The need for professional prenatal care varies among pregnant women. Perhaps like a bell curve, some women – on one end – will not need any techniques; Most will benefit from a few, whether in pregnancy and/or during labor; And a few women in every group will need specific professional techniques. This article describes the professions pregnant and birthing women might use for fetal position or comfort needs. Each have skills to offer a mother seeking a safer fetal position for birth.
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Professionals Involved in Pregnancy
Physicians can monitor fetal position with ultrasound. When a baby is discovered to be breech (buttocks or feet first), or transverse (sideways), the physician may offer a “version,” or manually flipping the baby by turning the baby with their hands. Posterior babies are not manipulated in this manner because it is not likely to succeed. It doesn’t seem that it would easy on the posterior baby either.
An attempt to externally turn the baby, External Cephalic Version (ECV) is safer to do after the baby’s lungs are matured. The concern with doing one earlier is to wait for lung maturity in case the force of manipulating the baby can, rarely, pull the placenta from its warm nest in the uterine lining. An emergency cesarean would be done to try and save the baby. To help with the success of the ECV, a doctor keeps close watch on the baby with ultrasound and may want to use Tributaline, a drug to relax the uterine wall. This drug can make moms edgy and jittery for a short time. The idea, though, is to make the uterine wall less resistant to turning the baby. It is a drug also used to stop premature labor contractions.
Gail on preparing for an ECV: I suggest doing a week of daily Fantastic Four body balancing techniques and pelvic alignment activities with self-care and a professional before the External Cephalic Version when time allows. Midwife Maire in Rio recommends the Spinning Babies approach even three times a day for the week before the ECV and finds more babies have turned themselves and more ECVs than average (50%) are successful.
A word on manual versions
The doctor or midwife tries to move the breech or transverse baby head down by pushing through the mother’s abdomen against the baby’s body. Version carries a risk and so should never be done by an inexperienced person, no matter their title (sometimes a student, new caregiver, or bold bodyworker might be tempted to overstep their experience to try to do, what seems to them, a good deed). Monitoring the heartbeat is so important because a slowing heartbeat will be the first sign that the baby shouldn’t go further in that direction. Manual external version has risk of tearing the placenta from the womb, tightening a wrapped cord and turning the head and body without bringing the arm along, so that the arm is left in an awkward angle. Most often the version goes fine, but it has risks to be weighed with letting the baby stay breech and either having a vaginal birth or a cesarean (hopefully not until labor begins on its own).
Penny Simkin recommends a doula or other supportive person be with the mother going through the version. The trained doula often has experience with eye-to-eye contact and a type of verbal coaching that is very helpful through potentially difficult procedures such as a version.
A 2003 study, “External cephalic version beginning at 34 weeks’ gestation versus 37 weeks’ gestation: A randomized multicenter trial,” shows higher rates of vaginal birth for women who had external cephalic version at 34 weeks rather than at 37 weeks, which is currently the accepted time in pregnancy to do an external cephalic version.
Midwives must have a chance to develop their skills to feel a baby’s position with their hands. It takes time and experience. In clinic settings where appointments are short, midwives may not have the time (or the training) to tell a breech from a head-down baby in a mother who has a tight broad ligament or firm abs. But with experience, midwives can pick up the subtle details of fetal positioning. They are more likely to have palpation skills than physicians because the faster the pace of a clinic day, the less time providers have for feeling the baby. Nevertheless, sometimes its hard to tell exactly how a baby is lying in the womb.
Even when a midwife knows that baby is in a posterior, breech or transverse position, her opinion of when to do something about it can vary. Some midwives feel that we should just trust nature and wait and see what happens. This attitude will result in about a 3-4% breech occurrence at the time of birth, and a high rate of posterior presentation.
Some midwives will work with mothers to use good maternal positioning in pregnancy. They will refer women to alternative practitioners who can help achieve a better fetal position if the baby doesn’t seem to be able to do so by 34-36 weeks. A few midwives work with mothers to help the baby get head down by 30-32 weeks. Midwife Anne Frye is the author of Holistic Midwifery as well as many other midwifery textbooks. She promotes the use of a gentle method of version at 30 weeks gestation.
