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Our Favorite Exercises for Optimal Fetal Positioning

If you were to ask me why I do what I do, one of the first things I’d say is that I want you to have the information I wish I had when I had my babies.

Seriously…the more I learn, the more I understand about my births and the more strongly I feel about educating other women.

full-3It’s not that I had horrible births–I think of my first birth experience as my “starter” birth. I was so afraid of birth as a whole that I completely gave my power away and ended up with a cesarean when it may not have been necessary. Prior to my second birth, I educated myself and felt truly inspired and empowered. I felt the power of knowledge and it sent me on the journey that you find me on today. Everyday I learn more–I’ve become a birth junkie! I love a good birth story and I can’t read enough about birth and pregnancy in general!

In fact, not long ago I stumbled across some information about fetal positioning that I wish I had known more about when I was pregnant. You see, Oliver was breech. I had my heart set on a VBAC (vaginal birth after cesarean) and at 34 weeks my little guy flipped out of his optimal position. When he spun it sent me into a spin! I was desperate to get him to flip back! I wanted my natural birth dammit!

In my opinion, 90% of your birth experience is due to how you prepare yourself for birth and the decisions that you make. But that other 10% is up to your baby. And sometimes that little 10% makes a HUGE difference. Sometimes we don’t get to decide how our babies are born, but we sure can plan for the best. Our birth plans should not just be focused on outcomes, because, sometimes, we don’t get the outcome that we wanted. But, when we focus on how we feel during our birth experience, that leaves us with a greater perspective.

20160218_173832Eventually, I had to relinquish control of Oliver’s birth. I had to let go of my expectations of how I wanted it to end up. Despite my strong desire for a VBAC, I ended up having to have another cesearean.You can read more about my experience with that here.

In the United States today about 3-4% of babies are breech at full term. which means they’re in position to exit the uterus feet or butt first rather than head first. In the past (before the 1960’s) virtually all breech babies were safely delivered vaginally,  Today, most are born by cesarean section.

Beginning in the 1960s, more and more obstetricians began to deliver breech babies by cesarean presumably because they preferred the predictability. But not every doctor jumped on the c-section wagon immediately; many continued favoring vaginal breech births.6

Enter the Hannah Term Breech Trial (TBT) published in 2000.5 The TBT followed 2,083 breech babies in 26 countries, randomly assigned to either vaginal or planned C-section delivery. Early data suggested fewer newborn deaths and injuries occurred in the C-section group. According to Heather Weldon, M.D., an OB-GYN at Southwest Medical Group OB/GYN Associates in Vancouver, Wash. “Within months, breech C-sections went from 50 percent to 80 percent and, by 2006, 90 percent. Then, we found out the study was flawed.”6

Almost immediately after its publication critics began poking holes in the study. First off, the researchers did not factor in the risks of cesareans when they did the study. Some poor outcomes that were attributed to vaginal delivery occurred in birth centers that used unskilled birth attendants or substandard techniques. Some babies had genetic defects or were premature. In short, many weren’t injured because they were delivered vaginally, but because of other factors. When looked at objectively, what the data seems to actually suggest is that vaginal births are better in some scenarios and cesareans better in others. It just depends on the situation.1

But, for the most part, the damage had already been done. Most hospitals do not allow breech babies to be born vaginally and many obstetricians are not even taught how to deliver a breech baby vaginally anymore.4

20160218_173353So, for many mothers like myself who were hoping to have a natural birth, hearing that your baby has gone breech can feel like a blow! It is normal for your baby to flip many times throughout pregnancy, but if you reach 37 weeks and your baby is still breech, many healthcare professionals will assume that you have run out of time and will encourage you to schedule a cesarean.9

However, one of the things that I found heartbreaking (because I found out too late) and incredibly hopeful (because I can pass it on to you) is that there are a lot of things that we can do to optimize our chances for a natural birth. The key is to understand WHY our babies go breech in the first place.

There are many factors that come into play here that we have no control over. There are genetic reasons. It can be because of the amount of amniotic fluid, a shorter umbilical cord or the amount of weight a woman gains during pregnancy. But there are several other factors that we CAN do something about.

