Wednesday, August 31, 2011

Spinning Babies vs. Ultrasound? Post 1

Penny Simkin alerted me of a new marketing for Ultrasound in childbirth. TrigMed has developed a concept for viewing labor progress -and adding yet another wire, or two or three, depending on use, with their LaborPro devise.

 TrigMed's LaborPro... My fascia is fluttering and my muscles feel mushy. What a weird experience to feel that we have stepped into a science fiction future.
Well, if it weren't so loud and probably dangerous to the baby I'd have no problem with this (Dr. Sarah BuckleyDr Pasko Rakic).

 If we join the argument about how nice it would be to avoid uncomfortable and inaccurate vaginal exams, How do we trade the baby's wellbeing for the mother's comfort? but then if gravity weren't so persuasive I'd simply jump down from high buildings to save having to go down the steps. The side effects of ease may not be as desirable as the intention.

 Will the benefits be worth it? If the hospitals can afford one, and if it is easy enough for the average provider and nurse to learn to use it accurately, then we are going to see these in labor rooms.

  Consider the possible uses, "Hard data" to justify cesareans and other interventions

- From Lack of descent - OP, whether justified or simply present
- OT, same, whether in transverse arrest or simply facing a hip during a lull in labor
- When the baby's head is in Extension (chin up)
- By Remote viewing of fetal flexion, presentation, position, and descent by a doctor or nurse in a centralized location

 Already I get emails from Spain, Italy and the Eastern US from women saying, "My doctor says my baby is OP and I should schedule a cesarean." -

  The good thing will be We can 

- Learn the Cardinal movements better
- Learn about the Immediacy and efficiency of various techniques at various stations
- Avoid internal exams (or will they want to check to verify and increase skills?)
- Possibly distinguish whether baby's head is stuck in the pelvis; actually doesn't fit; or is simply waiting to rotate, waiting for flexion, or  doing the necessary moulding?
- Achieve Remote viewing of fetal flexion, presentation, position, and descent in areas where experienced or expert providers can't get to easily

 Dang, who's got one of these toys and how do I get to play ?
 I so wish they weren't harmful. I'm so sad about that.
Women and babies are going to be exposed to this technology because they already are! Home and hospital providers use ultrasound in electronic fetal monitoring, doppler, and visual scans.  This isn't new technology, its simply a new marketing strategy to have the technology sold in a new way that requires a new purchase for the promised uses.

We in the physiological birth movement need to get jump in, gravity be damned, and be an ethical voice to move things towards solutions rather than more confusion. We have to talk about the "right use" of this (actually) invasive sound wave technology to make it non-routine and as an aid towards maternal position changes and choices, allowing more time in labor, and reassuring mothers and staff about the normalcy of childbirth.

I'd love to consider your comments for a future post on this development.

Tuesday, June 28, 2011

Demystifying the Pelvic Floor class

Last night, 30 women gathered at Blooma with Leslie Howard, Amy Metry and "Ruby" the pelvic floor model to explore the many facets of the female diamond. Soon we were laughing and learning. Here's some more about Leslie:

Leslie Howard Yoga in the News: Fit Yoga Magazine -December 2008

Curve Magazine - "5 Facts About Down There" January 2010
Vagina Pagina blog - April 2010
Yogic Muse Blog, June 2010
"A healthy pelvic floor is more than doing Kegels." Here are some gems from last night:

Its not that we shouldn't do kegels, its that doing kegels only addresses one of the three muscle groups of the pelvic floor. Kegels are meant to be done with something to kegel around...

Mula Bandha a yogi practice to engage the pelvic floor is a complex and somewhat advanced technique that is not appropriate for exercise yoga classes, but should be learned in serious training and as a separate and unique technique. (My paraphrase isn't as clear as Leslie's comments.)

Engaging the pelvic floor is good and stablizes the core.

The core includes the muscles from the respiratory diaphragm down to the pelvic floor, including the abs and psoas.

