Why It's Important

When I was 20 years old, I was on the path toward law school. I was intent on becoming a child advocacy lawyer in order to protect all of the vulnerable children that I saw in my day to day life. I was naive and I thought this would change the world.
I married a man and we made four babies and I realized that child advocacy does not need to happen only in a courtroom, but way before that time. I became a childbirth educator and a birth doula, and did not ask for it, but found myself becoming mentors for younger mothers. And through this, I came to realize, I was doing child advocacy.
I stood in my kitchen last night with this man who is leaving me. Whose childhood is so full of horror, I cannot even fathom it. I break to a million pieces thinking about the little boy who endured so much, and it presses me on to continue this work. We have a great opportunity, midwives and birth workers. We may not always see it come to fruition, but every interaction we have with an expecting family and with a new mother, we are planting seeds. We are advocating for those children in how we treat their mothers, in how we honor their family, in how we speak of the baby and to the baby. 

One of the amazing benefits of Facebook is that I can watch the families I worked with in their very beginnings blossom and grow. And it warms my heart to no end to see how many gentle mothers I see. How they choose parenting with love and respect, and how they are choosing to love and respect themselves as well.

Peace on earth begins at birth? I think it's worth a try.

The Female Form

On my way home from the gym today, I was chatting with my friend about body image.  Both of us being mothers of four breastfed children, we shared in the laments over our stretched out bellies and breasts.  We shared with one another our own struggles against body confidence, how our mothers' words and actions had affected the ways in which we viewed ourselves and our hopes and dreams for our own daughters.

It is hard to feel comfortable with your own female form in this day and age.  When we are constantly being bombarded by images of what some person somewhere decided was the "ideal" female shape, it is hard to find acceptance in a body that cannot fit that mold.

I grew up with a lot of inner confidence, but sadly lacking the outer confidence that I needed.  I felt confident in my knowledge and abilities, but was scared of how I might appear to other people.  It has taken many years to accept this body, this shape, these genes, this skin that cocoons the very essence of who I am.

When I started birth work, I was given the opportunity to see a wide range of female bodies, and I was blown away with how beautiful they were.  No matter if a woman was short or tall, tiny or large, this pregnant mother was breath-taking in my eyes.  Because pregnancy and birth were not about focusing on what was wrong, but rather on focusing on what was right with the female body.

These bodies of ours, they are amazing.  These stripes of stretched skin bear the mark of our having a hand in the creation of another human being.  This extra fluff on the belly belies the fat that was stored for transporting extra nutrients to a child if need be.  These not-so-perky breasts mark the wisdom that has been gained through patiently nursing, nourishing, nurturing these four children now half grown.  This body is an outward reminder of the inner changes that have occurred in my life.

This female form is not beautiful because it is firm and toned and polished and perfect.  This female form is beautiful because it has worked hard in its feminine role of growing, bearing, nourishing, and loving these little people in my life.  Why hide these accomplishments?  Wear them proudly because you earned them.

Birth is Universal

We sat around my living room, the three of us.  We laughed about the ridiculous things we had seen and heard in hospital birth rooms.  We gushed about the awe and wonder of a woman giving birth in all of her glory.  We opened up to one another and shared our concerns and asked for input on how to be better - in both the hands on and business aspects of birth.  We ate scones and hummus and thousand-layer cake and chocolates.  We nursed babies and re-directed school-age children, and sent them upstairs to find their own entertainment.  The three of us, though not knowing one another well, we clung to one another's words, experiences, souls.

Three different women, three different continents, three different cultures.  Together we represented a very broad range of beliefs and ways of life.  But we convened for the purpose of discussing something universal.  Birth.

I have found that this profession - the profession of being with a woman through her birth - is one that is unlike any other.  While bankers, mechanics, graphic designers can all gather together and talk about their lives, their work, their difficulties and successes, nothing can compare to the sisterhood that is created in sharing this work. 

No matter where I go in this world, no matter what ethnicity or culture or continent I am with, I have found that birth is universal.  Every child from the beginning of time has come from a woman's body, and to witness this everyday miracle is such an honor.  Everywhere on earth, from the beginning of time, other women have gathered around the laboring mother to help her, love her, cherish her through the transition of motherhood.  It is an amazing privilege to be able to share this experience with women all over the world and throughout time.

After the get together at my house, we all went our separate ways.  Three different religions, three different lifestyles, three different households, and yet this love of birthing women connects our souls and leaves us with a feeling of unity that cannot be described.

Inversion - Going Upside-Down to Make Things Right!

For years in my childbirth education classes I would joke with my students about how the only position worse than laboring on your back would be laboring upside down.  We all laughed and thought it was hilarious to imagine a women doing handstands in labor.  Funny how perspectives can change.

I was originally introduced to inversions by my chiropractor, who specializes in pregnancy and pediatric chiropractic care.  I often invited her to come to my childbirth classes to talk about the importance of posture, optimal fetal positioning, and chiropractic support in pregnancy.  Since many of my doula clients also saw her, we have always had an open relationship about ways in which to help laboring mothers.

The first time I went to her office with a client in early labor she had my client put her knees on the adjustment table and her hands on the ground.  I thought it was a bit odd, but I have seen a lot of odd things in this job that end up working!  It didn't make sense to me at first, but the more I asked, the more I pondered, the more I practiced it, it began to make perfect sense.

The Baby Entering The Pelvis

Think about driving a car into a parking space in a crowded parking lot.  You turn the wheel of your car and try to ease in to the tight fitting space when you realize, uh-oh!  I don't have enough room to maneuver my way into this spot!  Do you then keep driving your car forward?  No way!  That would result in crushing cars parked in the adjoining spaces.  So, you back up, take a different angle and try again.

 

This can also occur in pregnancy and labor.  As mentioned in my previous posts, there tends to be an optimal position in which babies best fit through the mother's pelvis.  Sometimes, babies start to move down into the pelvis in a manner that makes an awkward fit.  This can result in a stuck baby who does not make much forward progression.  In these cases, getting baby to first back up and then come in at a different angle is what will help baby best to realign and enter in a more suitable manner.

 

How Do You Do It?

