Getting Real With A Mama in My Practice Who Rocked Her VBAC

Part one and two of a an awesome video I was invited to do with Joni, a mama in my practice who had a homebirth birth after cesarean, that really brings together many things pregnancy, birth, and breathwork, holistic health and healing.

Learn how to rock your VBAC and have the birth of your dreams with these three different but crucial resources - so you can prepare like a boss!

Love Your Birth Course
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Get deep in this childbearing bible, a reference guide for the whole journey from planning a pregnancy, expecting, birth, postpartum and newborn care, with effective holistic modalities for common discomforts and issues along the way.

Get deep in this childbearing bible, a reference guide for the whole journey from planning a pregnancy, expecting, birth, postpartum and newborn care, with effective holistic modalities for common discomforts and issues along the way.

Posterior Position: Practical Steps for Prevention and Remedy

 
Art by Katie Atkinson @spiritysol

Art by Katie Atkinson @spiritysol

A baby in a posterior position is facing your abdomen, and baby’s back is towards your back. Some babies are born easily in the posterior position with baby facing mama’s face “sunny side up.” This is especially if Mama:

  • Has given birth before

  • Is carrying a baby of average or smaller size

  • Has an adequate sized pelvis

  • Is committed, relaxed and prepared

  • Is able to be upright, move and change positions at will

  • Has the ability to eat and drink freely

  • Is supported by providers who are patient, calm and trained to help baby turn

Art by Katie Atkinson @spiritysol

Art by Katie Atkinson @spiritysol

Other babies in posterior position can be more challenging, creating problems like not going into labor, water breaking prematurely before labor starts, slower more difficult labor progress, exhaustion, and labor felt mostly as back pain that can be harder to cope with. All of these factors increase the risk of complications, interventions and cesarean if baby can not be safely born vaginally. 

Epidurals increase the incidence of posterior babies, as well. But sometimes in prolonged labor, when Mama can no longer cope, the compassionate use of an epidural can help her give birth vaginally. 

The modern sedentary lifestyle of slouching in chairs over smart phones and computers, sitting back in sofas and car seats with associated poor posture, stress and tension in our bodies contributes to the rise in babies presenting in the posterior position. Many of us are no longer as active as our ancestors and indigenous cultures around the globe. We are not often leaning forward doing manual work, which helps baby’s heavier back come forward into the anterior position, unless we are doing activities like gardening.  

Art by Katie Atkinson @spiritysol

Art by Katie Atkinson @spiritysol

Ideally and actually most often, the baby will be in an anterior position facing your spine at term, or turns anterior during labor for childbirth. It is important to know when your baby moves into the optimal anterior position, so you can encourage the baby to stay there, which usually means an easier and shorter labor. 

You can learn on your own what position your baby is in. But if you are unsure, ask your practitioner for help figuring it out. Then try to pay attention to your baby’s position, without getting needlessly obsessed about it. This is easier to do when your baby moves or when momentarily lying on your back. It may take a lot of concentration to understand what is what at first, but soon you will get the hang of it.

When your baby is posterior, your tummy may look flatter and feel more squashy, and you may feel arms and legs and kicks all over the front towards the middle of your tummy. The area around your belly button may dip to a concave, saucer-like shape, and you may also experience long and painful practice contractions with a more severe lower backache as your baby tries to turn around to the anterior position to engage down into the pelvis.

When your baby is anterior, the back feels hard and smooth and rounded on one side of your tummy, and you will usually feel kicks under the side of your ribs. Your belly button will normally poke out and feel firm.

Pay attention to your posture and positioning at the time when your baby may be starting to descend into your pelvis, which is during the last 6 weeks of your first pregnancy, and the last 2-3 weeks of your subsequent pregnancies. The goal is to make room for your baby to assume the optimal position for birthing. 

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The baby’s back is the heaviest side of its body, and will thus gravitate towards the lowest side of your abdomen. So, if your tummy is lower than your back (such as sitting on a chair leaning forward), the baby’s back will tend to swing anterior towards your tummy.

If your back is lower than your tummy (such as reclining back in an armchair with your feet up), then the baby’s back may swing towards your back into a posterior position. With this in mind, when you are 34 weeks onward, avoid any position where you are spending time leaning backwards with your knees higher than your pelvis.

Ideally, ditch the chairs. If you do need to sit on one, make sure your knees are lower than your pelvis, and your trunk is tilted slightly forward. If you need to work at a desk, consider a standing one at least some of the time, resting an alternating foot on a step stool.

