Why do the Forward-leaning Inversion in pregnancy?

The Forward-leaning Inversion let’s the uterus hang by its own ligaments, to slightly lengthen and thereby untwist the ligaments supporting the lower uterus and cervix. 

The cervix may become less tipped or tight and then be able to let the baby’s head position better. We believe this technique prepares the cervix to dilate in labor more easily.

Reduce back pain, hip pain, or tailbone pain with repeated FLI (once daily is usual). Improved fetal positioning may result. A breech or transverse baby may turn head down. Forward-leaning Inversion can be done even if baby is head down and there are no suspected positioning issues.

How to do a Forward-leaning Inversion in pregnancy

Please be care when attempting this technique. Don’t drop into place. Move slow and be controlled to prevent falls and protect your placenta and ligaments from a jolt.

Learn how to do the Forward-leaning Inversion by reading the directions below outloud with your helper. You can also watch it taught on video in our Birth Preparation online course, or in our Spinning Babies® Parent Class and Daily Essentials videos. Parents across the globe are using these techniques for comfort in pregnancy and easier birth—and they’re working! Both are available on digital download/streaming.

You need a stable surface to kneel on higher than the spot your elbows will rest.

• The top of a stairs can actually be ideal. Your arms will rest on the 2nd or 3rd stair, depending on your height.
• If you kneel on the couch, you could place a stool next to you to help you walk your hands down to the floor and back up again.

Before you start, do some shoulder and neck circles to warm up.

1. Kneel on the edge of a couch (or the top of the stairs). Start with your head and shoulders high as you kneel. Feel this starting position in your body. You will return to this position at the end. You start in the “ending position.”
2. Now move your hands to the edge of the couch, bed, or other surface you are kneeling on. This is the “safety position”.
3. Carefully lower your hands one at a time to the floor. Then lower yourself more to rest on your forearms. Elbows are out and hands are close. This is the inverted position.
   • Let your head hang freely, but keep your chin tucked. Don’t rest your head on the floor. You can move your head if you like. 
   • Straighten your shoulders to make room for your head to hang. Do not use a pillow for your head. Do not rest on your head. 
   • Your knees should be close to the edge, and your bottom up high. You can tilt or sway your hips if you’d like, or gently, slowly undulate your spine.
   • You can flatten your lower back (posterior pelvic tilt) to make more room for the top of your pelvis. You can make slow movements in your spine and neck or not.
4. Take three breaths. 
   • Loosen your belly, but keep your shoulders strong. 
   • Tuck your chin and keep your neck long.
   • Come up early if your head pounds. Next time do neck circles before you begin to reduce the chance of your head pounding.
5. Come back up onto your hands, then lift yourself up to the safety position and then to the high kneeling position (ending position) again (see image above). You can use a stool, a block, or an assistant to help you up. Take two breaths here, then sit on your heels.
6. Swing your feet out together from under you. Keep your feet together, moving like a mermaid to prevent straining your symphysis pubis (pubic bone).

Do a Forward-leaning Inversion once daily for 30 seconds (roughly three breaths).

Breech or Sideways? After 30 weeks gestation we have some more tips. See our pages on breech or transverse (lying sideways) baby positions for additional recommendations.

Please note: When we first get upside-down, our body warns us with a throbbing head. After 3-6 times your body will realize you intend to be upside-down and your head will stop pounding. Just get up early if this happens and try again, one time each day. The feeling will go away soon enough.

Why do Forward-leaning Inversions in labor?

You may like to do a Forward-leaning Inversion once in early labor just to ease cervical dilation (shorten labor or lessen labor pain). That would be a proactive use of FLI.

Sometimes labors take longer than expected. Sometimes labor hurts more than easy to cope with the pain. Perhaps there are strong contractions without progress in cervical dilation. Sometimes a baby might be found to be in a less than ideal position, with the back on the right or towards your baby (spine-to-spine). Or sometimes baby is waiting behind a bone. Please consider doing a Forward-leaning Inversion in any of these situations. If you can hold the position for one contraction then the contraction will have another option to move baby out of the stuck position or the pain may be less afterwards, too.

