Category Archives: study days attended

The Third International Breech Birth Conference. Washington DC November 2012

Robin Guy
Heads Up breech birth conference

I was lucky enough to be invited to lead a workshop at this years International Breech birth conference.

My qualifications are that I have been lucky to work with Breech birth expert Mary Cronk MBE as an Independent midwife. We attended several breech births together and thus I started to learn breech birth skills. Our midwifery clients alowed us to take photos of their births for teaching purposes, and these have further added to our knowledge as we studied the many and varied ways breech babies are born.

My workshop was entitled “Arse Backwards” as my journey to learning breech birth skills started with the most unusual births. A double footling, a foot then knee, a foot and extended leg, VBAC breech birth – all at home, were marvelous to attend and record, to share with other health professionals and women expecting breech presenting babies. Unfortunately I do not have permission to share these photos on-line which is why Mary Cronk and I travel the country (and abroad) sharing the stories and skills of breech birth.

My presentation told the story of how I learnt breechbirth skills, and how important it is to share these skills with others, to give women the option of skilled birth attendants at their breech birth. I took along video footage of Mary Cronk sharing her wisdom which was very well received.

I also learnt a tremendous amount at this conference which will aid me in the future care of women planning spontaneous breech birth.

I hope to have time to write up the highlights, but until then check out the brilliant Rixa Freeze’s blog

Taunton Birth Forum 4th September 2012

I was delighted to have made it to The Taunton Birth Forum this month as I have had such a busy Summer I have missed a few. It is always a pleasure to See Eleanor Copp and her husband Simon and learn from the speakers she invites along.

This month was a real treat with speaker Katherine Ukleja teaching about the embryonic face. katherine is a Cranio Sacral Therapist, teacher and lecturer. She has also undergone prenatal and birth training with Ray Castellino.

Katherine started off explaining how human babies are born immature compared to other species, and how this means we are dependent on our parents for our basic needs (warmth food etc). Babies are reliant on face to face contact which enables their brain to develop. The baby’s “social nervous system” allows babies to pick out a human face and mimic facial expressions (such as sticking their tongue out) within minutes of birth. This allows baby to engage with parents and communicate it’s needs, as it is helpless otherwise. Through this social engagement and play the baby’s nerves learn to “self regulate”. The baby’s face is a major form of communication, and the helpless baby relies on parents being able to read it’s facial expressions.

Now the technical part

The embryonic stage of development lasts until 8 weeks. during this time all body structures are present and just develop further beyond that point. At 3-5 weeks of development the baby’s face begins to develop. It develops between the brain and the heart in a series of folds that used to be called gills, as they resembled those of fish.

The face is where the internal and external world meet. the outer world covered by the skin of the face, and the inner world of the body, with entrances at the mouth and nose. Exteroception being the sensitivity to stimuli originating outside the body and  interoception being sensitivity to stimuli originating within the body.

The structures of the face and head develop in the mesoderm (the middle germ layer of an animal embryo, giving rise to muscle, blood, bone, connective tissue, etc).  when the mesoderm is compressed it forms cartillage and when it is stretched it becomes membrane. Bone then develops from the cartillage. The base of the skull is formed from cartillage and are less moveable than the upper cranium. The cranial nerves develop in the folds of the embryonic face and make up what is known as “the social nervous system”. The cranial nerves supply the facial muscles, help babies orientate their heads towards their parents, and alow them to identify the human voice over background noise. The nerves that control expression are very important to humans. As adults we read facial expressions to tell if another human is safe to approach.

One branch of the cranial nerves, the vagus nerve, supplies the heart and lungs. it modulates the heartrate, enabling enough blood to supply the brain. It also allows baby to coordinate sucking, breathing and communicating. The cranial nerves exit the head at the base of the skull.

Because of our large brains our babies need to be born relatively immature. To enable passage through their mother’s pelvis the upper bones of the skull develop seperately and can move over each other (moulding) during the birth process to navigate through the pelvis.

 

As baby travels through the pelvis it moves under it’s mother’s pubic arch, and at this point there is potential for the nerves to be compressed or overstretched. This is more likely in instrumental births like forceps, ventouse and caesareans where traction is applied to the head to pull the baby out. There is also a possibility of this if the baby is pulled out by the head during a so called normal birth. (Note from Joy: in the normal birth process there should be no pulling on the baby’s head!).

