Forward-Leaning Inversion

IMG_3417
Photo by Crystal Garcia Photography

The Forward-Leaning Inversion is a classic here at Spinning Babies. Create more room in the lower uterine segment to allow baby to move into (or stay in) the ideal position for birth.

 

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 or a sudden stop (i.e. an accident, fall, or sports). This effect is not uncommon among women who twist to do their work (massage therapists, nurses, chiropractors, etc.) or who hold a child on one hip frequently. A twist in uterine ligaments can put the lower uterine segment into a slight twist which reduces the room for the baby to have a good head-down position. The baby needs more room to get in an ideal, or optimal, fetal position (Optimal Foetal Position in the UK or Australia) .

 There are sometime immediate benefits of doing an inversion!

 

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.
  • There is so much amniotic fluid around your baby that your doctor monitors you weekly.
  • In pregnancy if there is a suspected or known problem with the placenta, including pain of an undetermined origin. Get assessed immediately.
  • 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.
  • Your shoulders are too weak or too tight to support you in an inversion. Do other shoulder exercises first, including Down Dog.
  • 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.

 

How To Do a Forward-Leaning Inversion

Give the utero-sacral ligament and other ligaments a stretch.

  1. Kneel on the edge of a couch (or the top of the stairs)
  2. 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.
  3. Let your head hang freely. Your chin is tucked. Don’t rest your head on the floor. Your neck may need a little movement.
  4. Your knees are close to the edge, your bottom is highest. You can tilt or sway your hips, if you like.
  5. You can flatten your lower back (posterior pelvic tilt) to give more room to free your ligaments.
  6. Take 3 breaths.
  7. 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.
Photos by Keidi Lin Photography

 

Caution: Round ligament pain happens occasionally with the inversion (although, it’s not typical at all), and is not threatening. Round ligament spasms can be resolved with the Webster. Meanwhile, try warmth and self-massage and breathing. It’s OK to repeat the inversion in one day (for 30 seconds). Please pay attention to a pain that persists more than a few minutes. Report abdominal pain to your provider, including shoulder pain. Let’s rule out a placental problem brewing, as abdominal pain or shoulder pain might indicate. Understand the warning signs in pregnancy. Listen to your body and check out unusual symptoms with your physician before trying these exercises. Meanwhile thousands of women are getting mild or dramatic benefits from the inversions and sidelying (pelvic floor) releases in total safety. Be confident – know when to assess.

 

 

 

The Forward-Leaning Inversion is:

  • 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. Be mindful if polyhydramnios is the reason. I have too little info to comment on that dual situation. I tend to avoid it if there’s far too much water (a doctor needs to monitor the polyhydramnios).
  • Helpful as part of 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.

Due to the recommendations of the chiropractor, Dr. Carol Phillips, D.C., who developed the FLI, I have changed from avoiding the FLI for all babies in an unstable lie. Dr. Phillips said, and I’ve found, too, that the FLI is the prime technique for unstable lie!

Repeat the Forward-Leaning Inversion daily. Just 30 seconds is long enough! That’s about 3 breaths.

Letting the uterus hang for 30 seconds from the uterine ligaments stretches these ligaments. Swinging back up relaxes the uterine ligaments and makes room in the lower uterine segment. With repetition, the womb becomes more balanced (the uterus naturally tilts right, so here, 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.

  • Ask for help the first few times you try this.
  • You can do this daily at any time in pregnancy – or before!
  • 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 without tumbling -or twisting!
  • Allow your head to hang freely, chin tucked.
  • 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.

 

How to do an inversion, the video:

Inversion with Emily and Ludvig

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

Gail,

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, a history of an unstable lie (the baby goes from head down to breech to head down again easily), or a very loose muscle tone even with normal amniotic fluid.

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. The Breech Tilt is not the same inversion as a Forward-Leaning Inversion. It’s done longer and on the mother’s back. The Breech Tilt has the purpose of helping the 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 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 being inverted and have her move in a less than ideal position if she is already in a “good” position?

  • This type of inversion is for 30-seconds at a time, not 20-minutes, the typical recommendation for a Breech Tilt.
  • 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: now head down? –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.
  • A woman who has a very chronic imbalance, even without feeling the pain of it, begins to loosen. Her body is not in balance, but spasming ligaments are beginning to loosen. Her baby might rarely flip breech during this process. This is RARE. Continue to finish balancing the pelvis, uterus and ligaments and baby will return to a head-down position. Don’t delay! Please email right away if you think this happened to you.
  • For a normal pregnant woman there is very little risk of flipping the baby in this short time.

Could it? With hundreds of women now using the Forward-Leaning Inversion, I suspect it may occur that sometime a baby will flip breech. Would it be from a short inversion? Or would it be from beginning to loosen a very tight pelvis? Could it be from flipping a mother who is very loose with enough water for baby to flip? Continuing the balancing activities would let the baby get head down again in a couple days. This technique is working well to help transverse babies get head down. Use your intuition, common sense, and see if it is right for you.

What about the yoga position called Down Dog?

Down Dog in Yoga is good for lengthening hamstrings and opening shoulders when done correctly
Down Dog in Yoga is good for lengthening hamstrings and opening shoulders when done correctly. Knees can also be bent. However, Down Dog offers a different set of benefits than Forward Leaning Inversion.

Downward Dog and the Forward-Leaning Inversion accomplish different things. Both are good, but I think the Forward-Leaning Inversion is better for releasing torsion in the uterosacral ligament when the uterus hangs freely from this posterior ligament. Downward facing Dog, especially with straight knees, doesn’t allow for the fascia to reposition itself on the sacrum, nor does Down Dog let the uterus hang freely. Do Down Dog for happiness, to add length in the hamstrings for more pelvic flexibility, but do Forward-Leaning Inversion to make room in the uterus for baby to position well.

Down Dog just doesn’t seem specific to fetal repositioning. But let me know what you are finding! If you see a pattern that Down Dog is helping fetal position, share it. We all want to know!