This technique is also particularly helpful for a tight or swollen cervix, asynclitism (add Side-lying Release), deep transverse arrest (add Side-lying Release), or when a baby simply won’t come down despite a good position (add psoas release).

How to do a Forward-leaning Inversion in Labor

Remember: Don’t go fast, and do your best to protect yourself from falling.

Coming back up to kneeling makes this technique work best!

In a hospital bed,

1.  Begin in an hands-and-knees position on the electric hospital bed. Face the foot of the bed with your elbows on the foot portion of the hospital bed. 
2. Have your helper push the button to lower the foot of the bed until your hips are much higher than your shoulders. Now you are in the inverted position.
3. Have another helper or doula lay down and look at you so you can see their face.

If you are not in a hospital bed, simply follow the instructions in the pregnancy description above. Remember to:

• Let your head hang freely and tuck your chin. 
• Allow your neck a little movement, if you like.
• Tilt or sway your hips if you’d like.
• Flatten your lower back (posterior pelvic tilt) if possible, to give more room to free your ligaments. Do this if your baby is posterior, large or stuck in the pelvis. 

1. Take deep breaths and hang in there for 1 contraction, then come back up to kneeling. It’s best if an assistant will keep their hands on you at all times to prevent a fall! 
2. If in a hospital bed, raise the foot of the bed back to match the mattress and you’ll be in hands-and-knees once more. 
3. In all cases, if you are able, be assisted to come up to a full kneeling position. 

 Use a stool or step if you’d like, to help you walk your hands down.

You can repeat the FLI through one more contraction (right away or about 15 minutes later).

Repeat FLI once during each phase of labor (early, active, and pushing) if necessary, but be sure to have a provider ready to catch the baby if you were pushing, just in case this was the technique you needed! You can do a FLI through more than one contraction, coming up between, when overcoming labor dystocia (stuck baby).

How to do a Forward-leaning Inversion to help a breech baby turn head down

• • If your baby is breech, you might try the Forward-leaning Inversion for 30 to 45 seconds several times a day. 
  • For one day, do FLI 7 times in one 24-hour period. This is suggested for babies remaining breech after 32 or more weeks, but do not do 7 FLI day after day. If one day of 7 FLIs doesn’t turn baby by the next day, other techniques will likely be necessary.
  • After each FLI or up to three times a day, do the Breech Tilt for 5-20 minutes or the Open knee-Chest position. Do not do Breech Tilt or Open-knee-Chest with an already head-down baby. But you can do one FLI a day with a head down baby, for 30 seconds or three breaths, as above. 
  • Balance your muscles and pelvis in more ways if a day of repeated FLIs does not flip the baby.

  See this and other breech turning techniques in Flip A Breech, or buy our Helping Your Breech Baby Turn ebook. If you like detailed instructions with video, See our Breech for Pregnant Parents online offering. 

  

Tight before and loose after daily use of the Forward-leaning Inversion. These images don’t show a twist, but that can happen too.

When Should You Do FLI?

All pregnant women without a contraindication can do the Forward-leaning Inversion:

• Daily in pregnancy
• When there is pregnancy discomforts including constipation, stiffness, back pain, generally uncomfortable with baby’s movements or kicks
• When baby isn’t in an ideal position (head down on your left side is generally the most ideal)
• During each phase of labor (early, active, and pushing)
• Some will do an FLI with a contraction (when baby’s head is caught behind a bone)

When should You Not Do FLI?

