Upright Physiologic Vaginal Breech Birth

So grateful to Dr. David Hayes OBGYN @breechwithoutborders for their amazing continuing education workshop to thoroughly review the data and teach skills of attending vaginal physiologic breech birth globally. Some key take aways are: 📣Modern US clinicians and hospitals, and other countries that follow US, where only cesarean is taught and practiced for breech - please get back your skills and follow ongoing current impressive research and guidelines of other western countries where upright vaginal breech birth is being heavily studied and practiced as the norm, as it has been among community out-of -hospital midwives around the world through history.

More & more mamas don’t want c-section and all the risks associated with major abdominal surgery for them, their babies, and future fertility as the only option, and are seeking safe alternatives. Breech presentation occurs at term ~ 4% of the time ,vast majority are called frank with hips flexed, legs extended upward. Sometimes they can be turned head down to vertex presentation, sometimes they can’t and are breech for a reason. It’s very rare for a term baby to stand in the uterus, presenting one or two feet first - which is usually NOT footling (a common misdiagnosis) but complete or incomplete breech - hips flexed, buttocks in pelvis like a frank breech but one or two legs flexed, with one or two feet dropped down. These presentations in healthy pregnancy are fine candidates for term vaginal breech birth. It’s crucial for providers to know when to keep hands off, support mamas own movement and pushing efforts, upright positioning, how to resolve uncommon stuck arms, shoulders and head behind the pelvic bones, monitor baby’s condition, expedite birth and effectively resuscitate baby if needed.

Significantly less invasive maneuvers are required in physiological breech birth in upright positions with improved outcomes for mamas and babies. For mamas, breech birth is often claimed to be easier than birthing babies in head down position, with less injury to pelvic floor muscles and reduced tearing. Those I’ve attended all went well. The trouble and poor reputation associated with vaginal breech birth are mostly caused by unskilled providers, keeping mama on her back, impatience & pulling - which skewed the data of the older term breech trial they still quote. If you have a persistent breech baby know you have options. Get true informed consent!

If you’ve been told that your baby is breech at your mid pregnancy anatomy scan, know that baby is still swimming and it is likely they will be head down by term. If baby is breech later in the third trimester, don’t freak out. There are many ways to gently and lovingly ease your baby into vertex. Since there is slightly greater risk to breech babies born vaginally and by cesarean, and many people do not have providers near them who are skilled to attend them for a vaginal breech birth, it is ideal to try to encourage baby to turn head down.

Towards the end of pregnancy, the baby settles into its favorite position. Ideally, this position is vertex, meaning that its head is down towards your pelvis and its bottom is high up in your abdomen.

Less commonly, the baby is breech (with its head up and its bottom down towards your pelvis).

It’s not always known why a baby is breech at term. Sometimes it has to do with:

• Relationship between the shape of the baby and the shape of mom’s uterus or pelvic bones

• Location of the placenta

• Issues with the umbilical cord

• Excessive amniotic fluid

• Lax abdominal or uterine muscle tone

Labor and birth does carry more risk of complications when the baby’s head is not down towards the pelvis, even though breech is a variation of normal. So, when a baby is breech by the 30th week of pregnancy they should be encouraged to convert to the ideal vertex position. That said, the majority do turn by themselves at the beginning of the ninth month.

What to do When Baby is Breech

If your baby is breech at 30 weeks, consider doing a couple of the following exercises 10-15 minutes 2-3 times each day until your baby turns.

1. Belly massage. Massage your abdomen GENTLY in the natural direction the baby will turn. But stop if you meet any resistance, and never attempt to forcefully turn the baby yourself.

2. Visualization. Close your eyes and imagine your baby with his or her head moving down in your pelvis.

3. Coaxing. Play classical or relaxing instrumental music by your pelvis, so that the baby will turn towards the soothing sound. Or shine a flashlight by your pelvis, so that the baby may move towards the light.

4. Go for a swim. Swim laps and do some handstands in the pool.

5. Pelvic rocking. Shift your pelvis up and down and side to side while on your hands and knees.

6. Act like an elephant. Walk around the house on your hands and feet.

7. Bridges and inversions. If you have an established yoga practice, go upside down with any of the inversions, using props for supportive modifications. Headstands and downward-facing dogs work wonders.

Beginners should start with bridges. To do this, simply lie on your back with your feet flat on the floor approximately 1 ½ - 2 feet apart and your knees bent. Elevate your hips 9-12 inches higher than your shoulders. You can support yourself in bridge with a yoga block under your sacrum.

