Start today, it’s never too late to get a benefit, it’s not too early to get more benefits, just start appropriately and gently.
Linda writes:
I have a mom 22 weeks pregnant with twins. Right now, it appears they have their own sac and placentas. Should we be worried about getting them head down this early on? Linda (I attended your workshop in Florida.)
Gail responds:
It’s not about getting them head down this early, Linda. Its about getting more body balance now for:
- Comfort for the growing pregnant body
- Optimal blood circulation
- So the uterus has the most room on the day the babies decide to go head down – so that they can move head down when gravity and the weight of babies’ heads unite for that moment to happen.
Balance first; a head down fetal position (at 28 weeks and beyond) may be seen as a sign of balance. Optimal fetal position for the first baby may be the result of optimal balance. The second baby will come head down if able and sometimes that first becomes possible in labor after the birth of the first twin.
These sleepy twins pictured below were breech at 40 weeks and then, with one Forward-leaning Inversion flipped head down in time for a stress-free vaginal birth.
Balancing the womb means to help the womb be more symmetrical by releasing tension, twists or torsion in the uterine ligaments. Most women do not feel discomfort from ligament spasm unless rolling over sets off a spasm, or the doctor or midwife presses on a tight round ligament in an abdominal exam or one of the babies kicks a tight part of the broad ligament. Tight ligaments feel like jabbing pain or just discomfort.
Balance Means “Make Room For Babies”!
Balance is achieved with pregnancy activities, such as the activities on this website. Professional bodywork also helps overcome torsion or tensions from accidents and I suggest fascial release and chiropractic adjustments to correct any misalignments of the pelvis. Misaligned pelvic joints pull the uterus off-center and can, at times, affect the fetal position. Women with loose ligaments may need to wear a pregnancy belt, beginning in mid-pregnancy (or as soon as you learn about pregnancy belts). The alignment of the uterus with the aligned pelvis will help baby A to flip head down.
Whatever a healthy woman carrying a single baby can do, a healthy woman carrying twins can do.
All the techniques we recommend use the body’s own weight or position to work, and none of them are forceful as long as your helper isn’t forceful. We don’t manipulate baby’s position here.
A doctor or midwife might be trained to try to manually turn Twin A (in a special type of ECV) called a Charitê External Cephalic Version whereas, if there is only one baby in the uterus, several doctors or even a midwife may attempt to manually turn the breech baby to a head down position. (See our ebook or Nicole Morales and Jamie Mossay’s The Breech Release book.) This technique is not without risk and not widely successful, but can be tried. We suggest doing the balancing activities for a week or at least every day before the procedure and especially within the hour before the doctors give this a try. We believe there will be more ease and less force. Maybe even more success/
Will techniques the parent do at home be enough to help both babies head down?
Sometimes.
Sometimes our program of Daily Activities (Daily Essentials is a how-to video) and Three BalancesSM with more balances listed under our Techniques section work. Our ebook gives a 6-day program that you can also do with twins if the first or both is breech. Will it turn the head down baby breech? Not likely! Body balance means babies find space to both be head down. – As long as there is nothing blocking their turn in a balanced womb.
We don’t know how the twins are going to affect each other’s positions. Adding a very rhythmical and gentle movement may allow them to move head down. Think of multiple sized marbles filling a jar. You want to get one more in, so you jiggle the jar a little bit. The marbles shift some. You add water and jiggle, now the marbles accommodate each other more easily. Let’s think now about multiple babies in the womb.
Two babies may be lined up like two little compact ovals next to one another or they may be curled facing each other, a bit like a puzzle. More amniotic fluid (normal, or up to a high normal amount) gives more room for a big position change.
Drinking 3 quarts or liters a day is about right. Add more if you are doing athletics (please consider gentle stretches in pregnancy) or live in a hot, dry climate. Eat salt-to-taste, meaning if you crave salt have a little, and if you “never” eat salt, I would venture to say, have a little iodized salt daily. If you eat restaurant food, you’ll get salt unless it’s a very unusual restaurant.