• If medical contraindications exist for going upside down, such as high blood pressure or another risk of stroke
• If your baby isn’t growing well and has Intrauterine Growth Retardation (IUGR),
• If you have heartburn, glaucoma, or hypertension
• In cases where amniotic fluid levels are unusually large and the doctors are measuring your fluid levels with weekly or more frequent appointments
• If you have a sinus infection and going upside down is especially uncomfortable
• Right after eating, to avoid potential heartburn
• If there is a suspected or known problem with the placenta in pregnancy, including bleeding (but just an anterior placenta is not a reason not to do FLI)
• If you have uterine pain of an undetermined origin. If this is the case, get assessed immediately
• If the baby is having, or has had, frantic vigorous movements. Be sure to have the baby assessed immediately
• If the inversion causes unexpected pain. (Remember, your head may pound a bit for the first few times, but that’s not painful, just weird.) A severe headache should be evaluated by a physician immediately
• If your active labor is progressing well, you might prefer to Enjoy your labor!
• If there has been abundant fluid in labor and the baby is high at -2 station or above, and the water has released with the baby’s head high (in which case, open the pelvic brim with Walcher’s or a variation of Walcher’s)
• If you simply don’t feel that this is right for you (always trust the mother’s intuition and respect her choice)

Be Safe Doing Inversions

• Ask for help the first few times you try this. Have someone help you to move slow.
• If you are already in your third trimester, do a very mild (not steep) inversion a few times before trying a steep inversion to get the movements down.
• Use a stable surface where you can carefully lean forward to rest your forearms below your knees. Hold the edge of your surface before moving your hands to the floor. Do not go from a high kneeling position all the way to the floor in one movement!
• Be sure to get up and down gently, without dropping, thumping, tumbling or twisting.
• If your abdominal muscles have extreme separation you must be especially careful. Wear a pregnancy belt and go slow!
• If your shoulders are weak or too tight to support you in an inversion, you’ll feel stress. Roll your shoulders first and don’t begin with a steep inversion.
• Read the warnings and when not to do FLI. Please!

Warnings, contraindications, and guidance–PLEASE READ!

Listen to your body and check out unusual symptoms with your physician BEFORE going upside down. Thousands of women are getting mild or dramatic benefits from the inversion, but there are risks. Here’s what we know at this time.

Round ligament pain happens occasionally with an inversion. Round ligament pain is not typical, nor health-threatening. Round ligament spasms can be resolved with the Webster, self-care, warmth, or a specific sort of self-massage. It’s okay to repeat the inversion carefully (for 30 seconds) even though this is happening. The inversions may resolve the spasm but the Webster is specific to resolving this type of ligament spasm.

A pain that persists more than a few minutes or is especially severe deserves attention. Report any abdominal or shoulder pain to your provider. Be sure you understand the warning signs in pregnancy.

Don’t drop fast! One mother whose abdominal muscles were very separated dropped fast from a high bed and partially separated the placenta. She and the baby had to remain under observation in the hospital until she gave birth several days later (the mother and baby were both healthy). Another woman with a history of placental issue and high blood pressure experienced separation and had to have an urgent cesarean. 

Please note: The cloth is NOT in the groin but rather on the thighs, helping hold the mother’s weight. If done during a labor contraction, a doula or calm loved one would be in front of her face and under the table to give eye contact.

Inversion Video with pros and cons

Emily and Ludvig are 36 weeks pregnant (8 months) and their baby has turned sideways — into a transverse lie.

Emily uses the inversion to help “balance” her cervical ligaments that may be tight and twisting her lower uterus. She is also seeing a chiropractor and a midwife. If this doesn’t work, she may also visit a craniosacral therapist or Maya massage therapist. She’d like to have a natural birth, so it is important that the baby turn head down. The next day, the ultrasound done before the doctor tried to turn the baby showed the baby had turned head down!

We do see a couple actions that we have corrected in our education. Do come up to a high kneeling position and do so with someone holding on to your arm so you don’t fall if your blood volume can’t keep up with your movement upwards! Some people get light headed when they stand up, and so people can get light headed when they swing up to kneeling after FLI. Also, Emily puts one knee down before the other and this twists her symphysis pubis (pubic bone cartilage). That can strain the pubic bone and cause pain. Keep the knees together if you have to slide your knees off the couch or see how to do the mermaid when you get up. Here’s a photo of a good support hold for coming up to a high kneeling position after FLI – this is the best finish position before “mermaiding” your legs off the couch or bench.

