Weekend Movie: Mastering the Maneuvers

Okay, you really have to be a die-hard junkie to appreciate these two videos, but I found them to be very educational. Two maneuvers are known to help with shoulder dystocia, the difficult situation in which the baby's head has emerged yet the shoulder remains caught behind mom's pubic bone. One technique is the Gaskin maneuver, where mom turns over onto her hands and knees, named for the midwife of midwives, Ina May Gaskin. The other is the McRoberts maneuver, where the mother is supine, and her legs are flexed all the way back - think knees to ears, opening the pelvis as much as is possible on one's back.

Here's a 3D animation of this - it's REALLY short, blink and you'll miss it, but it shows exactly how this action works on mom's pelvis and the baby's shoulder.



With that in mind, watch this longer, real-life situation.



It seems clear to me that the change of position is the key thing here; in the video above, mom had already been on hands and knees, so the Gaskin maneuver is, well, moot. So McRoberts was perfect. On the other hand, if mom was in anything like lithotomy, switching to hands and knees a la Ina May could really do the trick.

The threat of cephalopelvic disproportion and thus risk of shoulder dystocia is a common scare tactic used to frighten women into unnecesareans. Whichever maneuver ends up being the appropriate one, what I love about the second video here is how clearly it demonstrates that, with a skilled care provider who is armed with the knowledge of these options, shoulder dystocia, while something to take very seriously and address swiftly, CAN be coped with. The midwife worked efficiently and confidently, and there was no sense of panic or dire emergency. I can't help but wonder how this would have turned out in a hospital setting.

Weekend at the Movies: Vive la difference!

The timing of this post I've been planning couldn't be better, what with the internet still abuzz and twitterpated from the birth streamed live by a woman named Lynsee just last night. But even earlier this week, a topic on Facebook was posited by Amy Romano: the great boon to the birth community that YouTube and other online video forums has been. We were all asked to share our favorite online birth videos, and there are a few absolutely incredible ones that are definitely my favorites (most notably the recent VBAC stories of Lindsey Meehleis and Alexandra Orchard, both of whom were so affected by their experiences that they became midwives themselves - truly transformative experiences in every way).

But the one that immediately sprang to mind for me was a black & white video that I had seen ages ago and tried to find again recently, to no avail. The film featured a blond woman, quite lovely, giving birth in a reclined but not supine position, alert yet relaxed, and best of all, looking absolutely, ecstatically amazed at what was happening! It's clear that she was watching herself in a mirror, and was totally enthralled and fascinated with her body and her baby, using her hands to feel what's going on, watching happily thrilled as the head crowns, rotates, and emerges. She pauses, in full, unpressured repose between contractions, no hollering to PUUUUSH or counting to freakin' 10, following only her own urges to push, including some pelvic shifting. It is astonishing to see, in a culture that focuses on the pain and angst and danger of birth - to see a woman filled with utter delight. The father (it seems clear) is guided through catching the baby himself, and when he brings it up to mom, the sheer, undiluted joy she expresses is equal parts infectious and touching.


(When you get to this video after you finish reading my waxings rhapsodical, take a moment: Can you envision what our birth culture would be like if THIS were the birth film they showed to the eighth grade health class?)

I had suspected YouTube might have removed it, and Ms. Unnecesarean confirmed this. Boo, hiss - I still have to give credit to YouTube for allowing so many birth videos, but it remains a bummer that they're censoring some. Luckily, the internet being what it is, I asked if anyone else might have seen this one, and might have any leads on other locations for it besides YouTube. Thanks to Amy's sizable following, someone procured it within MINUTES! I was floored and psyched - and I also got more than I bargained for.

The video I remembered is on there, starting at 3:40, and it's every bit as great as I remembered, but it's just one among 6 others in an 12 minute compilation - and all of the births offer something wonderful to witness. They are hospital births, but they are unlike pretty much any hospital birth I have ever seen (I imagine a birth with Dr. Wonderful or others in his rare, exotic species, would come pretty close). The women are mostly upright, many of them being supported in squats where their partners are acting as the birthing stool, and the doctors or midwives (my preschool level French couldn't distinguish this even if the audio were better quality) seemed engaged and positive, and largely hands-off. Young siblings are included in several of the births. Several fathers catch their babies with guidance, and one strips down nearly as much as his naked wife* (the mothers are all nude). Imagine an American hospital that encourages that much skin to skin not only with the mother, but the father, too. Imagine!

