[Best of Birthful] How a Baby’s Position Impacts Labor, with Gail Tully

Welcome to the Best of Birthful. Creator and host Adriana Lozada curated and edited each selection in this playlist of the show’s most popular episodes. It’s a tailored introduction to the expansive catalog she amassed over the first five years of Birthful’s 300+ shows.

How does your baby’s position affect the flow of labor? Are there things you can do during pregnancy that can help baby get in a better position? Will doing these things help you be more comfortable? Will it make birth easier? The fabulous Gail Tully from Spinning Babies is here to tell us all about baby’s position and labor flow.

 

Listen directly through our website player, or however you usually listen to podcasts.

 

What we talked about:

  • What does baby’s position have to do with labor flow?
  • Your baby’s position as a reflection of your soft tissues
  • How to figure out your baby’s position
  • The mobile sacrum
  • Balance! Balance! Balance that pelvis!
  • When in pregnancy does baby’s position start to matter?
  • How to help things align and flow for labor
  • Is your starter broken? What to do if labor is not progressing
  • The difference between a toned core and a strong core
  • Doing proper squats

 

Links for more on baby’s position:

 

Related Birthful episodes:

 

Transcript

How a Baby’s Position Impacts Labor, with Gail Tully

Adriana Lozada:

Hey, mighty one. With nearly 300 Birthful episodes in over five years, it may be hard to know where to begin listening to the show. To make it easier, we’ve put together the Best of Birthful series, which showcases some of our favorite or most relevant episodes. This is one of those. If you enjoy what you hear, make sure you subscribe. It’s free, and that way you won’t miss a thing. Enjoy.

Hello, mighty parents and parents to be. As always, thank you so much for the love you give the show and all the recommendations, and telling your friends about it. My guest is the amazing Gail Tully. Gail has over 35 years of experience working with birth, including 20 years as a homebirth midwife, and she is responsible for conceiving and developing Spinning Babies. Gail, welcome. So happy to have you here.

Gail Tully: Adriana, it’s wonderful to be with you.

Lozada: So, after 20 years being a midwife, what made you decide to focus on babies’ position and create Spinning Babies?

Tully: I’d been really learning about babies’ position through the time that was attending births actively and noticed that we didn’t have a lot of tools. We didn’t have a lot of techniques that were effective universally. Very often, the strategy today is to strengthen the contractions and get the cervix to dilate, and I am very pragmatic in looking at the physical, but I’m noticing that there’s a lot of soft tissue anatomy, a lot of muscles, ligaments, and by studying those and observing birth, I think that the baby’s position is a reflection of the mother’s soft tissues, the soft tissues, the muscles pull here, the ligament pulls there. Now, these aren’t the only reasons for babies to get into positions that are less ideal for birth, but I think that that’s the most common reason.

And so, by focusing on what we can do to make baby’s job easier, then we make labor easier for the mother. We help the labor to progress the way nature would have it progress. And more comfortably for the woman. More pleasurably. So, if she has hopes for a natural childbirth, we can add a lot of techniques in our approach to make that more enjoyable and more possible in today’s sort of busy obstetrical hospitals, right? There’s some pretty simple techniques, some of them are kind of unusual, that make room for the baby. And what I mean is it releases something too tight or it helps something come out of a twist. Maybe it’s a ligament from the uterus to the sacrum, right in between the uterus and the inside of the mother’s very bottom of her back, you know? Right in that triangular sacrum.

And if that’s pulled over to the side, the mother might not notice it. Sometimes, women are aware that one leg is slightly shorter than the other, or a hip is slightly rotated. It’s achy to walk. She has sciatica pain. These could be misalignments or a muscle that’s too tight.

Lozada: And it’s kind of her body sending signals of there’s something up here.

Tully: Yeah. Right? Because pain is always a signal to get our attention. What’s it teaching us? It’s our teacher. So, what I’ve been learning over the years is I started out talking about, “Well, if we do this technique, it helps labor progress.” Now I’m realizing, “Oh, the soft anatomy is something to really pay attention to.”

