Why Your Baby's Position Matters for an Easier Birth with Ann Gilligan RN, LNC, RPYT

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We will be diving into everything prenatal yoga, birth and baby related, hoping to inspire, educate and empower you through your journey into motherhood. Thank you for listening. - Hi, I'm Deb Flaschenberg, and I'm your host of yoga birth babies. And today we're gonna talk about optimal fetal positioning and something called the Gilligan's Guide. This is something I'm just learning about the Gilligan's Guide. Now, definitely not optimal fetal positioning, 'cause if you've been listening to the podcast, you know that is something I'm incredibly passionate about. When baby is better aligned in the body, then birth can flow more efficiently. So to have this conversation about the Gilligan's Guide, I have Anne Gilligan. So let me tell you a little bit about her. She is a labor and delivery nurse of 33 years. She's also a legal nurse consultant, a sexual assault nurse examiner, prenatal yoga teacher, proprietor of the Gilligan's Guide. She teaches providers, nurses, jewelers and pregnant folks how to prevent, identify and rotate a fetus in utero using what she calls the Gilligan's Guide. So Anne talks a lot about in this conversation what malposition is, how it affects birth flow. We also talk about why babies are presenting more in an incorrect position, what we call ROT, right, Oxford transfers, and how to help them get into a more optimal position. And we also talk a lot about inversions should you do the one pregnant. So I think you're gonna get a lot out of this conversation. I'm so excited for you to hear that. Now before we jump into my talk with Anne, I just wanna give you some updates of what's happening at prenatal yoga center. So we have added to our on-demand library. So if you can't come to our in-person classes, we wanna be able to offer the same services to online. And with the on-demand library, you can do it on your own timings. So you can check that out. We've added a childbirth education course. We've added a newborn care. And so I think if I'm kinda on track here, every workshop that we offer in person, we now have online, including a lot of our online prenatal yoga classes. So check that out at our website prenatalyogacenter.com. And while you're there, you can sign up for our free downloadable, the five simple solutions to the most common pregnancy, aches and pains. And of course, these can be done postpartum. And then you just get a little guide for days that you can't make it to class, but you're still feeling some neck pain or some back pain or some hip pain. I offer you a poser to how to resolve that. And then it also helps you come into our newsletters so you can hear about what's going on. Get a little tip each week about how to support your pregnancy and your birth and your early parenthood. And then the last thing I wanna talk about is our teacher training. So if you are someone that's deeply interested in supporting the prenatal community, check out our very thorough 85 hour online or in person you can decide which one's best for you prenatal yoga teacher training. It is a culmination of my over 20 years as a prenatal yoga teacher, a doula childbirth educator, parent. And that is what my students are studying. And it's a strong passion of mine. So as I mentioned, you can do it in person. You can do it online. And then before we get to the conversation with Anne, I just wanna say thank you. Thank you for being part of the community. Thank you for coming to class in person online and listening to the podcast. All right, we're gonna take a quick break when come back. Please enjoy my conversation with Anne Gilligan. At REI co-op, we don't just sell outdoor gifts. We use them, test them, trust them. So we know what to give this season. For joy rides, campfire cheers, and peak views. We know what to give the people you love who love to get out there. Because we're out there too. Just stop in and ask a green vest. Like me, for the best gifts out there, shop in store or at REI.com. I Anne, how are you? I'm great, thank you, how are you, Deborah? I'm doing so well. I love talking about baby positions and birth. And so I am so excited to pick your brain and just dive into this. So thanks for showing up for this. I really appreciate it. - I'm so excited to share what I know. - Yeah, all right, so let's take a moment. Anne, I just wanna hear a little bit more about you and how you got into birth work. - Well, I have been doing it for a little while. I graduated from nursing school in 1989. So that makes about 33 years. I have kind of established a reputation at this point of being what we call well-season nurse. I have experienced many things in the OB world. I've been a high risk labor and delivery risk, low risk labor and delivery nurse, meaning that I was working in the birth center for a while. I'm also a licensed legal nurse consultant, prenatal yoga trained teacher, a sexual assault, sexual assault nurse examiner, adult, and also an evidence-based birth instructor. - Wow, you got a lot on your resume. So you know this world of birth very, very well. So what I'm excited to talk about is malposition and how that affects babies. So for those that are listening, you probably know that I've had many conversations with Gail. It's all I have done, a ton of conversations about this, but my friend Terry Richman pointed me in the direction of Anne. And this is one of your specialties, Anne. So I guess we should start with an explanation of what malposition is and how it affects birth flow. - So in explaining malposition, I'm gonna start with kind of what it is. So presentation means that what is presenting into the pelvic brim first, meaning is it the head, which we call vertex, is it the bottom, which we could call a frank breach. Position is something different. Position means which part of the fetal occipit, which is actually the back of the fetus's head in relation to the pregnant person's back. So if that occipit is on the pregnant person's back, that's called left occipit and vice versa, right occipit, if it's on the right of the pregnant person's spinal, that the axis of their body. And there's another thing that we like to talk about in relation to malposition and maternal fetal positioning is ace and criticism. And what that means is there is a suture that runs down the middle of the fetal head. It's called a sagittal suture. And if that