I long for the day that I can compile an article like this. Linking will have to suffice for now. For some reason I can't even cut and paste here right now...
www.themidwifenextdoor.com/?p=1206
Thursday, October 21, 2010
Thursday, September 9, 2010
Why Homebirths Are Worth Considering
An interesting perspective ...
Why Home Births Are Worth Considering
by Melissa Cheyney, Assistant Professor of Medical Anthropology and Reproductive Health at Oregon State University
A new analysis by Dr. Joseph Wax comparing home births and hospital births, which was published in the recent issue of the American Journal of Obstetrics and Gynecology, not only presents misleading conclusions, it drives a wedge between two groups that cannot afford a greater divide: medical doctors and midwives.
The study documents similar perinatal (or the period immediately surrounding birth) mortality rates for home and hospital births, but claims a three-fold increase in neonatal (measured up to 28 days after delivery) mortality for home deliveries. Yet this analysis contains serious limitations and concerns those of us who practice midwifery in an out-of-hospital setting.
Beyond the issue of the flawed methodology, which has been addressed by several national organizations, including the Coalition for Improving Maternity Services and the Midwives Alliance of North America, there are serious cultural implications to this study.
As a medical anthropologist, I am concerned with the chasm with doctors and the medical establishment on one side, and midwives and the home birth movement on the other. In Oregon, where we have both licensed and unlicensed midwives working in home and in birth center settings, research has shown deep mistrust between doctors and some midwives. Many doctors have expressed the belief that only hospital births are safe, while midwives say they often feel marginalized and disrespected.
Such studies only deepen this mistrust and have the potential to increase hostility during encounters when midwives and their clients have to seek hospital care for complications. The end result is a system that can be detrimental to women and their babies because of the impaired ability to communicate across a cultural divide. Instead of a maternity system based on fear and misinformation, we need a system based on collaboration and mutual respect.
The United States is already the butt of jokes in the international public health community. We spend more on health care than any other high-income nation, while simultaneously serving the lowest percentage of pregnant women, as several of our key health indicators continue to decline each year. According to Eugene Declercq of the Boston University School of Public Health, the U.S. now has the highest number of maternal deaths relative to all other high-income nations, and we also rank second worst for perinatal deaths.
The U.S. has not reported a significant decrease in maternal mortality rates since 1982, and the Center for Health Statistics indicates that the rate of cesarean section in this country is now at a whopping 32 percent, marking the 11th consecutive year of increase. As the incidence of cesarean section rates rise, so do medical complications for mothers and babies, along with associated health care costs. The World Health Organization recommends a cesarean rate of no more than 10 to 15 percent, so our rate is two to three times higher than it should be.
The answer among the U.S. medical establishment has been to throw more expensive technology at the problem rather than retracing our steps to see where we went wrong. Instead of admitting that something is fundamentally broken with the system, organizations like the American College of Obstetrics and Gynecology continue to endorse the idea that medicalized hospital births are the only safe route for women.
We know that 99 percent of women in the U.S. are giving birth in hospitals, yet the United States has one of the highest infant mortality rates of any developed country, with 6.3 deaths per 1,000 babies born. Meanwhile, the Netherlands, where one-third of deliveries occur in the home with the assistance of midwives, has a lower rate of 4.73 deaths per 1,000.
While maternal mortality rates decreased among our peer nations between 2000 and 2005, they increased by more than 54 percent in the United States during the same time period. The two major differences between the U.S. and other nations, which have superior maternal and infant health outcomes, are that the latter offer universal health care and rely more extensively on cost-effective midwives as a public health strategy.
Consider the economics of the situation. The cost of a cesarean in the United States is about $15,000 and an uncomplicated vaginal birth averages $8,000 (without prenatal or postpartum care), while homebirth midwives charge $2,000 to $4,000 -- a fee that includes care from conception through the postpartum period. Exploring the option of home and birth center birth with midwives for low-risk women should be at the core of national health care reform and research. Instead, several generations of high-tech, low-touch birth and a pervasive cultural belief that birth is imminently dangerous -- even in healthy, low-risk women -- has led to powerful cultural blinders that limit options for women.
