We are joined by Brittany Sharpe McCollum of Blossoming Bellies Birth to dive deep into bias around pelvis shape, pelvic biomechanics & dynamics, and the relationship between the pelvis & movement during birth.
Brittany discusses the bias and racism inherent in classifying pelvic shapes as a predictor of labor outcomes.
She shares her definition for truly "optimal" fetal positioning, and what we can do to support it, without getting in the weeds about what *could* happen.
Finally, Brittany talks through her "5-4-3" guideline for encouraging movement and labor progress.
Don't miss the giveaway this week for Brittany's upcoming full day Creating Spaces workshop: happening over in our facebook group!!
Check out this episode's full transcript & shownotes!
We are joined by Brittany Sharpe McCollum of Blossoming Bellies Birth to dive deep into bias around pelvis shape, pelvic biomechanics & dynamics, and the relationship between the pelvis & movement during birth.
Brittany discusses the bias and racism inherent in classifying pelvic shapes as a predictor of labor outcomes.
She shares her definition for truly "optimal" fetal positioning, and what we can do to support it, without getting in the weeds about what *could* happen.
Finally, Brittany talks through her "5-4-3" guideline for encouraging movement and labor progress.
Don't miss the giveaway this week for Brittany's upcoming full day Creating Spaces workshop: happening over in our facebook group!!
Check out this episode's full transcript & shownotes!
Maggie, RNC-OB 0:05
Welcome toYour BIRTH Partners, where our mission is to cultivate inclusive, collaborative birthcare communities rooted in autonomy, respect and equity. I'm your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
We are excited to be back and kicking off season three of the podcast. It has been a little bit over a year since we first started talking with you all. And we are really excited to frame this whole season coming up around the concept of biases and benefits. So in our experiences, when we go to have conversations with people and we have different viewpoints and different opinions and different ways of practicing, oftentimes, we're seeing that that comes from a place where we perhaps haven't given enough thought, or we have learned from inappropriate or incorrect sources. And so we end up with these biases that impact the way we provide care, and the way we relate to each other and to our clients and patients. And so, throughout this season, we're going to be bringing up topics that we think have either had a skewed perception presented to many of us as birth professionals, or ones that we think just need a little bit more of our attention and awareness to understand the potential benefits. We are going to be kicking off this series today by talking about the pelvis and pelvic dynamics. And we are really excited to have a special guest on with us to discuss that. Brittany Sharpe McCollum is a pelvic dynamics expert, and she's going to give us all good information about what brought her into this work and why this is what she focuses so much of her professional energy on. We're eager to share this conversation with you all and hopefully start a dialogue about how we've kind of ignored the pelvis and what brought us to that place and where we can kind of go from here. Onto the show!
Alright, well welcome Brittany, we are so excited to have you join us on the podcast and just have a chance to dig into all things the pelvis and pelvic dynamics. And so if you want to just kind of introduce yourself a little bit to our listeners and let them know.
Brittany,CCE,CD 2:30
Yeah, sure. So my name is Brittany Sharpe McCollum. I am a certified childbirth educator, certified birth doula, and a pelvic biomechanics educator, I am based out of the Greater Philadelphia area. I teach childbirth classes for expectant parents and provide all the support and lactation support and movement and base classes. But also a large portion of what I do is trainings for clinical and non clinical birth professionals, the training them, the trainings themselves are not clinical trainings, but they are full of non clinical education that clinical providers can use to decrease their rates of intervention. And really, that is at the heart of what I do is restoring that autonomy to the person that's giving birth, pelvic biomechanics trainings vary in time from like one hour workshops or half hour webinars to things as long as full day eight hour workshops. And really what pelvic biomechanics refers to is understanding how the bones of the pelvis move apart from one another, and what changes are created in the available space in the pelvis when that happens. And then we take that information and we apply it to the labor and birth process. There's a little bit about fetal positioning in there and a little bit about where the baby is in the pelvis, and then a lot about how people are moving throughout their laboring processes. And one of the myths that I come across a lot in the work that I do is this idea that if somebody gets pain medication that they can't move, and now it's like a ball that goes out the window. And that could not be farther from the truth, because movement is of course part of comfort in labor, but it's also a huge component of progress in labor. And that's backed by study after study that has shown that moving throughout the laboring process can shorten the amount of time someone spends in labor and decreased risk of intervention. So that's a large part of what I do is pelvic biomechanics. And then a lot of what I do is kind of the other side of things working with expectant parents helping to implement a lot of this stuff, but also kind of providing just general childbirth, education and empowerment and skill building and confidence building for more positive birth experiences.
Maggie, RNC-OB 4:34
Yes! You are such a wealth of knowledge. I'm so excited to have you here. So I feel like in our in our talks leading into this, we need to kind of like reverse first and figure out how did we end up here. I had said in you know, in my like nursing education, the idea of pelvimetry as still kind of vaguely out there, ideal pelvic spaces and shapes and you know, all of that and as time has gone it felt like that at one point we were carrying about that and maybe in the wrong way. for the wrong reasons, and now I feel like it's kind of like it fell out of vogue and moving and what the pelvis is doing kind of isn't there. So do you want to kind of touch on that like historical piece of it.
