EBB 196 – Pelvic Biomechanics and Movement in Labor with Brittany Sharpe McCollum

 

• Read the EBB Signature Article on the Evidence on Birthing Positions at https://evidencebasedbirth.com/birthingpositions
• Visit Brittany Sharpe McCollum’s website here: www.blossomingbelliesbirth.com
• Sign up for Brittany’s upcoming Fetal Positioning workshops here
• You can also buy “Baby Got VBAC: An Inspiring Collection of Wisdom for Better Births After a Cesarean” here
• For parents, sign up for Brittany’s free webinar “Practical Pushing: Efficiency and Well-Being in Labor’s Second Stage”
• Follow Brittany on Instagram @blossomingbelliesbirth

Rebecca Dekker: 

Hi everyone. On today’s podcast, we’re going to talk with Brittany Sharpe McCollum about pelvic biomechanics and fetal positioning during labor. 

Rebecca Dekker: 

Welcome to the Evidence Based Birth® podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence – based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details. 

Hi everyone and welcome to today’s episode of the Evidence Based Birth® podcast. 

My name is Rebecca Dekker, pronouns, she/her, and I will be your host for today’s episode. We are so excited to welcome our guest, Brittany Sharpe McCollum. And if there are any content or trigger warnings that go along with this episode, we’ll post them in the Description or the show notes that go along with this episode.  

Brittany Sharpe McCollum, pronouns, she/her, is the owner of Blossoming Bellies Wholistic Birth Services based out of the Greater Philadelphia, Pennsylvania area, providing childbirth education classes, birth doula services and dynamic labor support, and pelvic biomechanics training workshops both for professionals and expected parents. 

Brittany has been offering birth work services since 2007 and continues to work towards change in the maternity care system in two ways. First, Brittany offers expected parents in-person and virtual group in self – paced childbirth education and doula support, guiding parents in developing the tools they need to be actively involved their care. Second, she shares her trainings on evidence based fetal positioning and pelvic dynamics and biomechanics through conference presentations, workshops, and webinars for health and birth professionals. Brittany is a sought-after speaker at many international childbirth conferences, including a standing-room only presentation at the Evidence Based Birth® Conference in 2019. In addition, Brittany facilitates private workshops virtually and in-person, as well as two annual trainings open to the larger birth community. 

Brittany is a contributing author to the book, Baby Got VBAC. She is a frequent contributor to panel discussions and events for the birth community. And she’s been a guest lecturer for several years at the University of Pennsylvania’s midwifery program. Brittany also developed and facilitated the online ICEA training for birth professionals on anatomy and reproductive structure. We are welcoming Brittany who lives in South Jersey with her partner and four children. Her website is blossomingbelliesbirth.com and she’s on Instagram @blossomingbelliesbirth. We are so thrilled that you’re here. Welcome, Brittany, to the Evidence Based Birth® podcast. 

Brittany Sharpe McCollum: 

Thank you so much. It is totally an honor to be here and talking with you today. Thank you. 

Rebecca Dekker: 

It’s so wonderful to have you here, especially after we had such an amazing experience with you at the conference in 2019. Take us back to the beginning. How did you get started as a birth worker? 

Brittany Sharpe McCollum: 

Yeah. The conference was amazing also. It was a fantastic conference all around and it was a really great presentation to that day. Let’s see. How did I get started? My oldest is about to be 15 years old, and I think it was both my pregnancy and birth experience with him that really kind of set the stage for me diving into birth work. I guess I started on my journey into doing birth work a few months after he was born. My pregnancy with him that left me so fascinated with the body and the adjustments that the body makes and what the body is capable of. I also felt like there was a bit of a disconnect between everything I was learning in pregnancy and the expectations that my providers had for me in labor and birth. 

I did not necessarily get straight answers to questions, but I let it go. I didn’t recognize that as a red flag. And I came out of my birth feeling really kind of unsupported by my providers and feeling like they didn’t offer a whole lot. I felt like, “It shouldn’t be like this.” I was so excited in pregnancy for birth and so excited just to be kind of entering into this journey and had really high expectations for the providers that I chose, and then came out of it feeling like, “Ugh, wow, that was not what I thought it would be.” And that kind of sparked in me a passion to learn more about the birth process and the system that people give birth in. And the more I learned, the more fascinated I became with it and started to explore certifying as an educator and then certifying as a doula. By the time my son was a year old, I had started teaching childbirth classes and then also attending birth as a doula. 