Working the abs and leaving the pelvic floor weak adds to incontinence, constipation and other problems of pelvic floor weakness and having the organs shoved down by tight abs without a stable floor.

Too loose or too tight causes their own set of problems. Some of the diamond can be too tight while another area can be too loose.

And an interesting ray of insight for me was about
how our floor relaxes and opens on the inhale and lifts on the exhale. Hmm.
Why do we push babies out on the exhale?
Oh, we exert on the exhale...
Umm, why are we exerting so much letting our babies out?
Oh, yea, we learned that to overcome the helpful pain drugs that weakened our bodies during birthing... we learned that to overcome the tension of having a doctor, a resident, a student and a nurse watching our yoni as they commanded us to "Push!"... we learned that because of the high fear atmosphere in the room which lends to a lot of clenching.

Ok, this is my ramble, not Leslie's comments.
So for years now when a woman is frustrated with pushing, confused about how to push, doesn't want to, and of course this is only if she has been told to push and it doesn't seem to be working for her for one of these reasons or for the reason that the head is not flexed,
I ask the women to stop pushing and release during the contractions (surges).
Just open around the baby and let the uterus do the work, keeping everything else loose.

Babies tend to flex, women tend to get back in tune with their bodies and labor tends to resume the progress towards birth.

Listening to Leslie I understand more of the physiology of why this seems successful so often.

More fun with the ruby diamond at Leslie Howard Yoga.

Thursday, March 17, 2011

DONA International explores Belly Mapping

General Session Presentations of the

17th Annual DONA International Conference

July 21-24, 2011

Boston, MA

Here are the exciting General Session speakers and topics you can look forward to learning from at the conference. A wonderful variety of Concurrent Session speakers and topics are also scheduled.

· "Third and Fourth Stages of Labor: Usual Practices under Heavy Criticism," presented by Penny Simkin, PT, CD(DONA)

· "Childbirth in 2011: Doula Practice in a World of Increasing Cesareans and Home Births," presented by Eugene Declercq, PhD, MBA, MS

· "Anesthetic/Epidural Medications and Their Impact on Breastfeeding," presented by Thoma

s W. Hale, RPh, PhD

· "What in the World is Belly Mapping?" presented by Gail Tully, BS, CPM, CD(DONA)

· "The WHO Code: Why Doulas Have to Care," presented by Marsha Walker, RN, IBCLC

· "Breastfeeding Made Simple for Doulas," presented by Kathleen Kendall-Tackett, PhD, IBCLC

Here's a big shout out to my many friends at DONA who've made it happen - Anni and Debbie and Penny particularly! And the one whom I wasn't even aware of who also spoke yes when the decision was in the balance.

This will be a fun look at Belly Mapping and the doula-mother relationship. Bring your cameras!

See you in Boston.

Wednesday, March 16, 2011

Mujer alumba en motoconcho, no le dio tiempo entrar al hospital

Ok, you're going to have to watch the first 30 seconds a few times.
This birth will first confuse you because the mother is leaning back
on a motor cycle! She's just been driven into the ER which I
think is quite resourceful.
(The sound is terrible. Its probably videoed from a cell phone.)
Ok, now what are you seeing?
The baby is born breech and comes readily - a good size boy
born in the "Impossible" breech position which is
Sacrum posterior. (I've seen in calmer conditions, too)
The worry is the chin will get stuck on the pubic bone. And I suppose
it must have happened to someone. But here we see the boy shoot out
into the woman's hands, good catch. Whether she is a doctora or a
nurse, the camera is now on her, rather than the mother and baby!
Wow, fast birth, fast catch fast camera action.

What a woman! What a driver!

Tuesday, February 15, 2011

Pelvimetry can still be worth something

Pelvimetry has been abandoned by many as meaningless. It may not have importance to those who do not know what changes they might make in their practice protocols for variations in pelvi. For those who know that the pelvis is dynamic and changeable, there are women whose can adapt their birth preparation to their pelvic shape or variation. javascript:void(0)Achieving a dynamic balance is helpful for all women, enhancing labor ease and progress."
The pelvic shape may be secondary to fetal rotation and flexion into the pelvis, but size and shape do take a role in childbirth. The fact that obstetric surgeons switch to cesarean surgery if the baby doesn't fit doesn't mean the rest of us are ignorant in ways to support the individual size and shape of the pelvis.

