Asynclitism means asymmetrical. Its when a baby’s head is tipped towards one shoulder. The tipped head has a harder time passing through the narrow part of the pelvis; the ishial spines. Labor becomes longer, and sometimes baby doesn't fit out the pelvis...Happily, we have techniques for this problem.
Early in labor the baby’s head enters the brim of the pelvis in asynclitism –tipped- to get around the protruding base of the spine (sacral promontory).
When the nurse checks the cervix at 3 cm she’ll notice that the baby’s head is closer to the mother’s front (usually). There is space between the baby’s head and the mother’s sacrum in back. We are reassured, as long as the forehead doesn't overlap the pubic bone (in which case we Help The Baby Engage in Labor).
Normally, the head has usually filled in the space evenly by 4-5 cm. The head has become symmetrical inside the pelvic canal. The head is synclitic.
Read birth stories about asynclitic labors at the end of this article.
Discovering asynclitism in labor
The nurse, doctor, or midwife will notice the asynclitism during a vaginal exam. The cervix will be thicker on one side and thinner on the other side. (Thicker in front is normal, in my experience and I don't worry to much about that.) The baby's head will seem a little lower and closer to the bones on the thin side. The baby's head will seem to angle away, deeper into the pelvis and less close to the mother's bones on the thick side. The nurse will have to think about it, so ask her to check for this before or during the vaginal exam.
Labor with an asynclitic baby
If the bag of water releases suddenly with a strong contraction there is a possibility that the baby's head comes down to the mid pelvis while still asynclitic. Asynclitism may be caused by a twist in the lower uterine segment causing the baby to twist to fit the area. More typically, the pelvic floor is asymmetrical and so the head gets tipped as it is pressed down with strong contractions on the uneven edges of the opening to the pelvic floor.
Labor is often longer.
Early in labor, before 3 cm, this is normal and desired.
Asynclitism becomes a problem when the head is still tipped at and after 5 cm dilation.
Dilation often takes longer and there can be a delay in progress at about 8-9 cm or 9 1/2 centimeters for many hours.
A mother may have significant pain in one hip. Hip pain may also be from one of the baby's arms being up along the head or a spasm in the muscles within the broad ligament.
Contractions are often strong throughout, unlike the ebb and surge of a posterior labor. Though that can happen too.
Longer second stages
It not unusual for second stage to last 3-6 hours when the head is tipped. I’ve also attended first time mothers with second stages 2 and 3 times longer than this.
The baby can develop a caput. This doesn't necessarily mean that the baby won't fit. Often, really often, the baby requires the mother to change position often (maternal positioning) to open the pelvis.
What to do?
- Do the Pelvic Floor Release.(Sidelying release)
- Then do the lunge (the lunge will work better after the pelvic floor / sidelying release)
- Doing the Dangle should follow the Pelvic Floor Release and the lunge.
- Sometimes resting and not pushing at all through 2-5 contractions helps molding. Rest in a Rest Smart position.
- Vertical positions, such as standing and Generic Levitra slightly bending the knees during a surge
- Stand with one foot on a stool
- Sit on the toilet with one foot on a stool and the other foot on the floor
- Pulling on a towel or rebozo during pushing contractions
- "Shake the apple tree" by shaking the mother's buttocks in the same speed you would shake a branch to make a ripe apple fall
- Keep moving during a contraction (its ok to rest, but don't "freeze" your body with tension)
Eating small amounts and drinking warm honey tea helps keep labor contractions strong enough to keep moving the baby.
Lying down in one position is not likely to allow the baby to descend further downward. Very specific and persistent techniques are often necessary.
As long as we are talking about what to do, please look into craniosacral therapy and pediatric chiropractic for baby after birth. They should know the special technques for babies. This can be very helpful with the breastfeeding latch.
Medically assisted birth
Sometimes the doctor will want to use a vacuum (ventouse) or forceps during a contraction to pull the head out. There are some risks, of course, but if the head is low enough, attempting to continue with a vaginal birth avoids the risks of major surgery to the woman herself.
Sometimes, a birthing woman simply needs more time to let baby come down. An attendant with the unique skills of supporting the long labor naturally is becoming a rare bird. More than just postponing a cesarean, skills for natural labor includes knowing how to help a mother continue labor without physical or emotional trauma. Of course, one of those skills is knowing when enough is enough. A cesarean is meant to be a life saver, not a life style.
Supporting the asynclitic labor
There is a dance the midwife does between forces of inertia and forces of birth. When to eat, when to rest and when to work the pelvis are vitally important when labor is long and the second stage even longer.
A doula, or two, can mean the difference between a vaginal birth and surgery. Her talents in emotional support may find themselves calming the nurses and providers.
The mother needs to want to continue the birth. After a particularly difficult birth we want to know that she is joyous and not second guessing herself. The birth team may need to get together to discuss the birth.
