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Walcher's to "engage" baby

This is an "engagement" technique  for labor to use only after 10 contractions with Abdominal Lift and Tuck. Walcher's Position will allow contractions to engage a baby that is high, not really in the pelvis yet. The baby may be stuck at the brim or inlet of the pelvis. Use this position through and between three contractions in a row to lower baby into a normal pelvic brim. Contractions make it work. 

Walcher's is for use in labor, but let's give a little back ground on engagement.

First babies normally engage by 38 weeks of pregnancy. Subsequent babies may engage before labor begins, or will usually engage with early labor contractions.

Engagement means the widest part of the baby's head has dipped below the entrance to the pelvis (the brim).

Standing and allowing the belly to hang forward (lordosis) keeps the brim open enough for the average baby to engage nicely. However, lack of engagement can be a cause for cesarean birth when labor contractions can't get the baby into the brim of the pelvis.

Baby has to get into the pelvis to get through the pelvis.

 

There are various maternal positions to open the pelvic brim more so baby can engage.

Dr. Walcher taught his technique for unusual cases when the baby couldn't engage and labor already began. 
He wrote a description in the late 1800s about moving a laboring woman to the edge of the bed and letting her legs hang off so the weight of her legs could pull her sypmphysis pubis far from her spine.

The wide arch opens the Anterior Posterior diameter to let the baby's head enter the pelvis.

Walcher's position is done off the side of a high, firm bed. Legs hang freely! (Yes, even though Dr. Potter put stools under mother's feet.) The pubic bone is the highest bone, opening the pelvis to let baby in during labor contractions.

 

Open the brim to let baby in

If a woman was birthing at home and didn't have a high bed, she could lay on her floor or on her low bed and use a "Trochanter Roll".  This is a 15" firm roll of bedding or a yoga bolster or such placed under the cheeks of the buttocks at the level of the trochanter of the thigh.  Alternatively, we can open the pelvic brim in a deep birth pool. Each of these opens the A-P diameter of the pelvis. 

 

"...Recently I did walchers for 2 patients with epidurals, it worked great. For one it took me and another nurse- heavy epidural. the other had great mobility so it only took me and a bit of assistance from her husband. With the second she found the postion hard so I took the wedge pillow and tucked it under her right side. She said that helped and was able to get through the 3 contractions. Both were successful."  -Marya Mollette, RN, USAF

 

 

Why Walcher's?

Walcher's position opens the brim front to back. The pubic bone opens away from the spine.

This makes more room for the baby to get into the pelvis. Kneeling opens the brim. A back bend opens the brim. Standing and letting the belly hang opens the brim a little. Walcher's opens the brim a lot.

Slouching closes the brim. Squatting closes the inlet while it opens the outlet. 

When Walcher's?

Use Walcher's when strong, frequent contractions are not helping baby to engage. The head may overlap the pubic bone or not, this is not visible usually but can be felt with your finger tips at the top of the symphysis pubis.

The baby is likely to be posterior. The chin is likely to be lifted (extended). One or both of these may be the reason, or it may be that the mother's pelvic inlet is a bit narrow front-to-back (AP diameter) for her baby's head.

Here's a story from a doula who suggested a laboring woman try this, and it was tough but effective.

Got to the mama's home and checked to see if baby was lodged (using your suggestion to palpate up from the pelvic bone), and he was not.  We got her into Walcher's position for a few minutes before she had a contraction and the intensity of her contraction in that position put her into tears.  She was unwilling to continue the position.  That was at about 9:15am.  About 30 minutes later we decided to leave to the birth center.  When we arrived at 10:15 she was checked at 6cm.  Baby was born at noon on the dot with essentially no pushing (using HypnoBirthing).  Truly seems like baby did just simply need to engage - and is possible that even just one contraction in Walcher's was all she needed.  Mama had a beautiful water birth, no tearing and is resting and overjoyed at how empowered she felt for her birth.  (Supported by an amazing husband!)...

 

Here's a story from a relieved Grandmother who found this article during an internet search:

Hello,

I’m not sure if this is the email I should contact regarding your wonderful website or not, but I just had to tell someone about the Walcher Technique for engaging the baby’s head and how it was a lifesaver for my daughter.

My youngest daughter, A____, was in labor since Tuesday night, having contractions every 10 min.  She couldn't sleep through the contractions and would get out of bed to work through the contractions.  She was literally ExHAUSTED.....the baby’s head wasn't engaged so her labor/dilation of her cervix wasn't happening/progressing.  We made two trips to the hospital (Tuesday night and Thursday night) only to come back home.  She had a midwife appointment on Friday and still no progress. 

Finally on Saturday afternoon, I searched the internet for something to tell me how to help her baby engage.  Well, the Lord led me to spinningbabies.com.  It showed the Walcher technique for engaging the baby’s head.  After four days of labor, we were willing to try anything.  We followed the directions, and it was amazing.  It said the uterus would then 'rest' and she could sleep/drink/eat until the uterus went to work again.  Well, it happened just like the website/technique said.  A___ was able to sleep for an hour and a half with no contractions.  Around 8 Sat. night we went to the hospital again and they checked her and found that his head indeed had finally engaged.  I was pretty upset that her midwives didn't know about the technique   They just kept saying to walk. 

Baby L___ was born at 3:26 a.m. yesterday (3/24/13) morning.

Thank you thank you thank you.  I only wish I would have searched web help and found your page four days earlier. 

A proud and thankful grandma, Diana D

 

 


 

How do you do Walcher's?

The laboring woman's legs hang off the bed into the air.  The legs are NOT supported. The weight of the hanging legs pulls the pelvis open more at the inlet. The edge of the bed is at the "smile" at the lower border of the buttocks. This is the level of the trochanter of the thigh bone (near the hip socket) but at the woman's back. 