Though I've only been interested in a woman's pelvic shape and size occasionally, not even annually when I was attending births regularly, there were situations when an interest was indicated.

The woman with a gynecoid pelvis often finds that labor itself will eventually get the posterior baby rotated to any of the anterior positions, or in some cases, gives birth to a posterior baby.

In a woman with an android pelvis, if her baby at the end of pregnancy is rather large (for her) and in the posterior presentation, I note that the forehead can settle into the triangular shape of the anterior inlet making rotation next to impossible unless the round ligaments and broad ligaments can be loosened (first time mother issue and older mother typically) and the baby helped to reposition to the LOA then the baby may never engage, even with labor. We start with this mama in 2nd trimester to achieve a dynamic balance so that her baby comes into the brim in the LOA position.

The woman with an anthropoid pelvis will start labor with either an OA baby (if engaged) or a direct OP baby and in either case the baby may rotate on the pelvic floor or may be born without any need to rotate. Could these be the women with the 3-8 hour posterior labors that find that all the fuss wasn't applicable to their experience?

In a woman with a platypelloid pelvis, her baby does need to get into the LOT position, usually with chin tucked in flexion, to enter the pelvis. Labor can be days shorter if this is achieved before labor rather than through long, hard, frequent contractions.

You see that the woman with the android pelvis, the fast sprinter or easy runner, may have an issue if her android pelvis runs on the small side and her baby is large (maybe she drinks more than a quart of milk daily and such foods that grow large babies). The woman with the platypelloid pelvis (only 5% of all) will be very interested in helping baby face her right hip (LOT or LOL in UK) to start labor. Overall, 65% of OP babies rotate to the OA by the end of labor. But starting labor in one of the anterior positions, or at least with a tucked chin, does make a difference for some pelvic types.

Most women can go into labor confidently without knowing whether their pelvis is round, oblong, or even triangular, but there are times when a little knowledge helps women prepare for labor and their providers pick techniques and exercises that promote rotation and descent rather than choosing common techniques at random, simply because they usually work and not knowing what the woman they sit with needs for this long labor.

Labor is worth it.

Monday, February 14, 2011

March of Dimes: Preterm Birth Rates Improve in Most States

March of Dimes: Preterm Birth Rates Improve in Most States

This is one group I have turned around on. We can reduce the prematurity rate.

1. Don't get induced!
2. Eat well -lots of dark leafy greens and other veggies, a bit of fresh fruit, meat and fish soups with boiled bone broth, a bit of salt (yes), brown rice and avoid the whites, white rice, bread, sugar, and potatoes.
3. Get your Omegas, fish oils, flax, and chia seeds.
4. Good teeth brushing and flossing.
5. Avoid sexually transmitted diseases (like you wouldn't think of that!) and other infections.
6. Avoid drinking alcohol, smoking tobacco and marijuana, drugs and over the counter pain killers.

And 7. Be happy and be grateful that your baby WAS born full term, even if the baby hasn't even been born yet!
(Yes, there is a Stanford study on this.)

Monday, January 17, 2011

Spinning Babies model at the class

When I do a Spinning Babies class, I ask the local hostess(es) to ask a local pregnant woman to come be our morning model. From 10:30-12 she helps us with Belly Mapping and the Pregnancy Protocol, heavily featuring Dynamic Body Balancing (Dr. Carol Phillips, DC). In Atlanta, GA, the first full day, and a Saturday after the ice melted from the roads, Nicole came to be our pregnant momma. See pictures at Debbie Pulley's Facebook. or
I ask for someone who is over due if possible, because these activities have led to labor beginning in 36 hours. When my model isn't due, 36 to even 40 weeks, they haven't started labor. But 41 weeks, we've seen labor in 12-48 hours.
Now, any 41 week mother could go into labor in 12 or more hours after anything, sneezing or laughing, right?
But when they feel a "thunk" or have to jump up during the activities because baby suddenly dropped, I'm thinking this is doing something.
Especially when labor goes so well. Its not scientific, but I am asking for researchers. Meanwhile, try it yourself!