There are doctors who support vaginal birth of twins, even with Twin B is breech. It’s important to seek and compare.
Relax with The Jiggle. If you can’t find a helper to jiggle you, you can jiggle your own hip or thigh! Jiggling is Not vigorous. You aren’t trying to force a baby to move. This is a physiological change you are seeking and a deep relaxation of involuntary muscles.
I notice that twins moms who do several Forward-leaning Inversions in one day (not day after day!) may have babies go head down afterward. It really surprised me that it worked for these two twins held in their advocate’s arms. Their mother did only one Forward-leaning Inversion and that was at 40 weeks! They both immediately went head down. It’s more usual that a twins mom would do 7 or more in one day and then two days later the twins might be head down.
And give yourself a luscious gift of regular Side-lying Releases. Teach your partner to do them well. See the page!
When time is of the essence, for example, you are 32-34 weeks or more, you need to seek with professional help.
Hi Gail, I am a Doula in the UK, I use your techniques all the time, most recently at a lovely natural twin birth in a midwife-led unit. I use Rebozo sifting and Forward-leaning Inversion at every visit and use many other techniques in labour! Thanks for all your good work! -Selina
Hi, Gail- I took your workshop in [Massachusetts] earlier this year; loved it and have been making great use of the pelvic release [Side-lying Release] & the [Standing] sacral release techniques, esp. Last week spent some time with a doula client of mine who’s G2P1, and was 35+3 with transverse twins. We did the [Side-lying Release] and the Standing Sacral Release, some good heart-to-heart talking, moxa, and the next morning Baby A was confirmed vertex by U/S! Exciting. Many thanks for your teaching….do you ever stop & just smile thinking of how many uncountable c/s you’ve prevented with your teaching???! Michelle L’Esperance Certified Professional Midwife, N. American Registry of Midwives WarmWelcomeBirthServices.com
Having a cesarean is a personal decision with your self, your care providers, and your babies!
If you are facing a cesarean because one or both twins are breech (bottom first) or one or both are sideways, you may like to try the activities listed above and below. They may help babies turn themselves head down.
Turning depends on why a baby is breech. If it is because there is a twist in your lower uterine segment, then these “balancing activities” may work very well. Here and there, there are still Obstetricians and trained midwives (homebirth in the US) who are specially trained in breech birth skills. If you find one that is comfortable with breech, you may still be supported in a plan for a vaginal birth even if the first twin is breech. Second twins often do well with a vaginal breech birth– the gate is wide open! Choose a doctor with skills to support this common twin birth scenario. If you have to travel for your birth, remember how you birth sets how you will live.
While not all intended natural labors continue with a vaginal birth (some have cesareans because the baby or babies aren’t lined up to come into the pelvis or because of health reasons for either mother or baby). So many women could have empowering twin births. Personally, I find twin births to nutritionally well fed and healthy women go quite amazing!
More important than how babies are born is how babies are grown. You may have to find good advice yourself about diet and rest during a twin pregnancy. Here’s a good start: Midwife Mary Cronk of the UK gives Guidelines for Twin Pregnancy. If you are well nourished and healthy and stay healthy through good nutrition for your needs, you are likely to go full term.
Eat about 6 protein servings a day, including an egg unless sensitive; with 3 quarts of water; salt-to-taste; dark greens daily and other fresh veggies; one Vitamin C source such as fruit or hibiscus tea; and a couple of servings of whole grains, not so much bread as whole cooked grains such as slow-cooked oatmeal, brown rice, quinoa, bulgar, buckwheat groats (high in iron). Pour a Tablespoon of Cod Liver Oil or Krill oil on your coooked grains (don’t cook the oil!). Tom Brewer recommended a baked potato with its skin (wash it well before baking and avoid the green ones!). I’d add to make one quart of the water a pregnancy tea of bulk sourced Red Raspberry Leaf Tea (1 part) and Alfalfa (1/4 part). Other additions in the tea can attend to other needs, such as 1 part Nettles for iron. Steep 5-15 minutes and drink hot or warm.