Brittany,CCE,CD 5:11
Yeah, where we came from? Sure. So there were two OBs last names were Caldwell and Moloy in the early 1900s, who studied skeletons and studied X ray images and classify the "female" pelvis into four basic shapes. And they did a whole lot of different studies on these four basic shapes. And they determined that the "female" pelvis has four basic shapes and everyone falls in every you know, birthing person falls into one of these four basic pelvic shaped categories. And what's so fascinating is that this became the guide for understanding the pelvis in obstetrics and midwifery moving forward. So even to this day, in obstetrical texts and midwifery texts, the Caldwell Moloy classification of pelvic shape is taught, despite the fact that even as early as the 1940s, people were coming out saying this isn't accurate. It's too precise of a classification. We can't classify pelvises in this way, as early as like 13-14 years after their first studies came out, people were saying wait a second, this doesn't seem accurate based on additional information, yet for some reason. And it's it's, I'm sure we can theorize about this. But it's not totally clear why there was never much questioning about this, it seems to me like this is how we're going to proceed moving forward. And I think my theory is that that idea of classifying pelvises into being more or less ideal for birthing babies fell very easily into the racism and bias that is part of Obstetrics. And we can totally touch on that more. But it was like a self fulfilling prophecy. And the fact you could say, well, this is why this group of people appear to be having more difficult births, which again, like we could break that down to, but we could let's just blame it on pelvic shape and say that they're just inferior, this group of people is just inferior and giving birth. And this is part of this, this strain of inherent bias that is still part of Obstetrics and midwifery today. And of course, you know, we're speaking really generally. And I want to make sure that we give credit to all the midwives & OBs that are doing things differently. But just generally speaking, it's this, this has continued to perpetuate bias in obstetrics and midwifery care up until this day, and we have a lot of research that has come out saying, in fact, no, there are not four basic pelvic shapes. Instead, people have variations of these pelvic shapes. And there can be different dimensions in you know, all three different basic planes of the pelvis. But it's a really kind of it's been a very, very, very slow road, getting to that point where there's greater awareness of that. And even now, I think in the in the greater birth community, there's still I mean, it's part of all trainings, there's still, this focus on this four basic pelvic shape idea, despite the fact that both obstetrical information and anthropological information doesn't support it.
Maggie, RNC-OB 8:20
It's so frustrating, it's no matter how many conversations we have about different topics, there are just so many things that that really circle back just how much during obstetrical and midwifery nursing education, we try to put things into a box, that it's not a box at all. And so we tried to make it one. And that hurts everyone involved, because we are pushing, we're pushing everything in. And we're trying to just say like, yep, it's black and white. These are the things Oh, great, we'll have these for pelvic shapes, and that will let us make some bigger judgment call about what's going on. Yep. And that it's not like you said, it's not based in good science, it is not based on fact and reality. And I think, without getting too far into it, but obviously the racism that was inherent in that decision and who had the gynecoid pelvis shapes and the eurocentrism there, like it is so pervasive into how we then continued to function and to to work as a birth industry. And it's really overwhelming how much that continues to this day, like you said, in all of these different facets when you are learning about anatomy within birth, it inevitably comes back into it, right?
Brittany,CCE,CD 9:39
Yeah, absolutely. I mean, they these oppressive forces, particularly against birthing people of color have really been in place from the start of this country. And so, when we then can, you know, when these two OBs then come up with a system of pelvic classification that only furthers this idea of again, certain people not having ideal "birthing hips," you know, it just again, like "Oh, yeah, this is why like this is this is why we're seeing this," for example, like, some estimates are as high as 50% of enslaved birthing people died in childbirth, in the 1800s. up to 50%. I mean, that's insane. And that's not caused by the birthing person that's caused by all of the problems, atrocities of being enslaved, yet, then they see these big numbers. And then, you know, not even 100 years later, we have this information that says, Well, this pelvic shape that people, particularly of African descent are more likely to have, which is not true, not based in current research. It's a narrow pelvic shape that causes babies to get stuck. Well, then that's that must have been why we're seeing so many people that are enslaved die in childbirth...NO. How about the idea that there's severe malnutrition, that there's severe trauma and violence, like, it's just it's mind blowing to me, that we can, we can pretend to boil it down to something so simple as that. And to have all this information coming out for years for literally decades, saying this isn't true, this isn't true. Yet, we're still being taught these basic ideas that have no basis in anthropological or obstetrical research.
Maggie, RNC-OB 11:27
Yeah, someone is able to put out their information. And even if it's immediately, near, days later retracted, even if it's that quick, it's out there, you know, and some people who, who want to believe that who want to push that narrative, they latch on to it, and they run with it. And it's hard to kind of get the horse back in the stable there. And so I think, what's, what it's think is awesome, and why we want to have you on here to talk about is it like, yes, there is a different way to do it, there is a different way to view this. And it's hard for those of us who were kind of like, trained educated to believe this about the pelvis, it can be hard to kind of like get that idea out of our head and then practice differently and kind of be reflective of that. So what do you kind of see, when you are educating birth professionals, both clinical and non clinical, what do you kind of see are like the big hurdles that we can kind of get over certain ideas that we have to let go of? And how do you kind of jump through that to a different way of thinking?
Brittany,CCE,CD 12:22
Yeah, so the two, like, if we're gonna really boil it down to like, very basic things, the two things that I see that seem to really affect people's labors and births, is when a provider thinks the baby's posterior, I think that can change the way a provider view someone's birth. And I think the other thing is that providers who really believe that pushing a baby out with the legs far apart, is going to create space in the pelvis, which is not true. But those are two things that are really simple. And I see very, very commonly, and they completely can affect the way someone's labor unfolds, this bias that we have against posterior babies is definitely, I think, kind of inherent in this idea of a classification. But also, you know, part of what attributes to a bias against that posterior position is the idea that someone who has a posterior baby may be more likely to have back pain so that we see someone that is, you know, having a maybe a harder time managing their labor than somebody whose baby is not posterior. And immediately we think, well, this labor is harder, this person's pelvis might not be as ideal, or the position of this baby is not as ideal. So immediately, I think for a lot of providers, the idea of the C section creeps into their head, and just the fact that now they're viewing this labor as less likely to wind up with a vaginal birth, will potentially change the way that they care for this person, it may change the amount of time that they give this person at different points in labor, it may change how willing they are to incorporate different movements and positions, they've already gotten it into their head that this labor may be more difficult, maybe more likely to wind up in a cesarean. So maybe we should just start planning for that. But I think that's a huge way that we see. Is it well, that that pelvic classification, miseducation about pelvic classification, and a lack of understanding about bodily mechanics affects the way providers view over if they're, if a baby is posterior, we can work with the posterior baby when we have the skills to understand how to move the body and how babies tend to rotate and descend and how to tell if they're, they're taking that more conventional path of rotation and descent or if they're kind of doing their own thing. We can totally work with that; posterior babies do not mean cesarean birth, but I think there is this kind of bias against that positioning that makes us think that posterior babies are potentially more of a "necessary" cesarean. And then I don't know if you want to touch on that...