sagittal suture is not in symmetry with the inlet of the pelvis or the outlet of the pelvis, meaning it's off to one side. If it's the horizontal or the transverse diameter of the pelvic bone, that is considered a ace and criticism. And ace and criticism is also considered a malposition. So anything other than a baby, a fetus, being on that left side of the pregnant person's body and not being in alignment with the bony pelvis, that is considered a malposition. So malpositioning, as we'll talk about further on down the road here, contributes to their rest of labor. As labor progresses, the malposition cannot correct itself. The further it gets down in the pelvic, it makes it harder for that baby. It can correct spontaneously through labor. And interestingly enough, the labor, I mean, excuse me, the research that we have is about 10 years old now, nine to 10 years old. And it says that most of these malpositions actually correct in labor. And only 5 to 10% of the infants are born in a malposition. And I believe anecdotally looking at all of the pregnant people that I do today is not accurate to today's statistics. So as labor progresses, the malposition of this fetal head or body can't correct. And so they're going to be there. therefore it goes, it worsens, it gets deeper in the pelvic cavity and possibly goes what we call occipit posterior, that creates a deflexed head or an extended head going back. The fetal head goes back and that can contribute to things like fetal intolerance or a rest of descent or a rest of dilation. So the fetus not being in the correct position in utero contributes to many things that will lead to the morbidities and that we'll talk about today. So super important to recognize the malposition early, apt term and in labor, and attempt to correct it so you can prevent those morbidities that happen in our, in our OB world. So really slow things down, so it's a baby's malposition and I'm really enjoying this but just simplifying it for some folks that are listening, if baby's malposition, the ear is to the shoulder, the chin is away from the chest, it can really stall labor, which is why we're seeing some very long labor, a lot of potosin used to try to get the power instead of necessarily focusing on the position. Is that right? That's correct. So right, and thank you for bringing in to lay person's term, it's really something that I strive to do since I'm constantly talking to medical professionals, so thank you. But yes, it's slow things down, which leads to more interventions, which lead to more interventions, correct. And so that's what we want to, we want to recognize it early and that's where I strive to, to place my education when I'm talking to people, is let's really try to identify it at term and during labor so we can attempt to correct it because truthfully, with our C-section rate the way it is today, these babies are not spontaneously rotating like they did 30 years ago. And you know, that contributes to the, like you said, prolonged labor is increase in the potosin, increase in epidural use, instrumental delivery, and of course the operative delivery rate. So those are the things that I strive to prevent. So, you know, not to worry because some do spontaneously rotate, but to involve movement and to involve purposeful recognition of it during labor is really important. And that's where I think having skilled labor and delivery nurses that are able to help out if they are. I mean, it's so hard, at least where I was a doula, they weren't one on one for a room, and then having doulas that are understanding of baby position, my own first child, his head was asymptotic, and I am so lucky I had a team and myself recognized something was off, and we had to work very hard as a very long labor, it was about 42 hours to readjust and like during the labor, it just took a super long time. And that was something that really sparked my passion to help those prenatally, how can we better align and balance the body so that baby is more likely to descend and rotate without obstacles, without tension causing the head to move, so you and I are so on the same page with this, this is really exciting. Yeah, and what you said in the beginning was you recognized it, and oftentimes the pregnant person does recognize there's something that isn't right, and we need to ask more questions and believe in them when they're stating something as such because that is where the real power is, is in listening and listening to the client, and do that point for 10 years, so I was the mom's teacher, so I was like, oh no, I knew what this means, darn, we have to adjust things, but that hasn't happened, I'm sorry what we're going to say. Well just going back to my history of, when I started, when I started in 1989, we would occasionally have an Oxford post year baby, and I remember on the unit we'd all get together as nurses and we'd talk about, oh you know what we, what should we do? Like I know this baby's OP, well on my unit today, I still work in a hospital, and on my unit today, 33 years later, this is a common theme, mouth positioning is the new normal, and so we have to recognize that as a medical community and do something about it, and that is the beauty of my, my training and my, my historical work is that I have seen the trend, and the trend is, we often have a mouth position baby on the unit, you know, up to 20, up to one out of four of our patients at a time, we're having this problem, and so it's really, really important that we're talking about it today. Well, that's a huge number, one out of four, so this brings me to kind of thinking back to my history when I was attending births, when I was in July, I didn't actually see a lot of care providers putting a lot of stock in baby's position, in fact, I would often try to ask, and I, I did feel like sometimes my efforts were dismissed, but what's interesting is I've been studying to become a spinning baby's parent educator, which I know is something you have in your background, and I, what was exciting was I was seeing a lot of L&D nurses at these workshops. So are you seeing, or how are you seeing fetal positioning being more accepted into the medical community? Yeah, I'm seeing a great interest. I am teaching a lot more, my business is booming, I am having a big interest from everyone, including providers, nurses, dualists, dualists are huge client base of mine, and, and then the pregnant person, and all about empowering and learning prior