Alternatively, lie on your front in the same “upside down” position, keeping your weight on your forearms and knees wide, with your bottom in the air. Lying on three pillows or a beanbag chair can help further elevate your hips.

Or, lie bent over the edge of a sofa or top of a staircase with your legs on the floor and your body lying down the sofa or stairs. Support your body with your hands or forearms so that your torso is inclined upside down.

Gently roll your hips side to side while in any of these positions.

Taking homeopathic Pulsatilla 30C will help the above exercises be more successful. Allow 4-5 pellets to dissolve under your tongue 3 times daily for 3-5 days. As with any homeopathic remedy, avoid eating or drinking for 15-20 minutes before and after.

Natural Remedies for Breech Babies

In addition to exercises that help your baby move into the best birth position, there are a few techniques that can be administered by care providers. If you’ve tried the above suggestions without success, look for a practitioner that practices one of the following.

MOXIBUSTION

Find an Acupuncturist or Doctor of Traditional Chinese Medicine who has had success turning  breech babies to vertex with moxibustion. The technique involves burning certain herbs close to the skin at specific acupuncture points.

WEBSTER TECHNIQUE

A chiropractor trained in the Webster Technique can use this sacral adjustment to help facilitate the pelvic alignment needed for your baby to get into birth position.

MANUAL TURNING (External Cephalic Version)

If all else fails, you can opt for having your baby turned manually if the right conditions are met (such as no cord around the baby’s neck or short cord, adequate amniotic fluid, and healthy baby as detected on ultrasound with a normal fetal heart beat). Sometimes this is can be easily done in your birth practitioner’s office at 34 -36 weeks, especially in a woman who has delivered vaginally before, while carefully assessing the baby’s heartbeat. It has a high rate of success in skilled hands and supportive conditions.

Experienced midwives can turn breech babies. Most obstetricians prefer to do it in the hospital, often with medication to relax your uterus, ultrasound guidance, and continuous fetal heart monitoring. But it can safely be done out in of hospital settings while monitoring baby.

Ask for a wedge pillow to support you in a tilted pelvic lift position, or a bed that can be placed at an angle, with your legs higher than your head to help baby out of pelvis. Also, having it down while in deep meditation being supported in a pool of water has been effective and a wonderful experience.

Once the baby is turned to the head down position, stop inverting yourself, wear an abdominal binder at all times to prevent the baby from turning back to breech.

If your baby insists on being breech as you approach your due date, discuss your options with your provider. If they are not supportive of your choices for a vaginal breech birth, find a different practitioner, optimally one who has the essential skills and philosophy of birthing breech babies vaginally when appropriate and safe to do so. You can ask for recommendations at Breech Without Borders.

A baby lying in the transverse position, however, can only be delivered safely by cesarean section.

For more information on having the birth of your dreams, check out my Guide to Pregnancy, Birth and Postpartum

If you desire personal guidance, schedule an online or in person coaching call with me.

Gestational Diabetes Screen & Alternatives

Gestational diabetes is rare in the healthy population. Occurring in about 6% of pregnancies, it’s incidence is increasing largely due to the growing obesity, insulin resistance and adult onset diabetes, poor diet and lifestyle habits in the United States. There is much controversy around gestational diabetes, how it is screened for and diagnosed, and whether universal screening improves outcomes as opposed to testing when there are risk factors. If you do have it, however, treatment that includes appropriate actions like maintaining ideal weight, enhancing nutrition and exercise habits does make a significant difference in reducing the serious health consequences for both you and your baby.

In the US, it is standard of care that all women are screened for gestational diabetes at 24-28 weeks of pregnancy, although in some other European countries, only women with risk factors are screened. Screening that is most common involves giving pregnant women a “Glucola” drink that has 50 grams of sugar in the form of dextrose, and then testing blood sugar an hour later. Many holistic providers and the families they serve are concerned about this potentially toxic drink laden with chemicals that may make them feel sick, harm them and their babies, and can be associated with false positives that label them unnecessarily as high risk. This increases stress and angst, leads to more testing, monitoring and potentially other risky interventions. They want alternatives.

