What is the Forward-leaning Inversion?

Why do the Forward-leaning Inversion in pregnancy?

The Forward-leaning Inversion potentially makes room for a good fetal position by untwisting any ligaments to the lower uterus and cervix that may be wound up from sudden stops or a twisted posture.

Kneeling afterward also allows temporarily lengthened ligaments to align the uterus with the pelvis. The cervix may become less tipped or tight and then be able to let the baby’s head position better, and the cervix to dilate in labor more easily.

This technique may also reduce back pain, hip pain, or tailbone pain. Improved fetal positioning does occur too. It is a very worthwhile activity because simply turning the baby’s head down is a notable achievement in and of itself.

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.

Learn how to do the Forward-leaning Inversion by watching Gail Tully teach it to pregnant parents 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 DVD or digital download.

1. Kneel on the edge of a couch (or the top of the stairs). Kneel high to see what it feels like in your body.
2. Hold the edge of the couch, bed, or other surface you are kneeling on.
3. Carefully lower yourself to your hands on the floor and then lower yourself more to rest on your forearms. Keep your elbows out and hands close. Use a stool or step if you’d like, to help you walk your hands down.
4. Let your head hang freely, but keep your chin tucked. Don’t rest your head on the floor. Your neck may need a little movement. Straighten your shoulders to make room for your head.
5. 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.
6. You can flatten your lower back (posterior pelvic tilt) to make more room for the top of your pelvis.
7. Take three breaths. Loosen your belly, but keep your shoulders strong. Tuck your chin and keep your neck long.
8. Come back up on your hands, then lift yourself up to a high kneeling position again (see image above) using a stool, a block, or an assistant. Take two breaths here, then sit on your heels.
9. Swing your feet out from under you. Keep your feet together, moving like a mermaid to prevent a pull on your symphysis pubis (pubic bone) and protect your pelvic stability.
10. After leaning forward on your elbows, come all the way back up to a high-kneeling position. Take two breaths and then sit on your heels for one more breath. That way you let your ligaments settle into a more symmetrical location while you catch your breath.

Do this once daily for 30 seconds (roughly three breaths).

For babies over 30 weeks gestation who are breech or transverse (lying sideways), see 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?

Sometimes labors have strong contractions without any progress in cervical dilation. Please consider doing a Forward-leaning Inversion in these situations. This technique is especially good if the baby is waiting to descend or rotate at -2 station, or remaining at 0 station but with strong contractions.

You can do Forward-leaning Inversion in early labor as your daily inversion, but if labor hurts or lasts longer than expected, then do another Forward-leaning Inversion at that point.

This technique is 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!

1. In the hospital, get on your bed on hands and knees and face the foot of the bed.
2. Put your elbows on the foot portion of the hospital bed (or a chair beside the bed). Have your helper push the button to lower the foot of the bed until your hips are much higher than your shoulders.
3. Continue with instructions until you are through one contraction, then raise the foot of the bed and be helped up to a full kneeling position.
4. Carefully lower yourself to your hands on the floor and then lower yourself to your forearms. Put your elbows out and your hands close. Use a stool or step if you’d like, to help you walk your hands down.
5. Let your head hang freely and tuck your chin. Don’t rest your head on the floor, as your neck may need a little movement.
6. Your knees should be close to the edge, with your bottom up high. You can tilt or sway your hips if you’d like.
7. Flatten your lower back (posterior pelvic tilt) if possible, to give more room to free your ligaments.
8. Take deep breaths and hang in there for 1 contraction, then come back up to kneeling with the help of an assistant. Keep your belly loose and your shoulders strong. Tuck your chin and keep your neck long.
9. Come back up on your hands, then lift yourself up to a high kneeling position again, using a stool, a block, or an assistant.
10. You can repeat this through one more contraction (or about 15 minutes later).

Repeat 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!

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

• If your baby is breech, do the Forward-leaning Inversion for 30 to 45 seconds several times a day. I suggest 7 times in one 24-hour period for babies remaining breech after 32 or more weeks, but not day after day.
• Then do the Breech Tilt for 5-20 minutes and follow up with the Open knee-Chest position. Do not do Breech Tilt or Open-knee-Chest with an already head-down baby.
• Balance your muscles and pelvis in more ways if a day of repeated FLIs does not flip the baby.

Alternatively, you could use an inversion table if you have access to one. See this and other techniques in Flip A Breech.

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 it?

All pregnant women without a contraindication can do the Forward-leaning Inversion in pregnancy and during each phase of labor (early, active, and pushing).

When should you not do it?

• If medical contraindications exist for going upside down, such as high blood pressure or another risk of stroke
• If you have heartburn, glaucoma, or hypertension
• In cases where amniotic fluid levels are unusually large and the doctors are worried and measuring weekly
• 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
• 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 normal.) A severe headache should be evaluated by a physician immediately
• If your labor is progressing normally. 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 days/times before a steep inversion.
• Use a stable surface where you can carefully lean forward to rest your forearms below your knees. Hold this 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.

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.

Are there any good alternatives?

If you have an inversion board, you can use that instead. Standing sacral release and chiropractics are helpful too, although they don’t have quite the same success.

What if my provider says not to do inversions?

Here’s an example I received:

Gail,

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.

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.