to going into the labor room. But the, the interest in, in particular, of Billigan's Guide is due to its effectiveness. People are riveted by the effectiveness of it, and so I continue to get references such as why I'm talking to you today, a people that are using it. I think that a funny story and how I got to talk to my specific group of physicians that I worked with about five years ago was a client, you know, going close to signing the permit for accessory and delivery, and the nurse calling me in the room, and asking if I would help with positioning, and me doing my guide with her, and then coming back out to my own, my own patient, which was actually on a different part of the labor and delivery unit, and I see the provider running down the hallway to this room where I just was, and I'm like, "Oh my gosh, what's going on?" Well, she was being called for the delivery. She thought she was being called to sign permit papers and that there was something going on with the fetal distress, and in essence, what she was being called for was a quick response to the guide being done and her for delivery. So she came right over to me and she said, "What was it that you did in that room?" And I said, "Well, Dr. So-and-so, I've been trying to tell you that this works in order to optimize that fetal position." So we laughed and she said, "Okay, you need to come to our meeting, our staff meeting next month and do some instruction." And when people see how maternal position works right before their eyes, and when clients experience it from their personal labors, that is how things are progressing, and that's why I'm so excited to be making such a difference, because. Well, it helps parents. It really does. And it helps everyone having gone through a very long first labor. It was really a battle then heading into parenthood for the first time. So if we can help people not have such a lot of hard labor and then possibly more interventions or recovering from a surgical birth, then that's what fires me up. So I love this, the work we're doing. So I guess before we go into the guide, since that's going to help talk about baby position and how the baby has to descend and rotate. Can you talk about the cardinal movements a baby will take on its journey through the pelvis? Yes, and I was just an interesting note. I was speaking to a group of providers and in asking them if any of them knew what the cardinal movements of birth was. And as since I was asking, what is the first cardinal movement of birth? The group couldn't answer that question, and it's something that we're not taught. And I think that it's really important to understand from the pregnant person's perspective up to the provider how the baby actually moves through the pelvis and the pelvic floor. But what you have to realize is those cardinal movements of birth that I'm going to speak about only occur when the baby's in that optimal position of being on that left side. So anything other than left, occipate transverse, left, occipate anterior for the baby to enter into the inlet or the brim of the pelvis, experiences those seven cardinal movements of birth. And the first one is engagement. So engagement leads to descent, flexion of the fetal head, internal rotation, extension of the fetal head external rotation of the shoulders and then what we call expulsion. which is birth. Some people say that there's seven other people if you look at the journals and the research might indicate that there's only four, which are flexion internal rotation extension and external rotation. But what I talk about in my teaching is that what's happening today, Deborah, is that we are not seeing a lot of these infants at term experiencing the first cardinal movement of birth, which is engagement. And engagement helps with that ripening of the cervix. I don't know if you, I don't know anything about your family or if you have a family, but when you have, when you experience that lightning, you remember forever, you remember the head on the cervix and that it's almost like it is you're working together the baby and the pregnant person to ripen that cervix and to prepare that pathway for the birth. And then what we know to is that the the ripening of the cervix with the head on the cervix, the baby is actually preparing itself for birth and increasing its surfactant to breathe and it's increasing its metabolism in order to deal with its sugars to prevent hypoglycemia. So there's all these things that actually happen to the infant by having the baby obtain that first cardinal movement of birth. So prior to today, we would have a bunch of what we call premigravatives, which are first time moms come in and their cervix would already be ripe. So they would be one to two centimeters, what we call 100% effaced in zero station. And so there you can just imagine the the progress of labor from there and the fact that their cervix is already ripe compared to what we're seeing today on admission is a fixed cervix closed, maybe one centimeter and then the baby high. So you don't have that pressure on the cervix. So as the baby moves through these cardinal movements of birth, it's it prepares the baby for actually extra uterine life in so many ways that we don't even understand. But that is the main problem today is that babies are not attaining the first cardinal movement of birth, which is engagement. The engagement gives us so much more success rate, a higher success rate when you have spontaneous labor that follows and you have a baby that's more prepared for extra uterine life. So sure the listeners are hearing that, especially the pregnant ones are like, okay, if it's not if engagement's not happening, how do I get it to happen? So how would you answer that question? So there is there are ways that you can mimic the ways in which maybe going back to why this is happening. What we as maternal fetal positioning people, the experts, what we think about is we think about, okay, how can we prevent this? How can we prevent the disengagement or the high higher station babies from occurring at term? So we can mimic what actually was happening 30 years ago and what was happening was people were up and moving around more and giving more opportunities for the fetus to obtain the correct position at term, which will help with spontaneous labor. What can we do? Well, we can we can mimic it by after 30 minutes, set your alarm. If you if you sit at a desk shop, set your alarm for 30 minutes and