Birth in Bloom

Positioning your baby - Pregnancy & Birth

"Let's change positions"...it's what I hear myself telling moms over and over again throughout labor.

I came across this fantastic article (with photos!) by New Moon Birth, giving some examples of the wonderful positioning that helps not only encourage baby into a good position for birth, but also to keep the flow of energy moving through your labor. Check it our here: Miles Circuit-Positioning Baby

The use of a birth ball during labor is more commonly practiced now, with some hospitals even providing them when you arrive in Labor & Delivery. But did you know how useful that same ball can be prenatally?

In the last 6 weeks of pregnancy, when you are encouraging the baby into the best position for birth, sitting on the ball or kneeling on the floor leaning your upper chest over the ball, will encourage the weight of the baby's spine to lie in the curve of your belly muscles.

When in this position, the baby's head is easily 'flexed' (chin tucked onto the chest), so that the smallest part of baby's head will be applied to the cervix first.

Choosing a ball

The labeling on the ball can be confusing. For instance I am 5' 3" and the recommended ball for me was a 55cm.  But for this use, I need a fully inflated 65cm ball to have proper positioning. Based on that I make the following recommendation to moms:

If you are 5' 7" or shorter, a 65cm ball is a good size for you When you sit on the ball you want your knees to be at a 90 degree angle. You can inflate or deflate the ball to help achieve this.

If you are 5' 8" or taller, a 75cm ball will be best for you. Same instructions as above.

"Take your ball to work day"

Why not make yourself more comfortable and supported by taking a ball to work? The average cost is around $15 and your back will thank you.

Other uses could be while siting at the table, watching TV, while rocking your older child to sleep. Really, anytime you would normally be sitting down, I say opt for the ball.

You can also use it for pelvic rocks or tilts, another great way to help baby into a good position for birth. While kneeling on the floor, rest your upper body on the ball and rock your pelvis up and down.

The ball isn't the only way to help encourage a good position for baby. Here are some other suggestions for encouraging optimal fetal positioning:

• Use yoga positions while resting, reading or watching TV - such as tailor pose (sitting with your back upright and soles of the feet together, knees out to the sides)
  
  
• Sit on a wedge cushion in the car, so that your pelvis is tilted forwards. Keep the seat back upright.
  
  
• Don't cross your legs. This reduces the space at the front of the pelvis, and opens it up at the back. For good positioning, the baby needs to have lots of space at the front.
  
  
• Don't put your feet up. Lying back with your feet up encourages posterior presentation.

• Sleep on your side, not on your back.
  
  
• Avoid deep squatting, which opens up the pelvis and encourages the baby to move down, until you know baby is facing the right way.
  
  
• Go for a swim! Swimming with your belly downwards - such as breaststroke or front crawl.

Need more ideas? Check out these other great positioning resources:

Malpositioning - Spinning Babies

Optimal Fetal Positioning - Natural Birth In Kitsap (great photos & explanations)

Posture in Pregnancy- Spinning Babies

Rebozo Repositioning

 

peaceful parenting: Fetal Lungs Protein Release Triggers Labor to Begin

~Reblogged via www.drmomma.org

We've long known that a mammal's lungs are the last organ to develop inutero before it is baby's time to exit. Disrupting this normal process (and initiating/inducing labor to start before a baby triggers labor on his/her own) frequently causes a cascade of complications - from difficulty in latch, poor breathing, increased infection, decreased immunity, under development, failure to thrive, and an increase in SIDS.

Now, University of Texas Southwestern Medical Center at Dallas researchers have found that it is in fact the fetal lungs themselves which provide the signal to initiate labor.

Drs. Carole Mendelson, Jennifer Condon and Pancharatnam Jeyasuria published findings that a substance secreted by the lungs of a developing fetus contains the key signal that initiates labor.

The protein released from the lungs of a developing mouse fetus initiates a cascade of chemical events leading to the mother's initiation of labor. This research, which has implications for humans, marks the first time a link between a specific fetal lung protein and labor has been identified, said Mendelson, professor of BioChemistry and Obstetrics and Gynecology and senior author of the study. Their research appears in the Proceedings of the National Academy of Sciences and is currently available online here.

The initiation of term labor is carefully timed to begin only after the embryo is sufficiently mature to survive outside the womb. Previous studies suggested that the signal for labor in humans may arise from the fetus, but the nature of the signal and actual mechanism was unclear. In this study, researchers found that the key labor triggering substance, surfactant, is essential for normal breathing outside the womb.