Lozada: So, you mentioned a bit of on the elements that come into play in determining baby’s position, and you spoke about soft tissues. Can you tell us a little bit more what those soft tissues are? What we’re think… What you’re considering?

Tully: That would be all the muscles, and ligaments, and even the membrane around the organs, muscle, ligaments, and joints, and vessels, called the fascia. So, when that comes into balance, and we don’t have to be perfect, but then we have space, and we have flexibility, and we have tone, and we have mobile, a mobile sacrum. And the mobile sacrum is the very key to childbirth.

Lozada: Why is that?

Tully: Because it moves a centimeter or two centimeters out of the baby’s path. Nobody really talks about that, but it’s known. It’s commented on. But it’s not really clearly discussed in the midwifery world, or the physician world, looking at the birth. For instance, I’ve heard Ina May talk about midwives in the Caribbean saying the baby won’t come until the back opens. What does that mean, the back opens? Well, the natural reflexes in childbirth, natural movement of the body in childbirth is not only the cervix dilating, but it’s also the sacrum backing away from the center of the body.

Lozada: So, Gail, how early should people start doing these activities?

Tully: So, imagine a spectrum from easy to difficult. If you truly are on the easy side, then a technique or two does it. So, the woman that happens to be on the more difficult side of the spectrum of ease will need to do several things. It would be great to have a questionnaire, so that we could figure out where we are on this spectrum of ease, but I don’t think it’s that simple, because there’s about 36 muscles going to the pelvis.

Lozada: On the website, on SpinningBabies.com, you have some daily activities, daily exercises, that any mom can do. Now, even if they’re on the easy or the more difficult spectrum, if they’re on the easy, this won’t… This won’t make things out of whack.

Tully: Right.

Lozada: They’re all going towards balance, so there’s really no harm in them doing them?

Tully: As long as people… Well, there’s certain contraindications, like don’t go upside down if you have high blood pressure, glaucoma, and then how are we gonna do it? We’re gonna do it gently. We’re gonna do it attuned to our body. We’re going to… You know, the guidelines I put in by doing it gently, or doing this one once a day, or that one once a week, those seem to be fine schedules. But some people will think, “Well, if this is good to do once a day, I’m gonna do it 10 times a day.” And you know, it’s the overenthusiastic kind of approach like that that I can’t say that may be too much. But adding balance does not make a baby in poor position, because the baby would be in the best position possible if the space was available.

Some women have back labor with posterior baby, and some don’t, and I didn’t have a posterior baby, and I had back labor because I’m short, and I had a car accident, and I thought going to the chiropractor couple of times was enough, but when I got pregnant again… I mean, when I got pregnant years after the car accident, you know, all I was doing was walking. And walking is great and it’s one of the most important exercises, but it doesn’t open the hips. You can imagine your legs are always going forward, back, forward, back. They’re never going… There wasn’t a lot of side to side, so forward lunges are perfect, but also doing some things with your thighs apart.

You know, you need like windmill is an excellent exercise, and there’s some specific hip openers, different wonderful exercises that are addressing more muscles. So, instead of me addressing the very same set of muscles all the time, I want to increase more muscles and get more range of motion. So, flexibility and range of motion, alignment, these are all words that kind of go with balance.

Lozada: So, what can moms do to make that sacrum more mobile and those soft tissues more aligned?

Tully: You know, I’ve really been influenced by Katy Bowman on this, and she really suggests starting out with calf stretches and doing calf stretches for a couple of weeks, and then getting into squats, and she has a very specific way of doing squats. And doing them more, once you learn how to do them with your feet flat on the floor and your ankles underneath your knees, I like hanging on to two doorknobs of one open door and leaning back away from the door. Like you’re gonna sit on a chair that’s too far behind you to actually sit on, but you’re tipping your pelvis to try to reach that chair. It’s too far back.

Lozada: So, sticking that tailbone out and kind of trying to keep your knees behind your toes.