Inversions can seem a bit scary at first.  And it's okay if it is a bit awkward.  You have a large belly and it will be awkward! 

What you'll need:

 

 

- A support person

- Stairs, a low table, a couch, or chair

Step One. You should begin by starting on your hands and knees, facing away from the furniture that will be supporting you.

 

Step Two.  With your support person helping, crawl backward and lift one knee up onto the furniture.

 

Step Three.  Pull up your other knee onto the furniture.

 

Step Four.  With your support person supporting your shoulders, push off your knees, up onto your feet, lifting your bottom farther up into the air, and attempt to make your body into an angle of 90* or less.  Make sure the mom releases her belly, letting it fully relax.

 

Step Five.  Hold this position for a minute at a time.  (Notice how the support person uses her knees/legs to support the shoulders while holding/shimmying the hips).  Make sure mom is keeping her belly relaxed.

 

Step Six.  Alternate onto elbows if needed.

Step Seven.  If desired/necessary, have the partner shimmy your hips to help disengage baby.

Step Eight.  Take a break on your hands and knees/elbows and knees but do not stand upright.

 

Repeat steps 1-8 twice if in late pregnancy, in between each contraction if in labor.

Now this is important!!  Before the mother gets into an upright position, it is incredibly beneficial to sift the mother's belly to help baby rotate into a better position, or angle him/herself into a better position.

 

 

Why This Works

 

The Uterus - If your uterus has any type of twist or imbalance to it due to uneven ligaments holding it to the pelvis and back, the inversion will be incredibly helpful at releasing those ligaments.  We humans tend to spend all of our time in an upright position.  In this position, the heavy uterus hangs down in the same manner day after day.  When a pregnant woman inverts, her uterus then hangs in a completely different manner.  This allow the ligaments to be gently pulled on and balanced on both sides of mom's body.  This will help the uterus to become aligned, allowing more room for a baby to move around.

The Baby - This technique can be incredibly effective at getting a baby to find it's best position through the pelvis.  Once the baby has started to engage into the pelvis in late pregnancy, it is much more difficult for baby to maneuver his way into different positions.  If his hand is up by his head, his head is extended, he's come down oblique, or posterior (to name a few predicaments), getting him *out* of the pelvis will be a much more effective technique to realigning him than just trying to move him in an already tight space.  Like that car in the parking space, backing up out of the pelvis before correcting the position of the baby will be much easier than trying to reposition him while he's hedged in.
 

In Labor

The inversion is most effective if done prior to the onset of labor.  This allows the repositioning to be done without the counter-acting forces of contractions.  Since contractions forcefully push the baby into the pelvis, trying to disengage the baby from the pelvis during labor can be difficult.  The contractions act as an additional force to gravity, like a bulldozer pushing that car into the parking space.  But, it can be done!

In labor, assume the inversion position as often as you can in-between contractions.  It can be difficult to hold the position through a contraction, but see if mom can do that as well.  The contractions will feel very odd in this upside down position, and mom will need a lot of support.  If mom is laboring in a hospital, you may need to work around a lot of wires and lines.  Having an i.v. or hep lock in her hand will cause some difficulty in leaning forward on her hands.  Helping her on to her elbows will be a better position if this is the case.

 

 

Signs That An Inversion Would Be Helpful

In Pregnancy:

* You are in your third trimester of pregnancy

* You have round ligament pain

* You have pressure in your back or bottom

* You have pressure in your hips

 

In Labor:

 * You are having prodromal labor

* Your contractions are sporadic or spaced out
* You are feeling the contractions mostly in your back
* Contractions are strong but baby is not moving down
* Contractions are irregular - coming at varying lengths, piggy-backing, or double peaking
* You are feeling a lot of pressure in your back or in your hips
* You have an urge to push while only 4-6 cm dilated
* You seem to be "stuck" at a certain dilation

 

Warnings!!

 

Please reserve the inversion for women with intact waters.  Once the waters are released, there is the added risk of a cord prolapse.  A mom can go to knees and elbows at this point, but a full inversion may add to the risk.

 

Please reserve the inversion for women with normal blood pressure.  Make sure mom feels okay with this position, can support herself with her arms and does not get a headache from being upside down.

 

 

Trauma, unexpected

Many times as doulas we are called to support a mother through a birth that doesn't go the way she expected.  Like the wedding we plan since childhood, our birth experiences are something we often dream of, plan out, idealize.  And sometimes it goes just so.  Perfectly.  But more often, there are things that go awry.  Sometimes in little ways, other times in large ways. 

These unexpected births can be difficult for the mothers and difficult for the doulas to know how to process, to support and help the mother through.  We've all had those births - the ones that encompass an unplanned epidural, a transfer from home to hospital, or an unexpected cesarean.  When mothers encounter resistance at the hospital, we know to pour on the love and support.  When mothers suffer through the agony of back labor, we know to keep our hands pressed firmly and endlessly in counter pressure.  When labors tend to go on and on with little progress, we persevere ourselves with endless encouragement and optimism, utilizing every possible tool we can find.  Those difficult hairpin turns in the labor can take a moment for our actions to support our ideas of taking everything in stride and readjusting our expectations.  But we keep on supporting, loving, tending.  And we know that these mothers will often need more time to process their births afterward, and that we need to be available and open for listening to the mother share her experience, her feelings, her grief.

But many of us have the idea that it is only those births that were intended to be natural births and ended up being medicalized that are the ones which mothers need longer support to process.  When we see a birth go quickly and naturally, we tend to rejoice and applaud the wonders of such an efficient birth process.  We often think, that was easy!  She got her natural birth, she must feel great!  This is not always the case, and we really need to be careful to not assume that any birth outcome is exactly what the mother intended.

My most recent client's labor started out slow and steady, easing into contractions, gradually building up in length and intensity.  And then, all of a sudden things changed so quickly, we barely had time to blink before we were rushing off to the hospital.  This mama's body switched gears so fast that her baby was born in the car in the hospital parking lot.  At first I was so pleased for this mama, who was fearful of encountering resistance to her natural birth plan in the hospital.  She didn't have to fight for a single one of her wishes!  Her baby came without any interference!  But I knew.  I could see it on her face.  That look of shock and trauma.  I knew how that felt. 