We get to see two perfectly vaginal, unhurried, relaxed births of twins. The first is a veritable feast. We start off with a gorgeous rotation shot at 1:06. As with most of the others, this one was extremely hands-off. Baby A lands softly on the towels, then a nurse gives the slightest possible bit of aid as the mother reaches down for the baby herself. Note: Meanwhile, no one is running around with instruments and towels and clamps and tables and suction bulbs. Daddy holds and talks to big sister about what she's seeing. Then Baby B backs into the world with absolutely zero sense of panic in the room, legs first and then rump, starting off with the same hands-off gentle landing that his predecessor got. (Speaking of, rather than being off getting weighed and measured and scrubbed, Baby A is simply being skin-to-skin on her chest, vernix and all.) Here the doctor, who we've barely seen up to this point, does step in with a little assistance as the head emerges - not yanking, but guiding the baby up in sort of a backward somersault. I'd be interested in seeing what people who attended the breech conference think of this maneuver - it seems gentle enough to my eye. Then Baby B, too, goes directly to the bosom. All this and we're 2 minutes and 10 seconds in! What a bounty.

The second twin birth, which follows the first, even takes place underwater. (I admit they had me biting my nails a bit on this, as they were quite leisurely in bringing the baby to the surface. I am all for not necessarily yanking the baby up as fast as possible, but this was just a bit too lackadaisical for me. Something between the two extremes would be my preference. Other thoughts? Please share.) Mom is the portrait of placidity.

And in the last video, though the birth itself was not a water birth, the baby is bathed in what I am assuming is a Leboyer bath shortly after birth - I have heard of (of course) but never actually seen this in practice before. I remember Peggy Vincent writing in "Baby Catcher" how Leboyer baths were a hot trend for a while among those families inclined to birth naturally, and how it was really mostly a headache for the nurses, trying to keep the water at the right temperature at the right time, and rarely went as smoothly as one hoped, with poor little ones squalling at the shock of a now-tepid bath. I can see how she would feel this way (though she appreciated how well-intentioned the idea was), and my impression is that the practice is basically obsolete today - but I can also see how this was part of the evolution towards birthing more gently, and I acknowledge its importance in that evolution.

I know, I know, quit yapping about it and show us the video already! Here's the thing, it's formatted so that I can't embed it here, and can't even directly link it, but the instructions are easy enough to follow. Go to this page, ignore all the other hospital videos on the page (or don't, but don't say I didn't warn you), and scroll down to #107. It looks like you may have to download this to Windows Media Player. If you don't have it, SRSLY, if you're interested enough in birth that you're reading this, it is worth it to install Windows Media to watch this. Get an upgrade if you have to, call Geek Squad, endure a tedious phone session with tech support, whatever you have to do. If it's not worth it, I hereby declare that I will pay you one million dollars**.

Laissez les bons temps roulez!

*If I recall correctly, this is also part of the Leboyer approach.
** Terms: one dollar a year for a million years.

Birthapalooza?

I mused about this on Facebook and Twitter briefly, but thought I might as well ponder it further here. How cool would it be to have a huge, real-life Birth Blogger's Bonanza? Less of a conference, more of a festival. Birthstock, perhaps. Or a Gathering of the (Birth) Blogs. Birtharoo? Burning Woman? Labor Coachella? Anyway.

I'm relatively new to the scene, though. Has it been done? Just blogs, and only birth & related peri-natal issues? I'm not talking a big formal BlogHer-like event, I imagine more of a raucous potluck (though with people traveling, I know that's not literally possible).

I dunno. I just love the birth & baby blogs I follow, and their devoted mistresses, so much. I think it would be amazing to get to meet them in person. *fantasizes*

Anticlimactic?

After a lot of buildup (don't say 'foreplay', Anne, don't do it, resist the temptation, resist . . .), having heard about it for many months with many rapturous reviews, I finally got to see "Orgasmic Birth" over the weekend.

If you haven't heard of it, it's a documentary on natural, or to be even more specific, undisturbed birth, going into the potential for ecstatic experiences during childbirth. Yes, you read that right, some women actually do have orgasms while giving birth. A small percentage, true, but it really can happen, and is more likely to happen when optimal support and minimal intervention take place. A lot of the physiological processes that take place during normal childbirth ARE similar to the processes that take place during sex, in fact. And encouraging the parents to engage in affectionate intimacy can, unsurprisingly, help the labor along. What gets the baby in, gets the baby out, as the great Ina Mae has noted.

The timing may have been off, though; throughout the film, I couldn't help thinking about the very recent Today Show piece and the wake of outrage it left in the birth advocate community (see the previous post for my own letter to the Today Show). Anyway, as a result, I found myself watching it through a skeptic's eye. One of the remarks in the Today piece that has inspired the most chagrin was the comment from a doctor, quoted by Andrew Goldman, that home birthers were seeking a "hedonistic experience". It seemed, to so many of us who made the decision based on research and much self-reflection, the most completely outlandish thing we had ever heard. Excuse me? HEDONISTIC? Are we on the same planet?

