I have had the privilege of working with a number of wonderful midwives in the last years during my midwifery training. Among the many things that I have learned, I hear one of Valerie El Halta’s sentences running through my head at births. Val teaches the difference between an intervention and an intercession (which I have discussed in a previous blog), discusses how to help prevent posterior babies, and then teaches, “If there is no progress with good contractions, it is most likely head position. Try a few things [repositioning the woman, walking steps, etc.] and see if they work. If not, be a midwife — fix it!”
There are many suggestions which help prevent babies from presenting in an unfavorable position, as you know from reading other blogs of mine ( and from checking out the website Spinning Babies). And remember: you don’t need to sleep on your left side every night – in fact, I discourage this for a variety of reasons; sleep however you like to sleep and in whatever position you are most comfortable. But once labor begins, the character of that labor often gives a number of hints that a baby is not in a favorable position (not only back pain, but labors in which the contractions/surges are coming very fast and furiously, but only lasting twenty or so seconds, peaking quickly but with little or no dilation). With many of the woman that I have been with who are not progressing, I have – with the woman’s awareness, permission and cooperation “gone in and fixed it.” Some of the babies were posterior – others were transverse or asynclitic. It is important to adjust the head before the woman gets “stuck” – and squatting, while occasionally useful, can actually commit the baby to that “stuck” position. You do not wait, Valerie tells us (since most doctors don’t think you can turn a baby’s head until the woman is very well dilated – but in fact, the woman is usually off to the OR for a section long before that). You can adjust or turn the head at 3-4 cm, saving the woman a long and arduous labor. ” What do you think suture lines and fontanelles are for?” she asks in her wonderful workshops: “They are God’s directional signals for midwives!” – as the fontanelle in the front of babies’ heads are large diamonds and the fontanelle in the back are small diamonds. Several of these women were women who had been in the hospital with their first babies and had ended up with pitocin and an epidural – or a cesarean – for that ole’ stand-by -“failure to progress.” With their subsequent babies, also presenting in unfavorable positions, as soon as the head was adjusted, the labor took off, and the baby was born.
After I began midwifing, I was still occasionally attended births in the hospital as a doula. Of course I was not permitted to examine the woman or adjust the head position in these situations. More than once, I pleaded with the midwife on call to make the adjustment – but I was brusquely told that they had never heard of doing such a thing and that it would be too dangerous to try. (Cesareans are pretty dangerous and uncomfortable, too, you know…..) I would not assist with the adjustment at home for a couple who was birthing in the hospital, and it was painful to know that I had learned a technique which may have made all the difference in the world for that couple.
Midwifery Today published the article by Valerie a while ago that presents very clear instructions on how to turn the baby’s head. IT WORKS. It is now online – “Posterior Labor: A Pain the Back.” The MT website also has the addendum to the article I wrote alongside “A Butcher’s Dozen” entitled “Heading in the Right Direction” – once you are on the Midwifery Today link scroll all the way to the bottom of “A Butcher’s Dozen” to view the addendum.) Making sure that babies are correctly positioned is important – visualization, chiropractic, acupuncture, relaxation, talking-to-the-baby, pulsatilla (for assisting the turn) and gelsemium (for lips and rings) and other herbs, as examples, all have their place in doing so.
At one of the last hospital labors I ever attended as a doula, when the doctor announced that it was time for cesarean, to “get this kiddo out,” the couple asked for a few minutes to talk privately. They asked that I stay in the room and asked what I thought. The woman had been at seven centimeters for hours without progress. I told them that they had hired me to assist them with a natural birth, and that I was absolutely convinced that they could do this – as long as the baby’s head was lined up well. I told them that in other cultures there is no pitocin or epidurals – women do not have these as options – and yet they have their babies. I reminded them that we are mammals – and that mammals have their babies. I told them that I had unwavering faith in a woman’s body’s ability to give birth. This was a couple who owned a yoga studio – they were so healthy and had wanted a natural birth so much (there is nothing natural at all about hospital births, unless the woman arrives and pushes her baby out… then again, what is natural about having to get into a car at nine centimeters and having to endure bright lights in the middle of the night) and although I had made a policy not to turn any of the babies of my labor support clients, I could not bear that this beautiful woman who had committed herself to teaching others about well-being and relaxation would be yet another woman with a scar on her belly. Before the doctor came back into the room I had her get into the polar bear position (breasts on the bed and bum way up in the air with an arch in the back) and adjusted the baby’s head. The baby was cooperative with the head now able to help out, I actually felt the cervix open to ten immediately – what a thrill – with my hand still inside. When the doctor returned, the woman was pushing ( we were never certain if she was excited, stunned, or disappointed….). Less than an hour later, the baby was born.
Another lovely couple had hired me to be their doula and had selected a midwifery service at the hospital. The midwife had done what she could to help this mother move past six centimeters. The shifts were changing, and the midwife told the couple that the next midwife coming on call would be discussing the possibility of a cesarean with them. When that next midwife came in, she took one look at me and said, ” I know you!” I asked her how she knew me, and she said she had heard me speak at a Midwifery Today Conference in Oregon a few years’ earlier. I asked her if she liked what I ‘d had to say. She responded that she’d found my talk “interesting.”
“Did you hear the part when I talked about having to adjust posterior babies?” I asked her. Yes, she had.
The laboring mother was tired and getting discouraged. The dad was wrung out and getting scared. The pitocin and epidural which were not part of their heart’s desire for this birth were beginning to look mighty appealing. I told the hospital midwife that it was clear that this baby’s head was not properly aligned, not well-applied well to the cervix and not helping with dilation — that this was one of those situations when adjusting the head would be a major help in reducing the chances for major surgery. She said that she had never done an adjustment asked if I would show her how to do it. We worked with the laboring mother, helping to keep her relaxed and giving her hope that this might “do the trick.” It did, in fact, and her nine pound baby was born without augmentation. It had been fifteen years since she had had a baby – the last birth had been a horror show with a “stuck” baby and a resulting forceps delivery – she was now 43 years old.
Not all of the babies I have attempt
ed to turn have done so, but the many who did, well, it made all the difference in the world.