after 30 minutes, go ahead and stand up, especially when the baby's moving and walk around for a minute and a half. Why don't you maybe swim more because in the prone position, we have we extend our arms up and out in a in a breaststroke. We allow baby to be hanging down in the hammock. So just thinking about creating more opportunities for the fetus to get in that optimal position prior to term around I see my clients at 34 weeks and optimally we would love for that baby to be in that optimal position. If it's your first baby by being in that on that left side at 38 weeks and 39 weeks if it's subsequent child. Let's start prenatal yoga in that list too. There's prenatal yoga in that list for sure and that is I have a guide. It's called Gilligan's guide 34 week brochure and that's actually being studied right now in Denver. It's now in its 10th month and what they're seeing Deborah is they're seeing people and I'm seeing it my own clients more people are going to spontaneous labor. So it's in a prevention mode waiting until labor can be too late sometimes. So we need to do more to prevent it prenatal yoga walking more realizing that when the baby's moving or kicking you in the ribs, the baby's talking to you and saying I need a little bit more space here. Can you help me? Can you stand up? Can you raise your arms up? Can you lean forward? Can you get in the bath? All these different ways have kind of been put together in this brochure and so at 34 weeks gestation. These pregnant people are actually doing these things on a daily basis and we're seeing more of people going to spontaneous labor. So prevention is obviously the best approach. Oh, I absolutely love this. Okay, we're going to take a quick break when we come back and you did answers a little bit. But I want to talk a little bit more why you think babies are presenting more in the RO to the right expert transfers and then you mentioned a few tools like moving and swimming and prenatal yoga. But let's go a little bit deeper into that. So we're going to take a quick break. We'll be right back. This episode is brought to you by B. Yogi. Over the years, I've had the opportunity to support so many yoga teachers through training and teaching careers, which is why I'm happy to partner with B. Yogi, a company I trust to help protect the professionals in our community. B. Yogi provides liability insurance created specifically for yoga teachers and wellness professionals, including prenatal yoga teachers. Whether you're teaching group classes, private sessions, or supporting students who pregnancy and postpartum, B. Yogi helps protect you from unexpected risks like slip and falls, malpractice claims and more. And if you're listening and thinking about enrolling in a yoga teacher training, B. Yogi offers students insurance too. So whether you're a student in training, newly certified or an experienced instructor, you can have coverage and support at every stage of your teaching journey. As a yoga berth baby listener, you'll receive $20 off of a professional insurance membership. Visit byogi.com/yogi berth babies to claim your exclusive offer. B. Yogi, protection and peace of mind for every stage of your teaching journey. We know what to give the people you love who love to get out there, because we're out there too. Just stop in and ask a green best. Like me. For the best gifts out there, shop in store or at REI.com. Okay, we're back. So it is interesting that not all babies end up in that L.O.A. or L.O.T. So why do you think we're seeing more babies presenting R.O.T.? There's simply less space on the right side. So you have your liver, which is a very dense organ that extends down beyond the right rib cage. So that is one reason. The other reason is we're just giving, as I stated earlier, less opportunity. So the babies on the right, kind of comfortable on the right side. They're actually more asymptotic on the right side due to less space. On the left side, we have more movable organs like your colon and your stomach, and so baby can actually get over there and obtain more of a non-acinclic position when it's when it's optimally positioned on the left side. Most babies, as you said, are your correct. Most babies that I see in my work on a daily basis are right, occipit transverse, and acinclic. They're heading over to one hip or the other. And that, of course, increases discomfort in the pregnant person. It relates to more frustrations and maybe some more inductions of labor because of the discomfort. So we have to realize that the reasons are real, why people are requesting to be done with the pregnancy because they're truly uncomfortable. So that is why they're presenting. It's just less space. And so we have to recognize that, and then to know that when the babies do obtain that left, it's a safer, more efficient, vaginal delivery. So if they are ROT, how are you encouraging babies to move to the left? So recognition is most important. So as you stated earlier, dual is really important. Establishing a great team of somebody you trust that have you have discovered through your questioning prenatally that they will address the position of the baby during labor really important educating yourselves. Antoneitally, but recognition early in your labor is essential because the further you go down the road of an extended time in labor the more interventions your team will bring on. So how do you do it? Well, I have a guide and I will tell you specifics about my guide today. Maternal movement, purposeful movement of the pregnant person and allowing her or him to get out of bed to have those telemetry monitors available during labor really important. And I'm going to talk briefly about A-ROMs. We'll talk about that a little bit more in detail if you want. Yeah, but avoiding that artificial rupture of membranes in order to allow the fetus to spontaneously rotate in labor, we need to allow that space. It is stated on all of our people that make our policies and procedures, all of our research-based journals such as the Green Journal. They make a statement to say that A-ROMs should not be done if we're not concerned about fetal status to allow for that fetal rotation to take place. So there's a trend today that's going on at least in my world to, and I hear about it from my clients nationwide, is that A-ROM is taking place way too early in the labor process. So just for those, again, you did say it, but just for those are like, what's that A-ROM? That's when