The Forward-Leaning Inversion is a classic here at Spinning Babies. Create room in the lower uterus to allow or keep baby into the ideal position for birth. This technique comes from Dr. Carol Phillips, DC.
Why do a daily inversion?
Balance. We want room for baby to settle head-down in the uterus, and not only head-down, but crown-of-the-head-down (flexed) and on the left. The goal of repeating the Forward-Leaning Inversion every day is to release the utero-sacral ligament and give baby the extra room.
The lower part of the uterus can get a twist in it from poor posture habits, holding a child on one hip, or a sudden stop (i.e. an accident, fall, or sports). This effect may also occur among women who twist to do their work (massage therapists, nurses, chiropractors, etc.). A slight twist can reduce the room for the baby to have a good, flexed head-down position. The baby needs room in the lower uterine segment to get in an ideal, or optimal, fetal position (Optimal Foetal Position in the UK or Australia).
Give the utero-sacral and other ligaments a gentle stretch so they can release.
DON’T GET UPSIDE DOWN if you have high blood pressure, or suspect placental separation (from bleeding that is not from cervical dilation).
How To Do a Forward-Leaning Inversion
Gently! Don’t drop into place, move slow and be controlled to protect the placenta.
- Kneel on the edge of a couch (or the top of the stairs)
- Carefully lower yourself to your hands on the floor and then lower yourself to your forearms. Elbows out, hands close. Use a stool or step, if you like, to help you walk your hands down.
- Let your head hang freely. Your chin is tucked. Don’t rest your head on the floor. Your neck may need a little movement.
- Your knees are close to the edge, your bottom is highest. You can tilt or sway your hips, if you like.
- You can flatten your lower back (posterior pelvic tilt) to give more room to free your ligaments.
- Take 3 breaths. Belly loose, shoulders strong. Chin tucked and neck long.
- Come back up on your hands, then lift yourself up to a kneeling position again, using a stool or block or help from your helper.
Warnings, Contraindications, Guidance – PLEASE READ.
Gentle as you go:
Listen to your body and check out unusual symptoms with your physician before trying these exercises. Thousands of women are getting mild or dramatic benefits from the inversion, but there are risks. Here’s what we know at this time.
Round ligament pain happens occasionally with the inversion. Round ligament pain is not typical, nor health-threatening. Round ligament spasms can be resolved with the Webster, or self care or warmth, self-massage and deep breathing. It’s OK to repeat the inversion (for 30 seconds) even though this is happening. The inversions may resolve the spasm but the Webster is specific to resolving this type of spasm.
A pain that persists more than a few minutes or is severe deserves attention. Report abdominal pain to your provider, including shoulder pain. Let’s rule out a placental problem, as abdominal pain or shoulder pain might indicate. Understand the warning signs in pregnancy.
Don’t drop fast. One mother whose abdominal muscles were very separated dropped fast from a high bed and partially separated the placenta. She and the baby had to remain in the hospital until she gave birth several days later, mother and baby were healthy. Another woman with a history of placental issue of IUGR and high blood pressure in a previous pregnancy experienced separation and had an urgent cesarean.
- If your abdominal muscles have extreme separation you must be extremely careful, wear a pregnancy belt and go slow!
- Your shoulders are too weak or too tight to support you in an inversion. Roll your shoulders first. Don’t begin with a steep inversion. Start easy.
When not to do the Forward-Leaning Inversion:
- Right after eating (do it when you don’t have a chance for heartburn).
- If you have very high (or very, very low) blood pressure, or are otherwise at risk for a stroke (or fall).
- There is so much amniotic fluid around your baby that your doctor monitors you weekly (no data, being conservative here).
- In pregnancy if there is a suspected or known problem with the placenta, including pain of an undetermined origin. Get assessed immediately. Do not do an inversion if you have or unsure if you have pain due to placental separation.
- If the baby is having or has had frantic, vigorous movements. Have the baby assessed immediately. Don’t wait.
