Techniques for labor progression....

Abdominal Lift

The Abdominal Lift is of the most effective early labor techniques for engaging baby in the pelvis.

As a contraction begins, link your fingers and lift your belly about two inches.
Bring your belly in (towards your spine) by one or two inches (depending on your size). Be comfortable.
At the same time, flatten your lower back. Your knees should be bent. Bending the knees, just a little, is necessary to do a Posterior Pelvic Tilt.
Hold your belly up through the entire contraction. It’s OK to sway or rock a little on your legs during the contraction, but hold your belly in one place to avoid being uncomfortable.
When the contraction ends, lean forward slightly and slowly let go of your abdomen. Move your legs to encourage circulation.
Repeat the Abdominal Lift for ten contractions in a row.
In labor, if baby is not IN the pelvis. Do this with contractions for ten in a row.
Labor contractions are frequent enough that you can predict when another is coming.
Labor contractions have not been increasing in strength.
Labor contractions might be really strong but baby remains high in or above the pelvis.
Back labor might be the reason you try this. It can resolve back labor when it’s because baby can’t get in the brim.

The Abdominal Lift and Tuck will encourage labor contractions to be closer together and get stronger when they have been at one strength for a long time (or dilation is not increasing), or in the presence of achy back labor. Either way, the resulting flexion of baby’s head will improve the labor progress and relieve the back ache. It can be used in latent or prelabor. The Abdominal Lift can be used to get active labor underway.

Walcher’s: Open The Brim

The mother’s legs either hang off the edge of the bed, or a trochanter roll is used to prop up the women’s pelvis and open the brim, as shown here.

This is an “engagement” technique for labor to use only after 10 contractions with Abdominal Lift and Tuck. Walcher’s Position will allow contractions to engage a baby that is high, not really in the pelvis yet. The baby may be stuck at the brim or inlet of the pelvis. Use this position through and between three contractions in a row to lower baby into a normal pelvic brim. Contractions make it work.

When Walcher’s?

Use Walcher’s when strong, frequent contractions are not helping baby to engage. The head may overlap the pubic bone or not, this is not visible usually but can be felt with your finger tips at the top of the symphysis pubis.

How do you do Walcher’s?

The laboring woman’s legs hang off the bed into the air. The legs are NOT supported. The weight of the hanging legs pulls the pelvis open more at the inlet. The edge of the bed is at the “smile” at the lower border of the buttocks. This is the level of the trochanter of the thigh bone (near the hip socket) but at the woman’s back.

When not to do Walcher’s

When the baby’s head or shoulders are not stuck on the pelvic brim. When baby has engaged and/or isn’t stuck at the brim. Effectiveness is usually found in 3 contractions. If not effective, recheck maternal position and if incorrect, correct the position and try for 3 more contractions.

Sidelying Release

This is not lying on one’s side and leaning your leg over!

The Sidelying Release (SLR) uses a “static stretch” to temporarily, slightly enlarge and soften the pelvis. Stretching the muscle spindles in the pelvic muscles lengthens the pelvic muscles for approximately 1-4 hours.

Benefits of Sidelying Release are temporary and include:

More pelvic mobility
Releasing muscle spasm (easier to sleep in pregnancy, less sharp contractions in labor)
Ease pain in pregnancy and birth
Make room for baby to turn into a better position
Longer, softer pelvic floor muscles for baby to move through during birth
Can be repeated every 4-6 hours, since the benefits are temporary

What situations is a Sidelying Release useful for:

Stall in labor (strong contractions and no dilation or strong contractions that have spread out and reduced)
Annoying hip or back pain
Sharp pain in pelvis or hips
Baby is in a breech, oblique, posterior position (add this to other techniques)
Contractions with no progress
Asynclitic head or baby’s head is tipped or tilted
Deep Transverse Arrest (baby remains facing a hip at 0 station, midway down the pelvis- follow with side lunge)
Posterior baby (in labor, do through 3 contractions on each side or 3 on first side and 2 on second side)
Contractions are more painful than expected

The SLR is a star in the universe of maternal positioning for comfort and progress.

How often do I do a Sidelying Release

Twice a week in pregnancy for a better fetal position
Once in early labor to reduce labor pain later and time labor takes
Again in labor if there are strong contractions and no progress

How to do a Sidelying Release

Use on a firm surface (I use a couch as an example). Choose a surface as long as the mother. The edge of a couch, bed, a heavy table or counter will do. A hospital bed works wonderfully, when raised a bit, during labor in the hospital. Some doulas and childbirth educators are experimenting with doing the Sidelying Release while the mother lays on the floor.

Please read the instructions below carefully. Doing it wrong doesn’t work.

