Focus on Spinning Babies: 10 things a doula should know

This weekend I got to attend a great Spinning Babies Workshop given by Spinning Baby trainer Jennifer Walker. It was a wonderful inspiring session and I would recommend it or similar to any doula.

In conservative antenatal education we are all taught to focus on the cervix as a measure of progress and change in labour. As doulas we know that the cervix is simply a symptom of the work of the fundus and all the surrounding ligaments, soft tissues and muscles and we rarely consider dilation in supporting a woman ‘s prgression in labour. Instead we look at the depth the intensity and the woman’s state. Is she still building endorphins, or has she entered into that trance like state of deep labour?

What Spinning Babies offers is an additional perspective to progression and movement (or lack of) in labour based on the baby’s position within the mother’s pelvis,  rather than on cervical dilation. An understanding of optimal positioning and of the symptoms of sub optimal positioning and how these can arise over the pregnancy can offer opportunities for the doula or midwife (or both) to take action to improve the positioning and therefore improve progression towards birth.

Here are the Top Ten Things that I learnt

1. Where the baby is,  is more important than dilation

A woman can be quite dilated, but if her baby is not in an optimal position to progress through the pelvis then the dilation is of no consequence, alternatively the woman can be hardly dilated at all, but once her baby gets into an optimal position, the labour can progress very quickly indeed. The position of the baby is determined by the mother and her pelvic balance.

2. Knowing the difference between passive patience and active patience

Passive patience is very high up on the doula check list in general. There is that idyllic image of the doula sitting and knitting which Michel Odent paints, and most experienced doulas will only become more hands on when the mother or her birth partner need and request more hands on support. However, in the worskshop, the point was made that whilst time is not often given to a birthing mother in our highly medicalised birth culture, continuing to simply wait and wait and wait for labour to progress can sometimes not help if the baby is not in an optimal position. Instead, if the doula and midwife can recognise the symptoms of sub optimal positioning and know exactly where in the pelvis the baby is and identify what aspect of the soft tissues, ligaments, muscles or fascia are contributing to the sub optimal positioning then action can be taken to improve the position of the baby. However its important to note that this is not some natural form of “active management of labour”, but rather an active style of waiting and supporting.

3. Balancing the pelvis, womb and everything that supports them enables good maternal position and baby’s position

Most women’s pelvis’ are not balanced. We all have previous injuries that we may have encountered along our teenage years or repetitive strains that we do on account of our job, or as part of our less than optimal posture. Also we all favour one side over the other to do certain tasks; for example writing, pulling or picking up things. All of these things accumulate and eventually we become unbalanced. When pregnancy starts we can take action to balance our pelvis’. There are exercises we can do daily and others weekly to improve pelvic balance and these are referred to as The Three Sisters, or more recently the Fantastic Four! In addition the practice of yoga and optimal sleeping positions can also be of great benefit.

4. Pelvis’ are differently shaped and shape will determine ease of the baby’s passage through it.

All women will have a slightly differently shaped pelvis. However in addition to the individual variations women have, there are generic groups of pelvis’. Some pelvis’ are more narrow in the inlet but wider in the outlet and others are wider in the inlet and narrower at the outlet. Depending which type of pelvis a woman has will determine whether the space for her baby to engage, rotate and descend is tighter or narrower or wider. It will also determine in which part of her pelvis the baby will have the narrowest fit during the journey to birth.

pelvis shapes
The four main types of pelvic shapes


Pelvis’ have three parts to them, an inlet a mid pelvis and an outlet. In Ireland traditionally most women have a gynecoid pelvis, however with a greater number of women from different cultures birthing in Ireland, a wider range of pelvic shapes are now more common. It can help if the woman knows the shape of her own pelvis.

5. Often where the baby is, is dependent on the quality and balance of the soft tissues

For example the tone of the muscles, the amount of tension in the round ligaments, the alignment and symmetry of the broad ligament, the tightness of the lateral sacral ligament, the length or shortness of the muscles, notablly the psoas muscle, and the pelvic floor muscles can all affect balance and ultimately the position of the baby. Hence the importance of daily balance practices during pregnancy and body work such as yoga, and also at least one visit to the chiropractor or osteopath during late pregnancy, or if funds permit visits throughout pregnancy!

6. Every woman benefits from daily practice during pregnancy to improve balance

The three sisters of balance (now the fantastic four) are useful daily practices in pregnancy and can also be used in labour as well if imbalance is suspected. They are

i. Rebozo sifting

sifting 2 sifting 3

ii. hanging the uterus


iii. side lying release


 iv. Standing sacral release


7. Tips to try in early labour or just before if the baby is high and at the pelvic inlet but doesnt engage

As doulas we are generally familiar with the symptoms that this scenario presents. Mothers will have a start stop labour that may go on for several days as the baby tries to engage,  the contractions may be double ones and painful but the true trance like state of labour doesn’t come on and the energy of the labour doesn’t move forwards. This can apply to early labour at home and to early labour in hospital/home.

