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’ 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
iii. side lying 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