Research and references
Bibliography for Asynclitism
[Created for "The Tipping Point; Helping the Asynclitic Baby"]
Bibliography for Spinning Babies 2013
The books and articles on fetal positioning and maternal positioning. Send your favorites to gail at Spinning Babies dot comm
Its hard to tell baby's head position from a simple vaginal exam. The baby's skull is made up of portions of the skull that move and overlap somewhat. These are called "plates" and they have names. The borders between them are mobile and are called "sutures." Sutures lines are supposed to reveal fetal head position. Is it worth an ultrasound in a difficult labor?
These studies help show which babies may stay occiput posterior using modern university labor and delivery practices.
Finish researcher Gardberg has helped us understand the rates of occiput posterior and how often they rotate. We'll start with a 1998 Gardberg study here and I'll refer you over to the 2005 Lieberman study which finds similar rates, though reports it as new information. Both show that about 1/3 of babies that start OP stay OP. Again, we miss the rates of left occiput transverse (lateral) and right occiput transverse (lateral) and the route of rotation for these babies.
These are some of the studies on what women can do in labor to effect labor progress and outcome. More are needed. Please send the names and links of studies which you find important. Together we can make this a better article.
From João P Souza and his research team in Brazil.
This review and randomization analysis found walking and being upright to be safe. Two of the studies looked at really long labors and perhaps that is why, overall, the report doesn't show moving around shortened labor compared with laying around. Interventions in labor were common, so this isn't a study to show anything about natural labor per se.
2nd Stage or Pushing Stage
MidwifeInfo.com website has this to say about a study on vertical positions in the 2nd Stage:
Fewer abnormal fetal heart rate patterns 1 trial - OR 0.31, 95% CI 0.11 - 0.91).
(Citation: Gupta JK , Nikodem VC. Woman's position during second stage. Cochrane Library)
Nancy from MidwifeInfo says, "I find this evidence too compelling to be ignored by those of us involved in the care of laboring women. There have been varied hypotheses about the reasons for the advantages of non-recumbent positions, such as stronger and more effective uterine contractions (Caldeyro-Barcia 1960), and improved alignment of the fetus for passage through the pelvis (Gold 1950); and also lessened risk of aorto-caval compression and improved acid-base outcomes in the newborn (Ang 1969, Humphrey 1974, Scott 1963). Until recently in the history of childbearing, women would try to avoid the dorsal position and would change position during labor when and as she wished (Engelmann 1882). Different upright positions were achieved using posts, hammocks, furniture, ropes or knotted pieces of cloth, kneeling, crouching or squatting using bricks, stones, a pile of sand, or a birth stool (Englemann 1881). Today, most women deliver in a dorsal, semi-recumbent or lithotomy position. We all know that it is easier for the midwife to monitor the baby and see what is happening if the woman is in a dorsal or semi-recumbent position (yes, the ubiquitous semi-Fowler's position), and we know that this is the position modern Western women expect to assume to birth their babies (or, all too often, to be delivered of them). After all, the TV screen in the labor room is positioned so that the view is best from the semi-recumbent position in the bed, so women just naturally get into bed and slide down into that position. Then they stay there.
Nancy continues, "I would like to propose that we, as midwives, using the best available evidence, make a non-recumbent position the default position for second stage of labor, and use a recumbent position only for specific situations. Why don't we do this now? I would hazard that the reasons have more to do with habit, hospital protocols, fatigue or overwork (I am frequently too tired or too busy to try something different, even if it occurs to me that it might help) than with a conviction that the semi-Fowler's position is better. Even with an epidural, most women can sit in a chair, on a commode, or on a birthing ball next to the bed; or they can stand next to the bed and lean over it, with support from another person. Remembering the significant advantages of an upright position, I would like to challenge all of us to use this evidence to encourage our patients to sit, squat, kneel, or stand to push their babies out."
Thank you, Nancy. I'm sure the readers of SpinningBabies.com agree! Visit MidwifeInfo.com
Researcher Gupta also had this report published:
Woman's position during second stage of labour.