Good tools to use here in addition to the Fantastic Four, are

  • Posterior pelvic tilts against a wall, as opposed to an anterior pelvic tilt (which women are often encouraged to do whilst sitting on a ball).
  • Abdominal lift and tuck if the mum is multparous,, this literally helps to lift the mum’s tummy into the pelvic area,
  • Crawling on hands and knees
  • Polarity techniques
  • Vigorous circling on the ball can be used (the analogy being an egg slipping into an egg cup if it is spun on the rim enough),
  • Walchers manoeuvre ie actually leaning back on the bed with the feet hanging off, or alternatively leaning backwards over the ball in a sort of half “camel” back bend for three contractions,


8. Tips to try when the baby is in the mid pelvis but not effectively rotating and so despite contractions the labour doesnt progress

The head has engaged in this case but is sitting at an angle within the pelvis in an asymmetrical way and has not completed the rotation it needs to within the pelvis in order for labour to continue. This is usually because the baby has not been able to adopt a good position, more often than not it can be due to the head not being tucked in, but being deflexed instead.

Symptoms here are where the labour has stayed at more or less the same point for a long period of time and the woman is tired. The woman reports continuous pain even between the contractions. She may be advanced in terms of dilation up to of between 5cm and 8cm. There may be a premature urge to push. Options to help here include

  • The Fantastic Four especially the side lying release for three contractions
  • Open knee chest position
  • Shaking the apple tree with the open knee chest. This enables the baby to move out of the pelvis a tiny bit and then when the baby returns he or she may have improved flexion with the chin tucked in,
  • Lunges, and lifting one leg up high in a lunge using a bed or a chair or going sideways up and down the stairs


9. Tips to try when the baby is in the outlet

At this point the mother may be fully dilated and it may even be possible to see the head through the labia, but the baby’s progress may be impeded due to a high arch within the pelvis or other positional issues associated with the outlet., More than likely though progress could be impeded by the  mother being asked to push in a way that makes her uncomfortable. Symptoms can include the lack of an urge to push and a cervical lip, or a lot of pressure from the care giver to do coached pushing. Options to help here in addition to the Fantastic Four include:

  • Squatting on a ball and leaning backwards can enable a wider opening at the pelvic arch
  • Putting pressure on the sacrotuberal ligaments so that they can release, even to the point of manually assisting the release if you are confident (that wouldnt be me!)
  • Sitting on the toilet with a straight back and bringing the knees together rather than extending them wide out
  • Ensuring that the mother is not curling around the baby, but is sitting or lying on her left side with her back straight, this is especially true if the baby is OP, as the baby will have a straight back and needs the mother’s straight back to get out! If she is lying on her side she will need a straight back and could use a peanut ball.


10. The importance of a tucked head in the baby

When the baby’s head is well tucked in then all the aspects of passing through the pelvis and putting appropriate pressure on the cervix can be achieved. Flexion is probably the most important aspect of  baby’s position. A LOA position promotes a good head tuck whereas an ROA may do the opposite. Practising the Fantastic Four in Pregnancy and using good sleep practices and safe movement practices during pregnancy will enable a baby to be more tucked in. This includes  exercises such as yoga, which naturally ensures that ligaments and muscles are well toned and the psoas is released from accumulated tension.

DISCLAIMER: These were things that I personally took from the workshop[. For guidelines and more information please either attend a Spinning Babies Workshop or consult the spinningbabies website


Labour: The process of separating from our mother

Mothering our mothers

I was with a few women the other day and one of the topics that came up was the difficulty in coping with the gradual realisation that our own mothers may be unwell with a poor or uncertain  prognosis. What does that mean for us as mothers in our own right, trying to care for our very young families and trying to be there for our mothers physically emotionally and spiritually? It means feeling over stretched, and can be especially intense when we are pregnant, And the very fact that it is our mother and not another relative makes it somehow more intense.

mother love 14

The small discussion that ensued made me reflect on our relationship with our mothers and mothering, and I started to see some parallels between preparing for birth and preparing for death; they are both about waves of separation. Becoming a mother and letting go of a mother seem to be somehow linked.

mother love ragastan

Journeying within our own mothers

Perhaps one of the reasons we feel differently about our mothers is that for many of us we lived inside her for 9 months! Our journey with our mother starts when we live within her during pregnancy. Some “energy workers” even point out that part of “us” existed in our mother’s eggs when she was growing inside her own mother, so perhaps in an energetic sense we know her very well, more than other relatives, we grew with her and are part of her from a long time back!