Watch TV, read and lounge while kneeling on the floor, over a beanbag, birth ball, cushions, or sitting backwards on a straight backed dining room or kitchen chair facing and leaning on its back. 

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Practice yoga to be in shape for the lunges and varied positions used to help your baby come down and out. Use yoga positions like bound angle (badha konasana) sitting with your back upright with soles of your feet together, or on your hands and knees while curving your back up like a cat followed by dropping your spine down in an arch and/or wiggling your hips from side to side. Get out your yoga mat and support your body with props like blankets, bolsters or blocks  as needed. 

Avoid crossing your legs, as it reduces the space in front of your pelvis and opens up the back. Sit on a wedge cushion in the car so your pelvis is tilted forward, and keep the seat back upright.

Avoid deep squatting until baby is anterior and well down in your pelvis or when needed in labor. Deep squatting opens up your pelvis and encourages the baby to move down, so refrain from it until your baby is in the anterior position. You can squat on a low stool or yoga blocks instead, keeping your spine upright.

Rest and sleep on your side, with two pillows under your bent right knee, which should be jackknifed up towards your chest, and keep your left leg straight out.

Swim with your belly downwards, doing the front crawl and breaststroke. The leg movements with the breaststroke in particular are great for opening your pelvis and encouraging your baby into an optimal anterior position.

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If Your Baby Is Posterior

Continue the above mentioned positions, and add the following exercises for 20 to 30 minutes each, 3 times daily while watching something inspirational, romantic or that makes you laugh, or while listening to music:

Maintain a knee-chest position, with your buttocks sticking up in the air to tip the baby  back out of the pelvis so there is more room to turn around to the anterior position.

  • Sway your hips back and forth and do the pelvic rock up and down while on your hands and knees.

  • Crawl around the floor on your hands and knees, or hands and feet like an elephant.

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  • Scrub your floors or do some gardening.

  • Swim belly down, kicking with straight legs only. Avoid frog leg movements.

  • Lie on a slant board (using an ironing board or see-saw), with your head down and your legs up or lay with your pelvis and legs on the top stair landing or sofa and rest on your hands or forearms on a lower stair so you are at a similar incline. Jiggle your pelvis as you do this.

  • Try resting and sleeping on your tummy using lots of pillows and cushions for support.

  • Sit on a kneeler-rocker, which is a kneeling stool that sits you in an upright position with your knees lower than your chest, and has a rocker underneath for movement that encourages your baby to rotate. There are several types. See what is best for you. 

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When baby turns to the anterior position, you can encourage descent further into your pelvis by walking around upright, gently massaging the baby’s buttocks downward, deep squatting and swimming, this time using lots of breaststroke frog leg kicking.

 
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If you have lax abdominal muscles from several babies or lack of toning exercises, use a supportive maternity binder to keep baby in place. Bellefit makes a fine one, as pictured below. You can check them out and purchase here.

If Going Into Labor With a Posterior Baby

Starting in early labor, try the following movements involving altering the level of your hips, which help wiggle the baby down through your pelvis:

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  • Walk up and down stairs, sideways if you need to.

  • Rock and dance from side to side.

  • March or tread in place.

  • Step on and off a step stool.

  • Climb in and out of the birth pool.

  • Lay on your side, so the part of your belly where your baby’s back is, can lean forward almost over the sofa or bed, with your upper knee resting on a lower chair.

  • Consider having your midwives help to rotate the baby using a variety of external techniques, or if needed, by manually lifting your baby out of your pelvis during a contraction.

During the pushing stage of labor:

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  • Kneel on all fours, with the other leg up in a lunge. Switch legs periodically. You can do this standing, alternating one leg up on a chair moving towards and away from it. 

  • Maintain a supported high squat in a birthing stool or hanging from a dangling squatting rope or your partner, with your bottom at least 18 inches off the floor.

  • You can rest on your side with one leg straight out and the other leg bent up towards your chest, supported with pillows.

  • Avoid lying back, semi-reclining, sitting or semi-sitting. 

For more information online, visit Spinning Babies, Association of Radical Midwives, or the GentlleBirth archives for Suboptimal Fetal Positions.

Check out my number one international best selling book Natural Birth Secrets and my Love Your Birth course, an online version of how I have helped thousands in my local practice.