How can you tell if the Inversions worked?

After doing Forward-leaning Inversions for a week, you’ll likely notice more ease in your back and neck. Your shoulders will be stronger. You may feel more fit in general.

If baby has been head down, you may just feel more comfortable. Baby may not move to the left until labor, but this technique is helpful with other techniques to prepare the body so that baby can turn through the pelvis with more ease in labor.

A breech baby often needs more techniques than just FLI. However, when a breech baby turns head down, kicks will be stronger in the top of the uterus than they felt before. You may feel more of the weight of the baby in your pelvis and this may change the way you walk, if late in pregnancy.

A baby in a transverse lie is lying sideways and in the last trimester of pregnancy, the pregnant belly generally looks wider side-to-side than top-to-bottom. When the baby moves into a vertical position the womb will look different, suddenly longer top to bottom and narrower on the sides.

Once head down, baby’s kicks will be strongest above the navel towards the ribs. One side of the womb may have a large portion of baby (the firm back) while the other side may feel softer and limbs might be felt. Alternatively, there may be limbs on both sides and “all over” the front without such an obvious firm side when baby faces the front. Learn more at Belly Mapping.

If you do this technique in labor, you’ll feel different afterwards, generally. There may be more comfort during contractions after the inversion (and sometimes during!). A baby is occasionally born quickly after an FLI aligned the uterus and baby if they were only a little off before. We see this sometimes when an FLI is done hours or days into a long labor. We notice that Daily Activities (or Daily Essentials) can sometimes prevent long labors or overwhelming labor pain.

Are there any good alternatives?

If you have an inversion board, you can use that instead. Standing sacral release and chiropractic/osteopathic care are helpful too, although they won’t reach the uterosacral ligaments. Here is a blog about alternatives to FLI.

What if my provider says not to do inversions?

I’m not here to conflict with your provider’s advice. Here’s an email to show how providers sometimes think about FLI:

I was hoping you could help me out… a CNM who saw one of my clients told her not to do inversions because it could cause the baby to become breech. Any help that you could offer would be greatly appreciated!

My response was that the CNM has palpated this mother’s abdomen. Perhaps the mother has polyhydramnios (far too much amniotic fluid), or very loose muscle tone even with normal amniotic fluid. I add that Intrauterine Growth Retardation (IUGR), a condition caused by placental insufficiency, may be a reason not to do Forward-leaning Inversion.

A normal pregnant woman with a head-down baby who does the Forward-leaning Inversion for 30 seconds at a time is not likely to flip her baby to breech. Sometimes a concern means the provider will advise to avoid an inversion. I’m going to leave the decision-making between the care provider and, perhaps, her experienced myofascial worker/chiropractor.

A provider might confuse Forward-leaning Inversion with the breech tilt or the Open-knee Chest position. These are not the same inversions, as they are done much longer. I’ve been recommending FLI for years and following many women through their pregnancies using this technique successfully. It is possible that a baby could turn breech. 

Of the hundreds or possibly thousands of women doing this inversion, there are understandably going to be some bad outcomes. I would very much like to be told about these cases.

Report any complications of pain or immediate bleeding, and describe the situation exactly, including the date, gestational age, health concerns, the way you did the inversion, whether it was your first attempt or not, and the time of complication. You can email me at gail@spinningbabies.com.

Please contact me if you have any concerns

Of the hundreds or possibly thousands of women doing this inversion, there are understandably going to be some bad outcomes. I would very much like to be told about these cases.

Report any complications of pain or immediate bleeding, and describe the situation exactly, including the date, gestational age, health concerns, the way you did the inversion, whether it was your first attempt or not, and the time of complication. You can email me at gail@spinningbabies.com.