Tully: Yeah. Your knees are behind your toes. Yep. Right over your ankles. And your knees are not that far apart. Comfortable for the belly to fit in between. And you don’t have to do a deep squat. You can start, you start out with the calf stretches for a couple of weeks, and then you do a few squats now and then through the day, but none of this 50 squats a day, 100 squats a day in the city living-

Lozada: Because we’re not used to doing squats. We gotta build up to it.

Tully: Yeah. And we need to do squats in our daily life, so put your cutting board on the floor and squat, scrape your vegetables. Or you know, find other ways to integrate squatting in your life. So, okay, calf stretch, squats, the hip openers, walking, and thinking about letting that core be toned and flexible, but not built up. We’re not trying to go for strength, or tightness, or shortness. Having tight abdominals in pregnancy is not ideal. You know, a tight neck and shoulders is not ideal.

Lozada: So, you just want toned.

Tully: Yeah, you want toned and flexibility. You want to have the movement.

Lozada: And then things like chiropractic adjustments, or you were talking about massage, or are those beneficial and are they required? Or can they-

Tully: They’re always required, but again, it’s like where are we on the spectrum? And so, if I misjudge myself as being overly ideal, sometimes I find out a little too late that I’m not. So, I’m not qualified to assess another person. That’s not my forte. But as most midwives, I tend to notice certain patterns. For one thing, pelvic instability and pain, like some women are in so much pain when they’re laying on their side in bed, or they’re in pain laying down, and they try on this side, and they try on that side, and they end up having to sit up, because they just can’t sleep. Pelvic instability is a sign something’s off and then fetal position reflects that instability, so to speak.

It’s also nutritional. We need good nutrition. We need good calcium magnesium; we need the proper kinds of iodine without being silly and taking iodine supplements without the supervision of an expert. We don’t want to be eating junk, because every bite counts right now.

Lozada: So, I want to talk about labor and I also want to talk about how can moms figure out what position their babies are in-

Tully: Yeah. Let’s talk about belly mapping.

Lozada: Yeah, because you’ve mentioned that baby’s position is sort of a reflection of their soft tissue, so that could be another… Figuring out how baby is can help them figure out how much, maybe a little bit of where they are on that spectrum?

Tully: So, first we have to know what weeks gestation it matters, and balance matters throughout, because we’re gonna have better hormonal function and comfort. Then we want to think, “Okay, it’s normal for the baby to be laying on its side in the womb.” Maybe a little oblique. Maybe really sideways. For 26 weeks of pregnancy. Then, around 26 weeks, then by the time 28, 30 weeks is happening, the heaviness of the baby’s head is such that it brings the baby’s head down. So, mothers have to think if they’re gonna figure out their baby’s position, how many weeks they are, so that they know what to expect. Because if they’re looking for the baby to be vertical and they find the baby sideways, but they’re 24 weeks in pregnancy, that’s pretty normal, so there’s no worry about it.

So, we do daily essentials. Any time of pregnancy, what every mother can, and if we need to do more for comfort, for fetal position, or for soothing a challenging birth history, we would start as early as we can. So, now to tell the baby’s position or not, we think about how little baby is. Like all people, the back is… The limb curves away from the back, right? Your back is smooth and flat. And the legs and arms sort of bend towards the front. And in the fetal position, you know the arms and legs tend to be curled up towards the tummy and the tummy bent a little bit, right? The chin drops down.

So, we can use that information when we try to figure out baby’s position. So, if a woman, a woman has to lay down on her back, and let’s say it’s gonna be more easy to figure out your baby’s position from 36 weeks to the end of pregnancy. Some women can find the baby’s position at 34 weeks and a very few women can figure it out at 28 weeks or so. And it depends on how firm, what I say is the broad ligament. A lot of midwives will say it’s the abdominals. How strong is the woman’s abdominals? That can be too, but it can also be tension in the broad ligament, because when you do some rebozo sifting, that tends to help relax the broad ligament. It helps put the mother in a relaxed state. It’s a wonderful technique. As long as she’s not bleeding or cramping, then you would never do these techniques and you would go to the doctor, right? You wouldn’t stop and do these techniques.

