Even at the end of pregnancy, even when the cesarean is scheduled...
Here we are at the Minneapolis Convention Center, off to the side of a Baby Fair with Katie and Jesse. Katie's breech baby flipped a few days after she began this routine. Katie was glad to avoid a scheduled cesarean and have a natural birth.
We started with something Katie was going to like! Rebozo sifting with a rebozo!
Technique: Rebozo Sifting (Manteado) The Rebozo is a woven scarf that is long and used for a number of purposes such as carrying babies and children and groceries.
Why sift? Rebozo sifting relaxes muscles that the mother can't relax herself. This relaxes the mother's broad ligament before each attempt to reposition a baby. Rebozo sifting is beneficial for all pregnant women.
A very short movement is all that is needed. The helper's hands shift only one inch (2 centimeters).
How is it done? Make a hammock to wrap and lift the belly to lift the weight of the baby off the mother's spine while she is on her hands and knees.
The helper stands behind the mother. The helper's knees are slightly bent, their back is straight with elbows near their sides.
They hold the scarf so that their wrists are straight, which protects the wrists from strain.
Lift and check in with the mother... does this feel ok?
When yes, then slowly rock the belly in the hammock you made. The scarf should not shift with the clothes, if it does you aren't lifting enough. The mother should be comfortable.
When the gentle rocking feels ok, speed it up. Now the important thing is you aren't rocking in wide arcs, but very short movements. Just about an inch or 2 centimeters. Meaning, your left hand raises 1 inch while your right hand goes down, then your right hand goes up 1 inch while your left hand goes down. 1 inch (2 cm) is not much! Making tiny circles like the rods on an old time train wheels is even better. I make a "choo-choo" train sound, "chugga chugga," under my breath to keep time. (!)
Stop slowly so you don't make the mother uncomfortable - which means stop slowly to keep the mother's trust! Its better, too. Don't try to manipulate the baby's position by a forceful flip at the end. Trust the release. When the baby finds room the baby will move.
How long? Until the helper's arms are tired, about 2-3 minutes.
How frequent? When you can get it! Daily, when you can and just before the forward-leaning inversion and breech tilt. Occasionally, if not possible daily. Also, use sifting to relax in early labor (between contractions).
Use in pregnancy and in labor (between contractions) for general relaxation.
Counter-indications, or don't use this when.... Don't do this fast if the mother has had spasms in her round ligaments, if she does feel pain when her doctor or midwife feels her lower belly for the baby's head, then sift very slowly (and she'll love it). But if she has had sharp pains in her lower front abdomen at times, this could bring on such a spasm. Do it slow and often and the spasms will stop coming on. (Add magnesium if you would like to support those muscle fibers so they don't spasm.) Don't do this if the mother doesn't want to or there is discomfort.
What else? I recommend Chiropractic with the Webster maneuver and symphysis pubis alignment in addition to the following soft tissue work.
Thanks to Guadelupe Trueba, Elena Carrillo and others for sharing the delights of the Rebozo with DONA International members and the world.
Technique: Forward-Leaning Inversion
Why? This activity stretches the supporting ligaments in the lower uterine segment, such as the cervical ligaments. The point, though, is in getting up!
When you get up, the ligaments relax. Repeating the stretch and relax many times helps release a possible spasm or asymmetry and allows the baby's head to fit more symmetrically during labor.
Who does this? The woman needs a spotter for the first few tries, depending on her sense of safety. The chair shown here is not reliable -or deep enough - so Jesse holds her chair so it doesn't slide. Your bed or couch will be more stable. One's bottom could be higher than in this picture, making the position even more stable.
How long? 30 seconds. That's three breaths long.
How frequent? Daily at a minimum, but with a breech, you may do this 2-3 times a day. More frequent, but not longer is the key.
Indications, or do this when... When you have a uterus. (I'm being funny, but I mean you don't have to have a problem, just a body!) Watch the videos before AND AFTER trying the inversions, mistakes are common!