In anthropology, we say that "normal is simply what you are used to." The power of socialization and the dominance of biomedicine have kept us from systematically examining a variety of birthing environments and providers as viable alternatives to the expensive and interventive hospital delivery that has become the norm in the U.S.
Finally, I must briefly address the study by Dr. Wax and his associates. Let me first say that their study found no difference between home births and hospital births when measuring perinatal death, which is the primary indicator for evaluating the safety of a mode of delivery. Yet, the study chose instead to focus on neonatal death, generally accepted as death within the first 28 days of birth and to emphasize this part of their research. A complex mix of psychosocial and clinical factors, including congenital anomalies, Sudden Infant Death Syndrome, unsafe home environments, and poverty, can all contribute to death in the first month of life. As Dr. Michael Klein of the Child and Family Research Institute in Vancouver, B.C. points out, after removing low-quality studies and out-of-date statistics, the Wax study actually demonstrates no difference in outcomes between home and hospital-based delivery, even for neonatal mortality.
Yet the authors included faulty data in their total analysis, comparing apples to oranges by mixing different types of data sets, such as grouping low-risk with high-risk mothers, and including babies born unintentionally at home.
As an anthropologist, I see a study like this as harmful to women and as having a much larger social impact than the authors possibly intended. For instance, there are many women in rural areas and women who are uninsured, or under-insured, whose only option is to give birth under the care of a midwife. How does this study affect these women? A study like this only exacerbates and undermines often already negative and tension-fraught relationships, making it more difficult for out-of-hospital midwives and physicians to work together when needed.
There is something to be learned from the centuries-old traditions of midwifery, and I believe that if doctors and midwives, including those who work in the home setting, could be willing to learn from and respect one another, women and babies in our country would benefit. After all, we are all working for the same end result: a happy and healthy mother and baby. Our differing visions of how to get there will require an attitude of cultural humility and a willingness to listen. Studies like the Wax study take us in the wrong direction.
Tuesday, September 7, 2010
Turning a Breech Baby
Okay, I'm stealing this from one of the ladies in one of my discussion forums. The most comprehensive list I've ever seen. Brilliant.
Turning the Breech Baby
(compiled and collected from numerous sources)
Before you begin to do specific things to help turn your baby, it would be really useful to learn how to determine whether or not the baby is breech by feeling your belly to locate the head. You could probably teach yourself by simply pressing gently on your belly to feel the baby's outline and following the various body parts until you get a good picture of how it's lying, but it might be easier if someone else could show you. The reason it's important to be able to do this is so that you know when the baby has turned and don't unwittingly "upturn" the baby through your efforts.
Swimming Pool Technique
Do a headstand in the shallow end of a pool or lake. This is said to be pretty
effective. You might want to have someone there to help you for support. It's also important to find a pool that's warmed to at least 72 degrees so that you are really relaxed. Ideally, you could find a therapeutic pool that is kept at a temperature higher than a regular pool where people heat themselves up swimming laps. Get into the pool and spend at least 15 minutes just paddling around and having fun. This will help you to relax those abdominal muscles to give the baby more room to turn, and the deep-water immersion will increase your amniotic fluid; also helpful to the baby's turning. You might try walking into the pool holding the baby's bottom up out of the pelvis. As the water gets deeper let go of the bottom of your belly, as the water will hold the baby up. When you are up to your shoulders the belly is de-weighted and so is the baby. Then dive head first down to the drain kicking your feet to help get you down. Water rushing by the stomach will help the baby to turn. The idea is that the mom and the baby are de-weighted and the heavy part of the baby (the head) will turn around. You might have to repeat this several times in order to get the baby to turn.