Maggie, RNC-OB 15:08
Yeah, it was like a lot to unpack there. But I think the one thing and that I've heard this from birth professionals of all stripes, the idea of you know that LOA baby like that that's what we want you know. And so I feel like I certainly know for you know, myself and other friends when you're pregnant and you're getting close and you know you're entering the end of that third trimester and you're kind of being more aware of like, "Alright, are we in that ideal spot?" And so you'll sometimes baby is great, and you just feel like, well, what a good pregnant person I am...babies right where they're supposed to be, it's gonna be so easy, like, check, you know, whatever. And other times, you are
Brittany,CCE,CD 15:42
And that's dangerous too.
Maggie, RNC-OB 15:45
You know what you think like, Okay, we've got it. And then other times, I mean, you're going through literal gymnastics, trying to get baby into this position, that isn't necessarily ideal. And I feel like that, if you want to touch a little bit more on that piece of it, because I think that idea that we again, like kind of in tangent with this pelvic shape idea, we got this impression that LOA or bust. And then we do a lot of work to make that happen. And maybe that's what needs to happen, but maybe it doesn't. If you want to kind of like break down some of that piece about how we as providers can like be aware of what your baby is, but in a bigger context.
Brittany,CCE,CD 16:24
Yeah, yeah, sure. Wow. So yeah, you brought up so much stuff, I can talk for like hours, little like phrases that you said. The position that a baby assumes, ideally, in late pregnancy is the position that the baby generally needs to be in in order to navigate the inlet or the top of the pelvis. So the position that is ideal for a baby at the end of pregnancy, and the start of labor is very dependent upon the available space for the baby in the top of the pelvis. But we don't know someone's pelvic shape. And you know, we can't provide or can't determine from an internal exam, what someone's pelvic shape is. And we're not getting pelvic symmetry, X ray pelvic imagery to determine the shape of our pelvises. And even if someone did have an idea as to the shape of their pelvis, it does not take into account the movements that can increase or decrease available space age different again, like each different plane or level of the pelvis, the inlet is the top, the mid pelvis is the middle and the outlet is the bottom. So you don't know what pelvic shape we have. Nobody typically knows what pelvic shape we have, unless we've had X ray pelvimetry in the past, and someone has really sat down with our dimensions and like kind of worked through it and figured out like, well, this is more oval shaped or this is more narrow here, which isn't happening. And so this idea that we're trying to get babies into one specific position, when we don't necessarily know if that would be the ideal position for that baby in our body sets us up to feel a lot of pressure and a lot of stress and a lot of anxiety at the end of pregnancy. Or like I commented on when you said like, oh, let's pat myself on the back because my baby is lol. Well, that's, that's great, if that's the best position for your baby to be in for your problems, which we don't know, maybe it is. But also then our emphasis has become well, things are going to be smooth sailing, because my baby's LOA. And that's just one piece of the puzzle, we still need to encourage descent and rotation and babies are amazingly active during the laboring process and wiggling their way down. Babies are not necessarily going to stay LOA. And also babies may extend their chin or tilt their head or wiggle their little hand up by their head, there are so many other things that can play into it. So I don't want anyone to feel anxious or like "oh, gosh, now my baby's LOA and now I have to worry about it;" NO. But instead just recognize that the position of the baby is a very kind of transient thing, babies are going to shift and take advantage of the available space. And if we keep utilizing movement through labor, we keep giving the baby that opportunity to find those little changes of space that they need to work their way down and out. Yeah, so I think that's all really important. I don't think people should be stressed out at the end of their pregnancy, trying to get their baby positioned a certain way. What I do encourage my clients to do though, which I think is really important is pay attention to how they're aligning their body and pay attention to how they're positioning themselves. are they spending hours a day (and this is the reality for a lot of us) hunched over a computer? Or are they slouching back on the couch because they've been hunched all day. Now at the end of the day, they need to slouch to watch TV, right? Like are they doing that? Or are they seated in a way where they're sitting up on their sits bones so that their pelvis is neutral? Are they elongating the front of their bodies so that they're giving the uterus lots of space in both the front and the back of the body? are they spending time in positions that helps to release tension in their body? Like all of these things I think are really Important to focus on because then if we've created the space for our babies to find the most ideal position in our bodies, that's what that's what I consider to be optimal, optimal positioning is in relation to the pelvis, the baby is moving through, which we don't know what pelvic shape that is. But we do know that if we give the baby lots of space to work with, we can trust that they're probably going to maneuver their way into a position that is working well. And if that position may not be working well, if we remember to utilize movement, especially movements that are appropriate for changing space in the ideal plane of the pelvis, then we can really help to keep that labor process progressing, even if a baby was in a position that wasn't so ideal to begin with. Yeah.
Maggie, RNC-OB 20:42
Okay. So for all of us listening, I think it's really helpful because I think this is like, it is so counter to the way we've tried to think about in the past, right. And I think that is because like we said, you know, we, there's a large part of us that like, we like rules, we like order, we like understanding like, this is how things can go. And birth continually shows us that that's, that's not possible. But we still crave that little bit of, you know, control. And so I think if you could say one more time, what you said about like, so optimal fetal positioning is, so that we can have like that sense, we are talking as birth pros with clients to empower them to feel that way too.
