It would be nice to have some research on all of the Spinning Babies recommendations and posted techniques. I can't wait to address the needs of birthing women until someone does the research on the Spinning Babies approach to childbirth. I can only be non-interventive and request that women work openly with their doctors and midwives about the techniques on this site. We'd all be being born out of glass jars before each of these techniques are thoroughly researched.  The Spinning Babies approach is active, holistic, anecdotal, and grassroots. Some of these techniques may have been studied, its true. And I don't hold that against them. Its just that they may not have been used in the studies in the manner in which I present them. That will make the study findings less than useful to our purposes. One example of that is the Karaminia's study on pelvic rocking in the hands and knees position, see article in this section.

If you are a medical researcher, doctor, student or midwife with an interest in doing research to advance Optimal Fetal Positioning, Maternal Positioning, and/or any of the Spinning Babies Principles or recommendations, please, please contact me. Let's discuss something that is doable within the constraints of your study parameters.

I'd love to have the forward-leaning inversion compared to "usual management." I'd love to see if teaching parents Belly Mapping first before a late pregnancy ultrasound increases their accuracy (or just awareness!) of their babies' position. What about the pelvic floor release and its effect on birth outcomes for asynclitic babies? What about that ROT baby and the route of rotation in comparison with the LOT baby? And just what is the frequency of starting labor with an ROT or OP fetal positions compared to LOT or LOA/OA baby these days? How frequent are ROA babies among first time mothers? These are answers I'd like to know! What do you want to study? Please message me on my Facebook or send me an email.

People are asking,

"What is the comparative accuracy rate between the kick, bulge, and movement techniques of [Belly Mapping], the palpations of a doc or midwife, and an ultrasound?"

My reply, sadly, is, no one has done a study on Belly Mapping's comparative accuracy to either palpation by an experienced provider or an ultrasound. This is something I've discussed briefly with a couple of medical students and nurses who have contacted me with an interest in Spinning Babies' potential research topics. However, until I can actually work with a group who are actually able to conduct the research we won't know.

Come aboard. Plan a research study with me. I've been using some of these techniques for 20 years or so. We can find one that fits your study needs. And, their fun!

"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 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.

The breech tilt is not the same inversion as a forward-leaning inversion. Its 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 the cervical ligaments and then, after the inversion, the ligaments 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. I haven't observed nor have I been told of a baby who's flipped breech.

A different inversion done incorrectly- A woman on the east coast was told by a student of mine (and a nurse at this woman's clinic) to do the Open-knee chest 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- 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. Its always good to go back over the instructions before recommending a new technique that you may not be fully familiar with. 

Breech Birth, Woman Wise. Maggie Banks, 1998 Birth Spirit Books, 15 Te Awa Rd., RD 3, Hamilton, New Zealand

Order the book at BirthInternational.com

Active Breech Birth: the point of least resistance by Maggie Banks. In March 2006, I attended the first international Breech Birth Conference in Vancouver, Canada which gathered together midwives, medical practitioners and researchers to discuss such issues as research, safety and techniques used during vaginal breech birth ... (full article in PDF format) from a list on BirthSpirit.

Commentary on The Hannah Breech Trial by Maggie Banks on  Radical Midwives.

Breech Birth: What are my options by Jane Evans
Evans J., 2005 Breech Birth - What are my options? Association for Improvements in the Maternity Services, Manor Barn, Thurloxton, Taunton, Somerset, TA2 8RH

Buy at CAPERS bookstore.

From the Independent Midwives Association in the United Kingdom:

"Jane qualified as a midwife in 1976 and worked in the NHS for 20 years. She was instrumental in raising homebirth rates, introducing waterbirth and in developing a domino scheme in her local area of Hertfordshire. Jane has become renowned for her experience in breech birth, twin birth and VBAC. She has been a member of IMA since 1991."

Breech Birth.  Benna Waites, 2003  Free Association Books, 57 Warren Street, London. W1T 5NR

Buy at Amazon

Medical Research

Many of the academic articles published on breech birth in the last decade have centered around the controversary following the Term Breech Trial, also known as the Hannah Trial.

Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group.Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Lancet. 2000 Oct 21;356(9239):1375-83.

Then two years later, the Hannah group came out with a reassuring finding:

Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. Whyte H, Hannah ME, Saigal S, Hannah WJ, Hewson S, Amankwah K, Cheng M, Gafni A, Guselle P, Helewa M, Hodnett ED, Hutton E, Kung R, McKay D, Ross S, Willan A; Term Breech Trial Collaborative Group. Am J Obstet Gynecol. 2004 Sep;191(3):864-71. Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.  Comment in:

• Am J Obstet Gynecol. 2004 Sep;191(3):872-3.