mothers love 7

In that womb time most people would agree that in the last months of pregnancy we feel our mother’s rhythms, her wants, her heartbeat, the lilt of her walk the sound of her voice and perhaps even her smile. We know when she feels fear, or anger and when her heart is open with love. Some midwives even suggest that a breech presentation enables a baby to hear its mother’s heartbeat more strongly and perhaps breech babies need that energy of the heart more than other babies.

mother love 12

Birth; a time of separation

When its time to let go and leave our womb home (and our mothers),  we initiate the time for birth, provided we are given the opportunity, and are not induced  of course. What makes us ready as babies to “let go” and be born is unclear. I always remember my mother in “wives tale” mode saying to me that birth is a process of separation, and that sometimes that process can be painful, for the mother and sometimes for the baby. I have always been mindful of that little snippet of ancient wisdom which my mother heard from a traditional midwife who attended her mother’s own 8 home births. in my work as a doula.

mother love 6

Even though when we are born we do physically separate from our mothers, “mother nature” herself immediately prompts us to seek her again with all our newborn reflexes, crawling, snuffling, reaching bobbing to find that point of connection at her breast where we can hear her heartbeat once more and feel comfort and holding. We leave and we return! The instincts that prompt us to do this last well beyond the first “golden hour” and research has shown that even babies who are three months old and have only ever been artificially fed will still make an attempt to seek the breast.

mothers love 5

Labour: a misnomer?

In English the name we give to the process which brings us to birth is “labour”. It suggests that giving birth is hard work, Your body will work hard and perform its physiological task. If birth is difficult or surgical there is often this (false) implication that maybe your body didn’t work hard enough or correctly. It implies that labour is unidimensional. Labour is anything but unidimensional of course! It is a delicate interplay of the physical, the psychological, the emotional the spiritual and the unknown. It is a transformational rite of passage which offers women an invitation to access something within them they may not have known about themselves. Strength, vulnerability, autonomy, passion, determination and instinct are a few things women sometimes cite.

mother love 22

In other languages however, this process of “labour” and birth is actually called “the separation”, the word “parto” means just that; letting  go, to leave, to separate.  It is from the Latin Parere I think. So birth is a process of separation, not simply a matter of hard work! Both mother and baby separate.

mothers love 6

Weaning and beyond

When we wean from her breast, when we crawl and then walk away we separate more. And even for those babies that have not been breastfeed or who are not parented by their birth mother, this weaning or moving away happens. Even though as adults we live quite separate lives from our mothers, sometimes in different countries, if our relationship is good, and sometimes even if it isn’t there is still that pull, that unusual different energy reserved just for our mother(s). Perhaps it has something to do with the lesson in unconditional love a mother can give us? Perhaps its more complex.

mother love 25

When we become mothers ourselves our children’s behaviours and our responses are often benchmarked against what we experienced as children from our mothers. Some of us have good experiences and some of us not so good  ones. The transformational invitation of parenting enables us to parent ourselves and address some of the hurt we may feel from our own childhoods. We don’t have to do that, but the invitation is certainly there.

mother love 21

Finally letting go

But then the day comes, or maybe the year comes, when we realise that our time with our own mother is limited, and everything comes at once. All emotions arrive. Tiredness, uncertainty, loneliness, mortality, the unknown. Its as if we become that child again seeking the warmth and the familiar heartbeat, and we feel the terror and the panic of not finding it any more. There is no pushing away the inevitable, no stopping it however much we want to.

mothers love 10

In that sense it is a bit like labour; we often want the intensity to stop, to to calm down, to give us a rest, but the energy of birth rolls on like a series of waves and we deal with each surge as it comes. We somehow find our own personal deep coping mechanisms and our trust. When labour is over we put our coping tools  safely away to use for the next labour maybe, and even when there are no more labours, what we learnt as birthing women never leaves us. These innate lessons of birthing are available to us in every one of life’s intense transformations; they are the gifts of the birthing woman that we give to ourselves!

mother love 8

Birthing and dying; arriving and leaving

And so in our meeting there were comments on how similar birth is to dying. Both ask us to let go and release. Its hard to mother young children and to have time to process what we feel about letting go of our own mothers as so many emotions arise at the same time, but if we look closely we will see that the emotions and the vulnerability they expose merely offer an invitation to experience the intensity of living and loving.