Brittany,CCE,CD 21:15
Sure. My favorite way to say it is optimal fetal positioning is optimal in relation to the pelvis the baby is moving through. Yes. And so we give our babies lots of space to work with in pregnancy, and we focus on alignment, and we focus on decreasing tension in our bodies. And we may utilize different techniques from lots of different ideas or methods in order to accomplish that. But rather than focusing on getting our baby's position to a specific way, let's focus on aligning our bodies and releasing tension and giving our babies lots of space to work with. And I think that kind of checks the boxes of giving people something to focus on which, yes, I totally agree with you. When we are facing an experience like labor that feels somewhat out of our control. It's really nice to have certain things that we feel like we can control, but it also takes off that pressure to force our babies to be in a certain position. And the thing with you mentioned I'm going to jump on this because you mentioned the gynecoid shaped pelvis, which is one of those four basic classifications that Caldwell Moloy came up with, and again like this is theoretical and disproven since then. But this idea of a gynecoid shaped pelvis is a pelvis that is wider side to side at the top than it is front to back at the top. And so this pelvic shape if somebody does happen to have like a characteristic of a gynecoid shaped pelvis, this typically favors a baby being in an LOA position. But that's just one variation of pelvic shape, like LOA can be a great position for some babies and for other babies it's not and an ROP position can be a great position. For some babies, in some pelvises, and for other babies, it's not. And again, just to emphasize, we don't know what pelvic shape we're working with, what we do know is how we can universally create space in the body and also in the pelvis.
Maggie, RNC-OB 23:09
Yes, I think that's so helpful for us as we're thinking like having these conversations with people to just keep that and I feel like for, you know, for our clients, for pregnant people, acceptance that whatever pelvis shape you have, known or unknown, there are ways we can work and still create space and still optimize that so that you don't have to feel down and out before you've even had it if someone told you way back when you had some pelvic shape, and that you're now feeling a lot of like limiting beliefs around that, that we can let go of some of that and realize that there are still ways for us to work to optimize each experience around that.
Brittany,CCE,CD 23:45
Yeah, yeah, definitely. And it's interesting if you go down the rabbit hole of searching things about pelvic classification, which again, I would not suggest doing, because it is not considered to be a research based way to approach the pelvis at this point. But if you just happen to do that, you'll find all sorts of interesting information about things like how different body shapes can signal to someone like what pelvic shape they have, again, not based in any sort of, you know, research that is well done and applicable, but it's just sort of...
Maggie, RNC-OB 24:15
"Birthing hips."
Brittany,CCE,CD 24:17
Right, exactly where someone has narrow hips, like these ideas. And like you had mentioned, these are things that sometimes people grow up hearing about too. So it already has planted this seed of possible doubt or possible confidence in somebody's ability to give birth. And then, you know, like, let's, let's look at the flip side of it. If somebody has been told their whole life, you know, that they have birthing. And then they they're, they're like expecting to have this like smooth labor because they have birthing hips and then something gets complicated immediately. their confidence is going to plummet. They're going to feel like Well, what's happening, something's wrong with my body. And that's totally not true. You can't tell from the outside if someone has birthing hips and quite honestly, I like to remind people that Anyone who's carrying a baby has birthing hips, like we all got birthing. It doesn't, you know, there's not that you can't look at some of them outside and be like, Oh, yeah, that person's gonna have an easy time with their labor. And that person's gonna have a hard time totally doesn't totally not applicable.
Maggie, RNC-OB 25:16
Yes. Yeah. And it is. It's just it's pervasive in society. And we've focused so much on external bodies and what they look like and what that tells us about their abilities. And like, that plays through really strong for birthing people as they're hearing stories from their family and positive or negative kind of taking all that information in to try to kind of, like, dictate somehow how their birth experience will go.
Brittany,CCE,CD 25:40
Yeah, yeah. And this is totally a different topic that is, I think, relevant and worth its own podcast, but its own podcast episode. But this idea to that in pregnancy, all of a sudden, people can now just comment on your body. Like, that's crazy, right?
Maggie, RNC-OB 25:55
Don't get me started. Yes. Right. Right. Yes. Yes. And it's hard because it's so like, we've all done it, and obviously, I've trained myself not to do it now. But it is so part of our assumptions about what is going on. And it really flows right through that. Yeah. So and then so the other piece you touched on, so that one piece and I feel like for everyone listening, like that piece about this optimal fetal position is related to the pelvis it in great, so you do not have to worry about trying to help your clients get into one set position. And the other piece you touched on was close knee, open knee pushing our belief around pushing and what ideal position there is for that.
Brittany,CCE,CD 26:38
Yeah. So I'm constantly having my mind blown when I'm at birth, and we're like, we're doing all this movement, and we have a provider that's totally supportive of it. And then it comes to pushing, and the providers like pull those legs apart and make space for the baby. And I'm like "oh my gosh," like immediately, I just feel like, oh, like everything, all of my excitement about how supportive and knowledgeable this provider was, has just gone out the window, because now we're at this point where providers like, okay, they're defaulting to whatever they've they've learned in their training, which provided the clinical providers don't they don't learn biomechanics, pelvic biomechanics, I mean, it should be a part of all obstetrical midwifery training, because it's just to me seems so obvious. Like, if we're going to be supporting someone and trying to get a baby out of their pelvis, why not learn everything about how the bones of the pelvis move, but really, I mean that that information is rooted in like physiotherapy and kinesiology. So when we can take our this information from these different disciplines and utilize it and obstetrics and midwifery, it's really powerful. But I've been at so many births, where providers say pull the knees far apart, make space for the baby. And as a doula, it's a challenging position because I am not a clinical provider, I can be asked to leave the room. And I feel like oh, like this is totally going against everything I talked to my client about. So when we pull the knees far apart, what winds up happening is that the femurs which are the thigh bones, they're connected at the hips, now the hips are in the lower third of the pelvis. And where the femurs connect to the pelvis, that's the true hips. When we rotate the thighs externally or pull them outward, we get pressure in at the hips, which causes the space at the bottom of the pelvis to decrease, sometimes by as little as a centimeter, but it could be significantly more than that could be possibly as much as maybe even three centimeters.
