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SASH Maternity. 2,437 likes · 1,742 talking about this. SASH maternity is based at East Surrey Hospital. Find information about pregnancy, birth options, breastfeeding and postnatal care.

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Parents-to-be can take their own virtual tour of the Princess Royal Maternity.

The 'Be Ready For Baby Coming' short videos provide everything you need to know about using maternity hospitals.

Features include NHSGGC midwives discussing basic topics such as what mums-to-be should bring with them on admission, where to find maternity unit entrances during normal and out of hours, plus tours of labour suites and a typical birthing room.

The videos also offer information about health topics including breast feeding, smoking and healthy eating.

A key advantage is that parents can watch the videos, which also have commentaries in Urdu, Polish, Slovak, Mandarin and Arabic, as well as BSL, again and again in the comfort of their homes.

The links below will open the playlist in YouTube.

English

Arabic

BSL

Mandarin / Simplified Chinese

Polish / Polski

Slovak / Slovensky

Urdu

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? be ready for baby (videos) : princess royal maternity hospital

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NHSGGC : Princess Royal Maternity Hospital

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Parents-to-be can take their own virtual tour of the Princess Royal Maternity. The 'Be Ready For Baby Coming' short videos provide everything you need to know about using maternity hospitals. Features include NHSGGC midwives discussing basic topics such as what mums-to-be should bring with them on admission, where to find maternity unit entrances during normal and out of hours, plus tours of labour suites and a typical birthing room.

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How big is a big baby?

The average newborn weighs about 3.4kg (7lb 8oz). Babies weighing more than 4kg (8lb 13oz) at birth are considered larger than average, or macrosomic (NCCWCH 2008, RCOG 2012). If you have a very large baby, weighing 4.5kg (9lb 15oz) or more, it can put you and your baby at greater risk of certain complications. Although many women give birth to very big babies without any problems, it's common to need a bit of help (HSCIC 2015).

About 11 per cent of babies in England are born at a weight of 4kg or more, with 1.6 per cent weighing 4.5kg or more (HSCIC 2015).

How will I know if I'm having a big baby?

It's very difficult to determine whether your baby is truly macrosomic while he's still in the womb (RCOG 2012). Only his post-birth weight confirms this.

Your midwife or GP may suspect your baby will be big if you're measuring large for dates. An ultrasound scan can give an idea of how big your baby really is. However, bear in mind this is not always accurate in later pregnancy. There can be a difference of about 10 per cent between your baby's weight predicted by ultrasound, and his actual weight at birth (RCOG 2012).

If the scan shows that your baby is large for dates, your midwife may want to monitor your blood sugar levels. This is to see if you are developing gestational diabetes (NCCWCH 2008).

What might cause my baby to be large?

Probably the most influential factor is gestational diabetes or pre-existing diabetes (Alberico et al 2014, NCCWCH 2008, Heiskanen et al 2006). You are also more likely to have a large baby if:

You have a high body mass index (BMI) at the start of your pregnancy (Ahmed et al 2012, Alberico et al 2014, NCCWCH 2008, Bhattacharya et al 2007, Heiskanen et al 2006, Salihu et al 2011,).

You've gained a lot of weight during pregnancy (Ahmed et al 2012, Alberico et al 2014).

You go more than two weeks past your due date (Heiskanen et al 2006).

You've gained a lot of weight between pregnancies (Villamor and Cnattingius 2006) or not lost weight from a previous pregnancy (Bogaerts et al 2013).

Ethnicity has a part to play (Wilson et al 2014) and even your baby's sex can make a difference, as boys are more often larger than girls (Ahmed et al 2012, Heiskanen et al 2006, Di Renzo et al 2007, Sojo et al 2010). And if you've already had a baby, particularly a large baby, you're more likely to have a large baby in a future pregnancy (Heiskanen et al 2006, Walsh et al 2007).
However, even if any of these factors apply to you, you're still more likely to have a baby of average size.

Most macrosomic newborns are born to women with a low risk of having a big baby (Heiskanen et al 2006, Walsh et al 2007). Your midwife or doctor will consider you low risk if you are not diabetic, for example (Alberico et al 2014). In reality, much of the variation in birth weights remains unexplained.

How will having a large baby affect the birth?

Giving birth vaginally to a big baby is very possible. Almost two thirds of very big babies (4.5kg or more) are born vaginally (HSCIC 2015) but it can be difficult.

Understandably, it may take longer to labour. An assisted birth is needed for about one in five vaginal births for very big babies (HSCIC 2015). Other common complications include an increased risk of heavy blood loss after the birth (Ahmed et al 2012, Weissmann-Brenner et al 2012) and of a severe perineal tear (RCOG 2007). If you've had a previous uncomplicated birth you're at an advantage, as you're more likely to give birth without any complications at all (Heiskanen et al 2006).

If your baby is over 4.5kg, there is a one in 13 chance that he will experience shoulder dystocia during birth, increasing to a one in seven chance if your baby is over 5kg (Rossi et al 2013). This is when your baby's shoulders become stuck after you've pushed his head out and is more likely to happen if your baby is very large (RCOG 2012). It's a rare but serious situation that needs immediate attention from an obstetrician.

If this happens, there will be a team of midwives and doctors on hand to help you so that you have the best chance of giving birth vaginally. They should give you clear instructions on when to push, or when not to push and what position to get into. For most women, changing to a better position will make it easier to free your baby's shoulder (RCOG 2012).

If you're large for dates, there's a possibility that your midwife may want to induce your labour early. If she does, ask her why. For most women with a large baby, inducing labour early doesn't have any proven benefit for mum or baby (RCOG 2012).

The only exception to this is if you have diabetes. Induction once you've reached 38 weeks of pregnancy or offering you an elective caesarean reduces the risks linked with giving birth to a large baby (RCOG 2012).

If your midwife suspects you have a large baby and recommends induction or a caesarean, ask her to talk you through the potential risks compared with a vaginal birth. Discussing your hopes, fears and the options available can be helpful (Reid et al 2014).

Will my baby's health be affected after birth?

Most big babies are absolutely fine. It's only if your baby had shoulder dystocia during birth that he may have a few problems afterwards. If your baby's shoulder gets stuck during the pushing stage, it may result in damage to the nerves in his shoulder and arm (RCOG 2012).

Nerve damage occurs in between two per cent and 16 per cent of babies who have shoulder dystocia (RCOG 2012). It's more likely to happen if your baby needs a lot of help being born or is very big (RCOG 2012). However, it can also be caused by the pressure of strong contractions (RCOG 2012).

If your baby has some nerve damage, he's very likely to recover fully (RCOG 2012, Wall et al 2014). If your baby's collar bone was broken during the birth, this should also heal without any problems (Paul et al 2013).

Last reviewed: April 2015

References

Ahmed S, Romeiko-Wolniewicz E, Zareba-Szczudlik J, et al. 2012. Fetal macrosomia--an obstetrician's nightmare? Neuro Endocrinol 33(2):149-55

Alberico S, Montico M, Barresi V, et al. 2014. The role of gestational diabetes, pre-pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia: results from a prospective multicentre study. BMC Pregnancy Childbirth 14:23 www.biomedcentral.com [Accessed November 2014]

Bhattacharya S, Campbell DM, Liston WA,et al. 2007. Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies BMC Public Health 7(1):168www.ncbi.nlm.nih.gov [Accessed November 2014]

Bogaerts A, Van den Bergh BR, Ameye L, et al. 2013. Interpregnancy weight change and risk for adverse perinatal outcome. Obstet Gynecol 122(5):999-1009

Di Renzo GC, Rosati A, Sarti RD, et al. 2007. Does fetal sex affect pregnancy outcomes? Gend Med 4(1):19-30

Heiskanen N, Raatikainen K, Heinonen S. 2006. Fetal macrosomia - a continuing obstetric challenge. Biol Neonate 90(2):98-103

HSCIC. 2015. NHS maternity statistics, 2013-14: maternity statistics tables. Health and Social Care Information Centre, Hospital Episode Statistics www.hscic.gov.uk [Accessed April 2015]

NCCWCH. 2008. Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. Revised reprint July 2008, National Collaborating Centre for Women's and Children's Health, Clinical guideline. London: RCOG Press. www.nice.org.uk [Accessed November 2014]

Paul SP, Heaton PA, Patel K. 2013. Breaking it to them gently: fractured clavicle in the newborn. Pract Midwife 16(9):31-4

RCOG. 2007. The management of third- and fourth-degree peineal tears. Royal College of Obstetricians and Gynaecologists, Green-top guideline, 29. London: RCOG press. www.rcog.org.uk [Accessed November 2014]

RCOG. 2012. Shoulder dystocia. Royal College of Obstetricians and Gynaecologists, Green-top guideline, 20b. London: RCOG press. www.rcog.org.uk [Accessed November 2014]

Reid EW, McNeill JA, Holmes VA, et al. 2014. Women's perceptions and experiences of fetal macrosomia. Midwifery 30(4):456-63

Rossi AC, Mullin P, Prefumo F. 2013. Prevention, management, and outcomes of macrosomia: a systematic review of literature and meta-analysis. Obstet Gynecol Surv 68(10):702-9

Salihu HM, Weldeselasse HE, Rao K. 2011. The impact of obesity on maternal morbidity and feto-infant outcomes among macrosomic infants. J Matern Fetal Neonatal Med 24(9): 1088-94

Sojo L, Garcia-Patterson A, Maria MA, et al. 2010. Are birth weight predictors in diabetic pregnancy the same in boys and girls? Eur J Obstet Gynecol Reprod Biol 153(1):32-7

Villamor E and Cnattingius S. 2006. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study Lancet 368:1164-70

Wall LB, Mills JK, Leveno K, et al. 2014. Incidence and prognosis of neonatal brachial plexus palsy with and without clavicle fractures. Obstet Gynecol 123(6):1288-93

Walsh CA, Mahony RT, Foley ME, et al. 2007. Recurrence of fetal macrosomia in non-diabetic pregnancies. J Obstet Gynaecol 27(4):374-8

Weissmann-Brenner A, Simchen MJ, Ziberberg E, et al. 2012. Maternal and neonatal outcomes of macrosomic pregnancies. Med Sci Monit 18(9):PH77-81.

Wilson J, Venkataraman H, Cheong J, et al. 2014. Diabetes in pregnancy and birth weight: differential effects due to ethnicity in a real-life observational study. Endocrine Abstracts 34 P241

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The average newborn weighs about 3.4kg (7lb 8oz). Babies weighing more than 4kg (8lb 13oz) at birth are considered larger than average, or macrosomic (NCCWCH 2008, RCOG 2012). If you have a very large baby, weighing 4.5kg (9lb 15oz) or more, it can put you and your baby at greater risk of certain complications.

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We have created virtual tours of each of our locations to show you the services we offer and to help you feel prepared for your arrival.

We provide maternity services at the Royal Sussex County Hospital in Brighton, the Princess Royal Hospital in Haywards Heath and in the community. You can choose whether you plan to give birth at home or at either of our hospitals.

It might be that the place you give birth changes, due to the circumstances of your pregnancy or perhaps an increased workload at one of our hospital sites. Please be assured that the quality of the care we provide is maintained across our entire service and changes will only be made to ensure that you and your baby are cared for in the safest place at that time.

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We have created virtual tours of each of our locations to show you the services we offer and to help you feel prepared for your arrival. We provide maternity services at the Royal Sussex County Hospital in Brighton, the Princess Royal Hospital in Haywards Heath and in the community.

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Download a transcript of the video

The maternity unit for all of the SASH geographical area is based at East Surrey Hospital. Last year, the maternity team cared for around 5,000 women and was the location for 4,500 births making it one of the busiest maternity units in the area. The service provides antenatal, intrapartum (labour and birth) and postnatal care, delivered by 128 midwives and supported by a team of obstetric and gynaecological consultants.

Midwifery key numbers

Maternity triage: 01737 231 764
Use this number to speak to a midwife for any advice or questions.

Burstow Ward: 01737 231 653
Antenatal clinic : 01737 231 726
Delivery Suite: 01737 231 764
Neonatal unit: 01737 231 765

Bump to Birth clinic

Would you like to know more about the choices you have on where you give birth? Come along to the Bump to Birth clinic to learn about the different birth options and help you make the choice that is right for you.

Join us for a cuppa and a chat and meet our team. The clinic is held on the last Saturday of each month, 2-3pm, in the Birth Centre training room, East Surrey Hospital. Booking is highly recommended. To confirm your place please call the maternity triage number on 01737 231 764.

Midwifery key contacts

Michelle Cudjoe
Head of midwifery
Divisional chief nurse for women and children's health

tel. 01737 768 511
x 6819/6435

Denise Newman
Deputy head of midwifery
Maternity matron

tel. 01737 768 511
x 6898

Elizabeth Hamilton
Maternity matron

tel. 01737 768 511
x 6898

Sian Dudgeon
Matron for antenatal services

Miranda Johnson
Matron for community and antenatal screening

More information

Maternity triage patient information leaflet

Video: Specialist Perinatal Mental Health Service from Sussex Partnership NHS Foundation Trust

"I would like to single out a midwife at East Surrey Hospital in Redhill, Surrey. The care, compassion, kindness and professionalism shown to my wife and I, and then to our newly born son, was first class. (She) is a credit to her profession and a lovely person. Her care made the birth of a son a very special event and something we will never forget."

