The Long Labor that Wasn't
Leah and Jeff are allowing me to share their birth stories with you. They run a small town, Family Chiropractic practice together.
I was expecting a long, first labor. Nothing is certain until the fat baby sings. There was a time in labor when we midwives stepped in to address a stall in labor. Did those interventions save the mom hours of unnecessary laboring? We feel it did. See what you think when you read,The Long Labor That Wasn't Long After All!
Being a chiropractor means you are frequently beside your patient, leaning with a twist in your own torso. Maintaining this working position may be what caused Dr. Leah's own uterine ligaments to twist and tighten.
Her baby grew well, but lay in the womb twisted at an angle that put his forehead forward and his hips sideways. Right: Proud parents at 8 mos pregnant
Left: Photo of a doll in womb who is facing the front in the right occiput posterior position.
Leah's boy was somewhat like the drawing on the left but with his bottom further over on his mother's right side.
The drawing on the right, here, is a more ideal starting position for labor; the left occiput transverse (left occiput lateral) position.
The android (left) and gynecoid (right) pelvic shapes don't have to do with this story. I'm going to assume that Leah has a gynecoid pelvis, nice and round and roomy for having babies.
Leah ate an excellent diet. Homebirth midwifery care fit her lifestyle and beliefs about her body's ability and her baby's needs.
What concerned me even more than his posterior position was that his back and hips didn't shift around in the womb. Except for his hands and legs having a small range to stretch in, his position didn't alter for the last three months of pregnancy. His hips didn't shift, for instance, from the right one day to straight up and down another. His legs didn't change their placement, either, only to stretch a bit with a kick going to the same general place. When a baby is OP, I am more concerned when a baby seems held in place than by the OP position itself. I wanted Leah to work on relaxing her broad ligament and cervical ligaments to give more movement to the uterus itself and by so doing, to her baby.
She was a first time mother. She trusted birth and trusted bodies to do what was needed.
When I spoke about techniques she could do in labor to help her baby get onto her left, she looked at me with polite disinterest. She is very sweet. But I think Leah would agree that she didn't see what my point was. Babies come out was her point.
Leah was interested in coming to Dr. Carol Phillips' Craniosacral Therapy workshop to be a pregnancy model for the advanced CST students. Here is a photo of Leah doing an inversion on the stairs at that workshop (left). A student's hands brace her. She uses the stairs as an incline to allow more room for her uterus to hang from cervical ligaments. This is a variation of the Inversion. She is almost in an hands and knees position, but with hands three steps lower than her knees/
At home, she tried a few inversions. Her husband did a couple Webster Maneuvers. That is a technique known to help breech babies flip, but works to help posterior babies rotate, too. It does, at least, when the technique is done early in pregnancy enough to help the womb become symmetrical before labor. But Leah was a week or two away from her time. Leah tried at least one pelvic floor release in pregnancy. I had asked her to do one with me in her living room. With little emphasis, I explained it would be good to try out this technique before labor in case it proves useful to us. Her baby's position had me thinking that it very well could be needed during transition.
Leah's labor began at 7 am. Contractions got right down to business. Jeanne, her other midwife, and I arrived to find her already in the birthing tub moving freely, mostly on hands and knees. I remember thinking in the midmorning, if her baby were LOA, I would expect a baby by noon with her contraction strength. But since the baby is OP, even though there is no slowing of the labor at that point, nor back labor, I wouldn't be surprised by a delay as the head descends. So, maybe she'll birth about 3 pm, I thought. Of course, I didn't say a word of this out loud. Leah stayed in the birthing tub much of the day. She often leaned on the tub's edge, kneeling in almost a hands and knees position. Jeff videoed.
Image of birthing woman in deep round tub on her hands and knees. Her knees are significantly angled away from her belly and her feet are out of the water. HER Husband touches her feet.
Midway through labor, progress slowed down. It was actually about 3 pm. Transition seemed like it was trying to take hold, but couldn't. I say this based on her labor pattern, the labor strength and Leah's sounds. Neither of us midwives had done a vaginal exam yet.