Sometimes this process is hard, confusing unfamiliar and unknown, again similar words that can be used to describe birth. What is important is to find yourself time, give yourself support, surround yourself with other women who are familiar with the territory, accept all offers of help with young children,seek professional support if you need it, talk to your midwife if you are pregnant and tell her how you feel, eat well, get plenty of rest, find your reflective space where you can connect with your emotions and as ever, BREATHE.

mother love 26

And one day (unbelievable as it seems when we are young), we will be asked to release our mothers with grace and gratitude hopefully realising that neither time nor space can separate us.

This post is dedicated to all those I know and love who have let their mothers go.

Midwife Jeannine and her mum Maureen (RIP), who told me all about her many births, who loved her children and who was loved in return, and who shared my own  mum’s birthday!


Focus on caesarean section – International Day of the Midwife 2016

Top  10 things I learnt at the Essence of Midwifery Conference

It was great to be invited to several events over this week in support of all the wonderful midwives who work so hard to support women during their journey to pregnancy birth and beyond in Ireland. The big day was the Essence of Midwifery conference at The Coombe. As usual they put on a great show and there were some great speakers and posters with the focus being on caesarean section and choice within it.

Maternity Strategy 2016

coombe susan kent1. That the maternity strategy has been launched a 100 days and nothing has yet been implemented. With a government now voted in, when is the action going to start in ensuring that women have access to along side midwifery led units?  The overview of the Strategy was given by Deputy Chief Nurse and Midwife Susan Kent

Caesarean Section Rate

2. That the c section rate in the North of Ireland was 36% but investment in evidenced based research, support, care pathways, informing women of their choices and in trusting women was able to reduce it to 25%. (Dr Niamh McCabe and Margaret Rogan Consultant Midwife.) There are four main reasons for c section (1) compromised baby, (2) “failure to progress”, (3) breech presentation and (4) previous caesarean section. Niamh and Margaret highlighted this last issue and the lack of informed choice surrounding VBAC in Northern Ireland that was a major factor in maintaining the high caesarean rate.

Risks of Elective Repeat Caesareans

Risks of Elective Repeat Caesarean section

3. .Women are rarely told the risks of Elective Repeat Caesarean Section (ERCS), instead the risks of VBAC are the primary focus of discussion. Niamh discussed some of the risks including placenta acretia and hysterectomy. Niamh pointed out that she hardly ever used to see placenta acretia when she started out in her practise and now she sees about one a month.

coombe signs of uterine rupture
Signs of uterine rupture in a VBAC

4. Women hoping for a VBAC are absolutely encouraged to use the water pool for labour and birth and also CTG as Niamh argued that it is almost impossible to have a uterine rupture without an abnormal CTG . However, if its a woman’s choice then she doesn’t have to have it and there are other signs that can be looked for. Niamh said that the rate of uterine rupture has increased over the years as more and more women are having c-births.

5. The increased risk of a fetal death with a VBAC is about the same risk as when you had the caesarean birth the first time round. The increased risk is perceived because in general  if you had a normal birth the first time round then the chances of your second baby dying is much less than your first.

MATERNAL DEATH RATE CS6. You are three times more likely to die with a ERCS than with a VBAC

7. The risk of a VBAC is about the same as of an IOL

Michel Odent

MICHEL ODENT8.Birth is a series of involuntary processes hindered by the interference of the neocortex

9. Melatonin and oxytocin work together to promote surges and birth. Light in the blue spectrum inhibits the production of melatonin. The most common spectrum used in delivery suite lights is blue spectrum. The light emanating from mobile phones is also in the blue end of the spectrum. Mobiles and apps are not good for connecting with your inner self and increasing oxytocin levels. Michel Odent.

Decision Making in Midwifery and Obstetrics

10. When we make decisions around pregnancy labour and birth we tend to believe that the more information we have the better decisions we will make, however what we need is sufficient information to reduce our uncertainty enough to make a decision.

Also decisions are often based on heuristic pattern recognition. Once we see a pattern it is difficult to erase it from our minds so even though what we are seeing is marginally different from the pattern we know, we will recognise it as the same. Situations that are similar to ones we recognise can fool us into making quick decisions based on faulty recognition. On the other hand we like using patterns to make decisions because it enables us to make decisions more quickly. Until we recognise a pattern we have to work things out from first principles, and that takes time which most HCPs dont have.   Prof Maskery.

Top 5 things I enjoyed

1. The company of being with midwives and womencoombe paula me and anne

2. The Japanese water blessing offered in honour of the daycoombe song

coombe studnet midwives13. The student midwife discourse “keep it going keep it going keep it going keep it going keep it going . . . keep it going keep it going” “Exactly how long is a breath?”

4.  The poster presentations. My favourite was the poster looking at caring for same sex couples

5. The food (lunch and the lovely dinner)