Spontaneous Rotation of the baby’s shoulders

This midwife gets full marks for keeping her hands off the baby’s head and shoulders and allowing the rotation to happen. This is a great teaching video for how the baby naturally turns due to the piston effect of the thickened fundus. So many practitioners pull, twist, and crank on the poor baby’s head/shoulders at this point and it’s lovely to see someone with twitching fingers able to control the need to muck about with a baby.

Unfortunately the magical moment of birth is ruined by putting cloth between the mother and her newborn (skin to skin is IMPORTANT) and then, immediately calling for syntocinon (pitocin) to inject into the woman. The mother is distracted from her moment of connection with the baby and weakly attempts to decline the shot but they are “just” going to give her a “little” injection.

Leave your comments please.

25 thoughts on “Spontaneous Rotation of the baby’s shoulders

  1. That is beautiful to see such a nice hands-off birth. Mom looks pretty exhausted after the baby is placed on her chest. (Not that I’m an expert, my experience is in pediatrics.) How was the rest of her labor?

  2. Beautiful teaching/learning video! I love the hands off 🙂 Well done!

    In a small part of my heart I am still hoping that the synto was for a particular cause, as opposed to routine! And indeed boo on the sheets between Motherbaby, and what seems like a very early call to cut the cord.

    Still, I am glad to see the beautiful birth truly done by mama/baby themselves! Thank you for posting this!

  3. The other person asks her if she should give the Synto in the I.V. or intra muscularly. It’s routine if that’s the first thing they’re talking about in the minute after a baby is born. No time there to see if it’s warranted or not.

  4. Disappointing to not hear permission sought for the synt, or explanation (this could have been discussed previously for all that we know?), though despite the hands off (so poised and ready to grab though – and seems it was hard to keep them off at times!) the lack of skin to skin, vigorous rubbing and cleaning and bright lights took away from this strong woman’s experience. It looks like it had been a long hard journey, and I find that her face looks flat and her spirit seems low.

  5. After watching again, I can see what you mean about interrupting the moment. She is smiling and looking at her baby until they give the shot, then she closes her eyes and seems to disconnect. With my two births I found the same thing, painful procedures derailed bonding.

  6. It was lovely to see the mom give birth without anyone pulling on her baby! I just caught a baby this morning who was 10 pounds. I literally just caught the little guy as he sailed out into the water because I thought Dad was going to catch! It is amazing how little we need to do.

    Gloria, all that stimulation that they were giving to the baby was the beginning, she kept putting her hand up to touch her baby and then would drop it because the nurse was in the way. I also heard the nurse say that the shot was “for the placenta” which makes me wonder if they were being aggressive with her fundus and doing cord traction which would have also caused her to be detached because of the pain.

  7. I do appreciate that the midwife allowed baby to spiral out herself. I know that is a big leap and it feels really good to acknowledge that.

    BUT, the rest of it made my stomach drop. The constant toweling of the baby, the lack of skin to skin, the midwife talking and telling her she’s going to do pit. The mother looks exhausted most likely she is just experience a “coming back” to her body from Birth World and she needs peace, quiet, solitude with her new one and her husband. I have a vision that if all in the room where silent, respected the final moments after the birth as sacred, psychologically and physiologically, the need for any pit would be negated.

    Again, I am feeling the joy of the steps we are making and the hands off midwife should be embraced for doing good work. But the work is constant…always changing and moving in a direction of undisturbed birth.

  8. Nice to see the hands-off birth. I wonder if this woman freely chose her birthing position? I wonder if she chose her clothing. There is no skin-to-skin contact – I wonder if this was the woman’s true preference, or whether skin to skin was ever presented to her as option. After such an amazing birth, and while the woman was still overwhelmed, it is a pity there was no stillness or waiting for the family to ‘have’ their moment before moving immediately onto the next tasks on the checklist. Was she haemorrhaging, that they had to be giving synto, discussing the placenta, and talking about cutting the cord within seconds of birth? ….. or is that just usual practice at this hospital?