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Maternity Services | Surrey and Sussex Healthcare NHS Trust

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The maternity unit for all of the SASH geographical area is based at East Surrey Hospital. Last year, the maternity team cared for around 5,000 women and was the location for 4,500 births making it one of the busiest maternity units in the area.

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Hypertension in pregnancy: diagnosis and management | Guidance and guidelines | NICE

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Evidence-based recommendations on the diagnosis and management of hypertension (high blood pressure) in pregnancy

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Overview | Diabetes in pregnancy: management from preconception to the postnatal period | Guidance | NICE

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This guideline covers managing diabetes and its complications in women who are planning pregnancy or are already pregnant. It aims to improve the diagnosis of

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Our downloadable factsheets provide detailed information about your rights and the law in pregnancy and childbirth. If there's an area we've missed that you would like to see covered, get in touch.

We do not deal with maternity-related employment or benefits issues. Maternity Action provide comprehensive information on your rights at work, access to benefits and breast-feeding rights.

Our factsheets cover the law in the UK, except where stated. They were last updated in April 2017.

Read our legal statement and copyright for terms and conditions of use of these factsheets.

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Our downloadable factsheets provide detailed information about your rights and the law in pregnancy and childbirth. If there's an area we've missed that you would like to see covered, get in touch. We do not deal with maternity-related employment or benefits issues. Maternity Action provide comprehensive information on your rights at work, access to benefits and breast-feeding rights.

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What will happen once I arrive at hospital?

If you're planning a vaginal birth, head to the labour ward when you get to the hospital. Hopefully you've been able to visit already, so you'll have some idea what to expect.

If you can't visit, it's worth asking your midwife in advance what is available and what is likely to happen. That way it's not all new on the day.

First, you will normally be taken to a labour room. Once you're there, you might like to change into something cool, loose and comfortable as labour rooms tend to be warm (Tommy's, 2015a).

Your midwife will ask you what has happened so far and examine you (with your permission). This will include recording your temperature, pulse and blood pressure, feeling your abdomen to check the baby's position and an internal examination (NHS, 2017a).

An initial assessment shouldn't include constant monitoring of the fetal heartbeat and uterine contractions at this stage (this is called cardiotocography). That's because there isn't enough evidence about whether it's beneficial at this point. It's uncertain whether it could result in harm for women and their babies compared with occasional monitoring (auscultation) alone (NICE, 2014).

Your midwife will tell you whether you are in active labour, which means you're having regular contractions and your cervix is dilated 4cm or more. If you're not, they might suggest you return home for the time being (NICE, 2014).

What facilities will the hospital provide?

What's available will vary between hospitals. So again, it's worth trying to have a tour of the hospital or a chat to your midwife in advance.

Facilities should include a comfortable bed for you and a comfy chair your birth partner (Newburn and Singh, 2003). You might also find beanbags, pillows and mats, temperature and brightness control, and space for you to move around freely during labour. But you're less likely to find those in a hospital than in a birth centre (Newburn and Singh, 2003).

It is important you feel relaxed and at ease during labour. If you feel tense and feel you're being disturbed, then adrenaline can cause your contractions to be less efficient (Lothian, 2004). Labour might slow down or stop.

To make the environment feel more homely and comfortable, it's a good idea to bring things from home. You might like to take your own pillows, floor mats or bean bags if the hospital doesn't have them, and maybe some music to help relax you.

Care in labour

If you choose to give birth in hospital, you will normally be looked after by a midwife. It is rare though that you'll have the same midwife who provided your antenatal care (CQC, 2018).

Depending on how long your labour goes on, more than one midwife might care for you as one shift ends and another begins. Medical students might also ask whether they can come into the room. If you're not comfortable with this, say so, or ask your partner to tell your midwife.

If you don't get on with your midwife for any reason you can try asking for another one (WHICH, 2018).

Obstetricians (doctors) will be available if you need their help. If there are complications at any stage, your midwife might ask a doctor to look after you (NICE, 2014).

If all is well, you might be left with your birth partner for varying periods of time, particularly during early labour. Yet you should never be left alone at a time that worries you and you should always be shown how to call for help if you need it (NICE, 2014; CQC, 2018).

Your midwife should encourage and help you to:

move around and get into whatever positions you find most comfortable throughout labour

have support from your chosen birth partner

feel you are in control, listened to and being cared for with compassion

keep eating and drinking if you want to (unless you've had opiates or might need a general anaesthetic)

use coping skills and pain relief techniques that you've planned, such as breathing, relaxation, massage, acupuncture, acupressure, hypnosis or playing music of your choice

talk to you about the risks, benefits and implications of different forms of pain relief like gas and air, opiates or an epidural.

If you have made a birth plan, make sure you share it with your midwife (NICE, 2014). Your birth partner could also do this if you're busy.

What will happen during labour?

Once you are in established labour, your midwife will check you every four hours or so to see how you're progressing. This might include taking your blood pressure, pulse and temperature (Tommy's, 2015b), as well as asking you how you're feeling emotionally. They could also offer you pain relief if you feel you need it (NICE, 2014).

The midwife should by this stage check your baby's heartbeat more regularly, usually using a small handheld device to listen to your baby's heart at least every 15 minutes (Tommy's, 2015b). Sometimes they might offer constant electronic monitoring although this can stop you being able to move around freely. Also, fetal scalp monitoring can be used.

Your midwife will offer you regular vaginal examinations to see how your labour is progressing (NHS, 2017b). Yet it's worth being aware that vaginal examinations are only one way of finding out how your labour is progressing (RCM, 2012). You can refuse them if you wish as there is no evidence to show that doing them regularly is particularly beneficial (Lewin et al, 2005; Downe et al, 2013).

Your midwife will record their observations on a chart called a partogram (NICE, 2014).

When you are ready to push your baby out, your midwife will help you find a comfortable position for giving birth (NICE, 2014). The midwife will offer much more frequent observations and examinations at this stage, possibly listening to your baby's heart rate every five minutes (NICE, 2014).

After the birth

Afterwards, your midwife will continue to care for you and check on you as you deliver your placenta. They should encourage you to have skin-to-skin contact with your baby, so enjoy it and don't feel rushed. Skin-to-skin contact is great as it helps babies to start breastfeeding and protects against the negative effects of separation (NICE, 2014).

Your midwife should recognise that the time immediately after the birth is when you and your birth partner are meeting and getting to know this new little person. So they should make sure anything they have to do is sensitive to this. They should try to keep you and your baby together and undisturbed (NICE, 2014).

When you've had your baby, you will usually be moved to a shared postnatal ward (RCM, 2015). You'll stay here while you wait for the appropriate checks and care planning (RCM, 2015).

Often, your birth partner, or whoever is looking after you, will be able to stay with you as much as you want after the birth (CQC, 2018). You might find that different units have different policies in this area so it's worth checking first.

One survey found that women are most likely to stay in hospital for one or two days after having their baby (CQC, 2018). Fewer women stayed between 12 to 24 hours, and less still stayed for up to 12 hours. If you're desperate to get home, it's worth being aware that almost half of all women found their discharge was delayed for some reason so be prepared for a bit of a wait (CQC, 2018).

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about labour and life with a new baby.

Make friends wit other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

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What happens when you give birth in hospital?

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If you're planning a vaginal birth, head to the labour ward when you get to the hospital. Hopefully you've been able to visit already, so you'll have some idea what to expect. If you can't visit, it's worth asking your midwife in advance what is available and what is likely to happen.

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Pre-eclampsia is a condition that affects some pregnant women, usually during the second half of pregnancy (from around 20 weeks) or soon after their baby is delivered.

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Supporting you with information about Pelvic Girdle Pain (PGP)

The Pelvic Partnership provide women and healthcare professionals with information about best practice for the treatment and management of pregnancy-related PGP, and to enable and empower women to access the right treatment. We have packed our website with information about PGP, so please do have a read, and use and share this resource.

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The Pelvic Partnership provide women and healthcare professionals with information about best practice for the treatment and management of pregnancy-related PGP, and to enable and empower women to access the right treatment. We have packed our website with information about PGP, so please do have a read, and use and share this resource.

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Itching and intrahepatic cholestasis of pregnancy - NHS.UK

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Find out about itching during pregnancy, including causes, ways to ease itching, and when you need to seek medical attention fast for possible intrahepatic cholestasis of pregnancy (ICP), also called obstetric cholestasis.

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The uterus is undisputedly the ultimate environment for the development and nurturing of a fetus. The sensory systems develop throughout pregnancy and affect the brain's development.

Fetal sensory development

Your baby begins to develop on a sensory level from the moment of conception. The first sense to develop is the sense of touch, emerging at 3 weeks gestation - before you knew you were pregnant. By the twelfth week, your baby can feel and responds to touch on his entire body, with the exception of the top of his head, which remains insensitive until birth.

The auditory system is completely intact by 20 weeks gestation but it is a few weeks before the nerves conducting sound are functional. At 23 weeks your baby can respond to loud noises and may jerk or even begin to hiccup after hearing a loud sound.

Taste buds emerge at 8 weeks and by 13-15 weeks your baby has taste buds similar to adults'. Anything you eat can flavour the amniotic fluid. While we are not exactly sure when the baby starts to perceive taste, we do know that a baby born prematurely (33 weeks) sucks harder at sweetened nipples and when saccharine is injected into the amniotic fluid in the third trimester babies suck faster.

Smell develops alongside the sense of taste. Since smells are essentially chemicals that are found to be present in amitotic fluid, it stands to reason that your baby can smell in utero as the chemicals pass from the amniotic fluid onto the smell receptors in the nasal cavity. The nasal cavity is protected by a plug of tissue until 28 weeks, but thereafter your baby will smell and respond to scents.

Your baby's tiny eyelids open at 26 weeks and at 6 months we know that babies can see light in utero. At 32 weeks gestation your baby can track a bright torchlight shone and moved across your pregnant belly.

The sense of movement and gravity from the balance (vestibular) system in the ears develops very early and begins to function at five months gestation. Like the sense of hearing and touch, the sense of movement is relatively advanced at birth.

The world of the womb

Knowing that the sensory systems perceive the intrauterine world by the second and third trimesters, we may wonder what the womb world is like on a sensory level.

The womb world is devoid of light touch - deep pressure touch and the sense of warmth are greatest inputs to the sense of touch. By the third trimester, the elastic uterus provides constant, deep pressure, like an all-day hug or massage. This tight hug keeps your baby curled up, with pressure on his back and his hands towards the midline. In this position, your baby can suck his hands and his immature reflexes, which are starting to emerge in utero are contained so that he feels secure. The temperature in the womb is always perfect, a temperature we call neutral warmth. Threatening touch, such as pain, high or low temperatures and tickle are completely absent during gestation.

In the womb, the overwhelming sounds (about 85 decibels) are the background sounds of your body. Your baby hears the gushes of amniotic fluid and blood flowing in the veins and of course your heartbeat and digestion. These background noises contribute to the constant white noise he hears. The consistent sound of the heartbeat is a particularly soothing sound and babies who are played a beat at the pace of the average heartbeat (72 beats per minute) fall asleep easier and cry half a much after birth. Sounds from the outside world are subdued (55 decibels) but the clearest sound he hears is your voice as it is carried not only outside the body but also through your bones in the form of vibrations. Dad's voice is the second most familiar sound to your baby and it is nice to know that within hours of birth your baby will recognize Dad by his voice.

Because all tastes you experiences pass into the amniotic fluid, your baby is prepared for the flavours your family eats even while in utero. The preference for sweet tastes is hardwired and babies prefer sweet flavours, swallowing amniotic more vigorously after you eat something sweet.

Even though your baby is interested in and tracks a bright light, the reality is that he is rarely exposed to bright lights and there is very little visual stimulation in utero. In general the womb world is visually muted and often it's quite dark. There are no bright colours or contrasting shapes in utero on which your baby can hone his developing visual skills. For this reason the visual system is relatively immature at birth.

In utero your baby is buoyed by amniotic fluid and whirls freely in a contained liquid bubble. Since water decreases the weight of an object by 50 times, your baby has the wonderful sensation of being 1/50th lighter than on earth. He is lulled by the constant rocking and swaying motion of this gravity-reduced world, gently rocked to sleep. When the lulling movement stops - such as when you rest or lie down, your little one may become wakeful and busy. During the third trimester, your baby's vestibular system has matured sufficiently to sense gravity and to turn to the appropriate 'head down' position in preparation for birth.

The fourth trimester

By understanding the world of the womb, you can make your little one's transition to the real world smoother.