While it is within your right to refuse the test, you may want to consider screening for gestational diabetes in another way and discuss your concerns and options with your provider. If your provider is unwilling to work with you on this, consider switching providers to one who will. Although we do not have enough evidence that alternative screens are as accurate as using the more extensively studied Glucola drink to screen for diabetes of pregnancy, alternatives are not to be easily discounted, and may be a viable option in the low-risk healthy population. 

It is recommended according to evidence based care, but you have the right to make an informed decision to decline. The evidence does support screening for diabetes of pregnancy (GDM), as the benefits of accurate diagnosis and treatment outweigh any potential risks of the screening blood test.  Treatment does impove health and birth outcomes, whereas untreated abnormally high blood sugar levels in pregnancy carries substantial risks to mamas and babies. In the early 2000s, the US  only screened those with risk factors, but since the rates of GDM are increasing, and rarely found in those without risk factors, it has become standard to screen everyone. In the UK, only those with risk factors are advised to get the one 3 hour glucose tolerance diagnostic test. There is disagreement on the best screen to use, and what numbers are diagnostic. In the US, standard of care is to use a two step process in which the pregnant mama drinks 50 grams of a Glucola drink made of dextrose and blood is drawn 1 hour later.  Some practitioners and labs use 140 as the cutoff blood sugar level indicating a positive screen others use 135, and some use 130. The lower the cutoff number, the increased number of false positives along with a slight increased ability to diagnose true GDM, whereas the higher the cutoff number the opposite effect can result.  So it depends on the cutoff number your provider and lab uses, each showing different degrees of sensitivity and specificity. Levels of 135-140 are considered normal according to the Mayo Clinic, ADA, ACOG and other highly medical sources.

There is an option for screening for gestational diabetes by home testing. This involves checking your fasting blood sugar at home when you wake up in the morning, and then again 1 hour after eating your usual breakfast, lunch and dinner. While approved for monitoring blood sugar once diagnosed with diabetes, this method of screening is less studied and without clear standards. It is also more cumbersome and costly, as you need to get the supplies to do it, then take the time to get it right and keep records to discuss with your provider at your next prenatal visit. 

I discuss natural alternatives to the chemically laden Glucola drink in my Natural Birth Secrets book 2nd edition….but here are some basic tips if you want a more natural approach.

Alternative Gestational Diabetes Screening Options to Glucola

Starting three days before your appointment, increase complex carbohydrates such as whole grains, sweet potatoes and winter squash.

The meal before the test should only contain protein, vegetables, and unsweetened dairy. A veggie cheese omelet is a great choice! Avoid sweetened foods, fruit, and carbs. If this last meal before the test is lunch or dinner, you can eat a normal breakfast, but avoid carbs or sweets for the rest of the day.

Fresh Test is a new organic alternative that is also said to taste good, with only three ingredients. It has exactly 50-grams of glucose yet is void of unnecessary artificial additives, and is laboratory tested to be virtually equivalent to the Glucola without the unhealthy ingredients. To make your own drink that is most equivalent to Glucola without the chemical additives, dissolve 50 grams of organic dextrose in 8 ounces of water. You will need to do some math. If there are 20 grams of dextrose in 2 Tbsp for example, then you need 5 Tbsp of the powder. You ideally want dextrose, as it is the sugar made from corn that makes up the Glucola drink, and it is most bioidentical to the sugar in your blood called glucose. Therefore, it is the best alternative to screen for gestational diabetes as the standard Glucola drink does, according to the laboratory parameters designed and tested for this purpose.

Another alternative is to drink an equivalent amount of pure corn syrup dissolved in your tea, since the sugar in corn syrup is dextrose. You can find organic non GMO varieties in the health food store, but you still need to do some math, to get 50 grams of sugar total. 

Reputable research indicates that you can instead, eat 28 all natural organic jelly beans or enough that equals 50 grams of sugar, which is studied to be a reliable alternative to the 50 gram glucose beverage. It is not standardized as is the Glucola drink, amounts and types of sugars vary with each product, so you need to do the math and make sure you are eating 50 grams of sugar. The study was relatively small but results can certainly be considered.

Other less ideal options are iced tea, organic Gatorade or a cola drink that has 50 grams of sugar added in the form of added table sugar or dehydrated cane juice (sucrose) - similar to the kind of sugar in jelly beans. They are not a first choice because they are not as extensively researched, the form of sugar is different than dextrose, and thus may have a different effect on your blood sugar levels and test results, designed to screen for diabetes based on your response to dextrose. 