Which is better, being upright or lying down to push out a baby? This review of the Cochrane articles "suggest several possible benefits for upright posture, with the possibility of increased risk of blood loss > 500ml. Women should be encouraged to give birth in the position they find most comfortable. Until such time the benefits and risks of various delivery positions are estimated with greater certainty when methodologically stringent trials data are available, then women should be allowed to make informed choices about the birth positions in which they might wish to assume for delivery of their babies."
I wonder about increased blood loss. I think we should look at how much comes with the placental gush and then how much over the postpartum period before we decide. Sometimes when women lose more at birth they lose less in the days and weeks following birth. Watching blood loss within the next hour or two and making a comparison of blood loss would show us if this initial increased blood loss is significant.
The Fetal Occiput Posterior Position...
The occiput posterior position challenges every aspect of labor care. Trying to prevent OP fetal position, diagnosing the OP position, correcting the OP position, supporting labor and making decisions about what to do for labor, and the delivery itself. Mothers and babies outcomes are often worse with both physical and psychological trauma being more common than with fetal occiput anterior positions. Here Penny Simkin highlights nine common beliefs and shows which are myths. Gail comments afterwards.
The Spinning Babies approach is active, holistic, anecdotal, and grassroots. Evidence-based medicine is a coat rack upon which convention hangs. The rack isn't what the Obstetrician wears. If US maternity were evidence-based, we'd have a cesarean rate below 15%, breech babies would be allowed to be born, and there would be a doula in every birthing suite. My arms are open and waiting for grad students who want to take on some of the successful techniques shared at Spinning Babies. I'm just not going to wait for convention to catch up with me.
Scroll down (Read More) to see the list of articles and books contributing to the Spinning Babies view on breech position and breech birth. Click on these underlined words to begin downloading the Bibliography for Breech pdf. [Adobe Acrobat PDF - 99.22 KB] You will download the Breech Bibliography pdf. that is at the bottom of this page. Use Acrobat Reader to view this pdf. file once it is on your desktop. You can download the Adobe Acrobat Reader for free onto your computer to see this and other pdf. files.
A study published in Clinical Endocrinology finds evidence that low levels of the thyroid hormone called thyroxine may be associated with more posterior positioned babies. While the 3 Principles are often effective in correcting malposition, there are occasional women whose babies do not respond, or respond in the amount of time the mother has after finding out her baby is posterior. This may be helpful information. In addition, it may be helpful to have your thyroid levels checked in pregnancy. The New England Journal of Medicine suggests a type of iodine supplementation in pregnancy.
Will a mother going into a hands and knees position during late pregnancy help rotate her posterior baby? Many mothers advise each other to spend time on hands and knees each day. Pelvic rocking helps relieve a sore lower back. But will it help the posterior baby rotate before labor starts? Gail comments afterwards with her Spinning Babies point of view.
There are reasons that laying on your left side is helpful in pregnancy. Most women (but not all) will have a lower blood pressure while lying on their left side compared to when lying on their right side. But with fetal positioning will lying on one's left help the baby's back to come over to the left, too? Two articles help answer the question of whether you should try and sleep on your left side to help your baby turn anterior.
Researcher Aaron Caughey finds giving more time will reduce 400,000 cesareans a year. See the Nov. 18, 2008 Orgyn.com article called Patience after stall in labor advised. Read the research itself. Obstetrics and Gynecology 2008; 112: 1109-15 Perinatal Outcomes in the setting of active phase arrest in labor.
Ellice Lieberman’s 2005 research article on Fetal Position and Epidural Analgesia
Ellice Lieberman and her research colleagues looked at which came first, the posterior positioned baby or the epidural. In previous research studies it was somewhat unclear if women having epidural anesthesia (here called analgesia) were more likely to have a posterior baby or whether women with a posterior baby in labor were more likely to ask for an Epidural. While they tracked that question to an answer they observed multiple changes in fetal position at four times during labor.
Research article title: Changes in Fetal Position During Labor and Their Association With Epidural Analgesia.