"We found that a protein within lung, surfactant, serves as a hormone of labor that signals to the mother's uterus when the fetal lungs are sufficiently mature to withstand the critical transition from life in fluid to airbreathing," said Mendelson.

"No one really understands what causes normal or preterm labor. There may be several chemical pathways that lead to labor, but we think that this surfactant protein, which is also produced by the fetal lung in humans, may be the first hormonal signal for labor to begin," reported Mendelson, who is also co-director of the North Texas March of Dimes Birth Defects Center at UT Southwestern.

In humans the signaling protein, called surfactant protein A, or SP-A, also helps immune cells, called macrophages, fight off infections in the lungs of children and adults by gobbling up bacteria, viruses and fungi that infiltrate the lung airway.

"Women who go into preterm labor frequently have an infection of the membranes that surround the fetus, and the number of macrophages in the wall of the uterus increases with the initiation of preterm labor. When women go into labor in their own time, at term, they also have an increase in macrophages in the uterus," Mendelson said.

This led the researchers to investigate whether there was a connection between what happens during normal labor at term and in infected mothers who go into early labor.

Mendelson continued, "This also raised the question: If bacterial infection can cause increased macrophage infiltration of the uterus in preterm labor, what is the signal for the enhanced macrophage migration to the uterus at term?"

In mice, the developing fetal lung starts producing SP-A at 17 days gestation; full-term delivery occurs at 19 days. The developing human fetus starts producing SP-A in increasing amounts after 32 weeks of a 40+week normal gestation, at which time the baby's lungs are essentially developed. As the fetus "breathes" amniotic fluid in the womb, the protein is released into the fluid.

"The SP-A protein binds to macrophages in the amniotic fluid, macrophages that come from the fetus itself," said Dr. Jennifer Condon, a postdoctoral researcher in BioChemistry and the study's lead author.

The macrophages, activated by the protein, make their way through the amniotic fluid to the wall of the uterus. Once embedded there, they produce a chemical that stimulates an inflammatory response in the uterus, ultimately leading to labor.

Researchers also found that injecting a pregnant mouse with SP-A before day 17 of the pregnancy caused the mouse to deliver early. Injection of pregnant mice with an antibody that blocks SP-A function caused them to deliver late. This would cause us to believe that women who carry babies post 42 weeks (as is common in some family lines) may do so because the necessary SP-A function is happening at later date in gestation (starting at 34 weeks instead of 32 weeks, for example).

Identifying the receptors on the macrophages to which the SP-A protein binds will be the next step, Mendelson said. "We think that bacteria may be binding to the same receptor on the macrophages to cause preterm labor in women. The bacteria mimic the function of SP-A, initiating the chemical reactions that lead to premature labor. If we knew more about this receptor on amniotic fluid macrophages, we may be able to design therapies or inhibitors to block preterm labor."

Other researchers participating in the study were Dr. Pancharatnam Jeyasuria, a research fellow in internal medicine and former fellow Julie Faust, now a medical student at Texas A&M University.

The research was funded in part by the National Institutes of Health and the Texas Higher Education Coordinating Board.

via www.drmomma.org

I'm on a roll...

...a HypnoBirthing roll that is! My last four births were all wonderful families who had taken the HypnoBirthing series of classes and all were special and unique in their own way but had one very common theme, calm. Feeling so blessed and lucky to be a part of this growing trend!

Doulaing the Cesarean Birth

After three births in four days, all cesarean deliveries, I'm more inspired than ever to think about what more I can do to support women in their cesarean birth experiences. I know that when a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. I also know that the majority of women who look to me for support before, during and after their births are hoping to avoid a cesarean. But what about when one becomes medically necessary for them, what happens then?

The The Centers for Disease Control and Prevention's National Center for Health Statistics has reported (Download Nvsr59_03 copy) that the cesarean rate hit another record high in 2009, with a preliminary rate of 32.9 percent. Including the three recent cesareans, my cesarean rate for doula clients is 16%. While all of them were performed for different reasons, each decision was come to after thoughtful, informed consideration and it is my hope that all of the moms look back and feel they made the best choice based on the information given to them, as well as the feeling they had in their gut, their instincts about what was right for them and their baby in that moment.