Leah followed her instincts to open her pelvic brim with this unique open knee position in the tub. Her pubic bone is a bit further than her spine here than in regular hands and knees. See her knees heading away from her belly?
While Leah's unique movement helped some, progress stopped when the baby began to descend. Something made transition stall. I thought I knew what it was. A stall doesn't mean contractions stopped. The contractions continued, strong and persistent, but unable to accomplish what they meant to do -- bring the baby lower and finish opening the cervix.
We midwives waited another hour to give her baby time to make the needed adjustments. We didn't see the hoped for change: a surge in the labor pattern. First we consulted quietly. Leah was moving freely and snacking well, but we'd already watched labor slip from good progress over the afternoon.
It was nearing supper time when I asked Jeanne if she were comfortable with me trying some techniques. She said she too felt like it was time to step in. We both had a sense. Perhaps, we were remembering earlier transports with other first-time mothers. We could see that if we didn't do something we'd be going in for Pitiocin, perhaps even a cesarean.
Even though the hours of Leah's labor had not been long, the vaginal exam did reveal that the fit wasn't going to be easy. The labor pattern had changed course for a reason.
I chose a relaxation activity or two (The First Principle) for each area the baby was to descend through; the lower uterine segment (where the baby currently was), the sacrum and the pelvic floor.
For the lower uterine segment, I chose the rebozo followed by an inversion.
For the sacrum, I chose a sacral release.
For the pelvic floor I chose, you guessed it, the pelvic floor release.
Two of the exercises were intense for Leah to do at the same time as her contractions were trying to bring her into "transition phase." Her muscles were too tight and twisted to let the baby down. (This sounds alarming. I am sorry to use these words, but such was the case.) The contractions roared on, not willing to give up. She agreed to do the relaxation techniques with our help for three contractions between and/or during each activity.
I wish I had pictures of this time in labor to share, but really it wasn't the time to pull a camera out and point it at a mother going through this labor event. The calm and reassurance was an important contribution to Leah's being able to cope with the unexpected stall (for her it was unexpected, even for me a little after the morning's fast progress) and the learning curve and discomfort of the inversion and pelvic floor release.
# First, she had the Rebozo sifting and the sacral release (of the myofascia) to loosen the area at and above the pubic brim;
# Then we did the inversion to release the cervical ligaments that were tight and twisting the lower uterine segment. That took care of the midpelvis area. if she needed more, we could do lunges to help the baby descend past the ischial spines at "0" station, but she didn't end up needing that;
# Last, we asked her to lay on her side up on the firm edge of her bed and did the pelvic floor release. This was the hardest and probably the most effective. She lay on one side for three contractions and then switched to the other side for three contractions.
# Into the deep tub to relax and let the buoyancy take the place of gravity. The water was soothing as well.
Quite soon, Leah began to push. Pushing was more work than she had expected. She got out of the tub to push where Jeanne could keep a close eye on descent.
With great effort, Leah began to pushe out her 9 pound, 15 ounce (4508 grams), healthy, asynclitic, posterior boy.
This photo was taken during second stage in her bedroom.
Here are Ayden's pictures. The one on the left shows Ayden seconds old. He has a cone-head, molded to show his posterior presentation in birth. You can see the classic, posterior molding for an extended (deflexed) head. The photo on the right was taken at one day old. He is looking adoringly at his Dad's eyes (off image).
Two years later, Leah and Jeff called us back for their second birth.
We were delighted. Though Leah had had a little more body work, her husband was so busy moving them into a new office and closing on a new house that she hesitated to ask him for consistent body work for herself. It was the classic case of the care giver not taking time to get herself some care.
Leah glows in pregnancy. She is buoyant and healthy, joyful and optimistic. Again her baby grew to "Minnesota corn-fed" proportions. We knew she could get her baby out. We also knew the baby was posterior. This little guy, however, had more mobility that his older brother had. Though I mentioned the usefulness of bodywork, I tried to show a confident and relaxed attitude so as not to stir Leah's stress hormones.