Fascia-centered bodywork may include Craniosacral, Dynamic Body Balancing, or Fasciatherapie Methode Danis Bois. A standing sacral release sets the lightest pressure (no, lighter!) on your sacrum and abdomen and begins “unwinding” the thickened areas of the fascia. The sacrum may return to its ideal angle and release the twist it would cause in the lower uterine segment.
Asymmetrical, or balanced, the womb will allow the baby to turn and face the mother’s right hip or back more easily. Side-lying Release is the Queen of Balance. More than side-lying, you are addressing 30 or more muscles that affect pelvic alignment and comfort. See the instructions, it’s tricky! The Standing Release is from Dynamic Body Balancing. Your partner can learn to “release your sacrum” after car rides, etc. In a car, your sacrum is tilted back and liable to wrinkle a bit, like a rug irritating baby’s nose (so to speak). The main problem is that the twist in the sacrum distorts the womb and the baby has a more difficult time lining up with the pelvis and cervix during the birth. This makes birth longer. See Spinning Babies®; Parent Class Video Download for how to do it. Diaphragmatic Release is a technique of fascial therapists, craniosacral therapists, and soft-tissue trained Chiropractors (some) which amazingly helps the tissues relax around the womb. It effectively releases the round ligaments which can be so tight they hold a baby’s forehead in front. The diaphragmatic release, also called Abdominal Release, will accomplish emotional release as well. The whole-person approach resolves deep tension quickly. Protect the body balance you have just enhanced with Rest Smart positioning while you sit or lie down: https://www.spinningbabies.com/learn-more/techniques/rest-smart/
Chiropractic adjustments can help the various soft and bony structures of the body relating to the womb. One well-known release is called the Webster maneuver. It is the same as for helping to flip a breech baby. It works well for a posterior. And can be used safely for twin pregnancies. Here is a lovely case study on helping breech twins flip head down spontaneously after Webster’s Maneuver on the Chiropractic Journal of Pediatric, Maternal & Family Health: Resolution of a Twin Breech Presentation with the Application of Webster and Diversified Chiropractic Technique, by Danita Thomas Heagy, D.C
Once you balance the womb and supporting ligaments, more room will be available within the womb, the sides will be softer and more flexible. A single baby will be able to sort herself out with gravity and movement. If the twin babies themselves aren’t blocking each other, then they, too, will move into place. Techniques to use in a twin pregnancy In order:
Enjoy your amazing body! Enjoy your full family! I’m a grandmother of triplets and there is 3 times the love!!
Are the twins still breech? Is one still breech?
In what’s called an External Cephalic Version (ECV) a doctor or midwife manipulates the baby around through the abdomen to a head down position. It’s not considered safe to do with twins. Add balance and the babies will follow. At least if they can navigate past one another. Gravity pulls, so if there is room for the heavy head of the baby to settle towards the bottom of the womb it will. The second baby lying cross ways or breech is not uncommon and may not be nature’s issue. If the space is available and then gravity follows the birth of the first baby (stand up), the second baby usually turns head down.
Breech twin birth can be nearly as safe as head down twins if you have a 2-4 skilled attendants. Whether twins or singletons, every breech baby deserves a provider who knows how to rotate stuck arms out and how to bring the nape of the neck into view before helping the head out. The first twin opens the way for the second twin. So if only the second twin is breech, then many doctors and some midwives who do twins will have the skills to support a vaginal birth (if not their peer support). Read about breech vaginal birth elsewhere on this website.
There are still skilled doctors and midwives accepting parents late in pregnancy to help avoid a cesarean if vaginal birth is a healthy possibility for those parents. Most doctors today lack skills for natural breech births and that includes twin breech births.
Experts in Obstetrics and the Cochrane Data Base consider a vaginal birth of a second twin to be medically safer than a cesarean for that twin. A doctor may consider to pull out the second twin vaginally, which takes some skill but not as much as for a singleton breech and so manual extraction of the baby is safer for a second twin and should be considered before a cesarean.