Rebecca Dekker: 

Wow, so you’ve been in this work for more than a decade now. 

Brittany Sharpe McCollum: 

Yeah. 

Rebecca Dekker: 

Yeah, congratulations. 

Brittany Sharpe McCollum: 

That makes it sound really long. 

Rebecca Dekker: 

It’s quite an achievement actually. 

Brittany Sharpe McCollum: 

Thank you. 

Rebecca Dekker: 

When did you start realizing the importance of pelvic biomechanics and fetal positioning and labor? Was there a moment in your career when you realized that this was a big deal and this was affecting a lot of births? 

Brittany Sharpe McCollum: 

Absolutely. Yes. It wasn’t right away. It was a few years in that I started kind of putting a lot of things together and realizing that here I am working with primarily first-time parents as a doula and seeing people whose labors had stalled out or who were winding up having cesarean births because their babies got “stuck” in the pelvis. And it didn’t sit right with me, because I felt like here we are with low risk pregnancy, a healthy birthing person, and a situation that winds up leading to major abdominal surgery. And so, I started diving a little bit more into the movement side of labor and birth. We always kind of think of movement as comfort. We move to stay comfortable during labor, but there’s so much more to movement than just comfort. And I started exploring resources that were not related to birth, resources that were instead related to kinesiology and anthropology resources and physical therapy resources, and realizing that there was this huge missing piece of the puzzle in the way that we were approaching births. 

There was movement looked at for comfort, but not necessarily understanding how the bones of the pelvis move to create space for the baby as the baby descends and rotates. It was a few years into my birth work that I started exploring all these other resources. And then, let’s see, I had my second son, I guess, about six years into doing birth work. And at that point, I knew I would be scaling back a little bit on attending birth as a doula. So, I started to put together all of the information that I had accumulated through these different resources into somewhat of a workshop format. 

And when my second son was about six weeks old, I taught a workshop on utilizing movement in labor and birth to help prevent stalls in the process. And it started out as a two-hour workshop and it has just grown tremendously and is now a two-day workshop that I facilitate. And the more I learn, I mean, I’m always learning more about movement and birth and movement in birth and dynamics, and it feels like this missing piece, because it’s not something that a lot of providers are utilizing and it’s not something that’s really a part of most doula training. I feel like it’s this really important piece of the puzzle that is often overlooked. 

Rebecca Dekker: 

Okay. Give our listeners a little bit of a primer. What is pelvic biomechanics and how does that relate to the baby’s position during labor? 

Brittany Sharpe McCollum: 

Yeah. Kind of a mouthful, pelvic biomechanics, pelvic dynamics, petal positioning. It’s a lot of stuff to wrap your head around so, I think, breaking it down really simply is the best place to start. When we’re talking about pelvic, obviously, we’re relating to the pelvis. Biomechanics really relates to the principles or laws that guide the outcomes of, in this case, movement with the pelvis. And so, when we’re thinking about biomechanics of the pelvis, for example, we might say, “Well, when we externally rotate the thigh,” that applies pressure in at the hips, and the biomechanical outcome would be decreased space at the pelvic outlet. Dynamics of the pelvis refer to the movements, and biomechanics refers to the kind of outcome of those movements. 

Rebecca Dekker: 

If I could just interrupt briefly, what’s the difference between the pelvic inlet and pelvic outlet for parents who don’t understand that? 

Brittany Sharpe McCollum: 

Absolutely. The pelvis has three main spaces within it, and the inlet is the top area of the pelvis or the top plane of the pelvis, where the baby enters in. And then, we have the mid pelvis, which is midway through the pelvis. And then, we have the outlet, which is at the bottom of the pelvis where the baby comes out. These three sorts of planes of the pelvis require different movements in order to help create space depending on where the baby is. That’s kind of the fetal positioning and station part of it. The station refers to where the baby is in the pelvis. And the fetal position refers to how the baby is presenting through the pelvis. Is the back of the baby’s head along the right side of the person’s body? Is it along the left side of the person’s body? Is it towards the back? Is it towards the front? 