In fact, as it was, I was unsure of her baby's position at Leah's last prenatal. His back was situated on her left side as if he were LOT, but when I felt his head, he faced either front or back, not the side. I thought he faced frontwards, but that would make his head at a 45 degree angle looking over his right shoulder to the front. That's more unusual compared to the more common looking back over the left shoulder. But he didn't seem low enough for his head to be OA. The sacral promontory would be pressing into his face if that were the case. Hmmm. Yet, I felt that I had palpated enough. I didn't realize I was feeling a lack of flexion. That would have explained his high station and the bump I felt of his occiput (back of his head).
I told the mom and midwife I was unsure which way he faced. Most OP babies on the mother's left had their backs a bit more towards the mother's back, settled into the mother's back left "corner," but not this child. His back was not in either of the more typical LOA or the LOP locations.
Leah kneels in labor tubLabor began at 3 am. Leah and Jeff's home was a long drive out of the cities. I arrived about 4:30. Leah and Jeff were in a familiar pose.
Labor moved right along. 15 minutes after I arrived Leah was feeling a little pushy. Just then, Jeanne came in, as if right on cue! The pushy feeling turned to spontaneous bearing down at 5 am. Leah moved and worked, labor was hard and fast. She coped bravely, beautifully. Her slender bones moving, making room for another hearty child.
The crowning took a few contractions. That always seems a little unusual to me when labor moves along lickety-split to pushing and then slows down. I thought about shoulders. Then the head moved out a little more. What was this? The shape was so unusual. My hands didn't know what to make of it and I couldn't see what I was feeling. My brain couldn't articulate in my sensory state of mind. Rather than a ball. A bar shape seemed to be emerging. Oh, it was clearly the head, but I couldn't think what made this horizontal shape. Leah's position made it impossible to see. My hands, not my eyes, perceived the shape of the coming head.
Then, in one contraction, the parietal bones and face were born.
There was the classic pause after the head. We don't mind the pause. It is a time for the shoulders to rotate to the oblique.
I noticed that the head was out well, no turtling. No sense that the shoulders wouldn't come readily with the next contraction. I caressed the head to wipe a bit of bloody show from the long blond hair. Wait. That's the back of the head I see. And Leah is still on her hands and knees.
The baby is posterior! I laugh in joy and mention it out loud. Just then the contraction begins and the shoulders emerge. The baby is out and I slip him forward under Leah's belly so that she can bring him up after she has lifted her shoulders up to a kneeling position.
River is born! Leah entranced with River
6 am- A 3-hour labor even with his brow presentation.
He is pink and vigorous.
The white vernix protecting his skin shows that he is not a bit overdue, like some posterior babies.
It wasn't until I saw him come up did I realize that the horizontal, rectangular shape my hands felt was his forehead. He came as a posterior brow presentation, at 10 pounds, 3 ounces / 4621 grams.
River's molding reduced so quickly River's molding changed so quickly. This picture at one day old shows a higher forehead than a newborn born crown first. A little egg sized bump at his hairline showed the leading bone (not visible).
Leah stayed in bed for two weeks and nursed both her boys, in tandem.
Don't worry, River didn't go hungry! Here he is tipping the scale at 12 pounds at one-month-old!
A healthy newborn; River tips the scale - quite literally -
It is so fun to watch the miracles of birth. Leah, Jeff, Ayden, River, Jeanne and I all hope to share a trust in the process of birth. Accepting a few moments of challenge is often exchanged by hours, days and years of blessings, as it was and will be for Leah and her family. Mothers are brave and dedicated. We do what we have to do. And find joy in the acceptance of the journey.
By the way, don't copy and use these pictures. They are private pictures, copyrighted by Maternity House Publishing and shared here with permission of the family. Be nice. Don't snatch them. I know its hard. They are so beautiful.