Side-lying Release

This is not just lying on one's side and leaning your leg over!

Weekly in pregnancy and once in early labor to ease and shorten labor. Stall in labor? Annoying hip pain? Contractions with no progress?  Asynclitic or posterior baby? This technique is a star in the universe of maternal positioning for labor comfort and progress.

I could call this the side-lying Leg-hanging release to remind you that it's not just laying on a side with the top leg forward.

I could call this the pelvic floor release. There are more muscles helped than the pelvic floor group, though.

Read the instructions below C. A. R. E. F. U. L. L. Y.  Doing it wrong doesn't work.
 

Notice how the hips and shoulders are "stacked". The bottom leg is straight. The top leg is relaxed and hanging off the table. The helper at the hip holds the hip from tipping! Picture by Traci Kennebeck. St. Louis, MO

 

How to do a side-lying release

You need a surface that is as long as the mother. Though yesterday, we did this with a couch that was not quite as long as the mother was tall and it worked anyway. The surface is usually a firm couch or bed, but can be a heavy, strong table or counter. A hospital bed works wonderfully when raised a bit, during labor in the hospital. Some doulas and childbirth educators are experimenting with doing the sidelying release while the mother lays on the floor.

A woman can do this alone, but a helper is very useful. If done alone, she braces herself with her arm, holding a heavy table, for instance. She has to consciously keep her hips stacked one above the other.

The mother lays on her side. She can choose which ever side she feels more comfortable or natural in first. She MUST do this on BOTH sides no matter which side she starts with, however, or she may make her pelvic floor more uneven.

 

 

How to do the Sidelying Release

 
1.)  The woman lies on her side on a firm surface. Her hip is close to the edge of a couch. She lays her head on her lower arm or a pillow.
2.)  Her helper stands in front of her. The helpers forward hip is against the surface. This prevents the mother from falling forward! 

3.)  The mother scoots her hip right up to the very edge of the couch. The pregnant woman’s pregnant belly is either between the helper’s thighs or they are belly to belly, depending on the height of the surface.

4.)  The helper curves both her palms around the edge of the mother’s anterior hip (front and top; ASIS).  The helper must prevent the mother’s hip from leaning forward when the mother does the next step. So she gets ready to hold it back. Meanwhile, the helper presses down firmly (but not as strongly as for counter pressure or the hip press, rather about 2-3 pounds of pressure or push down to create the weight of a 2-3 pound bag of beans or sugar). 
5.)  The mother straightens her lower leg. Her lower foot is flexed up. She doesn't "point" her toes forward, but brings them up (flexed).
6.)  Keep her top shoulder over her lower shoulder. (A second helper is useful to hold her top shoulder and give comforting words and eye contact, but isn't necessary if one isn't available.) The top hip stays over the lower hip, this is important.

Photo: Two workshop participants share one massage table. See how hips are stacked.

Support for the woman's upper shoulder isn't really necessary, we have the extra hands at a workshop. It is necessary, however, to keep the hip and shoulders one above the other so the torso doesn't twist.

7.)  When the helper is ready, but not before!, the mother slightly lifts her leg up and forward and then lets it slowly hang down in front of her. Helper: Don’t let her hip tip forward!
Here’s the point of the Side-lying Release:  Her top leg hangs forward and into the air. Let the full weight of the top leg hang. Keep the lower leg straight. The helper has to avoid the mother’s thigh so the thigh can hang freely. 
           She breathes deeply and slowly. Her belly is relaxed. Her leg relaxes more.

Photos: Penny Simkin experiences The Pelvic Floor Release / Sidelying Release on a massage table at the ICEA-Lamaze Mega Conference in 2010. She relaxes her upper leg completely (the lower leg is straight with toes up). Photo by Nickie Kerrigan, CPM.

8. )  How long? In pregnancy:  Her leg hangs like this for 1-2 minutes. It’s ok to try it longer, but its vital that its done on both sides. A few people have reported holding each side for up to 20 minutes to flip a breech!