The blood test to screen for gestational diabetes was studied and formulated to test your reaction to ingesting 50 grams of dextrose. Sucrose is made up of 50 % glucose and 50 % fructose. You will need to read ingredients and nutrition labels to use an alternative, an important skill to develop anyway. And you still need to do some math, as the nutrition label might say something like 23 grams of sugar per 8 ounce serving. 

When going for sugars that are not dextrose extracted from corn, you can choose any sugar sweetened drink without added fruit juice. Fruit contains a different type of sugar called fructose that makes the test less accurate as it has a different effect on your blood glucose levels than does dextrose and sucrose. If you can not find or have no time to figure it out and have low risk of gestational diabetes, Snapple 16 oz raspberry peach drink is second choice. Although it is mainly sweetened with sugar (sucrose), it does have a little fruit juice, which again is mostly fructose.

Coconut water is another, but less than ideal option, as it contains sugar in the form of mostly sucrose and glucose, and it does have some fructose as in fruit. ZICO coconut water 16.9 ounces has 20 grams of sugar, so you would need to drink 2 ½ bottles. Honey is another alternative, but it is also not made up of an equivalent sugar - it is sucrose and fructose. Again, you need to read the label. Different honeys have different amounts of sugar per serving size. 

Hopefully there will be more studies on these alternatives, but for now, are listed here to consider with your provider, if for some reason you can not take the dextrose or corn syrup equivalent and you are healthy, with healthy weight and lifestyle, with low risk for diabetes. 

45 minutes before your appointment, eat the jelly beans or drink an amount that equals 50 grams total of sugar, then nothing until the blood test, which will be drawn 1 hour after you consumed the drink or candy.

If you have time, do some form of exercise like taking a brisk walk for 20-30 minutes after drinking, but before the test.

Bring a high protein, whole carbohydrate and healthy fat snack to eat after the test if needed, to keep blood sugar stable. This will help you avoid unpleasant symptoms once your blood sugar drops, like shakiness, lightheadedness, fatigue, anxiety and irritability.

Rest assured, most healthy pregnant women (about 94%) do not have gestational diabetes. A positive screen simply means you need more testing to confirm it or rule it out. And if you do have it, you can learn how to keep your blood sugar normal throughout the rest of your pregnancy and life. 

If you need more guidance,  schedule a coaching call with me.

Be informed, empowered & educated with my online course Guide to Pregnancy, Birth & Postpartum - sold separately or in a bundle.

Tearing at birth

Worried about tearing at birth? If so, you are not alone. Although no guarantees (for example baby can come out with their hand by their head - compound presentation, that can result in lacerations), there are things you can do to help prevent tearing during pregnancy and at birth, even if you tore or had episiotomy previous birth. I have helped many mamas not tear or not tear enough to need stitching repair, despite the most serious of tears last time.

First off, say NO to routine episiotomy, in which the provider cuts your perineum and vagina at birth. It is is not only one of the most harmful, painful and unnecessary routine obstetric procedures, but also can lead to more serious tearing extending to the anus (third degree) and even the rectum (fourth degree). Make sure you maintain excellent nutrition, take in low glycemic foods and drink (especially if previous tear was related to baby’s large size - white four, fruit juices and sugar foods tend to grow bigger babies), avoid toxins like smoking, encourage baby anterior as you get close to term to prevent posterior positioning - I go into all this in more depth in my Natural Birth Secrets book 2nd edition. Research is conflicting about benefit of simple perineal massage to prevent tearing. What is more clear according to the research are devices specifically made to stretch vaginal and perinal muscles. In the last three to four weeks of pregnancy, you can prepare the muscles of your birth canal with one of the researched effective, pelvic floor medical training devices like Epi-no, or Aniball (easier to get in the US) as athletes and dancers stretch before working out or performing to prevent injury. They are like a balloon of sorts, that you insert into your vagina and gradually inflate 15-20 minutes daily, over a period of time to the size of baby’s head. They not only significantly reduce the risk of tearing or episiotomy, they also help you feel more prepared physically and mentally (and get a sense of what it feels like to have your birth canal stretch to the size of baby’s head so you relax into it), they ease childbirth, prevent stress urinary incontinence and been demonstrated to have other important benefits from reduced length of second stage of labor to improved Apgar scores - less fetal distress during the pushing phase. Incorporate the practice into your love making and have fun with it. Many mamas in my practice and midwives around the world swear by them, and urge first timers as well as mamas who have had more severe tearing or episiotomy previously to use them because of their successful results.