By Meg Faure
References
Eliot L. Whats going on in there? How the brain and mind develop in the first five years of life Bantam Books 1999
Faure M The Baby Sense Secret Dorling Kindersley (to be released 2011)
Faure M & Richardson A Baby Sense Metz Press 2010
Graven S & Browne J Auditory Development in the Fetus and Infant. Newborn & Infant Nursing Reveiws. Volume 8, Issue 4 2008
Hepper P. Unraveling Our Beginnings: On the Embryonic Science of Fetal Psychology. The Psychologist 18 (8) Aug 2005, published by the British Psychological Society.
Hopson J. Fetal Psychology Psychology Today, October 1998
Meisami E. et al Human Olfactory Bulb: Aging of Glomeruli and Mitral Cells and a Search for the Accessory Olfactory Bulb Annals of the New York Academy of Sciences, 1998
Trevathan W. Human birth: An evolutionary perspective. New York: Aldine de Gruyter 1987

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The secret world of the unborn - how your baby's senses develop in the womb

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The uterus is undisputedly the ultimate environment for the development and nurturing of a fetus. The sensory systems develop throughout pregnancy and affect the brain's development. Your baby begins to develop on a sensory level from the moment of conception.

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Your Body Before Pregnancy

Your Body Before Pregnancy

Before pregnancy, most of the space in your abdomen is taken up by the large and small intestines. There is no real separation between the areas of your pelvis and abdomen.

In the picture here, you can see that the vagina is behind the bladder (sac that collects urine) and urethra (tube for moving urine out of bladder and body). In its normal position, your uterus is above and behind the bladder, with the cervix protruding into the vagina. The pelvic colon, rectum and anal canal are behind the vagina and uterus.

Your Body at 12 Weeks of Pregnancy

Your Body at 12 Weeks of Pregnancy

At the 12th week of pregnancy, the placenta is much larger. It now produces the hormones needed to sustain the pregnancy. Your uterus is the size of a grapefruit and completely fills the pelvis. It rises up into the area of the abdomen, as shown in the image. The fundus, the upper end of the uterus, is just above the top of the symphysis where the pubic bones join together. This upward growth of the uterus takes pressure off the bladder and decreases the need for frequent urination. The mucus plug, a barrier to protect the growing fetus, fills your cervical canal.

The fetus is now about 3 inches long and weighs about 1 ounce. By this week, the fetus has fingernails and toenails and can open and close the fingers. The fetus will start to move, but you will not feel it yet.

At this point in pregnancy, the top of your uterus is about one-third of the distance between the bellybutton and the xiphoid cartilage at the lower end of your breastbone. Constipation is common because your uterus is pressing on your lower colon and hormones slow down your body's excretion process. Between the growth of your uterus and general weight gain, you may be feeling fatigued. Some women also experience heartburn as your uterus presses against your stomach.

Your breasts are also changing to get ready for breastfeeding. First colostrum and then milk are produced by the grape-like clusters of tiny sacs (alveoli) deep within the breast tissue. Clusters of alveoli form lobules, which come together to form 15 to 20 lobes. Each lobe connects to a lactiferous duct for conveying milk. As the ducts extend toward the nipple and areola (darker area around the nipple), they widen into the lactiferous sinuses. These sinuses (or milk pools) release the milk through 15 to 20 tiny nipple openings in each breast when the baby nurses.

At week 28, the fetus is about 16 inches long and weighs two to three pounds. The skin is wrinkled but will become less so as more fat builds up under the skin in the next few weeks. Fine, downy hair called lanugo, and a waxy white protective substance covering the skin called vernix, are on the fetus' body. Its eyes are open, and eyebrows and eyelashes were formed in the fourth month. The fetus sucks its thumb and its taste buds have developed. It kicks, stretches and moves frequently in your uterus-you'll feel it moving around and others might even be able to see these movements!

Fetal organs and systems are quite well developed by the 28th week of pregnancy, but the final two months of gestation are important for further maturation of all body systems and organs.

Your Body at 40 Weeks of Pregnancy (Internal)

Your Body at 40 Weeks of Pregnancy (Internal)

At full term, or 40 weeks of pregnancy, the fetus' head has generally lowered into your pelvis, where it takes up most of the space. This is called "lightening." In first pregnancies, this may happen a few weeks before labor. In repeat pregnancies, this can happen at the time of labor. The canal of the broad, enlarged cervix is still filled with the plug of mucous. If this is your first pregnancy, the small opening at the bottom of your cervix is usually not dilated, whereas if you have given birth before, it will often be open as wide as two fingers some time before labor begins.

At this point, you may be experiencing frequent urination, increased constipation, edema (water retention) and aching legs or vulva. Varicose veins in the vulva, rectum and legs are also possible. This is because of the position of the uterus, the pressure of the baby's head and a loss of muscle tone as the hormone relaxin loosens your tissues in preparation for birth. Other changes at this time include increased development of blood vessels and increased amount of blood.

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Before pregnancy, most of the space in your abdomen is taken up by the large and small intestines. There is no real separation between the areas of your pelvis and abdomen. In the picture here, you can see that the vagina is behind the bladder (sac that collects urine) and urethra (tube for moving urine out of bladder and body).

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AIMS Journal, 2011, Vol 23 No 4 Sarah Buckley shows us what is stopping birth working
In modern Western countries, including Australia and the UK, rates of obstetric intervention have reached extreme levels, such that very few mothers and babies experience labour and birth without drugs and procedures to assist or hasten the process. This has led to the erroneous belief that human birth is an intrinsically faulty system, and that modern women have lost the ability to give birth.

However, our women's bodies have their own wisdom, and our innate system of birth, refined over one hundred thousand generations, is not so easily overpowered. This system, which I am calling undisturbed birth, has the evolutionary stamp of approval not only because it is safe and efficient for the vast majority of mothers and babies, but also because it incorporates our hormonal blueprint for ecstasy in birth. When birth is undisturbed, our birthing hormones can take us into ecstasy - outside (ec) our usual state (stasis) - so that we enter motherhood awakened and transformed. This is not just a good feeling; the post-birth hormones that suffuse the brains of a new mother and her baby also catalyse profound neurological changes. These changes give the new mother personal empowerment, physical strength, and an intuitive sense of her baby's needs, and they prepare both partners for the pleasurable mutual dependency that will ensure a mother's care and protection and her baby's survival.

Undisturbed birth represents the smoothest hormonal orchestration of the birth process, and therefore the easiest transition possible; physiologically, hormonally, psychologically, and emotionally, from pregnancy and birth to new motherhood and lactation, for each woman. When a mother's hormonal orchestration is undisturbed, her baby's safety is also enhanced, not only during labour and birth, but also in the critical postnatal transition from womb to world. Furthermore, the optimal expression of a woman's motherhood hormones, including the fierce protectiveness of her young, will ensure that her growing child is protected and well nurtured, adding another layer of evolutionary fitness to the process of undisturbed birth.

The hormones of birth

There are many hormones involved in mammalian birth, and our understanding of their complex orchestration is limited. This article focuses on the hormones oxytocin; beta-endorphin; the catecholamines (adrenaline and noradrenaline); and prolactin. As the hormones of love, pleasure and transcendence, excitement, and tender mothering, respectively, these form the major components of an ecstatic cocktail of hormones that nature prescribes to aid birthing mothers of all mammalian species. An optimal hormonal orchestration provides ease, pleasure, and safety during this time for mother and baby. Conversely, interference with this process will disrupt this delicate hormonal orchestration, making birth more difficult and painful, and potentially less safe. All of these hormones are produced primarily in the middle or mammalian brain, also called the limbic system or emotional brain. For birth to proceed optimally, this more primitive part of the brain needs to take precedence over our neocortex - our 'new' or higher brain - which is the seat of our rational mind. This shift in consciousness, which some have called 'going to another planet', is aided by (and also aids) the release of birthing hormones such as beta-endorphin, and is inhibited by circumstances that increase alertness, such as bright lighting, conversation, and expectations of rationality.

Mother Nature's pragmatic and efficient principles dictate that these hormones should also help the baby at birth, and this is being increasingly confirmed by scientific research. This hormonal interdependence contradicts the common medical response to natural birth as the mother's prizing of her own experience over her baby's safety, and underlines the mutual dependency of mother and baby, even as they begin their physical separation.

Oxytocin

Oxytocin has been called the hormone of love because of its connection with sexual activity, orgasm, birth, and breastfeeding. In addition, oxytocin is produced in social situations such as sharing a meal, making it a hormone of altruism or, as Michel Odent regularly suggests, of 'forgetting oneself '.

Oxytocin is also the most powerful uterotonic (contraction-causing) hormone, and its release is associated with the contractions of labour and birth in all mammalian species. Oxytocin is made in the hypothalamus, deep in the middle brain, and is released in pulses from the posterior pituitary into the bloodstream every three to five minutes during early labour, becoming more frequent as labour progresses.

The number of oxytocin receptors in a pregnant woman's uterus increases substantially late in pregnancy, increasing her sensitivity to oxytocin. Oxytocin has also been shown to have a painkilling effect in rats and mice. Oxytocin catalyses the final powerful uterine contractions that help the mother to birth her baby quickly and easily. At this time, the baby's descending head stimulates stretch receptors in a woman's lower vagina, which trigger oxytocin release from her pituitary. This oxytocin release causes more contractions that promote more fetal descent, inducing more stretchreceptor stimulation and therefore even more release of pituitary oxytocin. This 'positive feedback loop' is also known as the Ferguson reflex.

After the birth, ongoing high levels of oxytocin, augmented by more pulses released as the baby touches, licks, and nuzzles the mother's breast, help to keep her uterus contracted and so protect her against postpartum haemorrhage. Skin-to-skin and eye-to-eye contact between mother and baby also help to optimise oxytocin release. Blood oxytocin levels peak at around thirty minutes postpartum and subside towards the end of the first hour. Oxytocin levels in the brain, which switch on instinctive maternal behaviour, may be elevated for substantially longer.

Newborn oxytocin levels also peak at around thirty minutes after birth so that during the first hour after birth, both mother and baby are saturated with high levels of oxytocin, the hormone of love. Newborn babies have elevated levels of oxytocin for at least four days after birth, and oxytocin is also present in breastmilk.

During breastfeeding, oxytocin mediates the milkejection, or letdown, reflex and is released in pulses as the baby suckles. During the months and years of lactation, oxytocin continues to act to keep the mother relaxed and well nourished, by enhancing the efficiency of her digestion. Other studies indicate that oxytocin is also involved in cognition, tolerance, and adaptation, and researchers have recently found that oxytocin also acts as a cardiovascular hormone, with effects such as slowing the heart rate and reducing blood pressure.

Uvnas-Moberg describes a 'relaxation and growth response' to oxytocin release, which reflects its ability to turn on the parasympathetic nervous system, which is involved with digestion and growth, and to reduce activity in the sympathetic 'fight-or-flight' system. Malfunctions of the oxytocin system have been implicated in conditions such as schizophrenia, autism, cardiovascular disease, and drug dependency, and it has been suggested that oxytocin may mediate the antidepressant effect of drugs such as Prozac.

Beta-endorphin

Beta-endorphin is one of a group of naturally occurring opiates (drugs derived from the opium poppy), with properties similar to pethidine, morphine, and fentanyl, and has been shown to work on the same receptors of the brain. It is secreted from the pituitary gland under conditions of pain and stress, when it acts to restore homeostasis (physiological balance); for example, by acting as a natural painkiller. Beta-endorphin also activates the powerful mesocorticolimbic dopamine reward system, producing reward and pleasure in association with important reproductive activities including mating, birth, and breastfeeding. Beta-endorphin is also released during episodes of social and physical contact, reinforcing pro-social behaviours among all mammals.

Like the addictive opiates, beta-endorphin reduces the effects of stress and induces feelings of pleasure, euphoria, and dependency. Beta-endorphin levels, as measured in the mother's bloodstream, increase throughout labour, peaking at the time of birth, and subsiding in the first one to three hours. Levels in the new mother's limbic system are elevated for much longer, as beta-endorphin takes more than twenty-one hours to break down within the brain and cerebrospinal fluid (CSF).

In labour, such high levels help the labouring woman to transcend pain, as she enters the altered state of consciousness that characterises an undisturbed birth. In the hours after birth, elevated beta-endorphin levels reward and reinforce mother-baby interactions, including physical contact and breastfeeding, as well as contributing to intensely pleasurable, even ecstatic, feelings for both.

Beta-endorphin is also important in breastfeeding. Levels peak in the mother twenty minutes after commencement, and beta-endorphin is also present in breastmilk. Researchers have found higher levels, at four days postpartum, in the breastmilk of mothers who have had a normal birth, compared with caesarean mothers; they speculate that this extra dose of beta-endorphin is designed to help the newborn with the stressful transition to life outside the womb.

Beta-endorphin, as a component of ongoing motherbaby interactions, induces a pleasurable mutual dependency for both partners, reinforcing and rewarding behaviours such as breastfeeding and physical contact that are associated with long-term well-being and survival.

Catecholamines

The fight-or-flight hormones adrenaline and noradrenaline (epinephrine and norepinephrine in US literature) are part of the group of hormones known as catecholamines (CAs) and are produced by the body in response to stresses such as hunger, fear, and cold, as well as excitement. Together they stimulate the sympathetic nervous system for fight or flight.