There is no place in another woman's birth experience for our own feelings.  There is no where in her own perception that we need to place our own feelings, or the way we think she should feel.  Mothers get that all the time from outsiders.  "You should be happy that you have a healthy baby!"  "You are fine."  "Just focus on the relief of this being over with!"  Why do so many press upon the mother how they need to be feeling?  We do this often in the obviously traumatic births.  But we also do this with those births that are unexpectedly traumatic.  "Wow!  That was fast!  You must be so happy!"  "How exciting that your baby was born in the car!"  Why must we assume that a mother feels a certain way just because we would feel a certain way, or because we expect her to feel a certain way?

Those births that seem great from an outside perspective are those that we, as doulas, need to be very aware of.  Never assume that a mother feels great, or doesn't feel great about her experience!  Check in with her.  Look her over, holistically.  How is her emotional state?  How is her mental state?  What is she presenting physically?  Touch her and look at her.  Quietly assure her that you are there for her and that she can feel safe to tell you her story.  Many times women are afraid to tell the truth of how they feel.  When everyone around them expects them to feel one way, why would they feel safe in countering everyone?  If even her doula expects her to be happy, then how does that impact the mother who is, in fact, not happy with her experience?

 

So doulas, listen up!  Make sure you are not overtaken by your own feelings.  Because, while they matter to you, they don't matter in the experience of the mother.  Only her feelings matter there.  Save your own feelings for your debriefings and reflections, but tuck them aside and open your heart to see and hear the story that the mother tells.  You may find yourself quite surprised that it is a very different story from the one in which you feel you just took part.

Life and Death

For the first time in 9 years of doula'ing, I had to step out and let someone else take over my roll of doula for one of my clients.

It was not due to my inability. Nor my lack of desire. In fact, I grieved over having to leave my laboring mother. But I knew that I left her in good hands, and I felt some peace with that.

In late April, as my client frantically nested, setting everything up in the nursery just so, cleaning bathtubs and refrigerators, and feeling the first little twinges and changes of impending labor, a dear friend of ours was on a drastically different journey. On a rescue mission to fly wounded soldiers to medical help, his helicopter was brought down, and his life with it.

While I cleared my schedule to focus on being available for my client, we heard about a helicopter crash and pilots who were KIA, and we prayed it wasn't one of our pilots. One of the ones we had travelled with through aviation school.

And after my last prenatal meeting, having talked through all of the mama's fears, her desires, sifted belly and baby to coordinate in mama's womb, we got the news. Our fears were brought to reality. It was Nick. And he was being laid to rest in five days.

The first day was spent in shock and utter disbelief. The second day in sobs of grief. We purchased plane tickets, booked hotels, and arranged for my mother to come and watch our kids. And then I remembered my client. A woman on the verge of welcoming life. Surely new life could wait while I honored a life already spent. Surely birth could hold out while we experienced death.

In the last days before our departure, I quickly coordinated a back-up plan, naively believing that my client would hold out for my return.

And on that night before we were to leave, we had our alarm clocks set to awaken us at 3 a.m., our funeral clothes pressed and hanging in travel bags, my client informed me that life could not wait. So, I went.

As this mama worked and walked and struggled and sipped, I imagined my friend, Julie, and how she labored that same evening in preparation for her husband's funeral. I rubbed and sifted and gentled and supported, and this mama praised Jesus for the new life about to unfold. And I wondered, is there someone with Julie to rub and sort and gentle and support her tonight? To praise Jesus for the life that was well spent? Is there a doula for death as there are doulas for birth?

And baby Jacob took his time. Like his name implies, he struggled to make his way out. My back up came in the wee hours of the night to take over as welcoming committee, and my husband and I flew off to make up the farewell one for our friend.

Jacob took his time coming. He struggled his way through his mother's pelvis, slowly moving toward his exit, and his mother struggled her way with his movements. It was not an easy birth, but at last he emerged, vigorous, healthy, crying. And I, so far away now, also struggled. I was torn between two worlds. I had left a mother transitioning into a new role, and was now present to witness my friend relinquishing a role she so loved. We also struggled our way through this ceremony of exit. It was not easy. We struggled with the right movements. We cried. And as my client said, "Hello little one! How I love you!" We said, "Good bye, dear friend. We love you."

 Life and death, they go hand in hand. They are events in our lives that change us forever. They help us to learn and to grow and sometimes take a lot of time to understand. Both events need to be covered in love and support, to be surrounded by strong and gentle arms, and tears that express what cannot be said through words.

And we need to remember, just as the new mother doesn't stop her journey at the birth, the bereaved do not stop their journey at the death.

A New Role Unfolds

I show up again today, armed with, well, my arms. And my heart. And my experience. But mostly my presence. This new role unfolds before me - a lot less telling, a lot less movement, a lot more quiet listening, a hug, a reassurance. This pace is much slower than I'm used to, and lengthier. But the benefits are amazing. To not end with motherhood, but, instead to begin there. When I teach childbirth classes, parents often become so focused on the childbirth aspect, they sometimes forget that the birth of their baby is not the end, but merely the beginning of their journey. Walking with women as they emerge from their own re-birth into mothers, wet around the ears, tender and vulnerable, this is an amazing blessing and honor to be here. To share. Babies, they are amazing. We think they are helpless and clueless and must be taught so much, but watch and learn. They have more to teach us than we have to teach them. Babies are not logical creatures. They are fully right-brained, instinctually powered individuals with so much inner wisdom. Us mothers, we tend to fear our right brains, afraid that we won't sound intelligent, that we'll let things get out of control unless we keep track of the numbers and facts. We have our books and our computers and our experts, but look! Your expert is in your arms. Your expert is in your soul. Mothers and babies, they are already experts. The hardest part of becoming a mother is what should be the easiest. Trust. Trust yourself. Trust your baby. You know already! And this is just the beginning. If you can open yourself up in the beginning to learn from your wee little teacher, you will soon find that they will teach you everything along the journey of parenting.

It's Not Always Easy

I recently had a couple from my childbirth classes go through two full straight days of back labor. Because I have spent so much time studying optimal fetal positioning, and apply it extensively in my doula work, it can be very difficult for me to stand back and not try to jump in and "help".