Physical therapy can help mothers cope with many pregnancy discomforts. Some women find that a physical therapist may be covered on their insurance, whereas a chiropractor may not be.
Prenatal Massage Therapists
Prenatal massage can be relaxing and beneficial for hormonal function and relief of pregnancy discomforts, and as a result, to get better sleep. But, “prenatal massage” is not specific for improving fetal position.
Therapeutic Massage in Pregnancy and Labor
Here is a massage that gets into making room for the baby. Therapists vary. Seek the “go-to” person for pregnancy and birth in your area. The Branco citation just below the Chiropractic description cites an article that shows that muscle stretch works.
Chiropractic spinal and pelvic adjustments can reduce or resolve pregnancy discomforts such as back pain, hip pain, sciatica, and heartburn. Chiropractic helps with optimal fetal positioning by helping the pelvis to be symmetrical. This, in turn, helps the uterus to be more symmetrical. Adjustments can help the baby to fit the brim better to engage in time to help stimulate cervical ripening. Adjustments also make the pelvis more flexible so that pelvic joints move more easily in labor.
Dr. Jeanne Ohm sends this description of Chiropractic techniques for optimal fetal positioning and easier birthing:
A chiropractic adjustment called the Webster technique is a specific sacral adjustment to help facilitate the mother’s pelvic alignment and nerve system function. This in turn balances pelvic muscles and ligaments, reduces torsion to the uterus. This may offer a greater potential for optimal fetal positioning. Originally used for breech presentations and then posterior presentations, current research is revealing the benefits of receiving the Webster technique throughout pregnancy for the prevention of dystocia. The International Chiropractic Pediatric Association offers chiropractors advanced classes on care in pregnancy, including the Webster technique. Providers certified in this technique are listed on the ICPA website here: www.icpa4kids.org.
See Dr. Jeanne Ohm speaking about natural birth and fetal rotation on YouTube. You can also watch two YouTube videos on Chiropractic Care in pregnancy to help a breech baby spontaneously flip head down.
OK — two weeks ago, after baby was turning breech to head-down daily for two weeks, I had a Chiropractor appointment. Baby was head up at the appointment. …. Baby turned head down that night and has stayed that way ever since! I’m still doing side-lying release daily, as well as daily inversions and body positioning techniques. So thank you SO MUCH!!!!!!! –Beth L.
A chiropractor can do the same, or similar, chiropractic techniques to help reposition a posterior, breech or transverse baby. Variations will reflect the chiropractor’s findings with individual women that they have helped in their experience.
Dr. Carol Phillips, DC, recommends addressing the skeletal system through adjustments, but equally addressing the fascia (with myofascial release) and the cranial rhythm (with gentle craniosacral therapy). She teaches everyone who works with pregnant and birthing women techniques that have been effective in her experience (and now in mine).
Dr. Phillips’ Dynamic Body Balancing classes give the necessary information for broad application by any bodyworker. Beginners are welcome. Chiropractors who attend will get additional instructions for when to apply particular adjustments, but the series can be taken by anyone dedicated to serving pregnant women in this way.
Ask the Chiropractor about adjustments of:
- The sacrum, both vertically (SI joints) and horizontally (for a buckled sacrum)
- The symphysis pubis
- The neck (Logan Basic is so helpful. Read a chiropractor’s birth story of how her posterior baby rotated when her own Chiropractor came at the 29th hour of labor and did Logan Basic allowing an instant labor progression!)
Neck adjustments do improve pelvic alignment, especially if accompanied by myofascial release. Not all Chiropractors are trained in Myofascial Release (see more on Myofascial Release below).
Check out Dr. Carol Phillips’ book, Hands of Love, on the womb, ligaments and muscles and how Chiropractic may help.
Emma tells how Luna’s birth was so much better!
After two long and excruciatingly painful back-to-back labours, one of which ended in a c-section and one which was a ‘near miss’, when I discovered I was pregnant with my third child I decided to find out whether there was a reason for my babies’ malpositioning and whether anything could be done about it.
