Turning Posterior Babies - Midwifery Today

February 12, 2002

Enjoy!

*Smile*

Chris (list mom)

http://www.alittleolfactory.com

o=o=o=o=o=o=o

MIDWIFERY TODAY E-NEWS

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Volume 4 Issue 5 January 30, 2002

Turning Posterior Babies

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Elsinore Theater,

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with silent auction and wine-tasting at 6:00 pm.

Benefit performance for the Oregon Midwifery Council and two other

organizations. The production of the V-monologues is usually only

staged as a benefit for organizations that work to end violence

against women. The OMC was so convincing in its argument that

midwifery helps prevent violence against women that it was given

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In This Week's Issue:

1) Quote of the Week

2) The Art of Midwifery

3) News Flashes

4) Turning Posterior Babies

5) Check It Out!

6) Midwifery Today Online Forum: Suturing after c-section

7) Question of the Week: Cravings

8) Question of the Week Responses: Placental tear

9) Midwifery Today Question of the Quarter: Postpartum care

10) Switchboard

11) Connections

12) Classifieds

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Quote of the Week

1) " The traditional midwife believes that birth proceeds in a spiral

fashion: labor starts, stops and starts, while the baby goes down, up

and down, and the cervix opens, closes and opens. Nature has no design

for failure; she holds her own meaning for success. "

-Sher Willis

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2) The Art of Midwifery

I believe in the old adage about prevention being worth more than the

cure. To this end, I encourage mothers to keep their bellies nice and

warm by buttoning up their jackets or wrapping a wrap or shawl around

them. I think some occiput posterior babies are just trying to keep

their bums warm when they assume this position!

-Joni

Guadalajara, Mexico

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3) News Flashes

A study of 22 mothers ranging in age from 22 to 43 years who gave

birth to a second child within two years of the birth of their first

child measured the mothers' milk output over a 24-hour period during

the first and fourth weeks after birth. The women produced about 31%

more breastmilk in the first week after birth with their second child

and slightly more milk by the fourth week, the report indicates.

Furthermore, those whose milk output was the lowest with their first

child had the greatest increases in milk production with the second

baby. " Health professionals should encourage women to breastfeed all

their children, whatever [the women's] experience with their first

child, " the researchers stated.

-Lancet 2001;358:986-987

4) Turning Posterior Babies

Occiput Posterior/Occiput Transverse (OP/OT): notes from Obstetrical

Training Day, October 31, 1997, Rochester General Hospital (New York)

Speaker: Henci Goer

[Ed. Note: These are excerpts; in no way do they represent Henci's

entire presentation. Notes courtesy of E-News reader Amy Haas. Thank

you, Amy!]

-Half of the cesarean rate results from OP/OT babies. With an epidural

this rate increases to three-quarters. 15 -30% of all labors start

with an OP/OT baby.

How to Diagnose:

1. Self-diagnosis: Belly shape; feels lots of hands and feet; frequent

urination; irregular labor pattern; ruptured membranes, back pain;

hard to pick up fetal heart tones, long painful labor

2. Caregiver's diagnosis: external palpation (harder to do in labor);

vaginal exam (look for suture lines when mom is dilated enough)

Predisposition:

1. Pelvic shape: convergent sidewalls, narrow pubic arch, sacrum

intrudes, prominent ischial spines

2. Size of baby: either very large or very small (not guided by pelvic

floor, can't get into position)

3. Right occiput anterior in pregnancy as opposed to left

4. Exaggerated spinal curvature (lordosis) and a relatively inflexible

spine

Correcting OP/OT in pregnancy:

1. Pelvic rocks: 10+ pelvic rocks on hands and knees per day

2. Dancing: rotate hips

3. Yoga: One midwife noted that her clients who do yoga have a smaller

incidence of OP/OT.

4. Crawling on hands & knees in a kiddie swimming pool

Strategies to Promote Rotation:

1. General tips:

-DON'T RUPTURE MEMBRANES

-Usually what the mother finds most comfortable is also most

effective. Let her move instinctively. Epidurals prevent instinctive

movement.

