Open-Knee-Chest: “Start Over!”

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Photo by Crystal Garcia Photography

Does baby seem stuck just inside the top of the pelvis? (Nurses would call this -2 Station)

Would you like to help the labor start over and go smoother? The Open-Knee-Chest helps back the baby out of the pelvic brim and start again in a better position.

  • In pregnancy? Open-Knee-Chest is only for breech babies.
  • In labor? Open-Knee-Chest is for babies not coming into the pelvis flexed and in good position.
  • Do not get into this position for any time when baby is still floating (-4 or -3 Station).

Sometimes a posterior or asynclitic baby is jammed in the brim of the pelvis stalling progress.  Penny Simkin, physical therapist, childbirth educator and doula, teaches us the Open-Knee-Chest correctly.

Penny asks, “Wouldn’t it be nice to back the baby up and start over?”

What is the Open-Knee-Chest position for Labor?

The Open-Knee-Chest position is a maternal position. It is not about making the knees wide apart.

Open-Knee-Chest opens the angle of the symphysis away from the spine, making the front-to-back entrance to the pelvis larger. Lovely. Contractions can then rotate the baby in that extra space. Labor contractions keep the baby head down.

 

When to do an Open-Knee-Chest

Open-Knee-Chest can be used in…

  1. In Pregnancy: to help reposition a breech-presenting baby, and in
  2. In Labor: to help reposition a head down baby whose head is inadvertently locked in the brim or midpelvis.

In pregnancy, this position was used to help breeches flip to become head down. It worked fairly well. See details below.

In labor, it’s used with contractions that are strong and rather close. The birthing mother is working hard and it seems that the baby just can’t rotate and can’t descend.

The indications may be:

  • Back labor without progress
  • Strong contractions without progress, even without back labor
  • Pain in the pelvic girdle (it could be hip pain or one-sided pain) in labor
  • No pain, but no progress either, yet there are regular contractions. They may be strong but they aren’t getting stronger and closer together.
  • A known posterior or asynclitic position without progress
  • Baby stuck in the brim, the pelvic inlet
  • Baby stuck at the ischial spines, the mid-pelvis.

 

When not to do an Open-Knee-Chest

  • Don’t do Open-Knee-Chest when the head down baby is NOT engaged and floating!
  • Don’t do this or any other inversions for women at risk of stroke, who have high blood pressure which warrants medical supervision.

 

How to do the Open-Knee-Chest position

There is a level of commitment to make this technique work. The birthing woman should be told that this is an effective position, but requires she be in this position for about 40 minutes (though it may be effective in less time, we can’t assume it will). Open-Knee chest allows the spaces between the contractions to let the baby back up about 1 centimeter and let’s the contractions have a chance to rotate the baby to a better position. This is why the mother is in this position through and between contractions.

 

Open Knee Chest by Patience Salgado
Open-knee chest is not how wide open the knees are, but rather, that the knees are far from the spine, opening the pelvic inlet. 

 

How to do the Open-Knee Chest

  1. Start with knee chest position. Mother’s chest is on the floor. Her face is on the floor (or a cloth covering the floor).
  2. Now move the chest and shoulders forward. Way forward. The knees stay put. Slip a pillow under the chest (not the face). See how the thighs and spine make a letter “A”?
  3. The helper in the back holds a long cloth, like reigns, wrapped across the mother’s upper thighs. This cloth is not on her abdomen at all. The helper leans back to take the weight of the mother’s lower body off her chest during the Open-knee Chest.
  4. A helper at the front, if you have an extra person, with clean socks, sits so that the mother can put her shoulders up on their ankles. This is very comforting during this position.

The mother gets into the Open-Knee-Chest for 40 minutes during active labor. To make it easier, a helper can sit in front of the mother so she can brace her shoulders on the helpers ankles!

Knee chest- Open Knee Chest
www.SpinningBabies.com Knee Chest is for comfort. Open Knee Chest is to back the baby out of the pelvis about 1 cm to help baby rotate.

 

Some doulas and midwives suggest the Open-Knee-Chest for a stall in a labor. This position may be especially useful for:

  • A baby that is somewhat high,
  • Posterior, or
  • Asynclitic at the brim, or
  • Has a hand across the pelvis in a way that has significantly slowed labor.

Ask your care provider if there is any reason you wouldn’t want to be upside down in the inversion or Open-Knee-Chest, such as abundant amniotic fluid and a loose abdominal tone which could risk a baby flipping breech. Uterine contractions will help prevent such a flip, and help the baby rotate to a left occiput transverse (left occiput lateral for UK, Aus, and NZ readers) position. The baby can then tuck his or her chin (flex, flexion) and engage more easily.

 

The Open-Knee-Chest means mothers knees are away from her pubic bone. The “Open” doesn’t mean knees are far apart. They are hip width apart. “Open” means there is a wider distance from your spine to your pubic bone! The spine and thigh make a “letter A.”

You can use a Rebozo like “reins” around the mother’s THIGHS to support her weight while she rests in this position and lets the baby reposition. The Rebozo is NOT on the abdomen or the baby. It is wrapped on the thighs to hold some of mom’s weight.
Jennifer Walker Dana Luzon and Gail doing Open Knee Chest with hip shaking

Jennifer Walker Dana Luzon and Gail doing Open Knee Chest with hip shaking

Before doing an Open-Knee-Chest

Is baby engaged? Do engagement activities first. Balance before Gravity- do the Sidelying Release!

 

During an Open-Knee-Chest

To potentially reduce the time it may take to reposition baby, “Shake the Apple Tree,” a traditional technique from Central American midwives. The mother’s buttock are grasp and shaken mildly, in short “shivers” for a long time. Muscles are relaxed from this technique, named so by Midwives Ina May Gaskin.

 

After doing the Open-Knee Chest

Follow this challenging inversion by a shower, perhaps, bending the knees and leaning forward, resting the arms on the wall of the shower. Or, lean and rest your upper body on a dresser while your knees are slightly bent and you can sway your hips to relax your muscles.