Tuesday, December 18, 2007

Continual Presence at the other end of life

Sitting with my dying niece tonight, I didn't want to leave her. But my son had to be picked up and I hadn't seen my husband in daylight for a while.

We're nearing the final vigil time. It is hard to leave and hard to go back. Each time I approach her home my stomach tightens because I don't know how far she may have slipped away from us since the day before. But there is a grace and a mystery to this that has many correlations to birth care.
Had to come back around to birth, didn't I? Even on the topic of death, I think about birth. Seems natural to me.

Dr.s Kennell and Klaus talked to us doulas about the importance of continual presence: Being with the mother from the time she calls us to her. Most often that is when she has begun early labor. Potty breaks are accepted, but meal breaks are far too long.

I haven't been able to be with Meg continuously. I know I will when her breathing becomes labored and shallow. That is in the last few days. But now is when she needs it. Each moment is so precious. But I can't stop the clock for my family, even for myself.
Sometimes I just got to get outside and walk, or talk with other midwives about anything about the beginning of life, or make a bead for a Christmas gift. I'm a little upset about myself. I have stayed at many births for days. This birth, back into spirit, though, has been months. This level of care, a few weeks now.

Yesterday, Meaghann hadn't said virtually anything all day. Later, as my sister and I dressed her for bed, she opened her eyes and clearly said, "Gail, are you still here?"

How I wanted to stay at her side. But I don't want to, too. She is still independent in her mind and she doesn't have much patience for being fussed over. It can make her crabby with us. Especially if we look worried. I get antsy, want to sleep in my own bed, get something ready for Christmas, or take time for a prenatal or postpartum visit.

Meg has wonderful support, from family, friends and hospice! Her mother is loving and attentive, they've been living together since Meg's 2nd brain tumor, 2 years ago. She has a loving sister who comes frequently; a brother who spoke to her so tenderly tonight. She has help from home hospice, and since Thanksgiving, a dear old friend of mine, Juli Kampmeyer, has come in to give palliative care. In college, we were going to go into nurse-midwifery together. Then, I held a panel of midwives for a community event and from it chose homebirth midwifery, and Juli went into Human Services and then went on a journey that led to home care for vulnerable people, including the dying. She is our midwife. She is our doula.

You readers who are doulas and midwives will have experienced times that loved ones of birthing women ask if you would help them when they have a baby. Well, I actually asked Juli if she would help me when I die.
Dying couldn't be any better than by having Juli by my side. ! Ok, this is the kind of humor you get after months of facing the death of a loved one, and all the earthy practicalities of ongoing care involved with someone who is losing physical abilities.

Meg has someone with her 24/7 now, of course. This 3rd tumor, advanced to a "glioblastoma multiforme," is pressing on her motor nerve and she can't do what she intends to do. Mentally she is often quite cognizant, but she has trouble speaking now. My work as a doula helps me perceive her needs fairly well.

Again tonight, Meg began to talk after a fairly silent day. Her mom teased her about eating chocolate after her teeth were brushed, and Meg smiled her crooked grin.
While being dressed for sleep, Meg's eye caught a decorative plate on the wall and she said, "I love that plate. I gave you that plate."
Kathy and I looked at each other. We haven't heard this many words from Meg for several days! Kathy said, "And I love the giver of that plate."
Quickly, Meg quipped back, "And I love the Givee!"

When later, I told her I had to go, she watched me begin to back up from her bed side. She said, "I love you, Gail."

A wave of sweet emotion hit me like a wave on the beach. A life time of love pours through a simple sentence. Love for your life ahead. It can send you dancing above the pain.

There are many levels in dying, like labor. You can focus on the pain or you can focus on the love. Being one of the doulas for my niece, as she winds down her life, is a walk in God's grace; peace beyond understanding. Brutally tender and surprisingly transcendent.

Monday, December 10, 2007

To try labor if baby is anterior

I've been contacted by a woman in southern Europe who is trying to decide if she should travel to a place where she can labor and give birth or to stay in her city and accept a cesarean without labor. What a position this mother finds herself in! What a dilemma!

Should she put her family into the stress of having her leave their hometown? Will her mate have to leave his work to be able to be at the birth of his child? Who will bring her food and supplements when she is so far away? Where are the women of her community? Will she obtain a vaginal birth at the cost of community support? What gapping hole in society leaves women in this state of childbearing.

Her process of decision making has brought up the question of whether she should try labor if her baby is anterior, but go ahead and accept a cesarean if her baby is posterior.

She has been following her baby's position with Belly Mapping and using some of the techniques in Spinning Babies. She describes her baby as changing from LOP to ROT, and wonders if now at 36 weeks she should book her cesarean.

I have a strong response....

Are you indicating, am I reading you correctly, that you wouldn't try for a natural birth unless your baby is LOT? or LOA? (Click here to see baby positions.)
My goodness, any labor is more likely to progress into a vaginal birth than not, especially if the baby engages by labor. If you do nothing but allow labor to begin and proceed, you are likely to give birth, Paulina!

Help the baby engage by hula hooping on a birth ball or the Walcher's position to bring the baby down. Engagement is more important than OA or OP. Try and help the baby to the left with hands on the right before trying to get the baby to engage. Naturally your baby would engage between 38-39 weeks.
  • Are you doing the Inversion as shown on the little video on my site? Use that one, not the other methods. This relaxes the lower uterine segment.
  • Did you get your sacrum adjusted? This will help the baby rotate now to a left occiput transverse (left occiput lateral) position.
  • A sacrum release by a myofascial person will also help there be more room in the back area of the pelvis.
  • An abdominal release and a round ligament release helps the baby rotate before engagement.

These are the body work things that really seem to make the difference. Oh yes, a pelvic floor release. That last seems to help with any position of baby so the baby can drop. Do that after you do the previous a couple times each. Or do the pelvic floor release in labor. For sure.

Then use an active birth approach to labor. Vertical positions, leaning forward, drug free, eating freely, drinking water and an occasional electrolyte drink, these things, and patience, will help you if you do have a labor longer than average. Don't time yourself, just keep up on food and fluids and emptying your bladder. Love your mate and your helpers and let that love be felt in the room. Have some fun with your adventure. Don't measure it and judge it like it is a fire that could get out of hand. It is a flower opening. Pour a little water on it and get in the sun, or in other words, a nurturing environment.

Think carefully if you would give up on your child's birth. This choice will last generations. You may have a need for a cesarean, but nothing you have shared with me shows that you do at this time, or likely will. Labor improves the hormonal function of you and your child.

I probably sound a bit forceful. It is just a response to finding a woman in your position. I believe you that your community birth environment has got you to this point.
Let me say that I believe in you, in the design of birth within us both, and in your ability to give birth to your little one.

There is a community of birthing women who can become your community, too.

Saturday, December 8, 2007

Doulas too?

One more post here in response to Joyce McFadden's blog From Doulas to Doctors; Women are still dismissed." Here is an extract :

  • A woman says to her male doctor, "Since the surgery I have pain right here." The doctor says, "That's not possible." Almost a year and at least $5,000 worth of medical expenses later, she's proven right. A woman says to her female doula, "There's something wrong with the labor, I need to go to the hospital right now." The doula repeatedly tells her she should just hang in there, it's not time yet, which proves to be a bad error in judgment.

See that middle sentence? That's a problem.

I'm so glad that Penny Simkin teaches in her doula trainings and conference sessions the sage point that a doula must leave her agenda at the door and let the mother lead her birth.

When encouragement turns to persuasion the gift of the doula is crumpled. There is an urge among either the naive new doula or the doula on a crusade to rescue birthing women. I'm not saying it isn't motivated from a reasonable desire to protect her from the kind of care described in the previous post. But the desire backfires.

When we seek to rescue we loose the equanimity of the mother doula relationship. We are no longer equals, no longer peers. The rescue worker doula has disconnected from the mother's choices to meet the doula's (and this sounds bizarre) desire to offer her more choices.
A pure motivation doesn't justify sloppy communication.

