Tag Archives: maternal manoeuvres

Running start

frank breech

In Physiological Breech Birth training, we teach breech practice according to the consensus statements developed with experienced professionals in Principles of Physiological Breech Birth Practice (Walker, Scamell & Parker, 2016), including:

Care providers should not disturb women’s spontaneous movements in an otherwise normally progressing breech birth.

Mother-led positioning offers the greatest physiological advantages.

Sometimes maternal-led positioning is most conducive; sometimes judicious guidance is appropriate, especially to help resolve delay.

When facilitating a physiological breech birth, care providers proactively use maternal position (or change in position) to promote normal descent.

The pictures below demonstrate asymmetrical maternal movement in a normal breech birth, in which the mother assumes an upright, kneeling position, with freedom to move her torso up and down as she feels the need. Study of effective, spontaneous maternal movements during successful breech births teaches professionals about all normal birth. Instinctive maternal movement can be read as purposeful and meaningful, in light of radiological evidence of changes in pelvic diameters (Reitter et al, 2014) — rather than counter-productive and needing professional interruption or guidance.

In this picture series, the mother spontaneously lifts one of her legs into an asymmetrical, ‘running start’ position. If a professional detects a slight delay in descent, it may be appropriate to suggest a change of position by raising one leg or the other, as a first-line intervention, a ‘maternal manoeuvre,’ before hands-on intervention. Often a change in maternal position, or rhythmic maternal movement (“give it a wiggle”) will prompt spontaneous descent to resume.

This mother is raising and lowering her torso with the aid of her partner’s thighs.

Dropping her torso, arching her back and tucking her hips under.

Moving her hips back towards her heels.

Squatting back onto her heels. This creates maximum space in the pelvic outlet as the breech passes through the ischial spines. The mother will not ‘sit’ on her baby, preventing the birth, but will instead raise her hips again when she instinctively feels the urge to do so.

Rising up again, arching her back. Creating space in the pelvic inlet as the shoulders and head enter.

Squatting back down. Spontaneous movements constantly change pelvic diameters as the baby rotates through.

Torso and hips rise up as baby rumps. Thrusting hips forward has a protective effect on the perineum and opens the inlet to assist engagement of shoulders/head. ‘Fetal ejection reflex.’

Pressure as baby descends. The mother drops her torso down again.

Moving into Running Start. The baby has not completely rotated to sacrum-anterior. The mother spontaneously lifts the leg on the side of the fetal legs, creating further space to assist rotation of the torso and descent of the anterior arm.

Significant descent occurs with the next contraction.

Running start continues to make space for gravity to do it work.

Almost there.

Straight to his mother’s arms.

The physiological process of welcome continues without interruption.

Thank you to the mother, who gave permission for her birth photos to be used for educational purposes; and to her family and midwives. One of these images appeared in the article, Unexpected Breech: What can midwives do?, in The Practising Midwife.

The Birth of Leliana

Jessica with Leliana

Image: Jacqueline Sequoia, used with permission

From Atlanta, back to Asheville

Jessica’s baby remained persistently breech at term, and she was unable to find a provider in South Carolina to facilitate a vaginal breech birth. When she attempted to decline a CS and negotiate a vaginal birth, she was informed that if she came into the hospital in labour, she would be given general anaesthesia and her CS would be ‘a lot rougher.’ (Folks, the ACOG published something just for you: Committee Opinion No. 664: Refusal of Medically Recommended Treatment During Pregnancy.)

This was Jessica’s first baby, in a frank breech position (extended legs), with no additional complexities. Her sister, Family Practice Doctor Jacqueline Sequoia MD, heard about Dr David Hayes and Harvest Moon Women’s Health because they were hosting my physiological breech birth training. Jacqueline includes obstetrics as part of her practice and booked to attend the workshop with some colleagues. Jessica and her husband Brian met with Dr Hayes to consider their options, and once Jessica made her decision, found a rental apartment in Asheville on Craigslist.

Let’s contemplate that for a moment. In order to have support for a physiological birth, rather than the threat of a coerced CS, women are having to relocate to another state and rent temporary accommodation, because the baby is presenting breech.

When Dr Hayes and I arrived at Jessica and Brian’s apartment, Jessica’s labour appeared to be progressing well. As people entered her space, Jessica gradually moved into the tiny bathroom at the back of the apartment, reminding me of Tricia Anderson’s metaphor of cats in labour. I turned off the light. This labour had a journey, as all labours have. Throughout her journey, Jessica was surrounded by people who love her. At the end of it, Jessica beautifully and instinctively birthed her little girl, Leliana, who weighed 7lbs 8oz.

This video contains graphic images of a vaginal breech birth.

Being attuned to the general lack of training in physiological breech birth among health professionals, and the consequences for women and babies, Jessica and Brian were keen to share this video of Leliana’s birth to help others learn. If you would like to read more about the minimally invasive manoeuvres used at the end of this birth, you can read our blog on Shoulder Press and Gluteal Lift.

brian

Thank you, Jessica, Brian, Leliana, Dr Sequoia and Dr Hayes for sharing this video. The link to this blog post can be shared, but the video cannot be downloaded or reproduced without permission.

Shawn

Breech birth of the day …

It’s not every day you get to watch a sea otter pup come into the world! But when a pregnant wild otter took shelter in our Great Tide Pool Saturday, we had a unique opportunity to see it happen. Sea otters can give birth in water or on land. You’ll notice that mom starts grooming her pup right away to help it stay warm and buoyant—a well-groomed sea otter pup is so buoyant it’s practically unsinkable! For more video of the birth (spoiler alert: the miracle of life is graphic!) check out our YouTube channel: http://mbayaq.co/1R0v6oD . Besides keeping the pup afloat, grooming also helps get the blood flowing and other internal systems revved up for a career of chomping on invertebrates and keeping nearshore ecosystems, like the kelp forests in Monterey Bay, and the eel grass at Elkhorn Slough, healthy.Our sea otter researchers have been watching wild otters for years and have never seen a birth close up like this. We’re amazed and awed to have had a chance to witness this Monterey Bay conservation success story first hand in our own backyard. Welcome to the world, little otter!

Posted by Monterey Bay Aquarium on Sunday, 6 March 2016