A baby can not get through the pelvis if the baby can't get into the pelvis.
Lack of engagement is a common issue for the woman who labors but the baby remains high in the pelvis. A common obstetrical solution is to do a cesarean. There are a few simple techniques that can be done. Some are easy to do, some are challenging. But once they are done, the labor is very, very likely to progress. And sometimes, the labor will even finish quite quickly with suddenly less pain than when the uterus was overworked trying to get a baby into the pelvis for days of labor. In fact, learning how to help baby engage can save hours and even days of labor. Check this out.
Read this article if you are hoping for a smooth, progressing labor and want to do some activities early in labor to be reassured.
Or, if labor doesn't start or progress as you expect.
You will find why and how to use the 1st Principle of Spinning Babies; Balance first.
There are differences seen in the labor pattern of an anterior baby and that of the posterior baby. These signals may help you determine whether a baby is in the occipital posterior position. These signals may also show up in labors where the baby has to get symmetrical for labor to progress, whether or not the long labor is caused by a posterior position.
Labor Progress Tips with the Three Principles of Spinning Babies©
Find what to do when in this list of labor activities for each phase and stage of labor.
Some women experience a labor pattern that is not described in childbirth preparation books. Strong labor seems to start and stop or surge and withdraw for some hours or days. Its not the night time surges that disappear with the sun. These come any time and contractions may be long and irregular but strong for hourse and then fade away. This pattern can occur with or without back labor. An internal exams reveals that baby is still high in the pelvis.
The baby must get into the pelvis to get through the pelvis.
We expect the first time baby to engage in the pelvis at 38 weeks. For some, the uterine action to engage baby seems like labor, sometimes as strong as labor associated with transition. But the baby isn't even on the cervix.
When the baby is not engaged in the pelvis the uterus works very hard to try to get the baby into the pelvis. The pain is on the pubic bone, but can also be felt in the back or rectum. When baby moves, baby may "grind" the forehead on the pubic bone trying to rotate away from the front of the pelvis. Sometimes there isn't pain to give a clue.
The cervix is often open less than 3 cm in a first time mom. But don't rely on the cervix! Sometimes women open all the way to 10 cm and yet the baby hasn't come into the pelvis.
The nurse, midwife, or doctor finds the baby high with a vaginal exam. This drawing shows a baby in the occiput transverse (slightly left occiput posterior since we see both eyes, but body matches the left occiput transverse).
Let's look compare two posterior babies in the next drawing. One is engaged. One is not. See the one overlapping the pubic bone?
If the baby isn't engaged, the nurse, midwife, or doctor may say the baby is -3 station. This unengaged posterior baby often must rotate to left occiput transverse before engaging. Spinning Babies techniques aim to help rotation. Otherwise, the baby would eventually be born by cesaresan. This mother might be told she is too small or her baby is too big. Rotation may solve the problem to let baby engage and descend through the pelvis.
The mother can check her own abdomen for a little tell-tale "ledge" resting on her pubic bone. If the ledge is there, its usually baby's forehead. Then we know contractions may start and stop until the baby is turned.
High in the pelvis might also be termed -2 station (2 cm above the halfway point of the ischial spines).
When baby is directly posterior the back of the head might be felt in the pelvis at -2 and the provider thinks the baby is engaged. This is also because the head won't wiggle. If the forehead overlaps the pubic bone then the forehead isn't in the pelvis and the baby isn't truly engaged.
Let's share the solution for many women in this situation:
3 Sisters of Balance relaxes the mother's abdomen and makes room for fetal rotation.
- Rebozo sifting
- Forward leaning inversion through 3 contractions
- Sidelying release through 3 contractions on each side
Now the laboring woman can often rest. Labor may be mild for an hour. She can snooze.
Surges begin again. If a woman isn't pushing her baby out, she follows the 3 Sisters with the techniques to match pelvic level:
Baby still high? We balanced, now we reposition the baby for flexion--
Abdominal lift while doing a posterior pelvic tilt to flatten the lower back moving the sacral promontory out of the way. Baby tucks chin and can now rotate out of posterior and descend. Do Abdominal Lift and Tuck through a contraction for 10 contractions in a row. Let the belly down and relax the back in between contractions.
Or, Baby is Zero, "0," station, in the midpelvis, or
+1, +2 station, lower down in the outlet.
Either way, strong labor isn't progressing labor.
Do 3 lunges on each leg, resting between ctr.
This series of techniques will help almost everyone.
A woman with an android pelvis, large baby and low thyroid may need help with more techniques, including a manual rotation of the baby by her OB or Midwife (done internally). If the posterior baby is large for the mother's pelvis and the mother's ligaments are tight, an excellent myofascial therapist who is specially trained in pregnancy may be necessary to avoid a cesarean.
To prevent that crisis in a labor, begin before pregnancy or early in pregnancy to release spasms and imbalance in the whole body and pelvis to promote optimal fetal positioning in labor.
The 3 Sisters is the most powerful contribution of Spinning Babies to the birth world. These sisters work to balance the pelvis in pregnancy and in labor. Starting balance in pregnancy may mean you won't need them in labor. Starting balance in pregnancy may mean you don't end up with a crisis in labor to a stalled labor or "baby won't fit." Some women need more specific balancing activities.
This addition to the Spinning Babies Website was inspired by a Huffington post: http://www.huffingtonpost.com/2014/01/08/photos-home-birth-social-media_n_4549531.html
A doula writes, "need suggestions for what to do to get a labor going...she has been ruptured for over 24 hours and not really contracting and wanting to avoid pit...."
When a baby is in the posterior position the head is not often applied on the cervix. Of posterior labors, 21% begin with the waters releasing (amniotic sac opened). Read Induction? and labor progress tips.
- Early labor comes on gently and doesn't pick up;
- Early labor comes... and then goes
- Labor comes at night and leaves during the daylight; or
- Labor comes on strong and then stops. And tries to start again, only to stop again.
What's the deal? "Is my starter broken?" Why can't labor get rolling? Here's why...
Tips and discussion
The art of the long labor involves helping a mother keep up her morale while addressing her body's needs for marathon activity. We can sooth the mother, especially helping her ease her busy mind or labor pain when we can.
It is important to address the reason for the long labor. When the issue is in the tissue there is something we can do. Tight muscles, tight ligaments -these can be relaxed with body work and things the mother can do herself or with help. Four specific techniques that are amazing.
While some posterior labors can go fast and finish with a flourish, others take days and finish with help. If you are experiencing (or anticipating) a posterior labor here are specific suggestions. Forget what you learned about the labor curve. Put on your hiking boots. You may have a walk in the park, but you may have just entered the "expert's trail."
Too often a swollen cervix sends birthing women to the operating room. Here's what to do about it.
Surgery or Nature? Women today are more often told that a cesarean is the safest option for them. Whether presented as an absolute or "as needed", the given reasons for a surgical birth, cesarean section, are becoming so common that it can be a challenge to discern whether or not the surgery is medically necessary for an individual person.