At the time of birth, to try to prevent tearing, you can honor the resting phase of labor, between end of transition and before feeling the urge to push. Wait for that powerful instinctual urge to bear down, when the baby descends low enough in your birth canal to elicit your natural fetal ejection reflex, and then use soft blowing breaths, to gently allow the emergence of your baby without forced coached pushing or pushing before you feel the urge, especially just because you are told your’e fully dilated. Gentle grunts to work with your body’s natural urges are not the problem. Avoid birthing positions like lithotomy (lying on your back with legs in stirrups, a flat surface or held wide open) or deep squatting. Use more upward, forward leaning, hand and knees or side lying, standing or dangling high squat positions, and if you are concerned, ask for perineal support by your attendants or have a water birth. I discuss this more comprehensively in my Online Guide to Childbirth.

You make plans for the best outcome, then surrender to the journey. Lean into the wondrous intensity of it all.

Routine Labor Interventions Needing to be Abolished

Routine interventions in healthy labor and birth that need to be abolished when all is well include not allowing food and drink, IV, laboring and pushing in bed on back, artificially breaking your bag of water, continuous electronic fetal monitoring - including the admission and periodic strip, using the outdated Friedman curve to asses progress, forced coached pushing during the resting phase before the fetal ejection reflex - during the resting phase once diagnosed as fully dilated, episiotomy, immediate and premature cord clamping.

Many labor in hospitals that don’t allow food and drink, and need IV to prevent dehydration which can cause complications needing more interventions….unless you are sneaking food and drinking plenty orally. If you’re pregnancy and labor are healthy and proceeding naturally, IV fluids aren’t at all necessary and may cause harm. Even the American College of Obstetricians & Gynecologists (ACOG), the American Society of Anesthesiologists (ASA) & of course the World Health Organization (WHO) all recommend encouraging oral fluids instead of IV fluids.

Why is this not happening? Routine intravenous fluids can over hydrate and decrease newborn weight & blood sugar & cause maternal swelling - even in the breasts which impairs breastfeeding, can be uncomfortable, get inflamed, infiltrated or cause infection; IV restricts needed movement in labor, undermines mama’s confidence and sense of feeling empowered and healthy. It’s harmful practice to restrict needed nourishment and hydration during labor and birth. As long as you are keeping well hydrated by drinking, you can absolutely feel no qualms about declining that routine IV. There is also no evidence to support the IV access called saline lock for low risk laboring mamas because in case of postpartum hemorrhage. The risk of that in this population is low, and needing treatment beyond natural remedies and medications without IV even lower. An excellent practitioner can start an IV in that rare emergency.

Artificially breaking your water is another routine intervention that has no place in normal birth. The bag of amniotic fluid is intact for a reason. Let it break on its own. Most often that is late labor or during pushing. Occasionally it breaks before labor or rarely doesn't break at all, leading to an en caul birth with baby born in the amniotic sac.

If you’re told there is little to no risk - it's just nothing - you are not getting informed consent or evidence based care. Breaking it artificially without medical reason has drawbacks like causing more intense painful contractions and use of pain medication to cope, increased risk of infection and fetal distress from cord compression without the protective barrier around baby. It can also lead to malposition of baby which can lengthen labor. All this leads to a cascade of other interventions from IV Pitocon, continuous external or internal fetal monitoring using an electrode screwed into baby’s scalp, and c - section. If your cervix is not soft, thinned out or dilated much, the risks of all the above significantly increase. If baby is presenting other than head first, or not yet engaged in your pelvis, breaking the water can cause the cord to prolapse needing emergency cesarean to save your baby’s life. It's proposed benefit of speeding up labor is possible, but no guarantee. Is that worth the risks? Sometimes a provider tells you they want to do it to check for meconium - not uncommon, which baby at some time of stress in pregnancy or labor had its first bowel movement that mixes with amniotic fluid. If there are no signs of fetal distress and heart rate is reassuring, why create more stress? Knowing there is meconium stresses the team, then you, as they now treat you as having a complication that requires more intensive surveillance. There is no need for this when all is well. When there’s a problem, such as prolonged or stuck labor and you’re exhausted or not coping well, after trying all other more natural remedies, breaking the bag can help. But make sure you are well informed by preparing in advance with my Guide to Pregnancy Birth & Postpartum.

