The Inversion

The Forward-leaning inversion is a classic here at Spinning Babies. Getting into an upside down position can increase the symmetry of the lower uterine segment; release spasming ligaments causing pelvic pain; or help a breech, an oblique (diagonal lie) or posterior baby reposition themselves.

Daily inversions in pregnancy may promote optimal fetal positioning. Done correctly, the ligaments will respond!

Why do a daily inversion?

Sometimes the uterine ligaments are not equal on each side of the body. If one side has shortened ligaments the entire lower uterine segment can have a twist in it. This effect is not uncommon among women who twist to do their work (massage therapists, nurses, chiropractors, etc.) or who hold a child on one hip frequently. A twist in the cervical ligaments can put the lower uterine segment into a slight twist which reduces the room for the baby to have a good head-down position. The baby may remain breech, posterior, or come down asynclitic.

How to do an inversion.

Find a safe place to get your knees and hips above your shoulders. Make sure you can get up and down with out tumbling. Allow your head to be free. Hold yourself up with your elbows and forearms, for instance. Or use an inversion table if you have access to one.

Just 30 seconds is long enough to give the cervical ligaments a stretch. If your abdominal muscles are tight (you can hardly tell the baby's parts through the abdomen), then repeat once or twice a day for several days. When shouldn't you do it? Skip ahead and see below.

Letting the uterus hang 30-seconds from the cervical ligaments stretches these ligaments. Standing back up relaxes the cervical ligaments and now the cervix can relax back in a more symmetrical position. When the baby is not in a good position, help the mother's uterus into a more symmetrical position and the baby will follow.

Watch a short movie of an inversion.

Emily and Ludvig learn to do an inversion. The movie is 1.5 minutes long. See it here, or read more instructions while viewing it on the Spinning Babies Lady Blog. Emily's baby was in a transverse lie (lying sideways in the womb) days before labor. If labor were to begin with the baby lying sideways there would be no choice but a cesarean. She learned to do the Forward-leaning inversion and did it twice for this movie and then again in the morning. Off to the Ultrasound that day and the baby had gotten head down by then!

Dr. Carol Phillips, DC shares an inversion image with Spinning Babies Website viewers! Dr. Phillips works extensively with pregnant women (as well as babies and children). She shares this slide from her PowerPoint presentation to train other chiropractors and craniosacral therapists. NOTICE: The mother's knees are at the edge putting her bottom way up in the air. She does not rest on her thighs. Inversion in late pregnancy

See the ligaments (pink in the inset). The weight of the baby gently pulls on the ligaments and gives a stretch to the cervical ligaments. See the short pink ligaments near the tailbone and sacrum. They are harder to find than the large broad ligament surrounding the baby. When the mother stands up the ligaments relax and are less tense than before.
Relaxing the uterine ligaments helps the uterus be more balanced. Meaning, symmetrical on either side. This helps the baby to get in a better position for birth- or helps the mother to birth a baby in a challenging position.

Leah is using the forward-leaning inversion in late pregnancy. Leah has her chin tucked and her womb actually hangs, for just a moment, by her cervical ligaments.

How not to do an inversion!

Do not rest your thighs on the chair or couch. Stephanie Larson's otherwise great DVD, Dancing for Birth, unfortunately shows the Wrong way to do a forward-leaning inversion from the chair! The ligaments are not released to the same degree -if at all.

Down Dog may not accomplish the same release. While Down Dog yoga pose is a great pose and beneficial in many ways, the tension of the ham strings may prevent the same release as the forward-leaning inversion shown here. Also, in Down Dog, I wonder if the uterus rest on the symphysis pubis preventing the same stretch that the forward-leaning inversion allows in the cervical ligaments (posterior uterine ligaments).

When not to do the Forward-leaning inversion:

There is more than the usual amount of amniotic fluid around your baby,
In pregnancy, the abdominal tone is unusually loose (the baby has an unstable lie),
The inversion increases heartburn
The inversion causes pain (its normal if your head does pound a bit for the first 4-8 times you get upside down as your body warns you that you aren't up right. It will learn you mean to do this and stop.)
Don't do an inversion if your baby isn't or doesn't seem engaged and you have an unstable lie.
In labor, there had been abundant fluid, the baby is high, -2 station, for instance, and the water has broken, in which case use a belly down position, such as Left Lean Over, until the head comes into the inlet, or
You don't feel that this is right for you.

When to do the Forward-leaning Inversion in pregnancy

Do the Forward-leaning inversion if you desire to increase balance in your uterine ligaments.

You get to decide. If you think this technique may be safe for you, do an inversion once a day through pregnancy. You can begin before pregnancy. I do one a day.

When to do the Forward-leaning Inversion in labor

    * Slow progress
    * Back or hip pain that seems more than from contractions and is not matched by the pain in the uterus or other hip.
    * In other words, something isn’t matching up, the labor pattern is not symmetrical.
    * You are advised to by your care provider (Dr., Nurse, Midwife) and you feel that it is safe for you to do so.

In labor, regular contractions keep baby head down so the inversion can be held through an entire contraction or 2-3, plus between them. Its better to repeat than stay there too long. Make sure the belly isn't held back from the bed. Let it hang free.

In the hospital, you can easily do the inversion with the help of the nurse or doula to adjust the birthing bed.

Kneel in the middle of the bed but face the foot of the bed. Place a pillow on the foot of the bed. Lower your elbows to the food of the bed. Your cheek can be resting on the foot of the bed.

Have help to lower yourself to rest your breasts on the pillows and let your chin come down off the edge of the bed. Tuck your chin.