The mom and dad both remained in touch with me throughout the labor via phone calls and text messages. They kept me updated with what was going on, and asked for input every now and then. I offered to come over and help them periodically, but I was not hired as their doula. They wanted to do this on their own.

And I thought over and over, if only they'd invite me over! I could help them out so much! At a difficult moment for the mom, dad asked me to come over and lend an extra set of hands. This was on their second night of intense back pain. I did a ton of rotational techniques, getting mom in all sorts of various positions. But I could only encourage mom to do what felt right to her. I could not take control over her body or her labor. As much as I'd like to have, this was her labor, and she needed to make the choices.

I went home after an hour of being with them. Left them relaxing in their bed, hoping that something I did had helped, but not knowing whether it had.
A few days later I received an email from the mom, and it really struck my heart what she said;

I feel like our labor experience really created and set the foundation for our family. I've had so many reflections on the beauty of it all. So many times we try to run from suffering at all costs and miss out on the amazing, redemptive power of it all. That was the hardest thing we have ever experienced, but it brought us closer together than we could imagine and because of that the pain was the best gift. Michael was an excellent coach and I admire him so much more now that we have been through that, and he has seen my strength by what we were able to do together.

If I had insisted on going over there earlier on in their labor, when I knew that I could make things easier for them, what would that have accomplished? It probably would have made for a faster, easier labor, yes. But did you hear how that labor has shaped these parents? A quick, easy labor was not what these parents needed. A long, difficult labor is what they were given, and they excelled with it. They learned from it. And they are wiser and stronger because of it.

As childbirth educators and doulas, we give our clients all the information and tools ahead of time, but then it is up to the couple as to how they will use it.
We are not to be their guides on the journey. Even if we know for certain a better way, an easier way, how a different decision will create a better outcome. We are not to guide them along the pathway to parenthood. The parents are the guides, learning some of the most important things they'll need to know as parents - how to make decisions on their own.

We are not the guides, we are the observers of this journey. A presence along the way to witness the strength and the transformation of these parents, emerging from self into selfless.

Why Natural Birth Isn't Beneficial...

Say, what??!! Isn't this blog titled, "Natural Birth In Kitsap"? Aren't you a propenent of natural birth?
Why, yes. Yes, I am.
What I want to share with you is something that has been spreading in the breastfeeding world for some time now, and I think needs to also spread to the birth world.
Natural birth does not hold benefits. It holds normalities.
As mammals, this is the normal way we were intended to birth babies. Moving, private, peaceful, freedom. As humans, this is the normal way we were intended to birth babies. Supported, loved, nurtured, unmedicated.
Natural birth doesn't add anything to the birth experience. It is the way the birth experience was intended to be. It doesn't benefit the baby. It doesn't benefit the mother. It doesn't bring short-term, nor long-term benefits. It is where we set our human standard. Anything other than this is deviating from the way we were inteded to be. Not birthing naturally brings risks.

Just as with breastfeeding, our bodies have a specific way to work. We have a specific birthing function, a specific feeding function. It is a correlation between the mother and the baby.
Any time we alter from that course, we increase risks of things going wrong, and causing harm.
Often times we are told that our bodies are not good enough. That, even though we are mammals, whose very defination is one who "gives birth" and "nurses their young", our bodies cannot do. We need help from man-made products. "Supplements".
We supplement with membrane sweeps, cervical ripenings, artificial oxytocin. Supplements lead to less of us, more of them, until we find ourselves unable to produce at all. Unable to produce milk, unable to produce contractions.
We are told our nipples are the wrong shape, our uteri are the wrong shape, our pelvises are the wrong shape. Our bodies will harm our babies. They tell us this, and they are wrong.
We are told that natural birth is dangerous, that it is impossible, that it is unrealistic, and that we are just trying to martyr ourselves. When did normal become such a big deal? When did we get so detached from ourselves that we can't fathom our bodies functioning in normal ways?
We have set the standard at medicated birth, just as our society has set the standard at artificially-fed infants. We have tests and procedures that are necessary for medical births, that have become routine and "normal". We have nurses trained to help medicated mothers but unaware of what to do for a naturally birthing one. We have doctors who have been trained to interfere and do so with such regularity, that we have to specifically state over and over that for *this* birth, we want to be left alone.
Shouldn't it all be the other way around?
Shouldn't we be wondering at the dangers of medicated birth? Of interfering with the natural bodily functions? Shouldn't we base our studies, not on how natural birth might lower risks, but how interference may increase risks? Shouldn't the burden of proof be placed on deviating from normal, rather than deviating from medicalized?
Why are we looking for studies and statistics which prove the worth of natural birth? Do we look for studies and statistics which prove the worth of natural breathing, natural urination, natural eating? Why don't we hear studies talking about the benefits of NOT catheterizing everyone? Or NOT putting everyone on a ventilator. Or NOT giving everyone a feeding tube? Wouldn't that be a ridiculous world to live in where everyone was made to believe that they could not eat, breathe or urinate without medical intervention?
And yet, with birth, we find a huge discrepency. A normal bodily function that is overseen by doctors, nurses, medications and machines. We are told that we can't do it naturally. And medicalized birth becomes the norm.
We need to stop setting the birth standard at medicalized birth. Any deviation from the normal way the body functions should be backed by a true medical reason. We should not be laughed at, rolled eyes at, scoffed at, annoyed at, or ridiculed for wanting to do what is normal. Normal should be supported and accepted. It should not be rare. It should not be so hard to attain. It should not be something we have to battle for!
The health benefits, bonding benefits, breastfeeding benefits, etc. associated with natural birth are not benefits at all. They are what every mother and baby were intended to have. They are the standard. And, yet, how many know this? How many are choosing risk because they believe that risk is normal?

Natural birth is not beneficial. Natural birth is normal.