So, I know that sounds a little extra cautious, but I realize I have to be very clear, as clear as I can be. And we are hearing wonderful stories of women having more comfortable pregnancies. Now, those women are working it every day and I don’t mean working it like an athlete.

Lozada: Keeping active and doing their daily inversions and your recommendations from the website.

Tully: Yes. And for those women that are already athletes, it’s the patience of softening, of getting that feminine softness for the baby to pass through. So, we want length in the pelvic floor, not strength in the pelvic floor. When we have length, we’ll have flexibility and tone, and there’ll be the strength there, but we’re not going for the strength.

Lozada: Because you need to create space.

Tully: Yeah. That’s right, Adriana. Thank you. Yeah. Yeah. We really think about it as let’s make space for the baby. We don’t have to know the baby’s position. I notice that if a mother… You know how mother gets a little browner line down the center of her tummy from her belly button down to the public bone? And that’s the… I call that the center line. If the… It’s really helpful in belly mapping because the mother can say, “Okay,” maybe it is her left side feels a big, firm, smooth part of the baby, feels kind of hard on that side, where her right side would be kind of more squishy, but bumpy. Little bumps or kicks maybe on her right side.

That means the baby’s back would be on her left and the limbs would be over on the right, so the baby’s likely facing her right side. That’s… Now, how do we know if that’s left occiput anterior or left occiput transverse, or left occiput posterior? Could be any of those three.

Lozada: Any of the lefts would be good, so they don’t need to get very much into that detail? Or just-

Tully: Right. That’s what I think. And even the left… The baby that’s posterior, if the back of their head is on the left, that usually means in most of these… For most of the left occiput posterior babies that their chin’s tucked. So, the contractions will help rotate the baby, where the baby that’s coming from the right, their back is straight because the right side of the uterus is more steep, and so that puts their forehead sometimes over the pubic bone, and so the first time mother doesn’t have her baby engage when she starts labor.

So, see, Spinning Babies is about how to help the baby’s chin get tucked, how to make room for the baby. It’s all to help the baby rotate with the contractions of labor, because rotation is very much a part of labor progress, and the natural process of labor, and having the baby rotate is a sign of progress, and it sometimes needs to happen before the cervix dilates very much. So, if we’re only looking at cervical dilation, we’re not looking at the key to labor progress. We’re looking at the result.

Lozada: Because, and we always hear this partnership of mom’s job is to dilate. Baby’s job to rotate.

Tully: Ooh. I bet you found that on the Spinning Babies website.

Lozada: I’ve been hearing that for years.

Tully: Well, that-

Lozada: It’s a perfect saying, right?

Tully: That’s where it comes from. And yes, yes, because it’s not really… By trying to force open the cervix with Pitocin, or different medications that are offered or directed to pregnant and birthing women, we’re looking for the result. And basically, Adriana, I liken it to the two-year-old who wants to go through the door. The two-year-old runs ahead of his or her mother, pounds on the door, wants to get outside to play. The mother comes over and turns the doorknob and magically the door opens and out they go to play. It’s like if we pound the pressure at the cervix with Pitocin, turning up that Pitocin, turning up that Pitocin, we are trying to break through that door without turning the doorknob. And the baby’s… When the baby rotates, it fits through the pelvis like a puzzle piece dropping into place. Then the back of the head, the crown of the head comes onto the cervix.

Because the mother’s been in labor now, her body’s ready to open. She’s soft. She’s ready to have her baby. We’re waiting on the baby.

Lozada: And I find that this is really important for moms to think about, like go to Spinning Babies and read the information, and don’t be overwhelmed, because you’ll figure it out. It’s harder to talk about it on audio, like on the radio, than to actually see it. So, there’s great visuals on Spinning Babies, but I so often hear a common fear of is my baby too… Will my baby fit through my pelvis? Is baby too big? And I think it’s really valuable all the work you do, because it has nothing to do, or not nothing to do, but that disproportion of head too big for the pelvis is extremely rare, whereas it’s more about considering you’ve gotta have the baby’s smallest part of the head go through the biggest part of the pelvis, and then it will work. So, it’s not so much of is my baby too big. Rarely is baby too big. It’s more is my baby in the right position and am I balanced and in the right position so that this baby can flow right through?

