A common question about using maternal positioning and the techniques featured at Spinning  Babies is whether using these techniques can cause a baby in a good position to get into a "bad" position. Another related question is whether doing these techniques for a head down baby can make the baby flip to head down.

I am inclined to say no. With exceptions....

There are many ways of doing these techniques, and more importantly, there are various times when people use them. Sometimes, parents or a doula may use a technique at a time when it is not appropriate. "If it ain't broke, don't fix it." 

An enthusiastic approach may urge a parent, doula or other helper to suggest a technique without an understanding of when and why to use that technique. Timing is not usually crucial, but could it be possible that, in a rare instance, having the "wrong" technique at the wrong time could cause a problem??  We have to consider the possibility.

Remember, not every birthing woman has either the same pelvic shape or pelvic tone. Some women will have asymmetry, due to a muscle spasm or muscle weakness or pelvic misalignment. Babies come in different shapes, too. Inherited traits may bring about a baby with a rather square-ish head. Another baby may have a bigger chest or long legs. While not usually an issue, combine one trait with another, for instance, a large posterior head trying to fit a smallish triangular (android) maternal pelvis can make labor longer, harder and less likely to end in a vaginal birth. This, then, is a great time for an Abdominal, or Belly, Lift. 

If we only introduce a technique when it is likely to help a slow or stalled labor, we are pretty safe in choosing any technique. But labor is progressing, when the mother isn't in an unusual amount of pain for her phase of labor, then an inversion or Abdominal Lift might be inappropriate. We could lift a baby out of a "good" position.

Here's an email that asks whether or not the doula's actions caused a sudden flip to a breech presentation.

"Hi Gail,

"I wanted to run something by you... We had a client a couple weeks ago with a somewhat irregular but progressive labor pattern, and we used the rebozo to do a little sifting, plus some abdominal lifting (which seemed to regulate and intensify ctx). After several hours things picked up rapidly, her water broke, and we went to the hospital. Upon arrival she was 7cm, baby's shoulder was presenting and by birth (by c/s) he was full breech. The CNMs were stunned, as they'd thought baby was vertex for months. [My doula partner's] question to me was, "did we cause this with the rebozo??" I couldn't imagine how, but she spoke with another homebirth midwife who said indeed it was possible. Thoughts??"

Dear [Doula],
Is it possible the sifting caused the baby to go breech or the abdominal lifting? I would think not. But let's analyze this in detail. Lets examine the possibilities.

What I don't know - Which baby this is for the mother; her uterine tone, tight or loose; and how vigorously the abdominal lifting was for this particular mother (meaning that if she was loose the lift could lift the baby more than it would in a woman with tight ligaments and muscles).

You say she had somewhat "irregular but progressive" contractions. Was she in early labor or active labor? Irregular contractions are normal for early labor, before 3-4 cm. Painful contractions in early labor may either be "progressive" in a short labor, but may indicate an asymmetry. Asymmetry is usually associated with a longer labor, but can exist in a short labor, too.

What we don't know - Since she didn't arrive to the hospital until 7 cm we don't know if the baby was breech before you arrived at the mother's home. An earlier examination of her abdomen by the hospital midwives may have shown the baby was breech before labor began. You won't get to know this. The mother may help shed some light on this question. Extremely active fetal movement, at a particular point in time, may be when the baby flipped. Babies can also flip without the mother noting the activity. On the other hand, without an ultrasound we are assuming the baby was head down.

Sifting with the Rebozo will relax the broad ligament of the uterus. A relaxed broad ligament will not cause a breech presentation. Sifting is done with the mother either on her back or, more comfortably, on her hands and knees. Neither posture is likely to cause a baby to flip to a breech position. I doubt that sifting was the cause of the breech presentation.

If one of these techniques caused the breech, I would suspect that doing the abdominal lifting too much might be a possible cause, but not the sifting. The reason to do an abdominal lift is to relieve distracting back pain or reposition a stuck posterior head. A fetal head in the posterior position is also often deflexed, the chin is up. See Flexion to learn a sign that indicates a need for chin tucking before labor begins.

Abdominal lifting will lift the baby's head and reangle it, ideally to fit the pelvis better. Abdominal lifting helps tuck the posterior baby's chin towards the baby's chest, making rotation and/or descent easier to accomplish.

