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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Asynclitic Heads

by Nancy Wainer Cohen

I have had the privilege of working with a number of wonderful midwives in the last years during my midwifery training. Among the many things that I have learned, I hear one of Valerie El Halta's sentences running through my head at births. Loosely paraphrased: " If there is no progress with good contractions, it is usually head position. Try a few things (repositioning the woman, walking steps, etc.) and see if they work. If not, be a midwife -- fix it!"

With every woman that I have been with this past year who has not progressed, I have - with the woman's awareness, permission and cooperation "gone in and fixed it." Some of the babies were posterior - others were transverse or asynclitic. It is important to adjust the head before the woman gets "stuck" - and squatting, while occasionally useful, can actually commit the baby to that "stuck" position. You do not wait, Valerie has told me (since most doctors don't think you can turn a baby's head until the woman is very well dilated - if in fact she ever gets there......) - You can adjust or turn the head at 3-4 cm, saving the woman a long and arduous labor. " What do you think suture lines and fontanelles are for?" she asks in her wonderful workshops: "They are God's directional signals for midwives!" Several of these women were women who had hired me not as a midwife, but as labor support. They were already in the hospital and were being "threatened" with pitocin and an epidural - or a cesarean - for that ole' stand-by -"failure to progress." In every ( every! ) situation - as soon as the head was adjusted, the labor took off, and the baby was born. The only situation that resulted in a cesarean was one of the hospital deliveries at which I was not permitted to examine the woman or adjust the head position. I pleaded with the midwife on call to make the adjustment - but she brusquely told me she had never heard of doing such a thing and that it would be too dangerous to try. (Cesareans are pretty dangerous and uncomfortable, too, you know.....) The woman herself is now sad that she did not have me assist with the adjustment at home, which I had suggested, before we left for the hospital - when it became apparent that things weren't going very far.....

Midwifery Today published the article by Valerie a while ago that presents very clear instructions on how to turn the baby's head. IT WORKS. She has taught me the difference between intervention and intercession. We also use visualization, relaxation, talking-to-the-baby, pulsatilla ( for assisting the turn) and gelsemium ( for lips and rings). At a hospital labor support birth this past week, when the doctor announced that it was time for the pit and epidural, to see if we could "get things rolling" - I spoke to my couple. I told them that they had hired me to assist them with a natural birth, and that I was absolutely convinced that they could do this - as long as the baby's head was lined up well. I told them that in other cultures there is no pitocin or epidurals - women do not have these as options - and yet they have their babies!! I told them that we are mammals - and that mammals have their babies. I told them that I had unwavering faith in a woman's body's ability to give birth. We adjusted the baby's head ( in private) and the baby was born soon after.

At a labor support birth this past week, the midwife who came on call had heard me speak at an MT conference in Oregon a few years ago. She was very warm and friendly, and told me that I could "do this birth" ( by the way, I do not "do" births - I attend them, or assist at them, or help to "receive" the baby with the parent's permission). I told her that it seemed necessary to adjust the head - she said "By all means please try! I have never done that!" Within a few minutes of the adjustment, the woman began to push and birthed her baby. It had been fifteen years since she had had a baby - the last birth had been a horror show with a "stuck" baby and a resulting forceps delivery - and she was 43 years old.

One last note. One of the women whom I attended had been at 7 centimeters for about four hours when I was called to her birth. Her cervix was swollen and not very giving. She had been told to pant and blow - not to push as it would further swell her cervix. The baby's head was asynclitic. I adjusted the head, and told her to push - much to the dismay of those around me. This did not come from new-midwife uppity-ness or arrogance - but from my intuition - " Just push, Kate - just push and lets see what happens." Within a few moments, she was fully dilated. In some situations, a cervix that has been at 7 for that long probably wants to "go" just as much as the mom wants it too! It just needed the baby's head more well applied to assist it in its final act of "disappearance"!