Here we see Katie get down from the chair in THE WRONG WAY! This is too much of a twist in her SI joint (at the back of the pelvis)! It may be better to put the top of one foot on the chair and then the other foot on the edge of the chair, too, clinging with knees in the air, and THEN put one knee down and then the other so there is little twisting. So, foot, foot, knee, knee, going with the opposite knee as the last foot to be used. Or do this on the bottom three steps and then you can climb down without twisting. The key is not to twist sharply as you see here. On a better surface, she could swing back up to kneeling, but this chair was all we had at the convention center.
Note: When we first get upside-down our body signals us (in case we didn't notice) by a throbbing head. After about 6 times your body will realize you mean to be upside-down and your head won't pound.
Technique: Open-Knee Chest
Why? Open-Knee Chest has been studied and shown that a higher number of breech babies will flip after time in this position.
Who does this? In pregnancy - I recommend that only mom's with a known breech baby do this position.
How? Knees are hip with apart - they are not wide apart! But knees are far from the belly, this "Opens" the pelvic brim, which is the point of this inversion.
How long? 20 minutes or longer. Again, ONLY with a breech fetus.
How frequent? 2-3 times a day.
Counter-indications, or don't use this when.... Very high blood pressure is present. Ask your medical provider if you are being seen for high blood pressure. If you are at risk for a stroke, don't invert!
We didn't have a picture of Katie and Jesse doing this so I'm having Penny and this Louisiana Mama show us!
Technique: Breech Tilt
Why? Women using the breech tilt experience more breech babies that flip. I think its better to do some balancing activities first.
Who does this? Only a woman carrying a breech fetus should invert like this for long.
How? Use a supportive and steady board with one end raised 15 inches. Put pillows around the bottom so the board doesn't tip and so you don't slide onto the floor.
How long? 10-20 minutes at a time.
How frequent? 2-3 times a day, following the forward-leaning inversion (done for 30 seconds)
Counter-indications, or don't use this when.... Very high blood pressure is present. Ask your medical provider if you are being seen for high blood pressure. If you are at risk for a stroke, don't invert!
Do these inversions even if you are also doing "Downward Dog" in yoga. They are NOT the same!
Thanks to Dr. Carol Phillips, DC, for teaching Dynamic Body Balancing and emphasizing the importance of the forward-leaning inverison.
Better balance may help breech babies flip
Technique: Standing Sacral Release (A myofascial technique)
Why? This re-balances the tough membrane (fascia) that wraps the sacrum. Sometimes the sacrum has a "buckle" or "wrinkle" in it which twists the lower uterine segment in turn. This is likely to release the "wrinkle" and, in turn, untwist the lower uterine segment.
Who does this? A myofascial therapist, or a chiropractor who knows myofascial release. Some doulas have even used this because its a good comfort measure for lower back ache in pregnancy or labor. Its non-invasive and gentle. Partner's can learn it and do it regularly.
How? This technique is easy to do when you slow down and tune into the connection. But it is hard to explain through words and pictures.
The mother stands facing a wall. She puts her hands or forearms against the wall. Her head does not rest on the wall unless she really wants it to, and then that's part of the release.
The helper stands to her side, facing either side the helper prefers. The dominant hand probably should go towards the mother's back.
The helper so lightly touches the mother that they have to pay attention or contact is broken. The weight of contact is the weight of a nickle (shilling?).
The helper's less dominant hand is on the mother's lower abdomen - to start with.
The helper's more dominant hand is turned, fingers down, and the "ball" or base of the thumb is gently resting on the "buckle" of the sacrum. Finding the buckle takes a couple light passes from the top of the sacrum towards the tailbone. When the base of the palm feels resistance of a subtle "ledge" of something under the woman's skin, that's the "buckle". The "force" (however lightly given) is towards the direction of the sacrum, off into the air, not towards the mother. Remember the fingers point down, but away from the body. The hand waits there, lightly (the weight of a nickle) until the buckle suddenly is gone and the hand slides suddenly off into the air.
Both the mother and the helper have their knees slightly bent. This helps each of them respond better to one another and the subtle movements going on in the technique.
The mother may feel like bending her knees quite a bit more and moving in response to her shifting fascia. This may be easy to resist, so the mother may be encourage to listen to her body and move to make herself even more comfortable. The helper attempts to "follow" her maintaining such a light pressure and perhaps moving the hand to follow the point of tension which sometimes leaves the sacrum to go somewhere else, for instance the hip or knee, or lower back, etc.
