During the early days and months it is best to wear your baby. They have spent 9 months tucked into a warm womb, sheltered from the world. The wiring of their brains and nervous systems have not changed from the beginning of human existence; however, the world they emerge into has changed tremendously. After birth the transition needs to be gradual. Babies and young children absorb impressions that are no longer limited to the sounds of nature, animals and a quiet family life. The impressions of our technical, electromagnetic world can be quite shocking; at the end of the day little ones must release either through crying, fussing, acting out or what we commonly call melting down. To lessen this impact we urge you to wear your baby, yes take them out of the car seats and strap them on.

The wrap we love best is the didymos. It is made in Germany of organic cotton, is beautiful, will last for generations and can be tied to carry your baby many ways. The second favorite is the Ergo - a quick pack for carrying an older baby. And the third is a good wagon; the one in the photo is made by the Amish, was purchased in 1987 from Lehman’s, and is still as good as new. It can carry multiple toddlers along with groceries or recycling. We do not have stock in any of these companies but do special order the didymos at our office.

There is currently much controversy in our state about this topic. The controversy concerns mandatory licensure but that’s a different topic. We are all midwives – certified nurse midwives, certified professional midwives, direct entry midwives, naturopathic midwives, lay midwives, traditional midwives, licensed midwives, unlicensed midwives…..have I left anyone out?

What we all do is attend women in labor. I use the word attend very specifically as it points to the direction of the art of midwifery; yes it is an art. Attending a woman in labor consists of directing ones attention in multiple directions simultaneously. The most obvious is towards the laboring mother and her soon to be born baby. Now comes the art – balancing the needs of these two people; the midwife is the one taking responsibility for the welfare of both. She is challenged to allow a woman to listen innerly, following the direction of her own unique labor pattern, to learn each woman’s laboring rhythm then to unobtrusively guide and encourage her when the pattern is deviating from what is safe.

She must have attention also for the wee passenger, whose journey is the actual reason for this amazing gathering of forces, understanding the physiology of his or her passage through the birth canal. What is the constitution of this new being? Can he weather a long labor and hours of pushing and as a toddler fall down multiple times in one day without a peep? Or is he the type that tends to startle easily, the more sensitive one or maybe he has gotten his little head cocked sideways and needs some help getting into a more favorable position. Those posterior babies can make for long labors and longer pushing (see the previous blog).

And then some attention is also needed for the rest of the birth team – her partner and family, her assistants and apprentices.

So how does she do all of this? A midwife must be present to attend. She must be physically present and here is the most difficult task – she must direct and maintain some attention within herself. A divided attention, simultaneously outwards and within. She must be attentive to higher forces that are actually directing the course of events called labor. Hers is to attend and not to decide the course. A midwife knows birth, lives and breathes the birthing process, can visualize the cardinal movements as the baby moves into the birth canal and kicks off has she is born. She knows when to step in, when to hold back, how to encourage and sometimes she must be a bit firm but mainly she attends to the matter at hand, asking herself what is needed now.

Back pain during pregnancy is common. Was your baby sunny-side-up or posterior?

“Yes, they said he was facing the wrong way, is that what you mean?”

Why posterior babies?

I was part of a research group that studied the transfer of out-of-hospital births into OHSU, a local medical school where I received my masters in nurse midwifery. An interesting discovery was that 75% of the transfers were for posterior babies.

So what is happening that so many babies are posterior?

Let’s think about how we, as women, were designed to spend our days. For the most part we would be squatting to tend to our cook fires and leaning over to do our chores. This created conditions that helped the baby find the most optimal position for birth; one with their back towards our front, either on the left or right, and with their head well flexed.

Problems with posterior births

When babies are posterior, meaning their backs are towards our backs, the whole labor is slower. This is because posterior babies don’t flex their heads well and therefore don’t descend into the pelvis easily.

They are working against, instead of with, the normal physiology of labor—flexion of the baby’s head, descent into the pelvis, turning more anterior and then extending their heads on the way out. What we call tuck and dive.

Solutions for posterior babies

So what can we do? We are certainly not going back to squatting and living in caves. However, we can choose to spend time sitting forward instead of lounging back during the last month of pregnancy or sit on a birth ball. In addition, there are methods we midwives use for turning posterior babies in labor. These same techniques can be learned and used before labor starts. YOU CAN TURN YOUR OWN BABY!

During the last few centimeters, from 8-10, it is the baby’s head that dilates the cervix which is why posterior babies get ‘stuck’ and mom’s don’t dilate. In addition the unflexed head puts pressure on the mother’s sacrum causing back pain that doesn’t let up between contractions.

Turning techniques

Our favorite technique is the rebozo. This is simply a shawl worn by women to carry not only their babies but many other things as well. Midwives use it in labor.

You can use any shawl or piece of fabric. You will need a partner.

1. Get down on all fours with your head a little lower than your hips.
2. Place the middle of the shawl, spread out, on your belly
3. Have your partner stand behind, straddling your legs and holding one end of the shawl in each hand.

Now relax while your partner moves the shawl back and forth, in short movements, first slowly and then fairly quickly. Do this for a few minutes each day. You will know when your baby has shifted because you will no longer feel her kicking in the front but on one side or the other.

This simple technique may possibly make for an easier natural birth experience for you and your baby.