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fetal positioning

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Birth Balls, Best thing ever

Birth balls, commonly recognized as exercise balls, have been used for many purposes over the last ten years, including physical therapy, abdominal exercise, and most recently to aid pregnancy and labor. Its shape and durability allow it to be used by a variety of weights and heights, and in multiple positions. Birth balls can aide in pregnancy and labor to improve fetal positioning, fetal descent and maternal comfort.

Fetal positioning can make a huge difference in how labor develops. A baby facing in the posterior position in the womb may have a slow descent, and can also cause painful back labor (Spinning Babies). Poor fetal position can also cause very slow dilation, often resulting in unnecessary interventions. In some cases, the baby may have a difficult time turning and become stuck, requiring surgery or forceps delivery (Spinning Babies). Fetal positioning can be improved by having good posture. Often pregnant women are sitting on cushy couches or less than ergonomic driver seats, causing poor posture (Spinning Babies). By sitting and resting on the ball, the posture is upright and forward leaning, engaging abdominal muscles while relaxing the pelvis area. The back is comforted and strengthened by ball use, supporting the pelvis. With proper alignment and a relaxed pelvic area, the baby will have room to position properly, and begin to drop into the pelvis (Spinning Babies). It also encourages the baby to settle into an anterior position that is optimal for labor (Spinning Babies). Often a posterior baby can be encouraged to turn during labor by sitting on the ball.

Fetal descent is defined as entrance of the presenting portion (usually the head) into the birth canal. Descending takes time and hard work from both mom and baby.The use of gravity and squatting positions are helpful in this process, but can be taxing on the mother’s muscles over a long labor. The birth ball is a great tool in this scenario, as it allows mom to sit in a squatting position, allowing the use of gravity and an open pelvis to bring the baby down, but also allows for rest. The mother can also lean forward while sitting, and receive a massage or counter pressure. The ball can also be hugged while deeply squatting on the floor. It allows mom a greater balance and ease in the position, one that can be utilized in the pushing stage.

The birth ball is a great comfort tool for mothers in labor. It allows the mother to rest while still engaging an open pelvis. The birth ball can be a great break from walking, while still remaining active (Birth Arts Handbook p.187). It allows the mother to do pelvic circles and rhythmic movements that help her ease the pain of contractions. These movements often help the baby to navigate the turns in the pelvis before crowning (Birth Arts International p.187).  The birth ball also creates a counter pressure against the perineum and buttocks that can ease the sensations of early transition, which can be a difficult time for the mother. Having the birth ball as a comfort tool the mother can find a coping mechanism and rhythm through her contractions. By having support and a rhythm to help her cope, the mother can navigate her labor and have a mental place to return to when labor gets hard.

By utilizing the versatility of the birth ball, a mother can improve fetal position, while encouraging fetal descent and increasing comfort during labor. By improving these aspects of birth, unnecessary intervention can be avoided, as well as the use for drugs. This can greatly improve outcomes for mothers and babies, especially in a hospital setting where the mother is out of her comfort zone.

Works Cited

Birth Arts International, Certified Doula Education Program. Demetria Clark. 2000-2015. P.187

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How I Turned My Breech Baby at 37 Weeks

My second pregnancy has been filled with a few challenges. While at an ultrasound, staff thought that one of the baby’s legs wasn’t growing as well as the other (only in the 5th percentile), requiring further ultrasounds to check her progress. Turns out, the baby was just fine, and at 35 weeks my OB wanted to do one final ultrasound to conclude the issue. At this point, I had a pretty good relationship with the ultrasound tech in the office. As soon as she started the scan, she says, ”Oh, are you planning a C-section. ?”

My brain goes haywire, “NO! What in the world?”  What I actually manage to spit out, “Um… no, why?”

“She’s breech. Her head is in your ribs, and her bottom is what is down low.”

Breech shouldn’t be the issue it is in birth, but we will save that for another post. In the area I live and with the doctors I work with, their hands are tied by the hospital. I was also not in a position to have a homebirth with a midwife. With a short window to get this baby flipped, I started tackling all my options and plan of attack. To break it down, here is what I focused on: posture, Spinning Babies, belly binding and mental aspects.

Fetal position can be affected by several things, but posture is a big one. Slouching on our comfy couches and less than ergonomic car seats can make for a breech or posterior baby. I started making sure I was sitting up straight or sitting on the floor cross legged, to give baby room to move and alter any poor alignments in my back and hips. I also found out it’s important to stay off the birth/exercise ball until I could confirm baby was flipped. The ball is great for many things, but sitting on the ball while she was breech could help her to engage deeper into my pelvis and not budge into a proper position.

To further aide in getting baby to flip into a proper position, I spent a lot of time on the website, Spinning Babies. There are several positions and exercises that promote proper fetal positioning, but the one I focused on was a steep forward inversion. While baby is actively moving, keep legs on the end of a couch or bed, and place elbows on the floor, keeping hips over the shoulders. Hold for three breaths and release. You are basically doing a shoulder stand, using gravity to get baby out of the pelvic cavity into space where they can more easily turn. (Definitely have help or a spotter for this one!) Here is the link to Spinning Babies and how to perform an inversion: http://spinningbabies.com/learn-more/techniques/the-fantastic-four/forward-leaning-inversion/

On to belly binding! This was very new to me, but super helpful and enlightening. With subsequent pregnancies, the tendons holding our uterus in position become more relaxed, creating a pendulum effect. (That explains the extra discomfort and ligament pain this time around.) For further information, check out http://midwifeatyourdoorstep.com/articles/optimalfetalpositioning.html . Typically binding is done with a wrap, but I used a ring sling to be able to quickly bind off by myself. Excuse my iPhone picture, but it was the best I could do at the time.  I spent most of my active time during the day with my belly bound, and noticed a decrease in ligament pain. I noticed a drastic increase in Braxton Hicks contractions, as well as pelvic pressure. I assume it was from finally getting baby into a good position. When I would get too uncomfortable I would take the binding off and just rest.

Using my ring sling to belly bind in my last trimester. Note to self: take better pictures.

Using my ring sling to belly bind in my last trimester. Note to self: take better pictures.

Throughout this time, I spent a great deal of energy in prayer and fear release meditation. I did not want a cesarean, and I knew a lot of my worry and stress could result in tension in the baby, negating any attempts to get her out of the breech position. I had spent my entire pregnancy listening to hypnobirthing recordings (watch for another post), and I increased my time spent in deep relaxation, as well as talking to the baby. I asked her to flip for me, so mama wouldn’t miss out on those first moments with her. I prayed about my fears, my concerns, and gave them to God before I fell asleep each night. I had to mentally let go of the iron grip I had on the expectations for my pregnancy and birth, and know no matter the end result, we would get our baby earth side and I would heal. Here's my favorite fear release:  

Finally, at 37 weeks baby flipped head down one evening before bed. She was kicking and I quickly did an inversion off the side of my bed. Throughout the night I could feel her shifting her position, and the next morning I had very strong pelvic pain, and Braxton Hicks were incredibly strong. At my next appointment, my doctor confirmed she was head down.  

For more resources on positioning and exercises to aide in flipping a breech check out:

Videos:


 



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