One of you will know when you are done. The mother because she feels the release, the helper because he or she has run out of time, I suppose. Helpers shouldn't worry that they don't know what they are doing. They don't really. But the fascia does. Follow the fascia.
How long? Time varies. The first time or two might take 2 -20 minutes or longer. Each person is different. 2-5 minutes becomes typical after the first time or two.
How frequent? Doing this a few times in pregnancy and once in early labor is helpful. Do this after a long car ride to help avoid breech. Daily, if the partner can do it, when the baby is breech. Should you do this once baby is head down?
Continue after any long car ride, long day on the legs, or periodically even when the baby is head down.
Indications, or do this when... Pregnancy is uncomfortable or the baby is in a less than ideal position (breech, posterior, transverse). Engagement doesn't occur by 38 weeks. Labor is long and descent is delayed. Labor is uncomfortable, especially in the back.
Counter-indications, or don't use this when.... If the mother can't stand up use the abdominal release(diapragmatic release) instead.
Technique: Diaphragmatic Release or Abdominal Release
Why? Relaxes the broad and round ligaments helping the pelvis to come into balance.
Who does this?A myofascial release therapist can teach this and you can learn to do this as a couple or with a doula or other friend.
How? The mother semi-sits on a couch with a helper kneeling on the floor. The mother can be comfortable, breathing freely.
The helper kneels or sits facing the side of the mother. The less dominant hand (with no rings!) is under the mother's sacrum. She lays on the helpers hand.The helper does not push or anything with this hand. This hand is passive. This hand can send warmth, love and relaxation. Your intent is to hold space and complete a circle with your top hand.
The dominant hand rests lightly on the lower abdomen. The pinkie finger is near the symphasis, fingers towards the hip that is opposite (furthest) from the helper. Gentle compression (the weight of a nickle again) is on the abdomen. The helper has to lift the weight of the upper arm and be mindful not to rest the weight of the arm on the mother.
The helpers hands are soft, light, warm and holding a good intent.
Their slight compression (aided by the weight of the mother on the lower hand) allows the fascia to begin to release. The mother breaths deep and slow, as if falling asleep. But not forced.
The baby will be quite active after wards. The release makes the broad ligament relax and that lets the baby move more freely and the baby notices this.
How long? Varies, wait for the feeling of movement of the fascia in the front and the back of the mother.
How frequent? A few times in pregnancy and during early labor as indicated by pregnancy discomfort or fetal malposition.
Indications, or do this when... First time mother; discomforts in pregnancy; discomfort or pain when baby kicks (this may indicate a tight broad ligament); anterior placenta (to help baby rotate past it more easily and reduce the chance of a posterior baby); consistent need for chiropractor, in other words, you keep going but keep being out of alignment
Counter-indications, or don't use this when.... No physical reason not to that I can think of.
Thanks again to Dr. Carol Phillips, DC!
Technique: Pelvic Floor Release (or Side-lying Release)
Why? An imbalance in the pelvic floor twists the lower uterine segment (are you seeing how these body structures are all related?). This asymmetry can lead to malpositions such as a brow presentation, a posterior baby or a breech. But most often are associated with the asynclitic baby, the one whose tipped head makes vaginal birth a challenge with long pushing stages and perhaps a switch to cesarean delivery.
Who does this? This can be learned from a myofascial therapist, or another professional who uses myofascial techniques, such as a chiropractor. The mother can even do it herself at home!
How? The woman lays on her side so that her shoulders are one above the other and she is not tilted! She can't be leaning back to look up at you, for instance.
Her upper hip starts out directly above the other one. So her top leg is resting upon the lower leg.
Her lower leg is straight as an arrow. Very straight.
Her partner or her doula supports her shoulders so the top shoulder doesn't tip forward. Face to face encouragement can be vital in labor and be the key to success! Don't ask the laboring mother to do this without eye to eye contact and constant encouraging words! I'm serious!
The helper (See me in the pictures) holds the anterior superior iliac crest... or the front of the hip bone. Press down about as much as you would to put a lid on a food container... firm but not a lot. Enough to notice, but not to make a statement, ok?