Depending on how a baby may be positioned and depending on where a baby is within those three planes of the pelvis, we have the opportunity to use specific positions to create space in order to help facilitate the baby’s rotation and to help facilitate space change where the baby is within those three planes of the pelvis. One thing that I like to remind people is that the pelvis doesn’t just open. When we’re attending birth, we hear providers say, “Open the pelvis.” The pelvis doesn’t just open all at once because it has these different areas and it responds differently to changes in pressure. When we open the top of the pelvis, the bottom, the outlet, actually closes. When we open the outlet or the bottom of the pelvis, the top closes. We have to kind of think how can we suggest or encourage specific positions in labor that will open that space where the baby needs it. 

Rebecca Dekker: 

Are you talking about like you would want to help open the top part of the pelvis at one point of labor and open the bottom part of the pelvis or the outlet at another point in labor, depending on where the baby is? 

Brittany Sharpe McCollum: 

Exactly. That was a much more succinct way of saying it. 

Rebecca Dekker: 

First of all, is there something intuitive? Because, I feel like, obviously, we have messed and tinkered with the process of birth so much that most people end up laying on their backs in bed with an epidural. The vast majority of people in the United States at least do. 

Brittany Sharpe McCollum: 

Yes. 

Rebecca Dekker: 

So, if we remove that and you’re having a physiologic birth and more of a setting that encourages natural behavior, do you find that most people move in the way that they need, or do they need to be encouraged? 

Brittany Sharpe McCollum: 

I love that question. I find that most people move as their body tells them to, and that’s exactly what they need for labor. This is such instinctive stuff. It’s just like you said, it’s kind of been blurred by this management of the laboring process that we have in this country, but also in other countries around the world. We’ve kind of lost sight of those instinctive things that people do to help facilitate the process. I love to tell people like, “This is not rocket science. This is really basic stuff.” And you actually, in a physiologic birth, which we can define that too, what you’re doing when you’re moving is helping the baby to descend and rotate. The idea though also is that we want to be able to take those instinctive movements that people do during labor and birth without medication, and then replicate that or modify it if necessary, so that people who have epidurals and labor can still get those great benefits of movement and position changes. 

One of the greatest myths out there in regards to labor and birth is the idea that if you have an epidural, you can’t move. That cannot be further from the truth. With epidurals, there are so many different positions and even movements within positions that can be done. We want to take those instinctive movements that people do without pain medication, and then apply them and modify if necessary for use with people who have epidurals too, so that they can get those great benefits also. 

Rebecca Dekker: 

Okay. Can I give you a few scenarios and you tell me what you would do? 

Brittany Sharpe McCollum: 

Yeah. 

Rebecca Dekker: 

Okay. I know you didn’t prep for this, but I feel like you can handle it. 

Brittany Sharpe McCollum: 

All right, I like it. 

Rebecca Dekker: 

All right. Say, you’re having a long induction and you’re very early in the process. Maybe you’re only a couple centimeters dilated. They’ve been doing cervical ripening. You’ve been having a lot of discomfort so you get an epidural. You’re not in active labor yet. What should you be thinking about in terms of movement of the pelvis and the biomechanics of the pelvis and the baby’s position? 

Brittany Sharpe McCollum: 

Yeah, great question. First and foremost, movement is more important than any specific position. I know we’re talking about specific positions, but I always want to tell people, “If you forget the specific things to do at which point in labor, just remember to move.” My guideline, actually, in my classes, I teach this Blossoming Bellies 5/4/3 Rule, which basically says change position every five contractions no matter where you are in labor. Whether you’re at the very beginning or the very end, somewhere in the middle, every five contractions, we should be trying a new position. The thing is that when I tell people that, they’re like, “Well, that sounds exhausting.” But in early labor, your contractions are farther apart, so you might be moving every 30 minutes, 45 minutes, something like that. In active labor, of course, you’re moving more frequently. 

The other parts of that kind of rule are the four basic positions that we’re going to use. That’s the four in that rule. They’re going to be standing, seated, all fours, and reclined. If in the scenario you gave someone has an epidural, then standing positions are kind of out of the question at that point, but we have seated positions. We have all fours that can be done on the bed, and we have side-lying or reclined positions that can also be done on the bed. And then, we change them up in three basic ways. That’s the three from that rule. And those basic ways that we create or change space in the pelvis is how we rotate our thighs. Actually, the rotation of our thighs affect space in the pelvis. How we tilt our sacrum or iliac bones, so basically, doing pelvic tilts, rounding or arching the lower back. 