- The inversion causes pain (remember, your head may pound a bit for the first few times, that’s actually ok if mild), but abdominal pain other than round ligament stretching is not right. Severe headache must be evaluated by a physician immediately. (I don’t know of this ever happening, but let’s be aware that sudden headache needs physician evaluation.)
- In labor, if labor progress is normal.
- In labor, if there had been abundant fluid, AND the baby is high, -2 station, and the water has released with baby’s head high (in which case, open the pelvic brim with Walcher’s or a variation of Walcher’s).
- You don’t feel that this is right for you. (Always trust the mother’s intuition and respect her choice to do or do not.)
Be Safe Doing Inversions
- Ask for help the first few times you try this. Have someone help you move slow.
- If you are already in your third trimester, do a very mild (not steep) inversion a few days/times before a steep inversion.
- Your head may pound a bit for the first few times you try it. Your body is signaling your unusual position.
- Use a stable surface where you can carefully lean forward to rest your forearms below your knees.
- Be sure to get up and down gently, without dropping, thumping, tumbling -or twisting!
- Allow your head to hang freely, chin tucked, neck long.
Tell me if you have a concern
Of the hundreds of women doing this inversion, very probably thousands, there are understandably going to be some bad outcomes. I must be told about them.
Report complications of pain or immediate bleeding and describe the situation exactly, date, gestational age, health concerns, way of doing the inversion, whether it was a first time or had been done, and time of complication. It seems that going fast and/or having an unstable placental bed add risk! gail@ Spinning Babies .com
The Forward-Leaning Inversion is:
- A daily activity for a normal, healthy pregnancy (recommended up to 30 seconds).
- Ideal for babies still in a sideways position (transverse lie) after 30 or more weeks.
- Ideal for babies who are in an unstable lie after 32 weeks.
- Helpful before breech tilt in a series of activities for the baby who is head up (breech) after 30 weeks.
- Wonderful for all pregnant women with no contraindications.
- Wonderful in labor for a persistent lip or stall in labor at any point if no contraindications.
Where does Forward Leaning Inversion Originate?
Dr. Carol Phillips, D.C., developed the Forward Leaning Inversion after observing a birth. It’s useful for men and women alike, though it only works on the utero-sacral ligaments on people who have sacro-utero ligaments. Men get the benefits to the spine and pelvis, as well as the circulatory benefits of inversion.
See more at Dr. Carol Phillip’s website, www.dynamicbodybalancing.com
How often should one do a FLI?
Repeat the Forward-Leaning Inversion daily in pregnancy. Just 30 seconds is long enough! That’s about 3 breaths.
Inversion in Labor
You can do Forward Leaning Inversion in early labor as your daily inversion. But if labor stalls, doesn’t progress as expected, then add another Forward Leaning Inversion at that point. Particularly for tight or swollen cervix, asynclitism (add sidelying release), deep transverse arrest (add sidelying release), or in spite of a good position, baby won’t come down (add psoas release).
Forward Leaning Inversion for helping a Breech Baby turn head down
- If baby is breech, do the Forward-Leaning Inversion for 30 seconds and then do the Breech Tilt for 5-20 minutes. Or, follow with the Open Knee-Chest position. Do not do Breech Tilt or OKC with a head-down baby. When baby is breech, you may do the Forward-Leaning Inversion for 30 seconds each, several times a day, along with other techniques in Flip A Breech.
Alternative: Use an inversion table if you have access to one.
Why does FLI work?
Letting the uterus hang for 30 seconds from the uterine ligaments stretches cervical ligaments. Swinging back up relaxes the uterine ligaments and makes room in the lower uterine segment. So its the coming back up that releases a potential twist.
With repetition, the womb becomes more balanced (balance means without an additional tilt or twist).
The benefits are amazing for babies lying sideways (transverse lie) after 30 weeks. But all mothers with any fetal position will benefit, even the ideal left occiput anterior. This technique is recommended for everyone with special invitations to women with twins, breech, oblique (diagonal lie), and posterior babies.