In labor: Let the leg hang like this through 3 contractions and switch sides for another 3 contractions. Stay like this between contractions, too!

9.)  Repeat on the other side immediately. Repeat for just as long, 1-2 minutes in pregnancy and through 3 contractions during labor.  It’s vitally important to do both sides so that you don't create more of an imbalance!

 

 "After we finished the left side, she got up to use the restroom. Contractions were more regular, not so close together and VERY productive. Suddenly she "had to poop!" Her water broke, she began to push and we scrambled to get things together for the hospital....I learned that I will reserve these spectacular techniques from Spinning Babies for when we're close to the delivery locale!" - doula, who'll remain anonymous for now.

 

What is the Pelvic Floor?

Within the bony pelvis is a supportive "floor" of muscles, much like the respiratory diaphragm. Resting, the "floor" is lifted, supporting the womb and other abdominal organs. Two openings (holes) in the pelvic floor allow the anus, the urethra and vagina to fit through it. The baby also comes through the pelvic floor during childbirth.

The pelvic floor opening is a front-to-back opening through which the baby turns like a button going through a button hole. Up-curved sides of the opening are strong and springy and direct the head to turn.

 

What's the problem?

If one side of the opening is tighter than the other, or higher than the other, the asymetrical tension can pull the pelvis out of balance. The baby can be tipped and/or rotated into an unfavorable position. 

Even if the pelvic floor is evenly tight, fetal rotation or descent (coming down) can take longer than usual. The strong pelvic floor of a dancer or horseback rider may lengthen labor considerably.

Common habits of modern life can make the pelvic floor tight on one side or even twisted. Simple things like driving a car or crossing our legs, sports accidents or falls on either the head or the bum might effect the pelvic floor.

Tension or torsion in the pelvic floor makes labor longer. An uneven tightness in the pelvic floor may make the baby's head tip causing an asynclitism (tipped head) that makes labor longer and increases the chance of cesarean or vacuum (ventouse). 

 

What's the solution?

The Side-lying Release (also called the pelvic floor release) can help labor progress.
Try it in the presence of a posterior, brow or asynclitic fetal presentation. Try it, also, when labor is taking longer or feels sharper than expected.

Tania and Alice's story, told through the emails of doula, Amy Peterson, shows how Side-lying prevents 3rd Cesarean.
 

 

Photo: Gail Tully presenting The Sidelying Release at the Midwifery Today Conference in Harrisburg, PA, April 2012 with Jan Tritten (right) and Carol Gautschi (left). Gail shouldn't be turning her head, right?!

Gail learned The Sidelying Release from Dr. Carol Phillips, DC.

 

 

 

Many more babies and mothers can enjoy immediate skin-to-skin contact when cesareans are avoided with this technique!

 

 

 

Who benefits from a side-lying release?

  • First time mothers benefit from releasing spasm in the pelvic floor once or twice in late pregnancy.
  • Ballet dancing, horse back riding and daily running strengthen the pelvic floor so much that fetal descent can be slow and birth can be much longer. This technique may shorten labor for these women.
  • Women who have had previous cesarean(s) for "failure to progress" or transverse arrest may benefit from a pelvic floor release in late pregnancy.
  • Women who have had posterior, breech or other less than favorable fetal positions in previous births or has a baby in an unfavorable position in their current pregnancy.
  • Women with a head down baby who kicks in her right side may benefit from the Pelvic Floor Release once a week, but there isn't harm from doing a pelvic floor more often, even daily. Women with breech, transverse, or posterior babies could do the pelvic floor release once a day.
  • Women whose joints are very loose may not need it daily and shouldn't do this activity daily. Since very few women are hypermobile, this would be a rare restriction. 
  • Women on bedrest may do this technique as part of a gentle stretching routine.

Anyone can do this technique, its not just for pregnant or birthing women. If intercourse or elimination is painful due to a tight or twisted pelvic floor give this technique a try.