the waters are artificially broken. So your care provider might say, oh, do you want us to break your water? So that's what that is. So can you jump into your guide, your Gilligan's guide? And also, how does it differ from spinning babies? Because that is pretty popular right now. Yeah, I'd love to. So, Gell Toley is here in Minneapolis St. Pauk. High respect for her. I actually was a spinning babies aware practitioner. I am no longer per my choice. And I can talk about that. Gilligan's guide is an algorithm. It's a graphic chart and very easy to follow. I designed it based on my experience and my thousands and thousands of deliveries that I have attended. So what it does, it is, is assist the pregnant person's body to rotate their unborn fetus into the optimal position for birth. It's very safe. It's very efficient. It's very simple and safe is my big word. As I stated, I'm a registered nurse with a license. I am a legal nurse consultant. I want everybody to be safe. And that's one of the reasons why I don't throw Gilligan's guide on to the internet for everybody to do. Because I think that it's really important as a nurse to determine if there's any health concerns with my pregnant people. So it's for maneuvers. As I stated, I designed the sequence of them. I designed the first three. The last one is actually one of my mentors, Dr. Carol Phillips. And Dr. Carol Phillips designed this sideline release, which is the last final maneuver. So what I do is I teach people how to prevent the malposition to begin with. So I take them at 34 weeks. It's the perfect gestation. I show them how to do the homework. I demonstrate things. I talk about the importance of different things after identifying their health history. And then number two, I teach them how to identify the malposition. So it's really important for the lay person in the dueling, the nurses, and the providers to be able to identify the malposition. And that is really important to know how to do it from a different perspective. You know, a doula can look at the belly. A doula can put her hands on the belly. She can't diagnose things or he can't diagnose things, but he can help that pregnant person identify it. So can the support person? So I teach them how to do that. And then I teach even deeper the medical provider way when you're doing an exam. What are you feeling? When you're when you're observing the pregnant person in labor, what do you see from a subjective and objective point of view? So I teach them all of that. And then I show them my actual algorithm and I teach them how to do those for maneuvers. And then I do a follow-up email. I'm always available to the clients for questions or concerns. So it's a really it's a deeper dive into maternal positioning. It's from a nurse's perspective and a nurse's perspective that has a lot of experience in the field. And I'm always thinking about safety. I'm not going to tell somebody to do a puppy pose for 30 minutes, for instance, when I don't know what her blood pressure is. So that that's where I'm coming from Deborah. And it's it's I'm not saying things are unsafe and other venues. I'm just saying this is my perspective on maternal positioning. I request that when you do Gilligan's guide that you're at your place of birth because it works so well. And I also request that you monitor the fetus. And that could mean doptone. It could mean a intermittent monitoring or it could mean continuous. But I do want that person knowing what the fetus is doing while they're doing my guide. So this isn't something that people do a head of time to help prepare to get baby engaged. Right, that the actual algorithm. Thank you for clarifying because it is confusing. The algorithm called Gilligan's guide is to be done at the place of birth. And that could be home, right? If you have a midwife coming to your home or and it also requires per my request that you're monitoring the fetus during the the the guide. What you can do ahead of time is related to the tools that we'll talk about in your next question. And the four the four principles that I want you to pay attention to. So there's four things that I would love for. Let's go ahead. Thank you. So the four principles, the things you can do at home and the things the beautiful thing is your body's already telling you to do these things. So you just kind of need to listen to your body. But the four principles and you should follow them in this order. So the number one thing you need to do before you do anything in relation to positioning is you need to relax the muscles and ligaments first. So the if you talk about what ligaments are, their dense bundles of parallel collogenous fibers. I love saying that because it's so beautiful and they they're functioning clinically while you're pregnant to stabilize, right? To stabilize that lower uterine segment and keep your baby safe. But if you're if they're cold, they're stiff, right? They're they're not they don't have that elasticity that I want to see. So I want you to think about relaxing your lower uterine segment and what I'm talking about specifically is your broad ligament, uterine sacral, round ligament. And then in relation to the pregnant person's body, the so-as, ilio-so-as, and your gluteal muscles. So if you think about that, let's break that down for someone that's like, what are those? Or it's so the broad ligament. I kind of think of it like a little scarf holding the uterus from the back of the front. I don't know if that makes sense. It's kind of like a wrap around it. It's a fold of the peritoneum. You're correct. And it is kind of this it's the what the uterine sacral, round ligament are actually embedded into. So we want to think about just if you take your hands and put them on either side of your lower uterine segment, they're going to wrap around and they're going to be in the front here is how they stabilize the front. You only have support on your uterus on the bottom part of your uterus. The top doesn't have that support. So you want to relax the lower uterine segment is how we regard it in medical terms. And so if you place your hands right on either side on right on top of your well, kind of in your groin area, that is the area that I'm referring to. And then the so as is attached to L1 L5 and wraps around to the inner troll canter. And so those as the hip flexer again, kind of put in late terms. Very good. Hip flexors. But then the gluteum muscles too. So think about those big muscles in your