Both resources are unique, but each provide an in depth, one-of-a-kind holistic approach created by me, a seasoned nurse midwife of over two decades, who has seen everything! It is now recommended by midwives, physicians, health care professionals around the globe, and doulas take it for their certification training.

As always, if you need more personalized guidance, schedule a consultation with me

 

Postpartum Bleeding: Holistic Prevention Strategies

 

It is normal to have light bleeding in labor as your cervix dilates and breaks its tiny blood vessels. And as baby emerges from the birth canal there can some local tearing that can cause bleeding. Expect to experience the most bleeding at delivery and postpartum. Most of this bleeding is from where the placenta was located in your uterus. 

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At normal vaginal birth and immediate postpartum, it is common to lose up to a half liter of blood. After cesarean birth, one liter of blood loss is the average. After birth, your uterus needs to contract around the major blood vessels that supplied the placenta to close them off and prevent excessive bleeding. 

The first few days, bleeding can be like a heavy period. Then, it tapers to a moderate period, after which it becomes lighter and changes color over several weeks from shades of red, then pink to brown. The body is healing the former placental site, shedding the internal scab there, and extra tissue and blood that was lining your uterus during pregnancy. 

Postpartum hemorrhage usually occurs immediately, or up to the first 24 hours post birth, and remains a major cause of maternal death in the US and around the world. It must be taken seriously. Currently, there is substantial evidence in support of what is termed ‘active management of the third stage of labor,’ to reduce the risk of severe excess postpartum bleeding. It includes the use of:

  •  The synthetic hormone oxytocin (referred to as Pitocin in the US) via intravenous or intramuscular injection

  • Early cord clamping with waiting 1-3 minutes until baby gets at least most of the cord blood

  • Controlled traction on the cord along with counter pressure on the uterus to effect placenta delivery within the first 5-30 minutes after birth

  • Uterine massage to make sure it is firmly contracted

  • Assessments every 15 minutes for the first two hours. 

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The above process, or a similar version, is done routinely in most hospitals, and can certainly be done in out of hospital birth settings. However, the studies that determined these procedures, were based on hospital births in mostly resource poor but also well developed countries. Like all studies, they have their limitations and flaws, some were even considered to be of poor quality according to the esteemed Cochrane Review. Also these interventions are not without side effects and concerns. The American College of Nurse-Midwives support the use of active management of third stage of labor in low resource settings, according to their position statement, although they do admit its benefits are not as clear in the low risk healthy population, and encourage the provider to have a risk benefit discussion with each pregnant family so they can make an informed decision about it. 

Most homebirth and birth center moms and providers are passionate about physiologic birthing, minimal interventions and holistic modalities, do not routinely want an injection of medication, and are more interested in natural alternatives. They trust the incredible wisdom of the normal birthing process, which has worked for thousands of years or we would not have survived as a species. They share a common belief that if it is not broken, don’t fix it, wary of medication and interventions unless absolutely necessary and benefits outweigh risks. They tend to like the alternative, ‘expectant management’ approach, which also entails close observation by the provider, but tends to take longer, allowing for the normal physiologic process to take its course, and for interventions only if needed in select cases. 

Photo by Julia Swyers

After birth, mom and baby are of course carefully assessed, but encouraged to bond skin to skin. There is no rush. Cord clamping is delayed until pulsation has ceased, or after placenta is birthed. Mom and baby are assisted to breastfeed which helps release mama’s own natural oxytocin.

The provider waits and watches for signs that the placenta is naturally separating and then assists mom into an optimal position usually using gravity, and encourages her to use her own bearing down efforts to birth her placenta. The provider may sometimes guide the birthing placenta with gentle traction on the cord, while supporting the uterus, then massages the uterus to make sure it is firm, assesses the bleeding until stable, and assesses and repairs tearing as needed. 

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Certainly, if there are certain concerns or risk factors, you may truly benefit from medical prevention and active management.

If there is an actual hemorrhage, make sure your provider is skilled, experienced, and fully equipped to deal with it with at least the commonly used effective medications, IV fluids, suturing material for lacerations needing repair, and hands on care that are usually sufficient to control it successfully. 

However, you can build up a strong blood supply and reduce excess bleeding and its risks with the following suggestions for natural support both in your pregnancy and postpartum.

Prenatal Support

Make sure you get checked and treated for anemia common in pregnancy, that your iron stores (ferritin) are sufficient. 