Tully: Flow right through. That’s it. Because it’s the angle of the head. Not the size of the head. The baby whose chin is tucked can help with the birth, can wiggle its shoulder, and press the crown of the head down. It can find the roomier spot in the pelvis. You know, the baby is designed to do that and this… The head is designed to mold and turn into that cone shape that people find funny to joke about, you know?

And that cone shape goes away within hours. You gotta take a picture right away, because it’s gonna be gone before the hour. And it is fascinating to me to see the competence and the skill of the baby being born and the instinctual competence of the mother who is somewhat in balance. Like I said, we don’t have to be perfect. She’s getting those signals in birth. She goes deep into her birthing being and the hormones flow through her. There’s this rhythm to labor that she can trust and follow when her and the baby are lined up together.

Lozada: And with that rhythm, things will flow.

Tully: Yes.

Lozada: So, let’s say mom’s in labor and labor isn’t flowing so well, and the contractions aren’t coming like clockwork and stronger, longer, closer together, but they are a little kind of all over the place. Five minutes, three minutes, 20 minutes, 10 minutes. Not progressing. What then?

Tully: Yes. Well, I call that an asymmetrical labor pattern. It’s not predictable and it seems like starting, and then it seems like it’s stopping, and some women say, “Is my starter broken? Why won’t this labor start? What’s the matter?” And it can get tiring, and you get your expectations and your hopes up, and then it backs off. So, there isn’t this rhythm, right? You can’t establish this rhythm with this labor. So, what’s going on? A couple things to think about. Is the mother due? If the mother isn’t due and she’s having some contractions, is she hydrated? Is she talking to her care provider to get assessed? If they’re more than four an hour, she wants to get assessed.

If she is due, then is she a first-time mom? Is the baby engaged? Now, how do we tell if the baby’s engaged? Because sometimes when the forehead is over the pubic bone, the back of the head can be in the pelvis. If the midwife or nurse or doctor reaches inside to feel the baby’s head, they might feel it. Head’s not wiggling. It’s in the pelvis. But you know, Adriana, nobody checks the outside for the forehead. So, let’s check. Is the baby’s whole head in the pelvis? If not, we add balance. We do our balancing exercises. And there’s some special ones. We talked about the daily ones. There’s some weekly ones that can also be used in labor. We can do that rebozo sifting early in labor and follow it up with the forward leaning inversion, where the mother puts her knees on her couch, and as long as she doesn’t have high blood pressure, glaucoma, or some type of medical risk, she’s a healthy woman, she can put her knees on the edge of the couch, put one hand on the floor, the second hand on the floor, then the first elbow on the floor, second elbow on the floor, let her neck hang. She’s not resting her head on the floor but she’s tucking her chin. And this gives her uterosacral ligament a chance to stretch.

She takes just three breaths, just about 30 seconds. It’s letting that lower uterine segment have more space so the baby can tuck its chin. Then, we go from forward leaning inversion into sideline release. And sideline release is not laying on one side. It’s a very specific bodywork technique from the myofascial community. It’s very picky at how to do it, but really any adult can learn how to do it.

Lozada: And on the website you have beautiful illustrations or photos that illustrate how to do it with great instructions, so I’m just gonna tell people go there instead of trying to explain it with audio.

Tully: Exactly. But just to know that it’s very precise and the helper has to be close to the mother so she can’t fall. And it’s a great technique. It’s so… It relieves pain. It helps so many labors. And those are the three sisters, the rebozo sifting, the forward leaning inversion, and the sideline release. And then there’s standing sacral, so I call that the fantastic four, because the standing sacral gives flexibility and mobility to the sacrum, so we’re getting-

Lozada: Is that the lift and tuck?