buttock, right? So those are usually tight. And they're not working efficiently when we're sitting on average eight to 10 hours a day. Those aren't working efficiently and they're not firing and they're actually losing their elasticity. So when they're cold or when they're tight or twisted, we need to think about relaxing them. So we want to think about ways to relax the muscles and the ligaments at the lower uterine segment. And you can do this using your psyche, you can use this using your mind, you can use imagery, you can use music, you can use positive encouragement. You can actually use external forces too, such as getting in the tub, directing the shower head directly at the lower uterine segment, putting something a warm compress on either side of your broad ligament. So you want to think about that, and what's interesting, Deborah, too, is when we talk about external cephalic versions, which is the rotation from a medical profession of a baby that's breached to a non-breached position, we should be thinking about that too. We should be thinking about my number one principle of let's start thinking about relaxing the lower uterine segment prior to that extreme movement of skillfully bringing that baby to a vertex presentation, because I've done it and it works. When you think about that, bringing that principle of relaxation in. So if you've had some, I've had some doctors I've worked with actually given epidural for that. I'm assuming it was the same reason, just to soften everything. Yeah, but that turns it into an extreme medical. That was quite a thing, but yeah, with as my thinking, I wonder why they're doing that, and I assumed it was just to soften everything. Yeah, it does relax the uterine, it does relax the lower uterine segment, it does relax the pelvic floor, it relaxes everything from your belly button down. But I'm talking about just putting warm compresses on your broad ligament for 10 minutes. You'd be amazed at what that does. Yeah, one of the things I would pack, since I'm not practicing it's due anymore, but one of my favorite things was a hot water bottle. And I would put that at the lower belly, obviously with like a little cover over it. And then also at the sacrum, I found a lot of people really enjoy that there too. Yeah, you cannot ignore the sacrum and the ligaments that support the sacrum. The SI joints, I mean, it's really, it's really important to relax. So number two is you need to create space. So we can talk about all different ways to create space. Yes, space, and I'm talking about your space from your pubic emphasis, which is the inlet of your pelvis right at the top, to your xyfoid process, which is the bottom of your sternum, which is right down the middle of your ribcage. So if you think about creating space from your xyfoid process to your pubic emphasis, if you put your finger on your pubic emphasis and put your finger on your xyfoid and you're sitting down, all you need to do is stand up. By standing up, you're going to increase it by three to four centimeters. And that is why upright positioning, we know per research that that decreases the amount of time in first stage and in second stage, because you have gravity and more space. So the number two thing is creating space. Number three thing is now you've got to help this baby tuck its fetal chin. Because so many of these babies are ace and clinic and have, as we, as I stated in the beginning, have their fetal chin gone back, especially with an occipoposterior baby. Their heads are extended, so we need to help these babies tuck their chin. And number four, now you need to actually correct the position. But you need to think about those four principles in that order and order to rotate a baby. And so you can create your own Gilligan's Guide. But you really do need to think about those four things in that order in order for you to have success. So I think a lot of people are like, okay, I can warm up the lower belly, that's doable. They can stand up. And then you're talking about chin needs to be in the chest of the smallest part of baby's head is pressing against cervix. And that's where I think some people are like, okay, how do I do that? So can you offer some ideas about that? So without telling you how to do the guide, because I'm not going to share that with you today, unfortunately, because I want to do that on an individual basis with taking a health history. So if you just think about ways that your hips can move, I was taught by one of my favorite people in the world, one of my friends who's a doula, that it's really important to move like a hula dancer versus a person that's doing the fox trot, right? We want to be able to lift your hips and lift the right hip and then lift the left hip because that's going to give momentum for the baby to tuck its chin versus, particularly if the baby's in the mid pelvis. So just listening to the body, listening to the movements, allowing that person to get out of bed and that's going to really help. But I do have a specific way called fetal crumb tuck that I teach that actually can help that will help tuck that fetal chin. That makes no, I get it. I totally respect that you want to work one on one. And so that also brings me to, you'd mentioned you don't encourage like a butt up child's pose. And that is the reason you don't teach inversions, that's because you don't know the medical history of somebody. So here's how I approach inversions, and this is based on my own health. And it started 25 years ago when I was diagnosed with glaucoma. And I have a type of glaucoma for young, obviously I was young then, and it's a type of pigment dispersion glaucoma. And I worked with a recognized ophthalmologist glaucoma specialist. And what was happening was I am a yogi, and I did yoga daily, and I got into the crow poses and the headstands and everything. And what we were seeing, because I see my glaucoma specialist every six months, my pressures were going up. And because you check your pressures when you go in for glaucoma, and my pressures were succeeding with each visit going up higher. And I was requiring a second medication to maintain that. So what we concluded was it was my yoga inversions that were actually increasing my optic pressure. So here I am a labor and delivery nurse at the same time. So I'm realizing that when you put your head below your heart, you are increasing the intercranial pressure, okay, so just know that. So now we take today's pregnant