Make It or Break It

When I was pregnant with Glade, I knew that head down and breech could be checked for with hands.  I knew that those two were important.  My mom had a posterior baby (me) and I just thought that was something that happened.  Something that couldn’t be checked for, and either didn’t matter, or was just something certain people had to endure.

I didn’t know that you could check fluid level, baby’s position or weight, find where the heartbeat was and all that without an ultrasound.  I didn’t know that ultrasound wasn’t accurate at finding any of those.  Ultrasound was like a gift from God.

Then I met (let’s call her) Sandy.  The first homebirth midwife I have ever met in person.  When we went to the prenatal together (my first one), I had heard of palpation, but didn’t know what it told, or even why it was important.

She felt around for a few minutes, identifying parts of the baby, figuring out baby’s position, estimating weight/fluid, and then she knew exactly where she would find the heartbeat.

I was in awe.

This baby was posterior.  I knew what that was, but didn’t know it could be changed.  She had the mom sit differently throughout the next week, be a little more active, and we would see if the baby would turn around.

Amazingly, at our next appointment, baby was ROA! Right Occiput Anterior.  Baby’s spine (basically) was on the right side of mom’s belly button.  The best position for labor is either ROA or LOA.  Baby just glides down.

At that moment, I was hooked.

I was then so upset that more midwives and doctors didn’t do this.  What an amazing tool.  You take a few minutes, feel around, find out position, and go from there! No ultrasounds, no machines, and your hands do all the work.  Plus, who wouldn’t want to feel baby’s position??  I got to do it and I still think that was the coolest two minutes of my life.

This, has become the make or break point for providers for me.

First, how many cesareans would be cancelled for low fluid from a bad ultrasound reading?  Or a small birthweight baby?  Or bad positioning causing no descent and eventually a cesarean??  How many women would be spared an incision in their abdomen if a provider just figured out of baby was anterior?

Yes, it is fun to see baby in an ultrasound.  But have you ever heard an ultrasound tech tell you if your baby was anterior or posterior?  Have you ever had a really close guess to birthweight?  Have you ever been told exactly where the feet were or hands or butt of your baby without just guessing?

We don’t do it exactly like this, but it is close.  She feels for the baby’s spine first.  That is the best way to lead to the head or butt.  She then trails it down, hopefully to the pelvic bone area and can feel the neck, then the head from the fontanelles (soft spots).  We then to back, feel the butt, the legs, etc.  Then, because she knows exactly where everything is, finds the heartbeat first try.  Within seconds.

She can feel the amount of fluid and assess if anything feels off.  She can feel if it is a bigger baby or a smaller baby without checking fundal height (we don’t check that anyway).  She can help mom feel more informed as to where her baby is sitting and how to keep baby in a good position or how to get baby to flip to a good position.

I ask women all the time what position baby is in, and all I ever hear is head down or breech.  NEVER anything else.

Providers, this practice needs to come back.  Especially for midwives!  This is the most knowledgeable part of your arsenal.  It can tell you most everything you would need to know about how baby is doing.  And all you need is your hands!

Women, don’t settle for a midwife (even an OB) that doesn’t palpate your belly.  This is sooo important to having an easy delivery with minimal back labor.  Plus, you will know tons more about your baby and will know exactly what you are feeling if you ever want to palpate yourself.

If your provider doesn’t do this practice, talk to them about it.  See if they would.  If not, and if you don’t want to switch to someone that does, go to Spinning Babies website.  It will show you how to do a belly map, and figure out for yourself what position baby is in.  And then will help you with suggestions on how to get baby in the best position for a quick, easy delivery.

Be more active in your pregnancy.  Find someone that uses all the tools in their arsenal that aren’t electronic.  Find someone that knows which positions are best for delivery and are proactive with you in getting baby in that position.  Find someone that instead of just letting it ride if baby is head down, finds out if your labor will be easy, or you will have back labor throughout.

It isn’t hard, and truly will tell you more than an ultrasound will if you have one daily.

And if you can’t find a provider to do it, do it yourself.  You will save yourself tons of pain in labor by just finding out this one thing.

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4 Responses

  1. I always start with the heartbeat on the fetoscope: that tells me a lot about head down and which side the spine is on. It’s pretty easy from there!

  2. my last baby was lol, or lop… we knew that because MW checked every visit, I used the swiss ball, hands and knees etc but she didnt turn till I was in labour, I carried my first three lol too, and wonder if that has aggravated my hip problems… a good mw can find the heartbeat easily if she feels for where bubs is….

  3. Hmmmmmmmmmmmmmmmmmmmm… I wonder.

    As a prenatal/postpartum (and very possibly eventual labor) massage therapist, I wonder if palpation would be considered outside my scope of practice. Of course, I’d keep it primarily just as a teaching tool/point of knowledge, “Hey, here’s how you figure out how baby is positioned.” and not as a “medical assessment” tool since that definitely would be outside my scope. Hmm hmm hmm. Whatcha think?

    Also, as a side note, when I was my best friend’s doula several years back, the craptastic OB whose energy totally killed her labor came in to introduce himself when he came on shift and one of the few things he did was palpate her belly and estimate size and weight. I don’t remember how accurate he was because we were all just SOOOOOO put off by his attitude and energy.

    So that is 100% something to keep in mind for everyone learning/doing palpation; if you’re going to do it, be very aware of your energy and mannerisms. You’re asking to feel around an already personal (pre-pregnancy) part of the body that the woman has probably had dozens of strangers feeling and rubbing for the past several months in medical and social situations alike, and it can either be a moment to establish trust or distrust, depending on how you handle it. And if you’re off by a bit, you’re probably still more accurate than an ultrasound! That’s my two cents. 🙂

    • Great comment!! I completely agree. Palpation needs to be done with respect and consent. It is a very intimate thing you are doing and need to treat it as such.

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