Pelvic Tilt
You could try the breech tilt postural inversion. Begin at 32-35 weeks gestation. Try lying with the hips propped up 12-18 inches higher than the head 3 times per day for up to 20 minutes at a time. A slant board has good results, or you can prop one end of an ironing board securely on a sofa or chair. A long soak in a bath first will help increase amniotic fluid and relax you. Also, doing the slant on an empty stomach will give the baby more room to turn. It is important to relax, breathe deeply, and avoid tenseness. When done after the 30th week the pelvic tilt had an 88.7-96% success rate in 744 patients. This was reported in OB/GYN News Vol12, No.1. Apparently the tilt does two very useful things. 1) It helps to disengage the baby from the pelvis and, 2) when the baby's head comes up against the inside of the fundus, it's inclined to tuck its head and do a somersault into the vertex position.
Moxa Sticks
Use indirect moxa on Bladder 67 (this can also start contractions, so use caution). Locate your BL67 point. It is just beside the outer corner of the fifth toenail. You hold the lit moxa stick an inch or so above the pressure point and when it feels "hot", you quickly pull the stick away - this is about 2 to 3 seconds, then immediately you put the stick back down over the pressure point again until it gets "hot" again. You do this three times and then take your thumb and apply pressure on the mark for about 10 seconds - a slow count to 10. Repeat this for 7 days. In a randomized controlled group of 130 women, 75% of the babies in the moxi-treatment group turned to head down verses 48% in the control group. JAMA Volume 280 1998 pgs 1580-1584
Laser Therapy
One can use a 5 mW, continuous wave, red-beam laser on acupuncture point UB 67, five minutes per day toward the end of pregnancy, to help revert a fetus that is in the breech position. This was successful, for example, in 85% of 615 cases treated at the Shanghai Medical University (the control group had a 65.7% spontaneous conversion rate). The use of the red-beam laser on UB 67 is easier than moxibustion.
Visualization
Use Visualization to enhance the other techniques. See the baby already in the head-down position (not turning but already down)
Walking
Walk a lot. Soak in water and then walk a lot more.
Emotional factors
Is there a possible emotional factor in this breech presentation? Is fear causing tightness of the lower uterine segment and keeping the baby high? In which case, address the fear and give a few doses of Ignatia 30C homeopathic. Some midwives suggest talking the baby into turning.
Hypnosis
Hypnosis can help, both with trying to figure out what's going on with the breech and also to help turn it. Hypnotherapy may help pregnant women turn their breech baby around to the normal headfirst, or vertex, position. A researcher at the University of Vermont, Burlington, used hypnosis with one hundred pregnant women whose fetuses were in the breech (feet-first) position between the thirty-seventh and fortieth week of gestation. Aside from the visualization involved, the deep relaxation of hypnosis can help your abdomen relax enough to allow the baby to turn. A group received hypnosis with suggestions for general relaxation and release of fear and anxiety. The study, which appeared in the Archives of Family Medicine, reported that 81 % of % percent of the control group. Not surprisingly, hypnosis was most effective for the women motivated to use the technique.
Acupressure/Acupuncture (toe rubbing)
Use acupressure or acupuncture (preferably done by a professional) on Bladder 67 (which is on the outside of the little toe on both feet, right next to the nail). Just push your fingernail very firmly into this area and hold for 10 minutes. Another area is located on the outside of the little toe, right where it indents and attaches to the foot. This spot responds well to a firm, vigorous massage. The rubbing should be done to both toes, at the same time, for a period of 10 minutes, rest for 15 minutes, then repeat. This can be continued as often as needed until the baby moves.
The Webster Technique
Larry Webster, an Atlanta chiropractor, developed this technique. It is included so that you can give it to a your Chiropractor (do not attempt to do it yourself if you have no training!). It has worked when everything else has failed to turn a baby. Out of one group of 700 women-carrying breech, only 18 of their babies failed to turn.