A World of Safety Nets

“Differing definitions of safety also play a part. Doctors often feel unconcerned about side effects – even life-threatening side effects – provided they know what they will do to treat them and that the life-threatening ones occur reasonably rarely. So, two doctors writing for their colleagues can say reassuringly: “These [epidural] complications should not cause fatalities if trained personnel and adequate resuscitation facilities are available.” Loose translation: If a laboring woman develops a life-threatening complication from an epidural, she or her baby won’t die of it provided hospital staff are on the ball.”
From, The Thinking Woman’s Guide to a Better Birth by Henci Goer, page 127

“What has happened in the rich world is that, while removing the ideal food and feeding method, there has been progress in the elimination of other immediate risks. It is important to remember that it is still only a minority of the world’s population that can be artificially fed from birth without getting ill or dying.”
From, The Politics of Breastfeeding by Gabrielle Palmer

While these two quotes talk about two different things – medicated birth and artificial feeding – they are essentially saying the same thing about the world we currently live in. That those of us in first world countries live in societies filled with safety nets. And while that’s great for us, the rest of the world cannot manage to live the same way and afford the same healthy outcomes.

The switch from births happening at homes to hospitals and the rise of artificial milk for babies has followed a similar trend. They were at first disastrous. Dangerous. Doctors in hospitals and artificial baby food makers did not really know what they were doing. It was all trial and error, and many mothers and babies died as a result. With the awareness of germ theory, sanitation, and clean water sources, births in hospitals and artificial feedings improved. As the western world improved in wealth, it also began to take risks with its health. As long as they had a way of fixing the mistakes, it was okay to risk making them.

But living in a world of safety nets is a precarious world to live in. Walking a tightrope is risky, especially if there is not a safety net below. But even with the safety net, you will need to deal with the consequences of walking in a way that our bodies were not intended to walk. The feet of tightrope walkers tend to have many broken bones. Bodies react when we force them to do something outside of what they were intended to do.


When we interfere with the natural processes of labor, there will be reactions. Most doctors see these reactions as perfectly acceptable, since they tend to have plenty of safety nets set up in place – epidurals, pitocin, cesarean sections, drugs to bring blood pressure back up, resuscitation devices, and epinephrine. We believe that taking risks with our bodies while in labor is safe because we have become so accustomed to the safety nets. We have begun to forget what normal is meant to look like, and only what it’s like in a life of safety nets.



The same goes with artificial baby foods. A mother’s body is meant to breastfeed her baby, and a baby’s body is meant to breastfeed from it’s mother. When we alter this normal process, there are reactions. We have come to believe that ear infections, upper respiratory infections, and digestive problems are normal for infants because they happen so often. But these are reactions to altering the normal state of being. And this is only acceptable in our society because we have so many safety nets set in place. We have clean water to mix with formula. We have unbelievably easy access to fuel with which to heat the milk. We have easy access to transportation if our child becomes ill, and many hospitals, clinics and health care providers to offer care for our sick children. All of these are safety nets. Without such easy access to these things, feeding our babies with anything other than breastmilk would be dangerous.


But this alternate form of normal is acceptable in our society because a world of safety nets has become the new normal. And while I do not wish for these safety nets to stop existing – I am very thankful for them, actually! – I do wish that we would understand that safety nets are meant to protect us in case of emergency, not as a daily way of life. Normal labors should not routinely need to be induced or augmented. One third or our women should not need to have their babies removed from their bodies for them. Breasts should not be seen as so easily unable to provide nourishment. Ear infections and upper respiratory infections should not be common childhood ailments.

It does not take moving to a third world country to begin to understand the effects of a life based on alternatives without safety nets. What would we do in our comfy, wealthy society if these safety nets were suddenly sparse? It sounds unlikely, but all you need to do is consider Florida after the 2004 Hurricane Charley. Or the Gulf Coast after 2005’s Hurricane Katrina. We are not a country immune to natural disasters. And these disasters could easily wipe out all of our safety nets from beneath our feet.


In order for a medicalized birth to be above dangerous, there are many safety nets that need to be in place. Electricity, clean water, access to medications, availability of trained physicians, anesthesiologists, and surgeons. This may seem standard to many, but when hurricanes barrel through, earthquakes topple down, tsunamis wash away, or volcanos erupt around and upset all of this, we find that those must-have inductions and must-have cesareans become less urgent. We find that women can labor without being numbed, and that babies can come out without all the gadgets and gizmos set up in a hospital. And many see it as a tragedy that, because of a natural disaster, these women had to birth in a normal way!

In order for artificial feeding to be above dangerous, there are also many safety nets that need to be in place. How long does it take to boil water in order for it to be sterile? How many times must a mother do this in a 24 hour period for a formula-fed infant? How many gallons of water must she carry to her home? How much wood or other fuel source does it take to heat up the water for formula or for cleaning the bottles and nipples? How far is it to the nearest health care clinic, and how long would it take her to walk there with a sick child? How available is a health care provider in an emergency situation? During Hurricane Katrina, this is what formula feeding parents had to consider. In most of the world, this is what all parents have to consider.

I hear over and over again that formula feeding is perfectly safe ), and that breastfeeding really is not much better than formula feeding. What arrogance we have in our society! To take away the immunities and healthy digestive system our babies were intended to have, and replace it with a safety net of doctor’s trips, antibiotics, special hypoallergenic formulas, inhalers, insulin, etc. just because that is what is now normal, does not mean that it is safe. We can only claim it’s safety because we have all of the safety nets in place to catch our children when they fall. Those safety nets would not be as necessary if we followed the natural order our bodies and our babies’ bodies were intended to follow.

In our country, we have the ability to choose whether we want to have a natural or medicalized birth. We have the ability to choose whether we want to breastfeed or formula feed. But just because these choices are available, it doesn’t mean that they hold the same level of safety. At any moment we could be in a situation where our safety nets fail.