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Eat 3 large servings of wild greens or dark green leafy vegetables every day. They can be made into a salad, lightly sautéed or steamed. Good options are parsley, dandelion, alfalfa, kale, collard greens, comfrey and turnip greens.  For additional support, you can try the following:

NETTLE AND RASPBERRY TEA

Starting in the third trimester, drink 1 cup of this nourishing herbal infusion several times per day. 

  1. Combine a handful each of the dried herbs Nettles and Red raspberry leaf with 1 quart boiling water.

  2. Steep for at least 4 hours.

  3. Strain to a glass mason canning jar.

  4. You can add fresh mint leaves, lemon juice, or honey to taste.

GREEN DRINKS

Drink 1 ounce fresh, frozen, or powdered  wheatgrass juice 1-2 times daily to enrich and build your blood.

Or, try 1 scoop daily of powdered greens in your smoothie, 1-3 Tbsp bottled chlorophyll, or tablets or powders of spirulina and chlorella.

Postpartum

You need to rest in bed, on the couch or an outdoor lounge chair as much as possible for the first 2 weeks to recover.  Make sure you arrange for help in the home during this special time. Limiting activity and increasing rest help the area of open uterine blood vessels where the placenta detached to heal. 

Check the top of your uterus regularly for firmness, and massage it if it feels soft, until it hardens. Postpartum bleeding can be minimized when mothers are taught regular postpartum self massage of the uterus so that it stays firm and contracted around the blood vessels that supplied the placenta. 

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Start breastfeeding right away, and every 1 ½ - 3 hours thereafter, especially taking advantage of the times when your baby is awake and alert and eager to suck.  Nursing frequently causes the body to secrete its own natural hormone oxytocin to keep the uterus firm and decrease bleeding.

Urinate frequently to keep the bladder empty so the uterus can contract easier.

You can also take homeopathic caulophyllum 30 or 200 C immediately after delivery, then 3-4 pellets arnica 30C under your tongue every 2-3 hours. Or, try herbal shepherd's purse, 1 dropperful of the tincture three times daily for the first 3-5 days after birth. If you need additional herbal support for heavier or persistent bleeding, you can try a dropperful of Angelica tincture a few times daily. 

Most of the supplements and herbal remedies I recommend are available on my customized online holistic apothecary. Find the best supplements that have gone through my thorough screening process there. Look in the category for postpartum bleeding prevention or search them individually. My online dispensary is a convenient way for you to purchase my hand-picked, professional-grade, whole food supplements and other natural health products. Ordering is simple, and the products will be shipped directly to your home or work within a few days.

As always, if you need more personal guidance, schedule a consultation with me. 

If bleeding becomes heavier than a heavy period, and you are soaking through two maxi pads an hour for 2 hours, empty your bladder, make sure the top of your uterus is firm and massage it if soft until it becomes hard. If no relief, take 1 tsp shepherd’s purse herbal tincture under your tongue. You can repeat the dose a few times, but if the bleeding becomes heavier, contact your practitioner. 

Do read my Natural Birth Secrets book, to prepare yourself for a healthy, joyful and calm pregnancy and childbirth - NOW OUT IN SECOND EDITION!

For further inspiration, empowerment, and optimal health in pregnancy, birthing and postpartum, please make sure to take my online Love Your Birth course, so you can ROCK your journey wherever and however you plan to give birth.

Photo by Megan Hancock Photography

Photo by Megan Hancock Photography

 

Natural Induction Methods: The Evidence

 
Art by Catie Atkinson @spiritysol

Art by Catie Atkinson @spiritysol

Natural Induction Methods: An Unbiased Look at the Evidence

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Natural methods of labor induction have been sought after for millennia by third trimester mothers for a variety of different reasons. In modern times, they're frequently a resort of mamas who might be facing a medical induction if they don't labor naturally soon.

There are myriad purported natural induction methods, but both the efficacy and safety of the methods in question are often under-studied and sometimes dubious. It's important to understand the difference between treatments that are largely safe and those that could negatively impact labor, birth, or your baby's health.

The majority of popular natural labor induction methods revolve around the consumption of plants or plant derivatives, such as castor oil and dates or pinapple, or herbal and homeopathic remedies. In the case of simple fruit consumption, there's little risk to mom beyond a stomach ache caused by an overzealous attempt. This can mislead pregnant women into thinking that all plant-based methods of attempting to naturally induce labor are safe, which is not true. In fact, some more potent plant derivatives have been shown to lead to labor complications.

