An excerpt of this article was published in
The National Childbirth Trust (NCT) magazine in June 2015.
‘I turned my back-to-back baby and regulated my own contractions to avoid induction and cesarean section – most British midwives don’t know how to do what I did – #MakeBirthEasierCampaignUK aims to change that.’
Mum-To-Be Voyage of Medical Discovery
As an expectant first time mum I, like many other first-time mums-to-be, spent a lot of time doing research into all things related to pregnancy, labour and babies. Firstly I found an article on hypnobirthing in the newspaper. Then through my hypnobirthing teacher, it was in the last few weeks of my pregnancy that I discovered the website SpinningBabies.com which extends the concepts of optimal fetal positioning through non-invasive maternal postures and positioning during pregnancy and labour. Like a lot of expectant mums, I was hoping for a vaginal birth without medical intervention and the suggestion that simply through exercises and positional techniques, I could potentially find solutions for a range of possible complications in labour was fascinating.
Spinning Babies is a project by Gail Tulley, an American midwife. The website teaches exercises and positional techniques for helping to prevent fetal malposition or malpresentation in pregnancy or, for use during labour, if there is no progress or contractions are erratic, slow down or stop. Even reducing back or hip pain in labour. Techniques can encourage the rotation of transverse, breech and back-to-back babies and can even help the baby to engage.
A labour which is slow to progress, or contractions that slow down or stall can commonly be signs of a malpositioned or malpresented baby. While breech and back-to-back (medically known as Occiput Posterior or OP) are the most well known malpresentation and malposition respectively, there are all sorts of funny or awkward positions babies can get into in the womb. Often, if you can create a little bit more space for your baby to move by balancing the uterus and balancing/releasing the pelvic floor muscles / ligaments, your baby may be able to manoeuvre to align the smallest part of its head correctly with your pelvis/cervix and your labour may progress more smoothly and without delays. Gail Tulley has used and taught this range of techniques for many years, many of which come from chiropractic techniques.
The more I read on the Spinning Babies website, the more I was amazed. Something as simple as the baby’s head being tilted to the side slightly (asynclitism), or its chin not tucked to its chest (flexion), can add several hours and much effort to a labour. Very long labours can lead to mum or baby becoming tired or distressed which can often result in intervention, assisted delivery or caesarean section. This range of techniques can resolve many of these issues, so I decided to study the techniques section of the website in depth and used several exercises with, in my opinion, dramatic effect on both my labours.
My Incredible Births
My first baby struggled to engage in my pelvis for weeks without success, moving back up within 12-24 hours of engaging. I looked at exercises on SpinningBabies.com, in particular the ‘Side Lying Release’ (or ‘Pelvic Floor Release’), which relaxes and balances pelvic floor muscles and ligaments. I had a very strong pelvic floor from years of exercise and it’s probable that a lot of time spent slouching at desks, driving, carrying a bag on one shoulder, and crossing my legs had created imbalances in my uterus which, combined with my strong pelvic floor muscles, had reduced space in my pelvis and was hindering my daughter’s progress even before labour had started!
My first labour began with regular but weak, short contractions and no progress. My contractions were not getting longer, stronger or more frequent. I asked my husband to help me with some Spinning Babies exercises. We performed the ‘Rebozo’ exercise followed by the ‘Side Lying Release’. I was glad to have practiced this second one during the week before labour as it can be a little disconcerting and awkward on the first try! I have since discovered that if the instructions are not followed exactly, for the ‘Side Lying Release’ in particular, the exercise doesn’t have much effect so I am very glad I paid such attention to the detailed instructions on the website! Within a couple of contractions after completing the ‘Side Lying Release’ my stagnant labour transformed into full active flow. Instead of having a long, slow and tiring labour, suddenly I was in established labour with very strong, efficient surges, close together and lasting over 60 seconds. Exactly what I had hoped for! I went on to hypnobirth my little girl at my nearest Birthing Centre in the birth pool, without any drugs or intervention of any kind.