The mother has to be so close to the edge of the firm, hard surface that she relies on your totally to hold her from tipping off! Be trust worthy! This is the trickiest part.
As the helper pushes down and back on her hip bone the mother lets her top leg fall into the air. It hangs limp - you'll have to coach her to let her leg go. Hold her firm so she believes she can do this without slipping off. Let her leg hang freely, it should not touch the floor or you! Wait a minute or two. In labor, wait through and between three contractions (two if she seems like she'd never make it through three, you know her personality).
Then she lifts her leg back up. Someone might help her but it can't be the helper, she (or he) is holding her hip and must continue to so the mom won't fall.
She can lay on her back a second, then she switches sides. Her head goes where her feet were, or she switches to the other side of a massage table.
Repeat for the other leg.
Be confident and inspire confidence in the mother.
How long? This is hard to answer, but most important =Read IMPORTANT!!= is to do it on both sides!
How frequent? A time or two in pregnancy and then again in those labors that are long, delayed or have malpositions.
Indications, or do this when... Asynclitism; posterior presentation; to enhance a vaginal breech (done before labor or in early labor); slow descent due to a first time mother's strong pelvic floor (ballerinas and horseback riders, runners, etc.) Long previous labors or pushing stages. Hip pain. Preventative or to help along a labor.
Counter-indications, or don't use this when.... I suppose some back injuries of significant sort, like surgeries or spinal damage. I'm not sure who you wouldn't do this on. I suppose you wouldn't do it with a very large woman if you couldn't hold her from falling forward off the table or hospital bed. There is no need to do this if labor is progressing well. It can be done during pushing stage if labor slows due to a "tight fit" or asynclitic head or there is reason to "make more room."
But mainly, explain to the mother first that this may a somewhat uncomfortable technique (Some pregnant women find it more comfortable than not! Others find it challenging when a head is in the pelvis). Explain that it is vitally important to do it on both sides so that more asymmetry isn't caused by doing it on only one side - and really tipping the head to the side because it was only done on one side.
Ask the laboring mother before you start, to hold the position for 3 contractions on one side and 3 contractions on the other side. Let the mother pick which side to start on. She will pick the more comfortable side first and that's fine.
This technique is awesome. It has helped many women avoid a cesarean (but not all). I would say it works wonders and After its done, the reduction in the pain women feel in labor is significant!
Again, thanks to Dr. Carol Phillips, DC, for teaching me this one at a long birth. That willing birthing woman was suddenly so relaxed that she dozed at 8 cm and began pushing her baby out so quietly the midwife almost didn't turn around from her charting at the counter to catch the baby! Later, I've used it at many a labor with an asynclitic baby. Its not always dramatic, but almost always resumes progress. This shows that a lot of slow progress isn't the bony pelvis as much as the tension of the pelvic floor. Its worth a try!
These are the main things to help a breech baby flip.
More Balance that every mother can do
Technique: Psoas Release
Why? A tight psoas (so-as) muscle pair keeps baby high. A long labor can relax the psoas, as may an epidural, but why not improve your body's balance by relaxing your psoas in pregnancy.
Who does this? The mother herself.
How? Lie on your back with your feet on a chair so that your calves are at a 90 degree angle to your thighs. Thighs are straight up and down and calves are horizontal. After five minutes, roll to your side and get up slowly.
One day you will notice that your lower back relaxes enough so that the space between your lower back and the floor disappears. Don't force your lower back to touch the floor, wait till it happens on its own. Then repeat this technique occasionally. Before that, do it daily as much as you can, but for five minutes at a time.
How long? 5 minutes or less, if you don't feel good on your back.
How frequent? Every day.
Indications, or do this when...you walk upright. Constipation, lack of engagement of baby's head after 38 weeks. Previous long labor. First time mother. History of sexual or emotional abuse. Desk work or lots of sitting.
Counter-indications, or don't use this when.... Any time on the back is not possible. Roll over to your side if you feel unwell while doing this.
Remember, you spend 5 minutes on your back for a prenatal exam. This 5-minutes will be ok.
Technique: Hands through the hole
Why? Balances the pelvis and "opens" the hips, allowing easier descent of the baby in labor.
Who does this? Women themselves. Learn this "pose" at yoga and from a physical therapist.