-Help the baby rotate by using positioning that opens the pelvis,

activities or manipulations that shift the baby, and gravity to bring

the baby down.

2. Birth ball: lean on it, or sit on it and lean on bed. Rotate hips.

3. Positions:

-Hands and knees during pregnancy. One study showed a 3/4 rotation in

10 min.

-Side-lying, SIMS position. Lie on the same side as the baby is

facing, then switch.

-Lunge: opens one side of pelvis, feels good; let mom choose side

-Squat-Kneel: opens pelvis

-Squat

-Dangle: almost a hanging sit, mom's back to sofa, don't go into a

full squat

-Standing leaning forward

-Kneeling, facing back of hospital bed

-Knee-chest position (rear end in the air), 30-35 min. in early labor

will almost always turn baby.

-Semireclining, heels together (don't use with epidural)

-Pelvic rocks

-Change position

4. Activity or Manipulation

-Lots of position changes

-Pelvic rocks

-Stroke the mother's belly in between contractions in the direction

you want the baby's back to go.

-Double hip squeeze: Sit facing mother, place both hands on back of

each hip and squeeze.

-Write the baby's name with pelvis

-Stair climb

-Crawl back and forth

-Acupressure: fingernail pressure on outer edge of little toenail

(could also turn breech)

-Delay epidural until at least 5 cm dilation. Doing one earlier may

lock the baby in the OP/OT position. Stay off back, even

semireclining. Hands and knees may be possible. Supported squat (w/

epidural): Set up bed like a birth chair, use stirrups as hand holds

and to support forearms.

-Manual internal rotation by care provider (Valerie El Halta - see

Midwifery Today Issue 36). Do early. May invoke negative memories for

women with a history of sexual abuse.

-Don't rupture membranes - could wedge baby permanently into the OP/OT

position, preventing rotation.

-Cup mothers kneecaps and push back to relieve pain.

Coping with a Long Difficult Labor:

1. Extra support: Secondary labor support person (doula); use talking

for relaxation and positive reinforcing attitude (e.g., " My body knows

just what to do " chant).

2. Food and drink: calories, especially at home

3. Stay home in early labor, which is often prolonged.

4. Reframing the problem:

-It's normal for an OP/OT labor to be longer and hard.

-Going from 50% effaced to 70% effaced is a major change.

-Stuff is happening.

-Cervix going from anterior to posterior is progress.

-Use short-term goals, bargain for milestones.

-Stay in the present; focus on the now.

5. Develop a ritual: women will often do this automatically if allowed

to.

6. Groan " open " on the exhale.

7. Use shower or bath. (One hospital reduced its epidural rate by 80%

by requiring women to take a bath before getting their epidural.)

8. Show the mom on pelvis model what she is feeling looks like

9. Hot pack with rice and herbs heated in microwave

10. Avoid vaginal exams

11. Don't push too soon; delay until head on perineum - reduces use of

forceps.

12. Per American College of Obstetricians and Gynecologists: The

duration of second stage is not related to fetal outcome as long as

fetal heart tones are good.

Coping with Back Pain:

1. Temperature: A laboring woman's skin is sensitive to temperature.

Hot items should be cool enough to hold, frozen items should have

intervening layer(s).

-Heat: Local blood flow and temp. increase, muscle spasms decrease -

contributes to relaxation

-Cold: Local blood flow and temp. decrease - works best for decreasing

pain because it slows transmission of painful sensations (Ice chips in

an exam glove, frozen peas)

2. Touch

-Counterpressure

-Acupressure - low on sacrum (inch out on either side), sciatic point

(dimples in rear end), palm (center, high five and hang on)

3. Sterile water injection: intradermally, 20 sec; sharp local pain: 1

-2 hr. relief. Do not use saline. (see Midwifery Today Issue 44)

4. TENS (transcutaneous electronic nerve stimulation): effectiveness

questionable

5. Pain medication: Delay epidural until 5 cm. dilation, delay pushing

until head is on perineum (reduces the use of forceps).