Think about it. I think it is the hardest thing about being a doula. The doula sees the spectrum of behavior coming from medical staff. Some excellent, some brutal. That's a fact. But the mother holds in her heart that she will be welcomed appropriately, celebrated for bringing life, as I've said, and cared for compassionately. She expects that. She may not be thinking defensively about avoiding interventions. And even if she was, it is not the doulas role to prevent her from having them, but only to educate her about them before birth, and to be compassionate about her use or non use of interventions during the birth.

If the mother herself chooses not to use a routine intervention the doula can offer a number of ways to support her choice. But the doula has a line that she can't ethically cross. And certainly that line would be access to care!

If Men could have babies?

I've heard it again. "If men had babies...." Joyce McFadden's blog entry "From Doulas to Doctors" explains well the emotional disruption of being ignored in your own birth process. She says, and the brackets are also hers, "[If men gave birth] I think there would be more transparency in the process, and that patients would be treated with a modicum of respect, and as intelligent, functioning human beings with the right to participate in their own care."

Her blog gives an accurate portrayal of what too many women experience in a setting where surgery is becoming, not second nature, but is replacing "first" nature.

The only thing is, is that her conclusion is off. Women doctors are not inherently more respectful of women patients, not OB patients. Each male or female doctor makes the decision for themselves whether to extend themselves beyond their technical performance and reach out to the heart of the patient. In other words, are they living as a healer or a technician?

I was a doula for a woman who picked a prestigious all-female OB group. She told me in her pregnancy how reassuring it was to have women caring for her. Women, who understood what it was to be in her position, pregnant and wanting compassion and celebration for this miracle of bringing life.

Her labor went fast. In fact, so fast that the doctor and I came into the room while the mom was crowning in 2nd stage. So fast, that I began to coach (a term and a style I don't normally use, but it fit at this moment) as I crossed the room to help the mom cope with the feeling of stretching skin around her baby's eager head.

""It's ok, its your baby's head coming." I didn't want to direct the birth, but I also didn't want her to push her baby out hard into the air unattended, because the doctor was still gloving up. So as not to put myself in the place of the baby catcher, I said, "Your doctor is going to tell you how to pant so the baby's head comes out smoothly." I was trying to get that word "pant" in there.

But to my surprise, and the mother's, her doctor wheeled around and shouted, "I'm the doctor here, and I am cutting an episiotomy." I'm sure her far sighted vision was able to see across the room (and around the back of her head) that the crowning baby was stuck or the yielding perineum of her patient was going to burst or something noble motivated this woman doctor.
She swept across the room and deftly grabbed her favored implement and quickly cut the mother open even as the baby was emerging.

I can go on to describe numerous similar descriptions of women who cut without reason, who use the vacuum on actively birth women, who threaten the mothers with the death of their child if they don't submit to induction. And this last by nurse-midwives.

On the other hand, I've been a doula to women who have the nurse-midwife group in town that includes one male midwife. Early in their care, mothers sometimes say, I don't want the male midwife, I want a woman at my birth. Usually at some point in their pregnancy they end up seeing John. A big smile comes over their face. Several have said they almost prefer John to the other midwives they've seen.

You see in each case, we chose to be present with who we are with, or we don't. Its not the gender, its the power a person supposes they have over another person. The illusion of power disconnects you from humanity.

If a doctor or midwife doesn't acknowledge informed consent, or acknowledge the voice of the woman at all, they have no motive to connect with her. Their sentiment may be for the relationships with the nurses. They are chatty because they are exercising their power among nursing staff who have to work in the OR and listen to the doctors. They smile, of course, like paid admiration. The nurses want to get along with their co-workers, including the docs, so its not wrong to establish working relationships. It is wrong to desecrate the sanctity of a mother's birth.

Is this disconnect the price of technology and the cost of high paid technicians? Do we allow them this power because they save lives? Do we sacrifice the quality of life for nearly all new mothers so that we can save the lives of a few? And if so, then why are we losing more babies than countries with less technology? We aren't getting the rewards of our sacrifice.

I rapidly go to the larger problem. If it is seen as gender, it may be because, as a society, and too often as individual women, we have given the male gender the power to disconnect from us. Put a woman in that place of power and we see the same pattern of disconnect.
The pattern is there. We have to transcend the pattern, not the gender. The gender is besides the point.

Friday, December 7, 2007

Might as well accept surgery?

A woman pregnant with breech twins emailed saying her physician recommended signing up for surgery. He predicted that they weren't going to flip head down. Yet, she was less than 32 weeks pregnant!

The direction a twin lies in is determined by the same things that determines a single baby's direction. Plus one more thing, the other twin.

While they are still little, helping the mother with her soft tissue symmetry can help them both be head down. The ideal time to work on this is before or during the 2nd trimester. Yet, twins still have a good chance of turning head down when they are but 32 weeks.

As the pregnancy passes the 30 week mark, some body work and maternal activities will help reduce any possible twist in the lower uterine segment or pelvic misalignment that might prevent head down positions. See the 3 Principles of Spinning Babies. And, while you are there, read the Pregnant with twins article.

When your uterus is symmetrical the babies can more readily turn head down with gravity.

We all might consider that a doctor who is setting a woman up for a cesarean this early in pregnancy will find other ways to arrange a cesarean after the babies turn head down. Predicting a cesarean two months before the babies are due is more of a sign of our litigation society and the profit motive of hospitals than a reflection of a physician's intuition or grasp of the nature of birth.

If, at any point, you agree to a scheduled cesarean, then ask if there is any responsible motive to add prematurity to the surgical risks.

A woman would have to stand her ground to have your surgery at full term, 40 weeks or after labor begins.
The March of Dimes is concerned with "late prematurity" and the increase in infant mortality caused by induction or scheduled cesareans that are unintentionally early
This sounds like a strong opinion, but is a summary of the data.
Furthermore, read Dr. Brewer for info on a healthy diet that is wonderful for twin pregnancy.

Tuesday, November 27, 2007

What we know about fetal positioning

Spinning Babies is only one piece of evidence for the growing interest in fetal positioning. Parents, midwives, nurses and doulas are increasingly interested in how a baby's position may influence a birth. Physicians have been studying this connection for decades.

Understanding fetal positioning is not as simple as noting the differences between 1 position, anterior, with another position, posterior. There are many nuances, such as
  • how much the chin is tucked towards the chest,
  • the shape of the inlet and
  • the size of the outlet,
  • the synclitism of the baby's head,
  • the activity of the mother and
  • the strength of her labor.
  • Even whether her amniotic sac is intact or ruptured can make a difference.

As we learn something new about fetal positions and how babies rotate we can forget older concepts that still hold their own value when looking a large group of posterior births.

We know that posterior births involve more complications and interventions that anterior births, when comparing groups of births. (Not necessarily a single posterior or anterior birth.)

We know that in labors where the baby begins labor in a posterior position, about 30% of the babies will still be posterior at the end of birth
that of first time moms whose babies have been posterior in labor, 29% will have a cesarean operation to finish their births.

We don't know an easy activity for all mothers to do to prevent a posterior labor.
We don't know an easy activity for all mothers to correct a posterior fetal position.
We don't really know which babies will rotate out of the posterior position into an anterior (and easier) position and finish the birth vaginally.

But, I do know, that in the mothers I help through pregnancy and in labor, that there are some important activities that mothers can do to either help their babies rotate themselves into a better position, or to descend through the pelvis to be born either posterior or occiput transverse.

Please see the Short List of What to Do in Pregnancy. Its on the SpinningBabies.com website.

Monday, October 8, 2007

Rebozo for Comfort in Labor

Fabian relaxes Ayanna with the Mexican Rebozo.

The Rebozo is a long, woven scarf used for a variety of purposes. Here, the birthing mother feels relaxed by the lifting and gentle rocking of her heavy belly. She is in between contractions. Fabian will slow down, stop and wait during the contraction. Then several seconds after the contraction is done, perhaps when Ayanna sighs to show her relief, he begins again. 5 minutes or so is quite relaxing.

Tuesday, October 2, 2007

Three thank yous

Three thank yous came my way to day. And I would first like to pass them on to the sources from which the information came to me; first God, then my midwifery and doula community, and then to the body work community.
Here is the emailed thanks,

Thank you for getting back to me. I went to the Dr, this morning and the baby is head down and "snug". Apparently, the few things I've done from the list of suggestions on spinningbabies.com worked!!! Thanks again for answering my questions.