The Atlanta Spinning Babies Workshop was hosted on January 15, 2011 by the Georgia Birth Network and See Baby Perinatalogist, Dr. Bradley Bootstaylor and his staff.
Saturday's pregnant model was Nicole King, and she was 41 weeks pregnant with her second baby. She sent me this email today, the workshop was on 1-15.:

Here is the quick version: 1.16.11, 4:02am Baby Boy DiBella 9lbs. 21in. was born at home in the tub caught (just barely) by our midwife. Total birthing time approx 1hr 40min :) Intense and perfect! Stay tuned for the official story today or tomorrow...thanks for all you had to do with my amazing birthing time :)

Nicole King HCHI, HCHD, ICI
Adventures In Childbirth

I'm giggling again!! She may well have had a short birth anyway, but she did do some amazing work at the workshop! Pictures will be added soon.

Saturday, January 8, 2011

How I came to be the Spinning Babies Lady

Leslie Lytle, a sponsor for the Spinning Babies and Resolving Shoulder Dystocia Workshops in Richmond, VA this year (2011) asked me how I came to the concepts behind my approach.

I didn’t come through academia. The community called me out.
In the hospital, I saw babies handled at birth with no understanding of their awareness and impressionable emotions. My desire was for babies to have someone there to welcome them, someone who recognized their sentiency. Observing birthing women, I became enamored with their ability to transform self impressions into the strength and tenacity (when sometimes needed) to give birth. To witness women birthing themselves into a new woman is also miraculous!

The first midwives to take me with them to births had me watch several births before giving me a role to play. Observing mothers and listening to the metaphors of midwifery and observing mothers again, I could check my beliefs with what I was observing.
Given the frequency of posterior labors,
I quickly found I wanted more information about how I might help better when women experienced a particularly long or obstructed labor.

Penny Simkin helped us all, in the birth movement, immensely by bridging the jewels of physical therapy with the benefits of emotional support. Together with the other founders of DONA International (and parent, doulas and doula supporters across the world now), she deserves much of the credit for making the continuous presence of the doula the greatest innovation in childbirth in the 19th century.

I began Spinning Babies to communicate the
teaching of midwife Jean Sutton (Optimal Foetal Positioning), and leader Penny Simkin (The Labor Progress Handbook) through a traditional midwife perspective.
While Jean Sutton and Pauline Scott's Optimal Fetal Positioning includes pregnancy and labor activities and postures to enhance progress, I still heard from a group of women that “did everything” and still needed a cesarean. Why?

When the answers within the culture of birth didn’t satisfy, I opened myself to other communities. In the world of bodywork, Carol Phillips, DC helped me understanding how fetal rotation can be enhanced or hampered by maternal balance. Observing her techniques in the births of my mothers, I found the answer I was searching for - that Balance may need to be restored before maternal posture or activities can be effective in this minority of birthing women. From Liz Koch I learned more about the Psoas, and from Collette Crawford, the benefits of certain yoga routines for pregnancy.

Many, many midwives, doulas, doctors, nurses, yoga teachers, and body workers have contributed to my understanding. Most notably my friend, Jan Hofer, midwife to over a 1,000 (remarkable for the state of Minnesota) who gave me the most lovely example of how a midwife can be with women.

Most importantly I learn from the mothers and babies I continue to observe.
One very important “ah-ha” moment came after connecting extended shoulders to a long arc rotation after yet another shoulder dystocia. In a long arc rotation an OP baby rotates to OA,
usually in labor, before the birth of the head. I began an in depth, and expediently experiential, exploration of Resolving Shoulder Dystocia techniques.