And so, the third part of that rule is asymmetry, doing something on only one side of the body, rather than doing it on both sides at the same time. What I would say in that scenario is change position really frequently. And let’s say, the baby is at the inlet of the pelvis, which is what we were talking about before, the top of the pelvis… 

Rebecca Dekker: 

They’re kind of high up still. 

Brittany Sharpe McCollum: 

Exactly. Yeah. Then, what we would want to focus on is having wide knees so that would be external thigh rotation, and incorporating some pelvic tilts or some rounded back positions to help pull the top of the sacrum out of the way, and remembering to change position often. We might take a seated position that is maybe like a butterfly position, the soles of the feet together, the thighs externally rotated. Sitting like that through five contractions with the epidural in the bed, and then maybe side-lying with a peanut ball between the thighs for five contractions. We have external thigh rotation, and we have asymmetry, because it’s happening on only the top thigh, that opening of the top thigh. So, remembering to move frequently is important. Remembering if the baby is high up at the inlet, that we’re using wide knees and we’re trying to incorporate some rounded lower back, and we’re incorporating that asymmetry into those positions as well. 

Rebecca Dekker: 

Okay. High baby, wide knees. And the 5/4/3 rule you said, so every five contractions, you said the four different types of positions you can try. And then, what was the third thing again? 

Brittany Sharpe McCollum: 

The three ways that we change space within those positions. 

Rebecca Dekker: 

Okay. 

Brittany Sharpe McCollum: 

The thigh rotation, the pelvic tilts, and the asymmetry. And the reason that I like to use that rule is because it’s important to emphasize that it doesn’t have to be big, drastic, dramatic movements. Because if we’re thinking, especially as a first time parent, maybe we have a longer labor in front of us, we don’t want to be exhausted by the time we get to the pushing part of labor. So if we just think, “Well, if I just rotate my thighs differently,” or “If I just lift one leg up rather than lifting with legs up, now I’ve created asymmetry.” These little subtle changes that we can do with the space in the pelvis make a really big difference for giving the baby the ability to wiggle down and out. It doesn’t have to be climbing the stairs for five hours straight. It can be side-lying on one side and then side-lying on the other side. Hiking the leg up towards the chest and stretching at the bottom leg, and then switching it up. It doesn’t have to be really exhaustive positions and movement that seems really dramatic. 

Rebecca Dekker: 

I think it’s really important because, I was thinking, especially for people who have inductions, which happen in about 40% of births in the U.S. at least, that sometimes people think like, “I don’t need my doula there in the beginning,” or the nurse might think, “Well, they don’t need a lot of attention right now because they’re still in very early labor.” But, it seems like it would be really important to have labor support of some kind during those early hours of an induction when you’re kind of “stuck” in bed, that it would be super critical that somebody’s actually helping you replicate early labor process, say, somebody having a home birth would instinctively be able to do. 

Brittany Sharpe McCollum: 

Absolutely. Absolutely. And as a doula, that might mean phone support or in-person, especially some doulas kind of come and go early on in labor. But if you have that, I always like to say that prenatal education, where you’ve talked with people like, “If this induction is going to occur, here are the different things that you want to do.” As a doula, I love to set up a time to check in with people if I’m not there with them yet in labor. They might be laboring, we give them kind of a plan to do for the next hour or two. “Here are the different positions to try, remember to move frequently.” “Let’s check in at two o’clock and see how things are going and come up with a new plan,” so that they don’t feel that they’re not getting support or that they don’t feel lost through what they’re experiencing, but instead they have a plan of position changes and some comfort techniques to them through that next hour or two hours. 

Rebecca Dekker: 

Okay. 

Brittany Sharpe McCollum: 

But yeah, you’re absolutely right. That support early on is crucial, just as much as it is later on as well, because we still have a baby trying to navigate their way into the top of the pelvis, which is just as important as the baby navigating their way through the middle and the bottom of the pelvis. 

Rebecca Dekker: 

Okay. Moving on further into the labor process, you’re getting into active labor. What are some tips you have for families in that part of the labor process? 

