Position position position
Mothers, when finding their ways to giving birth, will get into all sorts of positions, and babies will too. They need to dance together in order for birth to happen. I attended three women giving birth standing up recently, two in the last week, so I was thinking about that. Standing up seems like a cool and strong way to do it. For two of them, it was a sort of, on-the-way-to-somewhere-else kind of stand (aiming for the water didn't make it), while the third was, squat squat squat, oh baby is coming, I'm going to stand up.... a spontaneous need to stand.
Babies sometimes don't care what positions their moms are in.... They are coming out! But sometimes they get themselves tied up (literally in the cord) or they didn't do their forward roll flexed head homework, or there is just too much comfy roll space at the back of the pelvis by their mom's butt. At these times their mom's position really matters a lot. Midwives and doulas are rightly famous for using mothers' positions to try to help babies find the way out, and using gravity is a common sense and commonly used tactic (squatting, standing). Sometimes we do some seemingly nutty things though: Three frequently used and effective but rather counter-intuitive tactics, are what I am going to call: Polar Bear, Crazy Upside Down, and Who on Earth is McRoberts?
Polar Bear is also known as knee chest: It is about kneeling forward onto the elbows, head low and butt in the air like a polar bear cub (human cubs do it too sometimes). The baby is thus encouraged to roll out of the pelvis and forward with his back to her front. The mother's pelvis should be flared at the back like the butt up portion of a pelvic tilt. Butt in the air sure makes a mom feel vulnerable. Unpleasant, not intuitive, but you do what you have to do.
Crazy upside down is mother lying on her back with her head and shoulders down and her bottom raised much higher. Back is arched and legs hanging down (told you it was crazy). This is also pretty vulnerable, not at all natural, and well.... you do what you have to do.
And who on Earth is McRoberts? Dr William A McRoberts Jr, a google search revealed, was a chief of obstetrics at Hermann Hospital in Houston. His idea for helping to get ornery babies out (in the case of stuck shoulders... nasty one), was to have the mother lie on her back with her legs hyperflexed, knees pulled up towards her shoulders. Wow! When she does this her crotch is in the midwife's (doctor's) face; vulnerable and not natural again...., and sometimes it really gets babies out.
Two days ago I attended a birth in which the mother had had four butter births at home and should certainly have had another one. Who ever heard of a fifth time mother pushing for more than two hours....? Unless that baby is in a cooky position. The most common cookyness, as you may know, is sunnyside up. (Butter birth babies are born facing their moms' spines). This particular baby decided to be a wonky soldier. That is, he decided to not bother to flex his head (not an efficient way to do a forward roll, or to be born). Technically it is known as "military" position. He also cocked his head like your pet spaniel. This is technically called ascynclitic. The combo is a rough one.... and in this case required that crotch in the face hyprflexed move. A tired and dedicated mother rolled herself into that position and squeezed her sweet baby out at last. He was wearing a funky swollen bubble on the front and side of his head which proved his positional travails. Healthy mothers and babies are resilient. They both looked great today, two days later, even though there was still a squishy bit on the top/side of his head.