May 27, 2015
Volume 17, Issue 11
Midwifery Today E-News
“The Pelvis”
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In This Week’s Issue



Germany conferenceCome to Germany this October!

Plan now to attend our conference in Bad Wildbad, Germany, October 2015. You’ll learn from teachers such as Robin Lim (pictured), Elizabeth Davis, Cornelia Enning, Gail Hart, Fernando Molina, Sister MorningStar and Michel Odent. Choose from a wide variety of classes, including Breech, Mexican Techniques, Shoulder Dystocia, Birth Positions and Organic Midwifery.

Learn more about the Bad Wildbad, Germany, conference.



Quote of the Week

To lose confidence in one’s body is to lose confidence in oneself.

Simone de Beauvoir


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The Art of Midwifery

One of the midwife “tricks” that we were taught was to ask the mother’s shoe size. If the mother wore size five or more shoes, the theory went that her pelvis would be ample. Well, 98% of women take over size five shoes so this was a good theory that gave me confidence in women’s bodies for a number of years. Then I had a client who came to me at eight months pregnant seeking a home waterbirth…. She was Greek and loved doing gymnastics. Her 18-year-old body glowed with good heath, and I felt lucky to have her in my practice until I asked the shoe size questions. She took size two shoes…. I thought briefly of refreshing my rusting pelvimetry skills, but then I reconsidered. I would not lay this small pelvis trip on her. I would be vigilant at her birth and act if the birth seemed obstructed in an unusual way, but I would not make a self-fulfilling prophecy. She gave birth to a 7 lb girl and only pushed about twelve times. She gave birth in a water tub sitting on the lap of her young lover and the scene reminded me of Blue Lagoon with Brooke Shields—it was so sexy. So that pelvis ended the shoe size theory for me.

Gloria Lemay
Excerpted from “Pelvises I Have Known and Loved,” Midwifery Today, Issue 50
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Editor’s Corner

Midwifery Today Around the Globe

Midwifery Today has always been concerned with changing birth practices internationally as well as at home in the US. From our first magazine issue, we have highlighted birth and midwifery from around the world. Every woman and baby deserves the best possible pregnancy, birth and first years no matter where they live. There is no country that fully embraces this truth, although some do more than others.

To carry out our beliefs during our 29 years of publishing, we have had international articles in each issue of Midwifery Today. We even started a separate publication, International Midwife, which we published for a few years.

We have done approximately 75 conferences, many of which were held in different countries, such as China, Japan, Jamaica, Costa Rica, Mexico, the Bahamas, Australia and all over Europe, with many more planned. We hope you will join us for one!

The goal for each international conference is to bring the best ideas and information delivered by excellent teachers. We also hope that each and every registrant is inspired to fan the flame of midwifery and keep it burning brightly. Then, hopefully, each attendee goes back to their country and spheres of influence to bring lasting change.

Midwifery Today magazine is now being translated into Chinese by a native Chinese midwife. Our hope is that our magazine will bring changes to China, where so many of the world’s babies are born! Coming this fall will be a digital Spanish edition of Midwifery Today translated by my friend and colleague Eva Darias. As the magazine is already being translated into Russian, this means Midwifery Today will be in four of the most-spoken languages!

— Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

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Conference Chatter

2015 Germany Conference

From herbs and homeopathy with Lisa Goldstein to Spinning Babies with Gail Tully, the 2015 Midwifery Today conference in Bad Wildbad, Germany, promises to be our most enlightening and informative yet. Join Michel Odent, a leader in childbirth for over 60 years, for a full day of questions and answers on topics that concern you. Or watch and listen as the very skilled Angelina Martinez Miranda discusses positioning, remedies, techniques and customs from Mexico. Involve yourself in the magical process from conception to delivery with Fernando Molina and help a mother reconnect with her inner wisdom.

Register before 8 June to take advantage of the best discounts, and join our new Facebook group just for those who are going (or want to go) to Germany.

— Misha Hogan, conference coordinator

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Featured Article

Pelvic Trauma in Childbirth

How the body goes about getting a baby out is an extremely amazing feat. Seems downright impossible if you look at the size of a newborn baby and the size of the pelvis, especially the vaginal opening. What does make it possible is the way both the baby’s head and the mom’s pelvis are able to shift their sizes. The fetus’s cranial bones overlap to make it smaller, and the pelvic inlet and outlet are made larger by the movement of the pelvic bones as the baby passes through.

Most of the time in an uncomplicated birth this process goes about smoothly. However, if the pelvic bones aren’t able to move normally, then dysfunction can occur in the pelvis and the baby’s head gets greater than normal pressures on it as well.