During labour, maternal CA levels slowly and gradually rise, peaking around transition. However, high adrenaline levels in early labour, which reflect activation of the woman's fight-or-flight system in response to fear or a perception of danger, have been shown to inhibit uterine contractions, therefore slowing or even stopping labour. Noradrenaline also acts to reduce blood flow to the uterus and placenta and therefore to the baby.

This reflex makes sense for mammals birthing in the wild, where the presence of danger would activate the fight-or-flight response, inhibiting labour and diverting blood to the major muscle groups so the mother can fight or, more likely, flee to safety. In humans, high levels of adrenaline have been associated with longer labour and adverse fetal heart rate (FHR) patterns, which indicate that the baby is low in oxygen (hypoxic), consistent with CA-mediated reductions in uterine blood flow.

Research has also shown that very high CA levels can paradoxically stimulate uterine contractions, which may contribute to the fetus ejection reflex. According to Odent, this reflex occurs at transition, or perhaps even earlier in labour, and almost always follows an undisturbed birth, perhaps because low CA levels in early labour are necessary for its full expression. The mother experiences a sudden and enormous increase in CA levels, giving her a rush of energy and strength; she will be upright and alert, with a dry mouth and shallow breathing and perhaps the urge to grasp something. She may express fear, anger, or excitement, and the CA surge will produce, in concert with high oxytocin levels (associated with the Ferguson reflex), several very strong and irresistible contractions that will birth her baby quickly and easily.

After the birth, the new mother's CA levels drop steeply. If she is not helped to warm up, the cold-related stress will keep her CA levels high, which will inhibit her uterine contractions and therefore increase her risk of postpartum haemorrhage.

For the baby also, labour is an exciting and stressful event, reflected in increasing CA levels. In labour these hormones have a very beneficial effect, protecting the baby from the effects of hypoxia (lack of oxygen) and subsequent acidosis by redistributing cardiac output (blood supply) and by increasing the capacity for anaerobic glycolysis (metabolism of glucose at low oxygen levels).

The baby experiences a marked surge in CA hormones, especially noradrenaline, close to the time of birth, probably triggered by pressure on the head. This surge plays a very important role in the baby's adaptation to extrauterine life. It aids newborn metabolism by increasing levels of glucose and free fatty acids, which protect the newborn's brain from the low blood sugar that can occur in the early newborn period when the baby loses the placental supplies of glucose.

In addition, catecholamines enhance respiratory adaptation to life outside the womb by increasing the absorption of amniotic fluid from the lungs and stimulating surfactant release. Surfactant is essential for smooth inflation of the newborn lungs. CAs also assist with the necessary newborn shift to nonshivering thermogenesis (heat production), increase cardiac contractility, stimulate breathing, and enhance responsiveness and tone in the newborn.

High CA levels at birth also ensure that the baby is wide-eyed and alert at first contact with the mother. The baby's CA levels also drop steeply after an undisturbed birth, being soothed by contact with the mother, but noradrenaline levels remain elevated above normal for the first twelve hours. High newborn noradrenaline levels, triggered by a normal birth, have been shown to enhance olfactory learning during this period, helping the newborn to learn the mother's smell.

Prolactin

Prolactin, known as the mothering or nesting hormone, is released from the pituitary gland during pregnancy and lactation. Prolactin is named for its well-known prolactation effects, preparing a pregnant woman's breasts for lactation and acting postnatally as the major hormone of breastmilk synthesis.

Prolactin levels increase throughout pregnancy, helping to organise the expectant mother's brain for maternity. Prolactin's lactogenic (milk-producing) effect is blocked during pregnancy by high levels of progesterone, produced by the baby's placenta. When progesterone levels drop with the birth of the placenta, prolactin can begin stimulating milk production.

Prolactin levels decline during labour, reaching the lowest point when the labouring woman's cervix is fully dilated. Prolactin then rises again steeply in the moments after birth, perhaps due to stimulation of the mother's cervix during birth, reaching peak levels in the following two to three hours. After this, levels decline again slowly and reach another nadir from nine to twenty-four hours postpartum.

This postpartum maternal surge in prolactin provides maximum levels, available to brain and body, in the hour or so after birth. This elevation may be important in optimising maternal behaviours at this time, as well as ensuring successful lactation.

Animal studies show that prolactin release is also increased by carrying infants, and its association with paternal nurturing (including in humans) has earned it the added title 'the hormone of paternity.' Human studies have shown that just before the birth, fathers-to-be have elevated prolactin levels, which parallel the rise of prolactin in their partners. New fathers with higher prolactin levels are more responsive to newborn cries.

In summary

Mother Nature's superb design is hard-wired into our female bodies, providing an elaborate orchestration of hormones to enhance ease, pleasure and safety in labour, birth and postpartum. These hormones also ensure an ideal start to, and ongoing pleasure and reward from, breastfeeding and attachment, optimising well-being and survival for mother and offspring in the medium and long terms.

The full expression of these labouring hormones requires specific conditions: that the labouring mother feels private, safe and unobserved. This basic need is recognised by traditional systems of maternity care, which prioritise the emotional well-being of the labouring woman and ensure that she is cared for in a familiar place with known and trusted helpers. These factors will keep her as calm and relaxed as possible, and her adrenaline levels low.

Conversely, if she is not feeling private, safe and unobserved in labour, her adrenaline levels will increase, slowing labour and decreasing blood and oxygen supply to the baby and leading to fetal distress for vulnerable babies. Our current maternity care system does not done for slow labour and fetal distress. Interventions used for these indications such as synthetic oxytocin and caesarean surgery can further interfere with the hormonal orchestration for mother and baby, creating a cascade of intervention and depriving both of the ideal start that Mother Nature intends.

As Professor Kloosterman states so eloquently: 'Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine - nil nocere [do no harm].'

Following her recent UK seminars (recorded and available on DVD) Sarah adapted Chapter 6, Undisturbed Birth: Mother Nature's Blueprint for Safety, Ease, and Ecstasy, of her book Gentle Birth, Gentle Mothering, to produce this article for AIMS. Sarah's books, DVDs and articles are available at www.sarahbuckley.com
References
1. Buckley, SJ (2009) Gentle Birth, Gentle Mothering. Celestial Arts Buckley, SJ (2009) Gentle Birth, Gentle Mothering. Celestial Arts
2. Uvnas-Moberg, K (2011) The Oxytocin Factor : Tapping the Hormone of Calm, Love and Healing. 2nd edition. Pinter & Martin Ltd.

Further references and additional reading suggestions are available at www.sarahbuckley.com/undisturbed-birth-aims-reference

The AIMS Journal spearheads discussions about change and development in the maternity services..

AIMS Journal articles on the website go back to 1960, offering an important historical record of maternity issues over the past 60 years. Please check the date of the article because the situation that it discusses may have changed since it was published. We are also very aware that the language used in many articles may not be the language that AIMS would use today.

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Published on 1st December 2011

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AIMS Journal, 2011, Vol 23 No 4 Sarah Buckley shows us what is stopping birth working In modern Western countries, including Australia and the UK, rates of obstetric intervention have reached extreme levels, such that very few mothers and babies experience labour and birth without drugs and procedures to assist or hasten the process.

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This website gives you information, tools and resources to become an active member of your maternity care team and active participant in your care. You may be surprised to know that being fully engaged in your maternity care can make all the difference in the care you get, your experiences and the well-being of both you and your baby.

Having the skills, knowledge and confidence to wisely navigate your maternity care is important because:

The quality of maternity care varies a lot across providers and care settings. The care arrangements you make affect what happens to you and your health.

There is broad agreement that cesareans and many other maternity practices are overused and can cause needless discomfort and harm. Becoming informed and following proven tips can help you avoid these problems.

High-quality research points to many safer, more effective practices for you and your baby. But it can take many years before these practices are reliably provided to women and babies at the point of care. Knowing about and seeking best practices can make a big difference for both of you.

Your baby is counting on you to advocate for her or his best start.

You are embarking on many years of responsibility for managing health care across generations. Pregnancy and birth is an ideal time to develop skills, knowledge and confidence for a lifetime. You've come to the right place!

Stay connected with Childbirth Connection. Get updates.

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This website gives you information, tools and resources to become an active member of your maternity care team and active participant in your care. You may be surprised to know that being fully engaged in your maternity care can make all the difference in the care you get, your experiences and the well-being of both you and your baby.

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Angela Horn's
Home Birth Reference Page

Your browser does not appear to support frames. No problem - please go to the non-frames version of the Home Birth Reference Page.

The non-framed pages contain the same information as the framed pages; all you will miss is the navigation bar.

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Angela Horn's Home Birth Reference Page Your browser does not appear to support frames. No problem - please go to the non-frames version of the Home Birth Reference Page. The non-framed pages contain the same information as the framed pages; all you will miss is the navigation bar.

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Harvey Karp, MD, author of The Happiest Baby on the Block, describes a combination of techniques he calls the "5 S's" to help calm crying babies.

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The uterus is undisputedly the ultimate environment for the development and nurturing of a fetus. The sensory systems develop throughout pregnancy and affect the brain's development.

Fetal sensory development

Your baby begins to develop on a sensory level from the moment of conception. The first sense to develop is the sense of touch, emerging at 3 weeks gestation - before you knew you were pregnant. By the twelfth week, your baby can feel and responds to touch on his entire body, with the exception of the top of his head, which remains insensitive until birth.

The auditory system is completely intact by 20 weeks gestation but it is a few weeks before the nerves conducting sound are functional. At 23 weeks your baby can respond to loud noises and may jerk or even begin to hiccup after hearing a loud sound.

Taste buds emerge at 8 weeks and by 13-15 weeks your baby has taste buds similar to adults'. Anything you eat can flavour the amniotic fluid. While we are not exactly sure when the baby starts to perceive taste, we do know that a baby born prematurely (33 weeks) sucks harder at sweetened nipples and when saccharine is injected into the amniotic fluid in the third trimester babies suck faster.

Smell develops alongside the sense of taste. Since smells are essentially chemicals that are found to be present in amitotic fluid, it stands to reason that your baby can smell in utero as the chemicals pass from the amniotic fluid onto the smell receptors in the nasal cavity. The nasal cavity is protected by a plug of tissue until 28 weeks, but thereafter your baby will smell and respond to scents.

Your baby's tiny eyelids open at 26 weeks and at 6 months we know that babies can see light in utero. At 32 weeks gestation your baby can track a bright torchlight shone and moved across your pregnant belly.

The sense of movement and gravity from the balance (vestibular) system in the ears develops very early and begins to function at five months gestation. Like the sense of hearing and touch, the sense of movement is relatively advanced at birth.

The world of the womb

Knowing that the sensory systems perceive the intrauterine world by the second and third trimesters, we may wonder what the womb world is like on a sensory level.

The womb world is devoid of light touch - deep pressure touch and the sense of warmth are greatest inputs to the sense of touch. By the third trimester, the elastic uterus provides constant, deep pressure, like an all-day hug or massage. This tight hug keeps your baby curled up, with pressure on his back and his hands towards the midline. In this position, your baby can suck his hands and his immature reflexes, which are starting to emerge in utero are contained so that he feels secure. The temperature in the womb is always perfect, a temperature we call neutral warmth. Threatening touch, such as pain, high or low temperatures and tickle are completely absent during gestation.

In the womb, the overwhelming sounds (about 85 decibels) are the background sounds of your body. Your baby hears the gushes of amniotic fluid and blood flowing in the veins and of course your heartbeat and digestion. These background noises contribute to the constant white noise he hears. The consistent sound of the heartbeat is a particularly soothing sound and babies who are played a beat at the pace of the average heartbeat (72 beats per minute) fall asleep easier and cry half a much after birth. Sounds from the outside world are subdued (55 decibels) but the clearest sound he hears is your voice as it is carried not only outside the body but also through your bones in the form of vibrations. Dad's voice is the second most familiar sound to your baby and it is nice to know that within hours of birth your baby will recognize Dad by his voice.

Because all tastes you experiences pass into the amniotic fluid, your baby is prepared for the flavours your family eats even while in utero. The preference for sweet tastes is hardwired and babies prefer sweet flavours, swallowing amniotic more vigorously after you eat something sweet.

Even though your baby is interested in and tracks a bright light, the reality is that he is rarely exposed to bright lights and there is very little visual stimulation in utero. In general the womb world is visually muted and often it's quite dark. There are no bright colours or contrasting shapes in utero on which your baby can hone his developing visual skills. For this reason the visual system is relatively immature at birth.

In utero your baby is buoyed by amniotic fluid and whirls freely in a contained liquid bubble. Since water decreases the weight of an object by 50 times, your baby has the wonderful sensation of being 1/50th lighter than on earth. He is lulled by the constant rocking and swaying motion of this gravity-reduced world, gently rocked to sleep. When the lulling movement stops - such as when you rest or lie down, your little one may become wakeful and busy. During the third trimester, your baby's vestibular system has matured sufficiently to sense gravity and to turn to the appropriate 'head down' position in preparation for birth.