How? Lay on your back. Bend both knees with your feet flat on the floor. Breathe a few times.
Lift one leg, lets say your right knee, and put that ankle above the bent knee of the other leg.
Put one hand through the hole your right leg makes and grab the thigh or shin of the other leg (left).
Lift the left leg to grab it.
Hold the pose for a bit, and stretch your lifted knee, in this case, the right knee, away from your head. You will feel a stretch. Don't hurt yourself. Take a few breaths.
Put both feet down again and breathe a breath. Then do the opposite leg in the same way, opening the left knee, this time, away from your head.
How long? This may take two minutes to start with, and longer as you get more comfortable with it. Give yourself 5 minutes to do both legs by the third week into it.
How frequent? Daily when you can, but three times a week for your body to respond.
Indications, or do this when... Everyone benefits. All pregnant women can benefit.
Counter-indications, or don't use this when.... When lying on your back is impossible.
Start in symmetry. Then put your "hand through the hole" and grab either your thigh or your shin as you are able. Relax your back. Rest in symmetry. Switch legs and repeat.
Thanks to Colette Crawford from whom I first learned this from her yoga video for women's health.
Why? Hip flexibility and pelvic balance
Who does this?The woman herself. She learns this at yoga class.
How? There are three steps. Using a rebozo in this picture, the pregnant model wraps the scarf around the ball of her foot. She could use a pilates band or a belt. I use my sock because I can usually find it.
The first, both hands hold the belt. The right leg is straight, but not locked. That takes awareness. Lift the thigh muscle towards the hips to make the leg "active". Relax a bit while keeping your leg active. Notice your breathing. Let it be free. Then lift your leg towards your head. Don't hurt yourself. Give yourself some weeks to get more flexible.
The second, transfer the "belt" to your right hand (the picture doesn't show this with the right leg, but shows it with the left leg. Oh well, you will do both.) Let that leg open and rest on the wall. Again, the leg is straight but not locked. Breathe freely. Relax your leg into this while keeping your thigh muscle lifted towards your hips.
The third, cross your right leg over your body and rest it on a wall (or chair). Now the picture shows the right leg again. Sorry to confuse you. But read the directions again and you will get it. Let your leg rest, supported like that.
Switch legs and begin again.
How long? A minute or two for each step, or shorter and then repeat both sides again.
How frequent? 3 times a week or more.
Indications, or do this when... Everyone benefits.
Counter-indications, or don't use this when.... Again, only if someone can't at all be on their back.
Thanks to Clare Welter, CNM, who taught me this at her Sunday noon prenatal yoga class at MplsYogaWorkshop.com
Technique: Pelvic Tilts for general flexibility - but not specific to flipping a breech.
Why? Loosens the hips and sacrum. Relaxes the lower back and soothes an achy back at the end of a long day. This helps "loosen" tight fascia surrounding the abdomin, pelvis, and respiratory diagphragm.
Who does this? No professional help is necessary, but a yoga teacher or physical therapist can give advice about technique.
How?Hands are under your shoulders, knees are under your hips. Knees are a little apart, not touching. Focus on your lower back.
Your back starts flat (not sway back!)
Lift your lower back
Flatten your back again.
This is like "Cat Cow" yoga pose.
How long? Do 20-40 pelvic tilts for comfort, usually about 2-3 minutes.
How frequent? Daily for comfort, or as needed. In labor, for 20 minutes.
Indications, or do this when... the lower back is tired or achy; or the hips are stiff. After balancing techniques to help baby swing to the anterior, or during labor through several contractions for the same aim.
Counter-indications, or don't use this when.... Wrists or knees are too weak or damaged. Use a cushion for your knees and lean over a birth ball or soft chair so you aren't resting on your wrists, if that's better.
Thanks to Penny Simkin, PT, who taught all of us doulas the importance of the Pelvic Tilt. And to my sister, Kathy, who taught me this when I was 17 years old and she was helping me prepare for a natural birth.
And thanks to Katie and Jesse for sharing their photos with us here at SpinningBabies.com
There are professional body work techniques that will also help with Optimal Fetal Positioning using Spinning Babies first principle, Balance.
For breeches, add the Breech Tilt after the Forward-leaning Inversion.