Continuous electronic fetal monitoring (EFM) is still routine despite the overwhelming amount of evidence against its use. Non reassuring fetal heart tones is the second most common reason for first time cesarean in the States, after “Failure to progress”’, many unnecessary as babies are born vigorous without any signs of it. Per the research there is no benefit for the admission and periodic 20 min continuous electronic fetal monitoring strip either, in healthy low risk pregnancies. It isn’t just ineffective, it’s uncomfortable, harmful, leads to increased continuous fetal monitoring, other risky interventions and cesarean without making any difference in baby outcomes. There is no evidence to show that this kind of fetal monitoring is safe or effective, and has contributed to huge increase in cesarean rate without improving Apgar scores, cord blood gases, admission to neonatal intensive care unit, low oxygen brain damage and cerebral palsy, stillbirth and newborn death. Even Obstetric professional organizations like ACOG acknowledges this and endorses intermittent fetal heart rate monitoring with a hand held doppler in low risk pregnancies and those laboring without complications. Furthermore, they encourage training of staff to its use to facilitate freedom of movement and increased comfort. NICE in the UK as well as SOGC in Canada agree there is no evidence to justify routine use of continuous EFM & that intermittent hands on listening to fetal heart rate is the preferred method of monitoring. NICE goes as far as opining that providers NOT even offer continuous EFM to laboring women low risk for complications. The ACNM says intermittent listening of baby’s heart rate with a hand held device should be the preferred method of fetal monitoring in those low risk for complications. Research is not clear & guidelines differ even regarding who does benefit from continuous fetal monitoring, when it comes to certain higher risk complications. This is not what is happening in reality of US hospitals due to a variety of factors from big business of EFM, understaffing, lack of training and equipment to outdated policies, providers not keeping current or practicing evidence based care.

I don’t like to disturb a laboring mama when all is well, just periodically need to check on baby. Some mamas prefer the fetoscope but it can best be assessed with mama on her back, & most in labor don’t want to get out of tub and be on their back. I love using it in pregnancy, but in labor, find most prefer the doppler so mamas can stay in the tub, shower or any position they want to, & everyone can hear that most often reassuring heartbeat. Distressed babies usually tell us whether we use hands on doppler or intermittent monitoring - which also allows for freedom of movement and the enormous benefits of upward mobile positioning plus more contact with and support from your provider. Research also documents the benefits of continuous labor support (which can involve plenty of privacy if that’s what you need!). Being a midwife fly on the wall is often the best intervention in normal labor, who can be there if needed, otherwise keep the fly on the wall role- with a huge heart.

Assessing progress by outdated rigid parameters needs to go. According to evidence based birth, the definition of a “normal” length of labor that has been used since the 1950s based on the biased, flawed Friedman curve is obsolete. The new, evidence-based definitions of normal labor should be used, and the vague term “Failure to Progress” should be abandoned. Yet still used in many hospitals.
If the laboring mama and baby are both healthy, and as long as the length of labor does not qualify as an arrested labor, laboring mamas should be treated as if they are progressing normally, even if what seems to be slow and prolonged for the mama. Pregnant mamas - especially first time vaginal birthers should be given more time in the early phase of labor, making sure they keep well nourished and hydrated, mobile and active but also rested, and also well supported with a doula or doula like care. I have many more suggestions in my online course Guide to Pregnancy, Childbirth & Postpartum, as this can be a challenge to mamas and their partners.

If you are wanting or needing an internal exam, six centimeters—not four centimeters—should be considered the start of the active phase for most people and caregivers should keep in mind that normal early labor (before six cm) sometimes includes a period in which there may be no change in dilation for hours. People may decide, together with their caregivers, to delay birth center/hospital admission until active labor. Similar with homebirth, but there is a more intimate relationship there between midwife and mama, with periodic contact in early labor being the norm.

Still, people are still being told to labor in bed, and give birth on their back. I can’t believe this is still happening despite not just common sense but loads of research about the harmfulness and risks to this practice.

Laboring and pushing your baby out on your back goes against gravity and trying to do so is more work and stress on your body and baby. Laboring and pushing with the force of gravity is less painful and all the more easier. Lying on your back also causes your heavy uterus to exert some compression on major blood vessels that go to the baby which can cause fetal distress, let alone to your upper body and head - why people don’t feel well on their back late pregnancy. It’s a position that was created by doctors not birthing mamas, who would be more comfortable in any other position when given the choice. As it’s a position best for the provider not the mama and baby. And that’s the best birthing positions - what feels best at the time to work your baby down and out. I go over these best positions to labor and help your baby come through your birth canal and into the world with demos in my Online Guide to Pregnancy, Birth and Postpartum - sold separately or bundled.

