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An ultrasound image. Photo by Liz Jones.

An ultrasound image. Photo by Liz Jones.


Traditions In Prenatal Care

Liz Jones

For a parent, one of the greatest moments in your life is probably the day your child is born. It can also be one of life's biggest medical events. Increasingly, childbirth now involves surgery to deliver the baby by Cesarean section. In the US, about one in every three births are Cesarean. The procedure is more expensive and can be riskier than a so–called natural delivery. But often, a Cesarean is necessary because the baby is breech, meaning it's not head down. Many mothers will try anything to get that baby in the right position. So will the staff at a clinic near Tacoma, where they've hit on an alternative method that's delivering remarkable results. KUOW's Liz Jones has our story.


About a dozen women and their children wait in the lobby at the Lakewood Family Medical Clinic, just south of Tacoma. Past the reception desk, nurse Kara McEvoy gives me a quick tour.

McEvoy: "This is the lab. All of the staff here is bilingual."

Lakewood is a private, nonprofit community clinic. Most patients here are Latino, and nearly all are on federal or state–funded health care.

We stop at Timothy Panzer's office. He's a family doctor here. He works with McEvoy and the other nurses to provide pre natal care to expectant moms. He says with a breech baby, the standard medical approach is to try something called a cephalic version.

Dr. Panzer: "Which is manually, in the hospital, at the labor and delivery floor, manually trying to turn the baby with the doctor's hands on the outside of the woman's belly."

Jones: "And I understand the versioning can be painful for the mother, is that right?"

Panzer: "Absolutely, yeah. It can be really uncomfortable."

That versioning process also comes with some medical risks and a hefty bill. If it doesn't work, a Cesarean, or C–Section, is typically scheduled.

And if a woman gets a Cesarean once, chances are she'll need one for subsequent births.

Panzer: "So especially in the case of a first mom, a first delivery, if you can get that breech baby to turn, you've done a lot to help that mom."

When some of the nurses heard about a gentler way to try to turn the baby, called sifting, McEvoy says they were eager to give it a shot.

McEvoy: "If a doctor said to me, oh, she's breech, I guess you have to get the C–section scheduled. And I say no, let's get the sifting appointment set up."

Picture sifting like someone polishing a bowling ball. You stand behind the woman and take a sheet or a shawl and wrap it around her belly, like a harness. Then you pull on the cloth to kind of rock her from side to side.

The exercise is designed to loosen the woman's body and re–position the baby.

Alma Pisano is the woman who introduced sifting here. She's part of the clinic's labor support staff. She explains it's a Latin American tradition that's still practiced in many cultures.

Pisano: "How did I learn to do this? Stories of my mother. Listening to stories of other women. Reading, seeing, seeing what works."

As Alma, Nurse McEvoy and I talk, another doctor pops her head in the room. She's got a patient who's asking for some technique with a shawl but they didn't know the name for it.

Voice: "Come on in..."

The patient, Nancy, is just five months pregnant. She's got back pain. Her mother, Marie–Elena, came with her to the appointment, and was actually the one who asked about sifting.

Spanish/Marie–Elena: "My grandmother was a midwife who helped women give birth. And when I was pregnant, she was the one who did all this to me."

Apparently, it's also a good way to relieve back pressure.

Alma directs Nancy to kneel down and lean her body over a rubber exercise ball.

Spanish/Alma: "What I want to do is put the shawl here in front of the baby, like a cradle. Is that OK with you?

Alma stands behind Nancy. She wraps the shawl low on her belly, then pulls it snug and starts sliding it side to side.

Spanish/Alma: "So with this, I'm going to move your hips like this, like a dance."

She says she's doing this to move her hips and her bones, like a dance.

Spanish/Alma: "Mom, now I'm going to show you. Here, Marie–Elena, come help me."

Now Alma shows Marie–Elena how to do the sifting on Nancy. This is key, since this is a two–person exercise. Alma says it's best to do the sifting a few times a day, along with other exercises to help the baby rotate.

Alma says out of her last nine breech patients, seven have turned. Granted, there's no scientific study on the effectiveness of sifting. But still, Alma's success rate so far is pretty good. Especially compared to the more painful versioning technique, which works about half the time on average.

Alma hopes mothers like Marie–Elena, who grew up with this tradition, can help keep it alive in the States.

Spanish/Alma: "I hope so, because this can help. But these are also the generational changes. That's why we're here, to keep the histories."

The clinic staff here is also doing its part to keep the tradition going, and weave it into their standard practice. At least they are now. But nurse McEvoy remembers that wasn't exactly the case a few years ago when a colleague, Dr. Yosha, first brought it up at a staff meeting.

McEvoy: "So here's Dr. Yosha, who's actually pretty new to the organization, who started talking about sifting. And I heard a couple chuckles. The other doctors were laughing a little bit. And he's like, hey, it works. All I gotta say is it works."

Now, McEvoy is a sifting convert. Although she's only sent a few breech patients to Alma, she says they've all come back with good news.

McEvoy: "Flipped! Head down! Cancel the C–Section!"

I'm Liz Jones, KUOW News.

© Copyright 2010, KUOW

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