Apparently Dr. Webster (died a few years ago) was first inspired after attending his daughter's birth who's baby was breech. Though the birth was successful he still felt there must be something more that could be done to help a baby present vertex. One morning this technique just came to him and he wrote it down.
In general it is best to have this technique done every other day for at least 6 visits before the due date. The fastest Webster saw it work was within 45 minutes. Even after the baby turns, mom should be checked regularly up to the day of delivery.
Step One: Place the woman in a prone position. Flex each leg toward her buttocks; find the side of most resistance. Adjust sacrum (P-A on that side, contact point sacral notch below P.S.I.S., use light thrust due to softened ligaments of mother).
There are two possible occurrences after adjustment:
1. The most resistant leg releases to equal the least resistant leg (80%)
2. The least resistant leg comes back to equal the most resistant (20%).
You are looking for an equalization of resistance on flexion of legs on the buttocks. This equalization should take place before going on to step two. If the woman is evaluated on her side, the lower leg will automatically be 1 inch more resistant; allow for this in your evaluation.
Step Two: Place woman in a supine position On the side opposite of sacral adjustment, draw a line 45 degrees lateral and inferior from the umbilicus; draw another line from the ASIS inferior and medial 45 degrees. Where they bisect hold an I-S contact with your thumb (3 to 6 oz. of pressure). Rotate thumb from bisect point 15 degrees in either direction until muscle bundle is felt. hold thumb contact for 60 to 90 seconds. You will feel the muscle drop away from your pressure. Stop at this point. Do not adjust another segment that day.
Adjust every 2 to 3 days for 2 weeks; the baby should turn. If during the second or third visit there is equal resistance on both buttocks, do not adjust. On alternate days you can adjust elsewhere along the spine. (Vallone, 1990)
Another view of the process: The first thing to determine is which of the mother's hamstrings is tighter than the other. Mom can lay on her side (or stand w/support). Bend the knee of each leg back to buttock to find the tighter hamstring (sometimes it is also the shorter leg). This side will be the one for the first point of contact.
The first acupressure contact point will be just below the sacral notch (in acupressure also known as bladder 43). With mom lying on her side, very light pressure is applied, post. to anter., for 10 to 15 seconds.
Then mom lies supine and the 2nd contact point will be on the OPPOSITE side of the first. Feel along the iliac crest and find a tight spot. Place the back of your thumb (nail side down) on that spot & move your arm upward (inferior to superior) along the crest with very light pressure (really no "pressure", just the weight of your thumb).
Increase Amniotic Fluids
Also, do what you can to increase that amniotic fluid. Drink plenty of water, and being in deep water will help by squeezing the fluids in your tissues into your bloodstream and increase the volume of amniotic fluid.
Knee-Chest Position
In Ob.Gyn. News, Jan. 1, 1977, Dr. Juliet DeSa Souza, retired professor of obstetrics and gynecology at Grant Medical College, Bombay, India, reported to the World Congress of Gynecology and Obstetrics that postural treatment corrected breech presentation to a head-first presentation in 895 of 744 patients studied. She also reported that in her private practice 70 of 73 cases were corrected. The "knee-chest exercise" consists of having the woman on her elbows and knees, so her hips are higher than her head, and to stay in that position for 15-20 minutes a few times a day.
Cold/Music
Are you familiar with the frozen peas trick? Figure out which way the baby needs to turn to make it to a vertex presentation, then while in the pelvic tilt position, place a bag of frozen peas (or ice bag) on the back side of the baby's head (babies tend to move away from the cold). Then place a flashlight and/or some nice music down close to the vagina (babies gravitate toward the light and music). Or you might try the reverse and play some "headbanger" music near the baby's head so it will want to move away from it.