Maggie, RNC-OB 28:33
And every centimeter counts!
Brittany,CCE,CD 28:36
That's just as we say, another thing I like to remind people is that when you're pushing a baby out of your pelvis, every centimeter...so when we externally rotate the thighs pull them far apart like that, we get less space at the outlet of the pelvis. Internally, rotating the thighs, bringing the knees in closer than the hips actually creates more space because it pulls out on the hip. So you get an extra centimeter maybe even as much as three centimeters at the outlet of the pelvis. But pushing a baby out with the knees closed is so foreign to many providers, it goes against everything they've ever seen in birth, and it goes against the position for pushing a baby out that they're most comfortable with, which is somebody birthing on their back, somebody is birthing on their back, or even in a semi reclined position. Having the knees together means that the provider can't easily see what's going on. And that can be challenging for a provider because they're used to watching every step of the baby's crowning process. Side lying is a great option for having the knees together. But a provider has to be familiar or comfortable with moving to the back of the person to catch the baby. Which again, always amazed at how providers really need to be in the front of the like we can just move around to the back and we can catch the baby from behind. You know, midwives have always said throughout history "babies are born out the back" you know if somebody is pushing the baby out there in all fours and the providers bye by catching my baby, we can, we can utilize that same concept by having somebody birth on their side, knees together provider catches the baby from behind. But it's just so different than what they're familiar with that there's often a lot of reluctance. And again, I want to put out there, there are so many providers that are that are open to new things, and that are recognizing that there's always more to learn. And I've been at birth, where I think in my year as a doula there, I think it may have been even the first time that providers have caught a baby from behind. But it's so awesome when they see it happen. I know then that it's like, oh, this is possible. And hopefully, they're going to bring that into future births. So there are providers out there that are constantly willing to try new things and learn new techniques and recognize that there are limitations to to conventional obstetrical midwifery training. But there are also a lot of providers that surprised me and how willing they appear to be supportive of position changing and things like understanding biomechanics. And then when it comes down to it, it kind of default to a lot of things they've just been doing for years.
Maggie, RNC-OB 31:05
Yeah, and I think that I mean, obviously, that we've talked about, and we continue to talk about, like, there are just there are limits and how much you can learn in any any training program, formal or otherwise. So, you know, even for midwives and doctors, nurses, you've gone to school for years to learn how to do this, you still are only, you're still only able to get so much knowledge and ingrain it into your practice in that amount of time. And things do change. You know, so even if the best way, best practice, when you learn with something, it's going to change and acceptance of that. And realizing that doesn't make you a bad provider, you don't have to feel guilty about every other birth that you didn't do it this new best way. Because I feel like for me, certainly, I feel like I was like, I don't know, a year late to like the close knee pushing. Like somehow it just, it missed me. I don't know, I had my own baby and somehow, like when it kind of became like this whole everyone's doing it. I was like, how long have we been doing this for? Just like, I just I missed it, you know? And so I remember being like, "Oh, this makes complete sense." I remember the first time that I sat there and felt my sitz bones and moved my legs. And so for those listening, if you try to figure out like what are they talking about, if you sit there you put your hands on the bottom of your pelvis, there's your sitz bones, you move your knees in and out, you'll feel like oh my gosh, I just opened my knees, which looks good, better. You think that'd be better, but shoot now sits bones are out of my fingers. They're way inside? Oh, I move my knees and oh, they've actually created more space there. So the first time I ever did that least I was like, Well, of course. And that makes complete sense. But so much of it, like you said is that like control peace and the our desire to have full understanding of the experience. And so for us on the outside, not in the birthing person's body, being able to see with our eyes, that baby is coming down further the baby's crowning fields confirming to us Yes, as an outside observer that yes, things are going the way they should. That doesn't actually matter, us knowing that the baby is getting closer to crowning, doesn't actually change what the baby's doing, but it feels like it and so I think that's one thing to definitely let go of. And doing that. It's like knowing "Okay, we're gonna do some closed knee" pushing for several contractions, we're gonna push a while like that. I don't need to check each time, I can trust that we are effectively pushing that baby is wiggling just the way that they need to. And then we'll try another position in a few contractions and see how that's going keep doing that and not feeling like we need to have that like ownership of the movement process to monitor and track how it's going at each step. And I thought that was like a big thing for me to kind of like shift my understanding my role in supporting pushing.
Brittany,CCE,CD 33:38
Yeah, I love that you said that. And I think what you said about for a provider, it's confirming to them to be able to see what's happening. I think that is very much what's happening like when I when and I haven't been able to put words to that and you just did for me. So I appreciate that. Because I've I've been in rooms where we're we're doing close knee pushing and like, based on what I know about observing someone birthing, it looks to me like it's working like they're they're feeling their contractions strong enough, possibly even with an epidural that they don't need guidance to know when to push. Maybe we've been doing that close me pushing her asymmetrical knees, like leading up to that point. And maybe there's been an exam at some point that verified Yeah, the baby came down a centimeter or so, in my head. I'm like, "Yes, this is working." And then when a provider feels like, okay, we need to be able to see what's going on. I It always feels to me like, oh, like now we're going to open this person's knees like that. But I think what you said is really spot on. Like for the provider. That's not necessarily they haven't necessarily just observed a birth, like they haven't just watched things shift in a person leaving because they're in and out of the room. They're not there consistently the entire time. So I think there it is, like this sense of confirmation that comes from watching the baby descending, like literally seeing the head coming closer. And I think it's a huge testament to the body that we are able to push babies out in positions where we narrow the space in the pelvis. That's amazing, but yeah, I think that's really interesting. I think that Yeah, I totally agree with that people get confirmation from watching the baby descend as opposed to just being like, yeah, we're going to trust that knowing that close knees actually opens the outlet, we're going to trust that the baby is coming. But sometimes that's not enough, when that's not what you're used to. Yeah, yeah.