If these nerves are dammaged the baby can suffer feeding problems, pain from the injury, impaired hearing and facial expressions. Cranial nerve injury can also affect arousal of the vagus nerve with increased heartrate, inability to sleep and colic. All of these injuries affect the baby’s ability to communicate with it’s parents, and their empathy with their baby. A traumatised newborn baby feeling fear cannot use the “fight or flight” mechanism, so develops a self preservation behaviour of freezing or playing possum. This makes communication even more difficult.

Babies need to communicate face to face from birth as eye contact and empathy encourage brain development. Playing with babies and sharing joy increases dopamine and oxytocin production in the baby, which increase brain growth. In babies the right half of the brain develops first. This ensures emotional strength develops before intelligence. The stimulation of the right half of the brain is important in the first year after birth, as without stimulation these areas can atrophy. A well developed brain leads to empathetic behaviours in the child rather than antisocial ones.

It is a survival mechanism for babies to be able to communicate. Babies read the emotional tone of their carers. If parents are unhappy then the baby will be unhappy.

What I’d like to share from what I learnt is that:

  • Babies are born very immature and depend on us for their survival.
  • Babies are ready to communicate with their parents from the moment of birth.
  • The birth needs to be gentle to avoid dammage to the cranial nerves.
  • No pulling babies out by their heads!
  • If a baby’s nerves have been dammaged he may be less able to feed or communicate his needs.
  • These injuries can heal with time but craniosacral therapy can help.

Thank you for sharing your wisdom Katherine. xx

The Joy of birth

Has anyone ever told you that birth can be pleasurable or even pain free? It may be a very strange concept to women bombarded with stories of painful or traumatic birth. As an Independent midwife I rarely see women needing pharmacological pain relief, the main reasons being that they feel safe, loved and respected. They know and trust their midwife and know the sensations of labour are not to be feared. When a woman feels safe and supported throughout childbirth her biological functions can work as they were designed to. Her body produces complex coctails of hormones, endorphins and oxytocin to bring forth her baby in joy and triumph.

The strong sensations of childbirth are actually signs that our body is working well. The discomfort alerts us to the start of labour so we can move to a place of safety and gather our birth supporters around us. As the baby moves through our body it instructs us how, and when to move, to paricipate in the intimate dance of birth. As sensations change they let us know that we are making progress, and to assume a birthing position. The sensations of the expulsive stage enable us to work with our body and baby to give birth. These signals are more likely to be perceived as painful if the birthing woman is unsupported, scared, disturbed, or interferred with. Most women with good support manage labour with self-help techniques, love and their own determination.

I am of course referring to healthy women, experiencing full-term spontaneous labour, with a baby in the optimum position. If a labour is induced or augmented with artificial drugs, if a baby is in a really unusual position, or if an instrumental or surgical birth is necessary, then pain can be more difficult to manage.

The secret to an enjoyable birth experience is preparation, good labour support, and Oxytocin. Oxytocin has been called the love hormone as it is produced when we fall in love, or make love. It is very important in childbirth as it makes the uterus contract, enhances maternal behaviour and enables the letdown reflex in breastfeeding. Oxytocin is a very shy hormone though. It is hard to produce oxytocin in stressful situations.

The same environment which is conducive to making love is also advantageous in childbirth. Can you imagine having to make love in hospital, with bright lights, little or no privacy, unfamiliar staff wanting to watch, examine, time and chart every move? It would be very hard to mainain that loving feeling, let alone reach orgasm.

Oxytocin production is enhanced in an environment of trust, privacy, love, tenderness, darkness and emotional and physical comfort. As normal labour progresses it is normal for a woman to become more inwardly focussed, and less inclined to commumicate. The thinking parts of her brain need to not be stimulated as she enters a different state, sometimes referred to as being in “labourland.” If a woman is disturbed during active labour the flow of oxytocin can be interrupted.

According to wikipedia “The word oxytocin was derived from Greek  oxys, and tokos, meaning “quick birth,” so you can see its advantages!

Of course, if medical management is really necessary it is still possible to give birth in joy. Loving support, being in charge of the decision making process and sending love to your baby throughout, can make all the difference.

See the films below to see how joyful birth can be.