Tully: No, no.

Lozada: Okay.

Tully: That’s help with engagement. So, first we did balance. Now we’re gonna do a technique that’s gonna aim the baby into the pelvis and help the chin tucked, and the essential part of this technique was designed by Janie King, an engineer in Texas who wrote Back Labor No More!! Excellent little book. And I just emphasize doing a posterior pelvic tilt while you do it, and that increases the success of this technique. It’s done for 10 contractions in a row and it helps tuck the baby’s chin and the contractions are the key. It’s not effective without the contractions. The contractions then rotate the baby off the pubic bone and let’s the baby into the pelvis.

Lozada: And the important thing is you really need to commit to those 10 contractions.

Tully: Yeah.

Lozada: I find.

Tully: Well, you’re often interrupted, you know? Something will… A person will come in and say it’s time for checking the baby’s heart rate, for instance. So, you don’t get to do it through one contraction. That’s okay, just start with the count on the next contraction. And so, Spinning Babies is the active part of patience. I’m giving those women that want to do some active preparation some very useful skills and tools to use, even though I realize that not everybody needs this.

You know, adding balance is not gonna hurt anybody, but not everybody is out of balance, right?

Lozada: Right. But the truth is we’ve got these really comfy chairs that let us slouch, and lean back, and we’re not doing many squats. I mean, we could. We all could use a little more balance. We’re not out of whack, but we could all use a little more balance.

Tully: Yeah. And the main thing is that we do it in a way where it’s just integrated with life and it’s not a worry and a concern, so that we’re not-

Lozada: Adding stress?

Tully: Adding stress. You know, we’re already stressed. It’s natural for pregnant women to be a little bit anxious about am I doing things right, so I’m in a kind of a predicament of talking about what are the common causes of an unexpected cesarean or an unwanted cesarean. And how to have this peaceful, chill kind of an attitude, which is where birth lives.

Lozada: Yeah. No… Yeah. That is our constant crux. Definitely. But I think you’re doing a great job of giving people, giving moms and their partners tools.

Tully: Adriana, you’re wonderful.

Lozada: Thank you so much, Gail.

Tully: You’re welcome.

Lozada: You’ve been listening to a Best of Birthful episode. To listen to the original, longer version of this episode, click on the link in the show notes. And there are many more where this came from. Look for episodes with the words Best of Birthful in the title to continue your deep dive to inform your intuition. You can find the in-depth show notes for this episode at Birthful.com. You can also connect with us directly on Instagram. We’re @BirthfulPodcast.

Birthful was created by me, Adriana Lozada, and is a production of Lantigua Williams & Co. The show’s senior producer is Paulina Velasco. Virginia Lora is the managing producer. Cedric Wilson is our lead producer. Alie Kilts contributed to the production of the Best of Birthful series. Thank you for listening to and sharing Birthful. Be sure to subscribe on Apple Podcasts, Amazon Music, Spotify, and everywhere you listen. Come back every week for more ways to inform your intuition.

CITATION:

Lozada, Adriana, host. “Best of Birthful: How a Baby’s Position Impacts Labor .” Birthful, Lantigua Williams & Co., October 17, 2020. Birthful.com.

 


 

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Gail by Tanya Villano

Courtesy of Gail Tully. Photo by Tanya Villano.

About Gail Tully

Gail Tully is the midwife from Minneapolis, Minnesota, USA who conceived and developed Spinning Babies®. With over 35 years experience working with birth, including 20 years as a homebirth midwife, Gail now consults and goes out on midnight runs to long labors or breech births to help the determined parents served by her midwifery and medical colleagues. Back in the day, Gail was kept busy organizing doula program development in hospitals and community non-profits in Minneapolis/St. Paul while training doulas with DONA International approval status. Spinning Babies, Belly Mapping, Resolving Shoulder Dystocia and now Breech Basics are her unique offerings.

Stay in touch with Gail and the Spinning Babies community through Facebook, Twitter, or Instagram.
 


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