 

A good support person will keep close eye contact with her face and speak soothingly to her through the approximately 15 minutes that it takes for 3 contractions to come and go.

Alternative: Trachanter Roll. Have the birthing woman lie over a large, tight, firm, roll. The roll is placed at the top of her thighs, right where her thigh bone connects to the hip socket. That's the trochanter of the femur. This is lower than the sacrum where you might imagine she needed support. 

The mother lays back like that, almost a back bend, through three contractions. She remains there in between the contractions, too. Its tough. Her lower back is not supported. Don't put the roll at her sacrum. It goes at the top of her leg bone.

 

 

 

What about Walcher's in a waterbirth?

 

 In the pool, we could call this position the Open-knee stretch. The mother's feet are actually out of the water in the first picture! Her knees are further from her head than her hips are, that's what makes this the "open-knee" - not to be confused with the open-knee chest position which is not practical for the birthing pool!

This seems to work well, too, when the mother holds the position through three contractions in a row.

I first noticed the woman in "The Long Labor that Wasn't" doing this in her birthing tub and asked her to continue with it. I've since suggested it for other women in the birth tub.

 

 Other uses of Walcher's are during a breech birth or shoulder dystocia. Those uses are not listed here, as the provider would have to have a clear understanding of the application of Walcher's in those situations. This page is more general. 

 

 

Here is a story that starts on the page that describes the Sidelying Release, it finishes here because the perservering mother used Walcher's in the water tub during her pushing stage of labor: 

...Now it was apparent that the baby was not at all low. She had a little cervix left, but it soon left (opened to full dialation at 10 cm). She'd gently pushed an hour in the bathroom and actively for another 30 minutes in the tub (after her cervix was found to have opened fully) and yet the baby wasn't coming down. In fact it was rather high. I suggested Walcher's variation for the birthing tub. She didn't seem to like me or my suggestion right at that moment, the laughter was over. She seemed to really want the relief of the tub. But contractions pressed the baby hard on her pubic bone. Once she said that I  knew what was needed was to open the brim (pelvic inlet) and let the baby's head slip off the front of her pelvic bone. So I suggested opening her brim in the tub (with the Walcher's variation) by being on hands and knees but having her knees far away from her belly, not spread open far, just hip width, but far from her belly so her feet are up and out of the water. She didn't care to do that. After a while when she asked why her baby still wasn't coming, my friend's midwife partner asked her if she would try my suggestion. She now did and it took 3-4 tries (it was hard to stay in that open position when the contraction peaked) but at least once she did and the baby slipped into the pelvis and progress resumed. 
In 7-8  pushes the baby was born in the water. She was a little slow to start but didn't need help other than suctioning her mouth and nose, rubbing her and lifting her back a little to "open her wings" so her lungs could inflate. (Rather than have her shoulders cuddled together over her chest the back is straightened so that her shoulders arch back as if she were in a standing posture but she is still in her mama's arms.)  I was tickled to have helped a family out and possibly prevented a homebirth transport with the combination of techniques. 

 

Other ways to help baby engage 

First babies are expected to engage at 38 weeks, or about two weeks before the expected birth. Read about engagement to learn more about what's expected here.

Walking briskly, chiropractic, standing sacral, and sitting up right are helpful for engagement. Sitting with feet wide apart on a firm exercise ball (birth ball) and making vigorous circles on the ball can help. Its good to rotate the posterior baby before forcing engagement when there is time to do the various methods and techniques for rotation in pregnancy and/or labor.

 

When not to do Walcher's

When the baby's head or shoulders are not stuck on the pelvic brim. When baby has engaged and/or isn't stuck at the brim. Effectiveness is usually found in 3 contractions. If not effective, recheck maternal position and if incorrect, correct the position and try for 3 more contractions.

Before: Use Walcher's before agreeing to high forceps or a cesarean when labor doesn't progress simply because the head isn't engaged.  This position was designed to avoid "high forceps" which were in more common use over 100 years ago. 

Next: Once the baby is in the pelvis (engaged) then labor may proceed quickly. If not, continue with encouraging labor in appropriate ways. 

 

History of Walcher's

Gustav Adolf Walcher was born September 21, 1856 and died on 30 06 1935 in Ellwangen (Jagst) in East Württemberg, Germany. He began his medical assistant job at the Women's Hospital under John of Säxinger. He directed a State-midwifery school in Stuttgart for his career. His commitment to breastfeeding, citing his principle. "A woman's child can give birth, it can also breastfeed." 

Old Obstetrics literature sites the first description coming from Italy in the mid 1700s. Dr. Walcher's in Stuttgart, Germany described this position carefully to German Obstetricians over 100 years later. Dr. Comstock of St. Louis sang the praises of Walcher's technique in an 1897 Obstetric review called The Medical Brief. After a short and bright promise the position was soon lost to American Obstetric literature. Walcher's reappears today in my 2011 article in Midwifery Today. 

 

Variations

The Trochanter Roll is a variation in which I learned from a local nurse-midwife using an adaptation of Walcher's for when the bed is low, or the woman is on the floor (see 2nd photo of the article).

Walcher's in the pool, or the Open-Knee Stretch is an adaptation I took advantage of when watching women labor with posterior-asynclitic babies and then asking them to hold that instinctive position through 3 contractions in a row.

I haven't seen this fail to engage a baby when the mother was in a non-progressing labor combined with lack of engagement in the 5 years since I've come across the position, but I haven't seen everything, either. Still, that's a pretty amazing observation!

 

References

Geburtshilfe Frauenheilkd 2014; 74(6): 541-543

DOI: 10.1055/s-0034-1368504