 
Occasionally, but not often, a woman does the pelvic floor release and gets tender or sore in the lower back, pelvic tilts or a standing sacral release relieves the discomfort in minutes.  

Is there any time you shouldn’t do a side-lying release?

  • If there is a history of fast births the side-lying release is probably not necessary.
  • In a labor that is progressing steadily there is no need for a pelvic floor release.
  • You can ask your care provider if there is any medical reason not to do the pelvic floor release. 
  • Recent hip surgery and the bruising and stitches haven't healed.
  • Any bleeding except for normal bloody show just before or during labor, or any threat of placental bleeding.
  • If you are seeing a myofascial worker, a craniosacral therapist or chiropractor, please talk to them first about doing the pelvic floor release to be friendly and respectful.
  • If You don't want to! (This is a no-bully website.) 


If you do the pelvic floor release do it on both sides. This is immensely important!

 

 

Caution: Do not do any exercises, including any inversions or twists including this inversion, or the sidelying release or pelvic floor release (same thing) if you are having cramps or pain of an undetermined origin (meaning not labor or prodromal labor, in labor its ok to do inversions as described here) before a physician can help determine that the pain is not related to the placenta. Round ligament pain happens occasionally with the inversion, not typically at all, and is not threatening, and can be solved with the Webster, with warmth and massage and breathing, or even repeating the inversion. Please pay attention to a pain that persists more than a few minutes. Report abdominal pain to your provider, actually include shoulder pain. I don't want you to put your self in a position that will dramatically change the uterus' position if there is a placental problem brewing. 

Stop these or other exercises immediately if the baby begins sudden, vigorous, frantic movements during the new position. Don't get  upside down or do the sidelying release after such vigorous movements before assessment. Have the baby's heart beat assessed immediately anytime, with or without exercise in which the baby moves frantically. Don't get upside down if you have high blood pressure or are otherwise at risk of a stroke. For your comfort, don't go upside down during heartburn or soon after eating or drinking to avoid heartburn or acid reflux.

Frantic fetal movement or placenta pain is an unusual occurance in any event, and extremely unusual at Spinning Babies, I have heard of one possible instance of each situation in the last ten years. There were warnings that were not understood, so 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 but know when to assess. 

 

When to do a sidelying release in labor?

What signs show that a side-lying release could be useful?

Discomfort in pregnancy from tight, tender areas (front or back), achy hips, or achy lower back may be symptoms that a pelvic floor release could offer comfort.
If the baby hasn’t engaged by 38 weeks gestation, a pelvic floor release may be helpful.

Left: Pelvic floor muscles (pink) have an opening for the baby to pass through. The tone of the pelvic floor (as baby comes down on the opening) is significant in fetal rotation.

 

In labor,

The benefits of a side-lying release help to over come a stall or plateau of dilation in the presence of strong contractions. In other words, the uterus is trying, its contracting. But the labor can't bring the baby down through the pelvic floor or can't bring baby down evenly.

  • Labor just can't seem to get started. Contractions start and stop.
  • Labor stalls at 5, 6, 7 cm or later. 
  • Baby's head is tipped or asynclitic.
  • Baby's head is stuck sideways, halfway down the pelvis at 0 station (Transverse Arrest) In this case, follow up with the lunge or the Open Knee-Chest position through several contractions.

 

 

Compare techniques according to pelvic station
The Sidelying Release can be used before labor, during labor contractions and between them, when baby is above the brim or down in the midpelvis. It seems from the labor that the mother's starter is broken (which isn't true), or her contractions are strong but not bringing the baby. (Contractions might slow down after a period of hard, but non progressing contractions, if the uterus gets tired of trying to move the baby.)  
 