She is generous. I also got two phone calls.
One from a doula still floating from attending her first birth. She noted how the mother met the emotional landmarks we talked about in class. When the dad suggested some pain medication the Nurse-Midwife told the parents which drugs were available to them. The mom didn't seem to answer. The doula thought she might be hesitating and so after a polite pause she said, or, you could try a bath or a walk and see how you feel about medication in 20 or 30 minutes. Well, you know how the bath often works. They were having a baby before any more talk about medications came up again. Its not that the doula's job is to avoid the meds. but it is her job to perceive the mother's needs and offer suggestions that might fit the mother's preferences.

There was another exciting call. A local midwife who attended my Resolving Shoulder Dystocia class last year called. She had a heartening story to share with me. The midwife with her had also taken my class, and after rotating the baby out safely she said they looked at eachother for a second and both said, "Gail!" I had to laugh, half in delight and half a bit embarrassed. But I am so glad the simple steps of FlipFLOP came back to the midwives when they needed it.

When this midwife expressed surprised that I seemed surprised the steps worked I told her everytime I hear how these techniques work for another person it is like looking up and seeing a brilliant rainbow that I didn't expect to see. Its awe inspiring. Such a mystery. Something much greater than anything I could come up with it.

Sunday, September 30, 2007

Doula means servant

First, I had to get over the funny sound of the word "doula."
Then, I had to remember a short and accurate way to describe what a doula does.
Quite a while later, I found out that some doulas didn't like being associated with the original Greek doula.

Originally the doula was the head servant of the woman of the house. That brings up slavery, servantude. The greeks had slaves. Doulas today are not slaves. We are forced to serve.

But lets not miss the honor in being a Greek doula. She led and organized the other servants who served the woman of the household. She kept a big picture, deligated tasks, anticipated needs and kept a harmony among a group. She kept everyone focused on the goals and needs of her lady.

I love the service role within my doula role. I doubt I'd be able to be a head servant. But that's another tale. When the mother sees my role to serve her, she will come forward and ask for comfort measures, favors and information to help herself give birth.

I can put my ego aside for that. I can put aside most of my needs. (My bladder is not so accommodating as my stomach, for instance.) Even, I can put aside what I think about birthing. Flexibile, this way, the mother can use me to her ends. And it is in this way, then, that I can be a channel for That which is using her.

I'm shaped by my service. Being a doula and having my ego chipped away at, I've become a better daughter to my aging mother and a better sister to my sister who is caring for my niece battling brain cancer.

But I still have to remember to bring these lessons home under my own roof. And that means I have to go now and put a meal on. Won't my guys be surprised.

Tuesday, August 28, 2007

Stormy night

What a storm last night. I was up at 2 30 am writing for my website and thinking of falling over into bed. Then I heard the sirens of the town to the west of us. Soon a rushing sound came from the west. It got louder and closer. Not real fast, slow enough to track it with my comprehension, but faster than a car.
I peered out the front window into the night. The oak branches were blowing wildly in the street light. I heard the rushing wind coming east on 106th street, the gap through the trees.
Lightening was flashing so bright and so fast that I thought my retinas would be harmed by it!
Sudden'y the wind rushed up the hill, past the street light and filled Humboldt with whirling mist, rain and dust. I couldn't tell if i were seeing the bottom of a funnel cloud or not so I pressed my nose closer to the window,... yeah. Good, no it wasn't a funnel cloud, but a wall of rain and wind that seemed contained like a movie trick.

Then the wind and rain came into the yard. Not just the wind that was here in the night blowing the trees, this was a wall of wind that hit the house and made the windows rattle and the walls groan. Light hail began rat a tat tating the house.

I got a bit nervous and went upstairs to shut windows and wake VIc. I checked Gairm's windows and woke him. Niether wanted to go to the basement. Gairm rolled over.

Vic came down stairs and by then, the storm seemed like a regular thunder storm. In 5 minutes it was a rain storm and five minutes after than a sprinkle, then silent.

Gairm's school was canceled as they have no power. We do, thankfully. Maybe we are on the powerline that goes to the emergency siren a block away. It diden't go off so Vic went back to bed last night!

What a series of storms going around. Seems like someone has a temper.

August 27, 1983

I just wanted to say that yesterday was Faith's 24th birthday. I was expecting to film her birth when the midwife was quite late and I found my self catching Faith. She was the first baby I caught and she made a dramatic appearance as a frank breech. Her Apgars were 10-10. She seemed mad --maybe because I was imploring her Mama, my friend, to pant when she wanted to push. We were waiting for the midwife (only to find out that she was already there). Its a fun story, but that's enough for tonight. The lights are wavering, the thunder is approaching and the town to the west has blared its tornado warning siren.

Faith, if you are out there reading this. I love you for letting me catch you. Its made all the difference in my life!

Wednesday, August 22, 2007

Better titles are needed for posterior topics

Three second-time moms have just contacted me with the same basic question. Two are 39 weeks pregnant and one was a little less. Each just discovered her baby is posterior. Each ask if something can be done to avoid another long labor with back ache, like their first posterior labors. One's physician offered her a cesarean just because of the posterior starting position so she switched physicians.

My web site had this information. Evidently, the information isn't accessible. I looked over my site and saw why. My titles are not discriptive enough. Sometimes I develop the subject beyond the scope of the title and so a viewer doesn't know where to look.

Improvements must be made. And will be. Meanwhile, try the search tool, reading The Three Principles and What to do when.

Thursday, August 16, 2007

Breech unassisted

Two weeks ago there were two couples in the Twin Cities Metro area with plans for unassisted home birth. Both couples discovered their babies were breech. They didn't know each other and I only met one couple. That couple called me suspecting their baby was breech.

This mom had used my web site in the past, so she looked up what she could find on breech position. They stopped over, being local, and we reviewed the inversion technique she was using and modified it slightly. I showed her husband how to do a sacral release (s0mething I learned from Deb McLaughlin in Duluth and Carol Phillips, now in Annapolis, MD).

Three days later her baby flipped head down.

The grapevine brought news of the other couple. They decided to have someone help them. Not having talked with them directly, I do not know who. She didn't seem to be a midwife or anyone we midwives knew. I don't know what her experience with breech birth was. I don't know if she knew what makes a breech birth work and what doesn't. I don't know if she knew how to return the head to a flexed position. I don't know if she memorized breech maneuvers. I don't know if she understood the principles behind them.

The baby got stuck and passed away before the helper could figure out how to free him.

When a breech birth goes well the parents and helpers might wonder what the fuss is about breech birth. Stories appear on the internet and birthing magazines about breech birth at home, sometimes unattended. Breech babies don't always survive a cesarean either.
Head down babies don't always make it either, for that matter.

When I heard that a breech baby died at home recently I rushed to call the couple I met. I didn't say a thing about the rumor. Just, hi, I'm checkin' in. How are you? She still felt the baby head down and kicking. Whew.

Meanwhile there is a family out there somewhere grieving. I don't know who you are, but I'm grieving with you.

Wednesday, May 30, 2007

Due date?

"My baby will be born on its birthday, not its due date. I am not in a
hurry. I am not on a schedule. I am patient. When I am in labor, I
will not rely on the clock to tell me how fast to go. I am not a
factory. I am a powerful woman, birthing a new person into the world." --Doula Daniella

Helping with the birth of twins

I was thrilled to be invited to help out two of my friend midwives with a family expecting twins. I'd only been to one homebirth twin birth and that was early on when even squeezing the bulb syringe deserved a review. After meeting me, the parents agreed to include me as one of their midwives.

A couple nights before these girls were born the lead midwife and I were chatting. She said in her early years, 26 years ago, her faith in birth got her through where experience was thin. She trusted the Lord and birth itself. But now, after many years, the things shes learned through experience can sometimes be a burden.

I knew what she was describing. Learning birth at home builds the trust first. There are fewer complications and less fear. But as we grow older we learn about the unexpected firsthand, not just in a book. We've found that something often comes up that wasn't in the books.