 

French woman enjoying giving birth – one of the best films of enjoyable birth I’ve ever seen.

Ecstatic birth –  shows the heights of pleasure some women can experience in labour.

Elephant birth – rather dramatic but worth watching just to see the power of birth and maternal instinct. Continue reading The Joy of birth

Breech Birth

Breech birthBreech birth is a very complex subject which needs in depth discussion with your care provider. I am lucky to have worked with one of the UK’s most experienced breech birth midwives, Mary Cronk, learning what I can about these unusual, but not abnormal  presentations. I have attended several breech births and taught alongside Mary Cronk, and Shawn Walker. I am happy to provide information and birth support for those carrying a breech presenting baby.

The Breech Birth Network run study days for health professionals and others wishing to learn more about spontaneous breech birth. This is a different set of skills to those needed to “Deliver” a breech baby which is a hands-on medical technique. Spontaneous breech birth is a hands off birth which can be facilitated by experienced midwives. The Royal College of Midwives consider this a normal type of birth.

Although breech is a normal presentation it carries additional risks compared with a head down birth. Breech babies are often born swiftly and spontaneously, but sometimes manouvers or surgery are needed to ensure baby is born safely. For this reason I recommend hospital birth with experienced care providers for breech presenting babies.

There are many things you can do to encourage a breech baby to turn see the brilliant spinning babies  website or the very funny pregnant chicken blog. The majority of babies who present as breech in pregnancy will turn head down by 36/37 weeks. If baby has not turned by 36/37 weeks of pregnancy you may be offered an External Cephalic Version (ECV) in hospital.

This ECV video  shows the technique used. The success rates (aprox 50%) vary with practitioner, whether it is your first baby, type of breech, how much fluid, size of baby etc. There is a small risk (1 in 200) of the baby becoming distressed during the procedure and needing immediate delivery by caesarean. More information is available here.

Breech babies can of course be born vaginally, but some doctors recommend caesarean surgery to deliver breech babies. Those doctors are probably basing their recommendation on the flawed Hannah trial (also called the Term Breech Trial or TBT) results. The TBT study seemed to indicate that babies born vaginally had worse outcomes than those born by caesarean, but when the outcomes were looked at 2 years later there were no differences in outcomes for the babies, but there are differences for the mother recovering from abdominal surgery. There have been many studies since, such as the PREMODA study (reported on at the 2012 breech birth conference) which show no differences in outcomes for breech babies born vaginally or by caesarean section. It is very important that you have a skilled midwife or doctor caring for you whichever type of birth you have.

The information and criteria which doctors use to determine who is a good candidate for sucessful vaginal birth can be found here. Please bear in mind that this green top guideline was published in 2006 and there has been lots of research done since then! I attended the International Breech Birth Conference in Washington DC in November 2012 and am eagerly awaiting the data soon to be published by Dr Frank Louven and his team in Frankfurt. See more information from the conference in Dr Rixa Freeze’s fantastic blog here.

See beautiful breech birth videos here:

A first baby born Frank Breech at home. Attended by a gentle doctor, this is a good illustration of spontaneous breech birth. The doctor does use a manouvre to help the baby’s head be born, and the baby doesn’t breathe immediately (this is fairly typical of breech born babies). You will notice how the doctor wisely does not cut the umbilical cord and how baby just requires stimulation to start breathing within a minute. Click here

A wonderful video of breech birth at home in water. It is the woman’s 4th baby and I can’t help wondering if baby would have got herself out sooner if the mother was in the supine position so buoyancy would have lifted baby’s body? The reverse of dry land breech birth, when the mother is on all fours and the baby descends aided by gravity. Anyway it’s a beautiful birth and a lesson to midwives that babies play an active part in the birth process.  You tube beautiful breech waterbirth

Another you tube film of planned breech birth at home clearly illustrating baby lifting her legs to flex her head (necessary for birth of the aftercoming head). It also shows how quickly breech babies can be born (this is the woman’s third baby), the midwife makes a very good catch of this little one! click on link Breech homebirth

There is also a lovely DVD you can buy which tells one woman’s story of deciding which birth was right for her and her baby. its called A Breech in The System. See the trailer here  and order your copy here

Of course I’m not saying all babies can, or should be born vaginally, but many can, and women should be given balanced information so they can make informed decisions about their care.