech values wipes the cells of culture, birth, and family from the bed of hands-on skills. 

The late Abby Kinne teaching breech skills to a midwifery student.
Abby was a dedicated teacher to first responders and medical and midwifery students.
Who in her area has taken her place? Does anyone know breech like she did in her region? 
New understanding in physiologically-based exercises for what Carol Phillips coined body balancing seem to help women themselves achieve head-down fetal positions for their babies. Spinning Babies suggests self care and professional bodywork and other ways to help baby get head down before manual force of external cephalic version or skipping attempts at turning babies and going straight to cesarean. 

If no one is available for breech skills, then breech birth is more risky but parents who choose vaginal birth have the right and are, importantly, not wrong to choose vaginal birth. It is the responsibility of providers to insist on breech skill wisdom and to seek it, bring it to teaching venues, and preserve it in law and protocol. We must not find ourselves to afraid to act correctly. 

The same mother writes, 

Thanks so much, Gail!  I did a lot of exercises to try to help the baby turn, and thank God, she did turn head down in just a few days... I am just hoping and praying that she stays that way:)  

Thanks again for all your help and your warm response.

March is Womens History Month. http://womenshistorymonth.gov/about/

Wednesday, February 1, 2017

Is there still time to flip my breech baby?

Spinning Babies helps flip a breech 
The look that says, "I did it myself!"

At 36 weeks the midwives were adamant there was a less than 3% chance of my baby turning from the frank breech position and had never heard of any exercises to do. 
I was recommended to have ECV [external cephalic version is when a doctor (or occasionally a midwife) tries to turn the baby by pushing on the abdomen in a very specific way] or a C-section, and told my homebirth was out of the question.
I did the exercises you outlined. And at my 37-week scan little Pearl was head down. The Sonographer [ultrasound specialist] said she had never seen it before and said she had thought it was anatomically impossible for a baby to have turned that late?!
She was born in the pool in our sitting room while her 2-year-old big sister slept upstairs.

"Spinning Babies empowered me to have 
the most perfect birth for my family."

Spinning Babies offers hope for women who want a vaginal birth. Many women will succeed in improving baby's position with self care techniques. Others will find interventions are less taxing. The sooner you begin, the more likely you will find the "balance" you need for more comfort in pregnancy and more ease in birth.

Typical timeline for breech position 

10-24 Weeks Gestation

Baby is often transverse or a bit oblique. Few babies are vertical now.
By adding body balancing now, the baby has an increased chance of ideal positioning later at 34 weeks and beyond.

24- 30 weeks

Babies are moving towards a vertical  Routine good posture with walking and exercise will help most babies be head down as the third trimester gets under way.

30-34 Weeks Gestation

Chiropractors  may add specific maneuvers for fetal positioning, sacral and symphysis alignment, Webster Maneuver, and other soft tissue work. 
The best time to flip a breech is now. Oxorn and Foote recommend external version at 34 weeks, but most doctors want to wait for baby's lungs and suck reflex to be more developed in case the maneuver goes wrong and starts labor or compromises the placenta.
There is often enough amniotic fluid for an easy flip before 35 weeks.

34-35 Weeks Gestation

A study showed this is the most effective period for moxibustion to help babies flip head down. We suggest doing moxibustion as part of a complete routine for helping baby head down.

36 -37 Weeks Gestation

An external cephalic version may be recommended about this time for the doctor or midwife to manually turn the baby head down. It's about a 50-50 success rate. We wonder if preceding the maneuver with body balancing will increase the success or ease of moving baby. Less tension or torsion in the path of the baby seems like a goal to me.

38 Weeks to Birth

A small number of babies will turn head down in late pregnancy. It may be that up to 1% of breech babies flip head down during labor. That's not a big chance, but it shows it's possible and does happen.
An external cephalic version might be appropriate to try even up to and including early labor.
You can work with your body to prepare and work with your care provider to turn baby safely, if possible, until either your water releases or contractions are regular.

Dr. Michel Odent in his book "Cesarean" suggests waiting for labor even if you plan for a cesarean birth for a breech baby. It's a bit challenging to pull together a surgical team in the middle of the night, but helps baby establish the brain changing catecholamine and other changes for living in air.

Gail and a pregnant couple show a short version of advice for helping the breech baby get head down, Spinning Babies Parent Class.

Planned birth benefits and risks

Women today are sometimes encouraged to finish pregnancy and have their babies delivered.
The suggestion can create a sense that induction or a cesarean is the route to safety. For many pregnant people the alternative of continuing the pregnancy until nature decides the birthday no longer feels natural or safe.

But what are the actual risks? Here is an Australian study looking at the results of delivery baby with technology.