My friend said when she reflects on that, that she goes back to the faith she had in the beginning when birth seemed so simple. We have a choice. We can breath fast, let our heart rate race and get tense. Or we can breath deep into the trust.

We still know what we know. We bring together nutrition, rest, trust and a good fetal position. Yes, there is the unknown, but it can be allowed, not feared.
We have a plan, we have a plan B, and we have a plan for going in to the hospital if needed-- Within these "plans," we take into account the unique qualities of the birthing mother, the baby or babies, in this case, and yes, the spirit of the birth. Communication is expressed through all these sources from one Source. And we must communicate our own thoughts, too. First by being receptive, then by speaking the truth, not the wish, of the moment. This is what I feel, see, touch, smell or hear. Not, this is what I hope to be or what I wish were true.

If it is given to you to know, you will know. Some things we can change, some things we are not given to know and then we must experience the course that unfolds. When we are receptive we can trust this mechanism to be protective. We move forward. When we fear, a lack of receptivity hides us in denial. We seek stability and stop hearing.

When control is an expectation, trusting birth seems ridiculous. But what can keep birth within the bounds of the known world? Monitoring every body function? Surgery without birth? Warnings and doubts expressed? There is no magic there, only an exchange. The unknown risk is traded for a known side effect. As if the frequency of induction makes the higher death rate of late prematurity acceptable. Believe it or not it is more medically acceptable than, say, the rate of death due to shoulder dystocia, which is lower than that the deaths in the first year due to complications of late prematurity.
First of all, preparation for a natural twin birth is quite different. Prenatal care for twins includes a woman's self care, 100-150 grams of protein daily, a gallon of fluids, salt to taste, chlorophyll liquid and Floradex with Iron, etc. etc.
Are women under medical care hearing this sort of nutritional counseling? No, they are given weekly ultrasounds and bed rest. Then once past 36 weeks, surgery. Are babies faring better?
Well, we have to look at twins born with after emotionally and physically nourishing prenatal care compared to the usual medical care. The food and supplementation we suggest has led to full term twins for my friend's other twins experiences and many other midwives, too.
As a doula for twin moms, The Brewer Diet, natural supplementation and Chiropractic care helped women get to 38 weeks and beyond. Much good can come of technical birth interventions when it is needed. I'm not naive. One family wanted their twins born at home, but one twin wasn't doing excellently at term and a cesarean helped them have a safe delivery, one that wouldn't have been safe at home.

I was the first midwife to arrive the other night. Thoughts went through my head as I drove closer to the home. Will I be prepared to handle the unexpected? Will my brain freeze? I stopped myself. Taking a deep breath I let trust in. The preparations were made, the prayers were said. Just take a step and walk in the door. The birth will be waiting for you there.

Two healthy babies were born a few hours later. And mom did great during and after. So that I'm not telling the family's story, let me just say that together the babies weighed just one ounce less than 15 1/2 pounds.
Every thing turned out so well at home that night. Everything went just about as expected. Everything went according to plan "B." So well in fact, the little ones' Apgar scores were 8-9 and 9-10 respectively. Praise God.

Wednesday, May 23, 2007

The hazards of induction may be worse than you thought

Induction of labor is a phrase meaning that labor contractions are encouraged by external means. Drug induced labor can be brought on with Pitocin in an IV drip, prostaglandin gels or a pill, cytotec (misoprostol). Dr. Michel Odent (www.birthworks.org/primalhealth) writes of the concerns about Induction and autism in Midwifery Today Online Magazine. Please read the entire article and support Midwifery Today. The following are exerpts from that article:

"We have many reasons to suspect a link between "autism epidemic" and "labour induction epidemic." The first reason is that in all studies that took into account independently the variable "labour induction," it appeared as a risk factor. Labour induction should be explicitly taken into consideration by epidemiologists, because it can be associated either with birth by the vaginal route (with or without intervention such as forceps), or with cesarean birth...

...the results of recent studies suggest that children with autistic disorder show alterations in their oxytocin system. The first clues came from a study of mid-day blood samples from 29 autistic and 30 age-matched normal children, all prepubertal.(Modahl, C., et al. Plasma oxytocin levels in autistic children. 1998. Biol Psychiatry (4): 270–77) The autistic group appeared to have significantly lower blood oxytocin levels than the normal group...

... Artificial induction of labour creates situations that undoubtedly interfere with the development and the reorganization of the oxytocin system in such a critical period. This fact alone is a reason for further epidemiological studies focusing on labour induction as a possible risk factor. It would be useful to know also how autistic children release oxytocin. Oxytocin is more effective when released rhythmically, in a succession of fast pulsations. Today it is possible to measure the rhythmicity "the pulsatility" of oxytocin release. In other words, the time has come to study autism as an "impaired capacity to love."'

Midwifery Today's Editor Jan Triton notes: Oxytocin is a hormone released by the posterior pituitary gland. Its mechanical effects, particularly its stimulating effects on uterine contractions during labour, have been known for a long time. Recently we learned that oxytocin also has important behavioral effects. Today we are in a position to summarize the results of dozens of studies by claiming that oxytocin is the typical hormone of love: Whichever facet of love one considers, oxytocin is involved. Read more in the free MT Online Issue.

To learn other problems with inducing labor, read the CIMS statement.

Rotating a posterior baby in pregnancy

Meanwhile, the woman in the previous post (from earlier today) realized her baby had been left occiput posterior (LOP). "His" back had been on her left and his fingers busy in front. The baby rode high and she couldn't lean forward without discomfort for herself and, she suspected, for her baby. I then felt her baby and agreed the baby was LOP.
I explained the 3 Principles: 1.) Relax what the mother can't herself relax. 2.) Use gravity to encourage the baby to settle into the front of the abdominal wall. 3.) Use movement to move the pelvis and soft tissues around the baby.

So we began:
1.) Abdominal release, also called a diaphragmatic release.
2.) Sacral release, also called a buckled sacrum release.
3.) She laid down and I stroked the sides of the abdomen, lifting the weight of her womb and wiggling my hands upward, jiggling the broad ligaments. She liked this.
4.) Rebozo "sifting" of the abdomen while she knelt and leaned her arms and head on the bed. Her husband tried this, too, surprised it was such an upper body workout. She smiled and said it was awesome.
By now she had no or little pain, remember she had taken the kali carb. See previous post.
5. ) We ended with a pelvic floor release. That put a stretch in her lower back where the pelvic floor attaches to the back side of the hip bone and sacrum. She did both sides so she didn't add to the asymmetrical pull of her body.

Her baby was now left occiput transverse (LOT), an excellent start position. Yet there was much amniotic fluid and the baby wasn't engaging into the pelvic brim yet. So unless her tissues were relaxed more completely so they could become symmetrical, the baby is likely to go back to posterior.

Her plan is to return to the Chiropractor and see what soft tissue work the Chiropractor can do. They can also continue with this list at home. I suggested she wait at least a week before trying another pelvic floor release. She planned to get on an inversion table for 30-60 seconds for a few times to help her lower uterine segment relax and in so doing, become more symmetrical.
Then the baby should be able to stay out of the posterior position.

Can this help hip and lower back pain?

I was asked by a second-time mother if she and her husband could come over and see what we could do about her hip pain. The pain went from the hip across the lower back at that level. She had it in the first pregnancy and this one, and was due in a month and was weary from such pain when ever she got up or down.
I warned her that I was not a body worker but they could come on over.
Watching her sit and move for a minute helped me to realize she had sciatica. I learned about a wonderful remedy for sciatica from my sister who suffered terribly, almost loosing her job and ending up in the ER before she tried homeopathic kali carbonicum 30 c. I carry "kali carb" in my midwifery bag. Ronnie Falcao has a list of homeopathy resources on her midwifery site.

Wednesday, May 16, 2007

Will doing an inversion turn a head down baby breech?

Q: "I have been doing several things to get my baby flipped. I am now 32.5 weeks pregnant. At my 32 week appointment my doctor said the baby is breech. Since then I have started seeing a Chiro for the webster technique, and have been doing moxibustion. My problem is that this baby moves ALL THE TIME. They are big movements ALL THE TIME. So, I never really know if it has flipped or not. I am just not good at being able to tell. If I begin trying the inversion will I risk undoing a head-down positional flip that might have already taken place?"