Reflection

The other day while waiting for my daughter's ballet class to finish up, I began chatting with a woman who was also waiting. During our chat, it came up that I am a doula. "A do-what?" this middle-aged Ukranian woman asked me.
Though the term doula is becoming more and more well-known, this is a question that I hear often. And I've noticed that older women tend to not understand the necessity of my role as do the younger women. And not knowing much about birth in the Ukraine, I was not really sure what this woman would think about the work I do.
"Are you more for the emotional support, then?" this woman asked me when I tried to describe my role at a birth.
"Yes! Exactly!" I responded.
This opened the door for this women to share her own experience, as often is the case when talk of my profession comes up.
I love that women feel that they can trust me to be a sounding board for them as they describe in great detail a part of their lives that is so intimate, and so personal. I love to listen and gain more insight into the beauty and pain of womanhood.
This woman told me of her first birth, thirty years ago at a Soviet hospital in what is now the Ukraine. She told me how she had no idea what was happening to her, that no one had explained how the baby would come out of her, and that no one bothered to inform her at the hospital. She told me how she was left alone to experience pain after pain, not knowing if she was dying. She asked me if I tell women what to expect before they go into labor. I assured her that this was a large part of my role as a doula, and that I teach entire class series on what to expect through my childbirth classes. "This is good," she told me. "Women need to know. And they need someone with them to help them through it. What you are doing, it is a very good thing."
I think that it is important for us, as birth workers, to hear not only the good stories of birth, but be reminded of the bad stories, and how our efforts must continue - that history must continue to change so that all women can experience birth in a safe and satisfying way.

OFP, part 4 - Putting Optimal Fetal Positioning into Practice

WHAT IS “OPTIMAL”?

What is Optimal Fetal Positioning? Optimal fetal positioning is the act of manipulating a mother’s body through movement in order to alter the fetus’s position into one that is favorable to moving through the mother’s pelvis.
In the previous blog post, I explained why the left occipital anterior (LOA) position is the most favorable for a baby to start in during labor. While this is true for the majority of labors, I’d like to refer back to the first blog post on the various pelvis shapes among women, and explore how this may not be true in all cases.
Because the gynecoid pelvis is the most common shape – one that 50% of women possess – this is the pelvis that is mainly referred to in OFP discussions. But, what if you have one of the other three types of pelvises? Optimal fetal positioning may then look different for you. While the general thought is that OFP is trying to get the baby into the LOA position, variations in the pelvic shape will change what is the optimal position for the baby.
I will reiterate here: the optimal position for the baby is whichever position the baby most easily fits through the pelvis. So, in the case of the anthropoid or android pelvis, the shape of these pelvises makes it much more likely for a baby to be in the posterior position. While a labor where the occipital bone of the baby is pressing against the mother’s sacrum may not sound ideal to the mother, if it’s the place that baby best fits through, it’s the best position in which the baby should be.

OPTIMAL FETAL POSITIONING DURING PREGNANCY

*POSTURE In the last blog post, I brought up one of the best things a pregnant woman can do to encourage OFP, and that deals with her posture.
I would say that the majority of “failure to progress” babies are due to malpositioning, and that the majority of the malpositioning is due to our modern lifestyles. Instead of walking for travel, we slouch in our cars. We do not sit cross-legged on the floor, nor do we squat, we lounge on sofas and in easy chairs. The majority of our work is done while seated, and the majority of us sit poorly.
So, watch your posture! Get a birth ball to sit on during the day. Tailor sit at home. Take breaks from sitting and do pelvic rocks. Spend a good 10 minutes when you get home from work just leaning over your kitchen countertop and moving your hipsThese positions will move the uterus forward, and help the baby to rotate into an anterior position. These postures will encourage flexibility in the pelvic joints which will enable them to open up to make more room for the baby.

*BODY WORK Some of us may need more help than just normal posturing to get our babies to move into more favorable positions.
Perhaps you had a bad fall when you were a kid. Maybe you were in a car accident. Or you played soccer and made the same one-sided twisting motion over and over again. All of these things can affect the pelvis alignment and uterine ligaments.
When the pelvis is bumped out of alignment, or the uterine ligaments are tighter on one side of the uterus, there’s going to be a twist in the uterus. While a slight twist or misalignment may seem like a minimal problem from the outside, everything is magnified on the inside. A slight twist outside turns into a large twist on the inside, making rotation more difficult for the baby.
Chiropractic care is wonderful for dealing with these bone and ligament issues. Mayan Abdominal Massage is another form of body work that helps get the uterus into better alignment.

*MOVEMENT What happens when you sit the same way, walk the same way, move the same way over and over again? Your body becomes rigid and tight, only allowing certain movements to take place. In pregnancy and birth, we want the body to be able to open up, the pelvis to open and move, the ligaments stretch. So, to help a baby be able to move, you need to move! Certain movements are more helpful during pregnancy and for optimal fetal positioning than others.

- squatting – opens up the pelvis, stretches your leg muscles, gets baby into alignment.

- tailor sitting – this stretches out the legs, opens the pelvis, moves the uterus forward and aligns your body.

- pelvic rocking – this helps get the baby out of the pelvis to allow it to move into a more optimal position, loosens the joints and ligaments of the pelvis and uterus and tones the abdominal and back muscles..









- forward lean – this helps to counter all the leaning back we do during the day. Lean against a table, a counter and while you lean move your bottom around to loosen up the hips!
















- hip shimmy – this is where, as mom leans forward (over a birth ball or a table or a bed) her partner comes up behind her, grabs each side of her hips and shimmies them back and forth. This helps to loosen up the pelvis and the uterus, gets baby moving around and feels good to mom








- dancing – dancing is one of the most fun ways of helping to get a baby positioned correctly! Last year when I attended a Zumba class with a friend, one of the dance instructors leading the class was 8 months pregnant. While her movements may have not been as mobile or precise as the other instructors, I couldn’t take my eyes off of her! The whole time I watched her I was thinking how great these movements were for her pelvis and uterus, and what a wonderful gift she was giving her baby through movement and flexibility!

* SIFTING Sifting is a technique that has been used by Mexican midwives for centuries. It involves wrapping a rebozo (“shawl”) under the bottom or belly of a pregnant mother, and shifting the shawl back and forth while raising the mother’s body slightly off the floor. This takes some arm strength, so have someone strong apply this technique! If you do not have a traditional shawl, a towel or sheet, or any longer piece of material, will work. This technique is similar to the hip shimmy in that it helps to loosen up the pelvis and uterus. It loosens ligaments and muscles, gets the baby moving, and can really help to rotate a baby. Whether or not sifting should be done on the woman’s belly or bottom depends on the position of her baby.




It is a wonderful technique to use on most pregnant women, as it often helps to ease any lower back discomfort that is common in pregnancy.