It's easier to get into Knee Elbow-position while the bed is flat and once you are in the bed, lower the foot of the bed. It would be less acrobatic for you than the steeper inversion.

Open-Knee Chest on hospital bed

When the care provider says no inversions

"Gail,
I was hoping you could help me out... a CNM who saw one of my clients and told her not to do inversions because it could cause the baby to become breech. I would like to educate her, the CNM, on the benefits of Spinning Babies techniques. Have any studies been done that I could reference? Any help that you could offer would be greatly appreciated!"

My reply is that the CNM has palpated this mother's abdomen. Perhaps she has polyhydramnios, far too much amniotic fluid, a history of an unstable lie (the baby goes from head down to breech to head down again easily), or a very loose muscle tone even with normal amniotic fluid.

These are reasonable areas of concern to avoid an inversion, though not necessarily absolute reasons. They'd be reasons to leave the decision making between the care provider and, perhaps, her experienced Myofascial worker/Chiropractor.

A normal pregnant woman with a head down baby who does the forward-leaning inversion for 30-seconds a time is not likely to flip her baby to breech.

The Breech Tilt is not the same inversion as a Forward-leaning inversion. Its done longer and on the mother's back. The Breech Tilt has the purpose of helping the baby's chin to tuck. The Forward-leaning inversion has the purpose of stretching the cervical ligaments and then, after the inversion, the ligaments relax. Repetition of the Forward-leaning inversion is to release a twist in the lower uterine segment, improving the angle of the fetal head or allowing the breech baby to find room for the head. I've been recommending this for years and following many pregnant women through their pregnancies with the Forward-leaning inversion. I haven't observed nor have I been told of a baby who's flipped breech.

A different inversion done incorrectly- A woman on the east coast was told by a student of mine (and a nurse at this woman's clinic) to do the Open-knee chest position for 20 minutes in pregnancy to help her posterior baby rotate. The next day she came into the hospital in labor and was sectioned for a breech fetal position!!! First of all, the Open-knee chest position is not to be used for posterior presentation unless -in labor- the baby's head is jammed in the pelvis and there is no progress with strong contractions, or as a comfort for back labor in the presence of contractions. Contractions keep the head down. Its always good to go back over the instructions before recommending a new technique that you may not be fully familiar with.

Is there any risk to being inverted and have her move in a less than ideal position if she is already in a "good" position?

This type of inversion is for 30 seconds at a time, not 20 minutes, the typical recommendation for a breech tilt. If a woman has a notably large amount of amniotic fluid the risk of flipping the baby moves from none to small, if she has loose ligaments and lots of water, a little more risk. If the baby's head is high (not engaged) and the water is broke, don't invert. For a normal pregnant woman there is little risk of flipping the baby in this short time

...Be in this head down, bottom up with pubic bone away from your spine position WHILE YOUR HEAD is flexed towards your chest.

"I am extremely optimistic that I have made really good progress with getting her head in a good position. I have also noticed that since yesterday, I am feeling more pressure and pinchy feelings on my cervix. I want to try the stairs. I also have made a Chiropractic appointment for Monday and a cranio-sacral appointment for Tuesday."
-Jennifer

Here's another letter from a woman who tried the inversion for pregnancy discomfort.

“Hi, Gail, I really need some advice. i think i am in early labour, cramping, lots of irregular painful contractions, loose bowels i have been like this for nearly 3 days. I am getting frustrated because my back is really hurting too and I can't figure position of baby.

I have been told its posterior. I have been trying for days for a couple of hours each day to do all the exercises but nothing has changed except baby has been trying to move in the night.

I feel very tired because of the cramps at night i don't know how much longer i can go on for like this.”

Hi, Your baby's position isn't causing this type of back ache, rather your uterine position is. To help release the twist in your lower uterus, you can do a number of things.

At home:

Try a complete Forward-leaning inversion on the stairs with your chin tucked. Have a helper to guard you. Kneel at the top of a short flight of stairs and crawl your hands down about three steps. Brace your elbow on that step and keep your knees on the landing above the stairs. Your helper is below you with their hands on their shoulders. Hold this position for five minutes or three contractions, which ever you can bear. Keep your chin tucked.

Lean forward during contractions with knees slightly bent, move as you instinctually feel the urge to with the contractions. Stand between occasionally to rest your legs. When you lay down, Rest forward. Lean over a ball or back of the couch when kneeling on the couch. Remember not to put your chin up in any position when your purpose is to correct the symmetry of your pelvis, baby's position or ligaments.

Try the Abdominal Lift and Tuck with your belly DURING your contractions.

If you can see a body worker,

Receive a sacral release and an abdominal release from a myofascial release person, cranio sacral therapist or a chiropractor that is trained in myofascial release. The Webster Maneuver, done by Chiropractors, who have the additional training, is one form of release for the round ligaments.

For those crampy contractions that do not lead to labor.

Have a pot of red raspberry leaf tea (bulk not tea bag). The minerals in the tea seem to help reduce leg cramps and uterine “irritability.”
Chewable calcium. (I don't suggest an antacid with calcium because I worry about heavy metals and too much antacid.)
A shower or deep bath, lay on your side with a towel rolled up between your knees and thighs to relax your ligaments.
Have a perception change. Don't think of this as labor. Your hormones are revving up. The Red Raspberry Leaf tea will help. Mind you this isn't raspberry flavored black tea, it is the real Red Raspberry plant leaf.
Try and sleep and be in the moment.
Eat drink and let your mind go so you can sleep.
Review what your caregiver said about when to call, but let your mind get off the clock otherwise.