A: "I can't say it isn't possible. But it is likely to help you turn your breech and isn't likely to flip a head down baby if you do the short form of the inversion.
You are right on time with your attempts to help the baby head down and I expect you to be successful. The movement you feel can be two forms, One, the limbs. Two, less likely, the whole body. It isn't that likely that the baby is going breech to head down to breech to head down to breech. Add transverse in there for each turn.

There are two ways to do the inversion:
One is for 10-20 minutes in the breech tilt or Open Knee Chest.
The other form of inversion is in the inversion as shown on the movie in my blog, You hold the inversion for about 1-2 minutes. Then you crawl forward and kneel before you stand up.
This second inversion style is less likely to flip a baby who is head down into a breech. You do it once a day to first stretch and then, in standing again, relax your lower uterine ligaments/cervical ligaments so they come out of a twist. Then the baby can turn head down more likely. Chiropractors can help in addition with the sacrum, pubic bone alignment and your neck to increase the chance of a head down baby. The Webster is important, too.

For a mom with a suspected breech baby at 35-40 weeks, there is less chance of accidentally flipping a head down baby to breech. I did hear of it happening once with a mom who had 2 children and was in her third pregnancy. She did the Open Knee Chest position (to rotate a posterior baby) for 20-30 minutes. I didn't talk to her, but heard about it. I wonder how much amniotic fluid she had, but we can guess that her womb was more relaxed than the average first time mom. The longer use of an inversion position, such as Open Knee Chest or the Breech Tilt is good for when either the hips or the head are dropped into the pelvis (engaged).

I wouldn't think that at 33 weeks your baby is engaged yet. I hope not. So a short term inversion may be the better choice. Ask your midwife or doctor if there is any reason not to do an inversion in your case. Please let me know how these techniques work for you." -Gail Tully

Thursday, May 10, 2007

After 3 cesareans, a home birth

Here is a woman's truly inspirational story. Watch Aidan's birth. Shown on onetruemedia.com As a midwife, I have been blessed to share several such journeys. Theresa's comments depict her emotional feelings. She had a transforming experience before her VBAC -- a common element to success. The chiropractic work was also likely to be crucial.

One baby's song to his Obstetrician

This Dad, singing for the baby boys and girls out there ("in there?") has got something to say to all of us about induction, bonding and more! Ready to smile? Click here to hear the Obstetrician Song. Its on the Compleat Mother web site.

Wednesday, May 9, 2007

Why does the position of the head matter?

A teapot will show us why it matters that things fit. The lid won't come off crooked, but will come off after rotating to the proper position.

Its the same thing with some of our babies. They may not be able to slip through the pelvis -until they rotate to a better angle.

Tuesday, May 8, 2007

Empowering (Movie) Birth

I don't follow the Hollywood stars but I have heard the name Rikki Lake. She's put together a movie about birth in America. Her birth, her friend's birth. She calls it The Business of Birth.
Its reaching the tv generation and ends with a warning from Dr. Michel Odent on the importance of labor hormones.

Saturday, April 14, 2007

Doulas as the key to continuous care

A mother told me this story. Her baby was a couple weeks old. The birth went well, but now a fever and redness on her breast worried her. She called her midwife who wasn't clear about what it was. Whatever she told her to do may not have been enough, or soon enough, because the fever grew. Her doula was able to stop by. The fever had grown to 104 and the red made a streak on her breast. She told her, if it were me, I would go into the hospital.

The mother had mastitis, an infection of the breast. Perhaps her milk had become blocked behind a tight bra strap. She didn't have time to tell me the complete story.

My point is, that there are times when a mother's care provider isn't completely available. Whether that is because it is between visits, after the usual visits, a shift change, or a busy day, there are times when the mother has to figure out her health needs herself. When a mom is sick she may not rally enough to initiate a course of action. She may not recognize how immediate her need is. Mastitus can flame up fast. She may not realize a small symptom can become a big problem.

The doula has a motherly way of keeping an eye on the mother. The doula is not a medical person. She doesn't diagnosis or treat problems. But very often she has experience in spotting something out of the ordinary. She can suggest the mother take the extra step to get the care she does need when something like this comes up.

The doula fills the gap.

Sunday, April 8, 2007

The Inversion Worked


"Thank you so much for your help and information. She began the inversion pose, and when she went in on Friday for the version, the baby had turned! YES!"

This email note was from a local doula who was helping a pregnant woman who found out her baby was breech at 36 weeks gestation (one month to the due date). The doula emailed me on March 28th and the mom found out the baby was head down by April 6th.

Sunday, April 1, 2007

The Tsunami of Technocratic Reproduction

The natural birthing community is feeling the oppressive weight of the technoreproductive tide that threatens to wash out all birth as nature designed it. I remember the Florida nurse that told me her hospital administrators told their doctors to get to a 50% cesarean rate and maintain it. Once there, the number will only rise. With these real economic pressures, medical doctors have been finding ways to lure women into agreeing on cesareans. The patient-driving rise in the cesarean rate is a myth. Its what happens in the prenatal appointment that erodes women's confidence until agreement comes from the loss of other options.

Marketing is set up to justify these economic aims is soft served to mothers who then become convinced of the safety of surgery over nature.

Many dedicated people are trying to present the benefits of the physiological process of birth to families. Not just for the birth process, but for the making-of-a-mother process and the becoming-human process. There are hormones secreted in the brain of both mother and baby during labor that help activate our fore brains, where spiritual centers are, and when supported correctly reduce the activation of the reptilian, hind brain that operates from fear. Humanity starts with birth.

See more on birth hormones on the Childbirth Connection.
Read about the potential for estactic birth on Sarah Buckley's blog.
See more on marketing cesareans at Shiela Kitzinger's site.

Sunday, March 25, 2007

The Elephant Birth

See the elephant tribe give birth. This elephant mother moves instinctively. Watch her legs. She isn't trying to kick the baby. She is easing the stretching she feels in her hips and the weight she feels bearing down into her upper thighs. I may be heady to define why she moves this way, but I've seen many human mothers move in very similar ways. She gives a slight squat to release the baby more.

The filming is invasive, even though we appreciate being able to see the birth. But I think the elephants are used to a car being parked near them on the road. It seems like a familiar spot for them. I've videoed births and felt invasive, too. Sometimes, after I've filmed a birth, a mother may look up from the baby in her arms and say, "It is too bad no one took pictures." She is surprised and I'm surprised she didn't notice the flash or the sound of the click. Other mothers see the camera and labor slows down. In those cases I put the camera away. I've missed some great footage, but the hormonal freedom of the birth is much more important. Safety, spontaneity and bonding are improved with privacy. And that includes the friend with the camera.

Elephant doulas. As the other elephants realize the birth is happening two particularly circle round the mother. Dr. Marshall Klaus explained this animal behavior at a DONA doula conference several years ago. When an animal baby has to rotate to be born through the pelvis, the species has experienced females attending the birthing mother. When a baby doesn't have to rotate, the species, like the Chimp, goes off alone to birth.

That doesn't mean that human mothers that prefer unassisted childbirth have babies that don't need to rotate. That is a species tendency, not an individual tendency. Unassisted childbirth is more about preserving privacy and preventing intervention. I don't promote unassisted childbirth, but I do promote being unobtrusive at a birth as much as possible.

The baby does fall on her back. The fall is a short distance and the road seems hard packed. Poor thing. But the fall isn't as far as for a giraffe baby. Birth isn't always sentimental or gentle. But the auntie elephant is there to encourage the baby to try and get up and push the baby away from the poo, as one commentator called it.

This is amazing footage. The mother's movement and connection to her tribe. The auntie elephants for circling and tending to the baby - without pushing the baby away from the mother. The follow up of the baby the next day is reassuring and surprising, too!

Saturday, March 24, 2007

Marketing Birth

Hospitals spend millions to draw parents each year. What are we in the natural birth and home birth movement doing to make birth "as nature intended" attractive to parents?

