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Roll-over

This is an alternative for Hands and Knees positionA series of poses for labor when progress is slow. Contractions help this technique to work effectively.  Penny Simkin and Ruth Ancheta call it the Roll-over and it is featured in their Labor Progress Handbook


At Spinning Babies, I've said, when you want to move the baby, move the mother. This technique literally rotates the mother to help the baby rotate! We've used variations of this technique for many years. The mom shown here is in a variation of the Hands and Knees position, the start of the "Roll-over."

What is the Roll-over?

The Roll-over is a series of gravity-friendly maternal positions in which the birthing woman rests in eight positions as she "rolls over." 

 

Why use the Roll-over?

The various positions give the woman a vairety of positions to rest in that may assist labor progress. This may be to rotate the baby, but also just to simpy let the baby "explore" which position helps descent. Sometimes, one particular position is noticeably more effective and for other labors, its a combination of all of the positions and the movement of the mother. 

When a woman is confined to the bed because of blood pressure concerns or due to the numbing effect of an epidural or narcotics, her support people can help her change positions. The Roll-over is a great way to keep track of which position to choose next - its simply the next position you would use if you were rolling over and stopping at each quarter turn or less.

 

When to use the Roll-over

Unlike many of the techniques on Spinning Babies website, it is ok to use this technique even when labor is progressing regularly. In the case of "Normal" labor, the idea is simply to rest in various Gravity-friendly positions.  

But when labor progress is slow, the Roll-over gives a systematic rotation for the mother's positions. 

When labor contractions are coming regularly and somewhat strong (or quite strong) but progress has either stalled or is slow. The baby may be known to be in a posterior position, or has his or her head deflexed (the chin is up or not well flexed).

The Roll-over can be used in pregnancy, too. 

Move the Mother to Move the Baby
Right side-lying Hands and Knees position for birthing Left side-lying
Start on one side, belly to mattress Move to a belly down position Next, to opposite side, belly down
     
I like kneeling belly down rather than taking a turn to semi-sit in bed There are two ways to lay on one's side. Leaning over or with hips stacked and a pillow from knee to ankle. Use both. A fun way to be belly down is to lie on pillows with two semi-inflated swim rings to support the bump. A pillow under the pubic bone, breasts, and to lift the feet are essential. 

You can find the original "Roll-over" drawings in the Labor Progress Handbook for better clarity. These drawings and photos are adaptations of Penny Simkin and Ruth Ancheta's actual and original Roll-over.
 

How to use the Roll-over

  1. Start with the Hands and Knees position. For two to three contractions, the mother rests on her hands and knees. She can certainly have her forearms resting over the raised back of the hospital bed or leaning on a birth ball to save her wrists from strain.
  2. After three contractions, the mom lays on her side. Either side. Let's say left side. A long pillow or rolled blanket separates her knees AND ankles to reduce pulling on her pelvic ligaments. She lies with the right hip directly over her left. Her back is straight and she doesn't lean forward or backward in bed.
  3. After three contractions, she rearranges herself so that she is now leaning quite forward. A pillow is there for her higher shoulder. The pillow between her legs is moved in front of her abdomen so that her right knee can be bent and rest upon a high pillow.  I call this, Left-lean over. Its a common "Bradley class" relaxation pose. The mother's belly button points into the matress as much as possible without lying on the baby. A pillow-y nest will raise the mother's pelvis and ribs a bit to give baby room, if needed.
  4. After three contractions, the birthing mom gets into an Open-Knee Chest position if she is able to move readily (if a woman is "on an epidural" she will need a lot of help and some open minded providers!). If not, she goes to the next position.
  5. After three contractions,  she lies on her right side, Right-right angle.
  6. After three contractions, she  lies on her right side, leaning forward as described above for the Left-lean over. So she is now, Right-right angle.

She starts again with Hands and Knees position. Continue this for two more rounds, if that is even necessary.

 

Open-Knee Chest on hospital bed in Trendleberg

 

This mother is in an Open-Knee Chest position while backwards on the hospital birthing bed. Its a form of an inversion.

An inversion is only appropriate if the head is engaged in a posterior, asynclitic, or deflexed (extended) position. Three contractions in this position, with or without the part of the bed where the mother's head is being lower than her knees.

 



  Other doulas have called this concept, "flipping pancakes."

 

Before doing this or other gravity-dependent techniques, relax the abdomen with Rebozo sifting, a sacral release and an inversion.

 

Roll-over to get to 10 centimeters dilation

The Roll-over is also useful to reduce an anterior lip. An anterior lip is when  a bit of cervix, less than a complete circle of cervix, is coming in front of the head. The mother wants to push or the care giver wants her to push. Instead of having the care giver manually push the cervical lip back over the head (which doesn't address the cause), the mother might try a round of the Roll-over tecnhiques.

 

Roll-over for flexion

The Roll-over may also be useful for helping the lifted chin to tuck. When the care giver can feel the front fontanel during a vaginal exam, this technique may help the chin tuck, which means, increase the flexion of the head (neck). The baby whose head is flexed fits the pelvis better, can rotate more easily and can descend more easily. Sometimes head flexion is the difference between a long labor or even a cesarean and a vaginal birth.


Around the country, nurses, doulas and midwives praise the effectiveness of this series of maternal positions. Some call it flip-flop. But I have another series of techniques for resolving shoulder dystocia that I call Flip FLOP, so I don't choose to have two techniques called the same thing.

Labor Progress Handbook by Simkin and Ancheta

 

I chose the same name used in the Labor Progress Handbook by Penny Simkin and Ruth Ancheta. Visit PennySimkin.com to buy the 3rd edition of the Labor Progress Handbook! This is one of the most important books available to avoid that unwanted cesarean due to a slight malposition in the baby's head.

 

 

 

When not to do this: Of course, some positions might be avoid if the mother has high blood pressure or the baby gives a deceleration in the heart rate during that position. These are rare occurances that don't warrant us avoiding the technique unless proven otherwise. Use discretion, but also confidence.

  • If your baby isn't engaged yet and labor has begun, focus on getting baby engaged with the Abdominal Lift and Tuck and/or Opening the Brim first!!!

 

Before: Before any series of activities using gravity and motion, I like to suggest activities for balance. The sidelying release may be helpful when possible. 

Next: If this set of general postures doesn't work in an hour or two, get specific to the baby's station and presentation to choose specific techniques. Of course, that can be done before, depending on the time you have. 

 

Try the lunge, dangle or dangle while grasping a rope or shawl overhead.

 

The roll-over is a favorite in Labor and Delivery wards. If the laboring woman must be in bed, this is a good option! Add a bed-lunge as needed to open the midpelvis. 

 

Illlustration coming

Illustration by Shanna dela Cruz (c) Ruth Ancheta 2004, reprinted by permission from Simkin, P. & Ancheta, R. (2005) The Labor Progress Handbook:  Early Interventions to Prevent and Treat Dystocia.  Oxford:  Wiley-Blackwell.