Posture and Alignment

We talk a lot about the importance of posture and proper alignment in terms of how it helps the core functions. You can read more about that here. However, there is now even one more reason that good posture and alignment is important. According to Gail Tully, creator and developer of www.spinningbabies.com, when we slouch it pulls our sacrum under, changing the position of our uterus. Some ligaments get overstretched. Some get too tight. This changes the position of our pelvis and offsets the balance that we need for a head down baby. Slouching or sitting for long periods of time in recliners can push our uterus up in our pelvis, reducing the space for baby in the lower part of our uterus and sometimes forcing baby to change positions.2

Repetitive Activities

2013_Walk_For_Hope_0165Another thing that can cause your baby to go breech is a “twisted uterus” caused by repetitive actions. A twisted uterus is most common in chiropractors, massage therapists and anyone who has an active job with repetitive motions. During both of my pregnancies, I kept very busy doing assisted stretching. This is a type of stretching where I am pulling on limbs, hoisting legs over my shoulders and using my body to leverage the traction and pull of my clients joints. It is hard work…and it’s repetitive. It makes sense that Oliver would end up out of position towards the end of his gestation.

Stress

Sometimes babies cannot maintain or find optimal position because one side of the pelvic floor is tighter than the other. This often happens as an outcome of stress and poor breathing mechanics. How we breathe determines how we function. Breathing seems like the most natural thing in the world. We rarely even think about it despite the fact that we do it 14 times every minute. When we are stressed we start to breathe up and down through our shoulders and neck instead of in and out through our diaphragm. This causes the diaphragm to contract and expand in an asymmetrical way. The diaphragm mirrors the pelvic floor. If the diaphragm is off, the pelvic floor is off.

So, what does this asymmetry mean for us? It affects our ability to take a true deep breath. When we lose our ability to use our diaphragm the way it was designed, we lose much of our core stability. And we are more likely to lose the balance that we need throughout our pelvis for our babies to maintain the proper position.

But Cara, you might be saying, I can’t just quit my job or stop worrying about how to pay my mortgage once I’m pregnant! How can I prevent stress, repetitive motions and poor posture during pregnancy?

I’m glad you asked! You can’t alway prevent a breech, but you can optimize your chances of having a vaginal birth by doing the exercises below. These exercises do not use gravity to change baby’s position, they help to balance the pelvis, making more room in the lower uterus for baby.8 So, they will NOT flip a head down baby.

Walking

Walking is something that almost everyone can do! Walking helps to lengthen the psoas muscles and strengthens the low back while moving the pelvis. Walking helps to balance the pelvis and can also help to lower stress.

Lunging

Lunges help build muscles around the hips and legs. But they also help balance the pelvis. The sacroilliac joint is substantially supported by the pelvic floor. Lunges help strengthen the glutes and hamstrings, while lengthening the psoas. This helps the pelvis as a whole function better and as a result, helps the pelvic floor function better.

How to: Stand with your feet hip distance apart. Step forward with one foot. Bend both knees and lower yourself down towards the floor. Inhale and relax the pelvic floor on the way down. Exhale and kegel as you straighten your legs and come back up.

Squatting

Many midwives believe that our bipedal bodies were made to birth in the squatting position because gravity assists the descent of the baby in the birthing canal and the act of squatting itself has been shown to increase the dimensions of the pelvis.3, 7

How to: Stand with your feet hip distance apart. You can use a chair or a countertop for support if you need to. Inhale and relax the pelvic floor as you squat down. Go as deep as you can while keeping your heels on the floor. Exhale and draw the pelvic floor up on the way up.

Inversions

The forward leaning inversion helps release the utero-sacral ligament, giving the baby extra room to move around, optimizing your chances of baby being in a good position for labor.

How to: Kneel on the edge of the couch. Carefully crawl forward with your hands until you can lower yourself down on your forearms. Tuck your chin, don’t let your head touch the floor. Keep your belly loose and your shoulders strong and breath deeply for 5 breaths. You can also tuck and untuck your bum to make more room for baby.