Today I attended a Writers' Festival in my town's city hall. That'd be Bloomington, Minnesota.
Marketing You and Your Book was a panel discussion that lured me in. Of course, I apply everything to birth. So while I was learning to promote a book I haven't finished writing yet, I was thinking how I could apply this knowledge to a world wide birth activist movement.
Three enthusiastic women presented, Mary Jo Sherwood from Marketing Volumes, Barb Tabor a media relations pro, and Lauri Flaquer from Saltar Solutions, auther of Ready, Set, Soar.

Lauri talked about branding yourself and your work. It took myself and most of the audience some time to get what she was talking about. It seems branding means developing a simple and easily identified theme connecting your work with a feeling. She even said some companies were marketing smells, but while I might love that vernix scent, some people might shy away from the smell of birth as a lure. Anyway, what she meant was let your product, say, your website, be instantly identifiable. Not only your logo, but your purpose and even your personality. I'm still trying to digest the concept. I think I kinda get it.

Lauri says Branding is creating a perspective of you. I'm not sure what that perspective is for Spinning Babies. But maybe you do.

Please help me by sending me a post or an email to say how does Spinning Babies seem to you. What words would you use to describe your feeling or your sense of Spinning Babies Website?
Give some words like, intelligent, casual, friendly, empowering... feel free to tell it like it is.

And what would you like it to be?

I want to redesign it and am hoping for lots of feed back. Take a minute and make a big difference.

Friday, March 23, 2007

Cord cutting

In the 1950s some cord cutting data was obtained. The recommendation to delay cord cutting was made. Sometimes it takes 50 years for a good idea to take. Here's a current study that states the benefit again:

Delay Cutting the Umbilical Cord, Research Suggests

By Amanda Gardner
HealthDay Reporter
Tuesday, March 20, 2007; 12:00 AM

TUESDAY, March 20 (HealthDay News) -- Newborns may gain several health benefits if the umbilical cord isn't cut for at least two minutes after birth, a new Canadian study suggests.

Delaying cutting the once life-giving cord, rather than clamping it immediately, results in better blood counts and iron levels for a baby, according to the meta-analysis -- or study of previous studies -- that appears in the March 21 issue of the Journal of the American Medical Association.

Monday, March 12, 2007

Tough thoughts on caring for others while Doula-ing my elderly mom

I haven't written for a while. Its been three weeks since my 82 year-old mom entered the VA hospital. (Getting great care, by the way!) My sister and I have been with her everyday. A couple of her dear friends have been by most days. Her lung had collapsed and she struggled with little air for a three days, maybe more, until consenting to go to the hospital. She thought she'd feel better if she'd only get a good night's sleep. We found out about the collapsed lung after an x-ray.

Caring for an elder is a special gift, I've learned. Caring for my own mother has increased her and my capacity and opportunity to love each other. We were pretty close, but now my heart just sings to see her. Its been a delight far more than any trouble driving to the hospital or letting go of home and work tasks. Caring for someone blesses the caregiver more than the needful person. She gets physical help, I get spiritual grace. Seeing the smile of a vulnerable person you are caring for is a motivating reward! I'm learning from her how to be humble in my vulnerability. She speaks praise to each caretaker who comes in. She teases, scolds and threatens with a smile. She is a bit of a flirt and is mischievious. The staff and doctors eat it up. They've taken to coming in at night with their coats on for a final good bye. She says it is because she is the only female veteran on her floor. But it is also that she makes them feel good and laugh. She lets them know they are appreciated.

This is not like who my tough mother was. She would hurl an sharp remark before risking sounding soft. She had and has a lot of compassion. Absolutely. But you better be able to swallow it in the form of bitters. Seeing the change reminds me of Shelley Taylor's work on women and stress. She found that women network and submit to authority figures under stress more often than go to "fight or flight."

The skills I've learned from being a doula at hospital births carried me many of the details of gaining information and asking for specific help tailored to my mom's needs. The staff is attentive on a professional and a touchingly personal way. But there are still things that my mom would communicate to her daughters that she wouldn't tell the staff. She didn't want to be perceived as a "pill taker" so, at first, she wasn't relaying the occasional pain of the chest tube, for instance, that bothered her especially as she tried to resettle in bed after being up for a few moments. Later, she began to like being pain free and we were able to help her get her Tylenol ahead of trips to x-ray and percocet before repuncturing the lung during her three chest tube procedures. On the first day, the nurse came in with an IV and I felt comfortable helping my mom refuse it. It was standard for all people in for "observation." This was before we heard from radiology that she had a collapsed lung. So for the last 3 weeks she has been IV free because we didn't accept a routine that wasn't specifically needed for my mom. I also know from birth that touch reduces stress, so when the bandage was changed we'd stroke mom's hand. It definately helped. In two days our fierce little warrior mother was asking for her daughters to come in when ever there was something painful about to occur or could be possible to occur.

Some skills I learned taking care of my mom that I wouldn't have learned at a birth. I'm not a professional when I'm with my mom, for one thing, so different observations come up. I see my mom try and balance my sister and my need to get information from her physicians with her need to only hear a little information at one time. She can only take in a little before her stress in hearing about lung punctures puts a buzz in her ear that obliterates the sense out of any words being spoken. Her stress blocks the time lines and "If that doesn't works," and she hears only that a procedure will be done. Sometimes, they say if A doesn't take in a couple days we'll do B. And she thinks B is imminent. I've seen this with birthing women, but being a family member now, I can pick up more nuances and understand more about her need to preserve mental health over her need for decision making.

I ask lots of questions. The sort of questions I ask get attention. They are not the usual. I want to know talc grades and long term pain probability and risk of recurrence. One day, a cardio-thoractic physician came in and asked if one us daughters were a nurse. I said, N0..., I'm not a nurse. And my mom piped up, but she's a midwife. He said, come and hold this tube for me while I restitch it to her chest. Now I have two options, first, faint. No, that wouldn't instill confidence in the youngest child in the family. So, next thing I know I'm opening his sterile pack and he's clipping the old stitch and sticking my mother's thin chest skin with lidocaine and sewing not one but three separate stitches so the tube won't work its way out. Meanwhile, I'm wiggling a kink out of the chest tube and suggesting a splint be attached to the junction where two tubes join so the kink can't return (a previous kink, I believe, added 2-4 days to the hospital stay). He builds the splint from tongue depressors and tape. The next day I add another pair of "craft sticks" (as mom calls 'em) because the first set migrated and the kink was threatening again. Holding the tube for the doctor (a non-medical skill to be sure) I wonder at how I get into these situations. Up close and personal with my mom's tender and punctured skin I hold myself in the discipline I've learned and do not allow myself to go to pity. Pity doesn't serve. Good old pragmatism serves.

But I'm no match for my sister who is advocator in chief. Her mama bear instinct is super powered. In this case, cub instinct. Getting her mom morphine after the talc infusion which was only going to be "uncomfortable" and percocet was going to be enough. The procedure is only uncomfortable, but 2-3 minutes after the procedure the talc inflames the lungs and the pressure from the fluids and the inflammation is severe. Poor little bird. I dropped that ball, forgetting that when a doctor says "uncomfortable due to irritation" they really mean it hurts like hell. The docs said they dropped the ball, too. She's taught me volumes about fearless advocacy.

There are dozens of little communication errors that come up in medical care as with any group process that covers many details and goes on over time. Errors are going to occur whether for the elderly or the birthing. Having family present reduces some while allows others. I took mom down to breakfast one morning and to her x-ray and we came back with a kinked tube. While not my fault per se, it happened on my watch. Her lung partially collapsed again that day and her tube slipped out that night. A couple days later the doctors went to plan B, talc. My mom was told she'd be on the suction tube for three days after the talc infusion. But she'd been on suction for about ten days before that, trying to avoid talc. No one instituted any different behavior. Communication error. The cardiothoractic doctors meant three days without a minute off. The general medical doctors and nurses thought that meant, just as we had been doing, taking mom off suction to walk to the bathroom or go down stairs for Bingo at 7. One sentence, two meanings.