But there I was, watching a movie titled "Orgasmic Birth".

And I couldn't help thinking that maybe, just maybe, this is where the anonymous doctor got the idea. Now, it's not a BAD film, don't get me wrong, and contrary to the title, is hardly some birth fetish porno filled with scene after scene of women having orgasms. There's good information in there, and some really excellent commentary by experts. Christiane Northrup was absolutely wonderful, and Elizabeth Davis and Sarah Buckley were great too, along with many of the doctors and other professionals included in "The Business of Being Born".

But side by side with "The Business of Being Born", I think "Orgasmic Birth" is just not as strong a film. Mainly, I found it much less organized than "Business", and lacking the drive and flow that a narrative arc provides, and, more nitpickingly, lacking in humor and variety. I am most definitely part of the choir they're preaching to, no question. *I* get the point they're making. The fact that birth can be pleasurable in a way is a valid point, and one of the ways it is most relevant is in how the things that encourage pleasure are the very things that allow labor to function optimally. Yes yes yes. But I wonder what kind of an impression this film would give to a skeptic, an undecided mother, or even to someone opposed to home/natural/undisturbed birth altogether, to get back to my main point.

And I’m going to say it: One of my least favorite things about it is the title itself. A very common accusation from such opposing people is that women who are seeking an out-of-hospital birth are putting the birth "experience" above the safety of their child. Now, again, I get that they're trying to explain that the two do not have to be mutually exclusive, and that an ecstatic experience may be a by-product of such a supported, intimate birth, but through the skeptic's eye, I can see how the impression of "hedonism" might be given by the film.

Like I said, there are far fewer orgasms on display than you might think, and the emphasis isn't nearly as strong as the title suggests. If you already have a library of birth films going, this is definitely worth adding - especially for the "Birth By the Numbers" segment included in the special features. And, again, the contributions by Northrup and several others are worth the entire film - I particularly liked her comments on epidurals.

Scout's honor, when I first saw "The Business of Being Born", I remember saying (or at least thinking), "Now, if only Christiane Northrup had been included in the interviews, it would have been just about perfect." I wish I could edit my own pirated version of "The Business of Being Born", with Northrup's segments from "Orgasmic Birth" spliced in. Maybe a bit of Elizabeth Davis and Sarah Buckley's parts, too. Best of both worlds!


***

Two other notes on the Today Show piece: Ricki Lake and Abby Epstein have since weighed in with their own response. It's worth reading for their words alone, but in the comments I found a very interesting post by a woman who claims to know the couple whose tragic stillbirth was featured in the piece. She says:

The main reason that Riccardo and Catherine McKenzie decided to do that story was not to become anti-homebirth advocates, but to become pro-regulated out of hospital provider advocates . . . I will defend anyone who is worthy of defense but have to note that Catherine and I met as mothers who are in the slim majority- we lost our babies at home birth with , ahem, credentialed providers present . . .

They came forward in an attempt to continue to protect every mother and their partner that chooses home birth. Many perinatal organizations seems to be back peddling now- this organization is flinging mud on that one- is flinging mud and on and on it goes. Never forget please that on that day home birth did not lose a baby. A young couple lost a baby and that is what the story was supposed to be about- how if an out of hospital provider (any for that matter) is not practicing in compliance with the standards held by their peers, held by their profession, and as a matter bound by regulation that tragedy can strike. This was a tragic outcome on a day that was supposed to be joyful for this young couple.

Rather a different picture than the one painted by the Today Show, don't you think? I have mixed feelings about speculating on much beyond this, knowing that we're debating about a very real loss in an incredibly impersonal way, but I thought it was worth considering. If true, this does lend credence to the opinion that the couple's story was very much manipulated to fit the story's anti-homebirth agenda.

"Hi, my name is Anne, and I'm a Birth Junkie."

Everyone else: "Hi, Anne!"

I found this revealing If you _____, you might be a _______ list from Woman to Woman Childbirth Education (circuitously as usual, via Enjoy Birth's response in kind on her own blog). So I'll follow Enjoy Birth's cue with my own answers in bold:

You might be a Birth Junkie…

• if you blog about birth (more than just your own birth for historical purposes) or if your birth story is at least two pages long Check and check.
  
• if you failed math, but can quickly convert grams to pounds and ounces (approximately) Not quite there yet, but it's a goal. I did get my only D ever in math (that memorable report card was 4 A's and a D), so -partial credit?
  
• if you can say “vagina” in a sentence without blushing Oh please. Of course.
  
• if you can correctly use “os” in a sentence Are you kidding? I love the wizard of os! (Okay, that was horrible. Yes, I can. Ahem: The opening to the cervix is called the os. See?)
  