Since both babies had turned back-to-back during the labour, I had experienced ‘normal’ contractions and found them perfectly manageable so felt sure that if I could just get the baby to stay in the optimal foetal position, I could have the normal, calm delivery that I wanted and was capable of.
Research showed that the chiropractic Webster Technique was effective in allowing back-to-back babies to turn so I consulted Dr Craig who confirmed that this technique would indeed help to correct some issues with my pelvis which had most likely pre-dated the pregnancies.
After only six sessions it was clear to us both that my body had resolved its major issues and all that remained to be seen was what would happen during labour.
Craniosacral therapy is gentle and can be a dramatically effective technique. Craniosacral therapy helps pregnant women as well as newborns. Newborn techniques are a little different than adult techniques (such as how the temporal bone is worked with), and so special training is recommended before a craniosacral therapist works on newborns. Carol Phillips, DC, Level 3 class is excellent for learning to work on pregnant women and newborns.
The University of Minnesota has a very informative, online presentation on craniosacral theory and practice.
Read an article by Kara Maia Spencer in Midwifery Today called “Craniosacral Therapy in the Midwifery Model of Care.”
Elden, Helen, et al. “Effects of craniosacral therapy as adjunct to standard treatment for pelvic girdle pain in pregnant women: a multicenter, single blind, randomized controlled trial.” Acta obstetricia et gynecologica Scandinavica 92.7 (2013): 775-782.
Dynamic Body Balancing
Check out the Dynamic Body Balancing techniques of chiropractor Carol Phillips, DC.
She takes chiropractic knowledge, myofascial release and craniosacral therapy with an energy approach. This is a fascinating (and a little long) YouTube video to learn about her work with pregnancy. She is addressing a potential publisher. Listen to her talk about her daughter, Angel’s difficult infancy and childhood symptoms. Today Angel is one of our Twin Cities favorite craniosacral and Dynamic Body Balancing practitioners! Maybe we should nominate Carol for the Nobel Prize, eh?
Herbs can be for seasoning, nutrition or for healing. Nutritive herbs are like special food, a food for a specific purpose. Red Raspberry Leaf, for instance, helps tone the pelvic floor and uterus. It is high in calcium and reduces leg cramps and nausea while being safely (and widely) used in pregnancy. Make sure the Red Raspberry Leaf Tea you buy is not simply flavored black tea, but the real leaf of the Red Raspberry plant.
A few drops of Mitchella can be used nightly in late pregnancy if uterine contractions seem to keep you awake without bringing labor on. A dropperful of Motherwort tincture can calm the mind to help a tired woman fall asleep, but should not be used longer than three weeks straight.
Be careful that you don’t make the mistake some people make: If a little is a good thing, a lot must be better. I rarely recommend Blue Cohosh to start labor, for instance, because I’ve noticed that it is hard for mothers to dose themselves effectively by following a “recipe.” There are other ways that are more manageable and successful without requiring the necessary experience to get a labor going and yet not cause contractions that can last too long or give a mother whomper contractions after the birth. That’s my opinion.
There are a handful of homeopathic remedies that actually help babies get into improved fetal positions. Pulsatilla (Wind flower, see photo right) is known to help a breech flip head down, and I find it helps many posterior babies, too.
There’s a body type more specific for Pulsatilla. Others may find it works for them, too, or do better with their own constitutional remedy. Side effects can occur. Please consult a homeopath.
Over-the-counter doses should only be taken for three days at a time before stopping the remedy. A typical suggestion is to take five pellets under the tongue, once at night for three nights. Take a homeopathic remedy when the mouth is clean of food or toothpaste flavors, and without touching the tablets which are too sensitive to withstand skin oils.
Some suggest to stop taking Pulsatilla for three days and then take it once a night again for three days. Then stop for a couple weeks, but continue trying maternal positions and getting body work. It is working if after taking a dose you notice the baby moving more freely. If the baby doesn’t flip after moving more freely, a more “deep” dose is indicated, but consultation is recommended. If no reaction occurs consult a homeopath. Either way, read books on pregnancy and homeopathy, or other sources.