  9. Lovely! boo to the interventions that followed!

    I tried guiding my daughter while giving birth. It was a water birth and the Midwife along with her assistance nearly fell in the pool trying to reach for me. They were trying to “check for the cord” just as her head was emerging. I’ll tell you this much, my instincts kicked in and they were strong! I was was pulling AWAY from them!!! It was really incredible how my body just took over like that.

    I can really see the disconnect as soon as the personals got in the way. I wonder if the muckering can cause PPD & the more muckering the worse the PPD?!

    This is a great video to demonstrate a hands off delivery. There are too many stories of doctors yanking on the neck causing the spine to snap… and they’re taught to pull on the neck! That would change if empowered mothers would slap their hand away. Then again, America’s dark history revels a dirty secret in the delivery wards when they use to tie the mother’s hands to the bed to prevent them from (protecting their babies) slapping the doctor/midwife or nurse.

  10. Why is she on the drip? Why no skin to skin? Why is she in the position widely recognised as the worst to give birth?
    On the positive side: Hands off is great.

  11. Baby born at :47, Syntocinon IV mentioned at :59 and given IM at 1:23.
    Dad asked about cutting the cord only 25 seconds after the birth.
    Too much talking!
    Too much toweling: you can see the mom begin to smile and reach for baby at :51 but nurses hands are in the way. When the hands leave, she attempts to pull off the cloth at 1:01 but then the hands and the injection distract her. She attempts to reach AGAIN at 1:33 but the hands are in the way again, and she seems resigned to wait it out.

  12. This is a really great video showing being hands off, but all the other interventions (how little they might seem) are very distraction and uncalled for.

    Thank you for sharing it Gloria, great tool to use as a conversation starter too. Love it.

  13. Really neat to watch the hands not touch and wait. It is so awesome to see the body work. Too bad she had so many clothes on .

  14. I am this woman’s Independent Midwife – although I was not the attending midwife as my client needed to give birth in hospital and I am not allowed to give care. I was filming the birth.

    My client had lots of complications which I won’t discuss, but this was the reason for a hospital birth – she had previously had three lovely homebirths, two with me as midwife.

    The attending midwife was a soon-to-be qualified midwife and I think she did a pretty good job … the other voice was the supervising midwife.

    My client was shattered, she had been very unwell during the pregnancy and she had a long day …

    I will send the link to her to ask if she wants to comment further.

  15. Obviously a hospital birth, IV, gloves, gown. I would expect pitocin with a managed birth. Just because the pushing stage was hands off does not mean the birth wasn’t managed.

    To be honest, the mother seemed absolutely exhausted! What may seemed to see as interference, I saw as continuation. Baby appeared a bit floppy, the mother was obviously exhausted and not actively engaging her newborn. Baby doesn’t really pink and exert almost a minute after birth.

    If this is a managed birth, then transition for baby is a concern, and stimulation routine. But, they did do stim on the mother, they did make comment about the pitocin, she could have verbalized a refusal, and dad was right there, so he could have spoken up too.

    However, in hospital birthing, these are issues that should be spoken of before active labor, so maybe mom had consented prior to her birth….I don’t hear or see her trying to refuse. I just see exhaustion.

  16. Hello, this was my birth video – I am the mother and my baby, Robin, is now 3 months old. I enjoyed reading all your comments and seeing what you had to say and in retrospect I agree with pretty much everything you all said.

    I had a very difficult pregnancy which involved a lot of hospital admissions. Including pretty severe hydronephrosis on my kidney which caused terrible kidney infections. I also developed gestational diabetes which needed to be insulin controlled, polyhydroamnios and was on twice daily heparin injections for previous multiple bilateral pulmonary emboli. This was baby #7 for me, pregnancy #13 and my last two babies were on the larger side too (10lbs 2oz and 9lbs 7oz).

    Because I was in such a lot of pain I begged to be induced (maybe stupidly as I normally am all for natural labour and birth) and they agreed to a controlled ARM induction at 36 weeks. I was told at just gone 8am that I was being taken to maternity for my induction, but they didn’t actually break my waters until around 7pm as I recall. I spent all day dehydrating and starving and my sugar levels went low and I nearly had a hypo as a result.