An excellent explanation of the weakness of the Term Breech Trial came in 2004  from physician Andrew Kotaska:

Inappropriate use of randomised trials to evaluate complex phenomena: case study of vaginal breech delivery. Andrew Kotaska, senior registrar1 BMJ  2004;329:1039-1042 (30 October), doi:10.1136/bmj.329.7473.1039   Department of Obstetrics and Gynaecology, University of British Columbia, BC Women's Hospital, Vancouver, BC, V6H 3V5 Canada

Another rebuttal came from Dr. Marek Glezerman calling to withdraw the Hannah recommendations for universal cesarean for breech position:

Five years to the term breech trial: the rise and fall of a randomized controlled trial. Am J Obstet Gynecol. 2006 Jan;194(1):20-5. Glezerman M. Department of Obstetrics and Gynecology, Wolfson Medical Center, The Helen Schneider Hospital for Women, Holon, Israel.

Comment in:

• Am J Obstet Gynecol. 2006 Dec;195(6):e22; author reply e23.
• Am J Obstet Gynecol. 2006 Dec;195(6):1873; author reply 1873-4.

There are more great research articles, be sure to note if the articles and information you find on the web are research-based. Then read the research. Some research doesn't support the conclusions that the researchers make at the end of their published articles. Politics are in the birthing room. I'm not exempt, either. I have my opinion, too. Then, we have to separate the outcomes claimed for breech births where mother's are on their backs, and the midwife or physician extracts the baby compared to women on hands and knees  with a "hands-off-the-breech" approach. I was up putting this list on Spinning Babies as I waited for a midwife to call after her first breech catch. She and I had recently spent a day going over the Breech Update information I brought back to Minnesota after attending the Ottawa Breech conference last year. She had wanted to help the baby bend his knees, release his feet, etc. and every time she remembered me telling her, "hands off the breech, hands off the breech."   Mom and baby were tucked in, nursing, while she told me the story on her drive home. Now, I've got to go to bed, too.

  Breech Guidelines

Vaginal or caesarean delivery? How research has turned breech birth around  Royal College of Midwives-Evidence-Based Midwifery, Sept, 2008 by Mary Steen,Carol Kingdon

I like this article because it sites Mary Cronk's breech protocols at the end. Very nice. Please take Mary Cronk's life-saving instruction to heart and hand:

"Independent midwife Mary Cronk has suggested that if the labour progresses spontaneously, (that is, the contractions come often, last longer, get stronger, the cervix effaces and dilates, and the breech descends through the pelvis), the baby will be born. If this does not happen there is no place for augmentation, that is, trying to push the baby through the pelvis with contractions driven by oxytocic drugs. Nor is there any place for trying to pull breeches through the pelvis with managed breech extractions. Labours that do not progress are telling us that the baby should be born by CS (Cronk, 1998). The RCOG has recommended that a CS should be considered if there is a delay in the descent of the breech at any stage in the second stage of labour (RCOG, 2006)."

Here are the Canadian Guidelines for Breech Birth. These are from the SOGC, and may differ from the guidelines of an experienced homebirth midwife who has done many breeches. See the quote above.

Vaginal Breech Delivery Guideline; The time has come. By Andre' B. Lalonde, Executive Vice-President of the Society of Obstetrics and Gynaecololgists of Canada.

Breech Birth stories on the web (please submit your own!)

While these are lovely stories, Spinning Babies does not link to them as examples of how to catch a breech. I'm hoping for photos of a mother in a knee-elbow (hands and knees) position with no one touching the baby. If you have the right to share such photos, I'd love to link to your site/blog. If you'd give me permission to use them in a Breech Update class for midwives, I'd love that, too, but I won't expect that from you, I'll just let it be an extra blessing if it comes my way. 

A hands-off footling breech birth with Lisa Barrett Australian Midwife. Give it time to load and suddenly you will see the little video screen on Lisa's blog.

Stories at the Coalition for Breech Birth website.

BirthingWay.com Footling Breech story with photos.

Sebastian's Breech Birth. His mother said no to a version and no to a cesarean and went home to have her baby. Her skilled midwife did a hands-on breech delivery reflecting the influence of medical practice on home birth midwifery rather than the hands-and-knees, hands-off approach promoted here at Spinning Babies. Still, this a sweet birth story.

More breech births on Birth Love

A footling breech before the midwives could arrive, the lovely story of Bruno's birth.

A happy hospital birth story of a frank breech baby in the UK. James' Breech birth.

A happy hospital birth story of a frank breech baby in the US (Denver) with mom in the OR and forceps used (perhaps as a routine gesture?). Natalie's breech birthAm J Obstet Gynecol. 2004 Sep;191(3):864-71.

Will a mother going into a hands and knees position during late pregnancy help rotate her posterior baby? Many mothers advise each other to spend time on hands and knees each day. Pelvic rocking helps relieve a sore lower back. But will it help the posterior baby rotate before labor starts? Gail comments afterwards with her Spinning Babies point of view.