Turning a Breech with Homeopathics
Homeopathic Pulsatilla 30X can be indicated for turning a breech, especially if you are open to trying it. Use a 200c potency pulsatilla 200c 1 x day; repeat one more day if baby hasn't turned yet; or use Pulsatilla 30C (homeopathic; dosage 3-5 pellets under the tongue twice daily for 2 weeks; or try using homeopathic Pulsatilla 6X, one tablet under the tongue four times a day; or Pulsatilla 30c or 200c, one dose q 2 hours up to six doses in one day can be tried to turn a breech. Combine these suggested dosages with the breech tilt exercise. These are most effective if used in conjunction with a slant board, crawling, pelvic rocking, etc. Take the Pulsatilla tab just before beginning the breech tilt, slant board, etc. Homeopathic Pulsatilla can be used for any other sort of malpresentation such as posterior, transverse, etc.
Turning a Breech with Flower Essences
A doctor in Belgium, who ran a maternity hospital, also is a Bach flower practitioner, who uses Bougainvillea flower essence for turning breeches. It is supposed to work really well.
External Versions
An external version may be tried at about 36-37 weeks. Most versions are done usually with two midwives, one repositioning the baby and one holding the Doppler for the FHR. The word is SLOW... and gentle! (well, that's two words)... And listen with a Doppler every few minutes.... and for 15 minutes or so afterwards. Do fetal movement counts afterwards too for the next couple days at least. Think of midwife-type versions as "the gentle art of persuasion" - slowly getting a head up, and bottom turned down. Rest between each movement - scootch the baby a little bit and then hold the progress and listen to the FHRs. Any change and go right back! (this is a necessary precaution). A forward somersault movement is tried for, since this seems the more natural way a baby would move on his own. Occasionally though, a baby seems to move more easily the opposite way. Occasional a baby will wiggle right around on his own as soon as one starts working on him! Keep listening and make sure that this is the best thing as far as FHRs go. If the baby moves that quick and easy then all is probably well. Use low lights, a warm room, and wait till everyone is relaxed to start. Spend about 30 to 45 minutes, if needed, to do the procedure. Put a pillow under the hips and use a rocking motion with slight pressure. After the baby moves to transverse, the head may take a dip and then shows up in the pelvis. If a baby doesn't go very easily, don't push it. Also, stop if there are big changes in the FHR.
Here's an extremely interesting version method described in Wilson Cline's Concise Textbook for Midwives; Pb. Faber; pg. 426. Assuming an LSA breech, the steps are as follows:
"Firstly, Slip the palm of the left hand into the pelvis below the breech, and gently elevate it. Now tell the patient to take very deep breaths. Holding firmly on to the breech, you commonly find that it slides gently upwards as she breathes. In other words, the up-and-down movements of the diaphragm have pushed the baby's head downwards."Secondly, Slide the baby's head towards the right side of the uterus. Now you have a transverse lie."Thirdly, Raise the breech towards the fundus.
"Fourthly, glide the head into the pelvis, and check the fetal heart."
How To Keep a Baby Vertex After Turning
See if you can sit tailor fashion and bend forward as far as possible from the waist several times a day. This helps to drive the vertex deep into the pelvis. You may also take a l-o-n-g walk immediately after the baby turns. Try eating a big meal, and keep your bladder empty. Do squatting for 5-10 minutes, leaning forward, 2-3 times a day, to help encourage the baby to stay in a head down position.
Turning the Breech Baby
(compiled and collected from numerous sources)
Before you begin to do specific things to help turn your baby, it would be really useful to learn how to determine whether or not the baby is breech by feeling your belly to locate the head. You could probably teach yourself by simply pressing gently on your belly to feel the baby's outline and following the various body parts until you get a good picture of how it's lying, but it might be easier if someone else could show you. The reason it's important to be able to do this is so that you know when the baby has turned and don't unwittingly "upturn" the baby through your efforts.