It is incorrect to lift the baby aggressively, or too high out of the pelvis in some cases. Its incorrect to use an abdominal lift without the need for one. A fast, progressing labor would not indicate an abdominal lift, even with incoordinate contractions.

Done incorrectly, the abdominal lift can bring up the head and, if the pelvic alignment were to be off or the pelvic floor asymmetrical there could be a possibility that the baby might flip in response.

Now I would like to examine signs that the baby may flip on its own in response to labor.

Was this baby posterior before flipping breech? If so, labor may have been the cause of the flip, or labor with abdominal lifting.
Incoordinate contractions indicate an asymmetry in how the baby is presenting in the pelvis. Likely the fetal position is dependent on a preexisting asymmetry in the Asymmetry in the pelvis is associated with a higher rate of malpositions, in my experience. Carol Phillips, DC, explains how the misalignment of the bony pelvis pulls the soft tissues out of alignment, including the pelvic floor. The baby is forced to accommodate as best he or she can. Sometimes, rarely, this includes flipping to a breech presentation. It usually means, a posterior or asynclitic presentation.

While rare that a baby would flip in labor, this has been a summer of breech babies, and some babies do flip in labor.

In other words, doing nothing may also have seen a flip because the downward movement of the baby's head may have brought the head into contact with a type of restriction that can cause a breech presentation.

...This is a very important consideration. Unless we start sharing these experiences we won't know if the techniques themselves can cause a malposition. I don't think so at this point, but without dialogue, we'll never know.


In the mystery,
Gail

The doula wrote back,

1st baby, good tone, fit woman, gentle lifting only periodically over the course of an hour or so.  She was active when I started the rebozo - by irregular I mean they were q3-5 but would slow when resting, by progressive I mean they had gotten closer together and longer over the day after being prodromal throughout the night before.  Some doubling and backache starting, which made me think fetal positioning may be the issue.  Did rebozo on hands and knees, some gentle sifting alternated w/lifting.  After an hour there was more show and she said they felt more productive, then she got quiet.  We stopped the lifting then, but continued with gentle sifting as it relaxed the mother and felt good to her.  She didn't notice significant fetal movement or "flipping sensation" at any time before or during labor.

Since the mother didn't feel significant fetal movement, I would suspect the baby flipped during her sleep. That is a guess.

Consider this fictional scenario.

At best, this scene is a figment of my imagination after a stressful email. But perhaps, this scene could describe a rare occurrence from a misused technique.

A woman is in labor. Her baby's head is applied, meaning the head is down, pressing on the cervix. This is a happy sign of labor progress. It doesn't mean all is well, but it is reassuring that the baby has made it through engagement and will likely continue to fit the pelvis, whether or not the head is anterior or posterior.

A strong Abdominal Lift, or Belly Lift, is used, for whatever reason. See the correct indications for an Abdominal Lift (Belly Lift) in Techniuqes. The mother's muscles are loose, so that doing an Abdominal Lift is easy to accomplish. The baby is lifted off the cervix. Perhaps the pelvis is not symmetrical. One SI joint hurts while the other doesn't. The mother's abdomen is released between contractions.

But this mother's tissues were so soft that the pelvic floor and lower uterine segment doesn't guide the baby's head nicely down as they usually do. The baby's neck folds in the soft lower uterine segment. Another lift and another rest. The head is even more sideways. Next contraction the abdominal lift is not done. The contraction squeezes the uterus and pops the head into the mother's hip area instead of pushing the head towards the cervix.  Suddenly the baby is in a shoulder presentation or transverse lie.

Now the mother is told to wait in bed. Lying down prevents the baby from using gravity to correct herself. 

Or the mother stands, the baby quickly gets into the easiest vertical position possible. Which may be breech. 

If instead the mother stood and did a lunge on the side that the baby's head was on, perhaps the baby's head could have dropped back into the pelvis. Then the baby wouldn't have had to go breech.

If the baby does go breech, in time, the baby may flip to head down again. But when labor proceeds quickly, the baby may not have time. Strong contractions are moving the baby downwards. Since it is rare in America to have a confident catcher of breech babies on hand a cesarean is done.