person with increased blood pressure unbeknownst to them. And particularly today, since COVID, Deborah, we're seeing more pre-clampsia than we've ever seen. We don't know the relation yet. So you encourage people to do inversions when you do not know their pressure. And from a safety standpoint, I do not agree with inverse full inversions, and we'll talk about the difference in a pregnant person, unknowingly, not knowing what her blood pressure is. I don't think it's safe. I think you need to recommend, you need to talk to your provider about it, and then work into it gradually. So just know that inversions will increase the pressure and the blood vessels of the brain. And it all depends on how far below the head, excuse me, how far below your heart, your head goes. So if you do a down dog, for instance, your head is slightly below your heart, but here's the difference. My trunk is still not above my heart, so I'm in a V shape, right? So then the second question is, how high above the heart are the legs and your trunk? So if you're doing a full crow or a full headstander or a shoulder stand, you're creating the most pressure in your intracranial cavity. And so you can safely do down dogs that's considered a mild inversion. And particularly if you've worked your way up to that, because what happens is your blood vessels get used to it, it allows your blood vessels over time to strengthen in order to resist that increased pressure. So it's not like you're training your blood vessels. So I'm not going to tell my pregnant people to do full inversions, and I'm actually going to tell them to not do full inversions while pregnant. I totally agree. We don't teach inversions. And we do down dog. I'm going to say we do down dog, which you know, it's a minor inversion. But no, we do not teach full inversions in our prenatal style. I have many reasons for that, but I hear what you're absolutely saying. So I'm glad to hear when she said that I'm like, oh, I hope she doesn't include down dog in that. Oh, good. No, down dog. Yeah. I mean, think about your V shape and you're holding it there for what, 30 seconds. Yeah. Yeah. And so you have to realize the gravity has its place, right, in the birth world. Absolutely. Sometimes when I do Dr. Carol Phillips open knee chest, she developed that. I do open knee chest because we need to get that baby out of the bony pelvis. But full inversions, Dr. Carol Phillips actually designed that for the OB world. That was not the original intention. I heard this from her because she mentored me. She developed it. So you go down and you come up within three breaths. And so I've told other people that are teaching maternal positioning that I don't advise it based on my own medical history and my own discussions with my clients. common specialist. And he showed me all the research. We looked at it together, that it does increase your optic nerve. It does, excuse me, increase your, your vitrous humor pressure, which can damage your optic nerve. And it does increase your inner cranial pressure. And the reason why we're concerned about pregnant people and intracranial pressure is that you could have a potential seizure if you have pre-clampsia. And so we want to avoid that. And so that is why in my heart of hearts, I don't encourage people to do full inversions while pregnant. So thank you for explaining. That's a big explanation and I apologize for being medical, but and I obviously have a big, very passionate about it, but I'm only passionate about it because it's been a concern of mine personally for so many years. No, I appreciate it, too. And again, we don't, at my studio, we do not teach the pregnant person inversions. We don't have a place for that in our practice, but that's, again, my, my own take on that. So thank you. So we've been talking a lot about fetal positions for a vaginal birth. And I know some people are probably saying, "Why are we so focused on a vaginal birth?" And I just want to remind people it's not that cesareans are bad because they absolutely have an important place in birth. I think they really do. I think they could be overused, which could be a different discussion, but I feel like not all the time are the risks explained about cesareans. So maybe explaining the risks associated with cesareans, so those that are listening can understand your passion. Am I passionate about helping people find a more efficient flow for birth for a vaginal birth? Yeah, you're so right. And the fact that I, I literally have been down on my knees thanking my team. And I can get really emotional because I've seen so much and been involved in so many deliveries that there have been times, Deborah, where I have, I have, you know, put my hands together and thanked them for their skill at delivering these babies quickly and efficiently and actually quite beautifully as they enter into the abdominal wall to get a baby out safely. But what I have seen and what is demonstrated in our research and all over the journals is that we have more than tripled the rate of C-section since I had my first daughter in 1992. We're now at 32 percent in the United States. The US has one of the highest C-section rates in the world. And it's predicted that by 2030, it's going to be one out of three people are going to be to deliver a C-section in the US. And with that, as you stated, comes morbidities and even mortality. And without, I mean, it's grim. It's a grim subject. And it's hard to hear, but I do want you to know why I work so hard to empower my people and my, my OB teams to deliver vaginally because we do know those risks. And they're well documented. But first, I want to tell you the most common reason for C-section. And this is in order of occurrences. Number one is labor dystocia. And we know that labor dystocia is directly related to fetal malposition. Number two is non-reassuring fetal heart rate tracing. That is something that is not research documented yet. But I really encourage it with my experts in fetal heart rate tracing is that when a baby is in a malposition, you will see non-reassuring fetal heart rates. And when you fix the baby and get it out of that vagus response, autonomic nervous system response of having its head tilted back, you will have an improvement in the fetal heart rate. So that's number two reason for C-sections. Number three is a fetal malp presentation, multiple gestation, and then suspected fetal macrosomnia. So we're delivering people on the suspicion. We're