By addressing the baby’s rotation and descent in a series of techniques that simulate the natural progression of labor, success is increased (and injuries lessened) for both obstructed labors and shoulder dystocia (arguably also an obstructed labor, right?)

Seeking the “truth” in birthing offers many humbling and corrective discoveries that bit-by-bit increase the accuracy of my interpretations. I don't expect to reach the ultimate understanding, or a 3-Point Birth Methodology.

Rather, I present this material to learn this material. And in sharing, preserve some of the unique perspective of traditional birthing with women, couples, and birth practitioners of all kinds. Together, we can uphold the sanctity of birthing; physical, emotional and spiritual.

And that's what being the Spinning Babies Lady means to me.

Friday, January 7, 2011

Pelvic floor protection

A Spinning Babies visitor- "I along with many women, would greatly appreciate any info you could provide as to what to do during pregnancy and especially during the pushing phase that would prevent pelvic organ prolapse (rectocele, cystocele, uterocele, etc.) from occurring, or at least help keep any current prolapse from worsening."

For your pelvic floor protection:

No caffiene (yes!)
Regular inversions, legs-up-the-wall and if you can, shoulder stands
A myofascial pelvic floor release side lying release)

Yoga exercises for pelvic balancing and strengthening
Release of the Psoas muscle pair

In pregnancy the same
plus do the side lying release once in early labor and once during late labor, for instance in the presence of strong contractions but no (slow) progress or after the transition phase before a strong urge to push (if there is a lull then). Any time is fine, but those are examples.
Picture of a side-lying release (pelvic floor release).

A good fetal position for an average size baby is easier on the pelvic floor. Continue a short inversion every day (30 seconds).

In labor, use rotation friendly comfort measures (upright, walking, hands and knees, side-lying when resting and techniques if labor is slow due to fetal position).
Keep your bladder empty, especially during pushing.

Push on hands and knees or standing rather than on your back, any position other than on your back if you are not allowed to be on Hands and Knees or upright.

Don't hold your breath and push unless there is no progress due to either asynclitism or a hand in the way, or perhaps just size. (Rather take a little nap if the contractions are spaced, there's no urge insisting upon spontaneous pushing.)
Sit in a deep tub of water for a while during pushing, even if you don't birth in the tub.

Once in a while strong pushing is just necessary, but less likely for a second baby than for a first. Possible, but less likely.

Plus, avoid a pudendal block, epidural, episiotomy, vacuum or forceps! There is a lot of evidence that these things cause more pelvic floor damage. Of course, the vacuum or forceps is reasonable to consider if it avoids a cesarean, but deciding when it is necessary varies among providers. Try a pelvic floor release (again if necessary) if pushing is slow. I realize some women will pick an epidural. I don't want anyone to suffer, but don't deny yourself the support you may need, the preparation that may help, so you aren't left lacking support in labor.

Rest for 5 days after birth, no stairs, no carrying, no walks, not on your feet except to go to the bathroom or go to meals. Use a portable potty and a futon if you have to. Have prepared meals, friends bring food, etc.
Rest from day 6-14 in the home avoiding stairs except if you live on a multifloor home and need to use the stairs to go to the bathroom or to be with the family. Then down once and up once a day. Use a portable potty chair the rest of the time. Take your first outing at the end of this time, or in the second week. If you have to see the doctor before then, take a nap immediately afterwards and get help with meals that day.

Days 15-45 one errand a week, one visit a week to a parenting group or other place of support. No cleaning other than a short visit to the kitchen sink. No vacuuming or picking things up off the floor or carrying anything heavier than baby. Have someone else carry the car seat and carry baby in a sling, not the car seat of a baby carrier seat.

Continue at that time with yoga and pelvic floor balancing and strengthening most days (plan everyday and see if you can get in at least 5 days a week).

That's what's on the top of my head.

Whole Woman, Inc. has an article on Preventing Maternal Injury During Birth. You may find some more tips.

The Childbirth Connection has several articles on Preventing Pelvic Floor Injury and Dysfunction.

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.