Mamas need to be moving asymmetrically as they need to move working with their body and baby as well as using the force of gravity to help them guide baby down and out. The pelvis is three bones connected by ligaments and it can stretch to accommodate baby. It’s at is smallest capacity on your back. Pushing on your back is much harder as you have to work against gravity. Occasionally some mamas need to rest and can lay on their side, and some do want to birth on their back and it works for them. But the routine practice of insisting all mamas labor and birth on their back is harmful.

Good bye to forced coached pushing when fully dilated. If and when you are told you are fully dilated, rest, eat and drink if you need, get up and dance…but wait for the fetal ejection reflex (FER). When you wait for the FER, and naturally feel the urge to push, instinctively push, working with your body. It is a bit similar to pooping - think of what it feels like and what happens when you try to push it out for a prolonged period of time when you don’t feel the urge. Then think of how easy it is when you just go after feeling the urge. Some may need or want a little gentle guidance to get started but avoid forced coached pushing. It’s not evidence based because it’s harmful, associated with such problems as more swelling, tearing, fatigue, fetal distress etc. Honor the FER!

It happens. The sensations of pushing and FER, fetal ejection reflex can be so intense that mamas initially may want to fight it, which makes it all the more harder. What we resist persists. When we dive in and lean into the sensations we birth.
Being in the water helps. Movement in asymmetrical positions & roaring like a lion helps, as does channeling your inner monkey, letting your primal take over. Relaxation & coping techniques to practice in pregnancy so you can just tap right in to them in labor are a huge help, as is bringing fun, joy, the primal & sensual, & enhancing pleasure using all your senses into the birth experience . But a complete change in mindset and perspective is key, as is my preparation. You can learn to use different language for the sensations of labor, instead of pain which implies illness and something that needs to be remedied, and to see them for what they are. You can learn to use other words for contractions, which imply tension and negativity, and the word contraction is not empowering, and does not fully explain what is happening. Yes, the top of the uterus contracts so the birth canal can open and expand, as well as push out your baby. So expansions are also happening in labor – that is really the goal of what you are doing – expanding so your baby can emerge from your womb to the outside world, and you can both be birthed as a new mother and baby.

Suffering is a choice. And you can chose to embrace your intense sensations for what they are, as healthy signs, what is needed to birth, what your baby needs to transition earth side - not that anything is wrong. I go cover this in much greater depth in my online Guide to Pregnancy, Labor & Childbirth.

Routine episiotomy in a normal birth is of the most harmful unnecessary procedures. It’s so not evidenced based care. And if you do tear despite prevention efforts (it can still happen), little tears heal fine on their own; if we have to do a repair we do try to put everything exactly or almost exactly how we found it. The perineal and vaginal area of a mom who has given birth vaginally before never looks exactly like it did prebirth. But we do our best! Sometimes there is some scar tissue that forms and definite changes from muscle stretching. These are our beauty marks and badges of honor.

Immediate and premature cord clamping is another harmful routine intervention that needs to be stopped. Just think about it. We did not cut cords right away for most of history. No mammal cuts the cord after birth. They just allow the normal natural physiological process to proceed instinctively…or they would have not survived as species.

The number one best recipient for cord blood is baby. 1/3 of baby’s own blood backs up into the placenta during birth. Baby needs to get it back - it is loaded with blood volume oxygen, nutrients, stem cells, antibodies and ingredients essential for transitioning from womb to world and long term health. If you want to donate or bank the cord blood, if baby is doing well at least wait 10 - 15 minutes so your baby gets most of it and there is still enough to bank.

Don’t let them convince you to have it cut ever after a minute because they are in a rush or tell you some misinformation that it’s not good. Clamping right away was probably invented for the doctor but now we know it’s harmful. Delayed optimal clamping can even be done after cesarean until placenta is birthed if there is no other problem.

I have way more info on this in my Natural Birth Secrets book 2nd edition but make sure this is clearly communicated to your providers and written in your birth plan. Ideal is to wait until it stops pulsing completely, flat and white, and you can even feel and see that yourself. When all is well I don’t cut it until after the placenta unless they want a lotus birth.