The desired behavior wasn't written down. Therefore it wasn't done. No one meant to be lax. We thought we were following directions. So in our intention to do good we did bad. That is the worst thing about being human and attending to someone's health. Daughters do it, parents do it, doctors do it. We are all going to make a mistake in caring for someone. It is the most humbling and frustrating thing I can think of about being a human.

Somehow we think doctors don't make human errors. We've given doctors superhuman characteristics. I can see why. My mother the patient is vulnerable. She's scared. The doctor comes in to do a procedure and gives the impression that this is going to save her. She wants to believe that. She believes what he says. Its better for her state of mind.

Sometimes, as a doula or midwife I'm distressed over how many women agree to routine and invasive procedures. Its a different scenario entirely than a sick or hurt person getting specific care. Most birthing women are perfectly healthy. Healthy enough, by far, to given birth with their bodies' own physiological precision. But my mom had a specific crisis, a leak in her lung. Supporting her body's ability to heal it was tried two weeks and then a mechanical process (chemical process really) was tried to seal the lung to the lining. Her physiology was compromised before she sought treatment. Unlike a laboring woman, who gets treatment even while her physiology is functioning normally.

Reading the research is a bit confusing. I read several research papers, but did not really have a way to know how that information related to my mother's case. Sometimes as doulas and childbirth educators we encourage mothers and fathers to read the literature. Do the research. There is a fair amount of stress trying to figure it all out. How does this apply to them, they may think. Could daring to depart from the physician's course risk their child? Few women in pregnancy and fewer in labor can carry the extra stress of climbing a steep learning curb and maintaining a stability in the support relationship with the doctors they seek help from. We really ask a lot.

Many doulas are so saddened by the outcomes when parents go ahead with procedures that were not medically required. Our concern in the process may only be distracting. Pregnancy is a time for building support, not analyzing it. That needs to come before, for most women. Some can navigate those changes. We need to overhaul our advocacy and create an informed generation before they become pregnant. Thank goodness, doulas and families are there for the patient at any stage in life. Crisis needs support.

Support also comes from the medical staff. I saw magic in that relationship. To have someone with good authority, in fact, some of the highest authority in our culture, someone with know how put their attention on your wound is an incredibly reassuring. The eye contact, comfort and time given to my mother by her doctors was visibly uplifting to her. I felt those were the moments of healing. Through that intimacy and caring around her pain she was able to absorb their message and form a new life without smoking. She is actually excited about it now.

So far tonight, 5 days after the talc, and 6 hours after clamping the tube, mom's lung is inflated! Its holding!

Saturday, February 24, 2007

Minnesota Doula Bill

Susan Lane, of the Childbirth Collective non profit doula group, reports that the 2007 version of the doula bill, bill 1296, has been accepted in the House of Representatives in the Minnesota Legislature.
The Senate also has a version of the bill. The goal is to include doula care coverage by Minnesotan's health maintenance organizations and state medicare.
HF 1296 includes this current wording:

A bill for an act
1.2relating to insurance; requiring coverage for doula services; requiring medical
1.3assistance to cover doula services; establishing a doula registry; ensuring in the
1.4patient bill of rights the presence of a doula if requested by a patient; amending
1.5Minnesota Statutes 2006, sections 144.651, subdivisions 9, 10; 256B.0625, by
1.6adding a subdivision; proposing coding for new law in Minnesota Statutes,
1.7chapter 62A; proposing coding for new law as Minnesota Statutes, chapter 146B.

1.10 Subdivision 1. Scope of coverage. This section applies to all health plans as defined
1.11in section 62A.011 that offer maternity benefits.
1.12 Subd. 2. Required coverage. Every health plan in subdivision 1 must provide
1.13coverage for doula services when provided by a nationally certified doula of the mother's
1.15 Subd. 3. Special restrictions prohibited. Coverage under this section shall not be
1.16subject to any greater coinsurance, co-payment, or deductible than that applicable to any
1.17other nonpreventive service provided by the health plan.
1.18 Subd. 4. Definitions. The definitions in this subdivision apply to this section.
1.19(a) "Doula services" means emotional and physical support during pregnancy, labor,
1.20birth, and postpartum.
1.21(b) "Nationally certified doula" means an individual who has received certification
1.22to perform doula services from the International Childbirth Education Association, the
1.23Doulas of North America (DONA), the Association of Labor Assistants and Childbirth
1.24Educators (ALACE), Birthworks, Childbirth and Postpartum Professional Association
1.25(CAPPA), or Childbirth International.
2.1EFFECTIVE DATE.This section is effective July 1, 2007, and applies to coverage
2.2issued or renewed to Minnesota residents on or after that date.

The doula registry is currently described like this:
Sec. 5. [146B.02] REGISTRY.
4.13 Subdivision 1. Establishment. The commissioner of health shall maintain a registry
4.14of certified doulas who have met the requirements listed in subdivision 2.
4.15 Subd. 2. Qualifications. The commissioner shall include on the registry any
4.16individual who:
4.17(1) submits an application on a form provided by the commissioner. The form must
4.18include the applicant's name, address, and contact information;
4.19(2) maintains a current certification from one of the organizations listed in section
4.20146B.01, subdivision 3;
4.21(3) completes a criminal background check; and
4.22(4) pays the fees required under section 146B.04.
4.23 Subd. 3. Renewal. Inclusion on the registry maintained by the commissioner is
4.24valid for three years. At the end of the three-year period, the certified doula may submit a
4.25new application to remain on the doula registry by meeting the requirements described in
4.26subdivision 2.

The rest of the bill has to do with definitions and restating the responsibilities of the registry. Read the entire bill.
Congratulations, Susan, The Senate and House authors, The Collective, and other dedicated doulas and friends who have put this bill forward. Next it goes to Health and Human Services for approval.
Here is Susan's contact information.

Susan Lane, CD, LCCE
3rd Party Chair
The Childbirth Collective

Wednesday, February 21, 2007

The Tipping Point of Birth?

The book, The Tipping Point, by Macolm Gladwell reports on how small ideas grow among the right combination of people grow to marketing miracles or tragic epidemics of harmful behavior. He describes how some creative thinkers designed children's educational shows to stick in the children's head until they actually did offer an educational benefit.

Can we use the principles of The Tipping Point to improve maternity care in a significant way? In a national or world wide way?

Or will we be limited to transient local successes that fold up after the person fueling the program retires?

What can make positive maternity care behaviors "sticky?"

Read more about The Tipping Point at Malcolm Gladwell's website.

Saturday, February 17, 2007

Socialized medicine or socially engineered dis-ease?

I've been hearing that Universal Health care is a good thing for a long time. Certainly certain aspects of that would be wonderful. Like emergency care for people who now are left to suffer or die.
Here in Minnesota we have an ethic of helping each other and giving to social agencies to help those we haven't met yet and who are in need. A spot of socialism is a healthy adjunct to a well functioning free market system. I'm very proud of our county hospitals, one of which set up a payment schedule of $25 a month for a friend of mine who had bleeding tumors that needed treatment and yet had no health insurance or savings account to pay with.

Life expectancy is the same for Cuba as the US, and as odd as that may strike you, consider that Cuba's infant mortality is superior by far to ours. Since the Soviet Union's (Cuba's late sponsor) mortality rates were not as good as Cuba's I hesitate to credit the economic systems. Smaller units of socialization (communities) and traditional support systems, higher iodine intake, something else may be a more likely clue.
There may be some interesting answers to the question of how a country that spends 187. US dollars a year per person has improved survival (and literacy rates) than a wealthier country that spends about 100 times that per person per year.

Listen to some Canadians complain about health care. Limited to what and when you can get it and if it is a rare illness that's expensive to treat the treatment may not be given to a person even if it exists. I also hear the Brits worrying about national funds to pay for health care. Swedes pay close to 70% of their income on taxes.
Some universal coverage may be important, but what do we currently have for all? Immunizations? Ok, as long as I'm not forced to take 'em. Prenatal care? Really? And yet our current system is causing more and more premature babies, with higher induction rates, outdated weight and salt restrictions, and bears a large burden to our gap in the infant mortality rate. Plus these are the folks promoting cesareans without informed consent for women who don't need them--even though the maternal death rate is higher from unnecessary cesareans than for vaginal birth.
Why would a midwife demanding inferior care for all?
Why work for univeral bondage to allopathic medicine when we already see the crappy administration of big medicine in action now. Patients get 5 and 10- minute appt.s in spite of their needs just to push up the profit margin. Government control of health care just means the current corporations would get a goverment paycheck as they are kept in place as government contractors. The Fairy Godmother does not work in Washington, lobbyists do.

