The Abdominal Lift and Tuck

The Abdominal Lift is of the most effective early labor techniques for engaging baby in the pelvis. The Abdominal Lift was popularized by Janie McKoy King, a Texas Engineer who wrote Back Labor No More. I learned it from Penny Simkin at her Birth Doula Training.

I added the words "and tuck" to remind the user to tuck their pelvis. By this I mean do a standing Pelvic Tilt. By this I mean flattening the lower back. 

Barb and Tom try an Abdominal Lift and Tuck to move their labor along. This is Barb's fourth baby.

The baby is occiput posterior and early labor has been going on a few hours. Barb was interested in helping the baby rotate.  I was her midwife and suggested an Abdominal Lift and Tuck to help the baby tuck her chin (another use of the word  tuck) and rotate to the left occiput transverse. 

How to do it:

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. Notice Barb's bent knees. Bending the knees a little is necessary to do a standing Pelvic Tilt.

 Hold your belly up through the entire contraction. Its ok to sway or rock a little on your legs during the contraction but hold your belly in one place to awoid being uncomfortable.

When the contraction ends, lean a little forward and slowly let go of your abdomen. Move your legs to encourage circulation.

Repeat the Abdominal Lift for ten contractions in a row.

When to do it:

I mean besides during a contraction. Use the Abdominal Lift when labor contractions are frequent enough that you can predict when another is coming. This is because you will want to move into position as soon as, but not before, the contraction starts. If you start too late it will be uncomfortable, so just wait to start with the following contraction.

You only need to do these in two cases. To 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 achey back labor. Either way, the resulting flexion of baby's head will improve the labor progress and releave the back ache.

 It can be used in latent or prelabor. The Abdominal Lift can be used as active labor gets underway. If you use it successfully later than 6 cm, please email me and let me know. I have gotten in the habit of suggesting other techniques after 6 cm and haven't suggested it after active labor is well underway.

When not to do it:

Don't bother doing this with a labor that is progressing normally. Normal labor progress is when your labor moves along with contractions getting stronger and closer every few or several contractions.

If you have had fast labors in the past, you want to have your midwife or nurse near by in case this works quickly (ten contractions). Don't do this without having help near by.

Make sure you feel more pressure on your cervix, not less. There will be a relief to any back pain while increasing cervical pressure (pain?). This means the baby is now aiming where we  want, on the way out, not your back.

Another way to do it:

Shannon and Marcus found the Abdominal Lift significant in shortening their second labor. (The first took a little longer than two days.) Shannon stood by the wall so she could flatten her lower back on the wall and use it to brace herself. She also bent her knees a little bit.

If you stood against the wall doing a Pelvic Tilt the space behind your lower back would flatten and you wouldn't have room to reach your hand  behind yourself there during the Pelvic Tilt. Doing her Abdominal Lift this way allowed Shannon to concentrate on lifting her belly and relaxing through the contraction.

After Shannon did this Abdominal Lift through ten contractions she felt more comfortable. Once her labor picked up again her labor pattern was that of an occiput anterior baby-- she had the baby later that afternoon. 

This dramatic birth story is shared here with permission by the doula: 

Thanks to Spinning Babies, I believe we spared a c-section in St. Louis tonight! Tiny first-time mom had Gestational Diabetes and was induced with cervadil. Baby had never engaged in the pelvis, and mom had a posterior cervix and 0 dilation. When you have these conditions, the likelihood of having a vaginal delivery started by induction is statistically slim. When I arrived at the hospital, they had just started pit [Pitocin, an artificial labor stimulant]. The nurse said she had made no changes, although she'd been contracting all morning, with stronger contractions about 30 minutes before I got there. The nurse also said she had little to no room in her pelvis. I had two moms walk this exact path and both ended in csections. So I asked if mom would be willing to do Walcher's, and understandably, she just couldn't get to her back. So I asked if she'd be willing to kneel (which opens the brim) and allow me to do an abdominal lift on her with her next contraction. Now this mom was already very, very uncomfortable on pit , but she was willing. And she DID it...and later said something like, "I thought I was going to die, or split open" or something like that. Well, this mama moved her baby!! She started making new vocalizations, so the nurse checked her 30 minutes later, and she was at a FIVE with baby now engaged in the pelvis! She went from 0, posterior cervix to 5 centimeters dilated with an anterior cervix in 60 minutes with just a little pit, a strong will and a kneeling abdominal lift!!!!!

And THIS never, never could have happened had she got an epidural early on. Not ever in St. Louis hospitals anyway. This mama worked so hard and finally gave birth ... VAGINALLY!

An Abdominal Lift Story

A fifth time mom was having an unusually long latent phase. She had expected another fast labor, like her others. For 12 hours her contractions stayed five minutes apart, not real painful, but she wasn't able to sleep either. (Though a doula could have helped her get lulled to sleep.) I met her in the hall of the hospital. She was looking out the window and she recognized me from seeing me at her clinic a couple weeks before. Because the other births were fast, her husband didn't think a doula was going to be needed.

I described the Abdominal Lift and told her to make sure she did it in her room and in the presence of her nurse. I walked back to her room with her and explained the technique to the nurse. She was willing to try ten contractions with the Abdominal Lift.

Though I wasn't able to be her doula, I was able to stop in and see her the next day. She said, it was just like you said, ten contractions and I had an urge to push. I think the fast results were simply because she was an experienced mom with several fast births behind her, showing a roomy pelvic outlet.