The fourth trimester

By understanding the world of the womb, you can make your little one's transition to the real world smoother.

By Meg Faure
References
Eliot L. Whats going on in there? How the brain and mind develop in the first five years of life Bantam Books 1999
Faure M The Baby Sense Secret Dorling Kindersley (to be released 2011)
Faure M & Richardson A Baby Sense Metz Press 2010
Graven S & Browne J Auditory Development in the Fetus and Infant. Newborn & Infant Nursing Reveiws. Volume 8, Issue 4 2008
Hepper P. Unraveling Our Beginnings: On the Embryonic Science of Fetal Psychology. The Psychologist 18 (8) Aug 2005, published by the British Psychological Society.
Hopson J. Fetal Psychology Psychology Today, October 1998
Meisami E. et al Human Olfactory Bulb: Aging of Glomeruli and Mitral Cells and a Search for the Accessory Olfactory Bulb Annals of the New York Academy of Sciences, 1998
Trevathan W. Human birth: An evolutionary perspective. New York: Aldine de Gruyter 1987

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The secret world of the unborn - how your baby's senses develop in the womb

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The uterus is undisputedly the ultimate environment for the development and nurturing of a fetus. The sensory systems develop throughout pregnancy and affect the brain's development. Your baby begins to develop on a sensory level from the moment of conception.

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Maternal Positioning

Maternal Positioning is a phrase for talking about posture and positions women use in pregnancy and in labor for comfort or labor ease. Maternal positioning uses the 2nd Principle of Spinning Babies: Gravity.
Sitting up on the sitz bones is better for your back.
Maternal positioning is thought to influence the fetal position during pregnancy and birth. There is some evidence both for and against this claim in the literature.

Le Boursier du Coudray, Abre'ge' (1773) "counseled ... that women sleep on one side so that the opening of her womb, a bit off kilter, would be pulled by gravity into alignment with the vagina." -The King's Midwife; A history and Mystery of Madame du Coudray by Nina Rattner Gelbart

Fetal Positioning

Fetal Positioning is a phrase to talk about the baby's position in the womb.

Babies change position in pregnancy and during the birth process. True! That's nature's design! But, I do not believe fetal position changes are random. I think the research lacks attention to several factors. I believe there are multiple factors that come together to affect the fetal position changes.

The most important reason, I believe is what I simply call "Balance."

Maternal positions support the balance you have regained with daily walking, stretches and with professional body work. See samples for this in Rest Smart.

If a woman's womb is relatively balanced, then getting into gravity-friendly positions during pregnancy can help a breech baby to flip head down or a posterior baby to scoot over to the mother's left side and face her right hip.

Contractions of labor may help a posterior rotate to an anterior position with time. Time necessary for rotation may be shortened when a woman uses gravity-friendly maternal positions. Gravity-friendly positions are more likely to reposition baby if the womb is in balance. You see how they are connected?

Pregnancy Maternal Positions

Sitting with your hips higher than your knees

Sitting with your back straight and your rib cage lifted off your middle

Sitting on a firm exercise ball that allows your hips to be level with your knees or higher than your knees

Laying with your navel aiming towards the bed, floor or couch/ sofa, if not directly on your belly, then so that eventually an imagined light-beam coming from your navel would eventually find the floor

Brief Forward-Leaning Inversions, once a day

Squatting or supported squatting with your back flat against the wall and your knees bent (work gradually up to where you can squat with your feet flat on the floor for 2-5 minutes)

Holding your shoulders back, yet relaxed, while you walk briskly

Melissa stands and leans forward during contractions (Photo by Melissa Booth)
Some helpful maternal positions in pregnancy are:

All the same that are listed above, plus

Standing and leaning forward with your knees "soft" (slightly bent)

Standing and leaning back (straightening, even arching your back slightly)

Standing and flattening your lower back against the wall while lifting your lower abdomen during the entire contraction (See Belly Lift)

Kneeling

Kneeling and leaning forward on a bed or chair or exercise ball (hands and knees)

Kneeling and lifting your arms to grip a shawl or rope or bar above you

Kneeling and resting your elbows on the mattress or floor in front of you

Kneeling and resting your shoulders on the floor or mattress in front of you

In the deep birth tub, kneeling in a way that stretches your knees far away from your hips, so that your thighs are at a diagonal and your knees are further from your belly than your hips. This opens your pubic bone away from your spine and lets a posterior baby drop into the pelvis (engage). Do this only in active labor after you've tried to help baby rotate to the Left occiput transverse and that hasn't been able to happen for whatever reason.

Sitting on a birth stool

Lifting your arms to grip a shawl (Rebozo) and standing with your knees "soft" (slightly bent)

Labor Maternal Positions

Some helpful maternal positions in labor are:
The "L" shaped abdominal wall wrapping underneath the body and holding the organs up above is a major part of the female pelvic organ support system. So yes, our work is all about what I'm calling the natural shape of the female spine. And we come to that through posture. Exercise is fabulous, but its how we hold our body, as much as we can, through the course of the day....It becomes unconscious, pulling into this shape that we've trained ourselves to be in. It becomes effortless, and ultimately supportive of our abdominal and pelvic organs."
Adding your instinctive movements is an excellent way to "tune in" to what your body needs to do to respond to your labor.

From Christine Kent, RN "..How our spine is is primary, but how the abdominal wall is is equally primary. We're a whole tension-compression system. The whole thing works in harmony. There are really no parts in this system; it is a whole.
The living room couch may be the biggest contributor to unnecessary cesareans. Slouching on the sacrum is not helpful.
Katy Bowman Says on her Facebook called Aligned and Well: "I've said this before, but it can't be said too many times: Posture does not equal alignment. Posture is how something looks. Alignment is how something works. "Good posture" is cultural and is typically horrible alignment."

Katy has got a lot to say, and you may learn a lot from visiting her website.

What positions to avoid resting in

There are times in pregnancy and labor when it is perfectly OK to lie on your back. During an exam, rolling over, doing exercises and getting body work, for example. But when you are resting, it's better not to be on your back for the purposes of fetal positioning. You may feel comfortable on your back in the first half of pregnancy. Towards the end of pregnancy, your blood circulation will be better if you lay on your side than on your back. You can lay on your left or right as comfort directs you. Fetal positioning may be a concern of yours, however. For instance, you had a posterior labor previously or a cesarean for a long or stalling labor. Then, your resting position may matter as early as the end of the first trimester!

Maternal position alone is not usually enough to ensure a good fetal position by the time labor begins.

Balance in the uterus and pelvis precedes the success of using maternal positioning for changing fetal position.

Maternal positioning is Spinning Babies Principle 2: Gravity.

For some women, good maternal positioning includes not sitting and leaning back against the birthing tub. Lay on your side in the birthing tub, but don't semi-sit if you have any history of a long or posterior labor, shoulder dystocia or are experiencing a long second stage (pushing). Most of the time the baby will come out fine anyway, but its best to avoid this position for any longer than 15 minutes and avoid being spine-down for birthing your first baby (first vaginal birth).

You can also lie on your right side. The directions to lie on your left side are not meant to be a prohibition against laying on your right side. You can favor your left if your care providers suggest you lay on your left. But once in a while, you need to roll over just to give your left shoulder some circulation! Somewhere, there is a woman who must lay in one particular position and will have to ignore this advice in preference to her caregiver's advice. I acknowledge that and hope you do, too.

Conclusion

Gravity-friendly positions are rarely enough. Add movement to increase flexibility and reduce pain. Before either, add balance to help both Gravity and Movement ease birth.

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Maternal Positioning is a phrase for talking about posture and positions women use in pregnancy and in labor for comfort or labor ease. Maternal positioning uses the 2nd Principle of Spinning Babies: Gravity. Sitting up on the sitz bones is better for your back.

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Place of birth

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Hormones

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Hormones, labour and birth: an introduction

You know your hormones are going to be working hard at this time but you might not know exactly what they're doing. You'll in fact have four major hormonal systems active when you're in labour and giving birth. These hormones are:

oxytocin (the love hormone)

beta-endorphins (the hormones of pleasure and transcendence)

epinephrine and norepinephrine (the hormones of excitement)

prolactin (the mothering hormone).

(Buckley, 2002)

Here's what impact all four will have on you...

Oxytocin or the love hormone

Oxytocin is the love hormone, which is why it's released during sex, orgasm, birth and breastfeeding (Odent, 1999; Buckley, 2002).

Oxytocin will make you feel more affectionate and selfless, and its main function in labour is to bring on contractions (Dawood et al, 1978). You'll get a surge of oxytocin in the final stage, so if you're having a vaginal birth it will help you along with pushing.

Oxytocin reduces stress, calms you down and helps with pain during labour (Buckley, 2015). Impressively, your baby will also produce oxytocin before and during labour (Chard et al, 1971).

Oxytocin hangs around after birth too, helping you feel more relaxed, well-nourished and bonded with your baby (Buckley 2002, Buckley 2015). It helps with the let-down reflex during breastfeeding and protects you against postpartum haemorrhage (Buckley, 2002).

Beta-endorphins or the pleasure hormones

Endorphins are naturally occurring opiates, similar to morphine and heroin. Like oxytocin, they mostly appear during sex, pregnancy, birth and breastfeeding. Beta-endorphins reduce pain and suppress the immune system, which is important so that it doesn't act 'against' your baby (Buckley, 2002, 2015).

If you're stressed during labour, that can make you release excessive beta-endorphins, which may inhibit oxytocin and slow things down (Buckley 2015). That's why keeping things as calm as possible is a great thing in labour.

Beta-endorphin also helps with the release of prolactin during labour, preparing your breasts for feeding (Rivier et al, 1976).

And one more thing: it helps in the final phase of your baby's developing lungs too (Buckley 2015).

Epinephrine and norepinephrine or fight or flight hormones

You might have heard these two referred to as fight-or-flight hormones but their proper names are epinephrine and norepinephrine (adrenaline and noradrenaline). They are produced during stresses like fright, anxiety, hunger or cold and also when you're excited (Buckley 2015).

You're likely to get a high level of these hormones if you don't feel private, calm, safe and undisturbed and they can then inhibit oxytocin (Buckley 2015). Yet in the late-labour stage if you perceive danger or stress, they may paradoxically stimulate contractions so you give birth more quickly (Buckley 2015).

A rise in epinephrine when you're in the later stages of labour increases your levels of prostaglandin and cortisol to help with contractions. This will make you feel a sudden rush of energy and will cause several strong contractions and will help you push (Buckley, 2002, 2015).

These hormones help your baby too by protecting them against a lack of oxygen (Buckley, 2002). Your baby will have high levels of these hormones during birth but they'll drop quickly once you sooth them afterwards (Lagercrantz and Bistoletti 1977; Buckley, 2002).

Prolactin or the mothering hormone

Prolactin is the mothering hormone. And it's the major hormone for breastfeeding.

Prolactin starts to increase during pregnancy and peaks at birth (Buckley, 2002). Your baby produces prolactin in the womb too (Daniels and Martin, 1994).

Hormones and your feelings after birth

Lots of women get the baby blues during the first week after birth of her baby days (NHS Choices, 2018). You might feel down or depressed, emotional or irritated and likely to burst into tears at any second.

Don't despair though: these symptoms are totally normal. They're due to the sudden hormonal and chemical changes that happen after you give birth.

If you feel like you are suffering from something more extreme and it isn't going away though, talk to your GP or midwife. You might be suffering from postnatal depression and should get some support or help right away.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Buckley SJ. (2015) Hormonal physiology of childbearing: Evidence and implications for women, babies, and maternity care. Washington, D.C.: Childbirth Connection Programs, National Partnership for Women and Families. Available from: http://www.nationalpartnership.org/research-library/maternal-health/hor... [Accessed 25th April 2018]

Buckley SJ. (2002) Ecstatic birth: The hormonal blueprint of labor. Available from: http://www.dancingstarbirth.ca/Handouts/Ecstatic_Birth.pdf [Accessed 25th April 2018]

Chard T, Hudson CN, Edwards CR, Boyd NR. (1971)Release of oxytocin and vasopressin by the human fetus during labour. Nature. 234:352-354. Available from: https://www.ncbi.nlm.nih.gov/pubmed/4944487 [Accessed 25th April 2018]

Daniels G, Martin J. (1994) Neuroendocrine regulation and diseases of the anterior pituitary and hypothalamus, In Harrison's Principles of Internal Medicine, 13th edition. New York: McGraw- Hill. [Accessed 25th April 2018]

Dawood MY, Raghavan KS, Pociask C, Fuchs F. (1978) Oxytocin in human pregnancy and partrurition. Obstetrics and Gynecology. 1978; (51):138-143. Available from: https://www.ncbi.nlm.nih.gov/pubmed/622223 [Accessed 25th April 2018]
Lagercrantz H and Bistoletti H. (1977) Catecholamine release in the newborn infant at birth. Pediatric Research. 8:889-893. Available from: https://www.ncbi.nlm.nih.gov/pubmed/887309 [Accessed 25th April 2018]

NHS Choices. (2018) Feeling depressed after childbirth. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/feeling-depressed-afte... [Accessed 25th April 2018]

Odent M. (1999) The Scientification of Love. London. Free Association Press.

