Caroline - posted on 09/18/2009 ( 1 mom has responded )
This is the only complication I had...or I should say MIGHT have had, if it hadn't been corrected in time. Most doctors don't know how to do it. It is chiropractic, so it is only something that natural practitioners usually know about. My baby was positioned posterior, and my midwife turned my baby in less than 20 minutes, so I avoided the dreaded back labor that usually ends in transfer from home to hospital.
Once there, epidurals are usually needed, because of increased pain from the back labor. Then the usual cascade of interventions: epidural-->pitocin-->more epidural-->more pitocin-->baby's heartbeat slows from all the drugs-->emergency cesarean.
I was SO BLESSED to have had a midwife who knew how to turn my baby, so he was born at home in 3 hours, gently, and romantically, with just my husband present.
Here is the article:
There is an excellent way to change persistent posterior babies that has worked every time I have used it. It may need to be done several times in late pregnancy, but it will turn the baby every time. It is a chiropractic technique called a diaphramatic release. It is non-manipulative and easy to learn. I learned it from Dr. Carol Phillips, who teaches chiropractic care for pregnant mothers and newborns. Every midwife should know this technique. I no longer have any posterior babies. Neither my mothers nor I miss those long hard back labors!!
It is easy to recognize a persistent posterior baby. You cannot feel the back on palpation, rather only little lumps and bumps of limbs. To do a diaphragmatic release, it is best to have the mother lie on her back. If she is in advanced pregnancy and this makes her very uncomfortable, you can have her lie in a recliner or semi-sitting position. If you use that position, place a small pillow or adequate support behind her lower back.
One hand will go horizontally across her lower back where the uterine ligaments attach. This is where you would put lower back pressure during labor. You do not need to press, as just the pressure of the mother lying on your hand will be sufficient. (Be sure you take off any rings you may be wearing, for your hand's sake!)
The top hand will go on top of the abdomen, horizontally just above the pubic bone with the thumb upward. Just rest it lightly on the abdomen, no pressure. Then all you have to do is wait. Things may start right away or it may take several minutes before you feel anything. What you will feel is a motion beneath your hands. For the hand in back it will feel much like it does when there is a contraction taking place during labor as you feel the muscles tighten and contract beneath your hand and release. For the top hand it will be either a waving motion or a circular motion under your hand. At first you will think you are just imagining it, but you are not.
The best description I can give is that it feels as if the mother has a tennis ball in her abdomen that is being bounced back and forth between your hands. As it hits one hand it will roll across it or around underneath it and then bounce back to the other hand. Sometimes the motion is so great that it will actually make your hand wave on the abdomen. Sometimes the mother will feel things inside, sometimes not. What she feels may not be located where your hand is located.
The movement under your top hand may stay all in one place or move around. If it moves, try to gently follow it with your top hand to keep it centrally located under your hand. Do not move the back hand. Sometimes it will move around in a circle, sometimes off to one side, or even clear down to a hip. It all depends on the muscles that are involved and the type of injury that precipitated all the spasm of abdominal muscles.
Our muscles really only know how to contract and shorten, not how to relax and lengthen. They depend on another counter muscle to contract and pull the first one out of contraction. Abdominal muscles do not have as many counter muscles, so this technique allows the muscles to relax.
If you go back into the mother's history, you will almost always find a history of a car accident (especially with a seat belt on, where there has been a twisting of the abdominal muscles because we use only one-shoulder restraints) or severe fall. However, I have had a mother cause it simply by doing too much hoeing in the garden.
You continue the diaphragmatic release as long as you feel motion under your hand. Usually it will just fade away and you will no longer feel it. Sometimes, if you end up over a bony prominence, it will end with a vibration. The process takes some time, often at least 20-45 minutes. But if you consider the time you save in labor, it is well worth it. You may need to repeat the process over several visits. I usually start at about the 6th month unless I have a mother with a history of car accident or several prior posterior babies.
This procedure has also been used this technique to turn breech babies. I use it for transverse but find it less effective for breech. I usually use a tilt board for breech and then do a diaphragmatic release after the baby turns. It works marvelously well for posteriors. I have never done one where the baby did not turn to anterior. However, on some occasions, after a few days the baby will turn back to posterior and you will need to repeat the process more than once. The more severe the history, the more likely you will need to do it several times before the baby will stay anterior.
Posterior babies use to be the worst problem I had in births. The long hard back labors wore us all out and occasionally ended in transfers for maternal exhaustion. I am thrilled not to have these any more. Now my biggest problem is cervical lips! But I am working on a solution for that also, using evening primrose oil!
I do believe every midwife should have this valuable tool, the diaphragmatic release, in her bag of tricks. It is so easy and non-interventive. It is much better than other suggestions I have seen of putting your fingers in the baby's suture lines and trying to turn the head!