• if you can’t remember who won any gold medals for the US in the last Olympics, but you know US statistics for maternal and infant mortality, and the national C-section rate (bonus points if you know your local hospital(s) epidural, induction, and C-section rates) — if you’re not from the US, insert your own country Last I checked we were at a 31.8% national average c-section rate, and were about 27th on infant mortality (i.e. dead last in the industrialized world). Don't know the local rates at the moment. As for the Olympics, I heard something about some bong-smoker . . .
  
• if you can list the mother-friendly and baby-friendly guidelines from memory, and know which hospital in your area (if any) fulfills those goals Not totally from memory, but I could probably do a fill-in-the-blank. I do remember hearing that the local ones do NOT pass muster, sadly.
  
• if you can recite the midwifery model of care Well, I could pick it out of a lineup.
  
• if when you’re discussing something related to birth, you receive those polite but puzzled looks… right before your conversation partner moves away I totally recognize the glaze-over, usually shortly before the inching-away.
  
• if you see a circle about 4″ big, and you think “that’s fully dilated” I will now!
  
• if you have birth-related artwork somewhere in your house (includes placenta pictures and belly casts, etc.) This I do not, but I regret it.
  
• if you currently have or ever did have a placenta in your freezer I have one right this very moment. Plus a lotta breastmilk.
  
• if you have ever consumed placenta Nay, but next time, if there is one, I'd like to do the encapsulation thing. Chowing down on placenta chili is just a wee bit much for me, though I would consider it my doula honor to make it for a client! My veggie chili did get me onto the Food Network briefly, after all. (This is actually true.)
  
• if you have a model of a pelvis, uterus, or some other female organ Dang it, no, but I totally covet one.
  
• if you always keep honey sticks on hand It's already on my list for my doula bag. Plus my homemade "Larabars".
  
• if you’ve ever gone to the bookstore and hidden “What to Expect When You’re Expecting” (or some other similar non birth-junkie book) and replaced it with some pro natural-birth book Okay, I haven't actually *hidden" WTEWYE, but I have moved "Pushed" to more prominent spots. I HAVE hidden "Babywise" though. And I'd do it again! Though I now think placing little cards inside with the link to ezzo.info is probably the best bet. Making up those cards has been on my to-do list for a while.
  
• if other women get tired of telling you their birth stories before you get tired of hearing them Oh yeah. Especially on my favorite message boards.
  
• if you have a library (or would love to acquire one) of birth-related books and videos This I do.
  
• if you have 10 or more birth-related videos saved to your account on YouTube Not quite 10, but almost.
  
• if you appear on any YouTube (any internet) video talking about birth, in labor, or giving birth (picture montages count) Not really, though there is a picture of me looking exasperated in the birth tub out there in a few spots.
  
• if at least half of the blogs you regularly read are birth-related Oh, way more than half! It's either birth, cooking, or hilarious cakes gone wrong.
  
• if someone tells you she “had to have” a particular intervention and you can come up with several alternatives that were never mentioned to her (bonus points if she doesn’t get mad or defensive) I am not quite so bold yet. I'm very good at sharing that info if the mom is seeking it, though.
  
• if you refuse to play the “my birth was worse than your birth” game Totally.
  
• if you feel like you know your fellow online birth junkies (even though you’ve never actually met them) better than you know some of your flesh-and-blood friends A few of them, fer sher.
  
• if ten or more of your Facebook friends (or other equivalent) are people you’ve never actually met but know them through birth-related functions (blogs, email lists, etc.) Again, not quite 10, but getting up there.
  
• if you’ve ever gone to a birth conference I can dream, can't I?
  
• if you’ve ever emailed, mailed or called your state or national representatives about a birth-related matter YES!
  
• if someone tells you her baby is breech and you give her names (bonus points if you know phone numbers) of chiropractors skilled in the Webster technique or people who can perform moxibustion I have, once so far! once I start work, I'll always know the best for both in whatever are I'm in. I'd add the best IBCLC to that referenc list too.
  
• if you know what counterpressure is and how to apply it (bonus points if you’ve done it) Check! *cracks my LMT knuckles*
  
• if you know what a rebozo is (bonus points if you’ve used one) I do, though I've not used one in labor yet. I was wondering recently if I could use my un-ringed Maya Wrap for this.
  
• if you encourage your children, especially young children, to watch birth videos When she gets old enough to understand what she's seeing (she's 15 months), you better believe it.
  
• if you can get hoarse from watching TV birth shows (like A Baby Story), because you’re yelling through the screen at the woman or her care providers Oh. I'm like a soccer hooligan. Shameful really.
  

And finally

• if you regularly read this blog, you know you’re a birth junkie! Ta-dah!

• 
  

Try it yourself! And remember, admitting you have a problem is always the first step. Keep coming back - it works if you work it.