If baby is high in the pelvis or above the pelvis, a sidelying release can still help. Then go to Abdominal Lift and Tuck through, but not in between, ten contractions. If that doesn't work, do Brim-opening Walcher's position through, and between, three contractions. These allow the baby into the pelvic brim when the baby is -3 or higher (-2 is worth a try with Walcher's) and contractions are not able to bring the baby into the pelvis (engage the baby).
To sum it up, if baby is at a high station, Sidelying Release may help; if baby is already (well) engaged, Walcher's is not likely to help, but sidelying likely will help when baby is at or near "0" station.

A nurse-midwife tried the sidelying release during a stall in a long hospital labor she was at and later said, "Now I KNOW we have too many cesareans!" (Meaning the USA has statistically too many cesareans.)

 

 

 Why are we doing a pelvic floor release?The asynclitic baby has his head tipped to the side making the head seem larger and the baby less able to help with descent

The sidelying, pelvic floor release helps balance the pelvic floor muscles.

An imbalance in the pelvic floor like this can make the baby rotate to posterior, or make a posterior baby become a brow presentation. If one side of the pelvic floor is higher or tighter the baby’s head can tip into an asynclitic presentation (tipped). This makes the baby’s head seem much bigger and molding takes longer. The baby can’t help with the birth process very easily. The mom has much more work to do. 


I’ve been at births of asynclitic babies where pushing lasted a minimum of 3 hours, with 5 being common, all the way up to one birth in which infrequent contractions that were not strong made the 2nd stage take 18 hours.

 

The pelvic floor release at home in late pregnancyThe top leg hangs forward freely

 

What should one be feeling when doing the sidelying (or pelvic floor) release?

A subtle stretch of some muscles. This technique stretches any of three muscle or muscle groups.

  1. The pelvic floor
  2. The piriformis and other Deep 6
  3. Rotators
  4. Adductors
  5. Iliotibial Band

This woman points out where she feels a slight stretch from letting her leg hang freely while her hip is held back. Not all women feel something!

Where does one get a pelvic floor release?

A myofascial therapist can help guide you through a side-lying release, if you do wish for professional help.

With a little trial and error you can probably figure out how to do one at yourself and with a friend.  At home or in the hospital, more and more nurses and midwives are trying -and loving - this technique!

 

 

Doing the side-lying release by yourself without a helper

  1. Lay on your side close to the edge of the couch. Have a coffee table in front of you.
  2. Lay your head on your lower arm. Hold the table with your other hand.
  3. Make sure your hip is right on the edge of the couch! Right on the edge so that you feel that tipping forward would make you fall off. Don’t tip forward!
  4. Straighten your lower leg. Keep your top shoulder over your lower shoulder as best you can while you hold the table (move the table first to make this easier). Keep your top hip over your other hip, this is important.
  5. Let your top leg hang forward into the air. Let the full weight of your top leg hang. Keep your lower leg straight. Breath deeply and slowly. Let your belly relax.
  6. Let your leg hang like this for 1-2 minutes in late pregnancy. Let your leg hang like this through 3 contractions if you are doing this in labor.
  7. Repeat on the other side immediately. Repeat for just as long, 1-2 minutes in pregnancy and through 3 contractions during labor.

 

How to do a diaphragmatic release from an article in Midwifery Today. This is a complementary technique.

 

 

Gail's first experience with the Pelvic Floor/ Sidelying Release

I was taught the Side-lying Release by Carol Phillips, DC at a long birth. This first-time mother got to 4-5 cm on her 3rd day of on and off again labor. Carol arrived and showed me how to do this release. The mom went right into transition and her second stage was so smooth that the baby was crowning before anyone in the room realized she was even in the pushing stage! Her baby was in an anterior position and was not asynclitic. She simply had a really tight pelvic floor. Not everyone gets that great of pain relief from this technique, but it almost always enhances labor progress in a happy and noticeable way when done to help a stall (contractions without progress). 


Dr. Carol Phillips has a video of her class learning to do the side-lying release on her youtube channel. Be sure to watch the entire thing as Dr. Carol corrects mistakes of the students who are doing it. Here is the link: http://www.youtube.com/watch?v=y-07DqjNrS0&feature=plcp