With more room in the lower uterus, the baby may reposition without manipulation. Every healthy pregnant woman may benefit from 30 seconds of this steep inversion. Begin before pregnancy or in the first trimester…or now! Be careful, read the details to find out if you are one of those few who shouldn’t go upside down.
When baby’s position is not ideal, make room in the uterus and the baby will follow the space.
How to do an inversion, the video:
Emily and Ludvig learn to do an inversion. The movie is 1.5 minutes long. See more written details and perhaps see the same video load faster on the Spinning Babies Blog. Emily’s baby was in a transverse lie (lying sideways in the womb) days before labor. If labor were to begin with the baby lying sideways there would be no choice but a cesarean. She learned to do the Forward-Leaning Inversion and did it twice for this movie and then again in the morning.
Please don’t crawl down! I would now ask her to rise back up to the couch rather than crawl down to protect her SI joints in her pelvis. She got an ultrasound that day and the baby had gotten head down by then!
To do the FLI, the mother’s knees are at the edge putting her bottom way up in the air. She does not rest on her thighs. She rises back up to kneeling and doesn’t crawl down. This is best.
The weight of the baby gently pulls on the ligaments and gives a stretch to the cervical ligaments. When the mother swings back up to kneeling again the ligaments will relax a bit more and are less tense than before. Repeating this daily helps them relax back to a balanced tone (not too tight or too loose).
Relaxing the uterine ligaments helps the uterus be more balanced, meaning not pulled front or back or to either side. This balance helps the baby to get in a better position for birth- or helps the mother have more room or softness to birth a baby in a challenging position.
How not to do an inversion!
Do not crawl forward off the couch or bed one knee at a time. Instead, rise up and kneel on the top step, couch, or bed – or, slide both knees off together so you don’t twist your sacrum and pull open one SI joint. That might cause pain then or later! Protect your SI joints by keeping your knees at the same level (which is not to say apart or together, the knees should be hip width apart).
Do not rest your thighs on the chair or couch. The ligaments are not released to the same degree -if at all.
Down Dog may not accomplish the same release. While Down Dog yoga pose is a great pose and beneficial in many ways, the tension of the hamstrings may prevent the same release as the Forward-Leaning Inversion shown here. Also, in Down Dog, I wonder if the uterus rests on the symphysis pubis, preventing the same stretch that the Forward-Leaning Inversion allows in the cervical ligaments (posterior uterine ligaments).
The Forward-Leaning Inversion in labor
Do the FLI in labor when:
- Progress is slow.
- The cervix won’t open all the way (9 or 9.5 cm lip) or is 10 cm and baby isn’t descending though engaged in the pelvis.
- Back or hip pain that seems more than from contractions and is not matched by the pain in the uterus or other hip.
- In other words, something isn’t matching up, the labor pattern is not symmetrical.
- You are advised to by your care provider (Doctor, Nurse, Midwife) and you feel that it is safe for you to do so.
The Forward-Leaning Inversion can be used in labor even when baby is head down. Regular contractions keep baby’s head down, so the inversion can be held through an entire contraction and between them for 2-3 contractions. It’s better to repeat than stay there too long. Make sure the belly isn’t leaning against the bed. Let the abdomen hang free. Don’t bother with the FLI when labor is progressing, but try it when labor is stalled.
In the hospital, you can easily do the inversion with the help of the nurse or doula to adjust the birthing bed. Kneel in the middle of the bed, but face the foot of the bed. Place a pillow on the foot of the bed. Lower your elbows to the food of the bed. Your cheek can be resting on the foot of the bed.
Have help to lower yourself to rest your breasts on the pillows and let your chin come down lower. Tuck your chin.
It’s easier to get into Knee-Elbow position while the bed is flat, and once you are in the bed, lower the foot of the bed. It would be less acrobatic for you than the steeper inversion.