Rivier C, Vale W, Ling N, Brown M, Guillemin R.(1976) Stimulation in vivo of the secretion of prolactin and growth hormone by beta-endorphin. Endocrinology. 100:238-241. Available from: https://www.ncbi.nlm.nih.gov/pubmed/187406 [Accessed 25th April 2018]

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Hormones in labour: oxytocin and the others - how they work

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You know your hormones are going to be working hard at this time but you might not know exactly what they're doing. You'll in fact have four major hormonal systems active when you're in labour and giving birth.

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Breech baby

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Most babies who are in a bottom down (breech) position will turn to the normal head down position (cephalic) by 37 weeks. After 37 weeks they are much less likely to turn by themselves. However, it is often possible to manually turn a baby head down by applying gentle pressure on the mother's abdomen, thus improving the chances of having a straightforward birth. This technique is known as an External Cephalic Version or ECV and this page explains what is involved and answers some commonly asked questions.
Watch our video here
Who can have an ECV?

ECV is normally offered to women who are more than 37 weeks pregnant with a baby in the breech position. There may be reasons why your obstetrician (doctor) would advise you not to have ECV, e.g. if you have had a previous caesarean birth, if your baby is not growing well or if you have had vaginal bleeding or your waters have broken.

After your antenatal check up at 37 weeks, if your baby is breech your midwife or doctor will discuss the possibility of an ECV with you, including the risks and benefits. If an ECV is agreed then you will be given an appointment and information about coming in to hospital for the procedure.

What are the benefits?

Research has shown that ECV is safe and works in most cases.

ECV makes it more likely that you will give birth normally, reducing the risks for you and your baby that are associated with the major surgery of a Caesarean birth. These include thrombosis (blood clots), infection and haemorrhage.

A straightforward birth this time reduces your chances of having a caesarean birth in any future pregnancy.

Are there any risks?

Risks associated with having an ECV are very rare. However, an ECV may cause:

Your baby's heartbeat to slow down briefly. There is only a small risk of this. It happens to eight out of every 100 babies that have ECV, and they usually recover after just a few minutes. The procedure is always performed in the Delivery Suite so that on the extremely rare occasions that a baby is not coping well in their new position they can be born by caesarean.

Labour to start straight away. There is no need to worry as at 37 weeks your baby will be ready to be born.

Discomfort for some women, but it should not be painful.

If your blood group is rhesus negative you will be offered an injection of Anti D in case there has been any mixing of yours and the baby's blood during the procedure.

When, where and how?

The ECV is performed in the Delivery Suite (Tunbridge Wells Hospital at Pembury) at around 37 weeks.

On arrival your midwife will check you over and monitor your baby's heart rate continuously for 20 minutes to make sure everything is normal. You will be asked to sign a form to say that you agree to have the procedure.

Your baby's position will be checked using a portable scanner. You will be given a small injection of a drug called Terbutaline which will help your uterus (womb) to relax and therefore increase the chance of success. You will be asked to lie flat on the bed and the doctor will gently try to turn the baby in a forward or backward manner. If the doctor cannot turn your baby easily within a few minutes, they will stop trying.

Whatever the result, the midwife will monitor your baby's heart rate again for a further 20 minutes before you go home.

What is the success rate?

Around 75% (3/4) of babies will be successfully turned to a head down position. This will mean that the pregnancy can then continue as normal with a good chance of a straightforward labour and birth.

If the ECV doesn't work the doctor will discuss with you your options for the birth. In this hospital we normally advise that babies that remain breech at the end of pregnancy are born by Caesarean.

Is there anything I can do that might help turn the baby?
Positioning in late pregnancy
Some people believe that getting into certain positions (such as on all fours) late in pregnancy can encourage a baby to turn by itself; however, there is no significant research that shows that this will definitely work. Please ask your midwife to explain what you should do if you would like to try this.
Complementary therapies: Moxibustion
This is a traditional Chinese technique using 'moxa sticks' (made from an herb) as a gentle heat source applied to acupuncture points on your feet. Some scientific studies suggest it can be effective, but it hasn't been researched well enough for us to be sure.

Some women like to try other Complementary therapies such as homeopathy, but again there is not enough evidence to be sure that these are useful. There is no evidence to suggest that Moxibustion or other complementary therapies carried out by an appropriately trained practitioner is harmful to you or your baby, but we advise you check with your midwife or doctor first.

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Breech baby - Maidstone and Tunbridge Wells NHS Trust

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Most babies who are in a bottom down (breech) position will turn to the normal head down position (cephalic) by 37 weeks. After 37 weeks they are much less likely to turn by themselves. However, it is often possible to manually turn a baby head down by applying gentle pressure on the mother's abdomen, thus improving the chances of having a straightforward birth.

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Homework

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Womb to world

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Place of birth

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Find the right place for you to give birth, based on your preferences and personal circumstances. Our tool suggests the best maternity options for you to discuss with your midwife.

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External cephalic version

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An updated review by the Cochrane Collaboration has looked at external cephalic version (ECV), a procedure used in an attempt to turn breech babies into a head-down position, and considered whether this has an effect on presentation at and method of delivery, and perinatal and maternal morbidity and mortality.

In the background to their review, the authors noted that:

3-4% of women who reach full term will have a baby in the breech position.

Breech delivery has a higher incidence of poor perinatal outcomes than cephalic birth, and this is the case both for caesarean section and vaginal breech birth.

Most women whose baby is in a breech presentation would prefer a vaginal birth (although they would have a caesarean section if this was medically indicated).

Both methods of birth (vaginal birth and caesarean section) have been shown to be safe for the baby. Some studies show that caesarean section is safer for the baby than medically-managed breech vaginal delivery, though one analysis shows that vaginal breech birth is just as safe for the baby under certain conditions. Caesarean section does increase the risk of morbidity for the mother.

It is for this combination of reasons that ECV has long been seen as another option, and a way of potentially reducing the caesarean section rate and improving perinatal and maternal outcomes.

As the abstract below shows, the authors found eight relevant studies, which included the outcomes of 1308 women. The results show that ECV is effective, in that it does reduce the number of babies who are still in a breech position at term, and that it reduces the number of caesarean sections. There was not enough good data to be able to draw conclusions about whether ECV reduces perinatal mortality and morbidity, but the authors note that the data that are available from other studies suggest that complications from ECV are rare.

This is good news, but all reviews of this nature need to be considered in the context of the wider picture and debates. The wider debates in this area include the fact that much of the research on breech delivery has focused on interventive and medically-managed delivery (often including drugs, restricted maternal position, episiotomy and routine manipulation of the baby as it is born) rather than a more supportive approach which promotes physiological breech birth and where the practitioner intervenes only if there is a need to do so. Because of this, we need to be careful to recognise that the evidence in this area is almost all based on a medicalised approach, and that there may be more to learn from evaluating other methods of supporting women whose babies are in a breech position.

It is also worthy of note, however, that this is a really difficult area to research well. Among other issues, it is next to impossible to 'blind' participants or researchers to the method of delivery, and there may be differences in the way in which babies who are born head-first or bottom-first adapt to life outside the womb, which may affect their outcomes in the first few minutes of life. In another recent observational study (Beuckens et al 2015), the success rate of ECVs performed by trained midwives in primary health care or hospital settings in the Netherlands was found to be comparable with that of other providers, and the procedure was safe for low-risk women, but this kind of study is different from those that are included in the Cochrane review.

Background: Management of breech presentation is controversial, particularly in regard to manipulation of the position of the fetus by external cephalic version (ECV). ECV may reduce the number of breech presentations and caesarean sections, but there also have been reports of complications with the procedure.

Objectives: The objective of this review was to assess the effects of ECV at or near term on measures of pregnancy outcome. Methods of facilitating ECV, and ECV before term are reviewed separately.

Search methods: We searched the Cochrane Pregnancy and Childbirth Trials Register (28 February 2015) and reference lists of retrieved studies.

Selection criteria: Randomised trials of ECV at or near term (with or without tocolysis) compared with no attempt at ECV in women with breech presentation.

Data collection and analysis: Two review authors assessed eligibility and trial quality, and extracted the data.

Main results: We included eight studies, with a total of 1308 women randomised. The pooled data from these studies show a statistically significant and clinically meaningful reduction in non-cephalic presentation at birth (average risk ratio (RR) 0.42, 95% confidence interval (CI) 0.29 to 0.61, eight trials, 1305 women); vaginal cephalic birth not achieved (average RR 0.46, 95% CI 0.33 to 0.62, seven trials, 1253 women, evidence graded very low); and caesarean section (average RR 0.57, 95% CI 0.40 to 0.82, eight trials, 1305 women, evidence graded very low) when ECV was attempted in comparison to no ECV attempted. There were no significant differences in the incidence of Apgar score ratings below seven at one minute (average RR 0.67, 95% CI 0.32 to 1.37, three trials, 168 infants) or five minutes (RR 0.63, 95% CI 0.29 to 1.36, five trials, 428 infants, evidence graded very low), low umbilical vein pH levels (RR 0.65, 95% CI 0.17 to 2.44, one trial, 52 infants, evidence graded very low), neonatal admission (RR 0.80, 95% CI 0.48 to 1.34, four trials, 368 infants, evidence graded very low), perinatal death (RR 0.39, 95% CI 0.09 to 1.64, eight trials, 1305 infants, evidence graded low), nor time from enrolment to delivery (mean difference -0.25 days, 95% CI -2.81 to 2.31, two trials, 256 women). All of the trials included in this review had design limitations, and the level of evidence was graded low or very low. No studies attempted to blind the intervention, and the process of random allocation was suboptimal in several studies. Three of the eight trials had serious design limitations, however excluding these studies in a sensitivity analysis for outcomes with substantial heterogeneity did not alter the results.

Authors' conclusions: Attempting cephalic version at term reduces the chance of non-cephalic presentation at birth, vaginal cephalic birth not achieved and caesarean section. There is not enough evidence from randomised trials to assess complications of ECV at term. Large observational studies suggest that complications are rare.

Hofmeyr GJ, Kulier R and West HM (2015). External cephalic version for breech presentation at term. Cochrane Database of Systematic Reviews, Issue 4. [DOI: 10.1002/14651858.CD000083.pub3]

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External cephalic version: is it effective? is it safe?

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An updated review by the Cochrane Collaboration has looked at external cephalic version (ECV), a procedure used in an attempt to turn breech babies into a head-down position, and considered whether this has an effect on presentation at and method of delivery, and perinatal and maternal morbidity and

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Fourth trimester

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BRAIN

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External cephalic version

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Successful External Cephalic Version (ECV) - Turning a breech baby in just 2 minutes!

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Doctors at the Royal Sussex hospital in Brighton perform an ECV on a breech baby at 36weeks +3.

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Breech baby

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Head's up! A breech baby has their buttocks coming into mother's pelvis before the head. Usually, the buttocks will be born first, less often the feet or knees emerge first.

Is breech presentation a malposition or a normal variation?

What are the types of breech positions?

When is vaginal birth safer than surgery and when is a cesarean better?

There are four basic breech types:

1. Frank, or bottom first with legs extended towards baby's trunk;

2. Complete, or legs folded so that feet are very close to the buttocks;

3. Footling, or one or more feet coming into the pelvis first, the bottom is above the brim and the feet are below; at 37 weeks, the knees may be bent so that the baby seems to be sitting on the top of the pelvis dipping his feet into the pelvic tunnel;

4. Kneeling, or both knees are coming first, the feet are folded up behind the baby's thighs.

Unfortunately, even skilled sonographers, midwives and physicians, may chart the baby in an oblique or transverse lie with the label "breech". Follow the links to see more about those babies that have neither head nor bottom over the pelvic inlet.

Trying to turn your breech baby head down?

Spinning Babies Parent Class video walks you through all exercises steps we recommend for helping your baby turn head down on their own, or making an external version easier & more successful. Plus, you will learn the Spinning Babies approach using balance, movement and gravity for comfort in pregnancy and an easier birth.

Breech Position Consultation from Spinning Babies on Vimeo.

Spinning Babies Parent Class from Spinning Babies on Vimeo.

When, in pregnancy, is breech an issue and when is it fine?

In time, the breech Baby's head becomes heavy enough, between 5-7 months, for gravity to bring the head down in a symmetrical womb. The baby will move head down if there is room or if there is tone in the support to the uterus to direct baby head down.

Before 24-26 weeks most babies lie diagonal or sideways in the Transverse Lie position.

Between 24-29 weeks most babies turn vertical and some will be breech.

By 30-32 weeks most babies flip head down and bottom up.

By 34 weeks pregnant, the provider expects baby to be head down.

Between 36-37 weeks, a provider may suggest a external cephalic version.

About 3-4% of full term babies are breech; term is from 37-42 weeks gestation.

