A technique for labor when progress is slow. Contractions help this technique to work effectively.  Penny Simkin and Ruth Ancheta call it the Roll-over. Others have called it flipping pancakes.

At Spinning Babies, I've said, when you want to move the baby, move the mother. This technique literally rotates the mother to help the baby rotate! We've used variations of this technique for many years. The mom shown here is in a variation of the Hands and Knees position, the start of the Roll-over.

When to use the Roll-over

Use the Roll-over when labor contractions are coming regularly and somewhat strong (or quite strong) but progress has either stalled or is slow. The baby may be known to be in a posterior position, or has his or her head deflexed (the chin is up or not well flexed).

How to use the Roll-over

1. Start with the Hands and Knees position. For two to three contractions, the mother rests on her hands and knees. She can certainly have her forearms resting over the raised back of the hospital bed or leaning on a birth ball to save her wrists from strain.
   
2. After three contractions, the mom lays on her side. Either side. Let's say left side. A long pillow or rolled blanket separates her knees AND ankles to reduce pulling on her pelvic ligaments. She lies with the right hip directly over her left. Her back is straight and she doesn't lean forward or backward in bed.
3. After three contractions, she rearranges herself so that she is now leaning quite forward. A pillow is there for her higher shoulder. The pillow between her legs is moved in front of her abdomen so that her right knee can be bent and rest upon a high pillow.  I call this, Left-lean over. Its a common "Bradley class" relaxation pose. The mother's belly button points into the matress as much as possible without lying on the baby. A pillow-y nest will raise the mother's pelvis and ribs a bit to give baby room, if needed.
4. After three contractions, the birthing mom gets into an Open-Knee Chest position if she is able to move readily (not on an epidural). If not, she goes to the next position.
5. After three contractions,  she lies on her right side, Right-right angle.
6. After three contractions, she  lies on her right side, leaning forward as described above for the Left-lean over. So she is now, Right-right angle.

She starts again with Hands and Knees position. Continue this for two more rounds, if that is even necessary. Or, get up and try the lunge, dangle or dangle while grasping a rope or shawl overhead.

This mother is in an Open-Knee Chest position while backwards on the hospital birthing bed. Its a form of an inversion.

An inversion is only appropriate if the head is engaged in a posterior, asynclitic, or deflexed (extended) position. Three contractions in this position, with or without the part of the bed where the mother's head is being lower than her knees.

Before doing this or other gravity-dependent techniques, relax the abdomen with Rebozo sifting, a sacral release and an inversion.

 

Roll-over to get to 10 centimeters dilation

The Roll-over is also useful to reduce an anterior lip. An anterior lip is when  a bit of cervix, less than a complete circle of cervix, is coming in front of the head. The mother wants to push or the care giver wants her to push. Instead of having the care giver manually push the cervical lip back over the head (which doesn't address the cause), the mother might try a round of the Roll-over tecnhiques.

Roll-over for flexion

The Roll-over may also be useful for helping the lifted chin to tuck. When the care giver can feel the front fontanel during a vaginal exam, this technique may help the chin tuck, which means, increase the flexion of the head (neck). The baby whose head is flexed fits the pelvis better, can rotate more easily and can descend more easily. Sometimes head flexion is the difference between a long labor or even a cesarean and a vaginal birth.

Around the country, nurses, doulas and midwives praise the effectiveness of this series of maternal positions. Some call it flip-flop. But I have another series of techniques for resolving shoulder dystocia that I call Flip FLOP, so I don't choose to have two techniques called the same thing.

I chose the same name used in the Labor Progress Handbook by Penny Simkin and Ruth Ancheta.Scroll down on PennySimkin.com to see the $29.95 2nd edition of the Labor Progress Handbook