Factors that Hinder Rotation in Labor:

1. Reclining: Gravity works against you; reclining fixes sacrum so it

can't open.

2. Early epidural: Relaxes pelvic musculature too much; Pitocin use

and C-section rates increase.

3. Early amniotomy: Head surges down and there is a deep transverse

arrest. May actually slow labor down.

====

For a copy of the bibliography, please contact Amy V. Haas, email

avhaas

====

Henci Goer is the author of " Obstetric Myths versus Research

Realities " and " The Thinking Woman's Guide to a Better Birth, " New

York: Perigee Books, 1999. More information about the latter and an

order form can be found at the book's Website

http://www.efn.org/~djz/birth/betterbirth or at Amazon.com. The book

is also available in bookstores. Thinking Woman is required reading

for Lamaze, Bradley, ICEA, and BirthWorks childbirth education

certification programs as well as a number of midwifery certification

programs. Henci is an internationally known speaker on evidence-based

care in pregnancy and childbirth.

o=o=o=o=o=o

5) Check It Out!

~~~WWW.MIDWIFERYTODAY.COM~~~

A Web Site Update for E-News Readers

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

AUDIOTAPES FOR THIS ISSUE'S THEME

Complicated Birth Review with Experienced Midwives:

http://www.midwiferytoday.com/products/952T275.htm

Second Stage Difficulties Roundtables:

http://www.midwiferytoday.com/products/972T702.htm

Malpresentations:

http://www.midwiferytoday.com/products/971T561.htm

~~~~

MIDWIFERY TODAY ISSUE 36 for Valerie El Halta's article about turning

a posterior baby: http://www.midwiferytoday.com/products/MT36.htm

~~~~

OPTIMAL FOETAL POSITIONING, book by Jean Sutton & Pauline Scott:

http://www.midwiferytoday.com/products/OFP.htm

~~~~~~~~

6) Midwifery Today's Online Forums

I've heard that OBs are now doing only a single suture of the uterus

when suturing after c-sections, instead of an inner and outer suture.

Has anyone heard of this?

-Anon.

====

TO SHARE YOUR THOUGHTS AND EXPERIENCE ON THIS TOPIC, go to

http://www.midwiferytoday.com/forums/topic.asp?TOPIC_ID=1674

**PLEASE DO NOT SEND YOUR RESPONSES TO E-NEWS!**

====

To order the MIDWIFERY TODAY back issue on Cesarean Prevention and

VBAC, go here:

http://www.midwiferytoday.com/products/MT57.htm

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7) Question of the Week

Q: A woman who is about 25 weeks along is experiencing almost

overwhelming cravings for soap. She says the cravings have increased

with each pregnancy. Her labs are all fine - no evidence of anemia.

Suggestions?

-Anne Walters CNM

====

SEND YOUR RESPONSE to with " Question

of the Week " in the subject line.

o=o=o=o=o=o

8) Question of the Week Responses

Q: What can be done to repair a small placental tear in the third

trimester?

A client lost her baby in the seventh month of pregnancy as a result

of a tear in her placenta. She is pregnant again and due in May. Her

OB told her he could see a small tear on her placenta. Apparently

there was only a 10% chance of this happening again. Is there anything

she can take or do to help correct this problem?

-Anon

====

A: I'd consider bioflavinoids (1000 mg three times/day) and vitamin C

(1000 mg twice daily - no more than 2000 mg of vitamin C per day; be

sure to calculate in what she's getting in her prenatal if she's using

one). Vitamin C and bioflavinoids help stabilize capillary vessel

walls that may prevent further tearing.

-Keyena McKenzie, N.D.

====

A: Sometimes " tears in the placenta " (usually actually a separation of

the placenta from the decidua of the uterus) can be caused by high

blood pressure. That's probably why they are more common in tobacco

smokers (nicotine causes vasoconstriction). Also seen in women who use

methamphetamine or any kind of speed-like substance, or cocaine - they

raise blood pressure. This condition is also more common in women who

have elevated blood pressure for any reason. Keep the mother " cool and

calm. " Be sure she's not doing anything to raise her blood pressure.