During the month before 30 weeks, many babies are breech. The breech baby is vertical, so the womb is "stretched" upwards. This makes it easier for the breech baby to flip to head down around 28-32 weeks. Breech is not an issue until 32-34 weeks unless the womb has an unusual limitation in shape or size such as a bicornate uterus, in which case baby needs to be head down much earlier than when the uterus has more room.

The medical model of care addresses the breech position between 35-37 weeks, when baby survival outside the womb won't include special nursery care to breathe or suck. Physicians Oxorn and Foote, however, recommend helping babies turn head down at 34 weeks. Many home birth midwives suggest interacting with a baby at 30-34 weeks to encourage a head-down position (vertex).

Women who have had difficult previous births due to posterior, asynclitism or a labor that didn't progress, may want to begin bodywork and the forward-leaning inversion early in pregnancy (after morning sickness is gone and extra things like fetal positioning activities can be thought about).

Read the details about what to do at what time in pregnancy in the membership level of SpinningBabies.com (coming).

Common issues with breech are:

Health of the baby overall

Safety of the birth

Safety for the mother facing surgical birth

Emotions of the mother and partner

Reasons for breech
Breech babies may have a number of reasons for being breech.

Born earlier in pregnancy than full term and hadn't had time to turn head down.

About 1 in ten breech babies has a mild or major physical difference reducing their ability to turn head down. For instance, some Down's Syndrome babies will be breech.

Two studies show that more mothers of breech babies have low thyroid function compared to all women who don't have a breech baby at time of birth. This may show a metabolic connection to fetal position.

A low lying placenta blocks the room for the head

The cord is wrapped around the baby

The first time mom has a tight abdomen, super strong core, less water

The mom whose birthed about 5 or more times, has a loose womb and baby isn't prompted to turn head down by muscle tone

In my experience, most babies are breech due to uterine ligaments and muscles being either too tight and asymmetrical (twisted or torqued) or too loose.

For example:

The sacrum is not straight and a short line at the top of the buttocks veers to one side or the other in a subtle way.

The ala of the sacrum may be rotated on a vertical axis.

There may be a buckle on the horizontal segments of the sacrum.

An imbalance may be restored to balance if a woman has the right technique or help for her body. The SI joints or the symphysis pubis may be out of alignment, as well. I heard about these causes from chiropractor friends and observations have bore these ideas out.

Success in flipping babies is high with this approach.

Many Chiropractors can loosen the ligaments by doing the Webster Technique. Adjusting the sacrum, for both a vertical twist or a buckled (horizontal wrinkle) sacrum will let the baby put their head down more readily because the bones won't be in the way. It often takes a complete approach, not one without the other, for success.

Breech position may be caused by imbalance (asymmetry) in the mother's pelvis or soft tissues. In other words, a tension or a twist in the lower uterine segment may be a "soft tissue" issue. This is not the woman's fault, we simply live in an era where a slight twist in the pelvis is common. For example,

Pressing the gas pedal while driving;

Crossing our legs;

Sports injuries;

Abrupt stops as in a "fender bender" torquing our torso;

Carrying a toddler on a hip; falls; or even

A head or ankle injury

All of these can twist the pelvis and, in turn, twist the uterus, resulting in asymmetry.

When any part of the pelvis is out of symmetry (crooked) then the ligaments supporting the womb are pulled and twisted, too. The shape of the lower womb can be altered by this. The baby then has to find a way to fit that isn't quite what nature intended. A twisted sacrum is common for breech (and posterior).
Aligning the pelvis, and relaxing tight uterine ligaments attached to the fascia near the pelvis, are why chiropractic adjustments can often help breech babies flip to a head-down position.
One thing I've observed is that when the breech baby does flip head down during the last month or two of pregnancy, that the baby often moves to the head down, posterior (face forward) position. When a breech position is suspected, using the forward-leaning inversion and the breech tilt can help the baby flip head down.

Spinning Babies view on the common cause of breech presentation

Some midwives will say that breech babies may be breech because they want to be. Hmmm. That may be, but I suggest we address a possible imbalance of the uterus. I believe the baby will get in the best position possible given the space in the womb. It's not that any woman isn't perfect inside, but optimal room in the uterus depends on pelvic alignment and ligaments of equal length.

Bring balance and tone to the womb and the baby will move spontaneously into the best position they can, in the time they have, between balance and birth.
See "when to do what" on Flip a Breech

Isn't breech birth normal? Haven't breech babies been being born since the beginning?

The breech position can be a normal response to the shape of the space inside the mother's womb. Usually, the womb is aligned to encourage the baby to be head down. Whether or not the reason that any particular breech baby doesn't or can't settle head down in the womb is normal varies, just like the situations about head down babies vary. Not all head-down babies have easy births; and not all breeches have difficulty. Far from it. Most breeches have smooth births when birth is spontaneous.

As long as the baby is able to complete the rotation and movements for breech birth (called the Cardinal Movements), and there are no malformations of the baby or the mother that might interfere, the birth can be natural and normal. Hands-and-knees (knee-elbow, all fours) birth allows the baby to complete the spontaneous cardinal movements. The famous phrase, Hands Off The Breech is a message to providers, and to all of us, not to interfere by offering help that really is no help at all.

Most of the time, a breech baby can be born vaginally and quite safely. Most breech babies, just like head-down babies, tuck their chins and come out in a tube shape. (Don't worry! As soon as the baby comes through the birth canal, you'll see the more familiar baby shape unfold!) When the baby's head is tucked in like this, making the baby rather tube-shaped, then breech is actually in a fine position for birthing naturally.

Online resources for parents and providers considering vaginal breech birth via a physiologically sound approach

Midwife Mary Cronk, one of the most experienced midwives with home breech birth in the world, has written a very excellent article on the breech as an unusual but not abnormal position, and the hands-and-knees position to protect the baby's own spiraling motion through the pelvis for safe breech birth. Read this exquisitely valuable article by Mary Cronk.

Jane Evans, a UK midwife who works closely with Mary Cronk, continues their education efforts with midwives and physicians interested in the Cardinal Movements of breech birth. Jane wrote Breech Birth; What are my options?

Ina May Gaskin, America's foremost midwife, posts an exciting article on the lost art of breech birth. Her spirit and wisdom comes across the page to you.

Maggie Bank posts her articles on breech birth at BirthSpirit.com. She also has a Breech Birth book out with excellent photos.

A group of parents and professionals in Canada are promoting the normalcy of breech birth and helping connect parents with professionals that support natural breech birth and the research to support breech vaginal birth at Coalition for Breech Birth.

Here is a beautiful picture of a laboring woman on her hands and knees with her baby mirroring her position as she is halfway born! Musings of a Redhead blogspot.

Here is a video of another mother in hands and knees. The complete birth and 30 seconds of the postpartum is intact, so you can see the birth in real time. Her baby's Apgars were 10-10. Breech Home Birth at SpinningBabies.blogspot.com. This birth is entirely hands off, except for the long delay in wiping the baby's head clean so Mama could kiss her and the midwife not being verbal enough to ask the other midwife to move the wet pads out of the way so the baby could be put through the mother's legs to her arms.

Lisa Barrett, Australian Midwife has a lovely blog with home breech photos to her commentary on the normalcy of breech. She also has a video of a Frank Breech (legs extended). You notice the position of the baby whose chest is to the mother's tailbone (head and sacrum anterior at this point). This is the safe breech position assuring the arms are not stuck at the pelvic inlet.

Here is the lovely story of a footling breech, born at home. There is a lull in labor during which the mother walks the neighborhood. She comes home and has her boy. There are entrapped arms, which we don't see, and a trapped head for which we see the midwife deftly correcting the flexion and then baby is out. Good thing the midwife really knew her moves! Pictures are gorgeous, very candid, like you are there and peeking in on this precious event.

There is a lovely breech waterbirth on YouTube (you decide about the music selected). The time seems agonizingly long until you learn the Cardinal Movements and the signs that the birth is proceeding well (Thank you, Jane Evans, for teaching us this!). See the baby fix her own extended head and come out. The baby's SA position and the pulsing cord assure that there is time for her to do this and that there is no cord compression. Tone is good; but you see the placenta come with the head. That was a long time for the head, and the uterus let the placenta go during that time. Fortunately, the baby came before running out of oxygen with this early placental release. A beautiful video, powerful, transformative, challenging and entirely hands off. I am so grateful for this video! Thank you, breech family for posting it!

When there is a surprise breech its best to keep your hands off the baby completely. A surprise breech is often progressing well - and that's why the midwife or doctor either didn't check position in labor (though they can mistake down for up occasionally, it happens) or they arrive at the birth as the baby is coming. Here is a mother's story of her surprise breech and the midwife's mentor knew to keep hands off!

With these lovely images, what's the issue with birthing breech babies, then?

If the baby's chin is tucked and the mother is in a good, vertical position, even a term, footling baby may still be born without a problem. However, when the chin is up, the baby's head seems bigger. A few breech babies will slip out positioned like a lollipop instead of a tube.

Head up or head down, the extended chin makes a problem. The head down baby with the chin up can either take more time, need help to tuck or be born by cesarean, usually in plenty of time. Head entrapment is more possible with a footling breech, but a stuck head can happen with any type of breech baby. Read about avoiding breech complications below.

Many times, a head that is "star-gazing" can be adjusted during the birth - IF the doctor or midwife has taken the time to really learn the physics of birthing the breech head and the techniques necessary. Even with ultrasound, there is no way to be sure the baby won't become stuck. Knowing the three levels of the pelvis and where the widest space is at each level helps the provider know where to rotate the portion of the baby that is stuck on the narrow part of the pelvis.

The baby's death or severe injuries can result from using inexperience or wrong technique with breech birth. The most danger is when providers want to "help" and hold the baby incorrectly, squeezing vital organs, or pulling on the baby.

When the baby's chin is tucked to the chest, the baby will be more like a tube and fits well. This is true whether the baby is a frank breech or a footling breech.

Can't we use ultrasound to see the baby's head position?

An ultrasound in early labor or close to the baby's due date can verify head position at that time. It is thought by experts now, that only if the baby's head has been looking up during pregnancy is cesarean is the best choice. If the head is looking straight (neutral) or down (flexed) then the chin can tuck and a vaginal birth with experienced, breech-smart help may be as safe as a cesarean for the baby.

The baby's head and arm position can certainly change in labor. A mother, doctor or midwife can't always predict which baby will come well or get stuck. If the baby gets stuck, it is too late to do a cesarean. But it's not too late for a breech-smart baby-catcher to correct the problem by rotating the arms free and flexing the chin so the head can fit the pelvis.

Jane Evans, UK midwife, made a comment about ultrasound (sonography) causing the baby to lift the arms. Sometimes we see babies in ultrasounds quickly put their hands over their faces, or wave them near their ears in a defensive measure. (Ultrasound vendors call this "the wave.") She could be on to something with her observation.

Don't Pull On The Baby

Other problems in breech birth often are a result of the fact that the person helping the mother doesn't help in ways that are physiologically suited to breech birth.

When a breech baby gets stuck, the baby catcher needs to know rotation and flexion of the breech baby at the level of the pelvis where the baby is stuck.

Most breech injuries are related to provider error. Training is important. Repeating training regularly is important.

Hands and knees, and not touching the baby

Hands-and-knees position (or knee-elbow) is considered an upright position. With the mother on her hands and knees, the baby can conduct the cardinal movements of breech birth spontaneously in most cases (unpublished data shows less than 20% intervention may be needed in this maternal position). "Don't touch the breech" is an age-old rule that, when the mother is on hands-and-knees (or knee-elbow) position, allows the baby the safety of spontaneously movement. (With the birthing woman put on her back, or with the midwife or doctor touching the baby to deliver the legs or support the bum, the midwife or doctor may then have to grasp the baby and help overcome the lack of gravity and spontaneous rotation from 63%, up to 75%, of the time.)

Read this post at Mamas and Babies Blog about how an experienced attendant helped a young midwife resist the urge to "help" the surprise breech baby. It's an excellent example with an excellent outcome.

Here is a wonderful series of a hands-off (till the head requires a little flexion) photos from the Association for Independent Midwives in Great Britain.

Good news!

Fortunately, we are living when expert breech providers are gathering and sharing ideas and data. The Coalition for Breech Birth in Canada got Obstetricians, Midwives and parents together in Ottawa at their 2nd annual CBB conference (October 2009) and in Washington, DC at the 3rd annual CBB conference (November 2012). The midwives came teaching vertical birth and Dr. Frank Louwen (2009) and Dr. Anke Reitter (both years) came sharing the data success of their 300 breech births with mothers using the knees-and-elbows position. Australia also had a successful national breech conference with international breech birth experts in 2012. Breech skills are making a come back!

Malposition may be the mother's birthing position, not the baby's! The biggest problem with breech position is the lack of experience in the person catching the baby. Pulling on the baby can cause severe injury. As you've read in other parts of Spinning Babies, a vertical birthing position fits nature's design for safe birthing. When a mother is standing, sitting up or in a hands-and-knees (or knee-elbow) position, it will allow the baby to rotate through the open pelvis.