The best intervention in normal labor and birth is no intervention. Beloved obstetrician Dr. Michel Odent goes further and says best intervention in healthy childbirth is to knit. Knitting keeps our hands occupied instead of trying to meddle and fix something that isn’t broken. Part of Hippocrates oath doctors have to take after training is “First Do No Harm.”

But knitting goes deeper. It is the calm presence of an experienced attendant who has seen it all, communicating to you with their body language to relax, all is well. Their calm is contagious and will make you feel more calm. Their heart, ears, eyes and mouth are open to listen, watch, support, encourage and help you as needed; and of course they can put the knitting down as appropriate, but the point is brilliant.

The ideal is birth attendants are there, so there with the laboring mama, especially towards later labor when sensations can get intense, but know that mama needs to feel private, safe and undisturbed to labor best, to not feel watched; so we try to leave her alone, on her own, until she needs us. Even then, we try to be in background so mama doesn’t feel watched, after doing needed assessments without causing much disruption, as a lifeguard just in case and there of course if more support is needed.

Prepare yourself to be empowered, have an advocate and birth YOUR way!

Premature Rupture of Membranes at Term

How do you know your main bag of water breaks? You feel a pop & fluid bursts out of your vagina like a river, making a large ~ 2 1/2 - 3 cup puddle on the floor, or it totally saturates your clothes or where you were sitting/lying. You keep leaking fluid throughout the day that’s not pee, saturating your maxi pad like the first morning baby diaper, or your poured at least a few cups in it. It looks clear, blood tinged with white specs of vernix, or it’s brown/green color of baby’s first poop meconium (let your provider know). It does not look or smell like pee or semen (no history of recent sex). Your provider sees it flowing out of your vagina, pooling in your vagina on sterile speculum exam or on microscope, or simply + Amnisure test.

And it’s not the few tablespoons of fluid between the two membranes that can release before labor making ~ pancake size stain on your underwear, seat, sheets. It is important to know that as main membranous bag is intact. When in doubt discuss with your provider. They can confirm or rule it out. The test strip that turns blue with amniotic fluid is not diagnostic by itself as it can also turn blue with other things, like blood and even the fluid in between the membranes. It is important to be certain of the diagnosis of PROM. You do not want to be falsely diagnosed as “ruptured membranes” with all the possible unnecessary potentially treatment that entails.

PROM - premature rupture of membranes means when the main amnion bag of amniotic fluid breaks at term, before labor. It happens 8-10% of the time. It’s important to know for sure it’s not just a crack in the inner chorion membranous bag, leaving the main bag intact, so you’re not on the “clock” unnecessarily. Babies are double wrapped with a few tablespoons of fluid in between the two membranes - enough to make a pancake sized stain on your underwear or whatever you’re sitting on if outer bag tears, but then no further leakage. If in doubt, I advise wearing a maxi pad & walking around a few hrs. If it becomes saturated like an overnight diaper that’s the main inner bag with lots more fluid just > 1/2 liter; if it remains dry PROM is unlikely.
But is this “clock” evidence based? No. Recommending to induce to avoid risk of infection & stillbirth is based on outdated low quality studies from 1959s-1960s. According to newer quality research, as long as mom & baby are doing well & meet certain criteria, induction is just as much an evidenced based option as waiting for mama to go into labor on her own up to 48-72 hours later, without increased risk newborn health problems or death. 77-95% will go into labor anyway by 24 hours.

Many leading professional organizations like ACNM, RCOG, NICE, AOM, & RANZCOG recommend offering both options as acceptable as long as certain criteria are met - like single term uncomplicated pregnancy, clear fluid, no fever, no GBS, & normal fetal heart rate. ACOG says induce immediately but that if mom declines, waiting for labor to start on its own (expectant management) is acceptable. Waiting for labor to start on its own has very good outcomes for moms & babies. Induction of labor has strong consequences like the cascade of interventions, cesarean & birth trauma, & many opine it can not be justified as standard of care for a normal physiological occurrence in healthy term pregnancy.
It’s important to know your rights to autonomy, & be educated to make an informed decision if this happens. Do avoid or minimize internal exams or anything internal as it increases risk of infection.

If you are interested in more gentle ways of bringing on labor naturally refer to my Natural Birth Secrets book second edition.
Be informed, empowered & educated with my online course Guide to Pregnancy, Birth & Postpartum - sold separately or in a bundle.