If the blood pressure is high, do what you can to lower it. However,

if it has been high throughout the pregnancy, lowering it suddenly,

for example with blood pressure medication, can result in decreased

blood flow to the baby, which might cause trouble in itself. If

nothing else seems to work, modified bed rest might help. Anecdotal

evidence suggests that vitamin E, vitamin C complex, and vitamin A

from natural sources might help keep blood vessels and the placental

connection intact.

-Marion Toepke

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9) Question of the Quarter for Midwifery Today Issue 61

Q: What are the essential elements of good postpartum care? What is

your most noteworthy postpartum experience with a mother/baby/family

and what was the outcome?

Responses are subject to editing for space and style. Maximum word

count 400. If we print your response, you'll receive a free issue.

E-mail responses to: mgeditor. Include your postal

address.

We must receive all responses by February 6, 2002.

o=o=o=o=o=o

10) Switchboard

^=^=^=^=^=^=^

International Connections

In New Zealand you have a choice of free service from a GP who

delivers babies or a midwife who attends births, or to see an

obstetrician for a fee. If you go for the midwife option, she will see

women fairly frequently - usually monthly until 28 weeks, fortnightly

until 36 weeks, then weekly until the baby is born. Whether the visits

are in the woman's home or a more central clinic depends on the

midwife and the women's circumstances. Postnatal visits vary; the

legal minimum is 5 at home. Generally 2-4 times in the first week,

then as required after that, to weekly at 4 to 6 weeks. Baby and mum

are referred to Plunket, a specialised infant and toddler nurse team,

at 6 weeks and back to their GP for any followup at the same age. GPs

mostly use hospital midwives for labour and postnatal care.

Obstetricians work with either hospital or independent (self-employed)

midwives for labour and postnatal care. I am a self-employed midwife

working in a fairly busy central Auckland Practice and providing care

for 4 to 6 women a month, with one weekend a month off call. The

service is completely funded by the government for NZ citizens and

residents.

-Anon.

^=^=^

I congratulate midwives who are not polarized from your colleagues.

Although it is difficult not to become frustrated watching how things

are commonly done in hospitals, I believe in being friendly,

respectful, and making efforts at learning from everyone - CNMs, RNs,

and obstetricians who are very medically oriented. I would prefer to

do everything possible the holistic midwifery way if I had my choice.

I have learned, though, that with softness and love, and most of all

respect, it is easier to get to a point where you can openly share

very different birth ideas with people who do things differently. In

the end, there is communication and a positive change toward the goal:

make birth a safe, loving and spiritual experience, and help women

give birth how they choose.

An integral part of holistic midwifery is the gradual use and

promotion of natural and organic foods as an important way to prevent

complications. Unfortunately, a lurking enemy of organic foods are

genetically modified foods (GM crops), which create far more problems

than any of us may imagine. Please visit the following website and

read the latest bulletin. There will be an action in national

supermarkets against Kraft (see why in the bulletin) on February 6.

for the web site and bulletin

to email Kraft

to email and offer to distribute

leaflets in your community

-Aiyana Megan Gregori, midwifery student

ayunklo

Chile

^=^=^

Does anyone have advice about what to do for severe vaginal varicose

veins? During her last pregnancy, a former client had a severe case.

They were protruding from about two inches below her pubic hairline

all the way back to her anus and were bulging interiorly as well. In

the last trimester her labia were swollen to about two inches thick

and couldn't touch each other even when she tried to close her legs.

She would like to have more children. She is afraid of having the

veins removed with the laser procedure because her OB told her the

procedure causes the veins to shut and blood finds other ways to get

where it's going. Would those other veins just bulge out and become

varicosities with all the extra flow?

-Anon.

====

Can women who have vaginismus have vaginal birth?