Maggie, RNC-OB 35:17
So permission for everyone has been wanting to know that you can just let that go. You cannot observe each moment and things will still happen. You have it! It's hard. And I think so much again, it just comes back to how we've been trained and indoctrinated to think about our role as birth professionals as providers during the birthing process.
Brittany,CCE,CD 35:36
So I was gonna say to add to that, too, it's not only coming from providers, but when the average person is getting most of their information about birth from the movies, it's what we see in the movies.
Maggie, RNC-OB 35:46
Yes.
Brittany,CCE,CD 35:47
And so that's going to impact the way that the individual person thinks people should push baby that when I teach classes, one of the questions I ask is, what is the most common birthing position when no one tells you what position to get into? And sometimes people are like squatting all fours, which is what anthropological research tells us, but a lot of times, people are like, on your back. And it's like, well, that's really common when people are told to get on their back. But yeah, actually, let's talk about what position you pass about moving on in Do you pass a bowel movement lying on your back? Yes. If not, then you probably wouldn't throw the baby on your back, either in less than one told you to get into that position.
Maggie, RNC-OB 36:24
Yes. I mean, that's always helpful imagery, just for people to think about, like, what are you actually trying to do now? Okay, so So now, let's like think through it, because I think it is it is, it is an all of the media we consume. There is so much about how in TV and movies, how we depict the whole from your water breaking. And mere moments later, you're there pushing the baby. Like, I mean, there's so much anxiety and stress, we give people about a birth experience. It doesn't have to be there. But I do believe that the very first time I was helping someone to do closed knee pushing when I was still fresh, doing it. And I so maybe I didn't have like my lingo and technique down for it. And I was just unable to like, communicate effectively how to do it, because they just felt like no, like, like, I pull my knees back. And like I do like this. And I was like, Yeah, okay, yes, yes, yes. But it was like very hard to walk through it. Because we were both unlearning this feeling about like, what does it mean, to open your pelvis? It that does not mean to open your knees. But we see that and it is it's reinforced and like everything we've seen, and so trying to help them get into that position was I mean, we were laughing because it was funny, as I'm trying to like wonder like this? No, like, actually, your knees are together. Now the exact opposite of what we're doing now. No, just we couldn't seem to like make it happen. But I think that is it's just because it's again, it's like these biases we get about the way things have always been done, that make it hard for us to like, step through and into a different way of being. But yeah, yeah, the news is we can do it, we can eventually see things model things. And I think it's really helpful. Now I know you have resources, and there are like great videos of people doing closed knee pushing on YouTube. And it's all over the place now so that you can kind of walk through and see it and visualize that and even then show it to clients so that they can have a sense of like, this could be a comfortable way for you to help get baby outside while you're pushing. That, you know, helps you to kind of like back that up and start giving our brain new imagery to like, think about and make connections with.
Brittany,CCE,CD 38:12
Yeah, yeah, it's funny. Like I'm like totally in this birth bubble, where like, I'm surrounded by birth professionals and people that are like, constantly wanting to learn more and, and I'm like, yeah, closed knee pushing is all the rage. And then I go to a birth and I'm like, Oh, my gosh, the providers know about me. And I realize like, oh, wow, like I it's so it's so normal to me, that when I want to do I end up in a situation where it's not being supported, which is actually quite common when I'm attending births. I always feel like Oh, man, like there. I was thinking that everybody knew about it.
Maggie, RNC-OB 38:46
Yes. Yeah, I think it's still working its way, I think it's still trickling it is trickled. But it's continuing to trickle out and get there more so that there's more like, understanding about it. So I appreciate all like the work that you and so many other like educators do about, like getting this out into the mainstream and posting on social media and everything so that we can just start to see it because, and the pandemic has messed up too, because we're not having the same kind of conferences and meetings that you know, we once were, we're not seeing each other in the same ways to like, have more natural conversations about stuff. And so it's helpful just to continue to blast it out there in the world.