Parents in the 1980s worked so hard for the right to homeschool and small private and charter schools. The competition expanded options nad was a real boost for the creative teachers nad administrators among the public schools to step up school services.
Charter clinics? Yeah, we have the community clinic model now. And I'm glad for it. But how would we fight for grassroots health models when the monopoly is complete?

The FDA is already in a winning battle to restrict herbal remedies. The FDA approved breast implants; you know, those popular insertable balloons with a 100% breakage rate? Another neck exerciser for the FDA is cytotec. Why doesn't the FDA put the pressure on to stop cytotec when the uterine rupture risk includes alarming rates of mother and infant death?
I don't know, but I know some drug companies that are making more money than we can comprehend. Those are the guys that you want judging what is universally acceptable for health?

Smaller groups of people could come up with creative solutions for their locales, but a huge conglomerate of people are overwhlemed.
What else, besides subsidizing big corporations with government money would work that could provide quality care to all?

Thursday, February 15, 2007

First look

copyright 2006 Gail Tully

Morning window

As I sit at the computer and type this am, the sky is a bright winter blue. Sunlight angles low across the thin blanket of snow. The cool browns of four oaks and a basswood cast purple lines upon the lawn. Upwards, hundreds of dappled branches across the blue.

Four cardinals cluster close amidst the branches and flap apart again as the two bright males seek to overcome each other's competition for the two females. Suddenly a flutter of wings as they come beak to beak. Just as quick, they fly back to their original branches. They look at one another but I can perceive no hostility. I throw out a handful of sunflower seeds on the front walk. But they have other needs in mind.

Tuesday, February 13, 2007

Another transverse baby!

She wrote:
i just found out at my 35 week appt, my baby has its head at my right hip, and back down at my left hip.
i am a firm believer that God can do anything, and I have been praying, but i am scared to death to have a c-section, but that is all i think about. i am trying really hard to be positive, and do my exercises, and go to my chiropractor to get the webster technique done, but i guess
i need to know that it is posible for the baby to turn.
my dr made the comment that this is the worst transverse position, because the baby has to go backwards to get into position..any help would be appreciated !!! thanks

I wrote:
This is exactly, exactly the case of Emily last week! Her movie and story are on my blog.
[Feb. 9, 2007, How to do an inversion]

When you are done watching the video and reading the previous two posts go back to the regular Spinning Babies Site and search "transverse lie" using the quotation marks and then read each thing that comes up. It worked for Emily; it might workfor you.

Emily's baby was in the same position, back down and her baby slipped right down after 2-3 inversions, the Webster technique (different link here) and a prayer group praying for her. :)
Let me know!

Friday, February 9, 2007

Praise Report

"Hey, Gail, this is Maureen," the message on the phone said.
"I'm just sharing a praise report. We just got the ultrasound back and Emily's baby's head is down. And I am giving credit to God and to your hands that He used and your technique to get that head down. Thank you so much for meeting with them. She told me you were able to get some pictures and show her the technique and she did it again this morning. She said she felt a lot of movement last night. . .
Also, we prayed at church."

I have to pass this praise right along to Carol Phillips, DC for showing me how an inversion can help achieve optimal fetal positioning. Also, Emily saw the chiropractor exactly once with whom she got an adjustment of her pelvic joints and the Webster maneuver to release the round ligaments. The inversion I showed her helped the soft tissues, including the cervical ligaments. Together, these help get the womb symmetrical for the baby to drop down.

Would the baby drop down any way? Would the baby drop down with prayer alone? It may have been. Prayer has been studied by top universities and shown to improve health to a measurable degree. Most babies move head down. My feeling is that when the need for a cesarean can safely be reduced then our responsibility as parents and caregivers is to reduce that chance of surgery.
As far as the techniques being mine, they're not. I'm simply showing people how to apply the techniques and when. Maureen uses the phrase, "your hands" but she spoke metaphorically. I did not put my hands on this mother's belly. Maureen had recently palpated (felt) the baby. And Emily knew exactly where her baby was. She showed me and the shape of her belly made it clear also. It is an amazing honor to help facilitate, along with all these other wonderful people in the community, a healthier birth for families. Let's join Maureen in praising God.

Emily's baby had been transverse for about a week at 36 weeks gestation. See the earlier post this same date. A transverse lie midway through the last trimester is worrisome and not to be ignored. Fortunately, Emily was willing to do the inversion to help herself and her baby. Hopefully she and Ludvig will share a picture of their sweet baby next month!

How to do an inversion

An inversion is a technique for relaxing the lower uterine ligaments. It also helps a breech baby flip upside down. I learned the technique from Carol Phillips, a skilled chiropractor and craniosacral therapist who is knowledgeable in the birthing process.

The Spinning Babies Website lists a number of reasons a pregnant woman might do an inversion. See "Using the inversion in late pregnancy." This blog tells you how.

If you have questions about your situation, you may look at SpinningBabies.com for answers. I can't answer questions from the blog easily. You may email me, but if the answer is on the website, I will direct you there rather than answer. Thank you for considering the immense amount of time I offer to answer needs. A simple email is so much faster than a blog post to get to and to answer.

Do the inversion if you feel athletic enough. Don't do it if you have trouble breathing, with asthma, for instance. Ask your caregiver if there is any medical reason you shouldn't do this. Don't do it right after your breech baby has turned head down.

1. Have a helper to brace your shoulders so you don't come down from the couch too fast.
2. Have your knees on the edge of the couch.
3. Come down slowly.
4. Brace yourself on your forearms.
5. Relax your belly.
6. Relax your neck and head.
7. Hold the pose for 30 seconds for a head down, posterior baby, or a minute for a breech or transverse baby, if you can. Start with shorter times in the pose and work up to 30 seconds.
8. Crawl forward, bringing one knee down to the floor and then the other.
9. Come to your hands and knees.
10. Sit up, on your heels and catch your breath.
Crawl around the room helping the weight of the womb settle forward.

Watch a 2 minute movie:

Emily and Ludvig are 36 weeks pregnant (8 months) and their baby has turned sideways -- into a transverse lie. See a photo of the transverse lie fetal position earlier on this blog. Emily uses the inversion to help relax her cervical ligaments that may be tight and twisting her lower uterus. There are other reasons that a baby may lie sideways in the womb, but this is a common reason, and one that Emily can do something about. She is also seeing a chiropractor and a midwife. She may also visit a craniosacral therapist or Maya massage therapist. She'd like to have a natural birth, so it is important that the baby turn head down.

New: How can you tell if it worked?
A baby in a transverse lie is lying sideways and the mother's belly, in the last trimester of pregnancy, generally looks wider side-to-side than top-to-bottom.
When the baby does move into a vertical position the womb will look different.

Once head down, kicks will be strongest above the navel towards the ribs, and there will be suddenly more pressure in the pelvis. There may or may not be twinges in the cervix. The sides of the womb won't bulge, but one side may have a large mass of firm baby (the back) while the other MAY have limbs. Alternatively, there may be limbs on both sides and "all over" the front without such an obvious firm side when baby faces the front.
Learn more at Belly Mapping.

Friday, January 26, 2007

Web wisdom needed

In trying to ask what Spinning Babies Web readers need I find that the lack of comments may have to do with not having the blog linked on my website!

What I need is web wisdom.

Jen's Lactavist blog is charming. Found a smart preview of shoulder dystocia techniques and added a post myself.

There is also a deeply sad and precious gift in sharing on the web, and that is hearing the stories of parents who have lost a child. Each time I hear from such a parent I am so sad that I am so slow at getting information out there.
So much to say and such need. We hold the world in each of our hands. We must do, to help.
It makes my limitations so much more harsh and painful.

Jen's blog is at http://thelactivist.blogspot.com/

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.