The second twin may be born spontaneously, too, if contractions or gravity bring baby into the pelvis. The safety in spontaneous 2nd twin depends on how the second twin is doing. Monitoring is called for, and most 2nd twins do quite well but some don’t like to be left behind. Mama’s loving push and occasionally a gentle hand will guide them out before too long.
The best time to bring better balance into the body to encourage head down babies is early in pregnancy. The second trimester is a key time for body balancing. Still, some women can help their babies be head down later in a twin pregnancy. The hormones of twin pregnancy are wonderful! Continue the balance techniques (without the breech tilt (slant board), which is not in this category of techniques) until birth. An email
…She really wants a vaginal birth. She is with a very good OB now, but he is not comfortable doing Baby A as a vaginal breech. There are other options she is pursuing. I just wondered if doing techniques such as the ones you describe or for example, the Webster’s Technique or moxibustion would be safe seeing as how it’s twins….
My answer was something like this: I can answer with my opinion.
Non-invasive techniques such as the two you mention seem compatible with multiples as well as singletons. More importantly, let’s acknowledge the woman with a breechling who desires a natural birth or VBAC and has a doctor who doesn’t/or can’t support her desires. She desires her original birth plan strongly. She realizes her doctor isn’t on board with that but he/she is so good in other ways, and the relationship is already established. Changing providers seems more alarming than continuing with the original doctor, even if the plan for a cesarean is causing distress. The pregnant person feels they have no choice. But they are making a choice for the known option rather than seeking a new option.
So a mother of twins may try to get their twins to flip, which may happen. Focus on turning the baby becomes the only way to keep the established relationship with the doctor and continue the hope for a natural birth.
Changing providers may lead to an empowering vaginal breech birth, but such providers are few and far between. Still they exist. Sometimes knowing this option relaxes the body and the baby finds that little bit of room they needed to flip to head down.
I’d suggest self care or professional body balancing with an Aware Practitioner and pelvic alignment with a Webster Certified Chiropractor for a good team approach. Moxibustion and Acupuncture have some success as well. I think more is better than one modality. We don’t know which modality a particular body might respond to, but time is of the essence and flipping is less likely without increased balance of the soft tissues and pelvic joints.
Always talk to your babies. Have your partner talk to the first baby directly by putting a tube (paper towel roll or clean vacuum hose) to the lower right side of your belly and talking heart to heart to get baby’s attention. This will encourage your baby to look to the sound and get his/her head in an LOT position, the ideal start position. The most important thing is love.
Using the late Dr. Tom Brewer’s diet twin moms are going full term with healthy 7-8 pound babies. It never hurts to eat green leafy veggies, plenty of lean protein and a gallon of water a day, with salt to satisfy your taste in your food. 35-38 week-old twins will nurse almost hourly each, with a 2-3 hour break while sleeping; while 40 week twins may go 2 hours more often, and 3 and sometimes 4 hours when sleeping. Babies born early are at higher risk for health problems and death in the first year of life. If we can prevent premature birth we can reduce risk. Why work hard to keep the babies in the womb and then induce, or even surgically remove them, before 40 weeks? Where is the evidence of safety with that plan?
March of Dimes is giving obstetrics the dickens for causing an epidemic of premature babies when they are induced or sectioned before they are due. Some twins may need to be born early for specific health-related reasons, such as a significant twin-to-twin transfer, but that is the exception, not the routine. Ask your doctor if the induction is “just in case,” or do you have a specific risk for continuing to go to term? It’s one thing if one baby is slowing down and/or the heart rate is not variable or one baby isn’t growing, but the argument that your womb will get too big to work properly is bonkers. Eat well and get your iron and protein intake up. Full term is full term, twins or singletons. Placentas and wombs aren’t time bombs, but beautifully designed organs for safe gestation. Feed your placenta so it is healthy enough to do the work for nine months. Don’t smoke or eat junk. Every day counts. Discuss any decisions you make with your doctor and midwife.