-Azar Golmakany

Reply to: agolmakany

====

I am a registered midwife in the province of British Columbia. I would

like to assure readers that the statements Ms. Lemay makes [issue 4:4]

about being " terrified of our governing body " and being " cautioned in

writing...not to go near that office without a lawyer " do not apply to

me or to any of the 40 or 50 registered midwives I know and am in

contact with on a frequent basis. All the colleges for healthcare

professionals are regulatory bodies that set guidelines to ensure

public safety and that professional standards are met by their

members. So far I have found the BC College of Midwives to be most

helpful and supportive in situations where I felt unclear about my

role or was having difficulty with another healthcare professional, an

organization, or a client. Midwives in this province as well as the

College of Midwives fervently hope that the women we are serving are

happy with our services. Unfortunately we cannot ever guarantee that.

Neither, of course, can Ms. Lemay. I know clients who were not happy

with her services just as some were not happy with mine.

Our clients are free to choose whether or not their babies receive eye

medications and vitamin K injections. The fact that none of Ms.

Lemay's clients receive either of these things makes me wonder if the

parents are receiving good unbiased information and are free to make

their own decisions about these medications. I feel deeply insulted by

her comment that she has not " had to hurt or 'strip membranes' on

anyone in order to retain a license. " I have no idea where this notion

of what midwives in BC do or are required to do comes from. I have

only swept membranes at clients' request, and even then very

infrequently. Performing the sweep has nothing to do with my license

but rather with the client's desire to promote an earlier labour or

" get things going. " If it hurts them, we don't continue. I resent the

portrayal of licensed BC midwives as interventionist, uncaring and

hurtful in our practice.

I can assure you that I do not spend my time " pleasing physicians or

hospital administrators. " Yes there are times when hospital protocols

must be acknowledged, and yes there are times when my preferred

management approach differs from that of an involved physician, but on

the whole I find that I have benefited from hearing the opinions of

others, and once in a while they have been right, or they have seen

something I haven't seen or know something I didn't know. One of the

most dangerous things any of us can do is assume we are always right

or that we know more than anyone else. Pregnancy, labour, birth, and

the early days of life are miraculous, wonderful, and awe-inspiring

experiences. I hope everyone involved with birthing families has a

deep respect for these miracles and the humility to acknowledge that

neither they nor anyone else can claim to know it all when it comes to

the creation of life.

-Julia Atkins, RM

If Gloria Lemay has never administered vitamin K to a baby, then she

is not offering informed decision-making to her clients. Such

decisions belong to the parents - armed with the best available

information - not to the caregivers.

Registered midwives in BC have thousands of satisfied parents in their

care each year. They are offered choice of birthplace in a funded

program. They realize that they are treated with decency and respect,

given good care and information, and encouraged to question all

procedures and treatments.

-Catherine Ruskin, RM

o=o=o=o=o=o

EDITOR'S NOTE: Only letters sent to the E-News official email address,

, will be considered for inclusion.

Letters sent to ANY OTHER email addresses will not be considered.

o=o=o=o=o=o

11) CONNECTIONS

I am interested in an apprenticeship with a home birth midwife. I

have a BSN and I am working toward a CNM. I do not care if the

midwife is a CPM or a CNM. I am willing to relocate. I have no

family obligations as I am a single 50 year old. Please help me to

achieve my dream. Thank you. email address is abach777

o=o=o=o=o=o

12) CLASSIFIED ADVERTISING

The International School of Traditional Midwifery in Ashland Oregon is

accepting enrollment for 2002 classes that start in May. For

information contact: ISTM Catalog-MTEN, 3607 Hwy 66, Ashland, OR

97520 or call 541-488-8273.

o=o=o=o=o=o

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Midwifery Today: Each One Teach One!

February 12, 2002

Oh so NOW you post this LOL! Actually we didn't know Jordan was " sunny side

up " until I was ready to push. My OB just reached up there and " turned "

him...ouch! I never want to go through " back labor " again My lip has

finally healed from where I bit it many times and my glasses are all

scratched up from where I banged them against something (don't know what,

DH's watch??) during transition.

But it all turned out ok in the end

--

Chris Ziegler <chrisziggy1

Tue, 12 Feb 2002 15:06:44 -0700