* DUMPING Dumping is a technique that was brought to my attention by my friend and chiropractic care provider, Dr. Joella Pettigrew. When a pregnant mama comes into her practice and she determines that baby is lodged into a bad position, before she performs an adjustment on the mother, she will have her get up on her table, and bend down – feet on the raised platform, bottom in the air, and hands on the floor. This is something that should not be done by oneself, but with supporters on both sides. What happens with this position is that it allows gravity to work on getting the baby out of the mom’s pelvis, in order to then get the baby to rotate into a better position through the chiropractic adjustments. Dumping prior to the other movement techniques helps to increase the likelihood of getting a posterior baby into a more optimal position.

GETTING BABY TO FLEX ITS HEAD

Referring back to the second part of the OFP posts, whether or not a baby’s head is flexed can make a huge difference on the ease with which the baby will fit through the mother’s pelvis. How to get a baby to flex its head may be a question that arose while reading through that post. While it’s not as simple as the rotational techniques, there are still some things that can help get a baby to have a well flexed head.
First off, before a baby has engaged deep into the mother’s pelvis, a skilled midwife can feel, through palpation, whether or not the baby’s head is flexed. And, if the baby’s head seems to be extended, she can help the baby to flex its head all from the outside of the mother.
Another way to encourage a baby to have good flexion, is to have toned abdominal muscles. Women with multiple pregnancies, which tend to stretch out both the uterus and the abdominal muscles, seem to present more babies with extended, or asynclitic heads. Keeping the abdominal muscles toned in between pregnancies, and through pregnancy with pelvic rocks, will greatly help with getting the baby to flex his head.
Along with well-toned abdominal muscles, sifting can be very helpful in getting a baby to flex his head. The shifting movement of the mother’s body can help to shimmy the baby down in the most accommodating place of the pelvis and encourage the baby to tuck his chin.

OPTIMAL FETAL POSITIONING DURING LABOR

Many of the techniques for optimal fetal positioning during pregnancy can also be applied during labor. While it’s best to have baby in an optimal position prior to labor starting, sometimes it cannot be helped!

*MOVEMENT Key to any labor, but especially one in which the mother is trying to get a baby to change position, movement allows gravity and momentum to work together to get a baby to rotate. Walking is simple to do and a wonderful way to encourage rotation! The back and forth shifting of the pelvis as the mother takes her steps helps to get baby moving too.
Rotating the hips while sitting on a birth ball is another movement which encourages baby to move and find the best fit through mom’s pelvis. Dancing with a partner, or just moving side to side, swaying your hips, these primal, unconscious movements that many mothers make during labor are all ways that the body works to get a baby to move around and down.

*UPRIGHT Unless you are trying to get the baby out of the pelvis, or to move more specifically, upright positions will allow the most opportunity for babies to rotate and find their good fit. It also tends to be most comfortable for moms, allowing them to freely move.

*TURNING A BABY FROM RIGHT TO LEFT If the baby is starting with its occipital bone facing the mother’s right side, it is important to remember that babies tend to move dextrorotationally. Meaning that they move clockwise and will therefore have to move into a posterior position before swinging around to the left. How will you know if the baby is in a right position? One way is belly mapping, which can be discovered at the spinning babies website. Another way you can see a baby’s position is by looking at the mother’s hips from behind her. If a baby’s occipital bone is pressing down into the pelvis, you will most likely see that side of the mother’s pelvis bulge out. This is only visible if the baby is in a more posterior position. If the baby is starting in an ROA position, you will probably not see any difference in the hips.
If baby is starting out in an RO position, the best way to get it moving in the right direction is to purposely rotate the baby first into a posterior position. That may not sound pleasant, but if a baby is turning clockwise, it will need to move around the back before coming back over to the left! Depending on which position baby starts in – ROA , ROT or ROP, you may need to start with right side-lying to get baby to move farther back.
If the baby is engaged into the pelvis, and especially if the bag of waters has broken already, it might be necessary to first get the baby out of the pelvis. Dumping was one option already mentioned, though it might be scary to do during labor. Another technique for lifting babies out of the pelvis is called the belly lift and tuck (described below). I discovered this technique on the spinning babies website and have used it very successfully! Once baby is brought back up out of the pelvis, sifting while mom is on her back is what I’ve found to be best.
This shimmies the baby to rotate into a posterior position. Sift only between contractions. Babies rotate between contractions, move down during.
Once baby is established in the posterior position, moving mom onto her left side will help get the baby rotated into an LO position. Just side-lying can do the trick. A little hip shaking while mom is side lying isn’t bad, either.
When you feel certain that baby has moved to the left side (again, look for the hip bulge), have mom get up and walk around to get baby to engage in this position. Hopefully, once this is done, progress will be seen soon after!


*SIFTING This was brought up as part of the rotational process above, but it can be helpful no matter what position you either think, or know, the baby is in. Sifting is also the best technique to use if a mother has one of the “other” types of pelvises in which the baby best descends in a posterior position, or with an asynclitic attitude. Sifting is like jiggling a key in a lock to make it fit. It will help to get the baby into the pelvis because it is moving the baby around until it finds the best fit!

*BELLY LIFT AND TUCK This is a technique I learned from the spinning babies website and have used successfully in getting stalled labors going again. What I discovered with labors that progress with contractions but not with dilation, is that it often has to do with either the attitude of the baby’s head, or the position of the baby. If a baby cannot fit down into a pelvis, it will not be putting pressure on the cervix to dilate it. In Bradley® classes, we talk about the NAP – the Natural Alignment Plateau – that occurs in over one-third of all births. While there are many reasons for an NAP (emotions, hormone production, head molding), one of the most common is what the name infers. Alignment.
When you help the baby get into a better alignment, the labor will progress with dilation and descent.


What the belly lift and tuck does is lift the baby out of the pelvis where it is assumed he has tried to descend, either with a wonky head, or in a suboptimal position. Once he got there, he couldn’t go any further. So, when the mother lifts her belly up during a contraction, it helps to lift the baby out of the pelvis. While mom lifts her belly, she also tucks her pelvis under as she would do during a pelvic rock. This helps the baby find a better entry point into the mother’s pelvis. If the stall in the labor is due to the baby’s need to flex or straighten his head, this may be all that is needed to finish labor rapidly. If baby still needs to rotate, this technique in combination with some of the others will be best in getting labor to progress further.


