August 5, 2015
Volume 17, Issue 16
Midwifery Today E-News
“Posterior Birth”
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In How Will I Be Born? Jean Sutton explains the principles of optimal fetal positioning in a clear and straightforward manner. Written for expectant parents, this book is packed with helpful advice and information, including an informative chapter on posterior position. A must-read for all pregnant moms and a book for the practitioner’s lending library. To order



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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 Elizabeth Davis (pictured), Robin Lim, Cornelia Enning, Gail Hart, Fernando Molina and Sister MorningStar. 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.



Harrisburg conferencePlan now to attend our conference in Harrisburg, Pennsylvania, next April!

“Honoring Our Past, Embracing Our Future” is the theme. April 6–10, 2016, are the dates. Planned speakers include Eneyda Spradlin-Ramos (pictured), Michel Odent, Elaine Stillerman and Carol Gautschi.

Learn more about the Harrisburg, Pennsylvania, conference.



Quote of the Week

An arrow can only be shot by pulling it backward. So when life is dragging you back with difficulties, it means that it is going to launch you into something great.

Unknown


The Art of Midwifery

I believe that all women go through pregnancy, labor and birth with their minds, hearts and vaginas. I needed all three for my pregnancies, labors and births. I used to be more concerned with a posterior position than with a breech position because where I help women give birth, they are more fearful with a posterior baby than a breech baby. I realized I needed to look at a posterior position baby the same way I did as the breech baby. I ask myself the same type of questions. Is this a first-time mom? Or, what number of baby is this for this woman? What birthing position(s) were her other babies in during the pregnancy, labor and birth? Why is she fearful of a posterior baby? Who was her birth helper and how did this person feel about her baby’s position? If this woman had a difficult or posterior labor and birth before, what did her birth helper say or do, and, most importantly, how did the birth helper verbally and physically respond to the baby’s position? Ask the woman to share her story of her posterior pregnancy, labor and birth; her thoughts and words are very important. They are her perspective and they can be “colored” by her birth helper’s own fear of a baby’s position.

Mary Cooper
Excerpted from “Posterior Births and Babies,” Midwifery Today, Issue 114
View table of contents / Order the back issue
Meet Mary Cooper at our conference in Harrisburg, Pennsylvania, next April.


ALL BIRTH PRACTITIONERS: The techniques you’ve perfected over months and years of practice are valuable lessons for others to learn. Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.


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Editor’s Corner

Posterior Babies

I wonder if the incidence of posterior position during labor is more common now than in the past. Some people believe that the way we sit, our inactivity and our overall lifestyles might be causing a greater incidence of posterior babies, but I am not sure if that is so. I don’t remember posterior babies giving me and my midwifery partner many problems when I was actively practicing. We would expect a long labor if a baby didn’t turn OA, but we did still expect them to come out. I wonder if all the negative attention that is paid to posterior positioning might be causing some of the issues for mom, but again, I really don’t know.

One of the techniques we have taught at Midwifery Today conferences is Valerie El Halta’s technique of getting in a hands-and-knees position and then dropping the chest to the floor (so the butt is up in the air). Have mom do this for about 10 minutes, rest and then repeat. This gives the head a chance to possibly disengage and reposition more favorably. Some babies need to come out posterior to fit through the pelvis, though.

“Posterior” has been a theme in Midwifery Today magazine twice now and we have some excellent articles on the topic. Our most recent issue (114) is on this theme and it contains articles on posterior position by Gail Tully, Elizabeth Davis, Lisa Goldstein, Diane Goslin and many more. Issue # 76 was also on posterior and it has some great articles by Michel Odent, Valerie El Halta, and Marion Toepke-McLean, as well as a great section on “Tricks for Turning Posterior.” These issues are available from Midwifery Today’s website. Don’t forget to subscribe!

— 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

Posterior babies—oh, the pain they can cause a mom in labor. Diane Goslin is a CPM who has delivered over 7000 babies since 1980. She primarily serves in rural and predominately Amish communities. She says that sometimes posterior babies aren’t a problem at all.

“It can be considered a problem to labor with a posterior baby, but it isn’t always! I have had moms without complaint give birth to a posterior baby and be surprised when baby came out looking up at them! However, mom may complain of more back pain, and labor may take a bit or a lot longer (but how do we really know?). Baby’s face may be a bit swollen or even bruised. The baby’s face is coming past the bony pelvis and is not as effective in pushing through as well as a flexed head with crown (occiput). I have only transported to the hospital one posterior-lying baby in 33 years.”

Meet Diane Goslin at our Harrisburg, Pennsylvania, conference next April and learn more about posterior positioning, breech birth and her amazing experiences.

— Misha Hogan, conference coordinator

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Featured Article

Posterior Perspective

“Don’t worry; you’ve still got plenty of time for your baby to turn.”

