Wednesday, March 8, 2017

Clarity in your birth

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

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

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

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

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

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

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

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

More ideas

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

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

Will Shoulder Dystocia occur?

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

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

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

Thanks for being out there doing what you do.

Practicing a typical hospital resolution of Shoulder Dystocia.

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

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

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

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

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

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

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

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

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

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

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

Much love,

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

Wednesday, March 1, 2017

Not Afraid to Care

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

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

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

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

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

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

A 2012 case report also cites dural puncture from a difficult epidural.
This woman was given diazepam to stop the seizure and magnesium sulfate through intravenous fluid injection until it was determined by spinal tap examination that a dural puncture was the cause.

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

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

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

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

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

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

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

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

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

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

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

The same mother writes, 

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

Thanks again for all your help and your warm response.

March is Womens History Month.

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.