In labor, if the mother decides enough is enough, the support team must seriously consider their options for finishing the birth. With a birth team that works well together and a willing mother, many mothers will perservere to finish the birth themselves. They will feel proud and may a bit confused as to why their labor was so difficult. What we don’t want is to have the mother feel like she was suffering. Listen to the mother and let her lead. Give encouragement while leaving an opening for her to lay down her hand.
The story, The Long Labor That Wasn’t is about an asynclitic posterior birth. There is another story of an asynclitic posterior labor at the end of the article called Pelvic Floor Release. Both babies in these stories had their chins extended. Both babies were born at home in good health. Asynclitism might repeat in a future birth, but often it does not.
Here's another story of a doula introducing techniques for asynclitism during a hospital birth in which the mom used epidural anesthesia. The doula was inspired to write a reference letter for Gail: "Help for an asynclitic birth wins doula's praise- a reference letter"
A co-venture video experience with Spinning Babies and Blooma Yoga! Coming Soon!
Spinning Babies; Daily Essentials For Pregnancy Video.
Together Sarah Longacre, international prenatal yoga instructor and birth doula, and Gail Tully, yours truly, created a unique instructional video for flexibility and comfort in pregnancy and to support better fetal positioning in time for birth.
Here are daily activities for stretching and balancing a pregnant body. Start early in pregnancy to prepare to make the most space for baby's best birth position and the most ease for mother's opening during the birth process.
We begin the program for women of average flexibility (or just plain stiff to start with) and beginner tips. But soon, you'll be ready to move freely! That's when Sarah brings the stretches all together into her easy to follow, playful, sensual, and flowing "Blooma Style" daily routine.
Sarah's "dance of opening," moves joints and ligaments to come alive under the delightful melody and percussions of Carin Vagle. This isn't about core strength; its about freedom of movement and creating space in the body.
Sarah plays along with Gail's little game of "Flashlight" to show pregnant women how to evaluate their own posture and positions. Smart Maternal Positioning helps baby snuggle their backs into the front of the womb for Optimal Fetal Positioning.
The Daily Essentials For Pregnancy includes tips for using Maternal Positioning around the house. Actual scenes in the bedroom, living room -and even the bathroom- gives practical instruction like no other video. You will be sleeping more comfortably immediately when using these tips. Within a week or two many pregnancy discomforts of the pelvis and lower back may be reduced when all these nurturing techniques are integrated into your daily lifestyle. Spinning Babies and Blooma Yoga-- a natural collaborative!
Spinning Babies Childbirth Preparation Class.
Soon pregnant parents around the world can take a Spinning Babies class from their own monitor! Join six couples as they learn the reason why Spinning Babies works and how it can enhance your labor and birth.
See techniques to do daily or weekly. Actual, real consultations with two couples right at our class location, one with a breech baby (head up) and one with a baby in a transverse lie (lying sideways).
Couples do the techniques together and show you how to do these at home.
Used alone or with the Daily Essentials, Spinning Babies Childbirth Preparation Class goes beyond the basics. Simple props show complex concepts sweetly. Little-known anatomy is linked to childbirth and the role of fetal positioning.
The section on labor discusses two labor patterns- the one "promised" in other books and the unexpected one associated with the posterior labor. Learn the common causes of long labor and techniques to help baby through the pelvis.
Be empowered; be prepared. After using this video throughout your pregnancy, while we can't promise, of course, you may not need the tips for labor progress. You can use that knowledge to help your neighbor. This video is all Spinning Babies.
Blooma Yoga Prenatal Yoga for AM and PM.
Warm up in the morning and cool down in the evening in two 30-minute sequences. Sarah Longacre shares her own blossoming pregnancy, Blooma style, to the exquisite music of Carin Vagle. Sarah's affirmations will carry you through labor with emotional strength and encouragement. Play this video when the others become too basic and you just want to dance and have fun. Wait, dance? Isn't this yoga? With Blooma and Carin Vagle, your spirit won't know the difference. Soar to greater freedom of movement. Bring your hormones into harmony with the day. Begin your day with serious play. Cool down at night with a sleep enhancing stretch before bed. This video is all Blooma!
Sarah's video is ready for you now! Get Blooma's AM/PM Yoga here
All three videos are professionally produced by Melissa Koch of Grey Duck Productions, with stills by Tanya Villano Photography, each of these three videos are dynamic on their own. Together they will enhance your pregnancy and labor experience with fun and empowerment in the most practical manner. Feel hope for your birth abilities, this is support for your journey. Gain the confidence and flexibility to fully bloom. I believe these videos carry the potential to bring your best birth dreams into the gentle reality.
Compassionately priced. Estimated Due Date for Daily Essentials March 2014; for Spinning Babies Parent Class, Fall 2014.