The biggest issue I encounter in working with postpartum women is the lasting effect of abnormal tension in the ischial bones. These bones are not commonly addressed in standard postpartum care. The lasting effects on women with ischial dysfunction could be low back and hip pain, pelvic floor muscle weakness, prolapsing of pelvic organs and painful intercourse.

Our pelvis looks like one continuous ring of bone, yet different parts of the pelvis have different names. The pelvis is comprised of two big ilial bones, which are the broad, elephant ear-shaped bones that connect on either side of the sacrum in the back. This area of connection, where you see little dimples in the low back area on some people, is called the sacroiliac joint. If you were to put your hands on your hips at your waist, you have contact with the top portion of these ilial bones. When you slide your hands down the outside edge of these bones towards the midline of your body, where your buttocks connect into your upper thigh, this is the area where your ischia are located. When you sit down on a chair, the pelvic bones in contact with the chair are your ischial bones. In the picture of the pelvis, the ischial bones are that part of the pelvis that has a hole in the middle. The lower part of the ring of ischial bone goes forward to connect to your pubic bone that sits low in the front of your body, in the middle of your two groin areas. The bone leading from the ischia to your pubic bone is called your pubic rami.

During the first stages of labor, the upper part of the pelvis needs to widen to allow the baby’s head to enter into the pelvis. To do this, the top portion of the sacrum needs to move backwards while the lower part of the sacrum, the tailbone area, moves forward. This is called sacral counternutation. In the later stages of labor, the opposite sacral motion, nutation, needs to occur where the tailbone moves backwards, while at the same time the ischial bones widen out to the side. It is during the last part of labor as the baby is coming out that pressure may be exerted more on one side of the ischium than the other.

As a physical therapist, I understand the mechanics of the joints and muscles and what needs to happen for childbirth. Adding to that knowledge is a skill I have developed to be able to sense or feel what the tissues and bones have gone through during a birth or an injury.

As I have worked on postpartum women, I have felt many pelvic floors where the tissues are still twisting a bit from the baby’s head rotating to come out. The pelvis may be a bit twisted or rotated as well. Many times the baby’s head has contacted one ischium more than the other. Most of the time that ischium is still splaying out to the side more than it should be. Sometimes both ischia are still in that splaying-out position and need help coming back into midline again.

Lynn Schulte-Leech
Excerpted from “Pelvic Trauma in Childbirth,” Midwifery Today, Issue 104
View table of contents / Order the back issue


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Website Update

Read this article excerpt from Midwifery Today magazine, now on our website:

  • Crossing Borders with Andrea—by Sister MorningStar

    Excerpt: Andrea called me at my home in the US, and we discussed her experiences, her past, her feelings, the doctor’s actions and statements, Andrea’s desires, needs, people resources and her instinctual knowing. Andrea’s expected due date was November 24 and it was November 29 when she called me again. She spoke of her confusion with the medical way with birth and her own instinct that it should be a natural straightforward event. Fear dominated the birth stories that circled around her. “Every time I interact with the medical people, I become filled with fear. Otherwise, I feel calm.” Andrea decided to keep waiting.


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Birth Q&A

Q: Do you use pelvimetry? If so, when and why or why not?

— Midwifery Today

A: Nope. Baby will either come out or it won’t. We can figure that out by laboring.

— Cheryl Gates

A: Nope. It does not tell us what the baby or pelvis will do in labor and during birth. Pointless and adds another element of fear to the process.

— Lisa Sulffridge

A: I wish I did. I met a postnatal mama this week who had been encouraged to go for a VBAC. She ended up with another emergency c-section. She told me her first baby never engaged; once she was kicked in the pelvis by a horse. It would have been nice to at least offer pelvimetry for this woman the first time around, not to mention the second time round. I know it’s seen as old-fashioned, and here in the UK it’s classed as an old science. Personally, I’d like to have those skills for special circumstances, not routine.

— Anouk Lloyd

A: Our practice offers this at 40 weeks as part of a vaginal exam; women can always decline. We wait till then so that we can assess the pelvis “when it matters” at the end of pregnancy when the pelvis has made the accommodations to pregnancy and had the full effect of the hormone relaxin. I don’t think that I would ever tell a woman that she should not try for vaginal birth based on the findings, unless it was pretty extreme. But it can be helpful to note pelvic shape to anticipate potential issues at birth. In CNM school, this was a required skill.

— Aubre Tompkins

A: I’ve offered suggestions to women of positions that allowed her to move the baby past a problem area based on pelvimetry. A coccyx that’s curved too deeply into the birth canal might have to break to allow the head by—usually a coccyx that was broken in the past. Whatever knowledge is gained should never be used to instill fear in anyone, including the birthing woman and the provider. I agree there are so many variables. Pelvimetry is not a panacea, just information.

— Kathy Berry


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