My second labour was very different. I had stop-start contractions for a week or so. They started every time I marched up nearby hills and, erratic as they were, they stopped during the evening or overnight. I guessed this was because my little boy was back-to-back in the final two weeks of pregnancy after months of being well positioned. I had planned a homebirth as statistically second births at home are at least as safe as the hospital and have less intervention, but I was still uneasy about the prospect of a home birth with a back-to-back baby. At 40 weeks +12 days, having an induction booked for 7am, I was nevertheless determined I wasn’t going to give in to a medicated start to labour without doing everything I could to avoid it. Introducing any one intervention can often lead to more interventions (this is known as the cascade of interventions) and I wanted a medically unassisted vaginal birth. So at 11pm the night before induction was due, I went out stomping up and down hills again at such speed that my husband had to ‘keep up’!
At 4am the next morning – induction day – I hadn’t yet given up hope of an intervention free birth and began marching on the spot in our bedroom which started contractions again albeit very erratic at seven minutes, then twelve, five, ten and so on. On-going irregularity in length, strength and frequency of contractions can be an indication that the baby may be in a less than optimal position for birth…it was time for Spinning Babies!
I chose the ‘Abdominal Lift and Tuck’ technique as this is a favoured method for turning a back-to-back baby and also useful for any baby that is not engaged in the pelvis at the start of labour. As the ‘Abdominal Lift and Tuck’ was something I could do alone, I left my husband sleeping soundly. Over the course of ten contractions I followed the website instructions to the letter, which took just over an hour. By the end of the ten contractions they were finally settling into a regular pattern as my baby had turned into a better position. With huge relief and only half an hour to spare, I made the call at 6.30am to cancel my induction appointment! Later that day I gave birth to my son in the birthing pool in my living room, again using hypnobirthing and without any drugs or intervention of any kind.
For me, the combination of hypnobirthing (to help my relaxation and comfort level mentally and physically), with Spinning Babies exercises (for aligning my babies correctly with my pelvis and smoothing their route into the world), was invaluable to prepare for easier, intervention-free births.
Spinning Babies techniques helped a friend to turn her second breech baby to head down so she was able to have a VBAC (vaginal birth after caesarean) and also helped my sister have a smooth birth with her second child. My sister’s first labour had been long and painful and proved quite traumatic due to the very difficult position of her baby. To avoid this second time around, in late pregnancy, she prepared for labour using the ‘Rebozo’, the ‘Forward Leaning Inversion’ and the ‘Side Lying Release’ techniques. Our mum was with my sister during labour, and having studied some of the Spinning Babies techniques with me, was ready to assist her into helpful positions.
Another friend had to be induced at 37 weeks due to very high blood pressure. Her baby was transverse at the time and so she asked her obstetrician if it was safe to wait for a few hours more and try some Fetal Navigation Techniques. They were happy to wait and sure enough baby turned head down. They induced immediately and within only two hours her baby was born smoothly! She was amazed that she was up and walsking around on the same day feeling ok because her two previous babies, also with early induction, were long and difficult forceps births which affected her recovery and comfort. She wished she had known about the techniques before baby number one!
As many of the techniques can be performed by women and their partners themselves, it can be very empowering for women and allow them to feel in control and have ownership of their own birthing experience. This was precisely how I felt from the moment I started reading SpinningBabies.com. I felt I had a toolkit from which I could draw out tools to change the course of my labour if it wasn’t progressing as planned. It was liberating to know I could take control and this is exactly what I did!
I believe every pregnant woman should have access to these Fetal Navigation Techniques and therefore stand a better chance at experiencing an uncomplicated, intervention-free birth. I am impassioned to do something about this. After all, if I can do what I did with SpinningBabies.com exercises, imagine what midwives could achieve with them every day. I asked myself the question – why don’t midwives in the UK use these techniques?