Brittany,CCE,CD 39:17
Yeah. And for expectant families, like pregnant people. I think that the prenatal education component is so important. Like if the first time you're going to practice a pushing position with close knees is when you're in labor, there are going to be so many other forces at play that if like people enter into this phase, I know you know this, like this phase in labor, where they're just so singularly focused on pushing their baby out that if someone tells them to do something, they're just going to do it because it's way easier to just do what someone's telling you in focus on pushing your baby out than it is to be like, "Wait a second, that's going against what I know, let me process that." You just don't have enough ability to divide that energy into two different things like baby eating something with a provider and you know, pushing your baby. So if we get familiar, if we create some muscle memory in pregnancy for these positions, they'll be easier to utilize in labor. If we practice the language, whether as the birthing person or a support person, the language that we're going to use to help advocate for that if we practice that language in pregnancy, that's going to make it more kind of easy to do those things. And then also remembering that this is instinctive like, this isn't. This isn't me saying like, no, this is how we should tell people to know like, this is instinctive stuff. I've been at so many births, where people instinctively pull their knees together. And then the provider says, Oh, no, no, you're fighting it pull the legs apart? No, they're they're pulling them together. Because they're like, again, going back to a bowel movement. If you're passing a bowel movement, you don't do it with your knees hiked all the way out to the side, your knees come together, or maybe there's a little asymmetry, you know, and you're just like, oh, and that's what people are doing instinctively. But those instincts are kind of overrun by then what providers are telling you. Yeah, so I think getting familiar with it, preparing to advocate for it in pregnancy, maybe even talking with providers ahead of time. And if it's feasible, finding a provider that is familiar with different ways of managing labor, or "managing labor" that don't, you know, increased risk to the parent, and increased risk of long term pelvic floor damage, which are all things that we see with those wide leg pushing positions. Yeah, so I think prenatal education is key. And I, you know, I mean, obviously, I'm a huge fan of doula support, and a huge fan of childbirth education classes, but like you said, you can go on YouTube and for free, you can find out this, I can't, I don't necessarily think that that replaces a great birth class or replaces doula support in any way. But there, there should not be a financial limit to your ability to learn these things and practice these things. Because there are so many good free resources out there and social media definitely has changed our ability to see birth happen. And it is one extreme to the other. We have like the regular media, like movies and TV shows showing birth. And then we have like, raw birth footage that's coming up in our newsfeed and Instagram, which, you know, I don't necessarily I think maybe we should have something in between where there's a little context for some of that raw footage. Otherwise, that can be a bit jarring to people that might not be ready for it but there is the ability to find a lot of information out there that is free of charge. And and yeah, how do you feel like you're ready to advocate and be actively involved in your birth? And again, like that's with or without pain, medication movement close me pushing all of that as possible with or without epidurals.
Maggie, RNC-OB 42:38
Yeah, yeah, I feel like as we wrap up, if you want to just kind of speak to that a little bit more, because I do feel like when we when we were talking, before we started recording, like that piece of you know, whenever when epidurals became very popular for pain relief during labor, in the hospital, as like hospital based birth pros, we kind of felt like check, like the epidural is taking care of pain. So we don't have to worry about, you know, like you spoke to earlier about kind of like the movement piece of being a pain reliever. But we also then kind of just like radio silence on why did movement matter? in labor? Why have people always moved, you know, through labor for millennia? So if you want to kind of like close this out with that piece of it in terms of like, how are we looking at movement as just a crucial part of any labor? not dependent on pain medication?
Brittany,CCE,CD 43:30
Yeah, definitely. So I think we typically associate movement with comfort, which then we associate with unmedicated birth, because if somebody has an epidural, they're probably pretty comfortable. I mean, statistically, they're far more likely to be fairly comfortable than not with an epidural. And so there is this idea of like, okay, that labor is being managed, we can just focus on the other things that we have to do. But movement is, of course about comfort, but movement is also about labor progress, when we're shifting that space, and the contractions are rotating and pushing the baby down. And this is even before we get to the pushing phase of labor, the uterus is still tightening around the baby and pushing the baby down a little bit. When we incorporate movement. During that process of dilation. We're helping the baby to find those changes of space, which help the baby to continue to descend and rotate, which decreases the likelihood of babies getting "stuck in the pelvis," and decrease the likelihood of things like the terrible term failure to progress in labor, which is being phased out and replaced by labour arrest, which I also think is just as bad. Anyway, so we can decrease the interventions that come with a baby possibly getting again, like "stuck" or labor stalling out, can help with labor progress. All the research that we have on movement in labor shows that it can help labor to progress. Also, though, I think, you know, we have to remember that movement also aids oxygenation of the baby, the more we keep the laboring person moving, the more the umbilical cord moves freely. I think a lot of times we incorporate movement, if there is a concern about the baby's heart rate now it's like let's get this person moving, why not move preventatively to keep things shifting. So I think that's a big part of it. So not only comfort, but also labor progress and oxygenation of the baby. And one thing that I love to point out that I think is really important when we're including movement in labor, is that it helps support people to be involved in the process, which leads to better feelings of satisfied satisfaction with the birth for both the person giving birth and their support person. So if we give support people a specific role, like, let's ensure that you're helping them to change position, every couple contractions, or your role is going to be rocking this peanut ball between their legs so that we keep shifting that space in the pelvis, partners or other support, people are now more involved. They're more invested in the birth process, which helps the laboring person to feel better cared for better supported throughout the process, and helps the person that's providing support from feeling disconnected from the process. So if we're talking about emotional well, being in labor and birth, I think movement is a part of that too, because it helps support people feel like they have a role in helping the process to move along. So I like maybe I'll just share my 543 guideline?
Maggie, RNC-OB 46:16
Oh, absolutely. I'm a big fan of the 543 rule!
Brittany,CCE,CD 46:20
I in teaching birth classes for like, almost 15 years. I have found that the beginning when I was teaching, actually, for several years into teaching, I'd be going over all these different positions, and some are for epidurals, and some are for unmedicated births and like all these positions, and even for the support person that is like really wanting to be involved, there is this glazed look in their eyes, because it's like, oh my gosh, how am I gonna remember
Maggie, RNC-OB 46:43
Information overload?
Brittany,CCE,CD 46:44
Absolutely, information overload. So after like years of teaching things, that way, I finally realized like, Oh, I should make this easier for the people that are providing support. So I developed this really super simple rule, I call it the Blossoming Bellies 5-4-3 rule. And so that's the just the name of my business. The 5-4-3 rule basically, is this: change position, every five contractions, choose one of four basic positions and the basic positions that I use are standing, seated, all fours and reclined. So any one of those or any combination of those, and change up space in the pelvis in three different ways. And the three different ways are how you move your thighs, whether like we talked about internal or external thigh rotation, how you're doing movement in the lower back the sacrum, so whether we're rounding or arching the lower back, and then creating asymmetry doing something on one side of the body and not on the other. And so the 543 rule, change position, every five contractions, choose one of four basic positions, change them up in three different ways, helps you to come up with different labor positions, and helps you to remember to move throughout labor without necessarily having to remember a million different positions. And I also like to emphasize that although we do talk specifically, like in my trainings, and in my classes about positions that are great for different points in labor, depending on where the baby is, movement is more important than anything else. So if you're like, I can't remember what opens the top versus what opens the bottom. That's okay. Because if you just remember to incorporate changes in position and movement frequently, that's going to be more important for keeping things moving, because by default, you're going to find a position that's working. And for those couple of contractions, it's going to really help to create some progress.