A woman’s subjective experience of her pregnancy is important to the midwife. With so many negative birth stories and comments bombarding mothers today, the last thing a midwife wants is for the pregnant mother in her care to be stressed by what’s spoken in the midwife’s own space.

Consciousness of the sacredness of the birth story is a gift of midwifery. An emerging story pours through women’s pregnancies. The pregnant woman’s story folds into our midwifery story, raising our world with the yeast of empowered birthing women. Belief in her ability and the natural unfolding of birth is the bread of birthing. Joy, confidence, bonding with her baby—these are all desirable states to rise in.

Sylvia said, “I didn’t know until she came out, and then when they told me how she came out [posterior and with her hands above her head] I was kind of pleased! Labor was well over 48 hours and I pushed for 3 hours. It was a homebirth.” Stories like Sylvia’s reassure those midwives wanting to protect the mother from over-concern about her baby’s position. We’ve all seen short, fast posterior labors with an alert baby slipping out.

Other equally thoughtful midwives feel their role is to inform mothers when they discover a posterior presentation and support the mother’s choice with what to do with the information. Does the midwife tell the mother or doesn’t she? Perhaps the midwife wonders if the implications of posterior presentation dampen the sweet bread of pre-labor innocence. Does a midwife’s choice to avoid naming the posterior position ensure positive states for the mother? A midwife may feel unkind or unwise to acknowledge that, for some women, a posterior labor may include a longer labor, more discomfort, sometimes as back labor, or a higher potential of departure from the original expectations of a natural childbirth. If the midwife had a more positive way to suggest proactive preparation, she may be more apt to include the mother in decision making for her baby’s current position. A posterior-presenting head has the forehead at the mother’s pubic bone. The occiput at the back of baby’s head is in the mother’s back or posterior. Sometimes baby’s head overlaps the brim of the anterior pelvis preventing engagement, fetal rotation and descent, which are key cardinal movements.

Gail Tully
Excerpted from “Posterior Perspective,” Midwifery Today, Issue 114
View table of contents / Order the back issue


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What is Midwifery Today magazine?
A 72-page quarterly print publication filled with in-depth articles, birth stories from around the world, stunning birth photography, news, reviews and more. Subscribe. Midwifery Today Magazine

Enjoy the wisdom and knowledge of our Germany conference teachers

You can now purchase a portable USB drive with MP3s of selected classes from the 2012 Germany conference. You will receive most classes from the two-day Midwifery Skills sessions, as well as several others. Teachers include Elizabeth Davis, Gail Hart, Carol Gautschi, Lisa Goldstein and Gail Tully. To order

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The Hemorrhage Handbook is filled with great stories told by expert midwives that give you superb insight into bleeding problems that may occur during the prenatal period, during the birth or postpartum. Topics include the importance of good nutrition, how the bloodstream works, herbs to use, emotional factors and Chinese remedies. Buy the book.



Website Update

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

  • Global Birth Models—by Kay Sandberg and Shane Carnahan

    Excerpt: We have chosen five key factors that cut across all projects featured. All of these key ingredients are aimed at reducing maternal and neonatal mortality rates. In order to fully grasp the “secret sauce” of each model, the five factors combined with other innovative aspects will paint a picture of what has been effective and why. 1) Sustainability—the ability to meet basic commitments and needs on an ongoing basis for the communities in which they work. Note that the ability to be self-sustaining is a goal of some projects and a fulfilled promise for others at this point in time.


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Birth Q&A

Q: What are your thoughts on posterior babies?

— Midwifery Today

A: Let’s make room for the baby…which is to say, let’s add body balance to release the innate design of pregnancy and birth, and soften the path while toning the structures that help fetal position and flexion. The baby will be able to rotate as long as the shape of the inlet allows, and an inversion with “shaking the apple tree” will help those for whom the inlet or the cervical ligaments are less optimal.

— Gail Tully

A: Have the mom lie on her left side and shove a large peanut ball between her legs. It is very hard on momma, but I have gotten babies to turn with 3 to 7 contractions.

— Heidi Basford Kerkhof

A: Most of the time, a baby who “gets stuck” is transverse arrest, not OP. But OP gets the blame because some of these kids were trying to turn to anterior from an original OP position. If it were possible to wait a bit longer, the great majority of those babies will finish the turn to anterior or might turn back to posterior to be born. But modern obstetrics doesn’t give most women enough time.

— Gail Hart

A: I welcome them. They don’t seem to create much of a problem if the mom just stays upright and active during labor. Should she experience severe back pain during descent, a rebozo can help. The advice shared on the Spinning Babies website is perfect. Honestly, most of the time these babies come out, surprising me, by being posterior, but usually only if mom is given a hands-off labor with no vaginal checks.

— Marlene Gryesten

A: For a posterior baby, keep mom in positions that allow her pelvis to move freely. Most posterior babies can be born just fine as long as that happens.

— Pamela Golliet


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