If you have only days to “flip” a baby or are in labor with a posterior baby who is having trouble rotating, you may need a “deeper dose.” You need a professional homeopath to get a 200C or 1M. A Homeopath can make sure you get the right dose. Pulsatilla is also associated with mucous production, including the lungs. When a deeper dose is taken, there can be some associated congestion. One mom with a history of chronic asthma had an asthma attack while her baby flipped head down. Other moms have had no congestion. Consult a homeopath, please.
Acupuncture uses extremely thin needles. Sometimes you feel them and many times you don’t. Acupuncture is well studied and quite effective for helping a breech to flip. Traditional Chinese Acupuncture is also used for “all” pregnant women in the 6th and 7th month for the “Bright Baby” treatment. Needles may be placed in the ears, hands, feet, or limbs. There are inexpensive community acupuncture clinics in many cities.
Acupuncture has been shown to be more effective for flipping a breech compared to waiting to see if a baby will turn head down on their own.
Moxibustion uses a tightly rolled stick of mugwort herb much like a stick of incense. The coal at the end of the moxibustion stick is held over an acupuncture point to heat the point. Repeated 2-3 times a day for 2 1/2 minutes per side of the body has given success to some mothers in flipping breech babies. The highest rates of success came in the 34-35th weeks of pregnancy.
Unlike pregnancy massage, Maya massage is not for relaxation specifically, but for treatment. Regular sessions are part of Yucatan midwifery. It is tricky to find a practitioner outside of the Mexican Yucatan. This is highly recommended for fetal positioning if you can find a practitioner. Call around in the body work community. It’s great also for menstrual and perimenopausal symptoms, and for retroverted uteri.
Myo means muscle and fascia is the leathery coating covering the muscles and bones of our body. This technique helps relax parts of our body that we can not relax with deep breathing or rest. The uterine ligaments have an amount of muscle tissue in them, this allows the ligaments to grow with the uterus. Craniosacral therapy utilizes myofascial release and some chiropractors know this as well. It’s very useful. A chiropractor can adjust our joints, but if the fascia is constricted, bunched up, it will pull the bones back out of place (pregnancy hormones tend to allow more movement, making adjustments have a shorter “shelf life,” so to speak).
Brian in Southern California contacted me. He’s an osteopath and told me:
A D.O. who practices manipulation would fill many of your categories: doctor, chiropractor, craniosacral therapist, and myofascial release practitioner. I would encourage you to visit my site https://www.lovelessdo.com as well as the AAO and Cranial Academy pages for further information.
From Caroline Stone:
The osteopathic interpretation of optimal fetal positioning would concur with [Jean Sutton], but would also consider that biomechanical factors in and around the mother’s spine, pelvis, and hips, tighter with mechanical tensions acting on and around the uterus, would also influence the position of the fetus in late pregnancy and leading up to birth. Releasing tensions in the pelvis, hips, back and tissues surrounding the uterus is thought to relieve physical stress around the uterus, making its mechanical environment as accommodating as possible, thereby allowing the fetus to align itself in the most optimal position.
Ms. Stone adds:
…It should be stressed that the osteopathic approach is not to perform “external cephalic version’….
This article was published in Visceral and Obstetric Osteopathy, Caroline Stone, Page 296, Copyright Elsevier (2006). Permission was given to include this quote on Spinning Babies Website and not elsewhere.
All of us can move with more balance and relaxation. The British Medical Journal did a study on the Alexander Technique. It does not discuss pregnancy, but does show how the Alexander Technique has been proven to reduce chronic back pain in six lessons without drugs or contraptions. Consult an instructor in how to use this in pregnancy. Watch a very nice video from the BMJ on the Alexander Technique. I loved my first appointment and do want to continue!
You can see that the listing here allows women and their babies to move into position, so to speak, to help themselves in a gentle, non-invasive manner. I’m not always against interventions and sometimes invasive interventions become necessary. But when we help ourselves become symmetrical and to relax involuntary muscles, then the baby and body can do what they are well designed to do, and often the invention is no longer needed.