Read this cool story of how a midwife, an forward-leaning inversion and someone else’s cesarean prevented one mom’s cesarean. A hospital midwife helps a mother whose labor stalled by advocating for the mother to get into this position. She calls it something else, knee-chest, yet her link is to this page, so I can only assume she linked the name for the technique she chose to the technique she used.
When the care provider says no inversions
I was hoping you could help me out… a CNM who saw one of my clients and told her not to do inversions because it could cause the baby to become breech. I would like to educate her, the CNM, on the benefits of Spinning Babies techniques. Have any studies been done that I could reference? Any help that you could offer would be greatly appreciated!
My reply is that the CNM has palpated this mother’s abdomen. Perhaps she has polyhydramnios, far too much amniotic fluid, or a very loose muscle tone even with normal amniotic fluid. I add that IUGR, Intrauterine Growth Retardation, a condition caused by placental insufficiency may be a reason not to do Forward Leaning Inversion.
These are reasonable areas of concern to avoid an inversion, though not necessarily absolute reasons. They’d be reasons to leave the decision-making between the care provider and, perhaps, her experienced myofascial worker/chiropractor.
A normal pregnant woman with a head-down baby who does the Forward-Leaning Inversion for 30-seconds a time is not likely to flip her baby to breech.
A provider might confuse the Forward-Leaning Inversion with the Breech Tilt or the Open-Knee Chest position. These are not the same inversions as a Forward-Leaning Inversion. They are done longer. The Breech Tilt has the purpose of helping the breech baby’s chin to tuck. The Forward-Leaning Inversion has the purpose of stretching uterine ligaments and then, after the inversion, releasing the ligaments so they relax. Repetition of the Forward-Leaning Inversion is to release a twist in the lower uterine segment, improving the angle of the fetal head or allowing the breech baby to find room for the head. I’ve been recommending this for years and following many pregnant women through their pregnancies with the Forward-Leaning Inversion.
A different inversion done incorrectly: A woman on the east coast was told by a student of mine (a nurse at this woman’s clinic) to do the Open-Knee Chest position for 20-minutes in pregnancy to help her posterior baby rotate. The next day she came into the hospital in labor and was sectioned for a breech fetal position!!! First of all, the Open-Knee Chest position is not to be used for posterior presentation, unless in labor, when the baby’s head is jammed in the pelvis (-2 station) and there is no progress with strong contractions, or as a comfort for back labor in the presence of contractions. Contractions keep the head down. It’s always good to go back over the instructions before recommending a new technique that you may not be fully familiar with.
Is there any risk to a baby moving into a less than ideal position if she is already in a “good” position?
- Changing baby’s position is not likely in a 30-second inversion unless the womb is quite loose (6th baby?)
- If a woman has a notably large amount of amniotic fluid, the risk of flipping the baby moves from none to small.
- Loose ligaments and lots of water equals a little more risk.
- A baby in an unstable lie might go breech again. –continue balance activities and wear a pregnancy belt 24/7 and don’t invert for a week or so or until an indication, such as posterior after one week of being head down or a labor stall.
- If the baby’s head is high (not engaged) and the water is broke, don’t invert. It might help, but it might add risk of a cord prolapse. Try Standing Sacral Release instead.
- Here’s something to think about: A woman who has a very chronic imbalance, even without feeling the pain of it, MIGHT experience her head down baby going breech. Her body was not in balance, spasmed ligaments are beginning to loosen. Her baby might flip breech once a very tight constriction was loosened but not completely balanced. This is RARE. It’s important to finish balancing the pelvis, uterus and ligaments so baby will return to a head-down position. Don’t delay! It can take 3 to 5 days of continued bodywork and self care. Please email right away if you think this happened to you and I will help you plan how to return baby to a head down position. I’ve heard of this twice in over ten years. So again, this is super rare.
- There is very little risk of flipping a head down baby or turning an anterior baby to posterior.
Forward Leaning inversion is working well to help transverse babies get head down when used 5x in one or two days.