For Midwives and Care Providers
In my discussions with midwives and mums-to-be, I have found that very few people in this country have even heard of SpinningBabies.com, although there are some UK midwives and doulas who are already transforming their practices (unofficially) with the techniques. I heard a report of midwives who tried a ‘Side Lying Release’ on their mum-to-be while she was being prepared for an emergency caesarean section (due to long labour) in the North-West of England. The surgery was cancelled just in time as the baby arrived within minutes of the technique being used! Just one other example of the amazing results which can be achieved!
I would dearly love to see Fetal Navigation Techniques officially adopted by midwives, antenatal teachers and doulas but, as is absolutely right, the British NHS (National Health Service) require evidence based clinical trials to prove they are safe and effective. Without any evidence at all, many healthcare organisations would not likely give serious consideration to doing their own clinical research. So the road to having large clinical studies even being considered is potentially a long and arduous one and this is a stumbling block to bringing these techniques into mainstream use by UK care providers.
However, this is a clinical issue and doesn’t stop women (and their partners) using the exercises for themselves. Many of the techniques are so simple and easy to perform for women with low risk pregnancies. There is clear safety advice for each technique on the Spinning Babies website which should always be referred to before attempting any of the exercises and, discussing the exercises with your midwife or obstetrician is recommended as they can advise on suitability for individual pregnancies.
Supporting the National Health Service
The British NHS is hugely short of funding, and midwives are short staffed and stretched to their limits under tremendous pressure. I believe that using these techniques the NHS could naturally help to reduce the time each woman is in labour which would give midwives more precious time with each birthing mother. The techniques can facilitate easier, faster and safer vaginal birthing thus reducing the ever increasing number of caesarean sections performed and the amount of drugs administered. It could also reduce the necessity for after-care for mums and babies – cutting down on post operative infections reducing traumatic births and even helping to reduce the occurrence of post natal depression. Speaking from a business perspective, collectively these reductions could save a huge amount of money for the NHS and help ease pressure on midwives in so many ways. More importantly this would save a lot of pain and trauma for women and babies!
The Campaign for Positive Change
I have launched a media campaign – Make Birth Easier Campaign UK – to raise awareness of Fetal Navigation Techniques (aka Spinning Babies) in the UK to a level where midwives and obstetricians want to learn about them and mums-to-be are fully informed and can request use of these techniques in their birth plans. I am hopeful that with key medical professionals on board with the theory, I can push for clinical research for these techniques and move closer to the goal of Make Birth Easier Campaign UK – Fetal Navigation Techniques being part of standard maternity care provider training curriculums and used routinely in mainstream maternity care; labour wards, birthing centres, and home birthing teams.
Clinical Evidence is Required
We know they work and there are no reports of safety issues when using the techniques as directed. However, having great stories about how well and how quickly Fetal Navigation Techniques work is not enough – it is not evidence. Official clinical studies are required to prove these techniques. Once there is some clinical evidence of those two basic and fundamental questions; do they really work, and, are they safe; then larger clinical research studies are sure to follow and eventually the evidence level will be hard to ignore and the techniques will be incorporated into maternity training (that’s the plan!). All it will take to start the ball rolling is one person, with the facility and funding to run a clinical study, to notice this campaign and get involved. I am determined to give women in this country a better chance at the birth they want and deserve. It seems so simple, and yet getting there is so complex!
Follow the Campaign
An excerpt of this article was published in The National Childbirth Trust (NCT) magazine in June 2015.
You can follow the progress of Make Birth Easier Campaign UK here at this website and on:
Written by Alix Fernando
Spinning Babies is on Facebook and Gail Tulley can be found on Twitter @SpinningBabiesLady.
Also on Facebook is the UK group – ‘Unlocking Birth: techniques to resolve and prevent malposition’.
The content of this website is not intended, and should not be read as constituting medical advice, diagnosis or treatment. Always consult your doctor, midwife or other qualified healthcare provider before making any changes to your birth plan or recommended routine.