Swimming Pool Technique
Do a headstand in the shallow end of a pool or lake. This is said to be pretty
effective. You might want to have someone there to help you for support. It's also important to find a pool that's warmed to at least 72 degrees so that you are really relaxed. Ideally, you could find a therapeutic pool that is kept at a temperature higher than a regular pool where people heat themselves up swimming laps. Get into the pool and spend at least 15 minutes just paddling around and having fun. This will help you to relax those abdominal muscles to give the baby more room to turn, and the deep-water immersion will increase your amniotic fluid; also helpful to the baby's turning. You might try walking into the pool holding the baby's bottom up out of the pelvis. As the water gets deeper let go of the bottom of your belly, as the water will hold the baby up. When you are up to your shoulders the belly is de-weighted and so is the baby. Then dive head first down to the drain kicking your feet to help get you down. Water rushing by the stomach will help the baby to turn. The idea is that the mom and the baby are de-weighted and the heavy part of the baby (the head) will turn around. You might have to repeat this several times in order to get the baby to turn.
Pelvic Tilt
You could try the breech tilt postural inversion. Begin at 32-35 weeks gestation. Try lying with the hips propped up 12-18 inches higher than the head 3 times per day for up to 20 minutes at a time. A slant board has good results, or you can prop one end of an ironing board securely on a sofa or chair. A long soak in a bath first will help increase amniotic fluid and relax you. Also, doing the slant on an empty stomach will give the baby more room to turn. It is important to relax, breathe deeply, and avoid tenseness. When done after the 30th week the pelvic tilt had an 88.7-96% success rate in 744 patients. This was reported in OB/GYN News Vol12, No.1. Apparently the tilt does two very useful things. 1) It helps to disengage the baby from the pelvis and, 2) when the baby's head comes up against the inside of the fundus, it's inclined to tuck its head and do a somersault into the vertex position.
Moxa Sticks
Use indirect moxa on Bladder 67 (this can also start contractions, so use caution). Locate your BL67 point. It is just beside the outer corner of the fifth toenail. You hold the lit moxa stick an inch or so above the pressure point and when it feels "hot", you quickly pull the stick away - this is about 2 to 3 seconds, then immediately you put the stick back down over the pressure point again until it gets "hot" again. You do this three times and then take your thumb and apply pressure on the mark for about 10 seconds - a slow count to 10. Repeat this for 7 days. In a randomized controlled group of 130 women, 75% of the babies in the moxi-treatment group turned to head down verses 48% in the control group. JAMA Volume 280 1998 pgs 1580-1584
Laser Therapy
One can use a 5 mW, continuous wave, red-beam laser on acupuncture point UB 67, five minutes per day toward the end of pregnancy, to help revert a fetus that is in the breech position. This was successful, for example, in 85% of 615 cases treated at the Shanghai Medical University (the control group had a 65.7% spontaneous conversion rate). The use of the red-beam laser on UB 67 is easier than moxibustion.
Visualization
Use Visualization to enhance the other techniques. See the baby already in the head-down position (not turning but already down)
Walking
Walk a lot. Soak in water and then walk a lot more.
Emotional factors
Is there a possible emotional factor in this breech presentation? Is fear causing tightness of the lower uterine segment and keeping the baby high? In which case, address the fear and give a few doses of Ignatia 30C homeopathic. Some midwives suggest talking the baby into turning.
Hypnosis
Hypnosis can help, both with trying to figure out what's going on with the breech and also to help turn it. Hypnotherapy may help pregnant women turn their breech baby around to the normal headfirst, or vertex, position. A researcher at the University of Vermont, Burlington, used hypnosis with one hundred pregnant women whose fetuses were in the breech (feet-first) position between the thirty-seventh and fortieth week of gestation. Aside from the visualization involved, the deep relaxation of hypnosis can help your abdomen relax enough to allow the baby to turn. A group received hypnosis with suggestions for general relaxation and release of fear and anxiety. The study, which appeared in the Archives of Family Medicine, reported that 81 % of % percent of the control group. Not surprisingly, hypnosis was most effective for the women motivated to use the technique.
