Friday, May 31, 2013

Inversion - Going Upside-Down to Make Things Right!

For years in my childbirth education classes I would joke with my students about how the only position worse than laboring on your back would be laboring upside down.  We all laughed and thought it was hilarious to imagine a women doing handstands in labor.  Funny how perspectives can change.

I was originally introduced to inversions by my chiropractor, who specializes in pregnancy and pediatric chiropractic care.  I often invited her to come to my childbirth classes to talk about the importance of posture, optimal fetal positioning, and chiropractic support in pregnancy.  Since many of my doula clients also saw her, we have always had an open relationship about ways in which to help laboring mothers.

The first time I went to her office with a client in early labor she had my client put her knees on the adjustment table and her hands on the ground.  I thought it was a bit odd, but I have seen a lot of odd things in this job that end up working!  It didn't make sense to me at first, but the more I asked, the more I pondered, the more I practiced it, it began to make perfect sense.

The Baby Entering The Pelvis

Think about driving a car into a parking space in a crowded parking lot.  You turn the wheel of your car and try to ease in to the tight fitting space when you realize, uh-oh!  I don't have enough room to maneuver my way into this spot!  Do you then keep driving your car forward?  No way!  That would result in crushing cars parked in the adjoining spaces.  So, you back up, take a different angle and try again.


This can also occur in pregnancy and labor.  As mentioned in my previous posts, there tends to be an optimal position in which babies best fit through the mother's pelvis.  Sometimes, babies start to move down into the pelvis in a manner that makes an awkward fit.  This can result in a stuck baby who does not make much forward progression.  In these cases, getting baby to first back up and then come in at a different angle is what will help baby best to realign and enter in a more suitable manner.


How Do You Do It?

Inversions can seem a bit scary at first.  And it's okay if it is a bit awkward.  You have a large belly and it will be awkward! 

What you'll need:


- A support person
- Stairs, a low table, a couch, or chair

Step One. You should begin by starting on your hands and knees, facing away from the furniture that will be supporting you.


Step Two.  With your support person helping, crawl backward and lift one knee up onto the furniture.

Step Three.  Pull up your other knee onto the furniture.

Step Four.  With your support person supporting your shoulders, push off your knees, up onto your feet, lifting your bottom farther up into the air, and attempt to make your body into an angle of 90* or less.  Make sure the mom releases her belly, letting it fully relax.

Step Five.  Hold this position for a minute at a time.  (Notice how the support person uses her knees/legs to support the shoulders while holding/shimmying the hips).  Make sure mom is keeping her belly relaxed.


Step Six.  Alternate onto elbows if needed.

Step Seven.  If desired/necessary, have the partner shimmy your hips to help disengage baby.

Step Eight.  Take a break on your hands and knees/elbows and knees but do not stand upright.

Repeat steps 1-8 twice if in late pregnancy, in between each contraction if in labor.

Now this is important!!  Before the mother gets into an upright position, it is incredibly beneficial to sift the mother's belly to help baby rotate into a better position, or angle him/herself into a better position.


Why This Works

The Uterus - If your uterus has any type of twist or imbalance to it due to uneven ligaments holding it to the pelvis and back, the inversion will be incredibly helpful at releasing those ligaments.  We humans tend to spend all of our time in an upright position.  In this position, the heavy uterus hangs down in the same manner day after day.  When a pregnant woman inverts, her uterus then hangs in a completely different manner.  This allow the ligaments to be gently pulled on and balanced on both sides of mom's body.  This will help the uterus to become aligned, allowing more room for a baby to move around.

The Baby - This technique can be incredibly effective at getting a baby to find it's best position through the pelvis.  Once the baby has started to engage into the pelvis in late pregnancy, it is much more difficult for baby to maneuver his way into different positions.  If his hand is up by his head, his head is extended, he's come down oblique, or posterior (to name a few predicaments), getting him *out* of the pelvis will be a much more effective technique to realigning him than just trying to move him in an already tight space.  Like that car in the parking space, backing up out of the pelvis before correcting the position of the baby will be much easier than trying to reposition him while he's hedged in.

In Labor

The inversion is most effective if done prior to the onset of labor.  This allows the repositioning to be done without the counter-acting forces of contractions.  Since contractions forcefully push the baby into the pelvis, trying to disengage the baby from the pelvis during labor can be difficult.  The contractions act as an additional force to gravity, like a bulldozer pushing that car into the parking space.  But, it can be done!

In labor, assume the inversion position as often as you can in-between contractions.  It can be difficult to hold the position through a contraction, but see if mom can do that as well.  The contractions will feel very odd in this upside down position, and mom will need a lot of support.  If mom is laboring in a hospital, you may need to work around a lot of wires and lines.  Having an i.v. or hep lock in her hand will cause some difficulty in leaning forward on her hands.  Helping her on to her elbows will be a better position if this is the case.



Signs That An Inversion Would Be Helpful

In Pregnancy:

* You are in your third trimester of pregnancy
* You have round ligament pain
* You have pressure in your back or bottom
* You have pressure in your hips

In Labor:

 * You are having prodromal labor
* Your contractions are sporadic or spaced out
* You are feeling the contractions mostly in your back
* Contractions are strong but baby is not moving down
* Contractions are irregular - coming at varying lengths, piggy-backing, or double peaking
* You are feeling a lot of pressure in your back or in your hips
* You have an urge to push while only 4-6 cm dilated
* You seem to be "stuck" at a certain dilation


Please reserve the inversion for women with intact waters.  Once the waters are released, there is the added risk of a cord prolapse.  A mom can go to knees and elbows at this point, but a full inversion may add to the risk.
Please reserve the inversion for women with normal blood pressure.  Make sure mom feels okay with this position, can support herself with her arms and does not get a headache from being upside down.