Planned births occur where a considered decision is made to deliver an infant, and in recent years there have been significant changes in clinical practice resulting in an increase in planned births before the ideal time of birth at 39-40 weeks' gestation. This is mostly attributable to the increased use of elective caesarean section and induction of labour.
The study of 153,000 Australian children published today in Pediatrics reports that overall, 9.6 per cent of children were developmentally high risk. In particular, infants born following planned birth before the optimal time of birth were more likely to have poor child development.
Using the Australian Early Development Census instrument, children in the study were assessed in five domains: physical health and wellbeing, language and cognition, social competence, emotional maturity, and general knowledge and communication.
Children scoring in the bottom 10 per cent of these domains were considered 'developmentally vulnerable', and children who were 'developmentally vulnerable' on two or more domains were classified as 'developmentally high risk'.
Compared to children born vaginally following spontaneous labor, the combined adjusted relative risk of being 'developmentally high risk' was 26 per cent higher for a planned birth at 37 weeks and 13 per cent higher at 38 weeks. This is after taking account other important factors associated with poor child development such as socioeconomic disadvantage, lower maternal age, maternal smoking in pregnancy and fetal growth restriction.
"The timing of planned birth is potentially modifiable, and the benefits of waiting should be communicated to clinicians, mothers and families," says study co-author, Dr Jonathan Morris of the Kolling Institute and the University of Sydney.
The study also reports that the risk of being 'developmentally vulnerable' increased with decreasing gestational age.
Compared to children with a gestational age of 40 weeks, the adjusted relative risk of being 'developmentally high risk' was 25 per cent higher at 32-33 weeks, 26 per cent higher at 34-36 weeks, 17 per cent higher at 37 weeks, and six per cent higher at 38 weeks.

Tuesday, January 3, 2017

Doctor was surprised: Transverse baby went head down at term

Doctors schedule a cesarean when a baby is lying sideways in the womb and the due date is less than a month away. This may be because it is rare to have the transverse lying baby move on their own to a head down position. 
The transverse baby lies sideways
across the top of the pelvis and
can't be born naturally.
Transverse lie is normal in early pregnancy
until about 26 weeks or so.
By 29-30 weeks we expect baby to be head down.

Common Strategies for a baby in the Transverse position after 30 weeks: 
  • Wait and see (less likely to help)
  • Manual External Version (doctor manually turns baby)
  • Cesarean (baby can't be born naturally when lying sideways)

Spinning Babies offers an uncommon strategy:

Dr. Carol Phillips, DC and Gail Tully
taken after one of Carol's weekend workshops. 
Dr. Carol Phillips, DC, friend and teacher of Gail Tully's, developed the Forward-leaning Inversion after watching the sudden ease of a birth following a ride down three flights of stairs in a gurney to the ambulance. The mother had been pushing and not able to move the baby. Dr. Carol had done all the techniques she usually saw get good results. So the midwives decided to transfer from the home birth to the hospital and get the baby born there. They just didn't want mom walking down three flights of stairs at ten cm just in case baby did come out on the stairs. So they called the ambulance crew in to help. They carried mom down on the stretcher head first -in case the baby came out on the stairs.  When they put the mom into the ambulance, swoosh, out came baby crying and kicking. 
What made that possible, Carol asked herself? The ride down the stairs head down! What anatomy did that effect?! The utero-sacro ligaments to the cervix!

Dr. Carol figured out a posture to replicate the ride this mama took. The Forward-leaning Inversion was born. 

Now we find it the perfect solution to the transverse lie. 

Read on the website about dangers and risks before you go upside down, please.

Here's the amazing story which came in today. This Mama had emailed a couple times this pregnancy and she had the same issue with her first pregnancy and used Spinning Babies to help in that pregnancy as well. Let's see what she says: 

Dear Gail, 
I have fantastic news for you. So to update you in my last email I mentioned that I was 39 weeks pregnant and had a fall 10 days earlier due to which my baby changed from head down to transverse lie position. My gynac [she may mean Obstetrician-Gynecologist] had scheduled me for a c-sec at 39 weeks 6 days because the baby was too big and they didn't think it was possible to change positions so late in the pregnancy. I consulted a second gynac who said the same thing. I had 3 days in hand to do your exercises and see if the baby's head would turn down.

On 16-18th December, I did the forward-leaning inversion and pelvic tilt. On the 17th, I felt the kicks higher up but wasn't sure where the head was. So to be sure we got admitted to the hospital at 1am so we could check the position of the baby before the scheduled csec at 8am. To our disbelief the head was down and not only that, the loop of nuchal cord around the neck was also gone. 

My [OB GYN] was in utter disbelief that the baby had turned for the following reasons:
1- the baby was fairly large - 3.6kg
2- she manually tried to spin the baby and it didn't move 
3- I was 3 days away from being full term

My labour only lasted 45mins from start to finish and I would also owe this to you for your tips of opening up the pelvic area to make labour easier. 

I am truly grateful to you for all your guidance on your website. It not only worked to spin my first baby back in 2014 but worked this time too. Your tips and exercises on the website were instrumental in helping me otherwise I'm sure I would have had to get a csec which is something I didn't want. 

I didn't end up purchasing the video but would like to donate to your organization. Please can you give me the details of how to go about it. 

Thank you from the bottom of my heart. I am spreading the word to everyone I know and my gynac will also recommend your website to her patients.

Lynn Saldanha, Mother

Learn how to do the Forward Leaning Inversion properly in this video excerpt of the Spinning Babies Parent Class. Purchase the full class on Vimeo to help you prepare for birth!
  Transverse Baby Consultation from Spinning Babies on Vimeo.

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.