Acupressure/Acupuncture (toe rubbing)
Use acupressure or acupuncture (preferably done by a professional) on Bladder 67 (which is on the outside of the little toe on both feet, right next to the nail). Just push your fingernail very firmly into this area and hold for 10 minutes. Another area is located on the outside of the little toe, right where it indents and attaches to the foot. This spot responds well to a firm, vigorous massage. The rubbing should be done to both toes, at the same time, for a period of 10 minutes, rest for 15 minutes, then repeat. This can be continued as often as needed until the baby moves.
The Webster Technique
Larry Webster, an Atlanta chiropractor, developed this technique. It is included so that you can give it to a your Chiropractor (do not attempt to do it yourself if you have no training!). It has worked when everything else has failed to turn a baby. Out of one group of 700 women-carrying breech, only 18 of their babies failed to turn.
Apparently Dr. Webster (died a few years ago) was first inspired after attending his daughter's birth who's baby was breech. Though the birth was successful he still felt there must be something more that could be done to help a baby present vertex. One morning this technique just came to him and he wrote it down.
In general it is best to have this technique done every other day for at least 6 visits before the due date. The fastest Webster saw it work was within 45 minutes. Even after the baby turns, mom should be checked regularly up to the day of delivery.
Step One: Place the woman in a prone position. Flex each leg toward her buttocks; find the side of most resistance. Adjust sacrum (P-A on that side, contact point sacral notch below P.S.I.S., use light thrust due to softened ligaments of mother).
There are two possible occurrences after adjustment:
1. The most resistant leg releases to equal the least resistant leg (80%)
2. The least resistant leg comes back to equal the most resistant (20%).
You are looking for an equalization of resistance on flexion of legs on the buttocks. This equalization should take place before going on to step two. If the woman is evaluated on her side, the lower leg will automatically be 1 inch more resistant; allow for this in your evaluation.
Step Two: Place woman in a supine position On the side opposite of sacral adjustment, draw a line 45 degrees lateral and inferior from the umbilicus; draw another line from the ASIS inferior and medial 45 degrees. Where they bisect hold an I-S contact with your thumb (3 to 6 oz. of pressure). Rotate thumb from bisect point 15 degrees in either direction until muscle bundle is felt. hold thumb contact for 60 to 90 seconds. You will feel the muscle drop away from your pressure. Stop at this point. Do not adjust another segment that day.
Adjust every 2 to 3 days for 2 weeks; the baby should turn. If during the second or third visit there is equal resistance on both buttocks, do not adjust. On alternate days you can adjust elsewhere along the spine. (Vallone, 1990)
Another view of the process: The first thing to determine is which of the mother's hamstrings is tighter than the other. Mom can lay on her side (or stand w/support). Bend the knee of each leg back to buttock to find the tighter hamstring (sometimes it is also the shorter leg). This side will be the one for the first point of contact.
The first acupressure contact point will be just below the sacral notch (in acupressure also known as bladder 43). With mom lying on her side, very light pressure is applied, post. to anter., for 10 to 15 seconds.
Then mom lies supine and the 2nd contact point will be on the OPPOSITE side of the first. Feel along the iliac crest and find a tight spot. Place the back of your thumb (nail side down) on that spot & move your arm upward (inferior to superior) along the crest with very light pressure (really no "pressure", just the weight of your thumb).
Increase Amniotic Fluids
Also, do what you can to increase that amniotic fluid. Drink plenty of water, and being in deep water will help by squeezing the fluids in your tissues into your bloodstream and increase the volume of amniotic fluid.
Knee-Chest Position
In Ob.Gyn. News, Jan. 1, 1977, Dr. Juliet DeSa Souza, retired professor of obstetrics and gynecology at Grant Medical College, Bombay, India, reported to the World Congress of Gynecology and Obstetrics that postural treatment corrected breech presentation to a head-first presentation in 895 of 744 patients studied. She also reported that in her private practice 70 of 73 cases were corrected. The "knee-chest exercise" consists of having the woman on her elbows and knees, so her hips are higher than her head, and to stay in that position for 15-20 minutes a few times a day.