The other category of natural induction methods involve forms of physical stimulus. Again, these have been attempted throughout the ages with varying degrees of success. Sexual intercourse, which is one of the most colloquially suggested methods of naturally triggering labor, has minimal risk unless a midwife or doctor has noted otherwise. Interestingly, despite its reputation, it has still been shown to be less effective at triggering labor than other forms of physical stimulus. Other stimulation methods include breast massage, acupuncture and acupressure, walking (most effective once actually in labor), uterine massage, and membrane stripping - to name just a few.

When you're attempting a natural labor induction, knowing what works and what doesn't is helpful; knowing what's healthy and what could harm your baby, however, is vital. We The Parents has compiled an infographic detailing nine of the most popular ways mothers attempt natural labor induction. For each method, the scientific evidence is examined. How much research has been done? And what do the results indicate about the efficacy and safety?

While this can help you to make an informed decision, it's also essential to get your treating physician, midwife, nurse practitioner, or other qualified health care provider’s go-ahead before trying any of these methods in order to avoid inadvertently harming yourself or your baby.

As a holistic midwife of just about 25 years, countless mamas have sought my guidance on how to bring on labor with natural modalities. I have experienced much success with a variety of methods - some not even mentioned here, but nothing has been consistent, and as with many natural remedies there is a paucity of research. As long as they are safe and sometimes effective, I will continue to recommend them, knowing that I am helping, and it is ultimately not in our control - babies prefer to come when they are ready. Many of the professional grade, top quality remedies I recommend and use often are available in my holistic online apothecary. Find the best supplements that have gone through my thorough screening process there. Look in the category for labor stimulation support or search them individually. My online dispensary is a convenient way for you to purchase my hand-picked, professional-grade, whole food supplements and other natural health products. Ordering is simple, and the products will be shipped directly to your home or work within a few days.

Also, even the powerful medicinal methods have significant risks we can not take lightly, as well as benefits when there are serious complications, and do not always work either.

A common reason women want to bring on labor naturally is the concern about being ‘too late’, the postdates testing and threat of hospital induction, along with the cascade of interventions associated with it. A key factor people often do not consider is prevention. When planning a pregnancy, I encourage women to take charge of their fertility, empower themselves with knowledge about their cycles, fertile signs and know when they conceived, so the due date is more accurate than if simply based on first day of last menstrual period alone. Read more about what you can do, covered more in depth in a previous blog. Women who do not know their cycles or the date they got pregnant can also consider an early first trimester sonogram, especially if they have a history of long or irregular cycles, or of being induced previously for carrying post-term babies; but a decision to do that should be an informed one, as there are also pros and cons of ultrasound to consider.

Knowing what you should do can seem daunting. I am here to help if you need more personalized guidance. You can also read my books, to prepare yourself for a healthy, joyful and calm pregnancy and childbirth, and for healing and enhanced well-being. For further inspiration, empowerment, and optimal health in pregnancy, birthing and postpartum, please make sure to click here to take my online Love Your Birth course, so you can ROCK your journey wherever and however you plan to give birth.

I have a holistic approach to life, including healing after pregnancy and birthing. Nothing replaces abdominal toning and exercise for restoring muscle strength and tone - which I encourage for all mamas as soon as they feel up to it postpartum. Nothing replaces touch, slow deep abdominal breathing, and a 'love your postpartum body' perspective that I promote.  

But I have found many mamas simply feel comforted by this support garment, especially early postpartum and temporarily as needed....to be used without forfeiting abdominal toning and strengthening exercise, breathing well and touch. I have found Bellefit supportive garments to help like they use belly binding around the world such as in Indonesia. They do aid in early postpartum healing and provide support many mamas feel comforted by.

I deal with human beings and the reality is many postpartum mom's struggle with body image, feel frustrated that getting back to themselves takes longer than expected. Being into holistic health and healing includes being sensitive to real human struggles - the mind, body, heart and soul of each person and their unique situation. 

Having helped countless women with these issues after having a baby as a midwife, I have found many still love that binding and feel better with this support, and ability to fit into their pre-pregnancy clothes comfortably and sooner than they would if they went through a C-section or natural childbirth recovery without it - especially when they have to dress up and fit into a certain favorite outfit for a special occasion or wedding not long after having a baby. For more info on the Bellefit girdle, check out my blog about it here

Have a Great Postpartum Recovery (with a little help from Bellefit)!