delivering sections. We're planning the section for a suspected big baby. And there's a really good article on evidence-based birth. I have to plug my Shira Rebecca Decker on big baby. So make sure you look at that. But C-sections just briefly is associated with an increase in morbidity and mortality than vaginal birth. So that is why I strive prevention is my motto. And so I try to prevent it with a vaginal birth. Subsequent uterine rupture is one placenta accretia, which is when the placenta attaches to the uterine wall, particularly the wound or the incision. Hemorrhage rates go up, hysterectomy, which is when they have to remove your uterus. Maternal death, which is really hard for me to say, bowel bladder injury, surgical site infection, and venous thromboembolism, which is quite deadly. And then we have to talk about the neonate. So there's decreased breastfeeding rates. And the biggest thing is all of this increase in our C-section rate does not appear to improve neonatal morbidity or mortality. So who, which is our World Health Organization, has recommended that the C-section, if you were to take everything into account, we can prevent and decrease it safely to 10 to 15 percent, which is the goal for 2020 healthy people. We want that was the goal for 2020. And now they've made a new goal for 2030 to be around 10 to 15 percent is where we should be in order to do that. We do. And a lot of people are working hard. So again, it's not just for the community listening. It's not that we demonize cissarians because they really do have a place. I think what we're agreeing or at least expressing is that can we reduce the rate of them for those that it's not? That was a medically necessary, a medallically indicated. And can we, as Anne was saying, community, labor dystocia, stalled labor. A lot of these things that we're talking about today can improve labor stalling. And so again, I'm just so excited that there are ways for people that are really invested in not having a Syrian trying to find a more balanced body so baby can be better positioned. So I'm so happy for the work that you're presenting. So thank you. Thanks for giving me the opportunity. It works. It's it's something that empowers the pregnant person. In the end, once I finish doing the guide, it is all about looking at them in the eye and telling them and and them knowing obviously they feel a difference. They no longer have back labor. They feel maybe some pressure in their pelvis telling them what they just did and the power of their body to have completed that circuit and to have done that. Even, you know, sometimes it's when they're very tired and they're just at their wit's end and they're able to go through that and do it and it is it's so empowering to them. And like you said, it's the beginning of their parented. I mean, this is something we have the most important job in the world and we have to realize that that those hours that we spend with people in labor are the beginning of their parented. And if we can make them feel whole and strong and successful, not that people that have a that a cesarean section don't feel that. I'm I'm not implying that whatsoever. I am so in awe of people that go through cesarean section. It is a another way to birth. But I strive every day to decrease morbidity by attempting to allow the body to do what it's meant to do. And not putting up barriers like the bed and the lane flat position and the not allowed to move because of the fetal monitor. We need to improve that space and allow for their body to do what it was meant to do. Oh, so beautiful. We're going to take another break when we come back. Now you have years of experience with this. So think about one final tip or piece of advice you'd like to offer new and expectant parents are right on our break. See my bubbles at the top of your mind. We'll be right back. Like me. Okay, so what golden nugget do you want to leave us with? Okay, so I often tell my clients this and it's the philosophy of of my world and I know that I know it. I know it in my heart. I feel it. I see it all the time the ability of the body to birth. So what I'm telling you is I want you to know your body. I want you to know your baby. I want you to surround yourself with people who listen to you, truly listen to you, support you, and quietly encourage you. And I want you to be the expert. Oftentimes I'm asked, gosh, you just taught me this. How do I, how do I approach this in the labor room? Like, I know all this information and what if they don't believe me? They will believe you. You need to know that you're the expert. Learn all you can about the tools to prevent, to identify and to correct the malposition baby. And then finally, no worries before 39, 38 weeks. So go about your beautiful pregnancy and the health of your baby and your body. But really, it's not a concern until you get full term at 38, 39 weeks that we want this baby to be in that optimal position of being on the left side. That's so wonderful. So where can people find your work? So GilliganSky.com, I'm on Instagram at GilliganSkyde, know that you can reach out to me for anything, for questions regarding a past birth, questions about a future birth. I'm here for you. This is my, this is my jam right now. This is what I do. This is what makes me happy, fulfilling and, and I'm here for you. And I'm proud of you. And however you're, you're approaching your pregnancy. Thank you so much for offering so much knowledge and so much for people to think about. And also for people to realize that they can very much be a part of this birth experience. I don't just have to watch it unfold. So thank you for giving the power back. So I appreciate it. I appreciate you so much and I love that you're teaching yoga to pregnant people. It's very important. Thank you. This has been an episode of Yoga Birth Babies, produced by prenatal yoga center. You can catch us on Facebook, Twitter, Instagram, and Periscope. I'm Deb Flashenberg. Thanks for listening. Now at Kroger, your points set up to more ways to save every trip. Use them your way to take dollars off groceries at checkout or save at the pump. You can even save up to $35 on your next fill-up. Same points, more choices. And with low prices on fresh, quality food, plus digital and personalized offers tailored to how you shop, your dollar goes further. Redeem your points online or in the app. Kroger, fresh for everyone. Restrictions apply, seaside or store for details.