For some of the moms I was able to stay by their side in the OR, for others I was in the recovery room before and after, to provide support to mom, dad and baby. In all instances I had to instantly shift internally from what mom had been working toward, most often a low-intervention vaginal delivery, to a birth which mom and dad may be completely unprepared for. Some families attend childbirth preparation classes, some read books, but quite often they are not sure what to expect of a cesarean birth. As a doula I encourage families to ask questions and understand fully what will happen during the procedure, what to expect after the baby arrives and have an idea of the timeline.

One thing I have seen over and over again in my three years as a doula is that no matter what type of birth you have, it is crucial that mom and dad have support, support and more support.  A cesarean birth is no different, moms still need comfort measures as they prepare for delivery, support and encouragement as they prepare mentally for a change in their birth outcome, emotional support during the cesarean birth, breastfeeding support after delivery, physical support as they recover, the list goes on and on.

I feel blessed to be a part of each and every birth experience and appreciate greatly the insights moms & dads have shared with me after the birth. Especially helpful is hearing what they would have liked to have known beforehand, so that I can better support future families. I would love to hear from other moms and dads about their cesarean delivery.  What did you find most helpful before, during or after delivery?

For more information about cesareans visit International Cesarean Awareness Network

Interested in a VBAC? This website has some great information VBAC.com

Wrap me up

There is nothing more soothing to a baby than the scent of her parents, the sound of their heart beating, and the feel of being snuggled in close. Babywearing allows baby to enjoy all of these sensations and more.

 

In a study published in the Journal  of Pediatrics, researchers found that babywearing for three hours a day reduced infant crying by 43% overall and 54% during evening hours. Tiny babies cry to communicate, not to manipulate so why are babies that are worn crying less? Because their needs are being attended to and they trust in their parents responsiveness to their needs, leaving them with the ability to relax and spend more time in the state of quiet alertness, the behavior state in which babies learn most about their environment

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“Trust yourself. You know more than you think you do.”

– Dr. Benjamin Spock

 

The Moby Wrap 

My very favorite babywearing tool is the Moby Wrap. With solid colors which can easily be worn by mom or dad, and the ability to transition between front or back carry, it’s ideal. The fabric has a bit of a stretch to it and crosses in back to evenly distribute weight, making it easier on your back than most carriers. But what I like most about is best described in this photo. See how baby is right there on your chest, close enough to kiss, love and snuggle and yet your arms are free to do all the other things our busy lives require of us! Check out all the beautiful wraps they offer at www.mobywrap.com

 

Here are a few positioning tips for safe babywearing:

• While you are getting used to wearing your baby, support him or her with your hands. As you go through the learning phase of moving and reacting, the urge to support your baby with your hands is instinctive. After you become a babywearing veteran, you can safely carry your baby in the sling or wrap with one or both hands free.
• Baby should not be curled tight chin to chest because this position partially closes baby’s airway. (With correct positioning there should always be at least one finger’s width of space under baby’s chin.)
• Sling fabric should not be draped across baby’s face. For slings made from thin, airy fabrics please check the airflow of the fabric by placing it over your own nose and mouth. No matter how breathable the fabric looks, if it is difficult for you to breathe through the fabric it will be difficult for baby as well.
• Baby should not be rolled so that his face is pressed tightly against the parent’s body. Position baby’s face upward when he or she is not actively nursing and when nursing ensure that baby’s nose is not blocked.
• An infant should be repositioned if he is having any sign of respiratory difficulty. Symptoms include: rapid or labored breathing, grunting or sighing with every breath and/or restlessness.
• Wear baby cautiously in the kitchen. Do not wear baby while cooking or working with sharp or hot objects.
• When wearing your baby and stooping over, bend at the knees, not at the waist, and hold baby in a sling style carrier with the sling with one hand.
• Do not ride a bicycle or other moving vehicle while wearing your baby. Baby carriers are not substitutes for an approved carseat.
• When going through doorways or around corners, be careful that baby's body does not stick out past your arm and strike the wall or doorjamb.

The positioning recommendations are for infants 0 to 4 months of age or until baby achieves good neck and head control. Once baby has good head control the neck muscles are generally strengthened sufficiently to support baby’s airway, even if baby becomes slightly curled or slumped in a baby carrier (or car seat, swing, bouncer etc.). However, please use common sense and monitor your baby frequently no matter his or her age and weight.

 

For more information about the benefits of babywearing check out these additional resources:

Babywearing International

Dr. Sears - Babywearing

Babywearing.com - an online babywearing forum