Biomechanics for Birth - A Labour of Love

A few weeks ago I was asked about the difference between my course and “Spinning Babies”. The short answer is - “the biomechanics are the same” - how can it be otherwise? Biomechanics is science and has an objective foundation. My course springs from over 20 years practice as a midwife and sets the insights it offers in the context of the constraints midwives encounter daily in the NHS today. The longer answer is “a bit more complicated - to find out more, read on!

I started writing this blog because recently a few people have asked me how my Biomechanics course differs from Spinning Babies, but realised almost immediately I couldn't really answer the question. Partly that's because I don't know what Spinning Babies teaches today. I constanty update my material as new evidence and thinking emerges, and I'm sure Gail Tully does the same. Inevitably the two courses have common elements, and I first learned about some of the positions I teach from Gail, but Spinning Babies was one of many experiences and insights that led to the creation of Biomechanics for Birth, and I thought a much better question was "Who the heck is this Molly O'Brien to be trotting round the globe talking to midwives about biomechanics and what does she teach?".

selection of books from Molly's libraryMy course has evolved through my practice, as both a clinical midwife and as a teacher, and examines a range of issues confronting midwives caring for women in labour. It's driven by a career long passion (some would say obsession) with "supporting and preserving normal birth".

It's no secret my background is a little "unusual", and one of the many serendipitous effects of my lifestyle at the time was that, even before I trained, I probably had more exposure to births outside a hospital environment than the number of home births some midwives attend in their entire career (that may be the subject of another blog one day!). These experiences meant that even as a student midwife my own perspective on birth had a strong focus on what is now called “undisturbed physiological birth” and it has never wavered.

"Biomechanics for Birth" is rooted in 20 years of clinical practice including 8 years supporting hundreds of women having undisturbed births in a Midwife Led Birth Unit. It's genesis was teaching student midwives as a UEA Associate Lecturer and being told that no one else was even discussing the ground I covered. I’ve participated in many courses and learning exercises, including Jean Sutton’s ‘Optimal Foetal Positioning’ back in my newly qualified days, Spinning Babies, Rebozo, self guided study about biomechanics, extensive study of physiological birth, the biochemistry of birth, it’s psychology, the debate surrounding evidence based practice and guidelines and the full impacts of overzealous interventions. That’s just a small sample - my library thrills me and I have a great passion to share my experience and knowledge.

A key element of the course is encouraging practitioners to re-evaluate perceptions of birth. Integrating biomechanical solutions wholeheartedly requires a change in how the birth process is seen. The course challenges dominant views on women’s capacity to give birth unaided. I don’t believe learning about biomechanics in isolation will improve women’s birth experiences unless midwives are able to challenge the status quo.  The essence of the course is “Biomechanics for Birth”, but it’s context is the political agenda of the maternity and childbirth arena.

The course focuses strongly on diagnostic techniques for suboptimal positions, that are, as far as I know, my own. Working in an environment where I could support the woman so birth could unfold physiologically helped me develop methodologies to recognise potential problems with position even in early labour. Asking the right questions combined with a deeper understanding of anatomy and physiology has proved to be a far more accurate tool to understanding what is making birth more prolonged and painful than those most of us were given in training. Identifying and piecing together signs of a suboptimal position requires a change in perceptions of birth from “birth is normal in retrospect” to trust and belief in birth as a normal physiological function.

It goes without saying that biomechanics, in depth discussion of the anatomy and physiology of the pelvis including nutation and counternutation of the sacrum, positions that make more space in the pelvis, use of rebozo and strategies that support physiological birth all feature. There’s also a focus on research and evidence related to the positions we use and participants are encouraged to record at least three case studies of births that have included use of the techniques taught in the course. These will be used in an advanced course currently under development and will help build a useful anecdotal picture of how biomechanical techniques can influence the course of labour.