Brittany Sharpe McCollum: 

Yeah. One thing that I love to emphasize is that in my opinion, it’s less about active labor and more about where is the baby, if we’re talking about in relation to positioning. Because, for some people, their baby might be midway through the pelvis in active labor, but other people’s babies might still be at the inlet. We want to think about where the baby is in the pelvis. Whether that means someone is gathering that information from internal exams, or maybe they are just paying attention to the sensations that they’re feeling. I love to think, “Okay, where might the baby be at this point? And let’s use that to figure out what positions we’re going to suggest next.” But when it comes to active labor, I think one thing that’s really important for people to pay attention to is whether they’re starting to feel some rectal pressure or not, because rectal pressure is a great indicator that the baby is starting to move down a little bit more. 

Depending on the length that someone is feeling rectal pressure for, maybe it’s time to start thinking about opening that mid pelvis. Paying attention to the sensations that someone’s feeling is really important. Paying attention again to that frequency of movement. If we’re thinking let’s still change position every five contractions, that’s awesome because we don’t have to worry about time. We’re just paying attention to the contractions. Let’s try something new after five. I think also in an unmedicated birth, getting up and using the bathroom frequently is great. It encourages a lot of movement. It encourages position changes, and then also just getting all of that urine out of the way helps to give the baby a bit more space too. 

I want to emphasize that, especially in an unmedicated birth, the movements, like you had said earlier, that people are doing are instinctive. Tap into that, don’t be afraid to move, listen to what the body’s telling you to do. Even if it seems weird, even if it seems like not what you’ve seen in the movies, it’s okay. One position that’s a favorite of mine is in all fours position with one leg hiked up, either out to the side, maybe resting on a yoga block, or maybe kind of a lunge while you’re in all fours. That’s not a position we get into on a daily basis. If you do that for the first time in labor, it’s like, “This is pretty weird,” but practicing that ahead of time and then utilizing things like that, being willing to try them out in labor is important. 

I also tell people that a support person’s role, whether the person laboring is with or without an epidural, the support person is involved in movement by reminding them to change position frequently, by offering a new suggestion, so that the person giving birth doesn’t have to use that thinking brain and can just follow these simple guidelines. Sometimes, people get stuck in one position and it feels daunting to move, so having a little bit of encouragement can be helpful. 

Rebecca Dekker: 

Yeah, I love those suggestions. I know being on all fours, resting my head on a birth ball was my favorite position, because it felt good on my back and I could rest my head completely during the contraction or wave. And then, with a partner’s role, one thing we teach in the EBB Childbirth class is that the partner, a big part of their role is to help with facilitating the movement changes. And one thing that we did, my partner and I, Dan, he would check with me right after contraction and be like, “Okay, after the next one, do you want to change positions?” We’d kind of plan it out almost one contraction ahead. A break between contractions where he’d ask me if I want to change and “Well, what do you want to do next?” And we’d make it through the next contraction and then we’d immediately change so that we could discuss it in one break and then implement it in the next break, and that kind of worked well for us. Planning it out. 

Brittany Sharpe McCollum: 

I love that. Absolutely. And then, it’s not too jarring. It’s not too much like, “Oh wow, I have to move right now.” It’s like, “Okay, I’m going to enjoy this next one. Enjoy this next contraction, and then I know that it’s time to move.” I love that idea. 

Rebecca Dekker: 

Yeah, and now we’re going to go to the bathroom or we’re going to do something different. 

Brittany Sharpe McCollum: 

Yes. One thing too, you had mentioned that all fours position that you really liked, I find that with my clients, they tend to really love that position also. That can totally be done with an epidural on the bed or it could be done obviously in an unmedicated birth. And one thing that I love to tell people with that position is incorporate movement into that position. Rock your hip side to side, do some kind of circles with your hips, lean forward, lean back, do some pelvic tilts, so that not only do we wind up in a position that is helping to open up space towards the middle and the bottom of the pelvis, possibly at the top, depending on how the thighs are, but also we are actually moving within that position too, and then it’s kind of wiggling the baby down and out. 

Rebecca Dekker: 

Yeah, I love it. What about later on as you’re getting closer, when you’re feeling a lot of pressure at the bottom, you can tell baby’s head is putting more pressure? What kinds of positions are beneficial for that part of the birthing process? 

