At the end of April, I had the special opportunity to take the Spinning Babies workshop taught by Gail Tully at the Midwifery Today Conference in Harrisburg. While the day was packed with information, I enjoyed every minute of it…I honestly felt excited about the prospect of having another baby myself after learning so many practical tips on how to promote optimal fetal positioning for both the baby’s sake and the mother’s comfort. Gail has a wealth of information at her fingertips, and I think I’d have to take the class several more times before I could really retain it all (even though I took lots of notes!), but I wanted to at least give a few pointers from things that I learned. Visit her website at: http://spinningbabies.com/ to learn more yourself.

To begin with, Gail showed a diagram about the structure of the uterus, and how it is covered in fascia, just like all of our other muscles. When the fascia is pulled or stretched in an unnatural angle, it is going to affect the way that the baby is positioned in the uterus. This is one reason why it is important to watch your repetitive movements…do you carry a child on your hip? bat a baseball? If the muscles and ligaments are too tight, too loose, or twisted, the baby will NOT be able to settle into the correct position. The balance of your soft tissue can be more important than your pelvic size. Thus, doing specific exercise techniques throughout your pregnancy (and during labor when needed) in order to help align these muscles can make a big impact on what position the baby settles into. When the womb is symmetrical, the baby will naturally assume a more flexed position.

When it comes to the “perfect position”, the place to aim for is having baby settled on the left side. The tendency is for baby to settle on the right side, as our uteri have a natural propensity towards this direction. However, the shorter, curved left side encourages the baby to flex his head and assume a “C” type position-his physiology is actually enhanced by this flexed position, as well as this position providing more consistent, even pressure on the cervix, which in turn encourages dilation. When the baby is on the mom’s steeper right side, the baby naturally wants to assume a more “military presentation”, where the head is not flexed-this causes uneven pressure on the cervix, and can really reduce progress in preparing the cervix for labor, and stalling progress during labor itself.

Demonstrating how the different muscle layers work to support or constrict the uterus

Another interesting aspect Gail brought out is how thyroid malfunction can cause the baby to assume a negative position. A root metabolism issue can affect the way in which the uterus operates, as well as causing it to be more susceptible to twisting. Making sure your entire body is working optimally can help prepare you for a better pregnancy and birth! The fact that we spend so much time sitting both in the car and in a reclined position also contribute to a asymmetrical uterus. Women used to be encouraged to sit “like a lady” with good upright posture, which can also help to promote good posture of the womb.

In presenting exercise techniques, Gail focused on three separate types of exercises that she calls the “3 Sisters” to provide balance and room for mom and baby. Each of these exercises helps the mom to relax, and thus in turn helps to relax the fascia of the uterus, which then helps to provide the balance to help the uterus to become more symmetrical. She would encourage pregnant mamas to do these exercises at the minimum of once a week, but once a day would be even more ideal! Besides encouraging baby to engage in a good position, these exercises can also help to improve mom’s comfort by relaxing the muscles that receive so much strain during pregnancy. In labor, these techniques help to promote descent of the baby, and can be done multiple times. Rather than try to explain these techniques myself, I’ll point you in the direction of where you can find instructions on her website:
– First, encourage deep squats and calf stretch. Then move on to the “3 Sisters of Balance” http://spinningbabies.com/techniques/activities-for-fetal-positioning/423-the-3-sisters-of-balance- :
1.  Rebozo sifting: helps relax the broad ligament and get the mother loose and relaxed herself. http://spinningbabies.com/techniques/activities-for-fetal-positioning/rebozo-sifting
2. Forward Leaning Inversion: This is best for resolving a transverse lie, and helps to encourage healthy circulation. http://spinningbabies.com/techniques/the-inversion
3. Side Lying Release: Helps relieve pressure on ligaments.

Once these techniques have been performed to help achieve balance, your next goals are Gravity and Movement-especially to help during a pause in labor.

During labor, you can use these techniques to help whenever you reach a point where progress is being stalled. Gail encouraged us to rethink the usual question of “what is dilation?” and instead think “where’s the baby?”. If the baby isn’t descending, then something needs to change, regardless of what dilation is. And depending on where baby is at, different techniques are needed to get the baby to descend. For any stall, she recommends trying the “3 Sisters of Balance” in order to relax mom and balance the uterus.

As you attempt the three above techniques, consider where baby is: If he is stuck at the brim of the pelvis (characterized by a long latent phase, or start-and-stop labors for days), then the baby needs to flex his head in order to enter the pelvis. Tight round ligaments can prevent baby from descending. At this point it is much more important to get the baby to enter the pelvis, rather than trying to get labor to become more regular. Dilation won’t do any good if the baby isn’t in the pelvis! Trying Gail’s Abdominal Lift and Tuck followed by Walchers, can help to flex that little guys head and get him to descend. http://spinningbabies.com/techniques/activities-for-fetal-positioning/abdominal-lift-and-tuck  http://spinningbabies.com/techniques/activities-for-fetal-positioning/walchers

If baby is stuck in the mid-pelvis (right at the ischial spines), labor tends to stall around 5-7cm. This can often be caused by a tight pelvic floor, and special attention to the side-lying release technique can help to relax those tight muscles. Trying a lunge, and the “Shaking the Apple Tree” techniques can also help to get the pelvic floor relaxed and help baby to descend.

When labor stalls around 9-10 cm (think anterior lip, etc), realize that you must address the root cause, not just push back the lip. Trying positions that open up that part of the pelvis can provide more room (deep squat, McRoberts, hip press, toilet, etc.). Sometimes putting pressure on the sacrotuberal ligaments can help them release and provide more room for birth. If there’s not an urge to push, try to rest, and wait until the body is ready-sometimes mama just needs a break!

There were many, many more things that Gail taught and shared…not to mention all the stories of different complicated, stalled labors where these techniques were used. If you ever have a chance to sit in on one of Gail’s classes, I would highly recommend it! Much of her information is located on her website, as well, which is an excellent resource for both midwives and mamas alike.

Where is baby’s position in relation to the mom’s pelvis? How can we use that information to help us decide which technique(s) to try?