Crawling

Crawling puts you on your hands and knees and allows your belly to be a hammock for your baby. This helps relax and release the tendons around the uterus. Crawling also helps coordinate the core muscles. By working contralateral limbs you are balancing your body.

How to: Get on the floor on all fours. Align your hands under your shoulders and your knees under your hips. Pick up the left hand and the right knee and move forward. Try and put your hand and knee down at the same time. Then switch to the other side.

Half-Kneeling Hover

This exercise helps to stretch the psoas and the inner thigh muscles while also building strength in the glutes and encouraging good posture. It is the “motherload” of pregnancy exercises! Tight psoas muscles keep the baby high and we want to encourage that little guy (or gal) to drop! A supple psoas will help the baby engage towards the end of pregnancy.

How to: Get into a half kneeling position. Swing the front leg out to the side until you feel a gentle stretch in the inner thigh. “Get tall” by reaching your head towards the ceiling and squeeze your butt. Sit  your hips back towards your heel then come back up.

We don’t always get the birth experience that we planned for. Sometimes this is due to circumstances that are beyond our control. But, other times, it’s because we didn’t have all of the information that we needed. Our mission is to get as much information out as possible to as many women as possible so that you can prepare for the best birth experience possible. That’s why we created our FREE 3 week training Labor of Love, the ULTIMATE guide to having an empowered birth experience. Build strength and a birth story that you love! Pregnancy and birth are two of the most amazing things that we do on this earth! Guilt and shame should not be synonymous with giving birth and becoming a mother.

Too many women feel shame about their birth experiences, their pregnant and postpartum bodies and the choices that they make during this transitional time.

But we choose EMPOWERMENT! And we believe that the key to feeling empowered during pregnancy and postpartum is fitness.

Ready to sign up? Join here—> http://bit.ly/mdlaboroflove

References

  1. Berhan, Y., & Haileamlak, A. (2016, January). The Risks of Planned Vaginal Breech Delivery Versus Planned Caesarean Section for Term Breech Birth. Obstetric Anesthesia Digest, 36(4), 215. doi:10.1097/01.aoa.0000504747.17851.8d
  1. Bowman, K. (2012, April 25). Katy Says…. Retrieved December 01, 2016, from https://nutritiousmovement.com/atootightpelvicfloor/
  1. Carvalho, D. E., Soave, D., Ross, K., & Callaghan, J. P. (2010). Lumbar Spine and Pelvic Posture Between Standing and Sitting: A Radiologic Investigation Including Reliability and Repeatability of the Lumbar Lordosis Measure. Journal of Manipulative and Physiological Therapeutics, 33(1), 48-55. doi:10.1016/j.jmpt.2009.11.008
  1. Gregory, K. D., Korst, L. M., Krychman, M., Cane, P., & Platt, L. D. (2001, March). Variation in Vaginal Breech Delivery Rates by Hospital Type. Obstetrics & Gynecology, 97(3), 385-390. doi:10.1097/00006250-200103000-00012
  1. Hannah, M., & Hannah, W. (2000). Term breech trial (TBT): A randomised controlled trial (RCT) of planned caesarean section (CS) vs planned vaginal birth (VB) for breech at term. International Journal of Gynecology & Obstetrics, 70. doi:10.1016/s0020-7292(00)82630-2
  1. Hehir, M. P. (2015). Trends in vaginal breech delivery. Journal of Epidemiology and Community Health, 69(12), 1237-1239. doi:10.1136/jech-2015-205592
  1. Lilford, R. J., Glanville, J. N., Gupta, J. K., Shrestha, R., & Johnson, N. (1989). The action of squatting in the early postnatal period marginally increases pelvic dimensions. BJOG: An International Journal of Obstetrics and Gynaecology, 96(8), 964-966. doi:10.1111/j.1471-0528.1989.tb03355.x
  1. G. T. (2002). The Three Principals in Pregnancy. Retrieved December 01, 2016, from http://spinningbabies.com/start/in-pregnancy/the-3-principles-in-pregnancy/
  1. Tully, G. (2013, June). Identifying and Resolving Obstructed Breech Birth: When to Touch and When to Be Hands-Free. Midwifery Today, (106).

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