Maggie, RNC-OB 48:28
Yes, I do. I love that rule. And like you said, I think it's such a helpful, just like paradigm shift from "Okay, I need to know exactly, you're in this position. And you're how many centers dilated the baby was in what Okay," and then you're trying to think through all these things, which, even for really experienced labor support people who do this professionally, that's, that's a lot to like, think through and remember, and like the heat of, you know, the moment and especially for the birthing person, or you know, their family member, support person, it gets to be too much. And so I think that, again, like the freedom of knowing that like, right, focus on movement, I think the 5-4-3 role is super helpful for just having like, I think it's really, it's specific enough to let everyone know, like for support person who likes to have a job, it's good for them to know that like in five contractions, I'm going to do something different, great. And that's really helpful for us too. It's helpful for me, you know, as a as a labor and birth nurse, when I am taking care of multiple people, it can be helpful for me to get guidelines, like I'm going to come back at this time, and we're going to change this way. If for some reason I'm not back then you can still feel free to go and do that and at any point to even sooner, but like just giving us a little bit more of a framework to work within. That doesn't feel like you're just spieling at someone as you're trying to kind of like help them so yeah, so I do I love that and I love just that focus on movement. I feel like it gets back to that the beginning of conversation about like that the optimal piece of it that like right, we're just trying to help this baby. We're creating space. We're letting the baby move within wherever they are, and find their their way down and try to try to manage everything obsessively, like many of us are want to do.
Brittany,CCE,CD 49:55
Yeah. Yeah.
Maggie, RNC-OB 49:58
Thank you so much for being here. And hearing all of this with us. It's so good. Is there anything else you'd like to share with our audience before see anything like coming down the pipe? Like we're reminded, like, where can they find you? workshop training coming up?
Brittany,CCE,CD 50:10
Yeah, sure, absolutely. So twice a year in Philadelphia, I teach a creating space workshop. It's a full eight hour workshop full day eight hour workshop for birth professionals, it has contact hours approved by acnm. So for people who are nurse midwives, nurses, they can get continuing education that's coming up in April, I always have it in the spring of the fall. This year, I'm doing both an in person workshop, which is limited in capacity because of COVID. But then also a virtual workshops are two different dates. So we have a virtual or we also have it in person. And then I also have a whole bunch of webinars, if you're just interested in like, kind of checking things out in this kind of a more condensed way. I have different webinars that are just an hour long. They focus on different topics of pelvic dynamics, you can find those on the website, some of things coming up that are live, like we're on a webinar on peanut balls for labor progress, coming up in May, so that'll be cool. But then I also have a bunch of recorded things on the website that are all available. The webinars are 15 bucks each, and a lot of them have contact hours approved by ICEA. Yeah, that's awesome. Find info there too. Yeah. And then social media is a great place to find me and my ridiculous reels that I make. I do like a lot of the the reels that I do on Instagram and stuff, I do focus on pelvic dynamics. So you get little 15 second snippets of ways to like potentially make labor a little bit easier, or a little bit more, you know, conducive to dissent and rotation. So that's always a good place to find information that's up at blossoming bellies birth, little snippets of information there that can piece together.
Maggie, RNC-OB 51:38
Yes, your social media game is strong. I always love seeing your posts. And I can speak to, I got the chance to take the Creating Space workshop last year, I guess, like early, early pandemic times. And I got to the virtual options, so I can attest to it was excellent. Even I know sometimes you will get weirded out about doing kind of these like active movement kind of classes virtually. And Brittany does a great job of really like bringing it in. So I definitely appreciate that. And if you're listening to this in real time, we are also going to be giving away a slot in the virtual workshop that's coming up. So we are coordinating that with Brittany. So if you're listening to it, this week that we're airing it then we will have like information for you all to enter that if you want to just like dive deep into this, we're going to do the virtual one so that our audience all over the place has a chance to share in Brittany's wisdom there. So we're really excited about that. Thank you so much, Britney, and thank you for being here and just sharing all of yourself with us.
Brittany,CCE,CD 52:26
Absolutely. It's so fun to talk about this. Like I said before we started recording, like I could talk for like 10 hours. Like, are we gonna be able to get it all in?
Maggie, RNC-OB 52:34
I would listen for 10 hours as well. But for our audience who maybe has lives outside of this, but we'll let them go here. [laughter]
Brittany,CCE,CD 52:41
Yeah, so this is awesome.
Maggie, RNC-OB 52:46
Thanks for tuning in. We love to learn and grow alongside with you. Please follow us at Your BIRTH Partners across social media. And in particular, we'd love to invite you to join us in our Facebook group, Your BIRTH Partners Community. There we have a chance to talk a bit more about the topics retweets podcast, and work through some of the difficult parts of applying these concepts and change your practices out in the real world as we all work together for more collaborative, inclusive and equitable care. That's also where you'll find more information about Brittany's upcoming creating spaces workshop and the giveaway we're doing for it. We'd also like to remind you about our show notes which can be found on our website, yourbirthpartners.org. There we'll share more resources some suggested readings from Brittany and suggestions for how you can incorporate pelvic dynamics awareness into your practice. Till next time!