Cold/Music
Are you familiar with the frozen peas trick? Figure out which way the baby needs to turn to make it to a vertex presentation, then while in the pelvic tilt position, place a bag of frozen peas (or ice bag) on the back side of the baby's head (babies tend to move away from the cold). Then place a flashlight and/or some nice music down close to the vagina (babies gravitate toward the light and music). Or you might try the reverse and play some "headbanger" music near the baby's head so it will want to move away from it.
Turning a Breech with Homeopathics
Homeopathic Pulsatilla 30X can be indicated for turning a breech, especially if you are open to trying it. Use a 200c potency pulsatilla 200c 1 x day; repeat one more day if baby hasn't turned yet; or use Pulsatilla 30C (homeopathic; dosage 3-5 pellets under the tongue twice daily for 2 weeks; or try using homeopathic Pulsatilla 6X, one tablet under the tongue four times a day; or Pulsatilla 30c or 200c, one dose q 2 hours up to six doses in one day can be tried to turn a breech. Combine these suggested dosages with the breech tilt exercise. These are most effective if used in conjunction with a slant board, crawling, pelvic rocking, etc. Take the Pulsatilla tab just before beginning the breech tilt, slant board, etc. Homeopathic Pulsatilla can be used for any other sort of malpresentation such as posterior, transverse, etc.
Turning a Breech with Flower Essences
A doctor in Belgium, who ran a maternity hospital, also is a Bach flower practitioner, who uses Bougainvillea flower essence for turning breeches. It is supposed to work really well.
External Versions
An external version may be tried at about 36-37 weeks. Most versions are done usually with two midwives, one repositioning the baby and one holding the Doppler for the FHR. The word is SLOW... and gentle! (well, that's two words)... And listen with a Doppler every few minutes.... and for 15 minutes or so afterwards. Do fetal movement counts afterwards too for the next couple days at least. Think of midwife-type versions as "the gentle art of persuasion" - slowly getting a head up, and bottom turned down. Rest between each movement - scootch the baby a little bit and then hold the progress and listen to the FHRs. Any change and go right back! (this is a necessary precaution). A forward somersault movement is tried for, since this seems the more natural way a baby would move on his own. Occasionally though, a baby seems to move more easily the opposite way. Occasional a baby will wiggle right around on his own as soon as one starts working on him! Keep listening and make sure that this is the best thing as far as FHRs go. If the baby moves that quick and easy then all is probably well. Use low lights, a warm room, and wait till everyone is relaxed to start. Spend about 30 to 45 minutes, if needed, to do the procedure. Put a pillow under the hips and use a rocking motion with slight pressure. After the baby moves to transverse, the head may take a dip and then shows up in the pelvis. If a baby doesn't go very easily, don't push it. Also, stop if there are big changes in the FHR.
Here's an extremely interesting version method described in Wilson Cline's Concise Textbook for Midwives; Pb. Faber; pg. 426. Assuming an LSA breech, the steps are as follows:
"Firstly, Slip the palm of the left hand into the pelvis below the breech, and gently elevate it. Now tell the patient to take very deep breaths. Holding firmly on to the breech, you commonly find that it slides gently upwards as she breathes. In other words, the up-and-down movements of the diaphragm have pushed the baby's head downwards."Secondly, Slide the baby's head towards the right side of the uterus. Now you have a transverse lie."Thirdly, Raise the breech towards the fundus.
"Fourthly, glide the head into the pelvis, and check the fetal heart."
How To Keep a Baby Vertex After Turning
See if you can sit tailor fashion and bend forward as far as possible from the waist several times a day. This helps to drive the vertex deep into the pelvis. You may also take a l-o-n-g walk immediately after the baby turns. Try eating a big meal, and keep your bladder empty. Do squatting for 5-10 minutes, leaning forward, 2-3 times a day, to help encourage the baby to stay in a head down position.
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