    They told me I had to be hooked up to a syntocinon drip to give my uterus “tone” before they could do a controlled ARM in theatre because my baby was also pretty unstable and kept moving from cephalic to oblique to breech and back. So I had a drip in one hand for syntocinon and in the other hand I was told I had to have a sliding scale. Personally I don’t understand why this was as despite being told I was NBM a couple of the midwives insisted I eat pieces of toast and drink tea and I think this may have been why it took so long before they did the ARM as I was told the Dr who was dealing with me was very angry that I’d eaten as there was a chance I’d need a Csection.

    Once my waters were broken my labour was pretty easy. It was longer than expected (I normally have fairly short labours) and by the time he was born I was exhausted and dehydrated and starving. When they put him on me (an experience I hadn’t had in a long time as with my home births I delivered the baby into my own hands) all I remember thinking is “why do I have to take him, I’m tired, hungry and feel like I’m dying of thirst and now I have to hold the baby too?!”. It’s quite sad when I remember back on it in comparison to my other births.

    To answer some of the questions (from my perspective – I’m obviously not a medical professional);

    My labour was easy, routine (for me) and relatively pain-free. I required entonox for the last half hour or so as I was fighting the urge to push having been told I was only 3cm, but otherwise it wasn’t too bad.

    I was told I had to have the synto because I’d had so many babies and was at risk of PPH. I know this isn’t true but was too tired to argue and just wanted the whole thing over and done with so my kidney would stop playing up.

    I did feel very disconnected from my birth experience and my baby. Too many people touching me, no ability to move off the bed except to sit in a chair beside it (and even then they argued with me), no skin-to-skin contact and that God awful gown…

    I did not freely chose my birthing position or location. I wanted to be in water (my preferred birthing location) and at the time I realised he was descending and birth was imminent I tried to get off the bed so I could lean against the wall and squat but was unable to do this because the midwife in charge wouldn’t get out the way and there were so many machines attached to me. I found giving birth in this position very difficult and painful and I sustained a small tear (which didn’t require stitches) which I blame on my poor position.

    But aside from all that I actually was very happy with my birth experience. It was different, not the natural hands-off style I am used too, but it was an end to my difficult and pain-filled pregnancy and the beginning of my new life as a mother of 7. I felt my midwife, Valerie was possibly the one person I drew most support from although my Husband was wonderful too – Valerie kept me sane and stopped me from demanding what would have been an unnecessary Csection. The student midwife who caught my baby was fantastic too, very supportive and nice to talk too. She sat with us virtually the whole of the last part of my labour and didn’t leave the room at all. I can’t really comment on the other midwife as I saw very little of her and had nothing to do with her really – she only seemed to come in to put the syntocinon up and for the actual birth.

    I’m happy to answer questions and I don’t mind Valerie discussing my birth experience.

  17. I did love seeing the baby turn on its own! That was awesome. I do wish baby could have gone skin to skin. Even if the baby needed stimulation, etc. To be skin to skin could only have helped mom and baby.

    Good job mom and midwife!

  18. Sarah Jean, Thanks so much for filling us in on the background of this birth. You should be so proud of yourself for birthing under such adverse conditions. Your little son is lucky to have you. Gloria

  19. Am i missing something? It’s common practice to wait for restitution once head is out (UK). I’m shocked at the idea that one wouldn’t wait for baby to turn… Am i understanding that elsewhere in the world the baby gets pulled out before restituting?
    Sadly Syntometrine / Synto is pretty standard for active 3rd stage if ANY risk off PPH (which P7 would be classified as).

    • Yes, you’re missing one of the choice pieces of N. American obstetric insanity. The thinking is that you can avoid shoulder dystocia by pulling the shoulder out with the birth of the head. Of course, it results in a lot of errors in choosing the right direction of rotation. The baby is pulled on and twisted in N. America instead of the British way of slapping the hands of invasive attendants.

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