Begin on the side of choice. Head is level on a pillow, not tilted. The neck is straight.
The helper stands in front of her. The helper has their leg or hip firmly against the edge to keep the mother from tipping off!
Holding a chair or table near the edge of the couch, the mother scoots her hip right up to 2” (5 cm) from the edge of the couch. A 3rd trimester woman’s pregnant belly extends beyond the edge.
The helper curves both palms around the edge of the mother’s hip (front and top; ASIS). The helper must prevent the mother’s hip from leaning forward after her leg hangs.
The helper presses down firmly (but not as strongly as for counter pressure, about the weight of a 2-3 pound bag of beans. Slight rocking of the hip helps relax muscles.
The mother feels straightens her lower leg. But the helper must not pull the leg straight!! Toes are up (flexed) toward her knee.
When the helper is steady and in place (but not before!), the mother slightly lifts her leg up and over her thigh and then lets it slowly hang down in front of her. Wait 2-3 minutes or until the leg hangs slightly lower. Do both sides so you don’t make the pelvis unstable.
Person gets up and walks around the room in each direction or up and back in a straight line, depending on the space available. (Where’d we hear that before?)

Helper: Don’t let her hip lean forward! Here’s the point of the Sidelying Release: Her top leg hangs forward into the air. Let the full weight of the top leg hang free. Avoid the mother’s thigh so the thigh can hang freely. The mother breathes deeply and slowly. As her belly relaxes, her leg relaxes more.

In pregnancy: Her leg hangs like this for about 2 1/2 minutes. It’s ok to try it longer, but it’s vital that it’s done on both sides.

A few people have reported holding each side for up to 20 minutes to flip a breech, but this length of time is not required for head down babies. Explore and see what feels best for each situation. Two 1/2 minutes on each side allows the stretch receptors to activate and most of the time, respond.

In labor: Let the leg hang like this through 3 contractions and switch sides for another 3 contractions (sometimes a rest comes after 2 contractions and the uterus stops contracting for several minutes up to an hour.)

You will see regular contractions that are more effective either immediately or after the hour rest period.

If contractions strengthen but then slow again, assess and address engagement or a locked sacrum. Then repeat SLI and see labor progress.

The Sidelying Release May be helpful when:

Labor just can’t seem to get started. Contractions start and stop, are strong then weak.
Contractions are strong but not bringing the baby
Contractions have slowed down after a period of hard, but non-progressing contractions, as if the uterus is tired from trying to move the baby.
When the mother feels pain beyond her ability to cope
Labor stalls at 5, 6, 7 cm or later.
Baby’s head is tipped or asynclitic.
Baby’s head is stuck facing a hip and halfway down the pelvis at 0 station (Transverse Arrest. In this case, follow up with the lunge 3x on each leg and repeat each leg another 3x before trying another technique).

LUNGES

The Lunge opens the midpelvis. It is a good technique to be used in labor during a contraction, for:

Helping an occiput posterior baby rotate or descend
Helping an asynclitic baby descend
Overcoming a stall in active labor

Why do a lunge?

The lunge helps when labor stalls and the baby is near the midpelvis – at 0 station, give or take a centimeter. It can help a baby who is lower than that when the stall in labor is due to a narrow pelvic outlet. It may help a transverse arrest (baby stuck between the ischial spines while facing the side, hip).

Before doing a lunge

Make sure the baby is engaged first. Do the Sidelying Release to make the lunge more successful

When to do a lunge in labor

Use when regular contractions are present (especially if baby is at “0 Station” or near it). Fairly moderate or strong contractions seem to work best with the lunge. This is because of the “spinning” power of the contractions. Once you get regular contractions, you will be able to move into the lunge position as the contraction begins. Put your foot down after the contraction finishes to relax your leg and prevent tired legs.

FORWARD LEANING INVERSION

Why Do A Daily Inversion?

Balance. The goal of repeating the Forward-Leaning Inversion (FLI) every day is to release tight to twisted uterine ligaments to achieve the full capacity of the womb. Give baby this room to aim the crown of their head first and more easily turn themselves around in labor.

For both head down and breech babies
For either anterior or posterior babies
Dramatic results for babies lying sideways (Transverse Lie) after 30 weeks gestation
Kneel on the edge of a couch (or the top of the stairs)
Carefully lower yourself to your hands on the floor and then lower yourself to your forearms. Elbows out, hands close. Use a stool or step, if you like, to help you walk your hands down.
Let your head hang freely. Your chin is tucked. Don’t rest your head on the floor. Your neck may need a little movement.
Your knees are close to the edge, your bottom is highest. You can tilt or sway your hips, if you like.
You can flatten your lower back (posterior pelvic tilt) to give more room to free your ligaments.
Take 3 breaths. Belly loose, shoulders strong. Chin tucked and neck long.
Come back up on your hands, then lift yourself up to a high kneeling position again (see picture), using a stool, block or help from your helper.