Brittany Sharpe McCollum: 

Yeah. If somebody’s feeling rectal pressure through their whole contraction, also in between contractions but not yet feeling the urge to push, I’m thinking the baby’s at the lower portion of the mid pelvis. I would be really focusing on encouraging a lot of asymmetrical positions that help to open up that at space midway through the pelvis. If the person is experiencing this constant rectal pressure with an overwhelming urge to bear down, then we’re going to start thinking about opening the outlet with positions, like bringing the knees closer together, which I know is not what we see in the movies and often in real life, so we can come back to that. Positions like knees closer together, arching the lower back, so that we’re actually creating that space at the outlet of the pelvis. 

If we don’t have that information from internal exams about where the baby is in the pelvis, then we really rely a lot on what people are feeling to determine how low the baby might be. To kind of go back to what I said in before, when there’s that rectal pressure during the contraction and also in between but not an urge to bear down just yet, an overwhelming urge to bear down, the baby’s nice and low but we’re not quite ready to be pushing yet. That’s the point where we think about asymmetrical positions, which could be a lunge or it could be a staggered leg position. It could be a position where someone’s on their side with that one leg stretched out on the bottom and then the other leg pulled up towards their chest. Peanut balls are really awesome to support side-lying positions, especially asymmetrical side-lying positions. 

Rebecca Dekker: 

Okay. Asymmetrical basically means one leg is doing something different than the other leg. 

Brittany Sharpe McCollum: 

Absolutely. Yeah. 

Rebecca Dekker: 

Okay. 

Brittany Sharpe McCollum: 

And both to the side, but then also out to the front too. We want to think not only about lifting one leg out to the side, but also thinking like a runner’s lunge. Staggering front to back also because that’s going to change space between the pubic bones and the sacrum, front to back in the pelvis. 

Rebecca Dekker: 

Can you talk about the importance of minimizing interventions when they’re not necessary in birth and how that helps with the pelvic biomechanics? 

Brittany Sharpe McCollum: 

Absolutely. Yeah. Sure. We kind of think about physiological birth as the gold standard, and earlier I said we would define that so we should define that, I guess. The physiological birth is pretty much the process when it’s not messed with. It’s the process when it happens spontaneously and when it continues to unfold without management or intervention. And the research does support that process, that physiological process, as being healthiest for the baby and the parent. Now, this doesn’t mean that sometimes complications don’t occur. That can absolutely happen. The idea is that even if complications occur, we can still take things one step at a time to adhere as closely as possible to that physiological process. And incorporating movement, especially with a clear understanding as to what movements are optimal at what point, then we are really helping to support that physiological process with benefit, without risk. And that’s the thing. 

When we intervene in the birth process, there’s always risk and benefit, and we weigh out those risks and benefits. And sometimes, even though there are risks, it’s beneficial to move forward with that intervention. But when we are applying interventions routinely, particularly to a low-risk healthy birthing population, we wind up in a situation where quite often those risks outweigh those benefits. And when we incorporate movement, that’s a really fantastic intervention that only has benefit and not risk. When we have the opportunity to intervene in a way that is only beneficial, there’s no reason not to do it. It’s kind of mind blowing to me that movement isn’t something that is routine in all births, because there is clear benefit and research has shown no harm in movement through labor too. 

Rebecca Dekker: 

Yeah, I wish we could have a conversation with real-life birth workers and nurses right now because I’d be really curious. We don’t have really recent research from the past couple of years on movement in labor and birth. I know the last major study in 2013, the Listening to Mothers study still found that a lot of people are not moving around once they get to the hospital. And now, we have the popularity of peanut balls has grown and we have other programs like spinning babies and other things, where I feel like nurses are getting more education on the importance of movement. But, I’m really curious. I would love to know what you think most births where you live, in Pennsylvania, do they have enough movement, or do you think people are mostly just stuck in bed and not really moving that much? 

Brittany Sharpe McCollum: 

That’s a great question. I think it depends so much on the individual support that people have. Not only from people like doulas, like professional nonclinical support, but it really depends quite honestly on the nurse that they have. And in our area, I live in South Jersey but we’re 15 minutes from Philadelphia. I attend a lot of birth in Philadelphia, as well as in South Jersey. And we are so lucky to have some really fantastic, incredible nurses. And those nurses tend to be either well versed in positioning, or really open to maybe exchanging information with doulas and incorporating movement even if they’re not well versed in it. But, every now and then, I do run into a situation where someone, a clinical provider, is very reluctant to incorporate movement. Quite often, they talk about liability, like this person could fall if they’re doing that. Research really doesn’t show that people are falling in labor. 