*HIP SHAKING Like dancing, moving, and sifting, the hip shake technique described in the pregnancy portion can help to rotate a baby into a better position. This is a useful technique if a mother does not want to lie down to be sifted, or does not want her belly touched with sifting. The partner can stand behind her, ask her to lean over the bed, counter, chair, etc., grab her hips firmly and move them in the same fashion as the sifting would.

Optimal fetal positioning is a wonderful skill to know, whether you are the pregnant mother, a doula, a nurse, midwife or doctor! Knowing how to utilize these techniques may mean the difference in a vaginal or a cesarean birth. It may mean the difference in a 12 hour labor and a 48 hour labor. It may mean the difference in an extremely intense back labor, or a labor that is more manageable. Knowing how to make the difference is an invaluable skill to have!

While all of these techniques can help get a baby rotated and into an optimal fetal position, it is important to remember that pelvises and babies’ heads are still amazing at adapting. Babies can still be born in posterior positions, with brow and face presentations, and in other “non-optimal” positions. It may take a little more time, and a lot more effort, but the human body is amazing at making birth work.

WHERE I LEARNED THIS STUFF (a.k.a References and Resources)
* Childbirth International Physiology in Birth Course Manual
* Childbirth International Birth Doula Skills Course Manual
* Understanding and Teaching Optimal Foetal Positioning by Jean Sutton and Pauline Scott
* The International Chiropractic Pediatric Association
* Joella Pettigrew, D.C.
* Spinning Babies

* The Belly Mapping Workbook
* Personal Experience

Optimal Fetal Positioning, Part 3 - Putting the Pieces Together

In my first blog post on Optimal Fetal Positioning I focused on the dimensions of the human pelvis. With my second post, I explored the shape and angles of the fetal head. This next post on OFP will be bringing these two parts together, showing how well they can fit when things are done right.

CARDINAL MOVEMENTS

The way a baby moves through the mother’s pelvis on its exit from the womb is described as the “cardinal movements.” The cardinal movements always begin with the fetal head in the LOA position, though sometimes babies do not go that route. The reason why LOA is the most described starting position is as follows.
As the baby enters the inlet of the pelvis, the widest diameter is transverse – from side to side. The baby’s head, when flexed well (or even when not), will be wider front to back. So, the best way for the baby’s head to enter the pelvis is in a sideways, or OT position.

INTERNAL ROTATION

As the baby is pushed further into the pelvis by the power of the contractions, and enters the pelvic cavity, the dimensions change. The cavity is more equally rounded, and since body movements tend to move in a clockwise direction (I’ll explain this more below), the baby is rotated from LOT to LOA.



EXTENSION

The pelvic cavity is where head flexion really has a big impact. With an equal diameter of 12 cm, a well-flexed head will have a much more successful journey past the ischial spines than an extended head with an 11-13.5 cm diameter. As the baby moves through the cavity, it will continue its rotation from LOA to OA.



EMERGING

Once the baby has moved through the pelvic cavity, the front part of the pelvis basically disappears with the pubic arch. But the sacrum and coccyx at the back are still creating a posterior resistance. The pelvic outlet is absolutely wider from front to back than to side to side. But, if mom is in a position that allows free movement of the sacrum and coccyx (side-lying, hands and knees, upright/squat), the front to back opening will be even greater as the baby pushes the sacrum and coccyx back. This anteroposterior opening creates a space that favors an OA position for the baby’s head.




CROWNING

As the baby’s head moves through the pelvic cavity, and under the pubic arch, on the outside of mom’s body we see the baby start to crown. Through the pelvis the baby has rotated from LOT to OA, and when the baby’s head is born, the baby is usually looking toward mom’s back

EXTERNAL ROTATION/RESTITUTION

The baby’s head has already gone on its internal rotational journey. As the head emerges, the shoulders follow with their own rotations. The shoulders enter the pelvis side to side, because they are widest that way, which puts the baby’s head in the OA position. As the shoulders move through the tight pelvic cavity, the body spins clockwise, and on the outside you’ll see the baby’s head turn toward its mother’s right leg.

As the shoulders move through the pelvic cavity, the rotation continues until the shoulders are front to back, this being the widest diameter of the pelvic outlet. Because of the pubic arch, the anterior shoulder will emerge first, followed by the posterior shoulder. The baby usually continues rotating until its facing up as the rest of the body is born.













BACKING UP

What I’ve just described is the best way that a baby fits through the twists and turns of the maternal pelvis. The two were designed to work together in this manner and allow the baby and the mother to remain intact. Getting a baby to this starting point is what optimal fetal positioning is all about.

DEXTROROTATION

Why does it matter if the baby starts in a left position or a right position? Inside the body, there’s a certain phenomenon that takes place called dextrorotation. This describes the body’s tendency to have its processes move in a clockwise direction. Our uteri move the same way. As the uterus contracts and releases, babies are turned in a clockwise manner. If a baby were to start out in an ROA position, this would mean that the baby would need to rotate all the way from ROA to ROT to ROP to OP to LOP to LOT to LOA. That’s quite a long journey and includes a nice length of time moving through the posterior position, which can be extra painful for many mothers. Starting out in the LOA position means that the uterus can focus on pulling open the cervix and moving the baby down, instead of also working on getting a baby into a good position.












GETTING A GREAT START

One of the best ways you can help start labor off right is by paying attention to your body movements in pregnancy.
Consider the way your spine curves. Most of us are lazy when we sit, especially if we like to sit in comfy seats such as couches and overstuffed chairs. In these places, we tend to tilt our pelvis back and curve out our lower spine, rolling our shoulders forward. Because the back of the baby’s head is heavier than the front of its head, sitting in slouched or reclined positions allows gravity to turn your baby to a posterior position, and the baby’s back is curved nicely along your curved back. If you were to sit with the pelvis tilted forward instead, your lower spine would have a nice curve inward, and your body would be more upright. This would allow the uterus to move forward, the baby to fit itself along the curvature of your spine, and the heaviest part of the baby’s head would then be toward your front.