Breech birth on the mother's back is not very safe. The baby can't help with the birth. Gravity pulls the baby into the mother's back, not out her vagina. The mother's sacrum is pressed by her weight into the bed and a doctor or midwife is more likely to pull, even gently. This is bad.

Breech, itself, may not be a malposition, but making a woman lay on her back to push is definitely a malposition!

Stuart J. Fischbein, MD typed in the chat box on the Heads Up live streaming and chat I attended March 6, 2016, "Well, Elliot, there is enough wisdom and evidence to suggest that when properly chosen, women can have better outcomes with vaginal deliveries and babies are no worse off. Actually, knowing what we do about the microbiome, epigenetics and bonding, a vaginal birth is really much better but those things are never considered in the medical model."

GAIL AND DR. STUART FISCHBEIN joined Dr. Elliot Berlin to watch Heads Up. Dr. Elliot, a generous Chiropractor in Los Angeles, made this film about choices and lack of choices in Breech Vaginal Birth. This film is mostly about the mother's emotional responses to provider reactions to her carrying a baby in the breech position.

You may rent or buy Dr. Elliot Berlin's video for download or streaming on any device.

Who can we find with breech vaginal birth experience?

Nearly all American doctors have poor training in breech skills, and many midwives are untrained in breech. You might try looking towards the far ends of the birth provider spectrum to find providers with breech skills: the chief of staff of Labor and Delivery at a big hospital, a country doctor, or the rare, breech-skilled, home birth midwife.

A childbirth educator, birth activist or doula might have the name of someone with breech skills. Some women and couples travel far to a doctor or midwife experienced in natural breech birth. These names are not likely to be put on the Internet with the current fear about breech vaginal birth and the high risk of potential legal costs. Even when breech birth goes well, midwives and doctors can face serious opposition for supporting a mother's vaginal breech birth.

What makes a person experienced with breech birth? Is it a certain number of breech babies? Is it a good knowledge of the physics and cardinal movements of breech birth? Is it knowing when to keep your hands off and when and how to help the shoulders and head without pulling? It is all these. And these skills are lacking in many countries today.

Dr. Frank Louwen of Frankfort, Germany is leading the world in safe vaginal breech birth in the hospital. His excellent teaching could transform breech birth practices world wide. His statistics on 750 vaginal breech births are quite positive, showing safety above any found when women lay on their backs. Getting published in this anti-breech climate is a challenge.

Dr. Anke Rietter of Frankfort, Germany is an expert in upright breech position for vaginal breech birth. She is a physician author included in the upright breech birth outcomes mentioned just above.

In Ontario, Canada, Dr. Peter O'Neill is a breech expert, trainer, and really sweet man. He asks women to be on their backs for breech birth, which I don't feel comfortable with, but then he is excellent in how he handles breech and I'm happy to refer to him. I got to take a training from him once.

Denver's Dr. Michael Hall is a natural breech birth advocate and expert. He's also happy with hands and knees for safety and says, "It makes sense."

In Los Angeles, California, Dr. Stuart Fischbein's site: https://www.birthinginstincts.com/. He's delivering breech babies at home in Los Angeles. In the hospital in Los Angeles, Dr. Wu is giving breech care.

Many midwives don't like to be listed even for their breech skills in today's political climate. I'd refer you to the world experts: Mary Cronk, Jane Evans, Betty-Anne Daviss, Maggie Bennet and Lisa Barrett. Ask the doulas privately.

As you search for a provider to help you, whether they have a degree or a reputation, ask her or him to show you how she or he releases stuck arms or a trapped head specifically. If they can't readily do this with a doll and pelvis (or teddy bear and crochet hoop or whatever props are around) then keep looking. They may be nice, sincere and skilled otherwise, but not in breech. I have seen home and hospital providers not know how to free a trapped baby, even after many breeches behind them because it had always been easy up until then. Breech birth can go well, but when it doesn't, more babies die because the confident provider really didn't know after all. I don't mean to be negative here, but if saying this straight can save a life, then I'm duty-bound to say it.

Here is a lovely birth story from an Arizona mom whose midwife invited a second midwife to share the support and skills of breech birth at a homebirth.
Breech & Cesarean

Most breech babies, in the USA, are born by cesarean surgery.

Though obstetricians in the US now consider breech too dangerous for vaginal birth, at some university hospitals in Norway, France and Canada, the safety of vaginal breech birth is well proven.

The techniques to help the arms and head of a breech baby are similar whether in a vaginal birth or a surgical birth. If delivering a breech baby, a doctor has to figure out how to get the chin tucked and past the mother's bones, or through the tight abdominal incision. Here is the World Health Organization's video training for breech birth. It shows women birthing on their back and the baby being partially extracted. This video shows the obstetrical model being taught to midwives in South Africa.

Now, if the mother gives birth physiologically, she and the baby work together, with gravity and labor, to help the baby rotate through the pelvis spontaneously. The techniques to help a breech baby flip that are listed in this website will help a woman's soft tissues be ready for birth, as well as for a better fetal position, so that if the baby doesn't flip, the womb will be more in line with her pelvis and her pelvis with her pelvic floor and so on. However wonderful we are designed for birth, even breech birth, having a skilled attendant is necessary for the unexpected. Read more in Mary Cronk's article on Hands Off That Breech.

Cesareans are widely considered safer for all breech births by obstetricians, as well as some midwives. Big city obstetricians are experienced in surgical breech birth. Surgery has reached an accepted level of safety, because of improving surgical technique, blood replacement and antibiotics to treat, the all too common, post surgical infection.

Major surgery has risks for the mother; blood loss, anesthesia, infection, etc. And for the baby; being born by cesarean doesn't mean being lifted up from the womb like being lifted up from a crib. Difficulty with the delivery of the arms and/or head can happen in a surgical birth, too. Whether by surgery or in a vaginal birth, the baby can suffer an injury or death.

Important physiological changes in brain development are now thought to occur during natural labor contractions. A scheduled surgery will bypass physiology. Surgery can be life-saving, but it isn't gentle.

In 2009, Media Centre of Canada published an article reporting that Canada had reversed its policy on breech birth, featuring The Society of Obstetricians and Gynaecologists of Canada.

In the article, Dr. Robert Gagnon, a principal author of the new guidelines and Chair of the Society's Maternal Fetal Medicine Committee, said, "Breech pregnancies are almost always delivered using a caesarean section, to the point where the practice has become somewhat automatic. What we've found is that, in some cases, vaginal breech birth is a safe option, and obstetricians should be able to offer women the choice to attempt a traditional delivery."

The article continues, "the society is also cautioning that many breech deliveries will still require a cesarean section, and that a vaginal birth is not recommended for some types of breech positions. In situations where a vaginal delivery is an option, the delivery should take place in a hospital setting. An experienced obstetrician should be present to attend the delivery and to offer a cesarean section if the labour does not progress smoothly or if complications arise." [To clarify, this comment is from the article, and not a statement from Spinning Babies. Its a fine idea. Though I think home breech birth can be safe with an experienced midwife team with rehearsed resuscitation skills, good labor progress (encouraged with body balancing activities such as the ones on this website and others), and a good mother-baby size match.]

Media Centre shared these breech links from Canada:

COMPARE the opinions of US and Canadian physicians on how a breech baby should be born. I discuss more about US and Canada breech birth methods later in this article.

A cesarean might be the best choice for a breech birth, if

Baby is less than 28-30 weeks gestation.

Baby is over 42 weeks gestation (not an absolute but should make you alert to other factors).

Baby seems large, 4,000 grams or 8 pounds, 13 ounces, (except in a rapid frank breech labor with good progress, so again, not absolute, but should alert you to other factors.) This is a conservative screening limit.

Mother has diabetes.

Baby has InteraUterine Growth Retardation (IUGR).

Care provider will touch the baby during the birth interrupting the breech baby's spontaneous cardinal movements and possibly causing the arms or head to extend with resulting need to rescue the baby with breech maneuvers.

Labor is slow after 5 cm or stops all together after labor had been going well.

You do not have a person (OB, Midwife, Birth Attendant, cab driver) who knows how to release stuck arms.

Labor doesn't progress with good, strong contractions and freedom of movement

Baby doesn't descend during late labor

There are any other issues that indicate surgical birth, such as a placenta covering over the cervix.

The mother or birth attendant is not confident with the natural birth of a breech baby

What are the other factors?

Slow progress

Metabolic sloshiness - low thyroid function, fertility issues, conception through artificial insemination, hypertensive

Pelvic torsion or somewhat small diameters

And again, lack of skill and experience in birth attendant, including OB or Midwife, whether or not they are confident.

A cesarean birth can be more baby-centered by:

Allowing labor to begin on its own, and then having the surgery within an hour or two

Delaying clamping of the cord until the cord stops pulsing, and

Putting baby into mother's arms in the operating room and

Cuddling and breastfeeding in the recovery room.

Here is a lovely cesarean breech birth. I cried upon seeing the mother's face when she saw her baby. How kind everyone is to the mother and child.

Love is the most important thing that your baby is yearning for!

Should I have labor before I have my scheduled cesarean?

Consider whether it is reasonable to your health and whether your labor would allow you to reach surgery in time, to see if you can go into labor before surgery. This will give the baby a catecholamine surge to prepare for air breathing (See "The Stress of Being Born" in Scientific American). Spontaneous labor might help protect against "late prematurity," a growing risk due to increasingly scheduled births that turn out to be not as close to nature's due date as was thought. Some women will appreciate early labor for these reasons, others will know that it is not feasible for them. Doctors will not be comfortable with this idea as it causes stress with the Operating Room staff and schedule.

Discuss the possibility of labor with your doctor, anyway, please don't spring it on him/her without forewarning. Sometimes delaying surgery until spontaneous labor is not wise, though, like when the mom has a long distance to drive and a previously fast birth or there are other health factors discouraging labor. Waiting for surgery until labor is inconvenient for everyone except the baby! Yet it is the baby that birth is for, isn't it? Healthy labor is good for healthy babies.

US and Canada on Breech Birth Methods

The first decade of the 21st century has seen an amazing examination of how breech babies are born. Early in the decade the Term Breech Trial, the nickname for the Mary Hannah study, recommended cesarean surgery for most breech births. But in examining the study, and adding more appropriate data and better interpretation of the data, Hannah's group found that, rather suddenly, qualified breech physicians were successfully swinging the vote over to vaginal breech birth.

Here's the general view of American College of Obstetricians:
NOTE: This view does not reflect the view of experienced breech practitioners, such as Dr. Michael Hall of Denver, for instance, who continues to attend natural breech births.
Obstet Gynecol. 2006 Jul;108(1):235-7. Comment in: Birth. 2007 Jun;34(2):176-80. ACOG Committee Opinion No. 340. Mode of term singleton breech delivery.

In light of recent studies that further clarify the long-term risks of vaginal breech delivery, the American College of Obstetricians and Gynecologists recommends that the decision regarding mode of delivery should depend on the experience of the health care provider Cesarean delivery will be the preferred mode for most physicians because of the diminishing expertise in vaginal breech delivery. Planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific protocol guidelines for both eligibility and labor management. Before a vaginal breech delivery is planned, women should be informed that the risk of peri-natal or neonatal mortality or short-term serious neonatal morbidity may be higher than if a cesarean delivery is planned, and the patient's informed con-sent should be documented.

Here is the new view of the Society of Obstetricians and Gynaecologists of Canada.

Dr. Robert Gagnon, a principal author of the new guidelines and Chair of the Society's Maternal Fetal Medicine Committee reported:

What we've found is that, in some cases, vaginal breech birth is a safe option, and obstetricians should be able to offer women the choice to attempt a traditional delivery.

Dr. André Lalonde, Executive Vice-President of the Society of Obstetricians and Gynaecologists of Canada, said:

The evidence is clear that attempting a vaginal delivery is a legitimate option in some breech pregnancies.

From the brief for Vaginal Breech Birth, 2009, by A. Kotaska et al.

This guideline was compared with the 2006 American College of Obstetrician's Committee opinion on the mode of term singleton breech delivery and with the 2006 Royal College of Obstetrician and Gynaecologists Green Top Guideline: The Management of Breech Presentation. The document was reviewed by Canadian and International clinicians with particular expertise in breech vaginal delivery.

Canada is following evidence-based logic in promoting the safety of many breech births. Still, the emotional setting of birth also adds to safety. Calm, trusting patience (which means, Hands Off the Breech!), and vertical (hands-and-knees position most excellently) are still critical aspects of safety in breech birthing.

NOTE: This view doesn't reflect that Canada is in great need of breech training for physicians and midwives to meet the needs of parents having breech babies. Women may not be able to yet find a qualified practitioner. Contacting the SOGC or Midwife Betty-Anne Daviss at UnderstandingBirthBetter.com may be helpful

Are you a provider? Read more on breech here.

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Head's up! A breech baby has their buttocks coming into mother's pelvis before the head. Usually, the buttocks will be born first, less often the feet or knees emerge first. Is breech presentation a malposition or a normal variation? What are the types of breech positions?

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Optimal fetal positioning