And then, the thing is too even when someone has an epidural, we think epidural means no mobility, and that’s not the case. Epidural means very little sensation, but you do still have that ability to support yourself, for example, in a position where you’re in all fours. And so, especially with somebody on either side, just providing like a gentle hand or just being present, we have that ability to change position in the bed even with an epidural. 

And I do think, in my experience doing this work from more than a decade, like you said, which does make it sound like a while, I have seen a huge change. When I first started doing this work, there was no discussion of movement, but now I do think that there’s much greater awareness about the benefits of it and how to incorporate it. I would love to see even more, and I would love to see understanding of the pelvic dynamics aspect of it too. Because, I think when we not only incorporate movement but we also incorporate positions that are specifically based on where the baby is in the pelvis, we have such a fantastic opportunity to just kind of keep things progressing and decrease the risk of things like labor dystocia, or labor arrest, and failure to progress, that terrible term. Yeah, so movement, I think it’s become a lot more “popular” in birth, but I think we still have a ways to go to. 

Rebecca Dekker: 

All right. Is there anything else you want to teach us about while we have you with us? 

Brittany Sharpe McCollum: 

Oh my goodness, I think it is important to recognize that the prenatal education component of it is so important. It’s very challenging someone to be in labor and learn new information, learn new things about how they should be moving. If we are able to reach people prenatally, expecting parents prenatally, about the benefits of movement and the ability to move, even with pain medication, I think we have an opportunity then to help people feel more empowered in their births and more empowered in speaking up about what they want to do. If they have an understanding as to how the bones of their pelvis move, if they have even watched a short Instagram video or something about movement, then they might be more confident in bringing that into their birth and saying, “This is something that I want to do.” 

I think it really does start with parent wanting to incorporate that, and then providers recognizing that, “Oh, this is something that the client wants so we need to be well versed in this also.” For parents, yeah, I think boosting your confidence by understanding your bodies a little bit more and being willing to understand more about movement both in medicated and unmedicated births can be a real game changer. 

Rebecca Dekker: 

Yeah, and that just goes back to the importance of education when you’re pregnant like you said, because most parents get their information about birth from the movies, which you already pointed out don’t have a very positive picture of movement. It’s on your back with your feet in stirrups, and knees wide apart, which you said is not necessarily beneficial for the pushing phase. And practicing the position seems like it would be important to you. Not just maybe watching videos, but actually trying them out so that it’s not brand new when you’re in labor. 

Brittany Sharpe McCollum: 

Yes, absolutely. I always tell people I’m not a person that believes that you need to train for birth. I really do feel like your body has that innate knowledge of how to give birth, but we have these big thinking brains that get in the way all the time. And if you’ve never been in the all fours lunge position and you try it for the first time in labor, your thinking brain is going to say, “Whoa, this is not something that we’re familiar with. We need to get out of this position.” But if you’ve practiced these positions in pregnancy, you’ve created a little bit of memory there, and now you’re thinking brain in labor is going to be like, “Oh yeah, we did this before. This is okay.” 

And one of the goals in labor is to really decrease that activity in the thinking brain, because it can overpower the primal brain and decrease the release of hormones and stall labor out. If we practice those positions ahead of time, create a little muscle memory, create a little memory in our thinking brain, then we’re in a position where we can really utilize that even more effectively in labor and birth. 

Rebecca Dekker: 

Yeah, and I think that a lot of our knowledge about how to cope with labor and how to move in labor was lost over the past 80 years with the onset of Twilight sleep and being confined to the bed during the labor process and things that we might have a hundred years ago watched our moms and aunts and grandmas and other family members do during birth like we’ve never seen before. There is a little bit of a learning curve because we’re trying to catch back up to where we used to be.  

Brittany Sharpe McCollum: 

Absolutely. And there’s this idea that like, “Oh, what is my body doing? This is weird. This isn’t right. This isn’t what I’ve seen in the movies. I shouldn’t be doing this.” But if we were watching people give birth, if we were seeing our mother give birth, if we were seeing aunts give birth, then we start to see all these different positions and movements that people instinctively do, and then we’d be more comfortable with that in our own births. I think if we, just like what you’re saying, if we change the imagery that surrounds birth in this culture, we have a real opportunity to change the way that people approach their experiences. And again, it has nothing to do with whether somebody chooses pain medication or not because you can change position when you have an epidural, but it has so much to do with how actively involved we think we should be during labor, and there’s active involvement whether somebody has an epidural or doesn’t. 

Rebecca Dekker: 

Are there any projects coming up that you want us to know about? 

Brittany Sharpe McCollum: 

Yeah, sure. I have some workshops coming up for birth professionals that you had mentioned in the intro, these workshops that I do for the general community. I teach one kind of very basic pelvic dynamics and fetal positioning workshop called Creating Space, and I do that both virtually and in-person in the Philadelphia area. We have that coming up, and then I am so excited about this new workshop that I started. I taught it for the first time last June and it’s coming up again in January. And it is Pelvic Shape, Fetal Positioning, and Obstetrical Bias. It’s really different. It incorporates a lot of movement because I love to do that, but it’s really a historiographical look at where obstetrics started in terms of deciding who was “better” at birthing. And then, it follows the pseudoscience that leads to pelvic shape classification and how that kind of affected this idea of optimal fetal positioning. And then, how we see this play out in obstetrical bias to this day. And then, we end the work- 

Rebecca Dekker: 

With racism? 

Brittany Sharpe McCollum: 

What was that? 

Rebecca Dekker: 

With racism? 

Brittany Sharpe McCollum: 

Yes, absolutely. Yes, with racism. We look at that throughout the historiographical look, we look at the racism that really started obstetrics and kind of infiltrated its way through every aspect of how people are viewed during labor and birth and how births are managed. And then, we end the workshop with a lot of discussion of posterior babies and supporting posterior babies through the process in a way that does not require intervention that brings risk. It’s really fun. It’s a totally different type of workshop than what I’ve ever taught before because it really is a look back at history. 

But I think in order to be able to best support people who have posterior babies, we have to recognize where a lot of that bias about posterior babies came from. We really go back to the mid 1800s or so and take a look at how things got started back then with the management of labor and birth. That’s coming up in January, and both that workshop and the Creating Space workshop have contact hours through ACNM. They’re an awesome opportunity for both clinical and non-clinical birth workers to get a little bit of extra information. And I think both of those workshops can be real game changers in terms of how you approach birth moving forward. And also, there are scholarships available for both of those workshops for BIPOC birth workers. Just to throw that out there too. 

Rebecca Dekker: 

Awesome. People can learn more at your website then? 

Brittany Sharpe McCollum: 

Yeah, yeah. My website, I update really frequently. There’s information there. There’s a section for parents and then there’s also a section for birth workers. Yeah, and so all the information about those workshops and the scholarships and all that are on the website. 

Rebecca Dekker: 

That’s super exciting. Thank you for sharing. People can go to blossomingbelliesbirth.com. And also, follow you @blossomingbelliesbirth. Thank you so much, Brittany, for coming on the podcast. Are there any final words you have for us? 

Brittany Sharpe McCollum: 

I just think that people should definitely come out of their births feeling like they did something really awesome. And I think incorporating movement and an understanding of the body is a great way to do that. It’s not about how someone gives birth or even whether things go according to plan, but it’s very much about how they feel about giving birth. And when we incorporate movement and encourage movement, we restore a lot of that autonomy back to the person who’s birthing and give them an opportunity to come out of their birth feeling like they did something really awesome throughout the process. Yeah, thank you so much for having me. This has been awesome. 

Rebecca Dekker: 

Yeah, thank you, Brittany. 

Brittany Sharpe McCollum: 

You’re welcome. 

Rebecca Dekker: 

This podcast episode was brought to you by the Evidence Based Birth® Childbirth class. This is Rebecca speaking. When I walked into the hospital to have my first baby, I had no idea what I was getting myself into. Since then, I’ve met countless parents who felt that they too were unprepared for the birth process and navigating the healthcare system. The next time I had a baby, I learned that in order to have the most during birth possible, I needed to learn the evidence on childbirth practices. We are now offering the Evidence Based Birth® Childbirth class totally online. In your class, you will work with an instructor who will skillfully mentor you and your partner in evidence-based care, comfort measures, and advocacy, so that you can both embrace your birth and parenting experiences with courage and confidence. Get empowered with an interactive online childbirth class you and your partner will love. Visit evidencebasedbirth.com/childbirthclass to find your class now.